Weekend Operations Research Articles

A COMPARATIVE ANALYSIS OF THE NUMBER OF ON-TIME RENEWAL OF LICENSES IN A GOVERNMENT REVENUE GENERATING AGENCIES IN THE PHILIPPINES FROM MAY TO AUGUST 2022, 2023

This study aims to analyze the on-time renewal of licenses in a Philippine government agency between 2022 and 2023, focusing on the impact of weekend operations. The conceptual model suggests that extended operating days lead to better service quality and increased revenue. The operational framework involves data comparison using unpaired t-tests and descriptive statistics. Assumptions include an expected increase in on-time renewals with weekend operations. The hypothesis predicts a higher renewal rate in 2023. The research design employs a descriptive and quantitative approach. Data obtained ethically undergoes analysis using an unpaired t-test. Results indicate a significant increase in on-time renewals in 2023, supporting the hypothesis. Recommendations include strategies for the government to optimize licensing office hours and encourage timely renewals. License holders are advised to capitalize on the extended period, and future researchers are encouraged to explore broader datasets for comprehensive analyses.

Emergency surgical treatment of colonic acute diverticulitis: a multicenter observational study on behalf of the Italian society of colorectal surgery (SICCR) Lombardy committee.

Colonic diverticulitis can be treated conservatively, but some cases require surgery. Patients can undergo Hartmann's procedure (H) or resection with primary anastomosis (RA), with or without diverting stoma. This multicenter observational retrospective study aims to evaluate the adherence to current guidelines by assessing the rate of RA and H in Lombardy, Italy, and to analyze differences in patients' features. This study included data collected from nine surgical units performing emergency surgery in Lombardy, in 2019 and 2021. Data for each year were retrospectively collected through a survey among Italian Society of Colorectal Surgery (SICCR) Lombardy members. Additional data were about: Hinchey's classification, laparoscopic (VLS) or converted procedures, procedures with more than two operators, procedures in which the first operator was older than 40years, night or weekend procedures, older-than-80 patients, COVID-19 positivity (just 2021). The total number of operations performed was 254, 115 RA and 130 H (45.3% and 51.2%, diff. 12%, p = 0.73), and 9 (3.5%) other procedures. RAs were more frequent for Hinchey 1 and 2 patients, whereas Hs were more frequent for Hinchey 3 and 4. RAs without ileostomy were significantly less than Hs (66 vs. 130, p = 0.04). Laparoscopy was more used for RA compared to H (57 vs. 21, p = 0.03), whereas no difference was found between RA and H with respect to conversion rate, the presence of more than two operators in the team, the presence of a first operator older than 40years, night or weekend operations, and for older-than-80 patients. This study confirms the adherence to current guidelines for the treatment of acute colonic diverticulitis in Lombardy, Italy. It can be considered as a preliminary survey with interesting results that may open the way to a further prospective observational study to clarify some aspects in the management of this disease.

The Weekend Effect in Femoropopliteal Bypass

Patients undergoing weekend operations might experience worse postoperative outcomes. This “weekend effect” has been well-described for many surgical procedures; however, this phenomenon has not been studied for femoropopliteal bypass.

A queuing system for inert construction waste management on a reverse logistics network

Many cities worldwide have built various types of facilities to manage the large amounts of construction waste generated year by year. One issue of great importance to the operational efficiency of these waste management facilities is the logistics management associated with waste collection and transportation activities. This research develops a queuing system to improve the management of inert construction waste (ICW). This system combines the queuing theory, a reverse logistics network (RLN) and a simulation function. The RLN integrates the sources of waste generation, the collecting and recycling facilities and the landfills, and the simulation function simulates the different processing capacities of the queuing system and the weekday and weekend operations of the facilities in the RLN. Multiple scenarios are considered in evaluating the effect of the queuing delays on the RLN to optimize ICW logistics management across the RLN. A comprehensive case study based on the practice of ICW management in Hong Kong further substantiates the utility of the proposed queuing system.

