COVID-19-related absence among surgeons: development of an international surgical workforce prediction model

AbstractBackgroundDuring the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks.MethodsAn international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent).ResultsBased on data from 364 hospitals across 65 countries, the COVID-19-related absence rate during the initial 6 weeks of the outbreak ranged from 20.5 to 24.7 per cent (mean average fortnightly). In weeks 7–12, this decreased to 9.2–13.8 per cent. At all times during the COVID-19 outbreak there was predicted to be sufficient surgical staff available to maintain at least 75 per cent of regular elective surgical volume. Overall, there was predicted capacity for surgeon redeployment to support the wider hospital response to COVID-19.ConclusionThis framework will inform elective surgical service planning during future COVID-19 outbreaks. In most settings, surgeon absence is unlikely to be the factor limiting elective surgery capacity.

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What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

Otolaryngology ◽

10.1177/0194599820969631 ◽

2020 ◽

pp. 019459982096963

Author(s):

Vanessa F. Torrecillas ◽

Kaden Neuberger ◽

Alexander Ramirez ◽

Paul Krakovitz ◽

Jeremy D. Meier

Keyword(s):

Elective Surgery ◽

Lag Time ◽

Cross Sectional Study ◽

Health Claims ◽

Third Party ◽

Prior Authorization ◽

Cross Sectional ◽

Before And After ◽

The Mean ◽

The Impact

Objective Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy. Study Design Cross-sectional study. Setting Health claims database from a third-party payer. Methods Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression. Results A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types ( P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time ( P = .98). Conclusion A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

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ACCURACY OF THE UPPER LIP BITE TEST;

The Professional Medical Journal ◽

10.29309/tpmj/2013.20.01.589 ◽

2012 ◽

Vol 20 (01) ◽

pp. 132-138

Author(s):

MUHAMMAD ATIF ◽

MUHAMMAD ABDULLAH ◽

MUHAMMAD JAVAD YOUSAF ◽

Khalid Buland

Keyword(s):

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Difficult Intubation ◽

Predictive Value ◽

Elective Surgery ◽

Cross Sectional Study ◽

Military Hospital ◽

Upper Lip ◽

Cross Sectional ◽

Sensitivity Specificity

Objective: To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficultlaryngoscopic intubation. Study Design: Cross sectional Study. Place and duration of study: The study was carried out at Department ofAnaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009.Patients and Methods: Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled afterwritten informed consent. The airways of the patients were evaluated by using the modified Mallampati classification (MMP) and theUpper lip bite test (ULBT). MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view wasgraded by Cormack and Lehane classification (Gold standard). Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy werecalculated for both the tests separately by using the 2×2 table. Results: ULBT had a higher accuracy of 94%, specificity of 99.2% andpositive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%.Conclusions: The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that itbe compared with the other prevailing tests as well which are often used to assess difficult intubations.

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Comparison of Laryngoscopic Views between C-MAC™ and Conventional Laryngoscopy in Patients with Multiple Preoperative Prognostic Criteria of Difficult Intubation. An Observational Cross-Sectional Study

Medicina ◽

10.3390/medicina55120760 ◽

2019 ◽

Vol 55 (12) ◽

pp. 760

Author(s):

Aikaterini Amaniti ◽

Panagiota Papakonstantinou ◽

Dimitrios Gkinas ◽

Ioannis Dalakakis ◽

Evangelia Papapostolou ◽

...

Keyword(s):

