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Wen ZL, Zhou X, Peng D. The effect of surgical starting time on elective colorectal cancer surgery: A propensity score matching analysis. Medicine (Baltimore) 2024; 103:e37072. [PMID: 38306533 PMCID: PMC10843472 DOI: 10.1097/md.0000000000037072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/14/2023] [Indexed: 02/04/2024] Open
Abstract
The purpose of the current study is to analyze whether surgical starting time affects the short-term outcomes of elective colorectal cancer (CRC) surgery. We retrospectively collected CRC patients who underwent elective surgery from Jan 2008 to Jan 2021 in a single clinical center. The effect of surgical starting time (morning surgery vs afternoon surgery, day surgery vs night surgery) on elective CRC surgery was analyzed using propensity score matching (PSM). A total of 6783 patients were included in the current study. There were 5751 patients in day surgery group and 1032 patients in night surgery group, and there were 2920 patients in morning surgery group and 2831 patients in afternoon surgery group. After 1:1 ratio PSM, there were no significant difference in terms of the baseline information (P > .05). Day surgery group had longer operation time (P = .000) and longer hospital stay (P = .029) than night surgery group after PSM. Morning surgery group had longer operation time than afternoon surgery group before PSM (P = .000) and after PSM (P = .000). Univariate and multivariate analysis of the total of 6783 patients were conducted to find predictors of complications, and found that night surgery was a predictor of major complications (P = .002, OR = 1.763, 95% CI = 1.222-2.543) but not a predictor of overall complications (P = .250, OR = 1.096, 95% CI = 0.938-1.282). Night surgery is a predictor of major complications after elective CRC surgery, therefore, surgeons should be careful when operating at night.
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Affiliation(s)
- Ze-Lin Wen
- Department of Gastrointestinal Surgery, Yongchuan Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiong Zhou
- Department of Gastrointestinal Surgery, Yongchuan Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Ginestra JC, Kohn R, Hubbard RA, Auriemma CL, Patel MS, Anesi GL, Kerlin MP, Weissman GE. Association of Time of Day with Delays in Antimicrobial Initiation among Ward Patients with Hospital-Onset Sepsis. Ann Am Thorac Soc 2023; 20:1299-1308. [PMID: 37166187 PMCID: PMC10502885 DOI: 10.1513/annalsats.202302-160oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/09/2023] [Indexed: 05/12/2023] Open
Abstract
Rationale: Although the mainstay of sepsis treatment is timely initiation of broad-spectrum antimicrobials, treatment delays are common, especially among patients who develop hospital-onset sepsis. The time of day has been associated with suboptimal clinical care in several contexts, but its association with treatment initiation among patients with hospital-onset sepsis is unknown. Objectives: Assess the association of time of day with antimicrobial initiation among ward patients with hospital-onset sepsis. Methods: This retrospective cohort study included ward patients who developed hospital-onset sepsis while admitted to five acute care hospitals in a single health system from July 2017 through December 2019. Hospital-onset sepsis was defined by the Centers for Disease Control and Prevention Adult Sepsis Event criteria. We estimated the association between the hour of day and antimicrobial initiation among patients with hospital-onset sepsis using a discrete-time time-to-event model, accounting for time elapsed from sepsis onset. In a secondary analysis, we fit a quantile regression model to estimate the association between the hour of day of sepsis onset and time to antimicrobial initiation. Results: Among 1,672 patients with hospital-onset sepsis, the probability of antimicrobial initiation at any given hour varied nearly fivefold throughout the day, ranging from 3.0% (95% confidence interval [CI], 1.8-4.1%) at 7 a.m. to 13.9% (95% CI, 11.3-16.5%) at 6 p.m., with nadirs at 7 a.m. and 7 p.m. and progressive decline throughout the night shift (13.4% [95% CI, 10.7-16.0%] at 9 p.m. to 3.2% [95% CI, 2.0-4.0] at 6 a.m.). The standardized predicted median time to antimicrobial initiation was 3.2 hours (interquartile range [IQR], 2.5-3.8 h) for sepsis onset during the day shift (7 a.m.-7 p.m.) and 12.9 hours (IQR, 10.9-14.9 h) during the night shift (7 p.m.-7 a.m.). Conclusions: The probability of antimicrobial initiation among patients with new hospital-onset sepsis declined at shift changes and overnight. Time to antimicrobial initiation for patients with sepsis onset overnight was four times longer than for patients with onset during the day. These findings indicate that time of day is associated with important care processes for ward patients with hospital-onset sepsis. Future work should validate these findings in other settings and elucidate underlying mechanisms to inform quality-enhancing interventions.
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Affiliation(s)
- Jennifer C. Ginestra
- Division of Pulmonary, Allergy and Critical Care
- Palliative and Advanced Illness Research Center
- Leonard Davis Institute of Health Economics, and
| | - Rachel Kohn
- Division of Pulmonary, Allergy and Critical Care
- Palliative and Advanced Illness Research Center
- Leonard Davis Institute of Health Economics, and
| | - Rebecca A. Hubbard
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Catherine L. Auriemma
- Division of Pulmonary, Allergy and Critical Care
- Palliative and Advanced Illness Research Center
- Leonard Davis Institute of Health Economics, and
| | | | - George L. Anesi
- Division of Pulmonary, Allergy and Critical Care
- Palliative and Advanced Illness Research Center
- Leonard Davis Institute of Health Economics, and
| | - Meeta Prasad Kerlin
- Division of Pulmonary, Allergy and Critical Care
- Palliative and Advanced Illness Research Center
- Leonard Davis Institute of Health Economics, and
| | - Gary E. Weissman
- Division of Pulmonary, Allergy and Critical Care
- Palliative and Advanced Illness Research Center
- Leonard Davis Institute of Health Economics, and
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; and
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Pogorelić Z, Janković Marendić I, Čohadžić T, Jukić M. Clinical Outcomes of Daytime Versus Nighttime Laparoscopic Appendectomy in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040750. [PMID: 37189999 DOI: 10.3390/children10040750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023]
Abstract
Aim of the study: To evaluate the clinical outcomes and complication rate of laparoscopic appendectomy in children operated on during the daytime versus nighttime. Methods: A total of 303 children who underwent laparoscopic appendectomy for acute appendicitis between 1 January 2020 and 31 December 2022 were enrolled in this retrospective study. The patients were divided into two study groups. The first group consisted of the patients who underwent laparoscopic appendectomy during the day shift from 07:00-21:00 (n = 171), while the patients in the second group underwent laparoscopic appendectomy during the night shift from 21:00-07:00 (n = 132). The groups were compared for baseline clinical and laboratory data, treatment outcomes, and complications. The Mann-Whitney U test was used to compare continuous variables, while the Chi-square test was used to compare categorical variables. A two-sided Fisher's exact test was used when the frequency of events in a certain cell was low. All p values less than 0.05 were considered significant. Results: The proportion of complicated appendicitis was almost the same in both patient groups (n = 63, 36.8% vs. n = 49, 37.1%, p = 0.960). Out of the total number of patients presenting during the daytime and nighttime, 11 (6.4%) and 10 (7.6%) developed a postoperative complication, respectively (p = 0.697). Additionally, rates of readmission (n = 5 (2.9%) vs. n = 2 (1.5%); p = 0.703), redo-surgery (n = 3 (1.7%) vs. n = 0; p = 0.260), conversion to open surgery (n = 0 vs. n = 1 (0.8%); p = 0.435) and length of hospital stay (n = 3 (IQR 1, 5) vs. n = 3 (IQR 2, 5); p = 0.368) did not differ significantly between daytime and nighttime appendectomies. The duration of the surgery was significantly shorter in patients presenting during the day than in those presenting at night (26 min (IQR 22, 40) vs. 37 min (31, 46); p < 0.001). Conclusions: Different shift times did not affect the treatment outcomes or complication rates for children receiving laparoscopic appendectomy.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, 21000 Split, Croatia
- Department of Surgery, School of Medicine, University of Split, 21000 Split, Croatia
| | | | - Tin Čohadžić
- Department of Pediatric Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Miro Jukić
- Department of Pediatric Surgery, University Hospital of Split, 21000 Split, Croatia
- Department of Surgery, School of Medicine, University of Split, 21000 Split, Croatia
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Tu Y, Ning Y, Li K, Pan Z, Xie J, Yang S, Zhang Y. After-hour elective total knee arthroplasty does not affect clinical outcomes but negatively affects alignment. Arch Orthop Trauma Surg 2023; 143:2129-2134. [PMID: 35614348 DOI: 10.1007/s00402-022-04490-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/16/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In cases of limited medical resources, elective total knee arthroplasty (TKA) sometimes needs to be performed after typical work hours. However, surgeon fatigue and logistical factors may potentially affect outcomes. This study aimed to detect whether after-hour procedures impair outcomes after TKA. MATERIALS AND METHODS Elective unilateral TKA from Jan 1, 2016 to Nov 31, 2018 was retrospectively selected and separated into two groups. Procedures started from 8:00 A.M. to 5:29 P.M. were identified as day-time surgeries, whereas those started from 5:30 P.M. to 11:59 P.M. were considered after-hour surgeries. Operative period, Knee Society Score (KSS), range of motion (ROM), total blood loss, length of hospital stay (LOS), and postoperative adverse events and complications were compared. Additionally, the components were evaluated radiologically. RESULTS A total of 321 patients were selected, including 258 (80.37%) patients in the day-time group and 63 (19.63%) patients in the after-hour group. Operative period, LOS, total blood loss were similar between groups. The overall and each specific incidence of postoperative complications were comparable between the two groups, but the incidence of postoperative vomiting (POV) was higher in the after-hour group. There was no significant difference in knee joint function as shown by the KSS and ROM, both on the 3rd day and at 2 years after surgeries. Radiologically, there were no significant differences between the two groups in the femoral notches (P = 0.592). However, better coronal alignment was detected in the day-time group (P = 0.002), consistent with which there were less outliers (P = 0.033). CONCLUSION After-hour TKA procedure does not exert an impact on clinical outcomes, but negatively affects lower limb alignment. Besides, after-hour TKA surgery impairs patients' comfort by increasing POV.
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Affiliation(s)
- Yuesheng Tu
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Yanhong Ning
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Kangxian Li
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Zhijie Pan
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Jiajun Xie
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Sheng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China
| | - Yang Zhang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China.
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Knio ZO, Zhang L, Watts DA, Zuo Z. Late surgical start time is associated with increased blood transfusion following gastric bypass surgery. PLoS One 2023; 18:e0282139. [PMID: 36827326 PMCID: PMC9956042 DOI: 10.1371/journal.pone.0282139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Surgical start time (SST) has demonstrated conflicting effects on perioperative outcomes due to confounding factors, such as increased acuity in later SST cases. This study investigated the effect of SST on blood transfusion after gastric bypass surgery, a complication-prone elective surgical procedure. METHODS This retrospective cohort study included all patients undergoing gastric bypass surgery at a single academic medical center from 2016 through 2021 (n = 299). The primary independent variable was SST (before vs. after 15:00). The primary outcome was blood transfusion. Secondary outcomes included postoperative respiratory failure, length of stay, acute kidney injury, and mortality. The associations between SST and outcomes were investigated with univariate analyses. Multivariate and receiver operating characteristic (ROC) analyses were applied to the primary outcome, adjusting for demographic and operative characteristics. RESULTS On univariate analysis, 15:00-18:43 SST was associated with an increased risk of blood transfusion (relative risk 4.32, 95% confidence interval 1.27 to 14.63, p = 0.032), but not postoperative respiratory failure, acute kidney injury, length of stay, or mortality. On multivariate analysis, the only independent predictor of postoperative blood transfusion was a 15:00-18:43 SST (adjusted odds ratio 4.32, 95% confidence interval 1.06 to 15.96, c-statistic = 0.638). ROC analysis demonstrated that compared to the 15:00 threshold, a 14:34 threshold predicted postoperative blood transfusion with better accuracy (sensitivity = 70.0%, specificity = 83.0%). CONCLUSIONS Despite having similar demographic and operative characteristics, gastric bypass patients in the late SST cohort had a greater incidence of postoperative blood transfusion in this single-center study.
