scholarly journals Non-medical risk factors associated with postponing elective surgery: a prospective observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Julia Becker ◽  
Gerald Huschak ◽  
Hannes-Caspar Petzold ◽  
Volker Thieme ◽  
Sebastian Stehr ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Low Socioeconomic Status ◽  
Elective Surgery ◽  
Nursing Home Residents ◽  
Hospital Staff ◽  
Data Management System ◽  
Electronic Patient Records ◽  
Specific Patient ◽  
Emergency Procedures ◽  
Patient Groups

Abstract Background Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons. Methods In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR’s patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann–Whitney U test and Fisher's exact test/χ2-test. Results Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer. Conclusions Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery. Trial registration DRKS00015836. Retrospectively registered.

scholarly journals Predictive Factors in Sacral Neuromodulation: A Systematic Review

2021 ◽  
pp. 1-21
Author(s):  
Ranjana Jairam ◽  
Jamie Drossaerts ◽  
Tom Marcelissen ◽  
Gommert van Koeveringe ◽  
Desiree Vrijens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Predictive Factors ◽  
Sacral Neuromodulation ◽  
Level Of Evidence ◽  
Specific Patient ◽  
Detrusor Contractility ◽  
Affective Symptoms ◽  
Lower Success Rate ◽  
Patient Groups ◽  
Based Medicine

<b><i>Introduction:</i></b> Sacral neuromodulation (SNM) is an effective treatment in patients with overactive bladder syndrome or nonobstructive urinary retention when conservative treatment fails. Several factors that could impact outcome with SNM have been studied. This systematic review investigated these predictive factors and their relevance for clinical practice. <b><i>Methods:</i></b> Systematic review according to the PRISMA guidelines was conducted. This review is registered in the PROSPERO register (CRD42015016256). <b><i>Results:</i></b> Seventy-eight studies (of which 11 abstracts) were included. Females, younger patients, and a tined lead procedure tend to be predictive in successful SNM outcome. Factors that did not influence SNM outcome were prior back surgery, surgery for stress urinary incontinence, affective symptoms, and duration of complaints. Reduced detrusor contractility is associated with a lower success rate. The level of evidence of most studies (graded according to the Centre for Evidence-Based Medicine) was 3b. <b><i>Conclusion:</i></b> Even though this systematic review investigated predictive factors (gender, age, type of procedure, type of lead, and detrusor contractility), no general consensus on predictive factors could be made. Most studies are small, retrospective, and involve a heterogeneous population. Therefore, prospective research in larger specific patient groups remains necessary to find predictors of SNM outcome.

scholarly journals Balancing scarce hospital resources during the COVID-19 pandemic using discrete-event simulation

2021 ◽  
Author(s):  
G.J. Melman ◽  
A.K. Parlikad ◽  
E.A.B. Cameron
Keyword(s):  
Resource Allocation ◽  
Discrete Event Simulation ◽  
Elective Surgery ◽  
Discrete Event ◽  
Specific Patient ◽  
Event Simulation ◽  
The Impact ◽  
Allocation Decisions ◽  
Allocation Strategies ◽  
Resource Allocation Decisions

AbstractCOVID-19 has disrupted healthcare operations and resulted in large-scale cancellations of elective surgery. Hospitals throughout the world made life-altering resource allocation decisions and prioritised the care of COVID-19 patients. Without effective models to evaluate resource allocation strategies encompassing COVID-19 and non-COVID-19 care, hospitals face the risk of making sub-optimal local resource allocation decisions. A discrete-event-simulation model is proposed in this paper to describe COVID-19, elective surgery, and emergency surgery patient flows. COVID-19-specific patient flows and a surgical patient flow network were constructed based on data of 475 COVID-19 patients and 28,831 non-COVID-19 patients in Addenbrooke’s hospital in the UK. The model enabled the evaluation of three resource allocation strategies, for two COVID-19 wave scenarios: proactive cancellation of elective surgery, reactive cancellation of elective surgery, and ring-fencing operating theatre capacity. The results suggest that a ring-fencing strategy outperforms the other strategies, regardless of the COVID-19 scenario, in terms of total direct deaths and the number of surgeries performed. However, this does come at the cost of 50% more critical care rejections. In terms of aggregate hospital performance, a reactive cancellation strategy prioritising COVID-19 is no longer favourable if more than 7.3% of elective surgeries can be considered life-saving. Additionally, the model demonstrates the impact of timely hospital preparation and staff availability, on the ability to treat patients during a pandemic. The model can aid hospitals worldwide during pandemics and disasters, to evaluate their resource allocation strategies and identify the effect of redefining the prioritisation of patients.

