scholarly journals Operating Rooms efficiency: leveraging data to improve management of elective surgery

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Quercioli ◽  
G A Carta ◽  
G Cevenini ◽  
G Messina ◽  
N Nante ◽  
...  
Keyword(s):  
Historical Data ◽  
Elective Surgery ◽  
District General Hospital ◽  
Operating Rooms ◽  
Accurate Estimation ◽  
Surgical Time ◽  
Accurate Analysis ◽  
Management Efficiency ◽  
Scheduling Model ◽  
The Mean

Abstract Background Careful scheduling of elective surgery Operating Rooms (ORs) is crucial for their efficient use, to avoid low/over utilization and staff overtime. Accurate estimation of procedures duration is essential to improve ORs scheduling. Therefore analysis of historical data about surgical times is fundamental to ORs management. We analyzed the effect, in a real setting, of an ORs scheduling model based on estimated optimum surgical time in improving ORs efficiency and decreasing the risk of overtime. Methods We studied all the 2014-2019 elective surgery sessions (3,758 sessions, 12,449 interventions) of a district general hospital in Siena's Province, Italy. The hospital had3 ORs open 5 days/week 08:00-14:00. Surgery specialties were general surgery, orthopedics, gynecology and urology. Based on a pilot study conducted in 2016, which estimated a 5 times greater risk of having an OR overtime for sessions with a surgical time (incision-suture)>200 minutes, from 2017 all the ORs were scheduled using a maximum surgical time of 200 minutes calculated summing the mean surgical times for intervention and surgeon (obtained from 2014-2016 data). We carried out multivariate logistic regression to calculate the probability of ORs overtime (of 15 and 30 minutes) for the periods 2014-2016 and 2017-2019adjusting for raw ORs utilization. Results The 2017-2019 risk of an OR overtime of 15 minutes decreased by 25% compared to the 2014-2016 period (OR = 0.75, 95%CI=0.618-0.902, p = 0.003); the risk of a OR overtime of 30 minutes decreased by 33% (OR = 0.67, 95%CI= 0.543-0.831, p < 0.001). Mean raw OR utilization increase from 62% to 66% (p < 0.001). Mean number of interventions per surgery sessions increased from 3.1 to 3.5 (p < 0.001). Conclusions This study has shown that an analysis of historical data and an estimate of the optimal surgical time per surgical session could be helpful to avoid both a low and excessive use of the ORs and therefore to increase the efficiency of the ORs. Key messages An accurate analysis of surgical procedures duration is crucial to optimize operating room utilization. A data-based approach can improve OR management efficiency without extra resources.

scholarly journals The Lichtenstein Plug Technique. The safe repair

2019 ◽  
Keyword(s):  
Femoral Hernia ◽  
Elective Surgery ◽  
Work Group ◽  
Average Hospital Stay ◽  
Early Recovery ◽  
Surgical Time ◽  
Average Hospital ◽  
Basic Work ◽  
Operative Complications ◽  
The Mean

Summary: Various techniques have been developed for the repair of femoral hernia. The technique with the Lichtenstein Plug since 1989 has allowed to obtain a lower rate of complications and recurrences, as well as an early recovery of the patients usual activities. Its application, widely spread in elective surgery, can also be performed in emergency surgery. The aim of this work is to review the experience of our basic group of work in the surgical treatment of Femoral hernia using this technique. Métodos: A retrospectiva descriptiva observacional sud das conducta in our basic work group from the surgery servicie of the General Tracking Hospital “Enrique Cabrera” veteen 2009 and 2018, to chicha this surgical technique das ampliad. De sud the anatómica variantes of hernias as well as post-operative complications and clínical evolución. Resultas: The mean age of the patients has 58.7 yesar (19-92 yesar), Begin the fémale with the Hughes incidente 78%, as well as, the most of frecuente locación the light, 67.5%. The próstesis usted in the hernioplasty was that of polypropylene. Local anesthesia was applied to 29 patients (63%) of them. The average surgical time was 25 minutes, (15-65 minutes). Ambulation was early and the average hospital stay was lessthan 24 hours, in most patients. Only one infection of the wound and one hernia recurrence in one patient was confirmed. Conclusion: Therefore, we believe that the Lichtenstein Plug technique should be considered among the techniques of choice in the treatment of femoral hernia