Is Cauda Equina Surgery Safe Out-of-Hours? A Single United Kingdom Institute Experience

Cauda equina syndrome (CES) can have devastating neurological sequelae if surgical treatment is delayed. However, out-of-hours surgery (weekdays from 6:00 pm to 8:00 am and all weekend operations) can potentially result in higher rates of intraoperative complications, resulting in worse outcomes. In the present study, we have described our outcomes for patients with CES during an 8-year period (December 2011 to October 2019) with the aim of assessing the risk of out-of-hours surgery. We performed a retrospective analysis of inpatient events and outcomes at 6 months of follow-up. Patient demographics, symptoms, and management data were extracted, and a risk factor analysis was performed using logistic regression. The outcome measures were the incidence of complications and symptom changes at follow-up. Symptom outcome changes between 2 time points were analyzed using repeated measures. A total of 278 patients were included in the present study. Surgery out-of-hours (P= 0.018) and prolonged operations (P= 0.018) were significant risk factors for intraoperative complications. Improved outcomes at 6 months of follow-up were found for lower back pain, sciatica, altered saddle sensation, and urinary sphincter disturbance, with no significant changes for the remaining symptoms. Out-of-hours surgeries did not significantly affect individual symptom outcomes. Our analysis has suggested that emergency decompressive surgery for patients with CES does not result in worsening of outcomes with out-of-hours surgery compared with in-hours. However, our findings also showed that no clear benefit exists to expediting surgery for those with severe presentations. Thus, decompressive surgery should be undertaken at the earliest possible time to safely do so.

Load and Unload Technology to Improve Round-Bale Hauling Efficiency

There are two key parameters in short-haul truck operations to deliver biomass to a biorefinery: (1) mass of the load and (2) cycle time (load, travel, unload, and return). A plan to optimize both these parameters is outlined in this study. Operation of a logistics system to deliver 20-bale racks to a biorefinery for continuous 24/7 operation, 48 weeks/year is described. Round bales are stored in satellite storage locations (SSLs) by feedstock producers. A truckload consists of two tandem trailers (40, 0.4 Mg bales), a specification that maximizes load mass. Load-out at the SSL (loading bales into racks) is performed by a contractor and paid by the biorefinery. Subsequent hauling (truck tractor to pull the trailers) is also contracted for by the biorefinery. Central control is specified; the “feedstock manager” at the biorefinery decides the order SSLs are loaded out and can route a truck to any SSL where a load is ready. Tandem trailers with empty racks are dropped at the SSL, and the trailers with full racks are towed to the biorefinery. Uncoupling the loading and hauling in this manner reduces the time the truck waits for loading and the SSL load-out waits for a truck; thus, productivity of both operations is increased. At the biorefinery receiving facility, full racks are removed from the trailers and replaced with empty racks. The objective for this transfer is a 10 min unload time, which completes a logistics design that minimizes cycle time. A delivered rack is placed in a rack unloader to supply bales for immediate processing, or it is placed in central storage to supply bales for nighttime and weekend operations. Three biorefinery capacities were studied: 0.5, 1.0, and 1.5 bale/min. The analysis shows that rack cost to supply a biorefinery processing a bale/min for 24/7 operation is ~3.00 USD/Mg of annual biorefinery capacity, and the rack trailer cost is ~3.25 USD/Mg. Total delivery cost, beginning with bales in SSL storage and ending with a rack being placed in an unloader to deliver individual bales for processing, is 31.51, 28.42, and 26.92 USD/Mg for a biorefinery processing rates of 0.5, 1.0, and 1.5 bale/min, respectively.

Outcomes of non-elective coronary artery bypass grafting performed on weekends.

