Waiting Time For Surgery Research Articles

Survival analysis after hip fracture: higher mortality than the general population and delayed surgery increases the risk at any time.

To estimate survival curves in patients with hip fracture according to gender, age, type of fracture, and waiting time for surgery and to compare them with the life expectancy of the general population. The study hypothesis is that survival after hip fractures is significantly lower than in the general population, especially in cases that underwent delayed surgery, regardless of age and gender. A survival analysis study was designed and approved by our institutional ethics review board. All patients who were coded with a diagnosis of hip fracture from 2002 to 2018 were included in the study. A total of 1176 patients were included, and the median age was 81 years (18-105 years). Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who underwent surgery on time and those with surgical delays. An exponential multivariate regression model was estimated, and a hazard ratio (HR) was reported for age, gender, and wait time for surgery. A significance of 5% was used, and a confidence interval level of 95% was reported. The Kaplan-Meier curves for delayed surgery (log-rank, p = 0.00) and the age group (log-rank, p = 0.00) were significantly different. Exponential regression estimated an HR 1.05 (1.05-1.07) for age, HR 1.80 (1.51-2.13) for men, and HR 1.93 (1.61-2.31) for each day of wait for surgery. The 2 significant findings of this study are that hip fracture patients over 40 years old have a higher risk of dying at any time compared to the general population and that the waiting time for surgery (a modifiable factor) decreases survival rates at any time.

Analysis of operation procedure and effect for emergency surgery in general hospital during novel coronavirus pneumonia period

BackgroundNovel coronavirus pneumonia (NCP) outbreak in Wuhan, China in early 2020, resulted in over 80 thousand infections in China. At present, NCP has an explosive growth in the world. Surgeons could refuse selective operation during the outbreak, but they must face the emergency operation. We hope to avoid the spread of NCP while ensuring efficient treatment of emergency cases.MethodsThe data of patients with incarcerated hernia admitted to Beijing Chaoyang Hospital during NCP epidemic were analyzed and compared with those in 2019. All cases were divided into NCP group and 2019 group. The operation data and inpatient protection process of emergency cases were analyzed. Result During the NCP epidemic, 17 cases with incarcerated hernia were treated in our department. A Total of 263 cases of the same disease were admitted in 2019. There was no significant difference in age, gender, BMI and hernia type between two groups. No significant difference was observed between the two groups in operation method and hospital stay. The waiting time for emergency operation of NCP group was significantly longer than that of 2019 group (P = 0.002). A buffer ward was set up by administrator of hospital during NCP outbreak. Hospitals were divided into “Red area, Yellow area and Green area” artificially, and strict screening consultation system was implemented. There was no case of SARS-nCoV-2 infection in medical staff.ConclusionIt was safe and effective to carry out emergency operation on the premise of screening, protection and isolation during the NCP epidemic. The increased waiting time for operation due to NCP screening did not threaten medical safety of emergency incarcerated hernia patients.

Simple and Effective Primary Assessment of Emergency Patients in a COVID-19 Outbreak Area: A Retrospective, Observational Study.

BackgroundThe rapid spread of COVID-19 has expanded into a pandemic, for which the main containment strategies to reduce transmission are social distancing and isolation of ill persons. Thousands of medical staff have been infected worldwide. Coronavirus testing kits have been in short supply, and early diagnostic reagents did not have high sensitivity. The aim of this study was to describe the characteristics of patients requiring emergency surgery in a COVID-19 outbreak area.MethodsWe assessed medical data regarding all patients who underwent emergency surgery at the main campus of Wuhan Union Hospital from January 23, 2020, to February 15, 2020. We classified patients based on suspicion of COVID-19 infection (suspected vs not suspected) before they were admitted to the operating room. We used descriptive statistics to analyze the data. Outcomes included the incidence of confirmed COVID-19 infection and length of stay, which were followed until March 25, 2020.ResultsAmong the 88 emergency patients included in this study, the mean age was 37 years. Twenty-five patients presented with abnormalities observed on chest CT scans and 16 presented with fever. The median wait time for surgery was one day. The median preparation time and median time until short orientation memory concentration test (SOMCT) recovery from anesthesia were 44.0 min and 23.0 min, respectively. The median postoperative length of stay was five days. Compared with patients not suspected of COVID-19 infection, six patients were confirmed to be infected with COVID-19 in the suspected group. No health care workers were infected during this study period.ConclusionSimple identification using temperature screening of patients, respiratory symptoms, and chest CT scans before being admitted for emergency surgery was rapid and effective. Shortened contact times might reduce the risk of infection. Additional investigations with larger samples and improved designs are needed to confirm these observations.