scholarly journals The Lichtenstein Plug Technique.the Safe Repair

2019 ◽  
Vol 2 (2) ◽  
pp. 01-03
Author(s):  
Pedro Rodríguez
Keyword(s):  
Femoral Hernia ◽  
Elective Surgery ◽  
Work Group ◽  
Early Recovery ◽  
Surgical Time ◽  
Average Hospital ◽  
Basic Work ◽  
Operative Complications ◽  
The Mean ◽  
The Right

Summary Various techniques have been developed for the repair of femoral hernia. The technique with the Lichtenstein Plug since 1989 has allowed to obtain a lower rate of complications and recurrences, as well as an early recovery of the patients usual activities. Its application, widely spread in elective surgery, can also be performed in emergency surgery. The aim of this work is to review the experience of our basic group of work in the surgical treatment of Femoral hernia using this technique. Methods A retrospective descriptive observational study was conducted In our basic work group from the surgery service of the General Teaching Hospital “Enrique Cabrera” between 2009 and 2018, to which this surgical technique was applied. We study the anatomical variants of hernias as well as post-operative complications and clinical evolution. Results The mean age of the patients was 58.7 years (19-92 years), being the female with the highest incidence 78%, as well as, the most frequent location the right, 67.5%. The prosthesis used in the hernioplasty was that of polypropylene. Local anesthesia was applied to 29 patients (63%) of them. The average surgical time was25 minutes, (15-65 minutes). Ambulation was early and the average hospital stay was lessthan 24 hours, in most patients. Only one infectionof the wound and one hernia recurrence in one patient was confirmed. Conclusion Therefore, we believe that the Lichtenstein Plug technique should be considered among the techniques of choice in the treatment of femoral hernia

scholarly journals Noise in Otolaryngology – Head and Neck Surgery operating rooms: a systematic review

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Gianluca Sampieri ◽  
Amirpouyan Namavarian ◽  
Marc Levin ◽  
Justine Philteos ◽  
Jong Wook Lee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Head And Neck ◽  
Patient Outcomes ◽  
Noise Level ◽  
Neck Surgery ◽  
Operating Rooms ◽  
Head And Neck Surgery ◽  
Noise Levels ◽  
Surgical Performance ◽  
The Mean

Abstract Objective Noise in operating rooms (OR) can have negative effects on both patients and surgical care workers. Noise can also impact surgical performance, team communication, and patient outcomes. Such implications of noise have been studied in orthopedics, neurosurgery, and urology. High noise levels have also been demonstrated in Otolaryngology-Head and Neck Surgery (OHNS) procedures. Despite this, no previous study has amalgamated the data on noise across all OHNS ORs to determine how much noise is present during OHNS surgeries. This study aims to review all the literature on noise associated with OHNS ORs and procedures. Methods Ovid Medline, EMBASE Classic, Pubmed, SCOPUS and Cochrane databases were searched following PRISMA guidelines. Data was collected on noise measurement location and surgery type. Descriptive results and statistical analysis were completed using Stata. Results This search identified 2914 articles. Final inclusion consisted of 22 studies. The majority of articles analyzed noise level exposures during mastoid surgery (18/22, 82%). The maximum noise level across all OHNS ORs and OHNS cadaver studies were 95.5 a-weighted decibels (dBA) and 106.6 c-weighted decibels (dBC), respectively (P = 0.2068). The mean noise level across all studies was significantly higher in OHNS cadaver labs (96.9 dBA) compared to OHNS ORs (70.1 dBA) (P = 0.0038). When analyzed together, the mean noise levels were 84.9 dBA. Conclusions This systematic review demonstrates that noise exposure in OHNS surgery exceeds safety thresholds. Further research is needed to understand how noise may affect team communication, surgical performance and patient outcomes in OHNS ORs. Graphical abstract

scholarly journals Scrotal reconstruction with superomedial fasciocutaneous thigh flap

