The effect of weekend and after-hours surgery on morbidity and mortality rates in pediatric neurosurgery patients

OBJECT Several studies have indicated that the 30-day morbidity and mortality risks are higher among pediatric and adult patients who are admitted on the weekends. This “weekend effect” has been observed among patients admitted with and fora variety of diagnoses and procedures, including myocardial infarction, pulmonary embolism, ruptured abdominal aortic aneurysm, stroke, peptic ulcer disease, and pediatric surgery. In this study, morbidity and mortality outcomes for emergency pediatric neurosurgical procedures carried out on the weekend or after hours are compared with emergency surgical procedures performed during regular weekday business hours. METHODS A retrospective analysis of operative data was conducted. Between December 1, 2011, and August 20, 2014, a total of 710 urgent or emergency neurosurgical procedures were performed at Texas Children’s Hospital in children younger than than 18 years of age. These procedures were then stratified into 3 groups: weekday regular hours, weekday after hours, and weekend hours. By cross-referencing these events with a prospectively collected morbidity and mortality database, the impact of the day and time on complication incidence was examined. Outcome metrics were compared using logistic regression models. RESULTS The weekday regular hours and after-hours (weekday after hours and weekends) surgery groups consisted of 341 and 239 patients and 434 and 276 procedures, respectively. There were no significant differences in the types of cases performed (p = 0.629) or baseline preoperative health status as determined by American Society of Anesthesiologists classifications (p = 0.220) between the 2 cohorts. After multivariate adjustment and regression, children undergoing emergency neurosurgical procedures during weekday after hours or weekends were more likely to experience complications (p = 0.0227). CONCLUSIONS Weekday after-hours and weekend emergency pediatric neurosurgical procedures are associated with significantly increased 30-day morbidity and mortality risk compared with procedures performed during weekday regular hours.

Download Full-text

Morbidity and mortality associated with anesthetic management in small animal veterinary practice in Ontario

Journal of the American Animal Hospital Association ◽

10.5326/15473317-34-4-325 ◽

1998 ◽

Vol 34 (4) ◽

pp. 325-335 ◽

Cited By ~ 104

Author(s):

DH Dyson ◽

MG Maxie ◽

D Schnurr

Keyword(s):

Cardiac Arrest ◽

Management Practices ◽

Anesthetic Management ◽

Small Animal ◽

Morbidity And Mortality ◽

Logistic Regression Models ◽

Significant Odds Ratio ◽

American Society ◽

A Prospective Study ◽

American Society Of Anesthesiologists

During 1993, 66 small animal practices participated in a prospective study to evaluate the incidence and details of anesthetic-related morbidity and mortality. Considering a total of 8,087 dogs and 8,702 cats undergoing anesthesia, the incidences of complications were 2.1% and 1.3%, respectively. Death occurred in 0.11% and 0.1% of cases, respectively. Logistic regression models were developed and showed that a significant odds ratio (OR) of complications in dogs was associated with xylazine (OR, 91.5); heart rate monitoring (OR, 3.2); American Society of Anesthesiologists (ASA) 3, 4, or 5 classification (OR, 2.5); isoflurane (OR, 2.4); butorphanol (OR, 0.35); technician presence (OR, 0.26); acepromazine (OR, 0.24); ketamine (OR, 0.21); and mask induction (OR, 0.2). Complications in cats were associated with ASA 3, 4, or 5 classification (OR, 5.3); diazepam (OR, 4.1); intubation (OR, 1.7); butorphanol (OR, 0.45); and ketamine (OR, 0.17). Cardiac arrest in dogs was associated with xylazine (OR, 43.6) and ASA 3, 4, or 5 classification (OR, 7.1). Cardiac arrest in cats was associated with ASA 3, 4, or 5 classification (OR, 21.6) and technician presence (OR, 0.19). This paper reports the incidences of complications and cardiac arrest in small animal practice and identifies common complications and factors that may influence anesthetic morbidity and mortality. This information may be useful in comparing anesthetic management practices.

Download Full-text

A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

The American Surgeon ◽

10.1177/0003134820973384 ◽

2020 ◽

pp. 000313482097338

Author(s):

Elizabeth McCarthy ◽

Benjamin L. Gough ◽

Michael S. Johns ◽

Alexandra Hanlon ◽

Sachin Vaid ◽

...