A scorecard for osteoporosis in Canada and seven Canadian provinces

SummaryThe scorecard evaluates the burden and management of osteoporosis in Canada and how care pathways differ across Canadian provinces. The results showed there are inequities in patients’ access to diagnosis, treatment, and post-fracture care programs in Canada. Interventions are needed to close the osteoporosis treatment gap and minimize these inequities.IntroductionThe purpose of this study was to develop a visual scorecard that assesses the burden of osteoporosis and its management within Canada and seven Canadian provinces.MethodsWe adapted the Scorecard for Osteoporosis in Europe (SCOPE) to score osteoporosis indicators for Canada and seven provinces (British Columbia, Alberta, Saskatchewan, Ontario, Quebec, New Brunswick, and Newfoundland). We obtained data from a comprehensive literature review and interviews with osteoporosis experts. We scored 20 elements across four domains: burden of disease, policy framework, service provision, and service uptake. Each element was scored as red, yellow, or green, indicating high, intermediate, or low risk, respectively. Elements with insufficient data were scored black.ResultsCanada performed well on several elements of osteoporosis care, including high uptake of risk assessment algorithms and minimal wait times for hip fracture surgery. However, there were no established fracture registries, and reporting on individuals with high fracture risk who remain untreated was limited. Furthermore, osteoporosis was not an official health priority in most provinces. Government-backed action plans and other osteoporosis initiatives were primarily confined to Ontario and Alberta. Several provinces (Saskatchewan, New Brunswick, Newfoundland) did not have any registered fracture liaison service (FLS) programs. Access to diagnosis and treatment was also inconsistent and reimbursement policies did not align with clinical guidelines.ConclusionGovernment-backed action plans are needed to address provincial inequities in patients’ access to diagnosis, treatment, and FLS programs in Canada. Further characterization of the treatment gap and the establishment of fracture registries are critical next steps in providing high-quality osteoporosis care.

Cancer Surgery During COVID-19: How We Move Forward.

Cancer Surgery During COVID-19: How We Move Forward.

Evaluation of wait times for assessment and epilepsy surgery according the geographic area of residence in the province of Saskatchewan, Canada

PurposeThe aim of this study was to determine and compare the waiting times for surgical assessment, neuropsychological testing and epilepsy surgery between people with epilepsy who live in cities with available neurologists vs not. MethodsWe reviewed all cases referred for epilepsy surgery between 2007 and 2017 at the Saskatchewan Epilepsy Program Royal University Hospital (SEP) (n = 98; Saskatchewan, Canada). Mann–Whitney U test was used to compare wait times from first diagnosis of epilepsy to epilepsy surgery between patients who live in cities with neurologists (mainly urban areas) vs cities without neurologists (mainly rural areas). ResultsThe mean age of patients who enrolled in SEP was 37.8 ± 12.8 years. The median wait time from date of epilepsy diagnosis to referral was 9.5 years in Saskatoon and Regina (cities with available neurologists) and 14 years in other areas of Saskatchewan (small cities and rural areas with no available neurologists) (p = 0.03). The median wait time from date of epilepsy diagnosis to first consult with the epileptologist was 10 years in Saskatoon and Regina and 15.5 years in other areas of Saskatchewan (p = 0.03). The median wait time from date of first diagnosis to epilepsy surgery was 13.2 years in Saskatoon and Regina and 18.2 years in other areas of Saskatchewan (p = 0.05). ConclusionA notable difference was observed in surgical wait times between patients who live in cities with available neurologists compared with people living in rural areas and cities with no neurologists. This suggests that delayed surgical treatment for epilepsy is related with the availability of neurologists.