2018 ◽  
Vol 45 (1) ◽  
Author(s):  
DANIEL FRANCISCO MELLO ◽  
AMERICO HELENE JÚNIOR
Keyword(s):  
Surgical Treatment ◽  
Complication Rate ◽  
Longitudinal Direction ◽  
Functional Results ◽  
Fasciocutaneous Flap ◽  
Surgical Time ◽  
Cross Sectional ◽  
Skin Loss ◽  
Scrotal Reconstruction ◽  
The Mean

ABSTRACT Objective: to describe the use of a superomedial fasciocutaneous thigh flap for scrotal reconstruction in open areas secondary to the surgical treatment of perineal necrotizing fasciitis (Fournier’s gangrene). Methods: retrospective analysis of cases treated at the Plastic Surgery Service of Santa Casa de Misericórdia, São Paulo, from 2009 to 2015. Results: fifteen patients underwent scrotal reconstruction using the proposed flap. The mean age was 48.9 years (28 to 66). Skin loss estimates in the scrotal region ranged from 60 to 100%. Definitive reconstruction was performed on average 30.6 days (22 to 44) after the initial surgical treatment. The mean surgical time was 76 minutes (65 to 90) to obtain the flaps, bilateral in all cases. Flap size ranged from 10cm to 13cm in the longitudinal direction and 8cm to 10cm in the cross-sectional direction. The complication rate was 26.6% (four cases), related to the occurrence of segmental and partial dehiscence. Conclusion: the superomedial fasciocutaneous flap of thigh is a reliable and versatile option for the reconstruction of open areas in the scrotal region, showing adequate esthetic and functional results.

scholarly journals Randomized controlled study comparing 2 surgical techniques for decompressive craniectomy: with watertight duraplasty and without watertight duraplasty

2018 ◽  
Vol 129 (4) ◽  
pp. 1017-1023 ◽  
Author(s):  
Eduardo Vieira ◽  
Thiago C. Guimarães ◽  
Igor V. Faquini ◽  
Jose L. Silva ◽  
Tammy Saboia ◽  
...  
Keyword(s):  
Wound Infection ◽  
Decompressive Craniectomy ◽  
Surgical Complications ◽  
Test Group ◽  
Csf Leak ◽  
Control Group ◽  
Surgical Time ◽  
Randomized Controlled ◽  
The Mean ◽  
Fluid Collections

OBJECTIVEDecompressive craniectomy (DC) is a widely used procedure in neurosurgery; however, few studies focus on the best surgical technique for the procedure. The authors’ objective was to conduct a prospective randomized controlled trial comparing 2 techniques for performing DC: with watertight duraplasty and without watertight duraplasty (rapid-closure DC).METHODSThe study population comprised patients ranging in age from 18 to 60 years who were admitted to the Neurotrauma Service of the Hospital da Restauração with a clinical indication for unilateral decompressive craniectomy. Patients were randomized by numbered envelopes into 2 groups: with watertight duraplasty (control group) and without watertight duraplasty (test group). After unilateral DC was completed, watertight duraplasty was performed in the control group, while in the test group, no watertight duraplasty was performed and the exposed parenchyma was covered with Surgicel and the remaining dura mater. Patients were then monitored daily from the date of surgery until hospital discharge or death. The primary end point was the incidence of surgical complications (CSF leak, wound infection, brain abscess, or subgaleal fluid collections). The following were analyzed as secondary end points: clinical outcome (analyzed using the Glasgow Outcome Scale [GOS]), surgical time, and hospital costs.RESULTSFifty-eight patients were enrolled, 29 in each group. Three patients were excluded, leaving 27 in the test group and 28 in the control group. There were no significant differences between groups regarding age, Glasgow Coma Scale score at the time of surgery, GOS score, and number of postoperative follow-up days. There were 9 surgical complications (5 in the control group and 4 in the test group), with no significant differences between the groups. The mean surgical time in the control group was 132 minutes, while in the test group the average surgical time was 101 minutes, a difference of 31 minutes (p = 0.001). The mean reduction in total cost was $420.00 USD (a 23.4% reduction) per procedure in the test group.CONCLUSIONSRapid-closure DC without watertight duraplasty is a safe procedure. It is not associated with a higher incidence of surgical complications (CSF leak, wound infection, brain abscess, or subgaleal fluid collections), and it decreased surgical time by 31 minutes on average. There was also a hospital cost reduction of $420.00 USD (23.4% reduction) per procedure.Clinical trial registration no.: NCT02594137 (clinicaltrials.gov)