Prognostic Factors ◽

Difficult Intubation ◽

Elective Surgery ◽

Significant Risk ◽

Significant Risk Factor ◽

Cross Sectional Study ◽

Laryngoscopic View ◽

Cross Sectional ◽

Intubation Difficulty ◽

Difficulty Scale

Background and Objectives: Video laryngoscopy has been proven useful under difficult airway scenarios, but it is unclear whether anticipated improvement of visualization is related to specific difficult intubation prognostic factors. The present study evaluated the change in laryngoscopic view between conventional and C-MAC® laryngoscopy and the presence of multiple difficult intubation risk factors. Materials and Methods: Patients scheduled for elective surgery with >2 difficult intubation factors, (Mallampati, thyromental distance (TMD), interinscisor gap, buck teeth, upper lip bite test, cervical motility, body mass index (BMI)) were eligible. Patients underwent direct laryngoscopy (DL) followed by C-MAC™ laryngoscopy (VL) and intubation. Change of view between DL and VL, time for best view, intubation difficulty scale (IDS) and correlation between prognostic factors, laryngoscopic view improvement, and IDS were measured. Results: One-hundred and seventy-six patients completed the study. VL lead to fewer Cormarck–Lehane (C/L) III-IV, compared to DL (13.6% versus 54.6%, p < 0.001). The time to best view was also shorter (VL: 10.82 s, DL: 12.08 s, p = 0.19). Mallampati III-IV and TMD ≤ 6 cm were related to improvement of C/L between DL and VL. Logistic regression showed these two factors to be a significant risk factor of the glottis view change (p = 0.006, AUC-ROC = 0.57, 95% CI: 0.47–0.66). 175/176 patients were intubated with VL. 108/176 were graded as 0 < IDS ≤ 5 and 12/176 as IDS > 5. IDS was only correlated to the VL view (p < 0.0001). Conclusion: VL improved laryngoscopic view in patients with multiple factors of difficult intubation. Mallampati and TMD were related to the improved view. However, intubation difficulty was only related to the VL view and not to prognostic factors.

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Prevalence and Predictors of Cancellation of Elective Surgical Procedures at a Tertiary Hospital in Uganda: A Cross-Sectional Study

Surgery Research and Practice ◽

10.1155/2020/1464098 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Alfred Ogwal ◽

Felix Oyania ◽

Emmanuel Nkonge ◽

Timothy Makumbi ◽

Moses Galukande

Keyword(s):

Surgical Procedures ◽

Orthopedic Surgery ◽

Elective Surgery ◽

Cross Sectional Study ◽

Mulago Hospital ◽

Sectional Study ◽

Related Factors ◽

Cross Sectional ◽

Elective Surgical Procedures ◽

Cancellation Rate

Introduction. The cancellation of elective procedures has been shown to waste resources and to have the potential to increase morbidity and mortality among patients. This study aimed to determine the prevalence of the cancellation of elective surgical procedures and to identify the factors associated with these cancellations at Mulago Hospital, a large public hospital in Kampala, Uganda. Methods. A cross-sectional study was conducted from January 10, 2018, to February 20, 2018. We recruited patients of all ages who were admitted to surgical wards and scheduled for elective surgery. Data on patients’ demographic characteristics and diagnosis, as well as the specialty of the surgery, the planned procedure, the specific operating theatre, cancellation, and the reasons for cancellation were extracted and analyzed using logistic regression. Results. Of a total of 400 cases, 115 procedures were canceled—a cancellation prevalence of 28.8%. Orthopedic surgery had the highest cancellation rate, at 40.9% (n = 47). Facility-related factors were responsible for 67.8% of all cancellations. The most common reason for cancellation was insufficient time in the theatre to complete the procedure on the scheduled day. No procedures were canceled because of a lack of intensive care unit beds. There was a significant association between surgical specialty and cancellation (P<0.05) at multivariate analysis. Conclusion. The prevalence of cancellation of elective surgical procedures at Mulago Hospital was 28.8%, with orthopedic surgery having the highest cancellation rate. Two-thirds of the factors causing cancellations were facility-related, and more than 50% of all cancellations were potentially preventable. Quality-improvement strategies are necessary in the specialties that are susceptible to procedure cancellation because of facility factors.

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Preoperative Fasting among Adult Patients for Elective Surgery in a Kenyan Referral Hospital

International Scholarly Research Notices ◽

10.1155/2017/2159606 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

George Njoroge ◽

Lucy Kivuti-Bitok ◽

Samuel Kimani

Keyword(s):

Elective Surgery ◽

Cross Sectional Study ◽

Adult Patients ◽

Mirror Reflection ◽

Preoperative Fasting ◽

Sectional Study ◽

National Hospital ◽

Cross Sectional ◽

Ethical Approval

Background. Preoperative fasting (POF) is physiologically and precautionary important during anesthesia and surgery. POF from midnight has been practiced despite the recommended shorter practice. Objective. Assessing preoperative fasting among adult patients scheduled for elective surgery at Kenyatta National Hospital (KNH). Methods. A descriptive cross-sectional study involving 65 surgical patients. A questionnaire of mixed questions on demographics, reasons, source of instructions, opinion on instructions, time, premedication practices, outcome, and complains on NPO was used. Analysis was quantitatively done with SPSS v. 22. Ethical approval was obtained from KNH-UoN ERC. Results. Of the respondents 93.8% lacked knowledge on the correct reasons for POF and felt that the instructions were unclear and less important <50%. POF instructions were administered by nurses 80%, anesthetists 15%, and surgeons 5%. Most of respondents (73.8%) fasted > 15 hours. The POF outcomes were rated moderately challenging as follows: prolonged wait for surgery 44.6%, thirst 43.1%, hunger 36.9%, and anxiety 29.2%. Conclusion. Nurses are critical in providing POF instructions and care, and patient knowledge level is a mirror reflection of the quality of interventions. This underscores the need to build capacity for nurses and strengthen the health system to offer individualized preoperative interventions as well as monitoring and clinical auditing of fasting practices.

