Report into "on the day cancellations" for plastic surgery in patients who failed to stop their medication

Last-minute cancellation of adult patients scheduled for cardiothoracic surgery in a large Dutch tertiary care centre

OBJECTIVES

Unanticipated cancellation of a surgical procedure is a common problem, causing distress to the patient and increases in healthcare costs. However, limited evidence exists on the effects of last-minute cancellations of cardiothoracic surgical procedures in particular. The goal of this study was to gain insight into the prevalence of and the reasons for last-minute cancellations and to examine whether cancellation is associated with adverse medical outcomes.

METHODS

Patients who were scheduled for elective cardiothoracic surgical procedures between January 2017 and June 2019 were evaluated. The reasons for the cancellations were assigned to the categories medically related or process related. We examined the differences in patient characteristics between those designated as no cancellation, medically related cancellations and process-related cancellations. Lastly, we examined the outcomes of patients who experienced a last-minute cancellation of a scheduled operation.

RESULTS

A total of 2111 patients were included; of these, 301 (14.3%) had last-minute cancellations. In 78 (26%) cases, the cancellations were attributable to medical reasons (e.g. infection, comorbidities); 215 (71%) of the cancellations were process related (e.g. another patient in more urgent need of surgery, lack of staff). Almost 99% of the operations with a process-related cancellation were rescheduled compared to only 71.8% of the medically related cancelled operations (P < 0.001). Patients with a medically related cancellation had significantly higher 1-year mortality than patients who had no cancellation (unadjusted hazard ratio 2.50; 95% confidence interval, 1.30-4.78; P = 0.006); after adjustment for the EuroSCORE II, this effect remained significant.

CONCLUSIONS

Last-minute cancellations were commonly seen in our cohort, and the reasons for cancellation were significantly related to adverse medical outcomes.

Prevalence of Alcohol Use and Associated Factors among Dilla University Students, Dilla Town, Southern Ethiopia: A Cross-Sectional Study

INTRODUCTION

Globally, alcohol is one of the most prevalent forms of substance use that is particularly high among young age groups. Despite the adverse health and social challenges associated with alcohol use, it is one of the most common risky behaviours among university students.

OBJECTIVE

This study aimed to assess the prevalence of alcohol use and associated factors among Dilla University students in Southern Ethiopia.

METHODS

An institution-based cross-sectional study was conducted at Dilla University among undergraduate regular students from January to February 2018. A systematic random sampling technique was used to get a total sample of 803 students each year from the department of the university. The collected data were coded, entered into Epi Info version 7.1, and analyzed with SPSS version 20.

RESULTS

A total of 803 participants were successfully interviewed with a response rate of 91.7%. Alcohol use prevalence was 41.8% (n = 336) among participants. Being in fourth year (AOR = 2.66, 95% CI: 1.64, 4.31), having friends who use the substance (AOR = 1.53, 95% CI: 1.09, 2.1), being a khat user (AOR = 1.48, 95% CI: 1.05, 2.09), and being a cigarette smoker (AOR = 1.76, 95% CI: 1.09, 2.84) were found to be significantly associated with alcohol use.

CONCLUSION

The current study revealed that fourth-year students, having friends who use the substance, being khat user, and being cigarette smoker had higher odds of alcohol use among the students. So the findings suggest that effective campus-based counselling and peer education should be implemented for early prevention, detection, and alleviation of alcohol use among students in the university.

Global prevalence and reasons for case cancellation on the intended day of surgery: A systematic review and meta-analysis

BACKGROUND

Cancellation of operation on the intended day of surgery affects the efficiency of Operation Room which incurs a significant financial loss for the patient, hospital, and health care cost of a country at large. This systematic and Meta-Analysis was intended to provide evidence on the global prevalence and determinants of case cancellation on the intended day of surgery.

METHODS

A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from January 2010 to May 2020 without language restriction. The Heterogeneity among the included studies was checked with forest plot, χ2 test, I2 test, and the p-values. All observational studies reporting prevalence and determinants were included.

RESULTS

A total of 1207 articles were identified from different databases with an initial search. Fort-eight articles were selected for evaluation after the successive screening. Thirty-three Articles with 306,635 participants were included. The Meta-Analysis revealed that the global prevalence of case cancellation on the intended day of surgery was 18% (95% CI: 16 to 20). The Meta-Analysis also showed that lack of operation theatre facility accounted for the major reason for cancellation followed by no attendant and change in medical condition.

CONCLUSION

The meta-analysis revealed that the prevalence of case cancellation was very high in low and middle-income countries and the majorities were avoidable which entails rigorous activities on operation theatre facilities, preoperative evaluation and preparation, patient and health care provider communications.

REGISTRATION

This Systematic Review and Meta-Analysis was registered in a research registry (researchregistry5746) available at https://www.researchregistry.com/browse-the-registry#home/.

Association of Continued Preoperative Aspirin Use and Bleeding Complications in Patients Undergoing Thyroid Surgery

Importance

No evidence exists to direct the management of preoperative aspirin (acetylsalicylic acid) use in patients undergoing thyroid surgery. Nevertheless, a considerable number of patients interrupt receiving aspirin therapy during the preoperative period to minimize bleeding complications despite the increased risk of experiencing major adverse cardiac events.

Objective

To determine whether aspirin therapy continued preoperatively increases bleeding complications in patients undergoing thyroid surgery.

Design, Setting, and Participants

Retrospective analysis of a consecutive sample of 570 patients, aged 18 to 100 years, who underwent thyroid surgery for benign and malignant disease from January 1, 2010, to December 31, 2015, by a single surgeon at a tertiary referral hospital center in New Orleans, Louisiana.

Exposures

Patients receiving aspirin therapy and patients not receiving aspirin therapy (aspirin naive) preoperatively.

Main Outcomes and Measures

Comparison of estimated blood loss, substantial blood loss, operative hematoma, nonoperative hematoma, and recurrent laryngeal nerve injury.

Results

Of 570 patients who underwent thyroid surgery, 106 (18.6%) were performed in patients receiving aspirin; of these, 23 (21.7%) were men and 105 (99.1%) were older than 45 years. Those receiving aspirin therapy displayed a 14.4-year difference in age (95% CI, 11.6-17.1). The aspirin group displayed a 20.3% absolute increase (95% CI, 9.3-30.7) in African American patients. Aspirin therapy was not associated with a statistically significant or clinically meaningful increase in intraoperative blood loss (2.5 mL; 95% CI, -0.4 to 5.3). Aspirin therapy was associated with a statistically significant increase in total hematoma formation (3.3%; 95% CI, 0.4-9.0), but the results were inconclusive. Aspirin therapy was not associated with a statistically significant increase in recurrent laryngeal nerve injury (2.6%; 95% CI, -1.1 to 8.6), but the results were inconclusive.

Conclusions and Relevance

These results suggest that aspirin therapy can be maintained prior to thyroid surgery without increased intraoperative bleeding. Further research with a larger sample size and more outcome events are required to make definitive conclusions regarding the association between aspirin use and complications, including hematoma and recurrent laryngeal nerve injury.