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

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.

scholarly journals LEARNING CURVE IN SINGLE-LEVEL MINIMALLY INVASIVE TLIF: EXPERIENCE OF A NEUROSURGEON

2017 ◽  
Vol 16 (4) ◽  
pp. 279-282 ◽  
Author(s):  
Samuel Romano-Feinholz ◽  
Sergio Soriano-Solís ◽  
Julio César Zúñiga-Rivera ◽  
Carlos Francisco Gutiérrez-Partida ◽  
Manuel Rodríguez-García ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Hospital Stay ◽  
Learning Curves ◽  
Surgical Experience ◽  
Surgical Time ◽  
Intraoperative Bleeding ◽  
Single Level ◽  
Piecewise Regression ◽  
The Mean

ABSTRACT Objective: To describe the learning curve that shows the progress of a single neurosurgeon when performing single-level MI-TLIF. Methods: We included 99 consecutive patients who underwent single-level MI-TLIF by the same neurosurgeon (JASS). Patient’s demographic characteristics were analyzed. In addition, surgical time, intraoperative blood loss and hospital stay were evaluated. The learning curves were calculated with a piecewise regression model. Results: The mean age was 54.6 years. The learning curves showed an inverse relationship between the surgical experience and the variable analyzed, reaching an inflection point for surgical time in case 43 and for blood loss in case 48. The mean surgical time was 203.3 minutes (interquartile range [IQR] 150-240 minutes), intraoperative bleeding was 97.4ml (IQR 40-100ml) and hospital stay of four days (IQR 3-5 days). Conclusions: MI-TLIF is a very frequent surgical procedure due to its effectiveness and safety, which has shown similar results to open procedure. According to this study, the required learning curve is slightly higher than for open procedures, and is reached after about 45 cases.

scholarly journals Scheduling Delayed Treatment and Surgeries Post-Pandemic: A Stakeholder Analysis

2020 ◽  
Vol 9 (1) ◽  
pp. 10-14
Author(s):  
Emily S. Patterson ◽  
Elizabeth Lerner Papautsky ◽  
Jessica L. Krok-Schoen ◽  
Clara Lee ◽  
Ko Un Park ◽  
...  
Keyword(s):  
Local Community ◽  
Elective Surgery ◽  
Stakeholder Analysis ◽  
Healthcare Providers ◽  
Hospital Staff ◽  
Operating Rooms ◽  
Inpatient Setting ◽  
Care Needs ◽  
Delayed Treatment ◽  
Increased Risk