Keyword(s):

Postoperative Recovery ◽

Logistic Regression Models ◽

Community Institution ◽

Physical Status Classification ◽

Estimated Blood Loss ◽

Comparative Review ◽

Significant Difference ◽

American Society ◽

The Individual ◽

American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

Download Full-text

Attending Surgeon Variation in Operative Case Length: An Opportunity for Quality Improvement

The American Surgeon ◽

10.1177/000313481808401011 ◽

2018 ◽

Vol 84 (10) ◽

pp. 1595-1599

Author(s):

Kirollos S. Malek ◽

Jukes P. Namm ◽

Carlos A. Garberoglio ◽

Maheswari Senthil ◽

Naveen Solomon ◽

...

Keyword(s):

Operative Time ◽

Resident Training ◽

Careful Consideration ◽

Analysis Of Covariance ◽

Surgical Resident ◽

Or Efficiency ◽

American Society ◽

Case Logs ◽

American Society Of Anesthesiologists ◽

The Impact

Balancing resident education with operating room (OR) efficiency, while accommodating different styles of surgical educators and learners, is a challenging task. We sought to evaluate variability in operative time for breast surgery cases. Accreditation Council for Graduate Medical Education case logs of breast operations from 2011 to 2017 for current surgical residents at Loma Linda University were correlated with patient records. The main outcome measure was operative time. Breast cases were assessed as these operations are performed during all postgraduate years (PGY). Breast procedures were grouped according to similarity. Variables analyzed included attending surgeon, PGY level, procedure type, month of operation, and American Society of Anesthesiologists class. Of 606 breast cases reviewed, median overall operative time was 150 minutes (interquartile range 187–927). One-way analysis of covariance demonstrated statistically significant variation in operative time by attending surgeon controlling for covariates (PGY level, procedure, American Society of Anesthesiologists class, and month) ( P = 0.04). With institutional OR costs of $30 per minute, the average difference between slowest and fastest surgeon was $2400 per case [(218–138) minutes 3 $30/min]. Minimizing variability for common procedures performed by surgical educators may enhance OR efficiency. However, the impact of case length on surgical resident training requires careful consideration.

Download Full-text

Sexual Dysfunction: Prevalence and Prognosis in Patients Operated for Degenerative Lumbar Spondylolisthesis

Neurosurgery ◽

10.1093/neuros/nyz310_117 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Andrew Kai-Hong Chan ◽

Erica F Bisson ◽

Kai-Ming G Fu ◽

Paul Park ◽

Leslie Robinson ◽

...

Keyword(s):

Sexual Function ◽

Sexual Life ◽

Quality Outcomes ◽

Degenerative Lumbar Spondylolisthesis ◽

Negative Effect ◽

American Society ◽

Lumbar Spondylolisthesis ◽

American Society Of Anesthesiologists ◽

The Impact

Abstract INTRODUCTION There is a paucity of investigation on the impact of spondylolisthesis surgery on back-pain related sexual inactivity. To this end, we utilized the prospective Quality Outcomes Database (QOD) registry to investigate factors predictive of improved sex life following surgery. METHODS This was an analysis of a prospective registry of 608 patients who underwent surgery for grade 1 degenerative lumbar spondylolisthesis at 12 high-enrolling sites. Of these, 218 patients were included who were sexually active and had both baseline and 24-mo sexual function follow-up. Baseline variables were collected. Outcomes were collected at 24 mo. Sexual function was assessed by the associated question in the Oswestry Disability Index, “With regards to pain, how would you say your sex life is?” Outcomes were dichotomized into patients who had improved sexual function and those who had same or worse sexual function. RESULTS Mean age was 58.0 ± 11.0 yr and 108 (49.5%) patients were women. At baseline, 178 patients (81.7%) had an impaired sex life. At final follow-up, 130 patients (73.0% of the 178 impaired) had an improved sex life. In univariate comparisons, those with improved sexual life had lower body mass index (BMI) (29.6 ± 5.5 vs 34.4 ± 6.0; P < .001) and a lower proportion of American Society of Anesthesiologists' grades 3 or 4 (33.1%% vs 54.2%; P = .01). Following surgery, those with improved sex lives noted higher satisfaction following surgery (84.5% vs 64.6% would undergo surgery again, P = .002). In adjusted analyses, lower BMI was associated with an improved sex life at 24 mo (OR = 1.14; 95% CI [1.05-1.20]; P < .001). CONCLUSION Over 80% of patients who present for surgery for degenerative lumbar spondylolisthesis report a negative effect of the disease on sex life. However, most patients (73%) report an improvement in sex life postoperatively. Improvement in sex life was associated with significantly greater satisfaction with surgery. Lower BMI was predictive of improved sex life postoperatively.