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Blindness Registers as Epidemiological Tools for Public Health Planning: A Case Study in Belize

Epidemiology Research International ◽

10.1155/2014/659717 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Sally L. Baxter ◽

Richard P. Wormald ◽

Joan M. Musa ◽

Daksha Patel

Keyword(s):

Public Health ◽

Diabetic Retinopathy ◽

Health Planning ◽

Population Based ◽

Service Planning ◽

Cross Sectional ◽

Screening Programs ◽

Surgical Services ◽

Public Health Planning ◽

Sectional Analysis

For public eye health programs, blindness registers can be an important tool for informing service planning. This study examines how the Belize Council for the Visually Impaired (BCVI) used its blindness register data to drive several public health interventions. Cross-sectional analysis was performed for all active registrants (n=1194) to determine the distribution of causes of registration according to age, sex, and geographical district. Cataract was the leading cause of registration (39.6%), followed by glaucoma (20.8%), diabetic retinopathy (10.2%), and childhood blindness (9.4%). The distribution of the causes of registration was fairly similar between men and women and across the various districts. However, in Stann Creek, whose population is largely of African descent, glaucoma exceeded cataract. For most causes, the majority of registrants were registered at age 50 or older. Follow-up was conducted four years later. Several interventions had been initiated, most notably bolstering cataract surgical services and creating screening programs for glaucoma and diabetic retinopathy. The register itself was also improved to maximize its utility for future use. While standardized surveys may be the most appropriate method of estimating population-based measures such as prevalence or incidence, the blindness register is still a valuable source of data for public health planning.

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Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention

BMJ Global Health ◽

10.1136/bmjgh-2021-006788 ◽

2021 ◽

Vol 6 (12) ◽

pp. e006788

Author(s):

Edwin Charles Ernest ◽

Augustino Hellar ◽

John Varallo ◽

Leopold Tibyehabwa ◽

Margaret Mary Bertram ◽

...

Keyword(s):

Surgical Site Infections ◽

Cross Sectional Study ◽

Cross Sectional ◽

Middle Income ◽

Surgical Safety ◽

Safe Surgery ◽

Low Middle Income Countries ◽

Utilisation Rate ◽

Surgical Teams ◽

The Impact

IntroductionDespite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs).MethodsWe conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15.ResultsThe SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.ConclusionOur findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.

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Comparison of Upper Lip Bite Test with Modified Mallampati Test and Thyromental Distance for Prediction of Difficult Intubation

Nepal Journal of Medical Sciences ◽

10.3126/njms.v5i1.36792 ◽

2020 ◽

Vol 5 (1) ◽

pp. 2-9

Author(s):

Sabin Koirala ◽

Bigen Man Shakya ◽

Moda Nath Marhatta

Keyword(s):

Difficult Intubation ◽

Predictive Value ◽

Elective Surgery ◽

Cross Sectional Study ◽

Upper Lip ◽

Cross Sectional ◽

Airway Assessment ◽

Total Percentage ◽

Bedside Test ◽

Sensitivity Specificity

Introduction: The prediction of difficult intubation using simple bedside test is of great importance to prevent mismanagement of airway. This study was conducted to compare Upper Lip Bite Test (ULBT) with Modified Mallampati Test (MMT) and Thyromental Distance (TMD) for the prediction of difficult intubation. Method: This was descriptive cross-sectional study conducted in 121 patients of American Society of Anaesthesiologists Physical Status (ASA PS) I and II patients scheduled for elective surgery requiring general anaesthesia with endotracheal tube. The airway assessment of the patients was done one day prior to the surgery using Upper Lip Bite Test (ULBT), Modified Mallampati Test (MMT) and measurement of Thyromental Distance (TMD) . On the day of surgery during laryngoscopy, Cormack-Lehane (CL) grading was recorded. The CL grading of III and IV was labeled as difficult intubation. The Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Likelihood Ratio (LR) of ULBT, MMT and TMD were calculated and compared. Results: The total percentage of difficult intubation, defined by Cormack-Lehane (CL) III and IV was 16.52 %. The sensitivity, specificity, PPV, NPV and accuracy of Upper Lip Bite Test (ULBT) was 50%, 100%, 100%, 91% and 91.74% respectively. ULBT had a significantly higher sensitivity, specificity and PPV when compared to MMT or TMD or MMT and TMD when combined together. Conclusions: Upper Lip Bite Test (ULBT) is better predictor of difficult intubation and it should be used along with other test during airway assessment.