A weekend effect with increased mortality has previously been reported in surgical patients and those with acute myocardial infarction (MI). We hypothesized that a similar phenomenon may exist in coronary artery bypass grafting (CABG). Patients undergoing non-elective isolated CABG (2011-2017) were included from a multicentre regional Society of Thoracic Surgeons database. Patients were stratified by weekend versus weekday operations and further analysed by specific day of the week. A total of 14374 patients underwent urgent or emergency isolated CABG with 410 (2.9%) operated on over the weekend. Weekend operations were more often emergency (36.1% vs 5.0%, P < 0.001) and more likely to be in the setting of MI (70.0% vs 51.2%, P < 0.001). Cardiopulmonary bypass times were similar [91 min (71-114) vs 94 min (74-117), P = 0.0749] and the frequency of complete revascularization equivalent (83.4% vs 85.3%, P = 0.284) between weekend and weekday operations. In risk-adjusted analyses, there was no increased odds for mortality in patients operated on over the weekend [odds ratio (OR) 1.07, P = 0.811]; however, there was an increased odds of major morbidity (OR 1.37, P = 0.034). Furthermore, compared with Monday, morbidity increased as the operative day approached the weekend (Tuesday 0.98, P = 0.828; Wednesday 1.07, P = 0.469; Thursday 1.12, P = 0.229; Friday 1.19, P = 0.041; weekend 1.47, P = 0.014). While patients requiring surgery on the weekend are higher risk, there is no independent effect of weekend surgery on mortality. However, these patients are at increased risk for major morbidity, the causes of which require further investigation.

Weekend Operation and Outcomes of Patients Admitted for Nonelective Coronary Artery Bypass Surgery

The "weekend effect" is a purported phenomenon whereby patients admitted for time-sensitive medical and surgical conditions on a weekend suffer worse outcomes than those admitted on a weekday. There are limited data on the weekend effect for nonelective coronary artery bypass grafting (CABG). We studied outcomes for weekend vs weekday operations for all adult patients in the 2013 to 2014 National Inpatient Sample (NIS) undergoing nonelective CABG. Of 101,510 patients undergoing nonelective CABG, 12,795 patients (12.6%) underwent CABG on the day of admission (n= 1230 for weekend and 11,565 for weekday admission, respectively). Patients undergoing surgical procedures on a weekend were more likely to have a diagnosis of ST-elevation acute coronary syndrome (47.2% vs 20.2%, P < .001), require intraaortic balloon pump support (46.3% vs 23.1%, P < .001), and undergo same-day coronary angiography (66.7% vs 41.8%; P < .001) or same-day percutaneous coronary intervention (11.8% vs 7.1%; P= .01). Weekend admission was associated with increased mortality in unadjusted analysis (6.1% vs 3.2%; odds ratio, 1.99; 95% confidence interval, 1.13-3.52; P= .02), but this effect was attenuated in the adjusted model (adjusted odds ratio, 1.22; 95% confidence interval, 0.63-2.33; P= .47). Patients undergoing CABG on a weekend had higher crude mortality but similar risk-adjusted mortality compared with their weekday counterparts. Some of the excess mortality observed for weekend operations is likely attributable to a sicker cohort of patients undergoing CABG on the weekend.

Weekend Effect in Carotid Endarterectomy.

Background and Purpose- Patients undergoing surgery on the weekend may experience worse outcomes, but this weekend effect has not been studied in carotid endarterectomy (CEA). Methods- We identified patients undergoing isolated CEA in the Vascular Quality Initiative between 2003 and 2018. Our primary outcome was in-hospital stroke or perioperative death (stroke/death), stratified by symptom status. For asymptomatic patients, we also compared rates of the Centers for Medicare and Medicaid Services quality metric prolonged length of stay (>2 days or failed discharge home). We calculated propensity scores and used multilevel, inverse probability weighted logistic regression clustering at the hospital level. Results- There were 86 123 repairs during the study period, 53% asymptomatic lesions and 47% symptomatic. Only 0.7% of asymptomatic patients underwent CEA on the weekend, compared with 3.1% of symptomatic patients. Patients undergoing weekend repairs were more often white, with lower rates of most comorbidities. In asymptomatic patients, weekend operations were associated significantly higher odds of stroke/death (odds ratio [OR], 2.3 [1.1-4.8]; P=0.02), and prolonged length of stay (OR, 3.6 [2.7-4.7]; P<0.001). In symptomatic patients, weekend operations were associated with significantly higher adjusted odds of stroke/death (OR, 1.7 [1.2-2.4]; P=0.007) and longer postoperative length of stay (3.3 days versus 2.0 days, P=0.002). However, the difference in stroke/death was driven by patients presenting with stroke (OR, 2.2 [1.5-2.3]; P<0.001), rather than those presenting with transient ischemic attack (OR, 1.2 [0.6-2.1]; P=0.56). Conclusions- We found evidence of a significant weekend effect in CEA, as weekend operations in asymptomatic patients and patients who presented with stroke were associated with higher rates of stroke/death and prolonged length of stay. However, there was no evidence of such an effect in patients with transient ischemic attack. These data suggest that weekend CEA should be avoided except in the case of expedited revascularization after transient ischemic attack.

