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Evans R, Taylor A. Constant high-level visual acuity during total laparoscopic hysterectomy using the OpClear ® system. J OBSTET GYNAECOL 2024; 44:2375590. [PMID: 39039900 DOI: 10.1080/01443615.2024.2375590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/22/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Operative vision can frequently be critically reduced during laparoscopic surgery by condensation and other matter accumulating on the distal laparoscope lens. By delivering saline and carbon dioxide across the lens, the OpClear system is designed to maintain operative vision without needing scope removal for lens cleaning. This study evaluates the system's efficacy in providing high-level visual acuity during laparoscopic hysterectomy while examining its utility through its impact on operative duration. METHODS A retrospective audit compared efficacy and utility for the three years before and after the implementation of OpClear in a single unit. Thirty-three cases were reviewed pre-OpClear, while 82 cases were analysed in the post-OpClear group. All cases involved routine total laparoscopic hysterectomies (TLH) performed by the same surgeon (AT) with similar complexity levels. RESULTS The OpClear system provided a consistently high level of visual acuity throughout the laparoscopic procedures. Scope removals, which typically result in non-productive operating time, were virtually eliminated. Consequently, in highly comparable cases, OpClear usage resulted in a 17-minute reduction in operating time over cases performed without the device. Additionally, in the OpClear group, there were trends towards reduced blood loss and shorter hospital stays, with patients in the OpClear group being discharged on first rather than second postoperatively. CONCLUSIONS The findings of this audit suggest that the OpClear system provides continuous high-level vision during laparoscopic hysterectomy. Further, reducing periods of non-productive time associated with scope removal for cleaning resulted in shorter operating times. Thus, the system has the potential to enhance safety, improve theatre utilisation and alleviate some of the surgical stresses associated with laparoscopic surgery.
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Affiliation(s)
- R Evans
- Women's Health Directorate, University Hospitals Dorset NHS Foundation Trust, Bournemouth, England
| | - A Taylor
- Women's Health Directorate, University Hospitals Dorset NHS Foundation Trust, Bournemouth, England
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Heyba M, Qasem F, Ibrahim AS, Habib T, Akl H, Al-Matouq SM. Improving Postanesthesia Care Unit (PACU) Delays: A Quality Improvement Project. J Perianesth Nurs 2024; 39:716-721. [PMID: 38363267 DOI: 10.1016/j.jopan.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/25/2023] [Accepted: 12/02/2023] [Indexed: 02/17/2024]
Abstract
PURPOSE Delays within the postanesthesia care unit (PACU) are a major cause of complications and inefficiency. In this project, we investigated the factors associated with delays in the PACU and implemented policies to mitigate these factors. DESIGN A quality improvement project. METHODS Data were collected for 10 months and included 1,134 surgical patients in a tertiary Obstetrics and Gynecology hospital in Kuwait. Several meetings were held with stakeholders to identify and overcome the reasons contributing to delays within the PACU. FINDINGS Among the top reasons for PACU delay were manpower shortage and lack of bed availability in the surgical wards due to improper admission and discharge policies. Policies were implemented to improve admission policy, hasten patient discharge, and improve patient flow through the operating theater (OT). These policies lead to a significant reduction (25 minutes) in the average time patients spend in the OT, mainly by reducing the stay in the PACU by 19 minutes. CONCLUSIONS PACU delays were mostly due to reasons outside the OT. Further, follow-up is needed to assess the sustainability of these improvements and identify any new challenges that may arise.
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Affiliation(s)
- Mohammed Heyba
- Kuwait Board of Anesthesia, Kuwait Institute for Medical Specialization, Kuwait City, Kuwait.
| | - Fatemah Qasem
- Kuwait Board of Anesthesia, Kuwait Institute for Medical Specialization, Kuwait City, Kuwait; Department of Anesthesia and Intensive Care, Maternity Hospital, Kuwait City, Kuwait
| | - Abdelrady S Ibrahim
- Kuwait Board of Anesthesia, Kuwait Institute for Medical Specialization, Kuwait City, Kuwait; Department of Anesthesia and Intensive Care, Maternity Hospital, Kuwait City, Kuwait; Department of Anesthesia and ICU, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt
| | - Tharwat Habib
- Kuwait Board of Anesthesia, Kuwait Institute for Medical Specialization, Kuwait City, Kuwait; Department of Anesthesia and Intensive Care, Maternity Hospital, Kuwait City, Kuwait; Department of Anesthesia and Intensive Care, Mansoura University, Mansoura, Egypt
| | - Hisham Akl
- Department of Anesthesia and Intensive Care, Maternity Hospital, Kuwait City, Kuwait
| | - Shaikha M Al-Matouq
- Kuwait Board of Anesthesia, Kuwait Institute for Medical Specialization, Kuwait City, Kuwait; Department of Anesthesia and Intensive Care, Maternity Hospital, Kuwait City, Kuwait
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Dexter F, Epstein RH. Lack of Validity of Absolute Percentage Errors in Estimated Operating Room Case Durations as a Measure of Operating Room Performance: A Focused Narrative Review. Anesth Analg 2024; 139:555-561. [PMID: 38446709 DOI: 10.1213/ane.0000000000006931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Commonly reported end points for operating room (OR) and surgical scheduling performance are the percentages of estimated OR times whose absolute values differ from the actual OR times by ≥15%, or by various intervals from ≥5 to ≥60 minutes. We show that these metrics are invalid assessments of OR performance. Specifically, from 19 relevant articles, multiple OR management decisions that would increase OR efficiency or productivity would also increase the absolute percentage error of the estimated case durations. Instead, OR managers should check the mean bias of estimated OR times (ie, systematic underestimation or overestimation), a valid and reliable metric.