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Determining Model for Maximum Blood Request (MSBOS) for Surgery: An Elective Surgery in Imam Ali Hospital, Zahedan, Iran

International Journal of Hematology-Oncology and Stem Cell Research ◽

10.18502/ijhoscr.v13i2.694 ◽

2019 ◽

Author(s):

Seyed Mehdi Hashemi ◽

Seyed Hossein Soleimanzadeh Mousavi ◽

Zeinab Tavakolikia

Keyword(s):

Surgical Procedures ◽

Blood Donation ◽

Elective Surgery ◽

Cross Sectional Study ◽

Blood Transfusions ◽

Hernia Surgery ◽

Cross Sectional ◽

Elective Surgical Procedures ◽

The Mean ◽

Common Problems

Background: Nowadays, excessive blood intake is one of the most common problems in educational hospitals, causing issues such as the lack of proper distribution of blood products among centres, increases in costs and blood bank workloads. So, programs such as a Maximum Surgical Blood Ordering Schedule (MSBOS) were introduced to design a blood ordering schedule, which is a guide to normal transfusion needs for common surgical procedures. Materials and Methods: This study was a descriptive cross-sectional study. The sampling method was designed and distributed among all sectors of the hospital. Each sector according to the demand for blood and cross-matched transfused units entered the rate of wasted and unused blood bags on the related forms. This study was performed on 1568 patients, of whom 562 (35/84%) were given blood transfusions. Results: The aim of this study was to determine the pattern for the maximum surgical blood order schedule (MSBOS) for elective surgical procedures/in elective surgery cases in Imam Ali Hospital, Zahedan. This study was performed on 1568 patients, of whom 562 (35/84%) were given blood transfusions. The mean C/T ratio was 1.61 ± 0.99, the mean TI was 0.61 ± 0.38, and the mean T index was 36.4 ± 30.16%. Conclusion: In general, only 55% of the blood units were used. Hernia surgery, thyroidectomy, and patients with renal problems had the greatest number of wasted units. Therefore, according to the results, indications of blood donation should be made correctly by health care personnel in all patients requiring a blood transfusion, and if there is an increased number of indications, packed cells are requested.

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Hyponatremia among Postoperative Children Administered with Hypotonic Fluids in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.7133 ◽

2021 ◽

Vol 59 (243) ◽

pp. 1131-1135

Author(s):

Ashish Lal Shrestha ◽

Susan Jehangir Homi ◽

Reju Joseph Thomas

Keyword(s):

Confidence Interval ◽

Postoperative Period ◽

Tertiary Care Hospital ◽

Elective Surgery ◽

Tertiary Care ◽

Cross Sectional Study ◽

Care Hospital ◽

Sectional Study ◽

Cross Sectional ◽

Hypotonic Fluids

Introduction: Hypotonic solutions in postoperative children may cause hyponatremia. Considering humidity and temperatures in India, this study was conducted to find out the prevalence of hyponatremia among postoperative children who were administered with hypotonic solutions in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital. Ethical approval was taken from the institutional review board of Christian Medical College, Vellore, India (Reference number: 9177). Children aged less than 15 years undergoing elective surgery, requiring fasting for more than 12 hours post-operatively with normal preoperative electrolytes and renal functions were included. Hypotonic fluids were administered following existent protocol. Electrolytes were repeated immediate postoperatively and at 12-24 hours. Data was entered into and analyzed using the Statistical Package for the Social Sciences version 18.0. Point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 109 participants, hyponatremia in the postoperative period was seen in 53 (48.6%) (40.7-56.5 at 90% Confidence Interval) children. Hyponatremia was found in the immediate postoperative period in 10 (9.2%) children. All received Ringer Lactate as maintenance intra-operatively and none were severe enough to need correction. In the 12–24-hour sample, 43 (39.41%) had hyponatremia and none in severe category. Conclusions: Asymptomatic hyponatremia was noted in normal children planned for elective surgery. Among children managed with the existing institutional perioperative (hypotonic) fluid management protocol, subclinical postoperative hyponatremia within 12-24 hours of surgery was noted in a significant proportion, which was more in the hot and warm months in tropics. There are grounds for switching to isotonic fluids for perioperative management.

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