Trauma theatre productivity – Does the individual surgeon, anaesthetist or consultant presence matter?

IntroductionWith rising NHS clinical and financial demands, improving theatre efficiency is essential to maintain quality of patient care. Consistent teams and consultant presence have been shown to improve outcomes and productivity in elective orthopaedic surgery. The aim of this study was to investigate the impact on trauma theatre productivity of different surgeons and anaesthetists working together in a Major Trauma Centre. The influence of consultant presence and weekend operating on productivity was also considered. MethodsData relating to a single orthopaedic trauma theatre was gathered retrospectively for a two-year period. Variables including orthopaedic and anaesthetic consultant presence, number and complexity of operations performed and procedure start times were collected for daily trauma lists. Individual anaesthetic and orthopaedic consultants were compared by productivity outcomes. The impact of surgeons operating more frequently with one anaesthetist was also examined. ResultsData relating to 2384 patients undergoing a total of 2787 procedures was collected. Orthopaedic consultant presence at the first surgical case (p < 0.05) and for 50% or greater of cases (p < 0.05) lead to higher mean number of cases performed per list and reduced turnaround time. Despite working with a significantly higher number of different consultant anaesthetists (p < 0.001) in year two, the productivity of surgeons as judged by list start time, total cases per list and total operating time was not significantly affected. Significantly earlier start times (p < 0.001) and shorter turnaround times (p < 0.001) at weekends led to maintained productivity despite shorter theatre time. No significant difference in productivity was found when comparing individual anaesthetic and orthopaedic consultants. Productivity was not significantly increased by surgeons operating more frequently with one individual anaesthetist. ConclusionIn the setting of an acute trauma theatre, orthopaedic consultant presence led to increased productivity. Furthermore, individual surgeon and anaesthetist pairings had no effect on overall productivity. Future efforts to improve productivity should focus on achieving earlier start times, consultant supervision of lists and reduced turnaround times between cases.

Why rolling out routine seven-day surgical services would threaten emergency care

Scheduling of elective weekend operations is entirely within our control and deaths are therefore preventable.

Delay Prior to Expedited Carotid Endarterectomy: A Prospective Audit of Practice

To identify reasons for delay before carotid endarterectomy (CEA) in a reconfigured "fast-track" system where patients were admitted from the TIA (transient ischaemic attack) Clinic for urgent CEA. Prospective audit in 89 recently symptomatic patients. Ten patients (11%) suffered recurrent symptoms between admission and surgery. Two strokes were sufficiently severe that CEA was cancelled. The median delay from index symptom to CEA was 8 days. 74/87 (85%) underwent CEA <14 days from the index symptom; 39/87 (45%) within 7 days. Forty-five (51%) were ready for CEA <24 hours of admission; 74 (83%) <72 hours. The most common reasons for delay to CEA were logistical, especially a failure to plan for access to weekend operating. Two-thirds of the Tuesday/Friday theatre lists that were reserved for urgent CEAs were actually used for CEA; 27 (33%) were not used for CEA but were utilized for another vascular procedure, and five (4%) were cancelled the day before and went unused. The vast majority of patients (85%) underwent CEA <14 days from the index symptom, but 11% still suffered recurrent symptoms prior to surgery. Transferring patients directly from the TIA Clinic reduced overall delays, but Vascular Units adopting such an approach might then be vulnerable to criticisms regarding prolonged lengths of pre-operative in-patient stay while patients were worked up for theatre. Protected theatre lists both optimized (and delayed) access to CEA, but the most important cause of delay was that we had not planned for weekend operating using specialist anaesthetic and theatre staff.

