Prioritisation of catheterised patients for elective bladder outflow obstruction surgery in the current coronavirus disease 2019 era to reduce catheter-associated morbidity

2020 ◽  
pp. 205141582096403
Author(s):  
Angela Kit Ying Lam ◽  
Kathie Wong ◽  
Tharani Nitkunan
Keyword(s):  
Median Time ◽  
Waiting Times ◽  
Waiting List ◽  
Transurethral Resection Of Prostate ◽  
Outflow Obstruction ◽  
Level Of Evidence ◽  
Bladder Outflow Obstruction ◽  
Patient Demographics ◽  
Accident And Emergency ◽  
Included Patient

Objectives: This study aimed to audit the waiting times for a transurethral resection of prostate (TURP) at our institution, and to evaluate the extent of catheter-associated morbidity in this population. Methods: This was a retrospective closed-loop audit, with cycle one between 1 January 2018 and 31 December 2018 and cycle two between 1 October 2019 and 29 February 2020. Data collected included patient demographics, catheter status, catheter-associated presentations to accident and emergency (A&E), admissions and waiting times for TURP. The waiting-list form now has a catheter box, and a goal of 30 days from waitlisting to operation was set for those catheterised. Results: In cycle 1, 36% of the 181 patients were catheterised, and waited a median of 119 days (interquartile range (IQR) 59–163 days) for their TURP, while those not catheterised waited a median of 118 days (IQR 57.75–188.25 days). Catheterised patients presented to A&E 93 times, resulting in 13 admissions, compared to two presentations and zero admissions for those not catheterised. The median time from catheter insertion to first A&E attendance was 20 days (IQR 2–101 days). In cycle 2, 33% of the 55 patients were catheterised, with the median waiting-list time falling to 32 days (IQR 22–46 days) in those catheterised and 33 days (IQR 20–49 days) in those not catheterised. All 11 A&E attendances were from catheterised patients, with no admissions. The median time from insertion to first A&E attendance was nine days (IQR 4–40 days). Eighty-eight per cent of the waiting-list forms had appropriately ticked the catheter box. Conclusion: Our study shows that catheterised patients awaiting a TURP are more likely to have complications necessitating A&E attendance. Prioritisation of these patients on the waiting list for bladder outflow obstruction surgery may help to reduce catheter-associated morbidity. Level of evidence: Level 2c.

scholarly journals RADIOGRAPHIC IMPLICATIONS OF THE SURGICAL WAITING LIST FOR THE TREATMENT OF SPINAL DEFORMITY

2018 ◽  
Vol 17 (1) ◽  
pp. 19-22
Author(s):  
LEONARDO YUKIO JORGE ASANO ◽  
MARINA ROSA FILÉZIO ◽  
MATEUS PIPPA DEFINO ◽  
VINÍCIUS ALVES DE ANDRADE ◽  
ANDRÉ EVARISTO MARCONDES CESAR ◽  
...  
Keyword(s):  
Surgical Planning ◽  
Negative Impact ◽  
Waiting Times ◽  
Waiting List ◽  
Surgical Morbidity ◽  
Level Of Evidence ◽  
Mean Waiting Time ◽  
Significant Negative Impact ◽  
Double Approach ◽  
The Mean

ABSTRACT Objective: The aim of this study was to evaluate the implications of long waiting times on surgery lists for the treatment of patients with scoliosis. Methods: Radiographs of 87 patients with scoliosis who had been on the waiting list for surgery for more than six months were selected. Two surgeons answered questionnaires analyzing the radiographs when entering the waiting list and the current images of each patient. Results: Data from 87 patients were analyzed. The mean waiting time for surgery was 21.7 months (ranging from seven to 32 months). The average progression of the Cobb angle in the curvature was 21.1 degrees. Delayed surgery implied changes in surgical planning, such as greater need of instrumentation, osteotomies, and double approach. Conclusions: Long waiting lists have a significant negative impact on surgical morbidity of patients with scoliosis, since they increase the complexity of the surgery. Level of evidence: IV. Type of study: Descriptive study.

