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Nardelli P, Giesinger J, Liebensteiner M, Pagenstert G, Neururer S, Leitner H, Dammerer D, van Rooij F, Saffarini M. Moonlight surgery: no influence of moon phase or Friday 13th on outcomes of total knee arthroplasty. Arch Orthop Trauma Surg 2023; 143:6169-6175. [PMID: 37306775 DOI: 10.1007/s00402-023-04919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/21/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The purpose of the present study was to investigate associations between revision-free survival and functional scores of total knee arthroplasty (TKA) and moon phase on the day of surgery, as well as operations performed on a Friday 13th. PARTICIPANTS The data of all patients that received TKA between 2003 and 2019 were extracted from the Tyrol arthroplasty registry. Patients that had undergone previous total or partial knee arthroplasty as well as patients that had missing pre- or post-operative WOMAC were excluded. Patients were allocated to one of the following four groups according to moon phase on the day of surgery: new, waxing, full and waning. Patients operated on a Friday 13th were also identified and compared to patients operated on any other days/dates. A total of 5923 patients met the inclusion criteria, with mean age of 69 ± 9 years, and comprising 62% women. RESULTS There were no significant differences in revision-free survival among the four moon phase groups (p = 0.479), and no significant differences in preoperative and postoperative total WOMAC (p = 0.260, p = 0.122), There were no significant differences in revision-free survival patients operated on Friday 13th vs. other days/dates (p = 0.440). The preoperative total WOMAC was significantly worse for patients operated on a Friday 13th (p = 0.013), which was observed in the pain (p = 0.032) and function (p = 0.010) subscales. There were no significant differences in postoperative total WOMAC at 1 year follow-up (p = 0.122). CONCLUSIONS Neither moon phase on the day of surgery nor Friday 13th were associated with revision-free survival or clinical scores of TKA. Patients operated on a Friday 13th had significantly worse preoperative total WOMAC but similar postoperative total WOMAC at 1-year follow-up. These findings could help reassure patients that TKA renders consistent outcomes regardless of the preoperative pain or function, and in spite of bad omens or moon phases.
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Affiliation(s)
- Paul Nardelli
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Giesinger
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Geert Pagenstert
- Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland
| | - Sabrina Neururer
- Institute for Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Hermann Leitner
- Institute for Clinical Epidemiology, Tirol Kliniken GmbH, Innsbruck, Austria
| | - Dietmar Dammerer
- Department of Orthopaedics and Traumatology, University Hospital Krems, Krems, Austria
| | - Floris van Rooij
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland
- Clinique Trenel, Sainte Colombe, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
- Clinique Trenel, Sainte Colombe, France.
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Truswell WH. From "Hello to Goodbye"-Guiding the Patient of Her Journey Through Facial Rejuvenation Surgery. Facial Plast Surg Clin North Am 2020; 28:429-436. [PMID: 33010860 DOI: 10.1016/j.fsc.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Facial plastic surgeons need to be very much more than excellent surgeons. They need to understand and have the ability to bring each patient into the practice family of the surgeon, the administrative and clerical staff, the nurses, the technicians, and the aestheticians. The entire staff must "own" the practice and the patient management philosophy of the surgeon. This article is the author's philosophy and method of guiding his patients through their journey of rejuvenative facial surgery based on 44 years of experience.
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Affiliation(s)
- William H Truswell
- Division of Otolaryngology-Head and Neck Surgery, University of Connecticut School of Medicine, Farmington, CT, USA; American Board of Facial Plastic and Reconstructive Surgery; American Academy of Facial Plastic and Reconstructive Surgery; Private Practice, Easthampton, MA, USA.
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Malik AT, Khan S, Ali A, Mufarrih SH, Noordin S. Total Knee Arthroplasty: Does Day of Surgery Matter? Clin Med Insights Arthritis Musculoskelet Disord 2018; 11:1179544117754067. [PMID: 29371786 PMCID: PMC5772502 DOI: 10.1177/1179544117754067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/27/2017] [Indexed: 11/15/2022]
Abstract
Introduction There has been an influx of research studies aimed at identifying all factors that contribute to minimizing cost and maximizing postoperative care after total knee arthroplasty (TKA). Length of stay (LOS) has been defined as a significant factor that contributes to increased burden. We aimed at looking whether day of surgery has any significant effect on the LOS and postoperative complications following total knee arthroplasty (TKA). Materials and methods Retrospective cohort study done at the Aga Khan University Hospital, Pakistan, from January 2007 to December 2015. A total of 611 patients who underwent a unilateral or bilateral total knee arthroplasty (TKA) were included in study: 269 (44.0%) patients underwent unilateral TKA and 342 (56.0%) underwent a bilateral TKA. Results Kruskal-Wallis test and post hoc pairwise comparisons showed that unilateral TKAs performed on Tuesday, Saturday, and Sunday resulted in a lower median LOS (P < .05). No significant association was seen in bilateral TKA group. Day of surgery was not associated with postoperative complications. Conclusions Unilateral TKAs performed earlier during the week and later on the weekend are associated with a significantly lower LOS. It is highly probable that patch ancillary services during the latter part of the week and a higher workload for the staff are important reasons for this phenomenon.