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Affiliation(s)
- Ziyad O. Knio
- Department of Anesthesiology, University of Virginia Health, Charlottesville, VA, United States of America
| | - Lena Zhang
- Department of Anesthesiology, University of Virginia Health, Charlottesville, VA, United States of America
| | - David A. Watts
- School of Medicine, University of Virginia, Charlottesville, VA, United States of America
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia Health, Charlottesville, VA, United States of America
- * E-mail:
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Association of Surgical Start Time with Outcomes of Benign Hysterectomy. J Minim Invasive Gynecol 2023; 30:389-396. [PMID: 36708764 DOI: 10.1016/j.jmig.2023.01.008] [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: 10/19/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVE To evaluate whether surgical start time is associated with clinical and financial outcomes of hysterectomies performed for benign indications. DESIGN Retrospective cohort study. SETTING University 5-hospital healthcare system. PATIENTS Women who underwent benign hysterectomy between 2014 and 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed demographic, operative, and financial data to evaluate the relationships between surgical start time and perioperative outcomes including operating room time, estimated blood loss, length of stay, same-day discharge, and adverse perioperative events. Additionally, we evaluated the impact of surgical start time on total hysterectomy charges. Descriptive statistics and multivariate logistic and linear regressions were performed adjusting for confounders. Our study identified 2894 women who underwent benign hysterectomy, with 1910 hysterectomies starting prior to 12 pm (am group) and 984 hysterectomies starting after 12 pm (pm group). A pm start time was associated with higher estimated blood loss (Median 100, interquartile range 50, 200 in the am group vs Median 125, interquartile range 75, 250), increased length of stay, and decreased likelihood of same-day discharge. No significant differences were noted in the rates of adverse perioperative events between the 2 groups. Surprisingly, an afternoon start time was associated with decreased total hospital charges (median am $14 055.30 versus median pm $11 724.80). These cost differences persisted after multivariate linear regression, and when stratified by hysterectomy surgical approach, remained significant in the open and laparoscopic cohorts. CONCLUSION Afternoon hysterectomy start time is associated with increased blood loss and length of stay with decreased rates of same-day discharge; however, there was no associated increase in perioperative adverse events or mortality. Awareness regarding surgical start time and outcomes can guide surgical scheduling and optimize same-day discharge.
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Does the timing of appendectomy affect outcomes and postoperative complications? Pediatr Surg Int 2023; 39:90. [PMID: 36695901 DOI: 10.1007/s00383-023-05369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE There is controversy about the necessity of nighttime appendectomy. The aim of this study was to determine whether timing of appendectomy performance plays a role on postoperative complications. METHODS A retrospective single-center comparative study was performed in children who underwent surgery for acute appendicitis between 2017 and 2021. Patients were divided into groups based on the time slot in which surgery was performed: morning (8:00 h-15:00 h), afternoon (15:00 h-22:00 h) and night (22:00 h-08:00 h). Demographics, intraoperative data, length of hospital stay, and postoperative complications were analyzed and compared. RESULTS A total of 1643 patients were included: 337 were operated in the morning, 751 in the afternoon and 555 at night. We found no demographic differences. When comparing the intraoperative data, no differences were observed in the percentage of complicated appendicitis. Night group patients presented a higher percentage of open appendectomies (64.5%) when compared to afternoon (49.6%) and morning (46.2%) groups (p < 0.001). Surgery time was also significantly shorter in the night group (45.2 min ± 18.9 min) (p < 0.001). There were no differences in length of hospital stay, postoperative complications rate or readmission rate. CONCLUSION These results show that in our institution time slot in which the appendectomy is performed has no consequences in postoperative outcomes and complications.
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Lecour S, Du Pré BC, Bøtker HE, Brundel BJJM, Daiber A, Davidson SM, Ferdinandy P, Girao H, Gollmann-Tepeköylü C, Gyöngyösi M, Hausenloy DJ, Madonna R, Marber M, Perrino C, Pesce M, Schulz R, Sluijter JPG, Steffens S, Van Linthout S, Young ME, Van Laake LW. Circadian rhythms in ischaemic heart disease: key aspects for preclinical and translational research: position paper of the ESC working group on cellular biology of the heart. Cardiovasc Res 2022; 118:2566-2581. [PMID: 34505881 DOI: 10.1093/cvr/cvab293] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/04/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022] Open
Abstract
Circadian rhythms are internal regulatory processes controlled by molecular clocks present in essentially every mammalian organ that temporally regulate major physiological functions. In the cardiovascular system, the circadian clock governs heart rate, blood pressure, cardiac metabolism, contractility, and coagulation. Recent experimental and clinical studies highlight the possible importance of circadian rhythms in the pathophysiology, outcome, or treatment success of cardiovascular disease, including ischaemic heart disease. Disturbances in circadian rhythms are associated with increased cardiovascular risk and worsen outcome. Therefore, it is important to consider circadian rhythms as a key research parameter to better understand cardiac physiology/pathology, and to improve the chances of translation and efficacy of cardiac therapies, including those for ischaemic heart disease. The aim of this Position Paper by the European Society of Cardiology Working Group Cellular Biology of the Heart is to highlight key aspects of circadian rhythms to consider for improvement of preclinical and translational studies related to ischaemic heart disease and cardioprotection. Applying these considerations to future studies may increase the potential for better translation of new treatments into successful clinical outcomes.
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Affiliation(s)
- Sandrine Lecour
- Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Bastiaan C Du Pré
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bianca J J M Brundel
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Andreas Daiber
- Department of Cardiology, Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Peter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Henrique Girao
- Faculty of Medicine, Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Center for Innovative Biomedicine and Biotechnology (CIBB), Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal
| | | | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan
| | - Rosalinda Madonna
- Institute of Cardiology, University of Pisa, Pisa, Italy
- Department of Internal Medicine, University of Texas Medical School in Houston, Houston, TX, USA
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Rainer Schulz
- Institute of Physiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Joost P G Sluijter
- Department of Cardiology, Experimental Cardiology Laboratory, Regenerative Medicine Center, Circulatory Health Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sabine Steffens
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sophie Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies & Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Berlin 10178, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Martin E Young
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Linda W Van Laake
- Cardiology and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Hong GS, Lee CW, Lee JH, Kim B, Lee JB. Clinical Impact of a Quality Improvement Program Including Dedicated Emergency Radiology Personnel on Emergency Surgical Management: A Propensity Score-Matching Study. Korean J Radiol 2022; 23:878-888. [PMID: 35926842 PMCID: PMC9434742 DOI: 10.3348/kjr.2022.0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the clinical impact of a quality improvement program including dedicated emergency radiology personnel (QIP-DERP) on the management of emergency surgical patients in the emergency department (ED). Materials and Methods This retrospective study identified all adult patients (n = 3667) who underwent preoperative body CT, for which written radiology reports were generated, and who subsequently underwent non-elective surgery between 2007 and 2018 in the ED of a single urban academic tertiary medical institution. The study cohort was divided into periods before and after the initiation of QIP-DERP. We matched the control group patients (i.e., before QIP-DERP) to the QIP-DERP group patients using propensity score (PS), with a 1:2 matching ratio for the main analysis and a 1:1 ratio for sub-analyses separately for daytime (8:00 AM to 5:00 PM on weekdays) and after-hours. The primary outcome was timing of emergency surgery (TES), which was defined as the time from ED arrival to surgical intervention. The secondary outcomes included ED length of stay (LOS) and intensive care unit (ICU) admission rate. Results According to the PS-matched analysis, compared with the control group, QIP-DERP significantly decreased the median TES from 16.7 hours (interquartile range, 9.4–27.5 hours) to 11.6 hours (6.6–21.9 hours) (p < 0.001) and the ICU admission rate from 33.3% (205/616) to 23.9% (295/1232) (p < 0.001). During after-hours, the QIP-DERP significantly reduced median TES from 19.9 hours (12.5–30.1 hours) to 9.6 hours (5.7–19.1 hours) (p < 0.001), median ED LOS from 9.1 hours (5.6–16.5 hours) to 6.7 hours (4.9–11.3 hours) (p < 0.001), and ICU admission rate from 35.5% (108/304) to 22.0% (67/304) (p < 0.001). Conclusion QIP-DERP implementation improved the quality of emergency surgical management in the ED by reducing TES, ED LOS, and ICU admission rate, particularly during after-hours.
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Affiliation(s)
- Gil-Sun Hong
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choong Wook Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Ju Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bona Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Bok Lee
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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10
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Lin ICF, Yoon AP, Kong L, Wang L, Chung KC. Association Between Daytime vs Overnight Digit Replantation and Surgical Outcomes. JAMA Netw Open 2022; 5:e2229526. [PMID: 36048443 PMCID: PMC9437749 DOI: 10.1001/jamanetworkopen.2022.29526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Recent evidence suggests that select delayed replantation may not adversely affect digit survival; however, whether surgical timing (overnight or daytime) is associated with digit replantation outcomes is unknown. OBJECTIVE To assess whether digit survival, complication rate, and duration of surgery are associated with time of replantation. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series study included all replantations performed at a single tertiary referral academic center between January 1, 2000, and August 1, 2021. Data were analyzed between October 2, 2021, and January 1, 2022. Four daytime surgery intervals were selected based on literature review. Daytime replantations started within the intervals whereas overnight replantations began outside the intervals. For each case, the procedure difficulty score and the attending surgeon expertise score were calculated. Logistic and linear regressions adjusting for confounders including procedure difficulty score and expertise score were used to assess surgical timing and outcomes. Participants were adults (aged ≥18 years) undergoing digit replantations between January 2000 and August 2021 with at least 1-month follow-up. Replantation was defined as the reattachment of a completely amputated digit that necessitated anastomosis of both artery and vein. EXPOSURES Daytime or overnight digit replantation. MAIN OUTCOMES AND MEASURES Viable replanted digit at 1-month follow-up, number of complications, and duration of surgery. RESULTS A total of 98 patients (mean [SD] age, 39.5 [15.3] years; 136 [93%] men) and 147 digits met inclusion criteria. Overall success rate was 55%. Between 4 pm and 7 am, overnight replantations were associated with 0.4 fewer complications (β, -0.4; 95% CI, -0.8 to -0.1) and 90.7 minutes shorter operative time (β, -90.7; 95% CI, -173.6 to -7.7). A 1-point increase in surgeon expertise score was associated with 1.7 times increased odds of replantation success for all intervals (adjusted odds ratio, 1.7; 95% CI, 1.2 to 2.4; P = .002). There were no differences in digit survival by surgical time. CONCLUSIONS AND RELEVANCE In this case series study of digit replantations, time of operation was not associated with replantation success. Overnight replantation was associated with fewer complications and shorter duration of surgery compared with daytime surgery. Results of this study suggest that overnight replantations may be performed with outcomes comparable to daytime replantations at a tertiary care academic center.
