Impacts of elective surgical cancellations and postponements in Canada

Improving Theatre Productivity by Digitising Surgical Equipment Repairs

Introduction A few cancelled surgeries are due to surgical equipment issues representing a significant burden to both patients and National Health Service (NHS) hospitals on waiting lists. Despite this, there remain very few strategies designed to tackle these avoidable cancellations, especially in combination with digitisation. Our aim was to demonstrate improved efficiency through a pilot study in collaboration with Broomfield Hospital (Broomfield, United Kingdom), MediShout Ltd (London, United Kingdom), and B. Braun Medical Ltd (Sheffield, United Kingdom) with the digitalisation of the equipment repair pathway. Methods MediShout digitised two distinct repair pathways: ad-hoc repairs and maintenance equipment services (MES). Pre- and post-digitisation outcome measures were collected including the number of process steps, staff contribution time, non-staff continuation time, turnaround time, cancelled surgeries, planned preventative maintenance compliance, and staff satisfaction. The number of steps, staff contribution time, and non-staff contribution time were calculated using cognitive task analyses and time-motion studies, respectively. Turnaround time and cancellation data were taken from existing hospital data sets and staff satisfaction was measured through two staff surveys. Results Digitising the ad-hoc repair pathway reduced the number of steps by 18 (118 to 100) and saved 74 minutes of total staff time (Broomfield Hospital and B. Braun) per repair, resulting in annual efficiency savings of £21,721.48. Digitising the MES repair pathway reduced the number of steps by 13 (74 to 61) and saved 56 minutes of total staff time per repair, resulting in annual efficiency savings of £3469.44. Turnaround time for the repaired kit decreased by 14 days and 29 days for the digital ad-hoc and digital MES pathways, respectively. Elective operations cancelled due to equipment issues decreased by 44%, from 1.5 operations/month pre-pilot to 0.83 operations/month post-pilot. Planned preventative maintenance compliance across the MES pathway increased by 67% (33% to 100%). Staff satisfaction with the repair pathway improved from 12% to 96%. Conclusion This pilot study showcases the numerous benefits that can be achieved through digitisation and offers an innovative case study to approach avoidable cancellations due to equipment failure.

Predictors of same day cancellation of elective surgery

Same day cancellations of surgery have adverse effects on both patients and health care systems. To date, the majority of research has evaluated reasons for same day cancellation, and relatively little is known about risk factors for cancellation. The aim of this study is to develop and evaluate the accuracy of a model for preoperatively predicting which patients are at risk for experiencing same day cancellation. While accurately predicting which patients are likely to experience same day cancellation remains challenging, predictive models may aid in the early identification of patients at risk for cancellation. Future studies are required to assess whether the use of predictive analytics leads to reduced cancellation rates in practice.

The Role of Mobile Health Technology in Perioperative Spinal Care: A Systematic Scoping Review and Narrative Synthesis

Smartphone applications play a crucial role in contemporary healthcare by aiming to enhance patient care through technology. Mobile health (mHealth) applications have proven to have transformative potential in enhancing patients' outcomes in candidates undergoing orthopedic and spinal surgery. In the context of the pervasive use of smartphones and the exponential growth of mHealth apps, totaling over 99,000 in 2021, the applications had a significant impact on lifestyle management, supporting initiatives like smoking cessation with motivational reminders and progress tracking. Patient compliance is significantly enhanced, reducing surgery cancellations and improving outcomes through effective adherence to pre-operative treatments and instructions. Physiotherapy receives a substantial boost as mHealth facilitates video-guided exercises, potentially improving compliance and treatment outcomes. Data collection takes on innovative dimensions, with mHealth apps capturing post-operative metrics like physical activity, offering valuable insights into patient recovery trends. Remote care is streamlined through features like photo uploads and direct messaging, proving especially beneficial in times of crises such as the COVID-19 pandemic. Despite these merits, challenges emerge, including issues related to technological literacy, potential discrimination due to paywalls, and concerns about patient data confidentiality. Overcoming these challenges requires standardized approaches, legislative measures, and ongoing research to refine and optimize mHealth applications for diverse healthcare settings.

