A Surgical Case of a Pseudoaneurysm of the RV-PA Conduit Infection due to Mediastinitis after Palliative Rastelli Surgery

OBJECTIVEHydrocephalus is recognized as a common disabling pediatric disease afflicting infants and children disproportionately in the developing world, where access to neurosurgical care is limited and risk of perinatal infection is high. This surgical case series describes the Project Medishare Hydrocephalus Specialty Surgery (PMHSS) program experience treating hydrocephalus in Haiti between 2008 and 2015.METHODSThe authors conducted a retrospective review of all cases involving children treated for hydrocephalus within the PMHSS program in Port-au-Prince, Haiti, from 2008 through 2015. All relevant epidemiological information of children treated were prospectively collected including relevant demographics, birth history, hydrocephalus etiology, head circumference, and operative notes. All appropriate associations and statistical tests were performed using univariate and multivariate logistic regression analyses.RESULTSAmong the 401 children treated within PMHSS, postinfectious hydrocephalus (PIH) accounted for 39.4% (n = 158) of cases based on clinical, radiographic, and endoscopic findings. The majority of children with hydrocephalus in Haiti were male (54.8%, n = 197), born in the rainy season (59.7%, n = 233), and born in a coastal/inland location (43.3%, n = 61). The most common surgical intervention was endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC) (45.7%, n = 175). Multivariate logistic regression analysis yielded coastal birth location (OR 3.76, 95% CI 1.16–12.18) as a statistically significant predictor of PIH. Increasing head circumference (adjusted OR 1.06, 95% CI 0.99–1.13) demonstrated a slight trend toward significance with the incidence of PIH.CONCLUSIONSThis information will provide the foundation for future clinical and public health studies to better understand hydrocephalus in Haiti. The 39.4% prevalence of PIH falls within observed rates in Africa as does the apparently higher prevalence for those born during the rainy season. Although PIH was the most frequent etiology seen in almost all birth locations, the potential relationship with geography noted in this series will be the focus of further research in an effort to understand the link between climate and PIH in Haiti. The ultimate goal will be to develop an appropriate public health strategy to reduce the burden of PIH on the children of Haiti.

Download Full-text

CPT to RVU conversion improves model performance in the prediction of surgical case length

Scientific Reports ◽

10.1038/s41598-021-93573-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Nicholas Garside ◽

Hamed Zaribafzadeh ◽

Ricardo Henao ◽

Royce Chung ◽

Daniel Buckland

Keyword(s):

Model Performance ◽

Individual Case ◽

Model Complexity ◽

Actual Case ◽

Surgical Case ◽

Relative Value ◽

Prediction Time ◽

Boosted Decision Tree ◽

Tree Models ◽

Duke University

AbstractMethods used to predict surgical case time often rely upon the current procedural terminology (CPT) code as a nominal variable to train machine-learned models, however this limits the ability of the model to incorporate new procedures and adds complexity as the number of unique procedures increases. The relative value unit (RVU, a consensus-derived billing indicator) can serve as a proxy for procedure workload and could replace the CPT code as a primary feature for models that predict surgical case length. Using 11,696 surgical cases from Duke University Health System electronic health records data, we compared boosted decision tree models that predict individual case length, changing the method by which the model coded procedure type; CPT, RVU, and CPT–RVU combined. Performance of each model was assessed by inference time, MAE, and RMSE compared to the actual case length on a test set. Models were compared to each other and to the manual scheduler method that currently exists. RMSE for the RVU model (60.8 min) was similar to the CPT model (61.9 min), both of which were lower than scheduler (90.2 min). 65.2% of our RVU model’s predictions (compared to 43.2% from the current human scheduler method) fell within 20% of actual case time. Using RVUs reduced model prediction time by ninefold and reduced the number of training features from 485 to 44. Replacing pre-operative CPT codes with RVUs maintains model performance while decreasing overall model complexity in the prediction of surgical case length.

Download Full-text

Prioritising surgical cases deferred by the COVID-19 pandemic: an ethics-inspired algorithmic framework for health leaders

BMJ Leader ◽

10.1136/leader-2020-000343 ◽

2021 ◽

pp. leader-2020-000343

Author(s):

Amit Jain ◽

Tinglong Dai ◽

Christopher G Myers ◽

Punya Jain ◽

Shruti Aggarwal

Keyword(s):

Decision Analysis ◽

Health System ◽

System Capacity ◽

Surgical Case ◽

The World ◽

The Face ◽

Algorithmic Framework ◽

Limited Health ◽

Healthcare Leaders

Elective surgical suspension during the COVID-19 pandemic resulted in a sizeable surgical case backlog throughout the world. As we ramp back up, how do we decide which cases take priority? Potential future waves (or a future pandemic) may lead to additional surgical shutdown and subsequent reopening. Deciding which cases to prioritise in the face of limited health system capacity has emerged as a new challenge for healthcare leaders. Here we present an ethically grounded and operationally efficient surgical prioritisation framework for healthcare leaders and practitioners, drawing insights from decision analysis and organisational sciences.