DELAY IN DIAGNOSIS AND MANAGEMENT OF ADOLESCENT ANTERIOR CRUCIATE LIGAMENT INJURIES IN A PUBLICLY FUNDED HEALTHCARE SYSTEM

Background:Delay to surgical anterior cruciate ligament (ACL) reconstruction after injury has been associated with increased frequency and severity of meniscal and articular cartilage pathology. Patient factors that contribute to delayed ACL reconstruction are not well understood.Hypothesis/Purpose:Identify patient factors contributing to delayed ACL reconstruction in a publicly funded healthcare system.Methods:A retrospective review of all patients who had a primary ACL reconstruction at a single institution between 2014 and 2018 was completed. Patient demographic data, side, history of physical therapy, and intraoperative status of the meniscus and articular cartilage were collected. Household income was determined based on federal census data of mean household income by postal code. Time from injury to orthopedic referral (W0), consult (W1), and ACL reconstruction (W2) was calculated. A logistic regression model was constructed to determine the impact of household income, age, and sex on W0, W1, and W2.Results:Eighty-three patients were identified with a mean age of 14 years (range, 9-17). Twenty-eight patients were male (33.7%). Mean time from injury to orthopedic consult was 124 days (range, 0-1096). Mean time from injury to reconstruction was 286 days (range, 51-1623). Eleven patients (13%) had ligament reconstruction within 90 days of injury. Fifty-three patients (63.8%) had meniscal or articular cartilage damage at the time of ACL reconstruction. There was no significant effect of patient sex, age, or history of physical therapy on time to ACL reconstruction. Household income was found to have a significant effect on time to ACL reconstruction. For every $10,000.00 increase in household income, time to reconstruction was reduced by 19%. Using median time to reconstruction (223 days), this represents a decrease of 42 days. Household income only had an effect on W0 with a decrease of 38.4% for every $10,000.00 incremental increase in household income. No association was found between time to ACL reconstruction and odds of meniscal or articular cartilage damage.Conclusion:At a pediatric tertiary care hospital in a public health care system, most adolescent patients are having their ACL reconstructed in a delayed fashion contributing to an increased frequency of intra-articular pathology. Increase in household income was associated with a significant decrease in time to orthopaedic referral. There was no difference in wait time for consultation (W1) or wait time for surgery (W2). Further research is needed to determine specific factors causing this discrepancy in access to healthcare within a publicly funded system.

MP30-19 ACCESS TO ACADEMIC FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY PROVIDERS FOR NEW PATIENT VISITS: HOW LONG ARE WAIT TIMES?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I (MP30)1 Apr 2020MP30-19 ACCESS TO ACADEMIC FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY PROVIDERS FOR NEW PATIENT VISITS: HOW LONG ARE WAIT TIMES? Wai Lee, Alice Cheung*, Chris Du, Stony Brook, Charles Loeb, Tal Cohen, Anjali Kapur, Steven Weissbart, and Jason Kim Wai LeeWai Lee More articles by this author , Alice Cheung*Alice Cheung* More articles by this author , Chris DuChris Du More articles by this author , Stony BrookStony Brook More articles by this author , Charles LoebCharles Loeb More articles by this author , Tal CohenTal Cohen More articles by this author , Anjali KapurAnjali Kapur More articles by this author , Steven WeissbartSteven Weissbart More articles by this author , and Jason KimJason Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000869.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A 2017 Merritt Hawkins study found that since 2014, wait times for Medicaid patients have increased by 30% in the fields of dermatology, obstetrics and gynecology, orthopedic surgery, and family medicine in major urban centers around the country. Our objective was to identify factors that may impact wait times for Female Pelvic Medicine and Reconstructive Surgery (FPMRS) urologists and gynecologists at academic centers. METHODS: We reviewed all Accreditation Council for Graduate Medical Education (ACGME) accredited urology and gynecology residency programs. We identified FPMRS-trained providers by reviewing physician profiles on institutional websites. We used an IRB-approved script to make calls to ascertain the earliest available appointment for a fictional female patient complaining of “urine leakage”. Wait times for Medicaid and Medicare insurance were obtained in separate calls. Statewide Medicaid density was calculated from United States 2017 Census data. Programs without FPMRS faculty (18.7%, 81/434) were excluded. FPMRS providers that did not accept Medicaid (15.6%, 85/557) were also excluded. Negative binomial regression was performed using SPSS v24. RESULTS: Our final analysis included 362 FPMRS providers at 353 urology or gynecology programs. The average wait time for a patient with Medicaid was 39.8 days (STD 44.9 days) and 34.1 days (STD 30.9 days) for Medicare. Gynecologists had longer wait times when compared to urologists for both Medicaid (42.5 vs 32.0 days) and Medicare (35.1 vs 31.3 days). Female providers had longer wait times when compared to male providers for both Medicaid (47.2 vs 32.4 days) and Medicare (38.8 vs 29.6 days). On regression, specialty and insurance type were not significantly associated with longer wait times, while gender of the provider was significant (OR 0.45 [0.25,0.64], p<0.01). State Medicaid density was also not significant. CONCLUSIONS: Our study found that nearly 1 in 5 academic departments did not have an FPMRS-trained provider. Based on wait times alone, there is high demand to see FPMRS physicians at academic institutions when compared to general urology (Medicaid 35 days, Medicare 23 days), dermatology (32 days), orthopedics (11.4 days), and obstetrics/gynecology (26.4 days). While our study only represents access to care at academic facilities and does not account for other physician factors that can influence wait time, our findings reflect a challenging landscape where training additional FPMRS providers is pivotal to meet demand. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e445-e446 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wai Lee More articles by this author Alice Cheung* More articles by this author Chris Du More articles by this author Stony Brook More articles by this author Charles Loeb More articles by this author Tal Cohen More articles by this author Anjali Kapur More articles by this author Steven Weissbart More articles by this author Jason Kim More articles by this author Expand All Advertisement PDF downloadLoading ...