Time to elective surgery and its predictors after first cancellation at Debremarkos Comprehensive Specialized Hospital, Northwest Ethiopia

Canceling elective surgical procedures is quite common throughout Ethiopia. Despite this, there is limited evidence about the time to elective surgery after cancellation in the country. Thus, the current study aimed to determine the time to elective surgery and its predictors after the first cancellation. An institution-based retrospective follow-up study was conducted on 386 study participants at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia, between September 1, 2017, and August 31, 2022. Utilizing a checklist, data were retrieved. To choose study participants, systematic random sampling was employed. Epi-Data version 3.1 and STATA version 14.1 were utilized. Kaplan-Meier curves and log-rank tests were employed. The Cox proportional hazard model was fitted. The mean age of the participants was 41.01 + 18.61 years. Females made up 51% of the patients. The majority were illiterate (72.3%) and resided in rural areas (70.5%). Surgery following the first cancellation had a cumulative incidence of 83.6% (95% CI: 79.6, 87.05) and an incidence rate of 32.3 per 1,000 person-days (95% CI: 29.3, 35.5). The median survival time to surgery was 25 (IQR: 17-40) days. Urban residence (AHR = 1.62; 95% CI: 1.26-1.96), being a member of health insurance schemes (AHR = 1.55; 95% CI: 1.24-1.96), stable other medical conditions (AHR = 1.43; 95% CI: 1.13-1.79), and timely completion of diagnostic tests (AHR = 1.62; 95% CI: 1.29-2.04) were significant predictors of time to surgery after first cancellation. Our study revealed that the time to surgery after the first cancellation was in the globally acceptable range and met the national target. Clinicians should focus on timely completion of diagnostic or laboratory tests, facilitating health insurance coverage, and comprehensive assessment and treatment of any coexisting medical conditions. It is urged to stratify each department's time for surgery, taking into consideration of important variables.

FROST 2.0: Factors Predicting Orthopaedic Trauma Volumes - A Validation Study

The anecdotal relationship between weather, season, and orthopaedic trauma volumes is understood by patients and healthcare providers: when the winter ground is icy, people fall. Previous research established that winter and summer months as well as ice and snow were significant predictors of orthopaedic trauma and surges in volumes. The current study validates the previously established predictive model in one Canadian city; the original methods were repeated using a new, yet geographically similar dataset. The effect of month and ice were consistent, which suggests the proposed model has sufficient external validity to guide resource allocation and primary prevention strategies.

Self-management of osteoarthritis while waiting for total knee arthroplasty during the COVID-19 pandemic among older Malaysians

BACKGROUND

The study sought to understand the self-management strategies used by patients during the postponement of their total knee arthroplasty (TKA) procedure, as well as the associations between the length of waiting time, pain, and physical frailty and function. The study focused on individuals aged 50 years and above, as they are known to be more vulnerable to the negative impacts of delayed elective surgery and rehabilitation. This study hypothesizes that delayed TKR due to coronavirus disease 2019 (COVID-19) will bear negative effect in self-management, pain, and physical frailty and function in older adults.

AIM

To investigate the effects of COVID-19 pandemic on self-management, pain, and physical function in older adults awaiting TKA in Malaysia.

METHODS

This cross-sectional study has the data of participants, who matched the criteria and scheduled for TKA for the first time, extracted from the TKA registry in the Department of Orthopaedics and Traumatology, Hospital Canselor Tuanku Mukhriz. Data on pain status, and self-management, physical frailty, and instrumental activities daily living were also collected. Multiple linear regression analysis with a significant level of 0.05 was used to identify the association between waiting time and pain on physical frailty and functional performance.

RESULTS

Out of 180 had deferred TKA, 50% of them aged 50 years old and above, 80% were women with ethnic distribution Malay (66%), Chinese (22%), Indian (10%), and others (2%) respectively. Ninety-two percent of the participants took medication to manage their pain during the waiting time, while 10% used herbs and traditional supplements, and 68% did exercises as part of their osteoarthritis (OA) self-management. Thirty-six participants were found to have physical frailty (strength, assistance with walking, rising from a chair, climbing stairs, and falls questionnaire score > 4) which accounted for 72%. Increased pain was associated with physical frailty with odds ratio, odds ratio (95% confidence interval): 1.46 (1.04-2.05). This association remained significant even after the adjustment according to age and self-management.

CONCLUSION

While deferring TKA during a pandemic is unavoidable, patient monitoring for OA treatment during the waiting period is important in reducing physical frailty, ensuring the older patients' independence.

Baseline factors and reason for cancellation of elective ophthalmic surgery

OBJECTIVES

To determine the baseline risk factors for elective ophthalmic surgery cancellations and characterise the reasons for cancellation.

