Operating time and postoperative length of stay in modern orthognathic surgery- A retrospective review of 562 osteotomies by a single UK surgeon

Background: Surgical excision for postaxial polydactyly type B is advocated to avoid long-term complications. Excision with local anesthesia (LA) in infancy represents a safe and effective treatment for this condition, although general anesthesia (GA) is employed by many surgeons. We present a comparison of surgical outcomes, cost, and time between LA and GA to support widespread change in management. Methods: A retrospective review of patients under 12 months of age undergoing surgical polydactyly excision by a single surgeon was performed. Anesthesia type, patient demographics, and complications were recorded. Comparisons were made between LA and GA groups on procedure cost, operating time, length of stay (LOS), and time from procedure end to discharge. Stepwise forward regression was used to identify the best model for predicting total costs. Results: Ninety-one infants with a mean age of 3 months (±1.9) were examined; 51 (56%) underwent LA alone, 40 (44%) underwent GA. Mean operating time was 11.53 ± 4.36 minutes, with no difference observed between anesthesia groups ( P = .39). LA infants had a significantly shorter LOS (2.5 vs 3.5 hours; P < .05), quicker postoperative discharge (32 vs 65 minutes, P < .05), and fewer overall expenses, 2803 vs 6067 U.S. dollars (USD), P < .05. Two minor surgical complications (1 in each group) were reported. Conclusions: This study demonstrates significantly decreased cost, LOS, and time to discharge using LA alone for surgical excision of postaxial polydactyly type B. Results suggest the approach is quick, economical, and avoids the risks of GA in early infancy.

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Operating time, length of stay and readmission rates for orthognathic surgery

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2019.10.263 ◽

2019 ◽

Vol 57 (10) ◽

pp. e90

Author(s):

Conor Bowe ◽

Ben Gurney ◽

James Sloane ◽

Paul Johnson ◽

Carrie Newlands

Keyword(s):

Length Of Stay ◽

Orthognathic Surgery ◽

Operating Time ◽

Readmission Rates ◽

Time Length

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Room 302, 10/16/2000 2: 00 PM - 3: 30 PM (PD) Relationship between Preoperative Risk Factors, Postoperative Length of Stay, Morbidity, Mortality and Hospital Costs in Coronary Bypass Surgery

Anesthesiology ◽

10.1097/00000542-200009001-00239 ◽

2000 ◽

Vol 93 (3A) ◽

pp. A-239

Author(s):

Tuula S.O. Kurki ◽

Unto Hakkinen ◽

Juhani Ramo ◽

Mauri Leijala

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Bypass Surgery ◽

Hospital Costs ◽

Coronary Bypass ◽

Coronary Bypass Surgery ◽

Preoperative Risk ◽

Preoperative Risk Factors ◽

Postoperative Length

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Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children's Hospital experience

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.5.peds1128 ◽

2011 ◽

Vol 8 (2) ◽

pp. 165-170 ◽

Cited By ~ 80

Author(s):

Manish N. Shah ◽

Alex A. Kane ◽

J. Dayne Petersen ◽

Albert S. Woo ◽

Sybill D. Naidoo ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Open Surgery ◽

Operating Time ◽

Endoscopic Procedure ◽

Sagittal Craniosynostosis ◽

Helmet Therapy ◽

Age At Surgery ◽

The Mean ◽

Strip Craniectomy

Object This study investigated the differences in effectiveness and morbidity between endoscopically assisted wide-vertex strip craniectomy with barrel-stave osteotomies and postoperative helmet therapy versus open calvarial vault reconstruction without helmet therapy for sagittal craniosynostosis. Methods Between 2003 and 2010, the authors prospectively observed 89 children less than 12 months old who were surgically treated for a diagnosis of isolated sagittal synostosis. The endoscopic procedure was offered starting in 2006. The data associated with length of stay, blood loss, transfusion rates, operating times, and cephalic indices were reviewed. Results There were 47 endoscopically treated patients with a mean age at surgery of 3.6 months and 42 patients with open-vault reconstruction whose mean age at surgery was 6.8 months. The mean follow-up time was 13 months for endoscopic versus 25 months for open procedures. The mean operating time for the endoscopic procedure was 88 minutes, versus 179 minutes for the open surgery. The mean blood loss was 29 ml for endoscopic versus 218 ml for open procedures. Three endoscopically treated cases (6.4%) underwent transfusion, whereas all patients with open procedures underwent transfusion, with a mean of 1.6 transfusions per patient. The mean length of stay was 1.2 days for endoscopic and 3.9 days for open procedures. Of endoscopically treated patients completing helmet therapy, the mean duration for helmet therapy was 8.7 months. The mean pre- and postoperative cephalic indices for endoscopic procedures were 68% and 76% at 13 months postoperatively, versus 68% and 77% at 25 months postoperatively for open surgery. Conclusions Endoscopically assisted strip craniectomy offers a safe and effective treatment for sagittal craniosynostosis that is comparable in outcome to calvarial vault reconstruction, with no increase in morbidity and a shorter length of stay.

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SP3.2.10 Establishing an Emergency Surgical Ambulatory Care (ESAC) pathway for acute laparoscopic cholecystectomies: a single centre experience from a District General Hospital

British Journal of Surgery ◽

10.1093/bjs/znab361.076 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Neil Donald ◽

Lavanya Varatharajan ◽

Kumaran Ratnasingham ◽

Shashi Irukulla

Keyword(s):

Laparoscopic Cholecystectomy ◽

Length Of Stay ◽

Ambulatory Care ◽

Operating Time ◽

District General Hospital ◽

Gallstone Pancreatitis ◽

Early Laparoscopic Cholecystectomy ◽

Patient Demographics ◽

Day Range ◽

Cost Efficiencies

Abstract Aims Early laparoscopic cholecystectomy is the gold standard for acute cholecystitis and gallstone pancreatitis. In order to deliver this service, a local Emergency Surgical Ambulatory Care (ESAC) pathway with a dedicated ESAC theatre list was established. The aim of this audit was to determine whether ESAC was associated with (1) improved length of stay and (2) cost efficiencies. Methods Consecutive patients who underwent an emergency laparoscopic cholecystectomy between October 2018 to October 2019 were identified. Data related to patient demographics, operating time, complications length of stay (LOS), reason for inpatient stay and re-admissions were collected. A dedicated ESAC service was introduced in July 2020. Outcomes were re-audited (July – December 2020). Results Prior to the introduction of ESAC, 142 patients (42% male, mean age 51 years (range 14 -82 years)) underwent an acute cholecystectomy, of which 13% were discharged on the same day. Median pre-operative LOS was 2 days (range 0-12 days) and median post-operative LOS was 1 day (range 1-16 days). Following the introduction of ESAC, 78 patients (32% male, mean age 49 years (range 22 – 89 years)) underwent an acute cholecystectomy, of which 76% were discharged on the same day and 90% within 1 day. Median pre-operative LOS was 0 days (range 0 to 7 days) and median post-operative LOS was 0 days (range 0-16 days). Conclusions Our results show that the introduction of a dedicated ESAC pathway improved both pre- and post-operative LOS. This subsequently saves approximately £80,000 per annum in hospital bed days.

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