Download Full-text

Effect of Intraoperative Fluid Management on Outcome after Intraabdominal Surgery

Anesthesiology ◽

10.1097/00000542-200507000-00008 ◽

2005 ◽

Vol 103 (1) ◽

pp. 25-32 ◽

Cited By ~ 570

Author(s):

Vadim Nisanevich ◽

Itamar Felsenstein ◽

Gidon Almogy ◽

Charles Weissman ◽

Sharon Einav ◽

...

Keyword(s):

Body Weight ◽

Hospital Stay ◽

Fluid Management ◽

Postoperative Outcome ◽

Protocol Group ◽

Number Of Patients ◽

Secondary Endpoints ◽

American Society ◽

American Society Of Anesthesiologists ◽

The Impact

Background The debate over the correct perioperative fluid management is unresolved. Methods The impact of two intraoperative fluid regimes on postoperative outcome was prospectively evaluated in 152 patients with an American Society of Anesthesiologists physical status of I-III who were undergoing elective intraabdominal surgery. Patients were randomly assigned to receive intraoperatively either liberal (liberal protocol group [LPG], n = 75; bolus of 10 ml/kg followed by 12 ml x kg(-1) x h(-1)) or restrictive (restrictive protocol group [RPG], n = 77; 4 ml x kg(-1) x h(-1)) amounts of lactated Ringer's solution. The primary endpoint was the number of patients who died or experienced complications. The secondary endpoints included time to initial passage of flatus and feces, duration of hospital stay, and changes in body weight, hematocrit, and albumin serum concentration in the first 3 postoperative days. Results The number of patients with complications was lower in the RPG (P = 0.046). Patients in the LPG passed flatus and feces significantly later (flatus, median [range]: 4 [3-7] days in the LPG vs. 3 [2-7] days in the RPG; P < 0.001; feces: 6 [4-9] days in the LPG vs. 4 [3-9] days in the RPG; P < 0.001), and their postoperative hospital stay was significantly longer (9 [7-24] days in the LPG vs. 8 [6-21] days in the RPG; P = 0.01). Significantly larger increases in body weight were observed in the LPG compared with the RPG (P < 0.01). In the first 3 postoperative days, hematocrit and albumin concentrations were significantly higher in the RPG compared with the LPG. Conclusions In patients undergoing elective intraabdominal surgery, intraoperative use of restrictive fluid management may be advantageous because it reduces postoperative morbidity and shortens hospital stay.

Download Full-text

Multi- and univariate analyses of the weekend effect for elective lower-limb joint replacements

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0116 ◽

2018 ◽

Vol 100 (1) ◽

pp. 42-46 ◽

Cited By ~ 2

Author(s):

WTE Briggs ◽

BLT Guevel ◽

AW McCaskie ◽

SM McDonnell

Keyword(s):

Length Of Stay ◽

Joint Replacement ◽

Lower Limb ◽

Weekend Effect ◽

Joint Replacements ◽

Risk Patients ◽

Postoperative Length ◽

Day Of The Week ◽

American Society ◽

American Society Of Anesthesiologists

Introduction The weekend effect is a perceived difference in outcome between medical care provided at the weekend when compared to that of a weekday. Clearly multifactorial, this effect remains incompletely understood and variable in different clinical contexts. In this study we analyse factors relevant to the weekend effect in elective lower-limb joint replacement at a large NHS multispecialty academic healthcare centre. Materials and Methods We reviewed the electronic medical records of 352 consecutive patients who received an elective primary hip or knee arthroplasty. Patient, clinical and time-related variables were extracted from the records. The data were anonymised, then processed using a combination of uni- and multivariate statistics. Results There is a significant association between the selected weekend effect outcome measure (postoperative length of stay) and patient age, American Society of Anesthesiologists classification, time to first postoperative physiotherapy and time to postoperative radiography but not day of the week of operation. Discussion We were not able to demonstrate a weekend effect in elective lower-limb joint replacement at our institution nor identify a factor that would require additional weekend clinical medical staffing. Rather, resource priorities would seem to include measures to optimise at-risk patients preoperatively and measures to reduce time to physiotherapy and radiography postoperatively. Conclusions Our findings imply that postoperative length of stay could be minimised by strategies relating to patient selection and access to postoperative services. We have also identified a powerful statistical methodology that could be applied to other service evaluations in different clinical contexts.