Weekend Arthroplasty: A Longer Inpatient Stay?

As pressures mount on efficiency, hip and knee arthroplasty surgery is increasingly being performed during weekends. Despite the growing trend for weekend orthopaedic surgery, there are virtually no published data on the effect of weekend operating on the length of hospital stay (LOS).

Impact of nighttime and weekend liver transplants on graft and patient outcomes

Safety concerns have been raised about nighttime and weekend patient care, but it is unknown whether these issues affect liver transplantation. We sought to identify the impact of nighttime and weekend liver transplants on graft and patient survival. We used the United Network for Organ Sharing database to review adult liver transplants from 1987 to 2010. Comparisons were made between nighttime and daytime operations and between weekday and weekend operations. Cox proportional hazard ratios (HRs) were determined 30, 90, and 365 days after transplantation after we controlled for relevant factors; 94,768 transplants were included in the analysis. The patient survival rates at 30, 90, and 365 days for nighttime operations were 96%, 93%, and 86%, respectively. The patient survival rates at 30, 90, and 365 days for weekend operations were 95%, 92%, and 86%, respectively. These rates did not significantly differ from those for daytime and weekday operations, respectively. The graft failure rate was unchanged at 30 and 90 days for weekend transplants but was modestly increased at 365 days [HR = 1.05 (95% confidence interval = 1.01-1.11)]. Graft survival was unaffected by nighttime transplantation. Nighttime and weekend operations for liver transplantation do not affect patient or graft survival, and this testifies to the patient safety measures in place.

Maximising Trauma Operatingand Training at Weekends

The Leicester Royal Infirmary is one of the busiest trauma units in the UK. A single accident and emergency department serves a catchment population of 1.1 million and receives 110,000 visits per year, with around 3,000 admissions to acute trauma beds per year. On average, two patients with a fractured neck of femur are admitted every day. Weekend operating lists run every Saturday and Sunday from 8am until 8pm.

Holiday and Weekend Operating Room On-Call Staffing Requirements

Every facility that performs cases on holidays has in some way decided on its operating room (OR) and anesthesia staffing for holidays. Previous studies have not examined how best to calculate appropriate holiday staffing. We analyzed weekend and holiday data from a university hospital. There were high rank correlations between the number of cases starting during each 12-h period of a holiday, the total hours of OR time used, and the patients and surgeons waiting for cases to start. Weekend and holiday 12-h periods were divided into 8 categories (e.g., Saturday 7:00 am to 7:00 pm). There was perfect rank correlation between the mean number of cases starting during each 12-h period and appropriate staffing during the 12-h period, whether quantified by total hours of cases or by the under-utilized and over-utilized OR time resulting from staffing decisions. The number of cases starting during each period of a holiday is a statistically valid end point for OR managers to use to evaluate how busy holidays are relative to weekend days. To be useful, the statistic must be combined with mathematically valid assessments of appropriate weekend staffing on-call, whether in-house, or from home.