METHODS

This is a retrospective, non-randomised study performed at a large tertiary ophthalmic centre. It included a consecutive sample of patients above the age of 18 who had an ophthalmic surgery scheduled at Cole Eye Institute, Cleveland Clinic, OH between January 2012 and December 2019. An automated search pull identified 75,908 scheduled surgeries (63,987 completed and 11,921 cancelled surgeries). Statistical analysis was performed using R (version 3.5.1). Main outcome measures were baseline factors that impact risk for surgery cancellation and reasons for surgery cancellation.

RESULTS

Analysis was performed on 69,963 scheduled surgeries (57.37% Female, 42.63% Male; Mean age of 62.72 years; 59,959 completed and 10,004 cancelled surgeries). Of the 2384 cancelled surgeries with reasons provided, the most common causes of cancellation were patient refusal (38.42%), patient health condition (18.79%), and rescheduling of surgery (15.27%). Female sex, black race, patient age less than 50 years, non-cataract surgeries, regional mean household income greater than $82,900, Medicare insurance, and geographical distance of less than 10 miles from home to the surgery site were each associated with a significantly increased risk of surgery cancellation (p < 0.01).

CONCLUSIONS

This study successfully identified several baseline factors predicting elective ophthalmic surgery cancellation. The clinical insights gained from these lines of enquiry may be used to construct models that not only identify patients at greater risk for cancellation but also highlight which interventions have greatest efficacy in preventing ophthalmic surgery cancellations.

The impact of a preanesthesia assessment clinic on scheduled elective case cancelations at a Thai university hospital

Elective surgical case cancelations negatively impact healthcare systems and patient dissatisfaction. Preanesthesia assessment clinics (PACs) have been established in many countries to facilitate preoperative medical optimization. However, their benefits for elective procedure cancelations in Thailand have not been formally assessed. This study evaluated the impact of a PAC on scheduled elective surgical case cancelations at a Thai university hospital. A retrospective cross-sectional study was conducted for the period covering from May 2016 to April 2017. We included all scheduled elective surgical cases at Siriraj Hospital, Thailand, canceled on the day of surgery. The cancelation incidences of patients attending and not attending the PAC were compared. Cancellation reasons were categorized as "patient issue," "hospital-facility issue," "surgeon issue," "anesthesiologist issue," "medical condition," and "miscellaneous." The PAC patients' reasons were rigorously explored to determine their preventability. There were 30,351 scheduled elective procedures during the study period. The case-cancelation incidences were 0.9% (95% confidence interval [CI], 0.7-1.2%) for patients visiting the PAC and 5.9% (95% CI, 5.6-6.3%) for those who did not. Medical conditions were the most common reason for cancelation for non-PAC patients (27.3%), whereas hospital-facility issues were the most frequent for PAC patients (43.8%). The cancelation rate for patient issues was significantly lower in the PAC group (4.2% vs 20.7%; P < .05). Thirty-one (64.6%) of the PAC patients' cancelations were potentially preventable. Of the 15 PAC patient cancelations related to medical conditions, 12 were for patients with a history of acute illness and were determined to be nonpreventable. Visiting the PAC was significantly associated with a decreased elective-case cancelation rate. Cancellations were most frequently related to hospital-facility issues for patients visiting the PAC and medical conditions for those who did not. Some PAC patient cancelations for medical conditions involved unpreventable acute patient illnesses. Clinical Trials.gov (NCT02816281).

Surviving The Surge: Nonurgent Elective Procedures, Intensive Care, And Mississippi's COVID-19 Waves

During the COVID-19 pandemic in Mississippi in 2020 and 2021, nonurgent elective procedures requiring hospitalization were halted three times to preserve the state's hospital resources. To evaluate the change in hospital intensive care unit (ICU) capacity after the implementation of this policy, we analyzed Mississippi's hospital discharge data. We compared daily mean ICU admissions and census for nonurgent elective procedures between three intervention periods and baseline periods corresponding to Mississippi State Department of Health executive orders. We further evaluated the observed and predicted trends, using interrupted time series analyses. Overall, the executive orders reduced the mean number of ICU admissions for elective procedures from 13.4 patients to 9.8 patients daily (a 26.9 percent decline). This policy also decreased the mean ICU census for nonurgent elective procedures from 68.0 patients to 56.6 patients daily (a 16.8 percent decline). The state managed to free, on average, eleven ICU beds daily. Postponing nonurgent elective procedures in Mississippi was a successful strategy that resulted in a decline in ICU bed use for nonurgent elective surgeries during times of unprecedented stress on the health care system.