Download Full-text

Postoperative Course After Emergency Colorectal Surgery for Secondary Peritonitis in the Elderly Is Often Complicated by Delirium

International Surgery ◽

10.9738/cc125.1 ◽

2012 ◽

Vol 97 (2) ◽

pp. 129-134 ◽

Cited By ~ 5

Author(s):

Stephan Engelberger ◽

Manuel Zürcher ◽

Jochen Schuld ◽

Carsten Thomas Viehl ◽

Christoph Kettelhack

Keyword(s):

Postoperative Delirium ◽

Statistical Significance ◽

The Elderly ◽

Morbidity And Mortality ◽

University Hospital ◽

Colorectal Origin ◽

American Society ◽

Emergency Colorectal Surgery ◽

American Society Of Anesthesiologists ◽

The University

Abstract Postoperative delirium, morbidity, and mortality in our elderly patients with secondary perionitis of colorectal origin is described. This is a chart-based retrospective analysis of 63 patients who were operated on at the University Hospital Basel from April 2001 to May 2004. Postoperative delirium occurred in 33%. Overall morbidity was 71.4%. Surgery-related morbidity was 43.4%. Mortality was 14.4%. There was no statistical significance between delirium, morbidity and mortality (P = 0.279 and P = 0.364). There was no statistically significant correlation between the analyzed scores (American Society of Anesthesiologists classification, Mannheimer Peritonitis Index, Acute Physiology and Chronic Health Evaluation score II, physiological and operative surgical severity and enumeration of morbidity and mortality score‚ or short ‚cr-POSSUM’) and postoperative delirium, morbidity or mortality. Postoperative delirium occurred in one-third of the patients, who seem to have a trend to higher morbidity. Even if the different scores already had proven to be predictive in terms of morbidity and mortality, they do not help the risk stratification of postoperative delirium, morbidity, or mortality in our collective population.

Download Full-text

Impact of Age on 30-Day Mortality and Morbidity in Patients Undergoing Surgery for Ovarian Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000486 ◽

2015 ◽

Vol 25 (7) ◽

pp. 1216-1223 ◽

Cited By ~ 13

Author(s):

Haider Mahdi ◽

Andrew Wiechert ◽

David Lockhart ◽

Peter G Rose

Keyword(s):

Ovarian Cancer ◽

Elderly Patients ◽

Age Groups ◽

Postoperative Mortality ◽

Improvement Program ◽

Mortality And Morbidity ◽

Logistic Regression Models ◽

Primary Debulking Surgery ◽

American Society ◽

American Society Of Anesthesiologists

ObjectiveTo examine the effect of age on postoperative 30-day morbidity and mortality after surgery for ovarian cancer.MethodsThe American College of Surgeons National Surgical Quality Improvement Program files were used to identify patients with ovarian cancer who underwent surgery in 2005 to 2011. Women were divided into 4 age groups: <60, 60 to 69, 70 to 79, and ≥80 years. Multivariable logistic regression models were performed.ResultsOf 2087 patients included, 47% were younger than 60 years, 28% were 60 to 69 years old, 18% were 70 to 79 years old, and 7% were 80 years or older. Overall 30-day mortality and morbidity rates were 2% and 30%. Elderly patients 80 years or older were more likely to die within 30 days compared with patients younger than 60 years, 60 to 69 years old, and 70 to 79 years old (9.2% vs. 0.6% vs .2.8% vs 2.5%, P < 0.001). Elderly patient aged 80 years or older were more likely to develop pulmonary (9% vs 2% vs 5% vs 3%, P < 0.001) and septic (9% vs 3% vs 5% vs 4%, P = 0.01) complications compared with patients younger than 60 years, 60 to 69 years old, and 70 to 79 years old, respectively. No difference in the risk of renal (0.2% vs 1% vs 1% vs 1%, P = 0.20) complications and surgical reexploration (4% vs 4% vs 3% vs 5%, P = 0.80) between the 4 age groups. In multivariable analyses after adjusting for other confounders, age was a significant predictor of 30-day postoperative mortality and morbidity. Compared with younger patients, octogenarians were 9-times more likely to die and 70% more likely to develop complications within 30 days after surgery. Other significant predictors of 30-day mortality were higher American Society of Anesthesiologists class and hypoalbuminemia (serum albumin ≤ 3 g/dL), whereas, surgical complexity, higher American Society of Anesthesiologists class, longer operative time, and hypoalbuminemia were other significant predictors of 30-day morbidity.ConclusionsElderly patients have a higher risk of perioperative mortality and morbidity within 30 days. Therefore, those patients should be counseled thoroughly about the risk of primary debulking surgery vs neoadjuvant chemotherapy.