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Affiliation(s)
- I-Chun F. Lin
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Alfred P. Yoon
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
| | - Lingxuan Kong
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor
| | - Lu Wang
- School of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor
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A-Lai GH, Hu JR, Xu ZJ, Yao P, Zhong X, Wang YC, Lin YD. Whether the start time of elective lung surgery impacts perioperative outcomes and cost? Front Surg 2022; 9:922198. [PMID: 36090328 PMCID: PMC9448901 DOI: 10.3389/fsurg.2022.922198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundFatigue and the long work hours of surgeons have attracted increasing concern in recent years. We aimed to explore whether starting time was associated with perioperative outcomes and cost for elective lung surgery.MethodsA retrospective study was conducted on elective lung surgery patients at a high surgery-volume center between September 2019 and November 2019. Patients were divided into the “early start group” if the surgery start time was before 4 post meridiem (pm), while the “late start group” was defined as surgery started after 4 pm. Perioperative outcomes and total hospital costs were compared between the two groups. In addition, multivariable logistic regression analysis was performed to identify whether start time was a risk factor for postoperative hospital duration, total hospital cost and length of operation time.ResultsA total of 398 patients were finally enrolled for analysis in this study. Of all the cases, 295 patients were divided into the early start group, while 103 patients belonged to the late start group. Baseline characteristics were all comparable between the two groups. Concerning Regarding outcomes, there were no differences in postoperative hospital duration, operation time, complication incidence or and other outcomes, while the total hospital cost tended to be different but still not significantly different without statistical significance (P = 0.07). In multivariable logistic regression analysis, surgery starting late was still not found to be a risk factor for long postoperative hospital duration, high hospital cost and long surgery time.ConclusionIn elective lung surgery, perioperative outcomes and costs were similar between the early- and late-start groups, and it was not necessary to worry about the surgery order for these patients.
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Affiliation(s)
- Gu-Ha A-Lai
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian-Rong Hu
- Operating Room of Anesthesia Surgery Center, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Zhi-Jie Xu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Peng Yao
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xia Zhong
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yu-Cheng Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi-Dan Lin
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
- Correspondence: Yi-Dan Lin
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'Out of hours' orthopaedics in an Irish regional trauma unit and the impact of COVID-19. Ir J Med Sci 2022:10.1007/s11845-022-03135-2. [PMID: 35999484 PMCID: PMC9398037 DOI: 10.1007/s11845-022-03135-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022]
Abstract
Introduction MRHT is the regional trauma service for the Midlands, providing 24/7 orthopaedic cover. ‘Out of hours’ surgery is reserved for those occasions where waiting for the next operating list during normal working hours would result in an unacceptable outcome for the patient. Aims To identify how many ‘out-of-hours’ surgeries were performed and what proportion of the total workload was made up by these cases. Secondly, to identify the impact of COVID-19 on our workload as an acute trauma service. Methods We performed a retrospective analysis of all operations performed in the emergency orthopaedic theatre between January 2017 and October 2020. Included were all emergency orthopaedic procedures performed after 6 p.m. and before 8 a.m. We compared this to the total number of trauma surgeries performed in the same time period to calculate the percentage of our total operations. Results There were a total of 7615 orthopaedic trauma operations performed in the 193 weeks. 164 of these were ‘out-of-hours’. This represents 2.2% of the total operations performed and is equal to 0.84 cases per week. 55 of the 164 (33.5%) were performed in children under the age of 18. 62 were performed between 6 and 8 p.m., 61 between 8 and 10 p. m., 31 between 10 p.m. and midnight, and the remaining 10 were performed between midnight and 3 a.m. Conclusion Surgery out of hours has been associated with increased complications, and so decisions to perform emergency surgery should not be made lightly. However, sometimes they are unfortunately necessary and are some of the most important operations we can perform as orthopaedic surgeons.
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13
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Too Many Cooks in the Kitchen. AORN J 2022; 116:211-213. [PMID: 35880928 DOI: 10.1002/aorn.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/06/2022]
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14
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Kabir T, Syn NL, Shaw V, Tan YHA, Chua HW, Ong LWL, Koh FH, Ladlad J, Barco JB, Wang P, Kui Y, Blasiak A, Zhao JJ, Ho D, Kam JH, Ngaserin S. Defining the optimal time to appendectomy: A step toward precision surgery. Surgery 2022; 172:798-806. [PMID: 35850731 DOI: 10.1016/j.surg.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/06/2022] [Accepted: 04/09/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND We aimed to investigate the association between time from admission to appendectomy on perioperative outcomes in order to determine optimal time-to-surgery windows. METHODS We performed a retrospective review of all the appendectomies performed between July 2018 to May 2020. We first compared the perioperative outcomes using preselected time-to-surgery cut-offs, then determined optimal safe windows for surgery, and finally identified subgroups of patients who may require early intervention. RESULTS Six hundred twenty-one appendectomies were performed in the time period. The patients with a time-to-surgery of ≥12 hours had a significantly longer length of stay (median 2 days [interquartile range 1-3] vs 3 days [interquartile range 2-4], mean difference = 0.74 [95% confidence interval 0.32-1.17, P = .0006]) and higher 30-day readmission risk (odds ratio 2.58, 95% confidence interval 1.12-5.96, P = .0266) versus those with a time-to-surgery of <12 hours. These differences persisted when the time-to-surgery was dichotomized by <24 or ≥24 hours. A time-to-surgery beyond 25 hours was associated with a 3.34-fold increased odds of open conversion (P = .040), longer operation time (mean difference 15.8 mins, 95% confidence interval 3.4-28.3, P = .013) and longer postoperative length of stay (mean difference 10.3 hours, 95% confidence interval 3.4-20.2, P = .042) versus a time-to-surgery of <25 hours. The patients with time-to-surgery beyond 11 hours had a 1.35-fold increased odds of 30-day readmission (95% confidence interval 1.02-5.43, P = .046) compared with those who underwent appendectomy before 11 hours. Older patients, patients with American Society of Anesthesiologist score II to III, and individuals with long duration of preadmission symptoms had higher risk of prolonged operation time, open conversion, increased length of stay, and postoperative morbidity with increasing time-to-surgery. CONCLUSION This study identified the safe windows for appendectomy to be 11 to 25 hours from admission for most perioperative outcomes. However, certain patient subgroups may be less tolerant of surgical delays.
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Affiliation(s)
- Tousif Kabir
- Department of General Surgery, Sengkang General Hospital, Singapore.
| | - Nicholas L Syn
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore. https://twitter.com/Nicholas_Syn
| | - Vera Shaw
- Department of General Surgery, Sengkang General Hospital, Singapore
| | | | - Hui Wen Chua
- Department of General Surgery, Sengkang General Hospital, Singapore
| | | | - Frederick H Koh
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Jasmine Ladlad
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Jason Bae Barco
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Peter Wang
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore; The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - You Kui
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore; The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Agata Blasiak
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore; The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Biomedical Engineering, NUS Engineering, National University of Singapore, Singapore
| | - Joseph J Zhao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Dean Ho
- The N.1 Institute for Health (N.1), National University of Singapore, Singapore; The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Biomedical Engineering, NUS Engineering, National University of Singapore, Singapore
| | - Juinn Huar Kam
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - Sabrina Ngaserin
- Department of General Surgery, Sengkang General Hospital, Singapore
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Levy HA, Karamian BA, Vijayakumar G, Gilmore G, Canseco JA, Radcliff KE, Kurd MF, Rihn JA, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. The impact of case order and intraoperative staff changes on spine surgical efficiency. Spine J 2022; 22:1089-1099. [PMID: 35121151 DOI: 10.1016/j.spinee.2022.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite concerted efforts toward quality improvement in high-volume spine surgery, there remains concern that increases in case load may compromise the efficient and safe delivery of surgical care. There is a paucity of evidence to describe the effects of spine case order and operating room (OR) team structure on measures of intraoperative timing and OR efficiency. PURPOSE This study aims to determine if intraoperative staff changes and surgical case order independently predict extensions in intraoperative timing after spinal surgery for spondylotic diseases. STUDY DESIGN/ SETTING Retrospective cohort analysis PATIENT SAMPLE: All patients over age 18 who underwent primary or revision decompression and/or fusion for degenerative spinal diseases between 2017 to 2019 at a single academic institution were retrospectively identified. Exclusion criteria included absence of descriptive data and intraoperative timing parameters as well as surgery for traumatic injury, infection, and malignancy. OUTCOME MEASURES Intraoperative timing metrics including total theater time, wheels in to induction, induction start to cut, cut to close, and close to wheels out. Postoperative outcomes included length of hospital stay and 90-day hospital readmissions. METHODS Surgical case order and intraoperative changes in staff (circulator and surgical scrub nurse or technician) were determined. Patient demographics, surgical factors, intraoperative timing and postoperative outcomes were recorded. Extensions in each operative stage were determined as a ratio of the actual duration of the parameter divided by the predicted duration of the parameter. Univariate and multivariate analyses were performed to compare outcomes within case order and staff change groups. RESULTS A total of 1,108 patients met the inclusion criteria. First, second, and third start cases differed significantly in intraoperative extensions of total theater time, wheels in to induction, induction start to cut, cut to close, and close to wheels out. On regression, decreasing case order predicted extension in wheels in to induction time. Surgeries with intraoperative staff changes were associated with increases in total theater time, induction start to cut time, cut to close time, close to wheels out time, and length of hospital stay. Switch in primary circulator predicted extended theater time and cut to close time. Relief of primary circulator or scrub predicted extended total theater time, induction start to cut time, cut to close time, and close to wheels out time. CONCLUSIONS Intraoperative staff change in spine surgery independently predicted extended operative duration. However, higher case order was not significantly associated with procedural time.
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Affiliation(s)
- Hannah A Levy
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A Karamian
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Gayathri Vijayakumar
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Griffin Gilmore
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A Canseco
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kris E Radcliff
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark F Kurd
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeffrey A Rihn
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S Hilibrand
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K Kepler
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D Schroeder
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Exploring Potential Schedule-Related and Gender Biases in Ophthalmology Residency Interview Scores. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2022. [DOI: 10.1055/s-0042-1744272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Abstract
Purpose Prior studies have revealed grading discrepancies in evaluation of personal statements and letters of recommendation based on candidate's race and gender. Fatigue and the end-of-day phenomenon can negatively impact task performance but have not been studied in the residency selection process. Our primary objective is to determine whether factors related to interview time and day as well as candidate's and interviewer's gender have a significant effect on residency interview scores.
Methods Seven years of ophthalmology residency candidate evaluation scores from 2013 to 2019 were collected at a single academic institution, standardized by interviewer into relative percentiles (0–100 point grading scale), and grouped into the following categories for comparisons: different interview days (Day 1 vs. Day 2), morning versus afternoon (AM vs. PM), interview session (Day 1 AM/PM vs. Day 2 AM/PM), before and after breaks (morning break, lunch break, and afternoon break), residency candidate's gender, and interviewer's gender.
Results Candidates in the morning sessions were found to have higher scores than afternoon sessions (52.75 vs. 49.28, p < 0.001). Interview scores in the early morning, late morning, and early afternoon were higher than late afternoon scores (54.47, 53.01, 52.15 vs. 46.74, p < 0.001). Across all interview years, there were no differences in scores received before and after morning breaks (51.71 vs. 52.83, p = 0.49), lunch breaks (53.01 vs. 52.15, p = 0.58), and afternoon breaks (50.35 vs. 48.30, p = 0.21). No differences were found in scores received by female versus male candidates (51.55 vs. 50.49, p = 0.21) or scores given by female versus male interviewers (51.31 vs. 50.84, p = 0.58).
Conclusion Afternoon residency candidate interview scores, especially late afternoon, were significantly lower than morning scores, suggesting the need to further study the effects of interviewer's fatigue in the residency interview process. The interview day, presence of break times, candidate's gender, and interviewer's gender had no significant effects on interview score.