Elective surgery wait time reduction in Canada: A synthesis of provincial initiatives

In an effort to reduce wait times, Canadian provincial governments have introduced numerous wait time reduction programs and policies. The objective of this study was to provide an overview of elective surgery wait time reduction initiatives across the Canadian provinces from 2000 to 2018. Each of the 10 provincial government web sites were searched. A theoretical framework for elective surgery wait time reduction policies was developed. The final framework is broadly organized into a supply-demand-performance management model. The majority were categorized as supply-oriented initiatives, which have been implemented by all the provinces in some form. Demand-oriented initiatives have been implemented the least. Our conceptual framework may be used to categorize wait time reduction initiatives for the purpose of policy development and evaluation.

653 Can We Improve the Clinical Experience of Adults With Congenital Heart Disease?

Over 90% of patients with congenital heart disease (CHD) now reach adulthood. They were asked of their impression of their clinical care and suggestions for improvement. Adults with CHD were recruited from a cardiology practice as part of an international study (APPROACH-IS II). They completed three additional questions highlighting the positives, negatives and areas for improvement of their clinical care. Thematic analysis was used to review the findings. To date of the 79 participants recruited, 50 have completed their questionnaires. 39 have answered the additional research questions. Most highlighted their appreciation of open communication and feeling supported. Good clinical outcomes, continuity, accessibility and thoroughness of their care were also key positives. Of interest over half of the participants failed to document negative concerns. Those that did, emphasised the impact CHD had on their lifestyle through the time commitment, cost of services and side effects of medications. Few patients were dissatisfied with public hospitals’ long wait times for surgery, poorer communication and lack of rehabilitation programs for young CHD patients. Some complained of limited understanding of the complexity of their CHD, previously explained to their parents and little understood by their general practitioners. Areas of improvement included the need for additional information about their CHD, availability of mental health services and support groups, together with improved transition from paediatric to adult services with ongoing review of their CHD and its prognosis. Understanding the concerns of adults with CHD and meeting their expectations may well improve their outcomes.

Factors Associated With Long Wait Times for Bariatric Surgery.

