scholarly journals P-L16 The Impact of Covid-19 on the Management of Primary and Metastatic Liver Cancers; A Single Centre Experience

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Adam Tweedie ◽  
Stephen McCain ◽  
James Mooney ◽  
Claire Jones
Keyword(s):  
Liver Resection ◽  
Length Of Stay ◽  
Wait Time ◽  
Colorectal Metastases ◽  
Recurrence Rates ◽  
Term Survival ◽  
Admission Rates ◽  
Liver Cancers ◽  
Neo Adjuvant Chemotherapy ◽  
The Impact

Abstract Background The Covid-19 pandemic has impacted on all aspects of health care. Surgical specialties have been affected by the impact on theatre time and space, staff re-deployments, reduced ICU capacity for non-Covid patients, and in some cases this has had a significant impact on wait time for surgery and overall surgical capacity. In our tertiary referral HPB unit, the service has been relocated to two different sites throughout the pandemic. We aimed to assess the impact of this on patients undergoing liver resection Methods We examined patient data for all patients undergoing liver resection in the 15 month period prior to the introduction of national lockdown, and compared this with all patients who have undergone liver resection since. We looked at total number of cases, ICU admission rates (planned vs unplanned), length of stay, case mix, histology, rates of laparoscopic vs open surgery, and length of time from completing neoadjuvant chemotherapy to surgery. Data were obtained from electronic care records and patient notes. Results The overall number of cases was similar (84 pre-covid vs 86 since) and basic patient demographics were unaffected. Median length of stay was the same for both groups (7 days). Colorectal metastases were the underlying pathology in the majority of cases (56/84 pre Covid, 56/86 post). Numbers of laparoscopic and laparoscopic converted to open cases were reduced in the post-Covid era, 12 prior versus four since. The median time from completion of neo-adjuvant chemotherapy to surgery was also affected, increasing from 46 to 62 days. Conclusions These data show some differences in patient care in the pre and post-Covid eras, in particular a lower rate of laparoscopic surgery and longer period of time between neo-adjuvant treatment and surgery. Longer follow up is required to see if these trends persist and their effect on long term survival and recurrence rates. However, despite the strains on the system there were similar numbers of patients pre and post Covid, indicating that patients are still presenting and being treated. This showed that staff responded well to the pressures of Covid, and trainee experience would have been similar

114 Allowing Overlapping Surgery Decreases Length of Stay in an Academic, Safety-Net Hospital

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 224-224
Author(s):  
Anthony Michael DiGiorgio ◽  
Praveen V Mummaneni ◽  
Jonathan Lloyd Fisher ◽  
Adam Podet ◽  
Clifford Crutcher ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Tertiary Care ◽  
Wait Time ◽  
Multivariate Regression Analysis ◽  
Safety Net ◽  
Neurosurgical Procedures ◽  
Urgent Surgery ◽  
Period 2 ◽  
Safety Net Hospital ◽  
The Impact

Abstract INTRODUCTION The practice of surgeons performing overlapping surgery has recently come under scrutiny. We sought to examine the impact of overlapping rooms on surgery wait time and length of stay in patients admitted to a tertiary care, safety-net hospital for urgent neurosurgical procedures. METHODS Our hospital functions as a safety-net, tertiary care, level-1 trauma center in the Southern United States. The neurosurgery service transitioned from routinely allowing one 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. Case urgency, patient demographics, case type, indication, length of stay and time from admission to surgery were tracked. RESULTS >452 total cases were reviewed (201 in period 1 & 251 in period 2), covering 7 months in each period. 122 of the cases were classified as “urgent” (59 in period 1 and 63 in period 2). In the these patients, length of stay was significantly decreased in period 2 (13.09 days vs 19.52, p = .002) and the time from admission to surgery for urgent cases trended towards a shorter time (5.12 days vs 7.00, p = .084). Insurance status of these patients was 26.2% uninsured, 39.3% Medicaid, 18.9% Medicare, 9% commercial and the remainder workers compensation, liability or prisoner care. Multivariate regression analysis revealed that being in period 1, having Medicare, having trauma as the indication for surgery, and undergoing a non-cranial or non-spinal procedure as significant factors for increased length of stay. CONCLUSION Recent studies suggest overlapping surgeries are safe for patients. In the case of our safety net hospital, allowing the neurosurgery service to run overlapping rooms significantly reduces length of stay in a vulnerable population who is admitted in need of urgent surgery.