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Hilowle AH, Mohamed AH. Exploring the Impact of Gender-Specific Approaches inRetrograde Intrarenal Surgery: Effects on Operative Efficiency and Patient Recovery. Res Rep Urol 2024; 16:177-185. [PMID: 39229592 PMCID: PMC11370754 DOI: 10.2147/rru.s480374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 08/27/2024] [Indexed: 09/05/2024] Open
Abstract
Objective Very limited data are available exploring the potential influence of gender on Retrograde Intrarenal Surgery outcomes. This study investigates the gender-specific influence of ShuoTongureteroscopy (ST-urs) and Flexible Ureteroscopy (F-urs) surgeries on operation efficacy and patient recovery in a sample of the Somali population. Materials and Methods We enrolled 390 participants. Participants were stratified into four gender-specific subgroups based on ureteroscopy operation type: 27.7% males in S-urs (group1), 44.4% females in S-urs (group2), 18.7% males in F-urs (group3), and 9.2% females in F-urs (group4). Primary outcomes included operation time, postoperative hospital stay duration, and VAS Pain Score. Multivariate logistic regression was used to assess associations. Results The mean age was 29.53 ± 7.61 years, 72.1% male and 27.9% female, with 46.4% of the patients undergoing ST-urs and 53.6% undergoing F-urs. Women had higher odds of prolonged hospital stays (OR = 2.62, 95% CI: 1.43-4.82, p < 0.001) and post-operation pain (OR = 5.06, 95% CI: 2.95-8.68, p = 0.002). Among men who underwent F-urs procedure, there was a significantly higher odds ratio (OR) of 6.14 (95% CI: 2.86-13.19, p < 0.001) for experiencing a long operation time. Conversely, for females, those who underwent S-urs surgery had a notably lower OR of 0.32 (95% CI: 0.13-0.79, p = 0.013) for long operation time, whereas those who underwent F-urs surgery exhibited a substantially elevated OR of 5.36 (95% CI: 1.85-15.53, p < 0.001). Both females undergoing F-urs surgery (OR: 5.16, 95% CI: 2.61-10.21, p < 0.001) and those undergoing F-urs surgery (OR: 5.25, 95% CI: 2.17-12.73, p < 0.001) experienced significantly higher post-operative pain. Conclusion Our research reveals gender disparities in retrograde intrarenal surgery outcomes. Women experience longer hospital stays and higher postoperative pain levels compared to men. F-urs procedures are associated with longer operation times and hospital stays, particularly affecting women. Contrarily, ST-urs offers shorter operation times for women but leads to prolonged hospital stays and heightened postoperative pain.
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Affiliation(s)
| | - Abdikarim Hussein Mohamed
- Department of Urology, University of Somalia, Mogadishu, Somalia
- Department of Urology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia
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Firde M, Ayine B, Mekete G, Sisay A, Yetneberk T. Root causes of first-case start time delays for elective surgical procedures: a prospective multicenter observational cohort study in Ethiopia. Patient Saf Surg 2024; 18:23. [PMID: 39010090 PMCID: PMC11251378 DOI: 10.1186/s13037-024-00405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/02/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Delays in surgery start times can lead to poor patient outcomes and considerable increases in healthcare expenditures. This is especially true in developing countries that often face systemic inefficiencies, such as a shortage of operating rooms and trained surgical personnel. With substantial effects on patient outcomes, healthcare efficiency, and resource allocation, identifying delays in first-case elective surgery is a crucial area of research. METHODS A multicenter observational study was conducted at three comprehensive and specialized hospitals in the Amhara region of Ethiopia from May 1 to October 30, 2023. The primary aim of the study was to determine the occurrence of late first-case start times, defined as a patient being in the operating room at or after the hospital's incision time of 2:30 a.m. The secondary aim was to discover potential root causes of delayed first-case start times. All patients scheduled for elective surgery as the first case on the operating list throughout the study period were included in the study. Every emergency, day case, after-hours case, and canceled case was excluded. RESULTS A total of 530 surgical patients were included during the study window from May 1 to October 1, 2023. Of these, 41.5% were general surgeries, 20.4% were gynecology and obstetrics surgeries, and 13.2% were orthopedic surgery procedures. Before the procedure started, nine (1.7%) of the participants had prolonged discussion with a member of the surgical team. Patients who arrived in the operating room waiting area at or after 2:30 a.m. were 2.5 times more likely to experience a first-case start time delay than those who arrived before or at 2:00 a.m. (AOR = 2.50; 95% CI: 1.13-5.14). Furthermore, participants with abnormal investigation results were 2.4 times more likely to have a late first-case start time (AOR = 2.41; 95% CI: 1.06, 5.50). Moreover, the odds of a late first-case start time were increased by 10.53 times with the surgeon being in the operating room at or after 2:30 a.m. (AOR = 10.53; 95% CI: 5.51, 20.11). CONCLUSION The research highlights a significant occurrence of delayed start times for the first elective surgical procedures. Therefore, directing attention to aspects such as ensuring patients and surgical teams arrive promptly (by or before 2:00 a.m.) and timely evaluation and communication of investigative findings before the scheduled surgery day could facilitate efforts to maximize operating room efficiency and enhance patient health outcomes.