Despite its proven safety and efficacy, bariatric surgery is an underutilized therapy for severe obesity. Wait times for surgery are largely unexplored in the United States and may impact access to care. To determine the amount of time between initial bariatric surgery clinic visit and operative date and identify factors associated with longer wait times. A statewide clinical data registry was queried from 2006 to 2016 and 60,791 patients undergoing primary bariatric surgery were identified. Demographics, comorbidities, 30-day complications, and 1-year patient-reported outcomes were compared between shortest and longest wait time quartiles. Analyses were performed using Chi-square, t-test, and logistic regression. Median wait times for bariatric surgery increased from 86 to 159 days during the study period. Median wait times were ≤67 days for the shortest wait time quartile and ≥204 days for the longest wait time quartile. Factors independently associated with longer wait times included Medicaid insurance [odds ratio (OR) 3.02; 95% confidence interval (CI): 2.58-3.53], sleep apnea (OR 1.49; 95% CI: 1.41-1.58), psychological disorder (OR 1.25; 95% CI: 1.18-1.32), hyperlipidemia (OR 1.21; 95% CI: 1.14-1.28), smoking history (OR 1.11; 95% CI: 1.05-1.17), and white race (OR 0.665; 95% CI: 0.614-0.720). Preoperative weight loss, risk adjusted complication rates, postoperative self-reported weight loss, and comorbidity remission were similar between groups. Over the past decade, eligible patients are experiencing longer wait times when pursuing bariatric surgery. Complex patients with Medicaid insurance are experiencing the longest delay despite similar outcomes and preoperative weight loss. Policies that delay surgery should be re-examined.

Change in Policy Allowing Overlapping Surgery Decreases Length of Stay in an Academic, Safety-Net Hospital.

The practice of surgeons running overlapping operating rooms has recently come under scrutiny. To examine the impact of hospital policy allowing overlapping rooms in the case of patients admitted to a tertiary care, safety-net hospital for urgent neurosurgical procedures. The neurosurgery service at the hospital being studied transitioned from routinely allowing 1 room per day (period 1) to overlapping rooms (period 2), with the second room being staffed by the same attending surgeon. Patients undergoing neurosurgical intervention in each period were retrospectively compared. Demographics, indication, case type, complications, outcomes, and total charges were tracked. There were 59 urgent cases in period 1 and 63 in period 2. In the case of these patients, the length of stay was significantly decreased in period 2 (13.09 d vs 19.52; P=.006). The time from admission to surgery (wait time) was also significantly decreased in period 2 (5.12 d vs 7.00; P=.04). Total charges also trended towards less in period 2 (${\$}$150 942 vs ${\$}$200 075; P=.05). Surgical complications were no different between the groups (16.9% vs 14.3%; P=.59), but medical complications were significantly decreased in period 2 (14.3% vs 30.5%; P=.009). Significantly more patients were discharged to home in period 2 (69.8% vs 42.4%; P=.003). As a matter of policy, allowing overlapping rooms significantly reduces the length of stay in the case of a vulnerable population in need of urgent surgery at a single safety-net academic institution. This may be due to a reduction in medical complications in these patients.

A Longitudinal Analysis of Wait Times for Bariatric Surgery in a Publicly Funded, Regionalized Bariatric Care System.

Bariatric surgery is proven to be the most effective strategy for management of obesity and its related comorbidities. However, in Canada, patients awaiting bariatric surgery can be subjected to prolonged wait times, thereby subjecting them to increased morbidity and mortality, as well as decreased psychosocial well-being. To assess the factors associated with prolonged wait times for bariatric surgery within a publicly funded, provincial bariatric network. This was a retrospective population-based study of all patients aged > 18 years who were referred for bariatric surgery from April 2009 to May 2015 using linked administrative databases to capture patient demographic data, socioeconomic variables, healthcare utilization, and institutional factors. The main outcome of interest was a wait time greater than 18 months. Multivariate logistic regression modeling was used to estimate odds ratios (OR) and 95% confidence intervals (CI). A total of 18,854 patients underwent bariatric surgery from April 2009 to December 2016, of which 2407 patients experienced wait times of > 18 months. On average, yearly wait times have increased for patients receiving surgery with wait times of 10.98 months (SD 5.48) in 2010 and 13.09 (SD 6.69) in 2016 (p < 0.001). Increasing age (OR 1.12, 95% CI 1.05-1.19, p = 0.0004), BMI (OR 1.08, 95% CI 1.04-1.11, p < 0.001), and male gender (OR 1.47, 95% CI 1.28-1.70, p < 0.001) were significantly associated with increased bariatric surgery wait times. Additionally, smoking status (OR 1.46, 95% CI 1.09-1.97, p = 0.0118) and obesity-related comorbidities particularly diabetes (OR 1.29, 95% CI 1.14-1.44, p < 0.001) and heart failure (OR 1.72, 95% CI 1.43-2.07, p < 0.001) were correlated with prolonged wait times for surgery. Socioeconomic variables including disability (OR 1.64, 95% CI 1.38-1.92, p < 0.001) and immigration status (OR 1.35, 95% 1.11-1.64, p = 0.003) were correlated with increased odds of longer wait times, as were regions with regionalized assessment and treatment centres (RATC) when referenced against centers of excellence (COEs) in number of days added with 20.45 (95% CI 13.20-27.70, p < 0.001). Wait times for bariatric surgery in a publicly funded, regionalized bariatric program are influenced by certain patient characteristics, socioeconomic variables, and institutional factors. This warrants further intervention and study to help improve these inequities when encountering potentially vulnerable populations awaiting bariatric surgery.