Precast Prestressed Concrete Pavement Pilot Project near Georgetown, Texas

The use of precast concrete is rapidly becoming a viable method for repair and rehabilitation of portland cement concrete pavements, with several projects under construction or in development throughout the United States. Construction with precast concrete offers numerous benefits over conventional cast-in-place pavement construction. Most notable is how quickly a precast pavement can be opened to traffic. Precast panels can be placed during overnight or weekend operations and opened to traffic almost immediately. In addition, because precast panels are cast in a controlled environment, the durability of a precast pavement is also improved. In March 2002, the Texas Department of Transportation completed construction of a precast pavement pilot project aimed at testing and further developing a precast pavement concept developed by the Center for Transportation Research at The University of Texas at Austin. This project was constructed on a section of frontage road along Interstate 35 near Georgetown, Texas. The project incorporated the use of posttensioned precast concrete panels. The panels were posttensioned in place not only to tie all the panels together but also to reduce the pavement thickness required and improve durability. The finished pavement demonstrated not only the viability of precast pavement construction but also the benefits of incorporation of posttensioning. Although the project was constructed without the time constraints and complexities that will eventually need to be considered for precast pavement construction, it ultimately helped to develop viable construction procedures for future precast prestressed concrete pavements.

Feasibility of Using Precast Concrete Panels to Expedite Construction of Portland Cement Concrete Pavements

As the number of vehicles on America’s roadways continues to grow at an unprecedented rate, pavements continue to deteriorate faster and require replacement. In urban and densely populated areas, however, pavement construction can cause traffic delays, thereby increasing user costs. A method for expediting pavement construction to reduce traffic delays and user costs is therefore needed. A feasible method for expediting construction of portland cement concrete pavements through the use of precast concrete panels is described. The main advantage of precast concrete panels is that they can be set in place and assembled quickly, allowing traffic back onto the pavement almost immediately. This allows pavement construction to be carried out in overnight or weekend operations, when traffic volumes are low, resulting in tremendous savings in user costs. The concept presented for precast concrete pavement should have the same, if not better, durability as conventional cast-in-place concrete pavements currently being constructed. Also, by incorporating prestressing, it is demonstrated that equivalent load repetitions and design life can be achieved with a significant reduction in pavement thickness over conventional pavements. Although the initial construction costs may be higher for precast pavements, the savings in user costs far outweigh any additional construction costs.

Timed oocyte collection in an assisted conception programme using GnRH analogue

Three-hundred-and-twenty-five patients on an assisted conception programme underwent 378 cycles of oocyte retrieval (OPU) following ovarian stimulation using a GnRH analogue and human menopausal gonadotrophins (HMG), a regimen which allows programmed cycles and delayed oocyte retrieval. Eighteen cycles were excluded (failed OPU in three and failure of fertilization in 15). In 360 cycles, patients completed their treatment with either in-vitro fertilization/embryo transfer (IVF/ET) (116) or gamete intra-Fallopian transfer (GIFT) (244), of which 241 took place at the normal time and 119 were delayed for 24 h or more to avoid weekend operating. The overall pregnancy rate per OPU was 29.5%, with the IVF group being 24.1% and the GIFT group being 32.8%. In the group of patients in whom OPU was delayed, the pregnancy rate was significantly higher in each sub-group than in the corresponding non-delayed sub-group (overall, 37.0 versus 25.7%; IVF/ET, 38.5 versus 16.9%; GIFT, 36.3 versus 31.1%). There was a significantly higher number of oocytes collected, gametes/embryos transferred in the group whose OPU had been delayed. In patients receiving GnRH analogue and HMG for ovarian stimulation, delaying oocyte retrieval is not harmful, may result in an improved outcome and allows OPU to be performed on routine operating lists. This facility, together with the improved pregnancy rates associated with this protocol of ovarian stimulation should improve the cost-effectiveness of assisted conception programmes.

Colorado River-Flow Management

A method of computing transient flow changes in a flowing stream is described. The results of more than five years of experience in the use of this method for estimating flows at the gaging stations of the 147-mile Parker-Imperial reach of the Colorado River are summarized. An account is also made of digital computer applications which enable tabulations of the expected flows at the gaging stations for each hour of the ensuing 24 hours to be made and transmitted to the Boulder City Office of USBR in time to be available at the beginning of each work day. Tabulation covering 72 hours are prepared for weekend operations.