Same day discharge following elective, minimally invasive, colorectal surgery : A review of enhanced recovery protocols and early outcomes by the SAGES Colorectal Surgical Committee with recommendations regarding patient selection, remote monitoring, and successful implementation

BACKGROUND

As enhanced recovery programs (ERPs) have continued to evolve, the length of hospitalization (LOS) following elective minimally invasive colorectal surgery has continued to decline. Further refinements in multimodal perioperative pain management strategies have resulted in reduced opioid consumption. The interest in ambulatory colectomy has dramatically accelerated during the COVID-19 pandemic. Severe restrictions in hospital capacity and fear of COVID transmission forced surgical teams to rethink strategies to further reduce length of inpatient stay.

METHODS

Members of the SAGES Colorectal Surgery Committee began reviewing the emergence of SDD protocols and early publications for SDD in 2019. The authors met at regular intervals during 2020-2022 period reviewing SDD protocols, safe patient selection criteria, surrogates for postoperative monitoring, and early outcomes.

RESULTS

Early experience with SDD protocols for elective, minimally invasive colorectal surgery suggests that SDD is feasible and safe in well-selected patients and procedures. SDD protocols are associated with reduced opioid use and prescribing. Patient perception and experience with SDD is favourable. For early adopters, SDD has been the natural evolution of well-developed ERPs. Like all ERPs, SDD begins in the office setting, identifying the correct patient and procedure, aligning goals and objectives, and the perioperative education of the patient and their supporting significant others. A thorough discussion with the patient regarding expected activity levels, oral intake, and pain control post operatively lays the foundation for a successful application of SDD programs. These observations may not apply to all patient populations, institutions, practice types, or within the scope of an existing ERP. However, if the underlying principles of SDD can be incorporated into an existing institutional ERP, it may further reduce the incidence of post operative ileus, prolonged LOS, and improve the effectiveness of oral analgesia for postoperative pain management and reduced opioid use and prescribing.

CONCLUSIONS

The SAGES Colorectal Surgery Committee has performed a comprehensive review of the early experience with SDD. This manuscript summarizes SDD early results and considerations for safe and stepwise implementation of SDD with a specific focus on ERP evolution, patient selection, remote monitoring, and other relevant considerations based on hospital settings and surgical practices.

Incidence and Risk Factors for Patient-related Short-term Cancellation of Elective Arthroscopic Surgery: A Case-matched Study

Introduction:

Short-term cancellation of elective ambulatory orthopaedic surgery can result in disruption to the process flow of the operating room, with resultant negative financial implications for the health system. The risk factors for patient-related short-term cancellations within 24 hours of the surgical date have not been well defined.

Methods:

A retrospective review of a single orthopaedic surgery electronic internal database was done to identify all cancellations from January 1, 2016, through December 31, 2019, which were made within 24 hours of the surgical date. Inclusion criteria included elective arthroscopic procedures canceled solely for patient-related issues. Any cancellation for surgeon-related or ambulatory center–related reasons was excluded. Demographic patient and surgical data, including insurance type, employment status, previous history of cancellation for the same surgery, socioeconomic status based on the Area Deprivation Index, and surgery type, were tabulated. Each cancellation was matched 1:2 with noncanceled cases based on the anatomic site of the arthroscopy scheduled. Multivariable logistic regression was used to examine associations of patient demographic and medical characteristics with surgical cancellation.

Results:

There were 4,715 total arthroscopic procedures done during the study period, of which 126 (2.7%) were canceled within 24 hours of the surgery date. The mean age of the canceled cases was 44.9 ± 16.1 years (range, 14 to 77 years), with 46 females (43%) included. The presence of MRI of the involved joint within 6 months of surgery (adjusted odds ratio [aOR], 0.39, 95% confidence interval [CI], 0.17 to 0.91) and current employment (aOR, 0.56, 95% CI, 0.33-0.94) were independently predictive of noncancellation. Current smokers were more likely to cancel within 24 hours of surgery (aOR, 2.63, 95% CI, 1.4-4.9). Finally, having previously canceled the same surgery was significantly associated with a current surgical cancellation (P = 0.004).

Discussion:

Identification of the factors associated with short-term patient-related cancellation of elective arthroscopy may serve as the basis for preoperative interventions aimed specifically at those more likely to cancel. In turn, these interventions can minimize preventable cancellations.