Regional Wait Times for Patients With Nonmelanoma Skin Cancer in Southwestern Ontario.

Nonmelanoma skin cancer (NMSC) affects many Canadians. Although morbidity and mortality are rare, the burden to patients and the health-care system is significant. This study aims to evaluate current plastic surgery wait times and care pathways for patients with NMSC in Southwestern Ontario. A retrospective chart review of 225 patients treated in Ontario from 2015 to 2018 was conducted. Inclusion criteria included patients with an NMSC managed with surgical excision. Referral information was compared. Primary outcomes were wait times: from referral to consultation, referral to excision, and consultation to excision. Data were analyzed using Student t test with equal variance. One-hundred forty-three patients were included from the academic cohort and 82 from the community cohort. Referrals to academic and community surgeons included lesion location (90% and 97.6%, respectively), but less frequently included size (18% and 29.2%, respectively). Most referrals to academic surgeons included biopsy results (78.6%), as opposed to community referrals (25.6%). Patients in the academic cohort waited 15.3 ± 12.7 weeks from referral to consultation, and 15.7 ± 13 weeks from referral to excision. Patients from the community cohort waited significantly shorter periods of 4.9 ± 3.1 (P < .001) and 11.7 ± 9.9 weeks (P = .016), respectively. However, patients of the academic cohort waited 2.4 ± 7.1 weeks from consultation to excision, while patients in the community cohort waited 6.7 ± 9.6 weeks (P < .001). Rates of negative peripheral margins on pathology were similar between groups, at 89.5% of the academic cohort and 88.9% of the community cohort. Deep margins were positive 5.7% of the time at the academic sites and 6.2% of the time in the community. Patients referred to academic centres waited significantly longer periods of time in several parameters compared to those referred to a community surgeon. However, academic surgeons often had expedited consultation-to-excision time frame. This study provides important data for future quality improvement initiatives in NMSC care.

The efficacy of green surgery pathway on senile hip fractures

Objective To evaluate the efficacy of green surgery pathway on senile hip fractures. Methods The green surgery pathway was implement in senile (≥75 years) hip fracture cases in our department since March 2016. A historically controlled trial study was designed: 97 senile hip fracture patients admitted between March 2016 and March 2017 were included in the intervention group and 78 senile hip fracture patients admitted between March 2015 and March 2016 were included in the control group. The patients’ general information were recorded, including gender, age, type of fracture, internal medical conditions, surgery method, the American Association of Anesthesiologists classification of physical status (ASA) classification, et al. The hip function was evaluated by the Harris score system at one week,6 months and one year after surgery. The waiting time for operation, operation time, length of hospital stay, complications during hospitalization and hip Harris score were compared between the two groups. Results For the baseline data between the two groups in terms of gender, age, fracture type, surgery method, ASA classification, and combined underlying disease, the differences were not statistically significant. The waiting time for operation of the green surgery pathway group (36.3±7.8 h) was significantly shorter than that in the control group (46.9±11.4 h, t=6.995, P=0.000). The operation time of the green surgery pathway group was 45.4±17.5 min, and that of the control group was 43.8±20.8 min, the differences were not statistically significant. The length of hospital stay in the green surgery pathway group (6.8±2.4 d) was significantly shorter than that in the control group (9.5±2.8 d), the difference was statistically significant (t=6.866, P=0.000). In the green surgery pathway group, one patient developed acute myocardial infarction at 15 h after surgery and died of invalid rescue. In the control group, one patient developed acute cerebral hemorrhage 3 d after surgery and died of invalid rescue. The incidence of pulmonary infection, urinary tract infection, and acne in the green surgery pathway group were lower than that in the control group, the differences were statistically significant (χ2PI=5.081, PPI=0.024; χ2UI=6.841, PUI=0.009; χ2acne=11.768, Pcne=0.001). For the incidence of acute myocardial infarction, acute cerebrovascular accident, pulmonary embolism and deep vein thrombosis between the two groups, the differences were not statistically significant. The Harris score of hip in the green surgery pathway was higher than that in the control group (72.6±13.1 points vs 62.2±15.4 points, t=4.826, P=0.000) one week after the surgery, the difference was statistically significant. While the score was slightly higher than that of the control group in the half year (93.8±16.8 vs 90.5±14.7) and one year (94.1±18.3 vs 92.4±15.9) after surgery, but the differences were not statistically significant. The mortality rate of the green surgery pathway was slightly lower than that of the control group within one year after surgery (6.19% vs 8.97%), but the difference was not statistically significant. Conclusion The implementation of green surgery pathway can reduce the occurrence of complications in bed, promote the early hip rehabilitation, effectively shorten the hospitalization time. It is worth further promotion because of its social benefits and health economic benefits. Key words: Hip fractures; Case-control studies; Treatment outcome; Postoperative complications

