Unplanned Return to the Operating Room in Upper-Extremity Surgery: Incidence and Reason for Return

Purpose – Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper is to evaluate whether performing regional anesthesia outside the OR in parallel increases total cases per day, improve efficiency and productivity. Design/methodology/approach – Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model evaluated pure operating modes of regional anesthesia performed within and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes) and assuming a standard three cases per day, what was the predicted end-of-day time overtime. Findings – Modeling results show that parallel processing of regional anesthesia increases the average cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the days going to overtime was reduced by 43 percent with parallel block. The overtime with parallel anesthesia was also projected to be 40 minutes less per day per surgeon. Research limitations/implications – Key limitations include the assumption that all cases used regional anesthesia in the comparisons. Many days may have both regional and general anesthesia. Also, as a case study, single-center research may limit generalizability. Practical implications – Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved. Originality/value – Simulation modeling can be an effective tool to show practice change effects at a system-wide level.

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Safety in the operating room during orthopedic trauma surgery—incidence of adverse events related to technical equipment and logistics

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-017-2862-0 ◽

2017 ◽

Vol 138 (4) ◽

pp. 459-462 ◽

Cited By ~ 3

Author(s):

E. A. K. van Delft ◽

T. Schepers ◽

H. J. Bonjer ◽

G. M. M. J. Kerkhoffs ◽

J. C. Goslings ◽

...

Keyword(s):

Adverse Events ◽

Operating Room ◽

Trauma Surgery ◽

Technical Equipment ◽

Orthopedic Trauma ◽

Orthopedic Trauma Surgery ◽

Surgery Incidence

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A Rare Axillary Artery Aneurysm with Limb-Threatening Ischemia

Journal for Vascular Ultrasound ◽

10.1177/154431670903300106 ◽

2009 ◽

Vol 33 (1) ◽

pp. 26-30

Author(s):

Jodi J. Grimm ◽

Nam Tran

Keyword(s):

Atrial Fibrillation ◽

Operating Room ◽

Upper Extremity ◽

Axillary Artery ◽

Secondary Infection ◽

Bypass Graft ◽

Outlet Obstruction ◽

Artery Aneurysm ◽

Pulsatile Mass ◽

Embolism And Thrombosis

Introduction Isolated subclavian or axillary artery aneurysms are extremely rare, accounting for less than 3% of peripheral aneurysms. These aneurysms can be caused by a secondary infection such as syphilis, trauma, Ehler – Danlos syndrome, poststenotic dilation from thoracic outlet obstruction, arthrosclerosis, or congenital reasons. They are at risk for rupture, distal embolism, and thrombosis. These complications can cause limb loss and or death. Case Report An 80-year-old woman presented to the emergency room with a cold left upper extremity. The patient had a history of atrial fibrillation, congestive heart failure, and hypertension. A presumptive diagnosis of peripheral emboli was made because of the patient's atrial fibrillation and recent myocardial infarction. She was taken to the operating room for a thrombectomy of the left brachial, radial, and ulnar arteries. At that time, a pulsatile mass was noted on the patient's shoulder, and an ultrasound was ordered. The ultrasound revealed a left axillary artery aneurysm measuring 3.62 cm anteroposteriorly x 3.72 cm transverse. There was nonocclusive thrombus within the lumen of the aneurysm. There was diminished, monophasic flow in the axillary and brachial arteries. Postoperatively the patient was placed on intravenous heparin. She was taken back to the operating room where a 7-mm Dacron graft was placed between the left axillary and brachial artery with exclusion of the axillary artery aneurysm. On postoperative duplex the bypass graft was patent. The patient did not suffer any long-term complications as the result of ischemia. Conclusion Although upper-extremity aneurysms are rare, and little is known about the natural history, there are multiple documented limb-threatening and or life-threatening complications. It is essential that they be treated in a timely manner as to avoid limb-threatening complications. An ultrasound can provide a noninvasive method of detecting a subclavian-axillary aneurysm. It can be used to screen patients when there is a suspicion of an aneurysm and determine the presence of concomitant thoracic or abdominal aneurysm.