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Nasseri Y, Oka K, Kasheri E, Cohen J, Ellenhorn J, Cox B, Lee A, Barnajian M. Robotic colorectal procedures: does operative start time impact short-term outcome? Surg Endosc 2022; 36:5669-5675. [PMID: 35277768 DOI: 10.1007/s00464-022-09086-0] [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: 04/05/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Previous publications revealed more complications in afternoon versus morning surgeries. With much attention given to robotic surgery outcomes, we sought to evaluate whether morning versus afternoon start time matters. METHODS In a retrospective review of a prospective database, 210 robotic colorectal surgeries were grouped into 97 morning versus 113 afternoon cases. Preoperative risk factors, intraoperative events, and 30-day postoperative outcomes were compared. An independent samples t-test, Fisher's exact test, and linear regression were used for categorical and continuous variables. RESULTS Morning patients were significantly younger than afternoon patients (59.5 vs. 65.5, p = 0.004), but there were no significant differences in gender, mean BMI, Charlson Comorbidity Index score, total operative time, console time, estimated blood loss, indications for surgery, and resection type. Morning patients had a significantly shorter mean length of stay (6.0 vs. 8.0 days, p = 0.021), but no significant differences in overall postoperative complications (0.30 vs. 0.30, p = 0.715), wound infection (5.2% vs. 7.1%, p = 0.564), anastomotic leak (0% vs. 2.7%, p = 0.251), ileus/small bowel obstruction (29.9% vs. 22.1%, p = 0.199), and 30-day readmission (8.2% vs. 7.1%, p = 1.000). When analyzing time of day as a continuous variable, we found no significant associations with intra- or postoperative complications. CONCLUSION We found no correlation between surgery start time and intra- or postoperative outcomes. This can be partly attributed to these cases being non-emergent and performed primarily by two experienced surgeons with highly trained operating room robotic staff in a large volume tertiary center. This, along with decreased fatigue attributed to superior ergonomics of robotic surgery, may have mitigated previously reported differences between morning and afternoon procedures.
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Affiliation(s)
- Yosef Nasseri
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA. .,Department of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Kimberly Oka
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
| | - Eli Kasheri
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
| | - Jason Cohen
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA.,Department of General Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Joshua Ellenhorn
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA.,Department of Surgical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Brian Cox
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anderson Lee
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA
| | - Moshe Barnajian
- Surgery Group of Los Angeles, 8635 West 3rd Street, Suite 880W, Los Angeles, CA, 90048, USA.,Department of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Li J. Revisiting delayed appendectomy in patients with acute appendicitis. World J Clin Cases 2021; 9:5372-5390. [PMID: 34307591 PMCID: PMC8281431 DOI: 10.12998/wjcc.v9.i20.5372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
Acute appendicitis (AA) is the most common acute abdomen, and appendectomy is the most common nonelective surgery performed worldwide. Despite the long history of understanding this disease and enhancements to medical care, many challenges remain in the diagnosis and treatment of AA. One of these challenges is the timing of appendectomy. In recent decades, extensive studies focused on this topic have been conducted, but there have been no conclusive answers. From the onset of symptoms to appendectomy, many factors can cause delay in the surgical intervention. Some are inevitable, and some can be modified and improved. The favorable and unfavorable results of these factors vary according to different situations. The purpose of this review is to discuss the causes of appendectomy delay and its risk-related costs. This review also explores strategies to balance the positive and negative effects of delayed appendectomy.
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Affiliation(s)
- Jian Li
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, Sichuan Province, China
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Cifarelli CP, McMichael JP, Forman AG, Mihm PA, Cifarelli DT, Lee MR, Marsh W. Surgical Start Time Impact on Hospital Length of Stay for Elective Inpatient Procedures. Cureus 2021; 13:e16259. [PMID: 34277303 PMCID: PMC8269978 DOI: 10.7759/cureus.16259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 11/28/2022] Open
Abstract
Background Hospital length of stay (LOS) remains an important, albeit nonspecific, metric in the analysis of surgical services. Modifiable factors to reduce LOS are few in number and the ability to practically take action is limited. Surgical scheduling of elective cases remains an important task in optimizing workflow and may impact the post-surgical LOS. Methods Retrospective data from a single tertiary care academic institution were analyzed from elective adult surgical cases performed from 2017 through 2019. Emergent or urgent add-on cases were excluded. Variables included primary procedure, age, diabetes status, American Society of Anesthesiologists (ASA) class, and surgical start time. Analysis of the median LOS following surgery was performed using Mann-Whitney tests and Cox hazards model. Matched-cohort analysis of mean total hospitalization costs was performed using the Student’s t-test. Results 9,258 patients were analyzed across five surgical service lines, of which 777 patients had surgical start time after 3 PM. The median LOS for the after 3 PM group was 1 day longer than the before 3 PM start time cohort (3.0 vs 2.1, p < 0.001). Service line analysis revealed increased LOS for Orthopedics and Neurosurgery (3.0 vs 1.9, p < 0.001; 3.0 vs 2.0, p < 0.05). Multivariate analysis confirmed that start time before 3 PM predicted shorter LOS (HR = 1.214, 1.126-1.309; p < 0.001). Case-matched cost analysis for frequently performed orthopedic and neurosurgical cases with an after 3 PM start time failed to demonstrate a significant difference in total hospital charges. Conclusion Optimization of surgical services scheduling to increase the proportion of elective surgical cases started before 3 PM has the potential to decrease post-surgical LOS for adult patients undergoing Orthopedic or Neurosurgical procedures.
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Affiliation(s)
- Christopher P Cifarelli
- Neurological Surgery, West Virginia University School of Medicine, Morgantown, USA.,Radiation Oncology, West Virginia University School of Medicine, Morgantown, USA
| | | | - Alex G Forman
- Strategic Analytics, West Virginia University School of Medicine, Morgantown, USA
| | - Paul A Mihm
- Surgical Services, West Virginia University School of Medicine, Morgantown, USA
| | - Daniel T Cifarelli
- Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
| | - Mark R Lee
- Neurosurgery, West Virginia University School of Medicine, Morgantown, USA
| | - Wallis Marsh
- Surgery, West Virginia University School of Medicine, Morgantown, USA
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Association between In-hospital Mortality and Low Cardiac Output Syndrome with Morning versus Afternoon Cardiac Surgery. Anesthesiology 2021; 134:552-561. [PMID: 33592096 DOI: 10.1097/aln.0000000000003728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent work suggests that having aortic valve surgery in the morning increases risk for cardiac-related complications. This study therefore explored whether mortality and cardiac complications, specifically low cardiac output syndrome, differ for morning and afternoon cardiac surgeries. METHODS The study included adults who had aortic and/or mitral valve repair/replacement and/or coronary artery bypass grafting from 2011 to 2018. The components of the in-hospital composite outcome were in-hospital mortality and low cardiac output syndrome, defined by requirement for at least two inotropic agents at 24 to 48 h postoperatively or need for mechanical circulatory support. Patients who had aortic cross-clamping between 8 and 11 am (morning surgery) versus between 2 and 5 pm (afternoon surgery) were compared on the incidence of the composite outcome. RESULTS Among 9,734 qualifying operations, 0.4% (29 of 6,859) died after morning, and 0.7% (20 of 2,875) died after afternoon surgery. The composite of in-hospital mortality and low cardiac output syndrome occurred in 2.8% (195 of 6,859) of morning patients and 3.4% (97 of 2,875) of afternoon patients: morning versus afternoon confounder-adjusted odds ratio, 0.96 (95% CI, 0.75 to 1.24; P = 0.770). There was no evidence of interaction between morning versus afternoon and surgery type (P = 0.965), and operation time was statistically nonsignificant for surgery subgroups. CONCLUSIONS Patients having aortic valve surgery, mitral valve surgery, and/or coronary artery bypass grafting with aortic cross-clamping in the morning and afternoon did not have significantly different outcomes. No evidence was found to suggest that morning or afternoon surgical timing alters postoperative risk. EDITOR’S PERSPECTIVE
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Maron SZ, Dan J, Gal JS, Neifert SN, Martini ML, Lamb CD, Genadry L, Rothrock RJ, Steinberger J, Rasouli JJ, Caridi JM. Surgical Start Time Is Not Predictive of Microdiscectomy Outcomes. Clin Spine Surg 2021; 34:E107-E111. [PMID: 33633067 DOI: 10.1097/bsd.0000000000001063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis of clinical data from a single institution. OBJECTIVE The objective of this study was to assess the time of surgery as a possible predictor for outcomes, length of stay, and cost following microdiscectomy. SUMMARY OF BACKGROUND DATA The volume of microdiscectomy procedures has increased year over year, heightening interest in surgical outcomes. Previous investigations have demonstrated an association between time of procedures and clinical outcomes in various surgeries, however, no study has evaluated its influence on microdiscectomy. METHODS Demographic and outcome variables were collected from all patients that underwent a nonemergent microdiscectomy between 2008 and 2016. Patients were divided into 2 cohorts: those receiving surgery before 2 pm were assigned to the early group and those with procedures beginning after 2 pm were assigned to the late group. Outcomes and patient-level characteristics were compared using bivariate, multivariable logistic, and linear regression models. Adjusted length of stay and cost were coprimary outcomes. Secondary outcomes included operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates. RESULTS Of the 1261 consecutive patients who met the inclusion criteria, 792 were assigned to the late group and 469 were assigned to the early group. There were no significant differences in demographics or baseline characteristics between the 2 cohorts. In the unadjusted analysis, mean length of stay was 1.80 (SD=1.82) days for the early group and 2.00 (SD=1.70) days for the late group (P=0.054). Mean direct cost for the early cohort was $5088 (SD=$4212) and $4986 (SD=$2988) for the late cohort (P=0.65). There was no difference in adjusted length of stay or direct cost. No statistically significant differences were found in operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates between the 2 cohorts. CONCLUSION The study findings suggest that early compared with late surgery is not significantly predictive of surgical outcomes following microdiscectomy.
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Affiliation(s)
| | | | - Jonathan S Gal
- Anesthesia, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, NY
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Tu DH, Qu R, Wang Q, Fu X. After-hours esophagectomy may pose additional risk to patients with esophageal cancer. J Thorac Dis 2021; 13:1118-1129. [PMID: 33717585 PMCID: PMC7947526 DOI: 10.21037/jtd-20-3141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The increase in the incidence of esophageal cancers (ECs) combined with fewer surgeons working at large centers will increase the likelihood of surgery for ECs being performed during later hours. This study aimed to compare esophagectomies’ operative outcomes for EC performed at different surgical starting times. Methods This was a single-center, retrospective study. Risk-adjusted cumulative sum curve analysis and Cox regression analysis were used to identify the potential change-point of surgical starting times. The participants were then divided into 2 groups according to the change-point time. Propensity score matching was used to control confounding factors between the 2 groups. We compared the short- and long-term outcomes in both groups. Results A total of 702 patients who underwent potentially radical esophagectomy from 7 May 2014 to 31 December 2017 in our institute were included. The 3-year all-cause mortality showed a significant change-point at 16:42, with an increment from 56.5% to 76.9% (P=0.043). Esophagectomy that commenced between 17:00–18:59 was associated with significantly lower overall survival (OS) [multivariate hazard ratio (HR): 2.47; 95% confidence interval (CI): 1.25 to 4.90; P=0.010] and disease-free survival (DFS) (multivariate HR: 2.14; 95% CI: 1.08 to 4.21; P=0.028). The participants were allocated to the during-hours group and the after-hours group according to the change-point of 17:00. A total of 84 participants in the during-hours group were matched to 33 participants in the after-hours group. The median operative time was shorter in the after-hours group [309 (during-hours) vs. 239 (after-hours) minutes, P=0.014); the after-hours group had a greater incidence of respiratory complications (22.63% vs. 45.45%, P=0.023) and 90-day mortality (0 vs. 9.09%, P=0.021). The 5-year OS (P=0.042) and DFS (P=0.030) were significantly higher in the during-hours group. Conclusions Esophagectomies started during after-hours are correlated with poorer surgical outcomes. It is recommended to cancel selective esophagectomies due to commence after 17:00.