The Effectivity of Therapeutic Communication on Pre-Surgery Education of The Implementation of Phacoemulsification technique Cataract Surgery With Local Anesthesia

Surgery, whether it is elective or emergency, is a complex event that triggers stress both on the patient and the family. Not only extending the surgery wait time, postponing or cancelling the surgery could increase the severity of the cataract that may result in blindness. This research goal is to know the effectivity of therapeutic communication on the implementation of cataract surgery. This research uses Pre-Experimental design with Post Test Only Control Group approach. A population of 176 respondents will be scheduled for cataract surgery to meet the inclusion criteria. The sampling technique is using simple random sampling technique and 64 respondents are divided into control and intervention groups. The data analysis is using Paired Sample T-test statistical test. The research result shows that almost all of the respondents who continue to the surgery with a number of 30 respondents (93,8%) and the number of respondents who postpone the surgery is only 2 respondents (6,2%), while those who implements daily communication shows that 22 respondents (68,8%) continue to the surgery and the 10 respondents (34,2%) postpone the surgery. The result of Paired Sample T-test statistical test shows that P value = 0,003 &lt; 0,05 means that there is a difference in the surgery between the intervention and the control group. The implications of this research can be applied by nurses to be more creative and innovative, professional and skilled in applying therapeutic communication when providing pre surgery cataract education.

The hidden cost of an extensive preoperative work-up: predictors of attrition after referral for bariatric surgery in a universal healthcare system.

Bariatric surgery is in high demand and patients generally undergo an extensive work-up process to maximize the success of surgery, especially in universal healthcare systems. Although valuable, this work-up process can lead to attrition before surgery. Therefore, we aim to assess patient and health system factors associated with attrition after bariatric surgery referral in a universal healthcare system. This was a population-based study of all patients aged ≥ 18 referred for bariatric surgery in Ontario, Canada from 2009 to 2015. Primary outcome was patients who dropped out of bariatric surgery after referral. Predictors of attrition after referral included patient demographics, clinical, institutional, and socioeconomic variables. Odds ratios and 95% CIs were estimated by multilevel logistic regression models. From 17,703 patients that were referred for bariatric surgery, 4122 patients dropped after the initial referral. Male patients, increasing age, and longer wait times for surgery were significantly (P < 0.0001) associated with higher odds of attrition. Additionally, smoker status, immigration status, unemployment, and disability were significant factors (P < 0.0001) predicting attrition. Patients who lived in lowest income quintile neighborhoods, when compared to those from the richest neighborhoods, had significantly higher odds of attrition (P = 0.02). Sleep apnea was associated with lower odds of attrition while diabetes and heart failure both with higher odds of attrition. Even in a universal healthcare system, there are various factors that could lead to increased odds of attrition before bariatric surgery. Clear disparities exist for certain marginalized populations. Further studies are warranted to ensure equitable utilization of bariatric surgery for all patients.