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“On Arrival Block”—Management of Upper Extremity Trauma with Resuscitation in the Operating Room

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0000000000003191 ◽

2020 ◽

Vol 8 (10) ◽

pp. e3191

Author(s):

S. Raja Sabapathy ◽

G. Venkateswaran ◽

V. Boopathi ◽

J. Balavenkat Subramanian

Keyword(s):

Operating Room ◽

Upper Extremity ◽

Extremity Trauma ◽

Upper Extremity Trauma

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Sterility of Miniature C-arm Fluoroscopy in Hand and Upper Extremity Surgery

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1714434 ◽

2020 ◽

Author(s):

James P. Hovis ◽

Stephanie N. Moore-Lotridge ◽

Ashton Mansour ◽

Breanne H.Y. Gibson ◽

Douglas R. Weikert ◽

...

Keyword(s):

Operating Room ◽

Upper Extremity ◽

Ambulatory Surgery ◽

Care Center ◽

Tertiary Care ◽

High Rate ◽

Main Operating Room ◽

A Prospective Study ◽

Surgery Center ◽

Main Operating

AbstractPrevious studies have demonstrated that sterile equipment is frequently contaminated intraoperatively, yet the incidence of miniature c-arm (MCA) contamination in hand and upper extremity surgery is unclear. To examine this incidence, a prospective study of MCA sterility in hand and upper extremity cases was performed in a hospital main operating room (MOR) (n = 13) or an ambulatory surgery center operating room (AOR) (n = 16) at a single tertiary care center. Case length, MCA usage parameters, and sterility of the MCA through the case were examined. We found that MOR surgical times trended toward significance (p = 0.055) and that MOR MCAs had significantly more contamination prior to draping than AOR MCAs (p < 0.001). In MORs and AORs, 46.2 and 37.5% of MCAs respectively were contaminated intraoperatively. In MORs and AORs, 85.7 and 80% of noncontaminated cases, respectively, used the above hand-table technique, while 50 and 83.3% of contaminated MOR and AOR cases, respectively, used a below hand-table technique. Similar CPT codes were noted in both settings. Thus, a high-rate of MCA intraoperative contamination occurs in both settings. MCA placement below the hand-table may impact intraoperative contamination, even to distant MCA areas. Regular sterilization of equipment and awareness of these possible risk factors could lower bacterial burden.

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Operating On a Stretcher Is a Safe Alternative to an Operating Room Table

International Journal of Orthopaedics Research ◽

10.33140/ijor.04.01.04 ◽

2021 ◽

Vol 4 (1) ◽

Keyword(s):