Download Full-text

398 Theatre Waste Management and the Impact of COVID-19

British Journal of Surgery ◽

10.1093/bjs/znab134.418 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

C Luney ◽

C Little

Keyword(s):

Environmental Impact ◽

Waste Management ◽

Management Practice ◽

Surgical Case ◽

Widespread Adoption ◽

Period Data ◽

The Mean ◽

Contaminated Waste ◽

The Impact ◽

Waste Management Practice

Abstract Introduction Audit of waste management in an elective orthopaedic complex was interrupted due Covid-19 pandemic. We investigated the impact of the enforced changes on theatre waste due to Covid-19. Method Over a 1week period data on waste bag availability and number of bags of each category of waste per surgical case in an elective theatre complex was collated; this was compared to waste generated during Covid-19 pandemic. Results Prior to Covid-19 only clinical waste bins were available in many non-dominant clinical areas providing evidence of inappropriate routine disposal of domestic/recyclable waste. Pre-Covid-19 a mean of 6waste bags were used per surgical case (3.7yellow clinical bags, 1.3black domestic bags, 0.4clear recycling bags), with Covid-19 changes to waste management practice the mean number of waste bags used per case increased to 11 (9 orange contaminated bags, 0.5black, 0.3clear bags). Conclusions Clinical waste management has a significant economic and environmental impact. Covid-19 has led to nearly all waste being deemed to be contaminated and so requiring incineration, with increased volumes of waste generated per case through widespread adoption of PPE. This has increased cost and reduced the ability to recycle non-contaminated waste.

Download Full-text

The effect of surgical case volume on outcome after the Norwood procedure

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2004.07.056 ◽

2005 ◽

Vol 129 (4) ◽

pp. 754-759 ◽

Cited By ~ 86

Author(s):

Paul A. Checchia ◽

Jamie McCollegan ◽

Noha Daher ◽

Nikoleta Kolovos ◽

Fiona Levy ◽

...

Keyword(s):

Norwood Procedure ◽

Case Volume ◽

Surgical Case

Download Full-text

Enlarged inflammatory multiple ground-glass nodules of the lung over five years' follow-up: A surgical case report

The Journal of the Japanese Association for Chest Surgery ◽

10.2995/jacsurg.29.890 ◽

2015 ◽

Vol 29 (7) ◽

pp. 890-895

Author(s):

Naoya Yokomakura ◽

Hiroo Nishijima ◽

Masakazu Yanagi ◽

Kazuhiro Wakida ◽

Aya Harada ◽

...

Keyword(s):

Case Report ◽

Ground Glass ◽

Surgical Case ◽

Ground Glass Nodules

Download Full-text

The Safety of the Esmarch Tourniquet

Foot & Ankle ◽

10.1177/107110079301400508 ◽

1993 ◽

Vol 14 (5) ◽

pp. 278-283 ◽

Cited By ~ 17

Author(s):

William C. Biehl ◽

James M. Morgan ◽

F. William Wagner ◽

Rodney A. Gabriel

Keyword(s):

Learning Curve ◽

Clinical Application ◽

Medial Malleolus ◽

Foot And Ankle ◽

Surgical Case ◽

Significant Difference ◽

Mean Pressure ◽

Continued Use

The use of an Esmarch bandage as a tourniquet in surgery has been criticized. Many authors claim that the pressures under the Esmarch are inconsistent and may be extremely high. We have seen few, if any, problems from the use of an Esmarch in surgery of the foot and ankle. The purpose of this study was to evaluate the pressures generated under the Esmarch tourniquet in a situation that mimics its clinical application, and to determine whether pressures of appropriate magnitude and consistency are obtained in order to recommend its continued use in surgery. Ten volunteers performed numerous applications of the Esmarch. The number of wraps and the width of the Esmarch bandage used were varied. The Esmarch was applied as it would be for a surgical case. Pressures directly beneath the Esmarch were recorded 8 cm proximal to the distal tip of the medial malleolus. Considering all volunteers and all pressures generated, a 3-in Esmarch applied with three wraps gave a mean pressure (±SD) of 225 ± 46 mm Hg. A 3-in Esmarch applied with four wraps gave a mean pressure of 291 ± 53 mm Hg. A 4-in Esmarch applied with three wraps gave a mean pressure of 233 ± 35 mm Hg, and a 4-in Esmarch with four wraps gave a mean pressure of 284 ± 42 mm Hg. The maximum pressures generated by any individual were as follows: 3-in three wraps, 321 mm Hg; 3-in four wraps, 413 mm Hg; 4-in three wraps, 328 mm Hg; and 4-in four wraps, 380 mm Hg. There was no significant difference in the magnitude or consistency of pressures generated between the experienced and inexperienced wrappers. There did not appear to be a learning curve for the application of the Esmarch bandage. We conclude that an Esmarch bandage, used as a tourniquet, can generate safe and reliable pressures. Either a 3-in or 4-in Esmarch bandage applied above the ankle with three circumferential overlapping wraps consistently results in pressures that are in a safe range.

Download Full-text