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Affiliation(s)
- Azeem Tariq Malik
- Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Shahid Khan
- Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Arif Ali
- Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Syed Hamza Mufarrih
- Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Shahryar Noordin
- Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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Kaddoum R, Fadlallah R, Hitti E, El-Jardali F, El Eid G. Causes of cancellations on the day of surgery at a Tertiary Teaching Hospital. BMC Health Serv Res 2016; 16:259. [PMID: 27412041 PMCID: PMC4944432 DOI: 10.1186/s12913-016-1475-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 06/24/2016] [Indexed: 11/17/2022] Open
Abstract
Background Cancellation of elective scheduled operations on the day of surgery leads to an inefficient use of operating room (OR) time and a waste of resources. It also causes inconvenience for patients and families. Moreover, day of surgery (DOS) cancellation creates logistic and financial burden associated with extended hospital stay and repetitions of pre-operative preparations as well as opportunity costs of lost time and missed income. The objective of this study is to establish the rate of elective surgical cases cancellations on the day of surgery and the reasons for these cancellations stratified by avoidable versus unavoidable within a tertiary care teaching hospital in Beirut, Lebanon as well as recommend appropriate solutions. Method This is a prospective audit of the operation theatre list over a period of eight months (January 1, 2013-August 30, 2013). All patients scheduled to undergo elective surgeries at the hospital from January-August 2013 were included. An assigned OR staff recorded the cancelled cases in real time. The assigned staff confirmed the cancellation reason and added additional explanation if necessary by calling patients or through direct inquiry of clerical and/or clinical staff the following day. A Pareto chart was constructed to prioritize the reasons that accounted for 80 % of the avoidable surgical cancellations. Results For the given study period, 5929 elective surgeries were performed, of which 261 cases (4.4 %) were cancelled on the day of surgery. 187 cases (or 71.6 %) were judged as potentially avoidable cancellations versus 74 (28.4 %) that were judged as unavoidable. Of the 187 potentially avoidable cancellations, lack of financial clearance, incomplete medical evaluation, patient not showing up for surgery, and OR behind schedule accounted for almost 80 % of the causes. Conclusion This study showed that the majority of cancellations were deemed avoidable and hospital related. A day of surgery cancellation rate less than 2 % is attainable. Determining the major avoidable contributors to DOS cancellations is an essential first step to developing appropriate interventions to improve operating theater efficiency. Recommended interventions were presented accordingly.
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Affiliation(s)
- Roland Kaddoum
- Deparment of Operating Room, American University of Beirut Medical Center, Beirut, Lebanon
| | - Racha Fadlallah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ghada El Eid
- Department of the Chief Medical Officer, American University of Beirut Medical Center, Beirut, Lebanon.
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Abstract
OBJECTIVES Later weekday of surgery for oesophageal cancer seems to increase 5-year mortality, but the mechanisms are unclear. We hypothesised that early postoperative reoperations and mortality might explain this association, since reoperation after oesophagectomy decreases long-term prognosis, and later weekday of elective surgery increases 30-day mortality. DESIGN This was a population-based cohort study during the study period 1987-2014. SETTING All Swedish hospitals conducting elective surgery for oesophageal cancer in Sweden. PARTICIPANTS Included were 1748 patients, representing almost all (98%) patients who underwent elective surgery for oesophageal cancer in Sweden during 1987-2010, with follow-up until 2014. PRIMARY AND SECONDARY OUTCOME MEASURES The risk of reoperation or mortality within 30 days of oesophageal cancer surgery was assessed in relation to weekday of surgery by calculating ORs with 95% CIs using multivariable logistic regression. ORs were adjusted for age, comorbidity, tumour stage, histology, neoadjuvant therapy and surgeon volume. RESULTS Surgery Wednesday to Friday did not increase the risk of reoperation or mortality compared with surgery Monday to Tuesday (OR=0.99, 95% CI 0.75 to 1.31). A decreased point estimate of reoperation (OR=0.88, 95% CI 0.64 to 1.21) was counteracted by an increased point estimate of mortality (OR=1.28, 95% CI 0.83 to 1.99). ORs did not increase from Monday to Friday when each weekday was analysed separately. There was no association between weekday of surgery and reoperation specifically for anastomotic leak, laparotomy or wound infection. Stratification for surgeon volume did not reveal any clear associations between weekday of surgery and risk of 30-day reoperation or mortality. CONCLUSIONS Weekday of oesophageal cancer surgery does not seem to influence the risk of reoperation or mortality within 30 days of surgery, and thus cannot explain the association between weekday of surgery and long-term prognosis.