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Affiliation(s)
- De-Hao Tu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rirong Qu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Wang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Warner LL, Hunter Guevara LR, Barrett BJ, Arendt KW, Peterson AA, Sviggum HP, Duncan CM, Thompson AC, Hanson AC, Schulte PJ, Martin DP, Sharpe EE. Creating a model to predict time intervals from induction of labor to induction of anesthesia and delivery to coordinate workload. Int J Obstet Anesth 2020; 45:115-123. [PMID: 33461839 DOI: 10.1016/j.ijoa.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Induction of labor continues to become more common. We analyzed induction of labor and timing of obstetric and anesthesia work to create a model to predict the induction-anesthesia interval and the induction-delivery interval in order to co-ordinate workload to occur when staff are most available. METHODS Patients who underwent induction of labor at a single medical center were identified and multivariable linear regression was used to model anesthesia and delivery times. Data were collected on date of birth, race/ethnicity, body mass index, gestational age, gravidity, parity, indication for labor induction, number of prior deliveries, time of induction, induction agent, cervical dilation, effacement, and fetal station on admission, date and time of anesthesia administration, date and time of delivery, and delivery type. RESULTS A total of 1746 women met inclusion criteria. Associations which significantly influenced time from induction of labor to anesthesia and delivery included maternal age (anesthesia P <0.001, delivery P =0.002), body mass index (both P <0.001), prior vaginal delivery (both P <0.001), gestational age (anesthesia P <0.001, delivery P <0.018), simplified Bishop score (both P <0.001), and first induction agent (both P <0.001). Induction of labor of nulliparous women at 02:00 h and parous women at 04:00 or 05:00 h had the highest estimated probability of the mother having her first anesthesia encounter and delivering during optimally staffed hours when our institution's specialty personnel are most available. CONCLUSIONS Time to obstetric and anesthesia tasks can be estimated to optimize induction of labor start times, and shift anesthesia and delivery workload to hours when staff are most available.
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Affiliation(s)
- L L Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
| | - L R Hunter Guevara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - B J Barrett
- Mayo Clinic Alix School of Medicine Mayo Clinic, Rochester, MN, USA
| | - K W Arendt
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - A A Peterson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - H P Sviggum
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - C M Duncan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - A C Thompson
- Division of Obstetrics, Mayo Clinic, Rochester, MN, USA
| | - A C Hanson
- Division of Biomedical Statistics and Informatics, Rochester, MN, USA
| | - P J Schulte
- Division of Biomedical Statistics and Informatics, Rochester, MN, USA
| | - D P Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - E E Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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Afternoon Surgical Start Time Is Associated with Higher Cost and Longer Length of Stay in Posterior Lumbar Fusion. World Neurosurg 2020; 144:e34-e39. [DOI: 10.1016/j.wneu.2020.07.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023]
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Althoff FC, Wachtendorf LJ, Rostin P, Santer P, Schaefer MS, Xu X, Grabitz SD, Chitilian H, Houle TT, Brat GA, Akeju O, Eikermann M. Effects of night surgery on postoperative mortality and morbidity: a multicentre cohort study. BMJ Qual Saf 2020; 30:678-688. [DOI: 10.1136/bmjqs-2020-011684] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
BackgroundSurgery at night (incision time 17:00 to 07:00 hours) may lead to increased postoperative mortality and morbidity. Mechanisms explaining this association remain unclear.MethodsWe conducted a multicentre retrospective cohort study of adult patients undergoing non-cardiac surgery with general anaesthesia at two major, competing tertiary care hospital networks. In primary analysis, we imputed missing data and determined whether exposure to night surgery affects 30-day mortality using a mixed-effects model with individual anaesthesia and surgical providers as random effects. Secondary outcomes were 30-day morbidity and the mediating effect of blood transfusion rates and provider handovers on the effect of night surgery on outcomes. We further tested for effect modification by surgical setting.ResultsAmong 350 235 participants in the primary imputed cohort, the mortality rate was 0.9% (n=2804/322 327) after day and 3.4% (n=940/27 908) after night surgery. Night surgery was associated with an increased risk of mortality (ORadj 1.26, 95% CI 1.15 to 1.38, p<0.001). In secondary analyses, night surgery was associated with increased morbidity (ORadj 1.41, 95% CI 1.33 to 1.48, p<0.001). The proportion of patients receiving intraoperative blood transfusion and anaesthesia handovers were higher during night-time, mediating 9.4% (95% CI 4.7% to 14.2%, p<0.001) of the effect of night surgery on 30-day mortality and 8.4% (95% CI 6.7% to 10.1%, p<0.001) of its effect on morbidity. The primary association was modified by the surgical setting (p-for-interaction<0.001), towards a greater effect in patients undergoing ambulatory/same-day surgery (ORadj 1.81, 95% CI 1.39 to 2.35) compared with inpatients (ORadj 1.17, 95% CI 1.02 to 1.34).ConclusionsNight surgery was associated with an increased risk of postoperative mortality and morbidity. The effect was independent of case acuity and was mediated by potentially preventable factors: higher blood transfusion rates and more frequent provider handovers.
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Arnaoutakis G, Bianco V, Estrera AL, Brinster DR, Ehrlich MP, Peterson MD, Bossone E, Myrmel T, Pacini D, Montgomery DG, Eagle KA, Bekeredijan R, Shalhub S, De Vincentiis C, Chad Hughes G, Chen EP, Eckstein HH, Nienaber CA, Sultan I. Time of day does not influence outcomes in acute type A aortic dissection: Results from the IRAD. J Card Surg 2020; 35:3467-3473. [PMID: 32939836 DOI: 10.1111/jocs.15017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/15/2020] [Accepted: 08/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Type A acute aortic dissection (TAAAD) represents a surgical emergency requiring intervention regardless of time of day. Whether such a "evening effect" exists regarding outcomes for TAAAD has not been previously studied using a large registry data. METHODS Patients with TAAAD were identified from the International Registry of Acute Aortic Dissections (1996-2019). Outcomes were compared between patients undergoing operative repair during the daytime (D), defined as 8 am-5 pm, versus the evening (N), defined as 5 pm-8 am. RESULTS Four thousand one-hundrd and ninety-seven surgically treated patients with TAAAD were identified, with 1824 patients undergoing daytime surgery (43.5%) and 2373 patients undergoing evening surgery (56.5%). Daytime patients were more likely to have undergone prior cardiac surgery (13.2% vs. 9.5%; p < .001) and have had a prior aortic dissection (4.8% vs. 3.4%; p = .04). Evening patients were more likely to have been transferred from a referring hospital (70.8% vs. 75.0%; p = .003). Daytime patients were more likely to undergo aortic valve sparing root procedures (23.3% vs. 19.2%; p = .035); however, total arch replacement was performed with equal frequency (19.4% vs. 18.8%; p = .751). In-hospital mortality (D: 17.3% vs. N. 16.2%; p = .325) was similar between both groups. Subgroup analysis examining the effect of weekend presentation revealed no significant mortality difference. CONCLUSIONS A majority of TAAAD patients underwent surgical repair at night. There were higher rates of postoperative tamponade in evening patients; however, mortality was similar. The expertise of cardiac-dedicated operative and critical care teams regardless of time of day as well as training paradigms may explain similar mortality outcomes in this high risk population.
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Affiliation(s)
| | - Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony L Estrera
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Derek R Brinster
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Marek P Ehrlich
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Mark D Peterson
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Eduardo Bossone
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Truls Myrmel
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Davide Pacini
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Daniel G Montgomery
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Kim A Eagle
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Raffi Bekeredijan
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Sherene Shalhub
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Carlo De Vincentiis
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - G Chad Hughes
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Edward P Chen
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | | | - Christoph A Nienaber
- International Registry of Acute Aortic Dissections (IRAD), Ann Arbor, Michigan, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Later Surgical Start Time Is Associated With Longer Length of Stay and Higher Cost in Cervical Spine Surgery. Spine (Phila Pa 1976) 2020; 45:1171-1177. [PMID: 32355143 DOI: 10.1097/brs.0000000000003516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of a surgical cohort from a single, large academic institution. OBJECTIVE The aim of this study was to investigate associations between surgical start time, length of stay, cost, perioperative outcomes, and readmission. SUMMARY OF BACKGROUND DATA One retrospective study with a smaller cohort investigated associations between surgical start time and outcomes in spine surgery and found that early start times were correlated with shorter length of stay. No examinations of perioperative outcomes or cost have been performed. METHODS All patients undergoing anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) were queried from a single institution from January 1, 2008 to November 30, 2016. Patients undergoing surgery that started between 12:00 AM and 6:00 AM were excluded due to their likely emergent nature. Cases starting before and after 2:00 PM were compared on the basis of length of stay and cost as the primary outcomes using multivariable logistic regression. RESULT The patients undergoing ACDF and PCDF were both similar on the basis of comorbidity burden, preoperative diagnosis, and number of segments fused. The patients undergoing ACDF starting after 2 PM had longer LOS values (adjusted difference of 0.65 days; 95% confidence interval [CI]: 0.28-1.03; P = 0.0006) and higher costs of hospitalization (adjusted difference of $1177; 95% CI: $549-$1806; P = 0.0002). Patients undergoing PCDF starting after 2 PM also had longer LOS values (adjusted difference of 1.19 days; 95% CI: 0.46-1.91; P = 0.001) and higher costs of hospitalization (adjusted difference of $2305; 95% CI: $826-$3785; P = 0.002). CONCLUSION Later surgical start time is associated with longer LOS and higher cost. These findings should be further confirmed in the spine surgical literature to investigate surgical start time as a potential cost-saving measure. LEVEL OF EVIDENCE 3.
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Harky A, Singh VP, Khan D, Sajid MM, Kermali M, Othman A. Factors Affecting Outcomes in Acute Type A Aortic Dissection: A Systematic Review. Heart Lung Circ 2020; 29:1668-1681. [PMID: 32798049 DOI: 10.1016/j.hlc.2020.05.113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/10/2020] [Accepted: 05/18/2020] [Indexed: 11/17/2022]
Abstract
Acute type A aortic dissection is a clinical emergency and is associated with significant morbidity and mortality rates if not managed promptly in specialised and high-volume centres. The mortality rate is increased by 1% for each hour delay in management; however, with advancement in clinical practice, diagnostic imaging and clinician awareness, this has been dramatically reduced to below 30% in most international centres. Not only timing of recognition of the pathology, but also other factors can significantly affect outcomes of such critical pathology. This includes, but is not limited to, age, extent of the pathology, existence of connective tissue disorders, hypertension, diabetes mellitus and surgeon experience. This narrative review will focus on current clinical practice and the evidence behind optimising each factor to minimise adverse outcomes in such high-risk cohort.