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 732 Delay to Elective Colorectal Cancer Surgery and its Potential Implications During the Covid-19 Pandemic: A Systematic Review and Metanalysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Whittaker ◽  
M Abdelrazek ◽  
A Fitzpatrick ◽  
J Froud ◽  
J Kelly ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Systematic Review ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Colorectal Cancer Surgery ◽  
Elective Resection ◽  
Hazard Ratios ◽  
Patient Groups ◽  
Number Needed To Harm

Abstract Aim The ongoing Covid-19 pandemic has interrupted the surgical treatment of colorectal cancer (CRC). This systematic review will assess literature concerning the risk of delay of elective surgery for CRC patients, focusing on overall survival (OS) and disease-free survival (DFS). Method A systematic review was performed as per PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were searched. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Metanalyses of the outcome’s OS and DFS were conducted. Forest plots, funnel plots, and tests of heterogeneity were produced. An estimated Number Needed to Harm (NNH) was calculated for statistically significant pooled Hazard Ratios (HRs). Results Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p = 0.020) and at three months the pooled HR for three datasets was 1.57 (95%CI 1.16-2.12, p = 0.004). Estimated NNHs for a delay at one month and three months were 35 and 10 respectively. Delay was non-significantly negatively associated with DFS on meta-analysis. Conclusions This review recommends that elective surgery for CRC patients is not postponed, as evidence suggests delays from diagnosis are associated with poorer outcomes. Focused research is essential so that patient groups can be prioritized based on risk factors for future pandemics.

scholarly journals Word-of-Mouth (WOM) distribution and intensity after elective surgery in relation to the decisive hospital choice process, satisfaction and recommendation

2020 ◽  
Author(s):  
Jan-Henrik Schiff ◽  
Hanna Streiter ◽  
Katrin Eichstedt ◽  
Sören Wagner ◽  
Andreas Walther ◽  
...  
Keyword(s):  
Word Of Mouth ◽  
Elective Surgery ◽  
Demographic Data ◽  
Hospital Staff ◽  
Normal Function ◽  
Post Discharge ◽  
Hospital Choice ◽  
Positive Ratio ◽  
Negative Communication ◽  
Health Complications

Abstract Background Patients frequently use experience-based sources when choosing a hospital, most often in form of word-of-mouth (WOM), which is perceived to be independent of direct information from providers. There is scarce data on the prevalence and intensity of WOM in the medical context. Methods This exploratory cohort study recruited patients for elective surgery at two maximum care facilities. In addition to demographic data, information sources used and determinant factors for decisive hospital choice were evaluated. After hospital discharge, a telephone interview was used to inquire about the state of health, complications, overall satisfaction, the extent and intensity of positive and negative communication and the estimated number of people reached by WOM. Results 348 questionnaires were evaluated and 231 patients were reached by telephone. Main sources for the hospital choice were the GP/specialist doctors, family and friends. Decisions were eventually based on the GP/specialist doctors, the hospital reputation and the spectrum of care provided by the hospitals. Post discharge, 94 patients were satisfied, 30 dissatisfied (107 neutral) with the care provided. After the operation, 120 had had contact with their GP/specialist doctors, 226 to family and friends, 129 to others, including 105 responses to the hospital staff. Postoperative persisting pain and a slow recovery to normal function were associated with lower satisfaction scores (p<0.05). Satisfied patients had given mostly positive (ratio 11.6: 1), neutral predominantly positive (ratio 2.2:1), dissatisfied rather negative (ratio 1:1.2) information to others. Per patient, positive aspects were passed on to 12, negative to 4 persons. All satisfied and 46.7% of dissatisfied patients would recommend the hospital to their family and friends. Conclusion WOM was found to correlate to satisfaction, with different proportions of positive and negative communication along the satisfaction continuum. Overall, the communication of positive aspects dominates

scholarly journals OV15 EMERGENCY SURGERY OF OBSTRUCTED VENTRAL HERNIA USING TAPP TECHNIQUE: A SAFE AND FEASIBLE APPROACH