Autologous Costal Cartilage Harvest for Rhinoplasty with Simultaneous Breast Surgery: A Safe and Efficient Technique

2020 ◽  
Vol 40 (9) ◽  
pp. NP480-NP490 ◽  
Author(s):  
Jay W Calvert ◽  
Millicent O Rovelo ◽  
Marc V Orlando ◽  
Edwin Kwon
Keyword(s):  
Breast Surgery ◽  
Capsular Contracture ◽  
Costal Cartilage ◽  
Donor Site ◽  
Level Of Evidence ◽  
Perioperative Morbidity ◽  
Patient Demographics ◽  
Included Patient ◽  
Additional Surgery ◽  
A New Technique

Abstract Background Autologous costal cartilage is frequently required for revision rhinoplasties and for challenging primary rhinoplasties. Patients undergoing a concomitant breast surgery can have costal cartilage harvested through their breast surgery incisions, thereby obviating an additional rib harvest scar. The safety and efficacy of this approach has yet to be described. Objectives The aim of this study was to evaluate the outcomes, safety, and results of a new technique, described here, for harvesting costal cartilage during a concomitant breast operation. Specifically, the rates of capsular contracture and rhinoplasty revisions were of great interest. Methods A retrospective review was performed evaluating the senior author’s experience with this technique. Data collected included patient demographics, operations performed, operative time, perioperative morbidity, and postoperative complications. Rates of capsular contracture and rhinoplasty revisions were compared with national averages. Results A total of 31 female patients were included. Ten (32.3%) breast complications occurred. There were 6 (19.4%) rhinoplasty complications, comprising 1 infection and 5 revisions. The capsular contracture rate was 6% and the rhinoplasty revision rate was 16%. Both of these rates are comparable to independent breast surgeries and rhinoplasties. There were no cases of perioperative mortality or major morbidity. Conclusions Combining breast surgery and rhinoplasty surgery allows for autologous rib harvest through the breast surgery incisions. This is a safe technique that results in outcomes similar to either procedure performed alone. In addition, the patient is spared an additional surgery and donor site scar. Level of Evidence: 4

scholarly journals Expectations of Shoulder Surgery Are Not Altered by Surgeon Counseling of the Patient

Joints ◽  
2017 ◽  
Vol 05 (03) ◽  
pp. 133-137 ◽  
Author(s):  
Cassandra Lawrence ◽  
Benjamin Zmistowski ◽  
Mark Lazarus ◽  
Joseph Abboud ◽  
Gerald Williams ◽  
...  
Keyword(s):  
Postoperative Outcome ◽  
Primary Objective ◽  
Shoulder Surgery ◽  
P Value ◽  
Level Of Evidence ◽  
Patient Demographics ◽  
Included Patient ◽  
Before And After ◽  
The Mean ◽  
Preoperative Counseling

Purpose The primary objective of this study was to evaluate if the current mechanisms of preoperative counseling influence patients' expectations of shoulder surgery. Methods Patients were asked to complete the Hospital for Special Surgery's (HSS) Shoulder Surgery Expectations Survey. The first survey was completed before the first appointment with one of four fellowship-trained shoulder surgeons. The second survey was completed after patients consented for surgery. Our analysis also included patient demographics and surgical factors. Results A total of 41 patients completed the HSS Shoulder Surgery Expectations Survey before and after their first appointment with the surgeon during which they consented to shoulder surgery. Before seeing the surgeon, the mean HSS Shoulder Surgery Expectations score was 72.5. After seeing the surgeon and being consented for surgery, the mean HSS Shoulder Surgery Expectations score was 74.8. The mean change in HSS Shoulder Surgery Expectations score (+2.3) was not statistically significant (p value = 0.242). We did not find any significant correlations between patients' expectations and demographics or surgical factors. Total HSS Shoulder Surgery Expectations scores and change in scores were not statistically different between the four surgeons (p = 0.146). Conclusion Patient expectations were not substantially altered after preoperative counseling. Further investigation is necessary to investigate factors correlated with expectations, the implication of unaltered expectations on the postoperative outcome, and methods for improving the preoperative counseling process. Level of Evidence Level II, prospective cohort study.

Does length of time spent on the waiting list for TURP influence the outcome?