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Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK; School of Medicine, University of Liverpool, Liverpool, UK.
| | | | - Darab Khan
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | - Muhammed Kermali
- Faculty of Medicine, St. George's, University of London, London, UK
| | - Ahmed Othman
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Meschino MT, Giles AE, Rice TJ, Saddik M, Doumouras AG, Nenshi R, Allen L, Vogt K, Engels PT. Operative timing is associated with increased morbidity and mortality in patients undergoing emergency general surgery: a multisite study of emergency general services in a single academic network. Can J Surg 2020; 63:E321-E328. [PMID: 32644317 DOI: 10.1503/cjs.012919] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Despite the widespread implementation of the acute care surgery (ACS) model, limited access to operating room time represents a barrier to the optimal delivery of emergency general surgery (EGS) care. The objective of this study was to describe the effect of operative timing on outcomes in EGS in a network of teaching hospitals. Methods We conducted a retrospective review of EGS operations performed at 3 teaching hospitals in a single academic network. Time of operation was categorized as daytime (8 am to 5 pm), after hours (5 pm to 11 pm) or overnight (11 pm to 8 am). Time to operation was calculated as the interval from admission to operative start time and categorized as less than 24 hours, 24-72 hours and greater than 72 hours. Results After we excluded nonindex cases, trauma cases and cases occurring more than 5 days after admission, 1505 EGS cases were included. We found that 39.0% of operations were performed in the daytime, 46.3% after hours and 14.8% overnight. In terms of time to operation, 52.3% of operations were performed within 24 hours of admission, 33.4% in 24-72 hours and 14.3% in more than 72 hours. The overall complication rate was 20.6% (310 patients) and the overall mortality rate was 3.8% (57 patients). After multivariable analysis, time to operation more than 72 hours after admission was independently associated with increased odds of morbidity (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.09-2.47), while overnight operating was associated with increased odds of death (OR 3.15, 95% CI 1.29-7.70). Conclusion Increasing time from admission to operation and overnight operating were associated with greater morbidity and mortality, respectively, for EGS patients. Strategies to provide timely access to the operating room should be considered to optimize care in an ACS model.
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Affiliation(s)
- Michael T Meschino
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Rice, Saddik, Doumouras, Nenshi, Engels); and the Department of Surgery, Western University, London, Ont. (Allen, Vogt)
| | - Andrew E Giles
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Rice, Saddik, Doumouras, Nenshi, Engels); and the Department of Surgery, Western University, London, Ont. (Allen, Vogt)
| | - Timothy J Rice
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Rice, Saddik, Doumouras, Nenshi, Engels); and the Department of Surgery, Western University, London, Ont. (Allen, Vogt)
| | - Maisa Saddik
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Rice, Saddik, Doumouras, Nenshi, Engels); and the Department of Surgery, Western University, London, Ont. (Allen, Vogt)
| | - Aristithes G Doumouras
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Rice, Saddik, Doumouras, Nenshi, Engels); and the Department of Surgery, Western University, London, Ont. (Allen, Vogt)
| | - Rahima Nenshi
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Rice, Saddik, Doumouras, Nenshi, Engels); and the Department of Surgery, Western University, London, Ont. (Allen, Vogt)
| | - Laura Allen
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Rice, Saddik, Doumouras, Nenshi, Engels); and the Department of Surgery, Western University, London, Ont. (Allen, Vogt)
| | - Kelly Vogt
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Rice, Saddik, Doumouras, Nenshi, Engels); and the Department of Surgery, Western University, London, Ont. (Allen, Vogt)
| | - Paul T Engels
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Meschino, Giles, Rice, Saddik, Doumouras, Nenshi, Engels); and the Department of Surgery, Western University, London, Ont. (Allen, Vogt)
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Wang B, Yao Y, Wang X, Li H, Qian H, Jiang L, Zhu X. The start of gastrectomy at different time-of-day influences postoperative outcomes. Medicine (Baltimore) 2020; 99:e20325. [PMID: 32481317 PMCID: PMC7249949 DOI: 10.1097/md.0000000000020325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Gastric cancer (GC) continues to be 1 of the malignant tumors with high morbidity and mortality worldwide. Although the improvements in targeted inhibitor therapy have promoted survival, the first choice for GC patients is still surgery. However, prolonged surgery may tire surgeons and affect surgical outcomes.To detect whether different time-of-day radical gastrectomy influenced short-term and long-term surgical outcomes.This study included 117 patients between 2008 and 2012 who underwent a radical gastrectomy. These patients were grouped into the morning (before 13:00) and afternoon (after 13:00) groups or divided into 2 groups according to the median operation start time (before or after 11:23). Then, the relevant influence of the surgical start time was analyzed.The morning group (before 13:00) and the front median group (before 11:23) showed longer operative time (P = .008 and P = .016, respectively), lower estimated blood loss (P < .001 and P = .158, respectively), and longer time before resuming oral intake (P < .001 and P < .173, respectively) than the afternoon group (after 13:00) or latter median group (after 11:23). Starting the operation in the morning had no effect on the rate of postoperative complications. The operation start time had no significant influence on the overall survival of patients who underwent a radical gastrectomy. However, in subgroup analysis, patients who underwent a distal gastrectomy faced poor prognosis when their surgery started after 13:00 (P = .030).The results suggest that the operation start time might be an indicator of total operative time, estimated blood loss, and the time to resuming oral intake. The operation start time may also influence the prognosis of radical gastrectomy in patients with GC.
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Linzey JR, Foshee RL, Fiestan GO, Srinivasan S, Mossner JM, Rajajee V, Sullivan SE, Thompson BG, Muraszko KM, Pandey AS. Late Surgical Start Time and the Effect on Rates of Complications in a Neurosurgical Population: A Prospective Longitudinal Analysis. World Neurosurg 2020; 140:e328-e342. [PMID: 32434015 DOI: 10.1016/j.wneu.2020.05.081] [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: 03/09/2020] [Accepted: 05/09/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The after-hours effect on postoperative complications has been poorly studied in the neurosurgical literature. A recent retrospective analysis showed that patients with a surgical start time (SST) between 09:01 pm and 07:00 am had a greater risk of complications. This study used a prospective registry to examine the relationship between SST and postoperative complications in a large neurosurgical population. METHODS We performed a prospective longitudinal cohort analysis of all consecutive adult patients admitted to our neurosurgery service between October 1, 2018 and May 1, 2019. Complications were prospectively recorded and classified as surgical or medical. Univariate and multivariate logistic regressions were used to analyze these data. RESULTS Eighty-five surgical complications (6.6%) and 110 medical complications (8.6%) resulted from 1285 operations on 1145 patients. Later SST was predictive of complications in the emergent population (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.01-5.15; P = 0.048) but not in the elective population. Extubation in the neurosurgical intensive care unit (NICU) versus the operating room strongly predicted medical complications (OR, 6.91; 95% CI, 3.33-14.34; P < 0.0001). Patients with a later SST were significantly more likely to be extubated in the NICU (P < 0.0001). CONCLUSIONS Patients undergoing emergent operations with a later SST were significantly more likely to have a postoperative complication. Patients who were extubated in the NICU versus the operating room were significantly more likely to have a medical complication. Patients were more likely to be extubated in the NICU if they had a later SST; therefore, SST may indirectly be associated with an increase in medical complications.
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Affiliation(s)
- Joseph R Linzey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel L Foshee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Gic-Owens Fiestan
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - James M Mossner
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Stephen E Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - B Gregory Thompson
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
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Cortegiani A, Ippolito M, Misseri G, Helviz Y, Ingoglia G, Bonanno G, Giarratano A, Rochwerg B, Einav S. Association between night/after-hours surgery and mortality: a systematic review and meta-analysis. Br J Anaesth 2020; 124:623-637. [DOI: 10.1016/j.bja.2020.01.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/12/2020] [Accepted: 01/29/2020] [Indexed: 01/11/2023] Open
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Zhou Y, Zhang Y, Guo H, Zheng C, Guo C. Risk Factors Related to Operative Duration and Their Relationship With Clinical Outcomes in Pediatric Patients Undergoing Roux-en-Y Hepaticojejunostomy. Front Pediatr 2020; 8:590420. [PMID: 33364222 PMCID: PMC7752895 DOI: 10.3389/fped.2020.590420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Operative duration might be important for perioperative morbidity, and its involvement has not been fully characterized in pediatric patients. We identified perioperative variables associated with operative duration and determined their influence on clinical outcomes in pediatric patients. Methods: We retrospectively reviewed 701 patients who underwent elective removal of choledochal cysts followed by Roux-en-Y hepaticojejunostomy. The patients were separated into the long operative time group (>165 min) and short operative time group (<165 min) based on the median operative time (165 min). Propensity score matching was performed to adjust for any potential selection bias. The independent risk factors for operative time were determined using multivariable logistic regression analyses. Results: The operative time was often increased by excision difficulty caused by a larger choledochal cyst size (OR = 1.56; 95% CI, 1.09-2.23; p < 0.001), a greater BMI (OR = 1.02; 95% CI, 1.00-1.15; p = 0.018), and older age (OR = 1.17; 95% CI, 1.02-1.39; p = 0.012) in the multivariate analysis. A long surgical duration was associated with delayed gastrointestinal functional recovery, as measured using the time to first defecation (p = 0.027) and first bowel movement (p = 0.019). Significantly lower levels of serum albumin were found in the long operative time group than in the short operative time group (p = 0.0035). The total length of postoperative hospital stay was longer in patients in the long operative time group (7.51 ± 2.03 days) than in those in the short operative time group (6.72 ± 1.54 days, p = 0.006). Conclusions: Our data demonstrated that a short operative time was associated with favorable postoperative results. The influencing factors of operative time should be ameliorated to achieve better outcomes.
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Affiliation(s)
- Yongjun Zhou
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Yunfei Zhang
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hongjie Guo
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Anaesthesia, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Chao Zheng
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China.,Department of Orthopedics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chunbao Guo
- Department of Pediatric General Surgery, Children's Hospital, Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Engineering Research Center of Stem Cell Therapy, Children's Hospital of Chongqing Medical University, Chongqing, China
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Addis DR, Moore BA, Garner CR, Fernando RJ, Kim SM, Russell GB. Case Start Time Affects Intraoperative Transfusion Rates in Adult Cardiac Surgery: A Single-Center Retrospective Analysis. J Cardiothorac Vasc Anesth 2019; 34:632-639. [PMID: 31882380 DOI: 10.1053/j.jvca.2019.10.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/09/2019] [Accepted: 10/26/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The goal of the study was to investigate the role time of day plays in perioperative outcomes. The authors examined intraoperative transfusion rates throughout the day in adult cardiac surgery patients. They hypothesized that the rate of transfusion changes with later case start times in scheduled cardiac surgery. DESIGN Retrospective observational study. SETTING Single academic medical center. PARTICIPANTS Adults undergoing cardiac surgery involving cardiopulmonary bypass. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was a composite variable of transfusion. The association between the time of day and the rate of transfusion was explored with a multivariate logistic regression to fit the effect of starting time as a cubic spline. There were 1,421 cases that met inclusion criteria. There were 1,220 cases that were matched for modeling. The estimated probability of a patient receiving a transfusion changed significantly with later case start times in the multivariable model after adjusting for initial hemoglobin, age, sex, height, ideal body weight, diabetes, peripheral vascular disease, stroke, chronic kidney disease, chronic obstructive pulmonary disease, duration of cardiopulmonary bypass, aortic cross clamp time, attending surgeon, and attending anesthesiologist (p = 0.032, C-statistic = 0.807, n = 1220). The estimated probability of receiving an intraoperative red blood cell transfusion increased with later case start times in the multivariable model (p = 0.027, C-statistic = 0.902, n = 1220). There was no difference in the probability of transfusion for plasma, cryoprecipitate, or platelets. CONCLUSIONS The observed rate of intraoperative blood product transfusion changed with later case start times in a multivariable model of scheduled cardiac surgery.