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Victor Vaello ◽  
Angela Santana ◽  
Diego Oto ◽  
Luz Juez ◽  
Raquel Arranz ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Intestinal Resection ◽  
Laparoscopic Approach ◽  
Right Hemicolectomy ◽  
Postoperative Recovery ◽  
Preperitoneal Space ◽  
Open Approach ◽  
Emergency Procedures ◽  
Peritoneal Flap ◽  
Ventral Incisional Hernia

Abstract Aim to explain and show the feasibility of laparoscopic TAPP technique in emergency procedures Material and Methods we present a 71-year-old female with personal history of obesity (BMI 32) and a laparoscopic right hemicolectomy performed in 2018, presenting at the ER with a 24-hour intestinal obstruction due to incarcerated ventral incisional hernia. Results laparoscopic reduction of the hernia contents was achieved without need of intestinal resection, prior to access to the preperitoneal space, creating a peritoneal flap that was dissected around the hernia. Following closure of the hernia defect, a polypropylene mesh was placed and the peritoneal flap closed. There were no intraoperative or postoperative events and patient was discharged on 3rd POD. Conclusions laparoscopic approach to emergency hernias in selected patients doesn’t differ from elective surgery, and offers great advantages in terms of evaluation of the incarcerated elements, and postoperative recovery, especially in obese patients where a conventional open approach has higher morbidity.

scholarly journals Subgroup analyses to determine cardiovascular risk associated with nonsteroidal antiinflammatory drugs and coxibs in specific patient groups

2008 ◽  
Vol 59 (8) ◽  
pp. 1097-1104 ◽  
Author(s):  
Daniel H. Solomon ◽  
Robert J. Glynn ◽  
Kenneth J. Rothman ◽  
Sebastian Schneeweiss ◽  
Soko Setoguchi ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Specific Patient ◽  
Subgroup Analyses ◽  
Patient Groups

scholarly journals Catheter-Based Therapies and Other Management Strategies for Deep Vein Thrombosis and Post-Thrombotic Syndrome

2020 ◽  
Vol 9 (5) ◽  
pp. 1439 ◽  
Author(s):  
Siddhant Thukral ◽  
Suresh Vedantham
Keyword(s):  
Deep Vein Thrombosis ◽  
Management Strategies ◽  
Patient Centered ◽  
Specific Patient ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Patient Morbidity ◽  
Patient Groups ◽  
Deep Vein

Acute deep vein thrombosis (DVT) causes substantial short-term and long-term patient morbidity. Medical, lifestyle, and compressive therapies have been investigated for the prevention of pulmonary embolism (PE) and recurrence of venous thromboembolism (VTE). However, patient-centered outcomes such as resolution of presenting DVT symptoms and late occurrence of post-thrombotic syndrome (PTS) have not been prioritized to the same degree. Imaging-guided, catheter-based endovascular therapy has been used in selected patients to alleviate these sequelae, but important questions remain about their optimal use. In this article, we review the available evidence and summarize the rationale for use of catheter-based therapy in specific patient groups.

Transfer medicine

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Spinal Injury ◽  
Legal Aspects ◽  
Patient Transfer ◽  
Specific Patient ◽  
Patient Groups

This chapter on transfer medicine includes transfer indications, decisions, general considerations and complications as well as legal aspects of patient transfer. Considerations for specific patient groups are described for neurosurgical, trauma, spinal injury, burns and obstetric patients. Complications and management are detailed in an ABCDE format. Transfer equipment including ventilators with modes of ventilation are also considered.

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