Many are interested in how to safely ramp up elective surgeries after national, state, and voluntary shutdowns of operating rooms to minimize the spread of COVID-19 infections to patients and providers. We conducted an analysis of diverse perspectives from stakeholders regarding how to trade off risks and benefits to patients, healthcare providers, and the local community. Our findings indicate that there are a large number of different categories of stakeholders impacted by the post-pandemic decisions to reschedule delayed treatments and surgeries. For a delayed surgery, the primary stakeholders are the surgeon with expertise about the clinical benefits of undergoing an operation and the patient’s willingness to tolerate uncertainty and the increased risk of infection. For decisions about how much capacity in the operating rooms and in the inpatient setting after the surgery, the primary considerations are minimizing staff infections, preventing patients from getting COVID-19 during operations and during post-surgical recovery at the hospital, conserving critical resources such as PPE, and meeting the needs of hospital staff for quality of life, such as child care needs and avoiding infecting members of their household. The timing and selection of elective surgery cases has an impact on the ability of hospitals to steward finances, which in turns affects decisions about maintaining employment of staff when operating rooms and inpatient rooms are not being used.

scholarly journals The Quality of Life Chronic Renal Failure (CRF) Patients in Hemodialysis Unit at District General Hospital Pringsewu Regency Lampung Province in 2018

2018 ◽  
Vol 68 ◽  
pp. 01009
Author(s):  
Virna Widora Saputri ◽  
Rico Januar Sitorus ◽  
H. M. Zulkarnain
Keyword(s):  
Quality Of Life ◽  
Family Support ◽  
General Hospital ◽  
Emotional Health ◽  
Sampling Technique ◽  
District General Hospital ◽  
Cross Sectional ◽  
Hemodialysis Unit ◽  
The Mean

The purpose of this study was to determine the factors that affect the quality of life of CRF patients in Hemodialysis Unit at Pringsewu District General Hospital. This study was conducted from February to May 2018 with cross sectional study design. The sampling technique using total sampling technique. Measurement of quality of life using KDQOL-SFTM version 1.3. The results found that quality of life scores were quite low in some domains and subscales. The mean of total score was 55.70 ± 21.30 with mean of Physical Health Composite (PHC) = 38.85 ± 9.26 and mean of Mental Health Composite (MHC) = 36.13 ± 7.08. Regarding the targeted area of ESRD, the scale of renal disease burden and occupational status scale resulted in the lowest score. The sleep quality scale score was 56.18 ± 20.72. Only 61 patients responded to questions of sexual activity with a score of 55.53 ± 27.44 on the scale of sexual function. In the 36-item health survey, the mean total score was 45.90 ± 21.95. The lowest score represented the limitations of roles caused by physical and emotional health problems. The result of statistical test showed that the variables significantly related to the quality of life of CRF patients were age, income, duration of hemodialysis and family support. Thus, family support was the variable that had the greatest impact on determining the quality of life of CRF patients. The CRF patients who lacked family support were 4.6 times more likely to lead poorer life compared to CRF patients who received good family support after being controlled by age, income, duration of hemodialysis, gender, working status, and diabetes mellitus variables.

scholarly journals Management of wound infection after appendectomy: are parenteral antibiotics useful?

2021 ◽  
Vol 8 (4-5) ◽  
pp. 638-644
Author(s):  
B. Harahsheh ◽  
B. Hiyasat ◽  
A. Abulail ◽  
M. Al Basheer
Keyword(s):  
Povidone Iodine ◽  
Perforated Appendicitis ◽  
Length Of Hospital Stay ◽  
District General Hospital ◽  
Antibiotic Use ◽  
Wound Infections ◽  
Perforated Appendix ◽  
The Mean ◽  
To Receive ◽  
Single Blind

This study investigated the use of antibiotics in the treatment of wound infections after appendectomy. The subjects were 72 patients with post-operative wound infections at a district general hospital in Jordan. All patients received daily antiseptic dressings with povidone-iodine 10% in alcohol. The patients were randomized in a single-blind trial to receive either no antibiotics or parenteral antibiotics metronidazole and cefoxitin. There was no significant effect of antibiotic use in patients with early inflamed or severely inflamed appendicitis. However, for patients with perforated appendicitis the mean length of hospital stay and the mean frequency of change of dressings were significantly reduced. We conclude that antibiotics do not offer any advantage in post-appendectomy wound infections except for cases of perforated appendix

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