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Affiliation(s)
- Dylan R Addis
- Wake Forest School of Medicine, Department of Anesthesiology, Winston-Salem, NC; University of Alabama at Birmingham, Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Birmingham, AL.
| | - Blake A Moore
- Wake Forest School of Medicine, Department of Anesthesiology, Winston-Salem, NC; University of Tennessee Graduate School of Medicine, Department of Anesthesiology, Section on Cardiothoracic Anesthesiology, Knoxville, TN
| | - Chandrika R Garner
- Wake Forest School of Medicine, Department of Anesthesiology, Winston-Salem, NC
| | - Rohesh J Fernando
- Wake Forest School of Medicine, Department of Anesthesiology, Winston-Salem, NC
| | - Sung M Kim
- Wake Forest School of Medicine, Department of Anesthesiology, Winston-Salem, NC; Vanderbilt University Medical Center, Department of Anesthesiology, Nashville, TN
| | - Gregory B Russell
- Wake Forest School of Medicine, Department of Anesthesiology, Winston-Salem, NC
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Agarwal AK, Hahn L, Pelullo A, Rosin R, Merchant RM. Capturing Real-Time Emergency Department Sentiment: A Feasibility Study Using Touch-Button Terminals. Ann Emerg Med 2019; 75:727-732. [PMID: 31493921 DOI: 10.1016/j.annemergmed.2019.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/28/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE Providing care in emergency departments (EDs) affects patients and providers. Providers experience high rates of work-related stress. Little is known about the feasibility of measuring real-time sentiment within busy clinical environments. We test the feasibility of measuring sentiment with touch-button terminals in an academic, urban ED. METHODS Terminals offered a choice of 4 sentiment buttons (very positive, positive, negative, and very negative). They were placed central to physician workstations, nursing workstations, and the patient exit. Pearson correlation coefficients (r) were calculated to estimate correlation between sentiment and volume metrics (arrivals, length of stay, waiting patients, and number of boarding patients) over time. RESULTS A total of 13,849 sentiments were recorded (June 2018 to October 2018); 9,472 came from providers (52.6% nursing) and 4,377 from patients. The majority of provider sentiments were negative (58.7%). Negative provider sentiment was associated with increasing number of patients waiting to be seen (r=0.45) and boarding (r=0.68). Positive provider sentiment was associated with increasing numbers of patients who left without being seen (r=0.48). Increased boarding was associated with more recorded sentiments (r=0.73). Negative patient sentiment was associated with increasing number waiting (r=0.55), boarding (r=0.67), and leaving without being seen (r=0.46). CONCLUSION This study demonstrates the feasibility of a novel approach to measuring "on-shift" sentiment in real time and provides a sample comparison to traditional volume metrics.
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Affiliation(s)
- Anish K Agarwal
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA; Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA; Penn Medicine Center for Healthcare Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Lauren Hahn
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA; Penn Medicine Center for Healthcare Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Arthur Pelullo
- Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA; Penn Medicine Center for Healthcare Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Roy Rosin
- Penn Medicine Center for Healthcare Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Raina M Merchant
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA; Penn Medicine Center for Digital Health, University of Pennsylvania, Philadelphia, PA; Penn Medicine Center for Healthcare Innovation, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Miyo M, Urabe S, Hyuga S, Nakagawa T, Michiura T, Hayashi N, Yamabe K. Clinical outcomes of single-site laparoscopic interval appendectomy for severe complicated appendicitis: Comparison to conventional emergency appendectomy. Ann Gastroenterol Surg 2019; 3:561-567. [PMID: 31549016 PMCID: PMC6750141 DOI: 10.1002/ags3.12277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/17/2019] [Accepted: 06/28/2019] [Indexed: 02/06/2023] Open
Abstract
AIM Single-site laparoscopic interval appendectomy (SLIA) for severe complicated appendicitis after conservative treatment (CT) to ameliorate inflammation and eradicate the abscess should be safer and less invasive than emergency appendectomy (EA). However, only a few reports have been published regarding SLIA. METHODS We retrospectively collected data on 264 consecutive patients admitted to Kinan Hospital for treatment of appendicitis between 2012 and 2018. The safety and feasibility of SLIA and its perioperative outcomes for severe complicated appendicitis were investigated. RESULTS A total of 61 patients were included in this study, 25 of whom underwent CT and 36 EA. Among the 25 patients who underwent CT, 23 (92.0%) succeeded; a total of 16 patients (69.5%) underwent SLIA. Compared to the EA group, the SLIA group had less bleeding (median volume 8.5 vs 50 mL, P = .005) and lower rate of expansion surgery (0% vs 27.8%, P = .022). Although the postoperative hospital stay was shorter in the SLIA group than in the EA group (9 vs 12 days, P = .008), the total hospital stay, including the CT period, was longer in the SLIA group than in the EA group (24 vs 12 days, P < .001). CONCLUSION SLIA is safe, feasible, and less invasive than EA and may provide the advantages of minimally invasive surgery even if appendicitis is severe. SLIA may be a promising option for complicated appendicitis in select cases despite its disadvantage of prolonging the hospital stay.
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Affiliation(s)
- Masaaki Miyo
- Department of SurgeryKinan HospitalTanabeJapan
- National Hospital Organization Osaka National HospitalOsakaJapan
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Baik J, Nam J, Oh J, Kim GW, Lee E, Lee Y, Chung CH, Choi I. Effect of operative time on the outcome of patients undergoing off‐pump coronary artery bypass surgery. J Card Surg 2019; 34:1220-1227. [DOI: 10.1111/jocs.14231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jaewon Baik
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Jae‐Sik Nam
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Jimi Oh
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Go Wun Kim
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Eun‐Ho Lee
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Yoon‐Kyung Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart HospitalHallym University College of MedicineSeoul Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - In‐Cheol Choi
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
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Wang X, Yao Y, Qian H, Li H, Zhu X. Longer Operating Time During Gastrectomy Has Adverse Effects on Short-Term Surgical Outcomes. J Surg Res 2019; 243:151-159. [PMID: 31176285 DOI: 10.1016/j.jss.2019.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/16/2019] [Accepted: 05/08/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Gastric cancer continues to be one of the malignant tumor types with high morbidity and mortality worldwide. Although remarkable improvements have been made to combat gastric cancer, surgery is still the first choice of treatment for gastric cancer. METHODS This was a single-center and retrospective study. A total of 110 patients who underwent radical gastrectomy with D2 lymph node dissection between 2014 and 2017 were included in this study, and all patients were treated by the same medical staff. Based on the median operating time, patients were grouped into a long-time group (>180 min) and a short-time group (≤180 min). Influences of operating time on outcomes of patients in the short-term and long-term groups were analyzed. RESULTS The long-time group showed a higher incidence of postoperative complications compared with the short time group (P < 0.01) with a significant decrease in serum albumin and the prognostic nutritional index value. Moreover, a long operating time was often caused by the operating start time (P < 0.001), excision difficulty caused by lager tumor size (P < 0.001), worse tumor differentiation, and deeper tumor invasion (P < 0.05). However, length of operating time did not significantly influence overall survival of patients who underwent radical gastrectomy. CONCLUSIONS The results suggested that operating time might be an indicator of the incidence of postoperative complication and that several important variables, such as prognostic nutritional index, serum albumin, operating start time, and excision time, could be intervened in the perioperative period to help patients gain a better outcome after gastrectomy.
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Affiliation(s)
- Xuchao Wang
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yizhou Yao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huan Qian
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Li
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinguo Zhu
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Comparison of nighttime and daytime operation on outcomes of kidney transplant with deceased donors: a retrospective analysis. Chin Med J (Engl) 2019; 132:395-404. [PMID: 30707168 PMCID: PMC6595725 DOI: 10.1097/cm9.0000000000000056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Kidney transplant is always emergent operations and frequently need to be performed at nighttime to reduce cold ischemia time (CIT). Previous studies have revealed that fatigue and sleep deprivation can result in adverse consequences of medical procedures. This study aimed to evaluate whether nighttime operation has adverse impact on kidney transplant. Methods: A retrospective analysis of recipients accepted kidney transplant from deceased donors in one center from 2014 to 2016 was performed. Daytime transplant was defined as operation started after 8 am or ended before 8 pm and nighttime operation was defined as operation ended after 8 pm or started before 8 am. The incidences of complications such as delayed graft function, acute rejection, surgical complications and nosocomial infections were compared between 2 groups. Student's t-test was used to analyze continuous variables such as serum creatinine (Scr) at 1-year of post-transplant. The Chi-square test was used to analyze categorical variables. Differences in recipients and graft survival were analyzed using Kaplan–Meier methodology and log-rank tests. Results: Among the 443 recipients, 233 (52.6%) were classified into the daytime group and the others 210 (47.4%) were in the nighttime group. The 1-year survival rate of recipients was similar for the recipients in the daytime and nighttime groups (95.3% vs. 95.2%, P = 0.981). Although the 1-year graft survival rate in the nighttime group was slightly superior to that in the daytime group, the difference was not significant (92.4% vs. 88.4%, P = 0.164). Furthermore, Scr and incidence of complications were also not significantly different between the 2 groups. Conclusions: Our results suggested that operation time of kidney transplant with short CIT has no significant impact on the outcome of kidney transplant. Nighttime operation of kidney transplant with short CIT could be postponed to the following day to alleviate the burden on medical staffs and avoid the potential risk.
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Emergency glioma resection but not hours of operation predicts perioperative complications: A single center study. Clin Neurol Neurosurg 2019; 182:11-16. [PMID: 31054423 DOI: 10.1016/j.clineuro.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/29/2019] [Accepted: 04/11/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Physical and mental status of neurosurgeons may vary with emergency status and hours of operation, which may impact the outcome of patients undergoing surgery. This study aims to clarify the influence of these parameters on outcome after surgery in glioma patients. PATIENTS AND METHODS A total of 477 nonemergency surgery (NES) and 30 emergency surgery (ES) were enrolled in this study. Using propensity score matching (PSM) analysis, 97 pairs of procedures from NES group were generated and then classified as group M (morning procedures, 8:00 a.m-1:00 p.m) or group A (afternoon or night procedures, 1:00 p.m-8:00 p.m). 30 emergency procedures were classified into group ESa (daytime emergency surgery, 8:00 a.m-6:00 p.m) and group ESb (nighttime surgery procedures, 6:00 p.m-8:00 a.m the next day). Differences in intraoperative risk factors and postoperative complications were analyzed. RESULTS Postoperative complications, including death within 30 days (p = 0.004), neurological function deficit (p = 0.012), systemic infection (p < 0.001) were significant higher in emergency procedures. Intraoperative risk factors including blood loss (p < 0.001), blood transfusion (p = 0.036) were also higher in emergency procedures than nonemergency procedures, although both procedures had comparable time duration (p = 0.337). By PSM analysis, patients in group M and group A were well matched and no significant difference of intraoperative risk factors and postoperative complications (all p > 0.05) were found. Furthermore, incidence of intraoperative risk factors and postoperative complications were similar in both groups ESa and ESb (all p > 0.05). CONCLUSION Emergency glioma resection is a very important risk factors of perioperative mortality and morbidity for patients. However, hours of operation did not necessarily predict postoperative mortality or morbidity, either in emergency or nonemergency glioma resection.
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Lindemann J, Dageforde LA, Brockmeier D, Vachharajani N, Scherer M, Chapman W, Doyle MBM. Organ procurement center allows for daytime liver transplantation with less resource utilization: May address burnout, pipeline, and safety for field of transplantation. Am J Transplant 2019; 19:1296-1304. [PMID: 30247814 DOI: 10.1111/ajt.15129] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/28/2018] [Accepted: 09/14/2018] [Indexed: 01/25/2023]
Abstract
Abdominal organ transplantation faces several challenges: burnout, limited pipeline of future surgeons, changes in liver allocation potentially impacting organ procurement travel, and travel safety. The organ procurement center (OPC) model may be one way to mitigate these issues. Liver transplants from 2009 to 2016 were reviewed. There were 755 liver transplants performed with 525 OPC and 230 in-hospital procurements. The majority of transplants (87.4%) were started during daytime hours (5 am-7 pm). Transplants with any portion occurring after-hours were more likely to have procurements in-hospital (P < .001). Daytime cases (n = 400) had more OPC procured livers and hepatitis C recipients and were less likely to have a donation after circulatory death donor (all P < .05). In adjusted analyses, daytime cases were independently associated with extubation in the operating room and less postoperative transfusion. There were no significant differences in short- or long-term postoperative outcomes. For exported livers, 54.3% were procured by a local team, saving 137 flights (151 559 miles). The OPC resulted in optimally timed liver transplants and decreased resource utilization with no negative impact on patient outcomes. It allows for ease in exporting organs procured by local surgeons, and potentially addresses provider burnout, the transplant surgery pipeline, and surgeon travel.