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Affiliation(s)
- Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK
| | - Fredrik Mattsson
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Hegab B, Abdelfattah MR, Azzam A, Mohamed H, Al Hamoudi W, Alkhail FA, Bahili HA, Khalaf H, Sofayan MA, Sebayel MA. Day-of-surgery rejection of donors in living donor liver transplantation. World J Hepatol 2012; 4:299-304. [PMID: 23293715 PMCID: PMC3536836 DOI: 10.4254/wjh.v4.i11.299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 10/31/2012] [Accepted: 11/07/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To study diagnostic laparoscopy as a tool for excluding donors on the day of surgery in living donor liver transplantation (LDLT). METHODS This study analyzed prospectively collected data from all potential donors for LDLT. All of the donors were subjected to a three-step donor evaluation protocol at our institution. Step one consisted of a clinical and social evaluation, including a liver profile, hepatitis markers, a renal profile, a complete blood count, and an abdominal ultrasound with Doppler. Step two involved tests to exclude liver diseases and to evaluate the donor's serological status. This step also included a radiological evaluation of the biliary anatomy and liver vascular anatomy using magnetic resonance cholangiopancreatography and a computed tomography (CT) angiogram, respectively. A CT volumetric study was used to calculate the volume of the liver parenchyma. Step three included an ultrasound-guided liver biopsy. Between November 2002 and May 2009, sixty-nine potential living donors were assessed by open exploration prior to harvesting the planned part of the liver. Between the end of May 2009 and October 2010, 30 potential living donors were assessed laparoscopically to determine whether to proceed with the abdominal incision to harvest part of the liver for donation. RESULTS Ninety-nine living donor liver transplants were attempted at our center between November 2002 and October 2010. Twelve of these procedures were aborted on the day of surgery (12.1%) due to donor findings, and eighty-seven were completed (87.9%). These 87 liver transplants were divided into the following groups: Group A, which included 65 transplants that were performed between November 2002 and May 2009, and Group B, which included 22 transplants that were performed between the end of May 2009 and October 2010. The demographic data for the two groups of donors were found to match; moreover, no significant difference was observed between the two groups of donors with respect to hospital stay, narcotic and non-narcotic analgesia requirements or the incidence of complications. Regarding the recipients, our study clearly revealed that there was no significant difference in either the incidence of different complications or the incidence of retransplantation between the two groups. Day-of-surgery donor assessment for LDLT procedures at our center has passed through two eras, open and laparoscopic. In the first era, sixty-nine LDLT procedures were attempted between November 2002 and May 2009. Upon open exploration of the donors on the day of surgery, sixty-five donors were found to have livers with a grossly normal appearance. Four donors out of 69 (5.7%) were rejected on the day of surgery because their livers were grossly fatty and pale. In the laparoscopic era, thirty LDLT procedures were attempted between the end of May 2009 and October 2010. After the laparoscopic assessment on the day of surgery, twenty-two transplantation procedures were completed (73.4%), and eight were aborted (26.6%). Our data showed that the levels of steatosis in the rejected donors were in the acceptable range. Moreover, the results of the liver biopsies of rejected donors were comparable between the group A and group B donors. The laparoscopic assessment of donors presents many advantages relative to the assessment of donors through open exploration; in particular, the laparoscopic assessment causes less pain, requires a shorter hospital stay and leads to far superior cosmetic results. CONCLUSION The laparoscopic assessment of donors in LDLT is a safe and acceptable procedure that avoids unnecessary large abdominal incisions and increases the chance of achieving donor safety.
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Affiliation(s)
- Bassem Hegab
- Bassem Hegab, Mohamed Rabei Abdelfattah, Ayman Azzam, Hazem Mohamed, Waleed Al Hamoudi, Faisal Aba Alkhail, Hamad Al Bahili, Hatem Khalaf, Mohammed Al Sofayan, Mohammed Al Sebayel, Department of Liver Transplantation and Hepatobiliary-Pancreatic Surgery, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
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