Operating Room ◽

Upper Extremity ◽

Turnover Time ◽

Complication Rates ◽

Surgical Time ◽

Tourniquet Time ◽

Safe Alternative ◽

Intraoperative Complication ◽

Operating Room Table ◽

Room Time

Purpose: The primary purpose of this study was to compare intraoperative and post-operative complication rates for upper extremity surgical cases performed on a standard operating room (OR) table with similar cases done on a typical hospital stretcher. Secondary measures reviewed included surgical time, turnover time, total OR time, blood loss, tourniquet time, and postoperative complications. Methods: Using our institution’s electronic medical record system, we reviewed 100 consecutive upper extremity cases performed on a stretcher as well as 100 consecutive upper extremity cases done on a standard OR table. All cases were performed by the same board certified, fellowship trained orthopaedic surgeon. The cases were performed between February of 2014 and May of 2016 at a level one trauma center and its associated outpatient surgical center. Basic univariate statistical analyses were performed, and the two groups were compared for primary and secondary outcome measures. Results: The data showed no significant increase in intraoperative complication rates when operating on a standard hospital stretcher compared to operating on an OR table. There were a total of 6 postoperative complications in the stretcher group and a total of 11 complications in the OR table group. The most common postoperative complication seen in both cohorts was infection. There was one intraoperative complication in the OR table group and none in the stretcher group. With regard to total operating room time, surgical time, and delta time (overall OR room time minus surgical time which was used to calculate the turnover time), we found that the OR table group had shorter times in each category. The total OR time for the OR table group was a mean time of 105 minutes compared to 146 minutes seen in the stretcher group (p= 0.0002). Similarly, there was a shorter mean surgical time for surgeries done on an OR table (73 minutes) when compared to surgeries done on a stretcher (104 minutes) (p = 0.0026). Finally, the average turnover time (delta time) for the OR table group was 32 minutes while the average turnover time for the stretcher group was 42 minutes (p= 0.0002). The average tourniquet time for the OR table group was 36 minutes as compared to 41 in the stretcher group (p=0.467). Conclusion: Operating on a typical hospital stretcher is a safe alternative to operating on a standard operating room table as there was no increased complication rate seen with surgeries performed on a stretcher compared to an OR table.

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Long-term intra-arterial shunt

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000486 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000486 ◽

Cited By ~ 1

Author(s):

David V Feliciano

Keyword(s):

Operating Room ◽

Upper Extremity ◽

Thoracic Aorta ◽

Axillary Artery ◽

Damage Control ◽

Uneventful Recovery ◽

Axillary Vein ◽

Descending Thoracic Aorta ◽

Resuscitative Thoracotomy ◽

The Right

This is a case report of a patient who sustained a stab wound to the right axilla with injuries to the right axillary artery and vein. The patient had near-exsanguination in the field and no recordable blood pressure upon admission to the trauma center. Resuscitation was performed with endotracheal intubation, a left anterolateral resuscitative thoracotomy with cross-clamping of the descending thoracic aorta, and the rapid infusion of crystalloid solutions and packed red cells. In the operating room, the third portion of the right axillary artery and the adjacent right axillary vein were found to be transected. As part of a ‘damage control’ procedure, the ends of the right axillary vein were ligated. A 14 French intra-arterial shunt was inserted into the transected ends of the right axillary artery to restore the flow to the right upper extremity. The patient’s postoperative course was complicated by a coagulopathy, adult respiratory distress syndrome (ARDS), and anuria. The coagulopathy and anuria resolved within the first 48 hours, but the patient’s ARDS was slow to resolve. On the 10th postinjury day, the patient was returned to the operating room for a definitive repair of the right axillary artery. After the intra-arterial shunt was removed, a reversed greater saphenous vein graft was inserted between the ends of the right axillary artery in a medial intermuscular (extra-anatomic) tunnel. The patient made an uneventful recovery and was discharged home on the 16th postinjury day.The following principles of advanced trauma care were part of the management of this patient: (1) occasional need for resuscitative thoracotomy with cross-clamping of the descending thoracic aorta in a patient without a thoracic injury; (2) ‘damage control’ operation with ligation of the right axillary vein and placement of a temporary intra-arterial shunt to restore the flow to the right upper extremity; and (3) vascular reconstruction with an extra-anatomic bypass in a previously contaminated field.

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Operating on a Stretcher is a Safe Alternative to An Operating Room Table

10.21203/rs.3.rs-141489/v1 ◽

2021 ◽

Author(s):

Christopher Garrett ◽

James Eric Neal ◽

Brett Lewellyn

Keyword(s):