Safety of prolonged wait time for gastrectomy in clinical stage I gastric cancer

BackgroundPatients with stage I gastric cancer tend to wait for surgery. Although the cancer may progress during such a delay, effects of wait time for surgery on survival remain inconsistent. Here, we evaluated the safety of surgical wait time on survival of patients with clinical stage I gastric cancer. MethodsThe outcomes of 556 patients who underwent gastrectomy for clinical stage I gastric cancer between January 2007 and December 2011 were retrospectively evaluated. Patients were stratified into three groups based on wait time: short- (<61 days, n = 185), intermediate- (61–90 days, n = 218), and long-wait (91–180 days, n = 153) groups. Clinicopathological findings and survival were compared among the groups. ResultsThe median wait time was 72 days. Age and comorbidities differed among the groups, but clinical and pathological cancer stages did not. Overall survival was comparable; the 5-year overall survival was 90.2%, 93.6%, and 88.8% in the short-, intermediate-, and long-wait groups, respectively. Multivariate analysis revealed that wait time was not an independent prognostic factor for overall survival. Adjusted hazard ratios (HRs) were 0.69 (p = 0.262) and 1.03 (p = 0.926) in the intermediate- and long-wait groups, respectively, with short wait time as the reference. Relapse-free survival was comparable among the groups (intermediate-wait HR = 0.80, p = 0.476; long-wait HR = 1.10, p = 0.740). ConclusionA half-year wait time for surgery was not independently associated with survival of patients with clinical stage I gastric cancer and may therefore be acceptable.

Queensland July to December 2018

The period saw a less than auspicious fiscal outlook combine with a few positive economic announcements to again produce mixed fortunes for Queensland. Retreating from its once warm embrace of the Adani coal mine — and battling unemployment, fire and flood across the state — the Palaszczuk government scored some “own goals” over failures in Queensland Rail, elective surgery wait times, and a name change to a Brisbane children’s hospital. Despite this, Premier Annastacia Palaszczuk and Labor finished the year with strong public opinion poll leads over the LNP. By contrast, Opposition leader Deb Frecklington struggled for traction as public warfare broke out between the Liberal‐National Party’s parliamentary and organisational wings over abortion reform.

Clinical pathway efficiency for elective joint replacement surgeries: a case study

PurposeThe purpose of this paper is to define a clinical pathway for total joint replacement (TJR) surgery, estimate the effect of delays between steps of the pathway on wait time for surgery and to identify factors contributing to more efficient operations and challenges to their implementation.Design/methodology/approachThis is a case study with a mixed methods approach. The authors conducted interviews with hospital staff. Data collected in the interviews and through on-site observation were analyzed to map the TJR process and identify the steps of the care pathway. The authors extracted and analyzed data (time stamps) from 60 hospital patient records for each step in the pathway and ran a regression on the duration of the whole trajectory.FindingsThere were wide variations in the delays observed between the seven steps identified. The delay between Step 1 and Step 2 was the only significant variable in predicting the total wait time to surgery. In one hospital, one delay explained 50 percent of the variation. There was misalignment between findings from the qualitative data in terms of strategies implemented to increase efficiency of the clinical pathway to the quantitative data on delays between the steps.Research limitations/implicationsThe study identified the clinical pathway from the consultation with an orthopaedic surgeon to the surgery. However, it did not go beyond the surgery. Future research could investigate the relationship between specific processes and delays between steps of the process and patient outcomes, including length of stay, mobilization and functionality in activities of daily living, as well as potential complications from surgery, readmission and the services required after the patient was discharged.Practical implicationsWait times can be addressed by implementing strategies at the health system level or at the organizational level. The authors found and discuss areas where there could be efficiency gains for health care organizations.Social implicationsStakeholders in care processes are diverse and they each have their preferences in how they practice (in the case of providers) and how they perceive and wish to respond adequately to patients’ needs in contexts that have different norms and approaches. The approach in this study enables a better understanding of the processes, the organizational culture and how these may affect each other.Originality/valueOur mixed methods enabled a process mapping and the identification of factors that significantly affected the efficiency of the TJR surgery process. It combines methods from process engineering with health services and management research. To some extent, this study demonstrates that although managers can define and enforce processes, organizational culture and practices are harder to influence.