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Affiliation(s)
- Meseret Firde
- Department of Anesthesia, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Biresaw Ayine
- Department of Anesthesia, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Mekete
- Department of Anesthesia, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amanuel Sisay
- Department of Anesthesia, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tikuneh Yetneberk
- Department of Anesthesia, Debre Tabor University, Debre Tabor, Ethiopia
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Henderson AP, Van Schuyver PR, Economopoulos KJ, Bingham JS, Chhabra A. The Use of Artificial Intelligence for Orthopedic Surgical Backlogs Such as the One Following the COVID-19 Pandemic: A Narrative Review. JB JS Open Access 2024; 9:e24.00100. [PMID: 39301194 PMCID: PMC11410334 DOI: 10.2106/jbjs.oa.24.00100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2024] Open
Abstract
➤ The COVID-19 pandemic created a persistent surgical backlog in elective orthopedic surgeries. ➤ Artificial intelligence (AI) uses computer algorithms to solve problems and has potential as a powerful tool in health care. ➤ AI can help improve current and future orthopedic backlogs through enhancing surgical schedules, optimizing preoperative planning, and predicting postsurgical outcomes. ➤ AI may help manage existing waitlists and increase efficiency in orthopedic workflows.
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Affiliation(s)
| | | | | | | | - Anikar Chhabra
- Mayo Clinic Department of Orthopedic Surgery, Phoenix, Arizona
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Tanaka MJ, Prasad R, Miller LA, Fleck MM, Stiles B, Boyne CJ, Nguyen THE. Team Approach: Improving Orthopaedic Operating Room Efficiency. JBJS Rev 2023; 11:01874474-202308000-00004. [PMID: 37549236 DOI: 10.2106/jbjs.rvw.23.00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The cost of surgical care accounts for almost one-third of all health care spending in the United States. Within health care spending, the operating room (OR) is one of the largest health care costs during a perioperative episode of care. Efficiency in the OR has been associated with increased productivity, safety, and quality of care. However, multiple sources of delays can contribute to inefficiency, and improving efficiency in the OR requires a systematic approach to identify and address each issue. We report on the case of a process improvement initiative implemented in a large academic institution to improve OR efficiency in outpatient orthopaedic cases, and we discuss the lessons learned through this program. Optimizing workflow in the OR requires a multidisciplinary team approach consisting of clinician leaders with common goals and open discussion regarding the needs of each team member, including circulating nurses, surgical nurses/technologists, and anesthesiologists. Our experience highlights the importance of practical, clinician-driven changes that are supported by administrative engagement, resources for staffing and equipment, and institutional flexibility, which are required to implement systemic changes to address and improve efficiency in the OR.
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Affiliation(s)
- Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rashmi Prasad
- Department of Anesthesia, Johns Hopkins University, Baltimore, Maryland
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Lewis TL, Alkhalfan Y, Ferreira GF, Nunes GA, Lam P, Ray R. Optimizing the Operating Room Setup for Minimally Invasive Forefoot Surgery: Technical Tip. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231198235. [PMID: 37720565 PMCID: PMC10503294 DOI: 10.1177/24730114231198235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Affiliation(s)
- Thomas L. Lewis
- King’s Foot and Ankle Unit, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Yousif Alkhalfan
- Guy’s and St Thomas’ NHS Foundation Trust, Maze Pond, London, United Kingdom
| | - Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | | | - Peter Lam
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
| | - Robbie Ray
- King’s Foot and Ankle Unit, King’s College Hospital NHS Foundation Trust, London, United Kingdom
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Dexter F, Epstein RH. Absence of a Comprehensive Literature Search Protocol in a Systematic Review of Published Studies Describing Operating Room Optimization. J Med Syst 2023; 47:35. [PMID: 36913027 PMCID: PMC10009342 DOI: 10.1007/s10916-023-01937-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Franklin Dexter
- Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, 6-JCP, Iowa City, IA 52242 USA
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