2018 ◽  
Vol 11 (3) ◽  
pp. 184-191
Author(s):  
Sian R Parsons ◽  
Michelle M Carey ◽  
James ET Jenkins ◽  
Kim Davenport
Keyword(s):  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Waiting List ◽  
Secondary Outcome ◽  
Transurethral Resection Of Prostate ◽  
Multiple Time ◽  
Level Of Evidence ◽  
Increasing Demand ◽  
Multiple Time Points

With an ever increasing demand for operative procedures within the NHS but little increase in capacity, waiting lists are lengthening, particularly for benign procedures. We sought to determine whether increasing time on a waiting list influences the outcome from a transurethral resection of prostate (TURP), with a primary outcome measure of success at inpatient trial without catheter (TWOC) and pre-operative, peri-operative and post-operative secondary outcome measures. Data was collected from four separate retrospective TURP audits performed between 2009-2015. A total of 379 TURP procedures were included with the time on the waiting list ranging from 8 to 384 days. In patients who were not catheterised pre-operatively success at in patient TWOC by 30 day intervals (in 30 day intervals from 1-30 days to over 151 days) was 79%, 83%, 88%, 87%, 100% and 83%; in those with a catheter, success was 46%, 71%, 75%, 100%, 50% and 86%. In conclusion waiting longer for a TURP does not adversely affect the outcome of inpatient TWOC. Level of evidence: Not applicable – this is a single centre audit over multiple time points.

scholarly journals Prostatic urethral lift (UroLift): a real-world analysis of outcomes using hospital episodes statistics

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Toby Page ◽  
Rajan Veeratterapillay ◽  
Kim Keltie ◽  
Julie Burn ◽  
Andrew Sims
Keyword(s):  
Real World ◽  
Hazard Analysis ◽  
Attendance Rate ◽  
Day Case ◽  
Patient Demographics ◽  
Kaplan Meier ◽  
Accident And Emergency ◽  
Case Surgery ◽  
Observational Cohort ◽  
Rate Requirement

Abstract Background To determine real-world outcomes of prostatic urethral lift (UroLift) procedures conducted in hospitals across England. Methods A retrospective observational cohort was identified from Hospital Episode Statistics data including men undergoing UroLift in hospitals in England between 2017 and 2020. Procedure uptake, patient demographics, inpatient complications, 30-day accident and emergency re-attendance rate, requirement for further treatment and catheterization were captured. Kaplan–Meier and hazard analysis were used to analyse time to re-treatment. Results 2942 index UroLift procedures from 80 hospital trusts were analysed; 85.3% conducted as day-case surgery (admitted to hospital for a planned surgical procedure and returning home on the same day). In-hospital complication rate was 3.4%. 93% of men were catheter-free at 30 days. The acute accident and emergency attendance rate within 30 days was 12.0%. Results of Kaplan Meier analysis for subsequent re-treatment (including additional UroLift and endoscopic intervention) at 1 and 2 years were 5.2% [95% CI 4.2 to 6.1] and 11.9% [10.1 to 13.6] respectively. Conclusions This real-world analysis of UroLift shows that it can be delivered safely in a day-case setting with minimal morbidity. However, hospital resource usage for catheterization and emergency hospital attendance in the first 30 days was substantial, and 12% required re-treatment at 2 years.

scholarly journals Value of Three-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping

2021 ◽  
Author(s):  
Serge Marbacher ◽  
Matthias Halter ◽  
Deborah R Vogt ◽  
Jenny C Kienzler ◽  
Christian T J Magyar ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Diagnostic Yield ◽  
Three Dimensional ◽  
P Value ◽  
Digital Subtraction ◽  
Patient Demographics ◽  
Included Patient ◽  
2D And 3D

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = <.001), and more often missed grade 1 (< 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

HOW TO REPORT AND MONITOR THE PERFORMANCE OF WAITING LIST MANAGEMENT

2002 ◽  
Vol 18 (3) ◽  
pp. 611-618
Author(s):  
Markus Torkki ◽  
Miika Linna ◽  
Seppo Seitsalo ◽  
Pekka Paavolainen
Keyword(s):  
Hallux Valgus ◽  
Waiting Time ◽  
Varicose Vein ◽  
Elective Surgery ◽  
Waiting Times ◽  
Waiting List ◽  
Mean Waiting Time ◽  
Number Of Patients ◽  
Potential Problems ◽  
Queue Discipline

Objectives: Potential problems concerning waiting list management are often monitored using mean waiting times based on empirical samples. However, the appropriateness of mean waiting time as an indicator of access can be questioned if a waiting list is not managed well, e.g., if the queue discipline is violated. This study was performed to find out about the queue discipline in waiting lists for elective surgery to reveal potential discrepancies in waiting list management. Methods: There were 1,774 waiting list patients for hallux valgus or varicose vein surgery or sterilization. The waiting time distributions of patients receiving surgery and of patients still waiting for an operation are presented in column charts. The charts are compared with two model charts. One model chart presents a high queue discipline (first in—first out) and another a poor queue discipline (random) queue. Results: There were significant differences in waiting list management across hospitals and patient categories. Examples of a poor queue discipline were found in queues for hallux valgus and varicose vein operations. Conclusions: A routine waiting list reporting should be used to guarantee the quality of waiting list management and to pinpoint potential problems in access. It is important to monitor not only the number of patients in the waiting list but also the queue discipline and the balance between demand and supply of surgical services. The purpose for this type of reporting is to ensure that the priority setting made at health policy level also works in practise.