scholarly journals Impact of a specialist service in the Emergency Department on admission, length of stay and readmission of patients presenting with falls, syncope and dizziness

QJM ◽  
2020 ◽  
Author(s):  
K Jusmanova ◽  
C Rice ◽  
R Bourke ◽  
A Lavan ◽  
C G McMahon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Admission Rate ◽  
Readmission Rates ◽  
Specialist Service ◽  
Admission Rates ◽  
Potential Benefits ◽  
Bed Days ◽  
The Mean ◽  
The Impact

Summary Background Up to half of patients presenting with falls, syncope or dizziness are admitted to hospital. Many are discharged without a clear diagnosis for their index episode, however, and therefore a relatively high risk of readmission. Aim To examine the impact of ED-FASS (Emergency Department Falls and Syncope Service) a dedicated specialist service embedded within an ED, seeing patients of all ages with falls, syncope and dizziness. Design Pre- and post-cohort study. Methods Admission rates, length of stay (LOS) and readmission at 3 months were examined for all patients presenting with a fall, syncope or dizziness from April to July 2018 (pre-ED-FASS) inclusive and compared to April to July 2019 inclusive (post-ED-FASS). Results There was a significantly lower admission rate for patients presenting in 2019 compared to 2018 [27% (453/1676) vs. 34% (548/1620); X2 = 18.0; P < 0.001], with a 20% reduction in admissions. The mean LOS for patients admitted in 2018 was 20.7 [95% confidence interval (CI) 17.4–24.0] days compared to 18.2 (95% CI 14.6–21.9) days in 2019 (t = 0.98; P = 0.3294). This accounts for 11 344 bed days in the 2018 study period, and 8299 bed days used after ED-FASS. There was also a significant reduction in readmission rates within 3 months of index presentation, from 21% (109/1620) to 16% (68/1676) (X2 = 4.68; P = 0.030). Conclusion This study highlights the significant potential benefits of embedding dedicated multidisciplinary services at the hospital front door in terms of early specialist assessment and directing appropriate patients to effective ambulatory care pathways.

Role of the surgeon as a variable in long-term survival after liver resection for colorectal metastases

2009 ◽  
Vol 100 (7) ◽  
pp. 538-545 ◽  
Author(s):  
Felice Giuliante ◽  
Francesco Ardito ◽  
Maria Vellone ◽  
Giuseppina Ranucci ◽  
Bruno Federico ◽  
...  
Keyword(s):  
Liver Resection ◽  
Colorectal Metastases ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Analysis of the effects of EHR implementation on timeliness of care in a dermatology clinic: a simulation study

2018 ◽  
Vol 25 (7) ◽  
pp. 827-832 ◽  
Author(s):  
Vahab Vahdat ◽  
Jacqueline A Griffin ◽  
James E Stahl ◽  
F Clarissa Yang
Keyword(s):  
Length Of Stay ◽  
Patient Care ◽  
Discrete Event ◽  
Wait Time ◽  
Simulation Models ◽  
Event Simulation ◽  
Dermatology Clinic ◽  
Average Patient ◽  
Encounter Time ◽  
The Impact

Abstract Objective Quantify the downstream impact on patient wait times and overall length of stay due to small increases in encounter times caused by the implementation of a new electronic health record (EHR) system. Methods A discrete-event simulation model was created to examine the effects of increasing the provider-patient encounter time by 1, 2, 5, or 10 min, due to an increase in in-room documentation as part of an EHR implementation. Simulation parameters were constructed from an analysis of 52 000 visits from a scheduling database and direct observation of 93 randomly selected patients to collect all the steps involved in an outpatient dermatology patient care visit. Results Analysis of the simulation results demonstrates that for a clinic session with an average booking appointment length of 15 min, the addition of 1, 2, 5, and 10 min for in-room physician documentation with an EHR system would result in a 5.2 (22%), 9.8 (41%), 31.8 (136%), and 87.2 (373%) minute increase in average patient wait time, and a 6.2 (12%), 11.7 (23%), 36.7 (73%), and 96.9 (193%) minute increase in length of stay, respectively. To offset the additional 1, 2, 5, or 10 min, patient volume would need to decrease by 10%, 20%, 40%, and >50%, respectively. Conclusions Small changes to processes, such as the addition of a few minutes of extra documentation time in the exam room, can cause significant delays in the timeliness of patient care. Simulation models can assist in quantifying the downstream effects and help analyze the impact of these operational changes.