Operating Room ◽

Upper Extremity ◽

Turnover Time ◽

Surgical Time ◽

Tourniquet Time ◽

Safe Alternative ◽

Intraoperative Complication ◽

Operating Room Table ◽

Standard Operating ◽

Room Time

Abstract Purpose:The primary purpose of this study was to compare intraoperative and post-operative complication rates for upper extremity surgical cases performed on a standard operating room (OR) table with similar cases done on a typical hospital stretcher. Secondary measures reviewed included surgical time, turnover time, total OR time, blood loss, tourniquet time, and postoperative complications.Methods:Using our institution’s electronic medical record system, we reviewed 100 consecutive upper extremity cases performed on a stretcher as well as 100 consecutive upper extremity cases done on a standard OR table. All cases were performed by the same board certified, fellowship trained orthopaedic surgeon. The cases were performed between February of 2014 and May of 2016 at a level one trauma center and its associated outpatient surgical center. Basic univariate statistical analyses were performed, and the two groups were compared for primary and secondary outcome measures.Results:The data showed no significant increase in intraoperative complication rateswhen operating on a standard hospital stretcher compared to operating on an OR table. There were a total of 6 postoperative complications in the stretcher group and a total of 11 complications in the OR table group. The most common postoperative complication seen in both cohorts was infection. There was one intraoperative complication in the OR table group and none in the stretcher group. With regard to total operating room time, surgical time, and delta time (overall OR room time minus surgical time which was used to calculate the turnover time), we found that the OR table group had shorter times in each category. The total OR time for the OR table group was a mean time of 105 minutes compared to 146 minutes seen in the stretcher group (p= 0.0002). Similarly, there was a shorter mean surgical time for surgeries done on an OR table (73 minutes) when compared to surgeries done on a stretcher (104 minutes) (p = 0.0026). Finally, the average turnover time (delta time) for the OR table group was 32 minutes while the average turnover time for the stretcher group was 42 minutes (p= 0.0002). The average tourniquet time for the OR table group was 36 minutes as compared to 41 in the stretcher group (p=0.467).Conclusion:Operating on a typical hospital stretcher is a safe alternative to operating on a standard operating room table as there was no increased complication rate seen with surgeries performed on a stretcher compared to an OR table.Level of Evidence: Level 3 evidence

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Biomedical applications: Pitfalls in the practice

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100169626 ◽

1994 ◽

Vol 52 ◽

pp. 378-379

Author(s):

J. D. Shelburne ◽

Peter Ingram ◽

Victor L. Roggli ◽

Ann LeFurgey

Keyword(s):

Operating Room ◽

Liquid Nitrogen ◽

Lung Tissue ◽

Biomedical Applications ◽

Microprobe Analysis ◽

Tissue Sample ◽

Cellular Level ◽

Tissue Samples ◽

Asbestos Fibers

At present most medical microprobe analysis is conducted on insoluble particulates such as asbestos fibers in lung tissue. Cryotechniques are not necessary for this type of specimen. Insoluble particulates can be processed conventionally. Nevertheless, it is important to emphasize that conventional processing is unacceptable for specimens in which electrolyte distributions in tissues are sought. It is necessary to flash-freeze in order to preserve the integrity of electrolyte distributions at the subcellular and cellular level. Ideally, biopsies should be flash-frozen in the operating room rather than being frozen several minutes later in a histology laboratory. Electrolytes will move during such a long delay. While flammable cryogens such as propane obviously cannot be used in an operating room, liquid nitrogen-cooled slam-freezing devices or guns may be permitted, and are the best way to achieve an artifact-free, accurate tissue sample which truly reflects the in vivo state. Unfortunately, the importance of cryofixation is often not understood. Investigators bring tissue samples fixed in glutaraldehyde to a microprobe laboratory with a request for microprobe analysis for electrolytes.

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Combining Values

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2002.marapr01 ◽

2002 ◽

Vol 7 (2) ◽

pp. 1-4, 12 ◽

Cited By ~ 1

Author(s):

Christopher R. Brigham

Keyword(s):

Lower Extremity ◽

Upper Extremity ◽

Evaluation Method ◽

Proximal Phalanx ◽

Common Error ◽

The Third ◽

Whole Person ◽

Impairment Ratings ◽

Upper Extremity Impairment ◽

The Individual

Abstract To account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart.

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