scholarly journals Epidural analgesia in a paediatric teaching hospital: Trends, developments, and a brief review of literature

2017 ◽  
Vol 27 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Jolin Wong ◽  
Serene Siu Tin Lim
Keyword(s):  
Epidural Analgesia ◽  
Teaching Hospital ◽  
Perioperative Period ◽  
Review Of Literature ◽  
Good Tool ◽  
Patient Demographics ◽  
Included Patient ◽  
Continuous Epidural Analgesia ◽  
Continued Use

Introduction: Continuous epidural analgesia has proven to be a good tool in the anaesthetist’s quest to provide excellent pain relief for an extended perioperative period. Pharmaceutical advances provide us with a larger array of both local anaesthetic (LA) drugs and additives that can prolong the duration or enhance the quality of analgesia, or both. The avoidance of LA toxicity is of paramount importance for safe prescription, especially in the high-risk neonatal and infant cohort, and all patients stand to benefit from ‘safer’ LA agents and adjuvants that promote the use of a lowered concentration of epidural LA infusions. We present a descriptive review of trends in epidural prescription and technique in our hospital. Methods: Our observational study was conducted over a period of 19 years in a tertiary paediatric teaching hospital. Prospectively collected data that included patient demographics, level of epidural catheter insertion, LA drugs and adjuvants used, as well as postoperative infusion rates, were then analysed retrospectively. Results: There was a decline in the use of paediatric epidural analgesia. Over the study period, we also observed a shift in preference of LAs and adjuvant drugs toward safer alternatives. Conclusion: Paediatric epidural analgesia is gradually being superseded by other analgesic modalities with superior safety profiles (e.g. peripheral neural blockade). However, indications remain for its continued use, and anaesthetists should be familiar with its technical aspects and pitfalls.

Baerveldt shunt surgery versus combined Baerveldt shunt and phacoemulsification: a prospective comparative study

2017 ◽  
Vol 102 (9) ◽  
pp. 1248-1253 ◽  
Author(s):  
Mohamad El Wardani ◽  
Ciara Bergin ◽  
Kenza Bradly ◽  
Eamon Sharkawi
Keyword(s):  
Complication Rates ◽  
Failure Rates ◽  
Shunt Surgery ◽  
Patient Demographics ◽  
Aqueous Shunt ◽  
Included Patient ◽  
Significant Difference ◽  
Negative Effect ◽  
Prospective Comparative Study ◽  
Baerveldt Tube

AimTo examine the efficacy and safety of Baerveldt tube (BT) implantation compared with combined phacoemulsification and Baerveldt tube (PBT) implantation in patients with refractory glaucoma.MethodsSeventy-six eyes of 76 patients were enrolled, 38 pseudophakic eyes underwent BT implantation alone and 38 phakic eyes underwent the BT implantation combined with phacoemulsification. Groups were matched for preoperative intraocular pressure (IOP) and number of glaucoma medications. Preoperative and postoperative measures recorded included patient demographics, visual acuity (VA), IOP, number of antiglaucoma medications and all complications. Patients were followed up for a minimum of 36 months. Failure was defined as: inadequate IOP control (IOP≤5 mm Hg/>21 mm Hg/<20% reduction from baseline, reoperation for glaucoma, loss of light perception vision, or removal of the implant).ResultsThere was a significant difference in failure rates between groups at 36 months (PBT 37% vs BT 15%, P=0.02). There was no significant difference for PBT versus BT in preoperative baseline ocular characteristics. At 36 months: median IOP=14 mm Hg vs 12 mm Hg, P=0.04; mean number of antiglaucomatous medications=1.7 vs 1.3, P=0.61; median VA=0.8 vs 0.7, P=0.44. Postoperative complication rates were similar in both groups (n=5 vs 5; 13% vs 13%).ConclusionsFailure rates were significantly greater in the PBT group at 3 years. Median IOP was also significantly higher in the PBT group. These results suggest that combining phacoemulsification with aqueous shunt surgery may have a negative effect on long-term shunt bleb survival.

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