Download Full-text

Anesthesia and Surgery in the Seated Position: Analysis of 554 Cases

Neurosurgery ◽

10.1227/00006123-198511000-00001 ◽

1985 ◽

Vol 17 (5) ◽

pp. 695-702 ◽

Cited By ~ 128

Author(s):

Jane Matjasko ◽

Patricia Petrozza ◽

Melvin Cohen ◽

Polly Steinberg

Keyword(s):

Severe Hypertension ◽

Air Embolism ◽

Morbidity And Mortality ◽

Anesthetic Technique ◽

Neurosurgical Procedures ◽

Atherosclerotic Cardiovascular Disease ◽

Cervical Stenosis ◽

Venous Air Embolism ◽

Continued Use ◽

The Impact

Abstract Because controversy exists regarding continued use of the seated position for neurosurgical procedures, this prospective (1981-1983) and retrospective (1972-1981) analysis of 554 seated patients was done to establish the incidence and severity of venous air embolism (VAE) related to type of surgical procedure and anesthetic technique; to examine the impact of specific monitoring practices on detection, morbidity, and mortality; and to establish the incidence of other complications related to the seated position (hypotension, quadriplegia, and arterial air embolism (AAE)). The overall morbidity and mortality related to the seated position was 1% (2 VAE, 1 AAE, 2 hypotension, 1 myocardial infarction) and 0.9% (1 VAE, 1 AAE, 2 hypotension, 1 quadriplegia), respectively. There has been no mortality since 1975. N2O did not seem to increase the incidence or severity of VAE. The seated position is safe in experienced hands if appropriate surgical and anesthetic skills are exercised in patient selection and management. Caution is advised in patients with atherosclerotic cardiovascular disease, severe hypertension, cervical stenosis, and right to left intracardiac shunts.

Download Full-text

Impact of the 1st and 2nd Wave of the COVID-19 Pandemic on Primary or Revision Total Hip and Knee Arthroplasty—A Cross-Sectional Single Center Study

Journal of Clinical Medicine ◽

10.3390/jcm10061260 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1260

Author(s):

Sebastian Simon ◽

Bernhard J.H. Frank ◽

Alexander Aichmair ◽

Philip P. Manolopoulos ◽

Martin Dominkus ◽

...

Keyword(s):

Single Center ◽

Cross Sectional ◽

Total Hip ◽

Single Center Study ◽

Hip And Knee Arthroplasty ◽

American Society ◽

American Society Of Anesthesiologists ◽

The Impact ◽

Second Wave ◽

Center Study

The aim of this study was to evaluate the number of primary and revision total joint arthroplasties (TJA/rTJA) in 2020 compared to 2019. Specifically, the first and the second waves of the COVID-19 pandemic were evaluated as well as the pre-operative COVID-19 test. A cross-sectional single-center study of our prospectively maintained institutional arthroplasty registry was performed. The first COVID-19 wave and the second COVID-19 wave led to a socioeconomic lockdown in 2020. Performed surgeries, cause of revision, age, gender, and American Society of Anesthesiologists-level were analyzed. Preoperative COVID-19 testing was evaluated and nationwide COVID-19 data were compared to other countries. In 2020, there was a decrease by 16.2% in primary and revision TJAs of the hip and knee compared to 2019. We observed a reduction of 15.8% in primary TJAs and a reduction of 18.6% on rTJAs in 2020 compared to 2019. There is an incline in total hip arthroplasties (THAs) and a decline in total knee arthroplasties (TKAs) comparing 2019 to 2020. During the first wave, there was a reduction in performed primary TJAs of 86%. During the second wave, no changes were observed. This is the first study quantifying the impact of the COVID-19 pandemic on primary and revision TJAs regarding the first and second wave.

Download Full-text