811 Should We Be Performing Day Case Laparoscopic Cholecystectomy (DCLC) After 3pm? Correlation Between Time of Operation and Post-Operative Hospital Stay

Introduction Laparoscopic cholecystectomy (LC) is a common daycase procedure. The British Association of Day Surgery (BADS) Procedure Directory sets out national performance targets for the number of LC’s treated as day cases. This study aimed to assess if operation time predicted unplanned inpatient admission. Method An annonymised retrospective review of all patients undergoing LC. The data was undertaken over two cycles. The first cycle was a 6-month period followed by a second cycle that was undertaken over three months. Data was obtained from multiple sources: discharge letters and the theatre data manager. Results Total number of cases was 160. In the first cycle, the zero night stay for DCLC was 56%, which lies within the top 50% of current national performance but is below the BADS target of 75%. In the second cycle, the zero-night stay was 70%, which falls just below the BADS target. While unplanned admissions resembled 30%. We had 136 cases underwent LC before 3 pm. While 24 cases had their operation after 3 pm. 19 patients out of those 24 stayed at the hospital. Conclusions The timing of operation of DCLC predicts inpatient admission; our data suggests that DCLC should not take place after 3pm in the afternoon.

Is Early Traumatic Facial Nerve Surgery a Priority during the COVID-19 Pandemic?

As otolaryngologists are exposed to high risk of coronavirus disease 2019 (COVID-19) infection, logic and evidence-based prioritization for surgeries is essential to reduce the risk of infection amongst healthcare workers. Several clinical guidelines and surgery prioritizing recommendations have been published during the COVID-19 pandemic. They recommended the surgery in the setting of immediate facial nerve paralysis within 72 hours after trauma, but none of the previous studies in the literature suggests that the optimal timing of operation should be less than 2 weeks from injury.

Timing of surgery for benign periacetabular tumor: virtual finite element analysis and clinical verification on 39 cases

BackgroundThe treatment of periacetabular tumor has always been met with great challenges, including the lack of a standard for the timing of surgery. The purposes of this study were to predict the risk for fracture by finite element analysis of benign periacetabular tumor; to guide the timing of operation; and to verify the practical application of this standard through clinical cases. MethodsBone defects in different areas of the acetabulum were constructed, and the fracture risk was predicted by finite element analysis. According to the results of finite element analysis and Enneking classification, the patients with benign periacetabular tumor were divided into the low fracture risk noninvasive lesion, low fracture risk invasive lesion, and high fracture risk groups. The grouping was used to guide the timing of operation. ResultsThis study included 39 patients who were followed-up for at least two years to verify the effectiveness of this program. The 12 patients in the low risk noninvasive lesion group that did not undergo operation showed no obvious pathological changes and no pathological fracture; there was no significant difference in the MSTS-93 score between the first and last visits (P > 0.05). The 7 patients in the low risk invasive lesion group were treated with adjuvant therapy before the operation; the MSTS-93 score was significantly lower on the first visit than on the last visit (P < 0.05). The 20 cases that had high risk for fracture underwent surgery after the diagnosis; of these, 13 patients achieved osseointegration of the graft bone and 7 patients had no prosthesis loosening, detachment, displacement or rupture after prosthesis replacement. The MSTS-93 score significantly improved from a preoperative value of 19.61 ± 7.32 to a final follow-up value of 26.28 ± 15.59 (P < 0.01). ConclusionsOur study confirmed that for benign periacetabular tumor, finite element analysis, combined with the nature of the tumor, can predict the risk for acetabular fracture and guide the appropriate timing and method of operation, thereby, enabling a safe therapeutic effect.

The Best Time for Completion Thyroidectomy on Differentiated Thyroid Carcinoma: A Literature Review

Background: Completion thyroidectomy is performed for high-risk differentiated thyroid carcinoma; however, the timing of the completion thyroidectomy is a matter of controversy. The current review aimed to assess the best time for completion thyroidectomy in patients with differentiated thyroid carcinoma. Methods: An electronic search was conducted in various databases, such as Pub Med, Google Scholar, Scopus, and Medline, for relevant articles assessing the timing of completion thyroidectomy from the first published article to October 2019. Keywords, “completion thyroidectomy” and “timing” were used. The search was limited to articles published in the English language. Among the 190 articles retrieved, only 11 fulfilled the inclusion criteria. Results: Of the 11 articles included, two were from Europe, one from Africa, one from Australia, and seven from Asia, and all were retrospective studies with the mean duration of studies being 12.71 ± 12.31 years. Five studies (45.5%) showed no effect of timing on the outcomes, two (18.2%) recommended both early and late operation, another two (18.2%) concluded that late operation is better, one (9.1%) found that early surgery is better, while one study (9.1%) stated that the timing of operation should be based on the category of the patient. Conclusions: The results were mixed with some studies recommending late completion thyroidectomy, some observing that both early and late thyroidectomy are safe, while some finding no effect of time on the completion thyroidectomy. Well-designed controlled trials will resolve the issue. Keywords: early completion thyroidectomy, late thyroidectomy, timing

Early corrective surgery may prevent Baroreflex impairment in congenital heart diseases

Arrhythmias in tetralogy of Fallot (ToF) and transposition of the great arteries (TGA) could be the consequence of reduced baroreflex-sensitivity (BRS). Hypoxia until the first surgical correction in these patients may impair BRS. We aimed to compare the BRS of ToF, TGA and control subjects and test the effect of the timing of operation on BRS. 19 patients with ToF, 22 patients with TGA and 19 healthy controls were enrolled. Carotid pulse pressure (PPc) was similar in ToF and TGA patients but lower in controls. BRS was lower in the ToF group compared to the control or to the TGA groups. The first operation was performed later in patients with ToF than in patients with TGA. Adjustment for PPc attenuated the difference in BRS between ToF and control subjects. Adjustment for age at corrective surgery abolished the difference in BRS between the ToF and the TGA groups. In ToF patients, reduced BRS could be explained by the stiffening of central arteries and the later corrective surgery. Earlier surgical correction may prevent irreversible deterioration of baroreflex-function and arrhythmia development in ToF patients.