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Affiliation(s)
- Jessica Lindemann
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Leigh Anne Dageforde
- Division of Transplantation, Department of Surgery, Mass General Hospital, Boston, Massachusetts
| | | | - Neeta Vachharajani
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Meranda Scherer
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - William Chapman
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Maria B Majella Doyle
- Division of Abdominal Organ Transplantation, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
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van Dijk ST, van Dijk AH, Dijkgraaf MG, Boermeester MA. Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis. Br J Surg 2019; 105:933-945. [PMID: 29902346 PMCID: PMC6033184 DOI: 10.1002/bjs.10873] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/12/2018] [Accepted: 03/08/2018] [Indexed: 12/15/2022]
Abstract
Background The traditional fear that every case of acute appendicitis will eventually perforate has led to the generally accepted emergency appendicectomy with minimized delay. However, emergency and thereby sometimes night‐time surgery is associated with several drawbacks, whereas the consequences of surgery after limited delay are unclear. This systematic review aimed to assess in‐hospital delay before surgery as risk factor for complicated appendicitis and postoperative morbidity in patients with acute appendicitis. Methods PubMed and EMBASE were searched from 1990 to 2016 for studies including patients who underwent appendicectomy for acute appendicitis, reported in two or more predefined time intervals. The primary outcome measure was complicated appendicitis after surgery (perforated or gangrenous appendicitis); other outcomes were postoperative surgical‐site infection and morbidity. Adjusted odds ratios (ORs) were pooled using forest plots if possible. Unadjusted data were pooled using generalized linear mixed models. Results Forty‐five studies with 152 314 patients were included. Pooled adjusted ORs revealed no significantly higher risk for complicated appendicitis when appendicectomy was delayed for 7–12 or 13–24 h (OR 1·07, 95 per cent c.i. 0·98 to 1·17, and OR 1·09, 0·95 to 1·24, respectively). Meta‐analysis of unadjusted data supported these findings by yielding no increased risk for complicated appendicitis or postoperative complications with a delay of 24–48 h. Conclusion This meta‐analysis demonstrates that delaying appendicectomy for presumed uncomplicated appendicitis for up to 24 h after admission does not appear to be a risk factor for complicated appendicitis, postoperative surgical‐site infection or morbidity. Delaying appendicectomy for up to 24 h may be an acceptable alternative for patients with no preoperative signs of complicated appendicitis. Delay is safe
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Affiliation(s)
- S T van Dijk
- Department of Surgery, Academic Medical Centre, Amsterdam, Netherlands
| | - A H van Dijk
- Department of Surgery, Academic Medical Centre, Amsterdam, Netherlands
| | - M G Dijkgraaf
- Clinical Research Unit, Academic Medical Centre, Amsterdam, Netherlands
| | - M A Boermeester
- Department of Surgery, Academic Medical Centre, Amsterdam, Netherlands
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Shetty T, Nguyen JT, Wu A, Sasaki M, Bogner E, Burge A, Cogsil T, Kim EU, Cummings K, Su EP, Lyman S. Risk Factors for Nerve Injury After Total Hip Arthroplasty: A Case-Control Study. J Arthroplasty 2019; 34:151-156. [PMID: 30314804 DOI: 10.1016/j.arth.2018.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Postsurgical acute nerve injury is rare but potentially devastating following total hip arthroplasty (THA). Previous literature suggests a wide range of incidence from 0.1% to 7.6%. Confirmed risk factors for these injuries remain unclear. METHODS THA patients at our institution who developed nerve injury during their admission for THA between January 1, 1998, and December 31, 2013, were systematically identified and matched with 2 control subjects by surgical date. Relevant patient and surgical data were obtained through review of patient charts and electronic health records. We identified potential risk factors and calculated odds ratios (OR) using a conditional logistic regression model with a parsimonious stepwise approach. RESULTS We identified 93 nerve injuries in 43,761 THAs (0.21%). The mean age of cases was 63 years. Adjusting for other factors in the model, patients <45 years were found to be at increased risk of developing nerve injury (OR, 7.17; P = .033). Similarly, patients with a history of tobacco use (OR, 1.90; P = .030) and a history of spinal surgery or disease (OR, 10.06; P < .001) were also associated with increased risk of nerve injury. For every 30-minute increase in surgery time after 1 hour, risk of nerve injury risk increased (OR, 1.48; P = .034). Assignment as first operative case of the morning was associated with a decreased risk of nerve injury (OR, 0.37, P = .043). CONCLUSION This study demonstrates that nerve injury is a rare complication following THA at our institution. We found risk factors that are possibly modifiable factors such as lumbar spine disease, smoking, and time of surgical scheduling.
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Affiliation(s)
- Teena Shetty
- Department of Neurology, Hospital for Special Surgery, New York, NY
| | - Joseph T Nguyen
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY
| | - Anita Wu
- Department of Neurology, Hospital for Special Surgery, New York, NY
| | - Mayu Sasaki
- Quality Research Center, Hospital for Special Surgery, New York, NY
| | - Eric Bogner
- Department of Radiology, Hospital for Special Surgery, New York, NY
| | - Alissa Burge
- Department of Radiology, Hospital for Special Surgery, New York, NY
| | - Taylor Cogsil
- Department of Neurology, Hospital for Special Surgery, New York, NY
| | - Esther U Kim
- Department of Neurology, Hospital for Special Surgery, New York, NY
| | | | - Edwin P Su
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY
| | - Stephen Lyman
- Healthcare Research Institute, Hospital for Special Surgery, New York, NY
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Linzey JR, Pandey AS. Does Surgical Start Time or Weekend Presentation Affect Clinical Outcome for Patients Presenting with Neurosurgical Pathology? World Neurosurg 2018; 123:281-282. [PMID: 30593964 DOI: 10.1016/j.wneu.2018.12.076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joseph R Linzey
- School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
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45
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‘After-hours’ non-elective spine surgery is associated with increased perioperative adverse events in a quaternary center. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:817-828. [DOI: 10.1007/s00586-018-5848-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
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Ishiyama Y, Ishida F, Ooae S, Takano Y, Seki J, Shimada S, Nakahara K, Maeda C, Enami Y, Sawada N, Hidaka E, Kudo S. Surgical starting time in the morning versus the afternoon: propensity score matched analysis of operative outcomes following laparoscopic colectomy for colorectal cancer. Surg Endosc 2018; 33:1769-1776. [DOI: 10.1007/s00464-018-6449-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
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Tessler MJ, Charland L, Wang NN, Correa JA. The association of time of emergency surgery – day, evening or night – with postoperative 30‐day hospital mortality. Anaesthesia 2018; 73:1368-1371. [DOI: 10.1111/anae.14329] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 12/01/2022]
Affiliation(s)
- M. J. Tessler
- Department of Anesthesia Jewish General Hospital Montreal QC Canada
| | - L. Charland
- Department of Anesthesia Jewish General Hospital Montreal QC Canada
| | - N. N. Wang
- Department of Anesthesia Jewish General Hospital Montreal QC Canada
| | - J. A. Correa
- Department of Mathematics and Statistics McGill University Montreal QC Canada
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48
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Intraoperative Handoffs and Postoperative Complications Among Patients Undergoing Gynecologic Oncology Operations. J Healthc Qual 2018; 39:e42-e48. [PMID: 27348430 DOI: 10.1097/jhq.0000000000000042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is evidence that systems-based factors influence surgical outcomes of intraoperative and postoperative morbidity. The goal of this study was to provide an exploratory analysis of systems-based variables and their associations with surgical outcomes in gynecologic oncology patients. We merged electronic records from operating room software with billing claims from major surgeries performed from 2011 to 2013, at a tertiary care academic medical center. Univariate and bivariate analyses were performed to evaluate the relationship between baseline demographic and clinical covariates (age, comorbidity, procedure type, and surgeon volume), the main exposure variables (case start time, case order, and personnel handoffs), and the primary outcome of 30-day postoperative complications. Multiple logistic regression models were created to analyze the contributing effect of each systemic variable on postoperative complications. The overall rate of postoperative complications among patients was 31.4% (n = 182). Although traditional risk factors of comorbidity, procedure type, and case length were the strongest primary drivers of complication risk, there was a significant relationship between handoffs among surgical scrub technicians and postoperative complications (odds ratio: 2.12; 95% CI: 1.00-4.47). As a novel finding in surgical quality and safety research, this supports greater efforts into integrating key staffing information into studies of systemic variables and surgical outcomes.
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49
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Linzey JR, Burke JF, Sabbagh MA, Sullivan S, Thompson BG, Muraszko KM, Pandey AS. The Effect of Surgical Start Time on Complications Associated With Neurological Surgeries. Neurosurgery 2017; 83:501-507. [DOI: 10.1093/neuros/nyx485] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 09/20/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - James F Burke
- Department of Neurology, University of Michigan Health System, Ann Arbor, Michigan
| | - M Amr Sabbagh
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Stephen Sullivan
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan
| | - B Gregory Thompson
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Karin M Muraszko
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan
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50
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Linzey JR, Williamson C, Rajajee V, Sheehan K, Thompson BG, Pandey AS. Twenty-four-hour emergency intervention versus early intervention in aneurysmal subarachnoid hemorrhage. J Neurosurg 2017; 128:1297-1303. [PMID: 28731402 DOI: 10.3171/2017.2.jns163017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent observational data suggest that ultra-early treatment of ruptured aneurysms prevents rebleeding, thus improving clinical outcomes. However, advances in critical care management of patients with ruptured aneurysms may reduce the rate of rebleeding in comparison with earlier trials, such as the International Cooperative Study on the Timing of Aneurysm Surgery. The objective of the present study was to determine if an ultra-early aneurysm repair protocol will or will not significantly reduce the number of incidents of rebleeding following aneurysmal subarachnoid hemorrhage (SAH). METHODS A retrospective analysis of data from a prospectively collected cohort of patients with SAH was performed. Rebleeding was diagnosed as new or expanded hemorrhage on CT, which was determined by independent review conducted by multiple physicians. Preventability of rebleeding by ultra-early aneurysm clipping or coiling was also independently reviewed. Standard statistics were used to determine statistically significant differences between the demographic characteristics of those with rebleeding compared with those without. RESULTS Of 317 patients with aneurysmal SAH, 24 (7.6%, 95% CI 4.7-10.5) experienced rebleeding at any time point following initial aneurysm rupture. Only 1/24 (4.2%, 95% CI -3.8 to 12.2) incidents of rebleeding could have been prevented by a 24-hour ultra-early aneurysm repair protocol. The other 23 incidents could not have been prevented for the following reasons: rebleeding prior to admission to the authors' institution (14/23, 60.9%); initial diagnostic angiography negative for aneurysm (4/23, 17.4%); postoperative rebleeding (2/23, 8.7%); patient unable to undergo operation due to medical instability (2/23, 8.7%); intraoperative rebleeding (1/23, 4.3%). CONCLUSIONS At a single tertiary academic center, the overall rebleeding rate was 7.6% (95% CI 4.7-10.5) for those presenting with ruptured aneurysms. Implementation of a 24-hour ultra-early aneurysm repair protocol would only result in, at most, a 0.3% (95% CI -0.3 to 0.9) reduction in the incidence of rebleeding.
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Affiliation(s)
| | - Craig Williamson
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | - Kyle Sheehan
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - B Gregory Thompson
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Aditya S Pandey
- 2Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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