scholarly journals Does Pancreatic Fistula Affect Long-Term Survival after Resection for Pancreatic Cancer? A Systematic Review and Meta-Analysis

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5803
Author(s):  
Andrea Grego ◽  
Alberto Friziero ◽  
Simone Serafini ◽  
Amanda Belluzzi ◽  
Lucia Moletta ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Ductal Adenocarcinoma ◽  
Cochrane Library ◽  
Recurrence Rates ◽  
Term Survival ◽  
Free Survival ◽  
The Impact ◽  
Disease Free

Background: The impact of postoperative pancreatic fistula (POPF) on survival after resection for pancreatic ductal adenocarcinoma (PDAC) remains unclear. Methods: The MEDLINE, Scopus, Embase, Web of Science, and Cochrane Library databases were searched for studies reporting on survival in patients with and without POPF. A meta-analysis was performed to investigate the impact of POPF on disease-free survival (DFS) and overall survival (OS). Results: Sixteen retrospective cohort studies concerning a total of 5019 patients with an overall clinically relevant POPF (CR-POPF) rate of 12.63% (n = 634 patients) were considered. Five of eleven studies including DFS data reported higher recurrence rates in patients with POPF, and one study showed a higher recurrence rate in the peritoneal cavity. Six of sixteen studies reported worse OS rates in patients with POPF. Sufficient data for a meta-analysis were available in 11 studies for DFS, and in 16 studies for OS. The meta-analysis identified a shorter DFS in patients with CR-POPF (HR 1.59, p = 0.0025), and a worse OS in patients with POPF, CR-POPF (HR 1.15, p = 0.0043), grade-C POPF (HR 2.21, p = 0.0007), or CR-POPF after neoadjuvant therapy. Conclusions: CR-POPF after resection for PDAC is significantly associated with worse overall and disease-free survival.

scholarly journals The impact of portal vein tumor thrombus on long-term survival after liver resection for primary hepatic malignancy

HPB ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. 1025-1033 ◽  
Author(s):  
Fan Zhang ◽  
Chong-De Lu ◽  
Xiu-Ping Zhang ◽  
Zhen-Hua Chen ◽  
Cheng-Qian Zhong ◽  
...  
Keyword(s):  
Liver Resection ◽  
Portal Vein ◽  
Tumor Thrombus ◽  
Portal Vein Tumor Thrombus ◽  
Hepatic Malignancy ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

Influence of postoperative morbidity on long-term survival following liver resection for colorectal metastases

2003 ◽  
Vol 90 (9) ◽  
pp. 1131-1136 ◽  
Author(s):  
C. Laurent ◽  
A. Sa Cunha ◽  
P. Couderc ◽  
E. Rullier ◽  
J. Saric
Keyword(s):  
Liver Resection ◽  
Postoperative Morbidity ◽  
Colorectal Metastases ◽  
Term Survival ◽  
Long Term Survival

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

2019 ◽  
Vol 17 (6) ◽  
pp. 543-548
Author(s):  
Anthony M DiGiorgio ◽  
Praveen V Mummaneni ◽  
Jonathan L Fisher ◽  
Adam G Podet ◽  
Clifford L Crutcher ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Tertiary Care ◽  
Wait Time ◽  
Safety Net ◽  
Medical Complications ◽  
Neurosurgical Procedures ◽  
Period 2 ◽  
Safety Net Hospital ◽  
The Impact ◽  
Total Charges

Abstract BACKGROUND The practice of surgeons running overlapping operating rooms has recently come under scrutiny. OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSION 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.

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