Retrospective analysis of the role of intra-operative parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism; a single center experience over 2 decades

Background: The role of intra-operative parathyroid hormone (IOPTH) monitoring during parathyroidectomy for primary hyperparathyroidism has long been debated. Objectives: Our main goal was to investigate the cure rates of parathyroidectomy for primary hyperparathyroidism with and without IOPTH monitoring. Our secondary goal was to investigate if operating room time can be saved when not using IOPTH monitoring. Design: A retrospective analysis of patients who underwent parathyroidectomy for PHPT for a single adenoma between 2004-2019 was performed. Cure rates and operating room time were compared. Results: 423 patients were included. IOPTH was used in 248 patients (59%). Four patients were not cured, two from each group, with no significant difference between the groups (98.8% vs. 99.1%, p=0.725). Surgery time was significantly longer in the IOPTH group, p<0.001. Conclusions: There is no advantage for using IOPTH during parathyroidectomy in suitable clinical setting. A focused procedure may be safely performed without IOPTH while achieving non-inferior success rates and reducing operative time.

Wide-Awake Brachioplasty: A Safe and Effective Technique for Local Anesthesia

Brachioplasty is a popular body contouring surgery which treats upper arm deformity related to both aging and massive weight loss. Demand for brachioplasty is growing, as the volume of bariatric surgery performed in the United States has doubled in the last decade.1 Local anesthesia offers multiple benefits for both patients and providers: it avoids anesthetic risks and anesthesia costs, decreases operating room time, and facilitates a more rapid recovery for patients. Brachioplasty is typically performed under general anesthesia or moderate sedation; this study details a successful technique to perform brachioplasty under wide-awake local anesthesia with high patient satisfaction and an excellent safety profile.

Operating Room Time Prediction: An Application of Latent Class Analysis and Machine Learning

Objective: The objective of this work is to build a prediction model for Operating Room Time (ORT) to be used in an intelligent scheduling system. This prediction is a complex exercise due to its high variability and multiple influential variables. Materials and methods: We assessed a new strategy using Latent Class Analysis (LCA) and clustering methods to identify subgroups of procedures and surgeries that are combined with prediction models to improve ORT estimates. Three tree-based models are assessed, Classification and Regression Trees (CART), Conditional Random Forest (CFOREST) and Gradient Boosting Machine (GBM), under two scenarios: (i) basic dataset of predictors and (ii) complete dataset with binary procedures. To evaluate the model, we use a test dataset and a training dataset to tune parameters. Results and discussion: The best results are obtained with GBM model using the complete dataset and the grouping variables, with an operational accuracy of 57.3% in the test set. Conclusion: The results indicate the GBM model outperforms other models and it improves with the inclusion of the procedures as binary variables and the addition of the grouping variables obtained with LCA and hierarchical clustering that perform the identification of homogeneous groups of procedures and surgeries.

OPERATING ROOM TIME ANALYSIS IN A TERTIARY CARE HOSPITAL : TO FIND BOTTLENECKS FOR IMPROVEMENT

BACKGROUND: rd Operating rooms (ORs) cost constitute a major investment of healthcare resources, approximating 1/3 of the total hospital budget and are among the most important areas of the hospital, contributing to both the workload and the revenue. OR efficiency is dened functionally in terms of underutilized and overutilized hours of ORtime. METHOD: A two p art study containing a prospective analysis time motion study of the operating room (OR) database to retrieve only the cases involving ve major operation theatres followed by a dichotomous open formal questionnaire with yes or no options to take the opinion of the operating room staff i.e., consultants, residents (both surgeons and anesthetists) and nurses RESULTS: Based on the time motion study the delays were mostly identied in T1-Wheel in time, T2- Anesthesia induction T6-cleaning of OR. In part 2 of the study it was evident that 65 % of the staff were of an opinion that OR is currently underutilized, 45% of the staff opined that signicant time is wasted between two surgeries and 75 % opined that they couldn't complete the scheduled list. CONCLUSIONS : Proper scheduling of regular cases and clarity in preparation of OT list, augmenting the man power, establishment good supply chain by providing sub stores in operation operating room, arrangement of sterile supplies and other equipment for the OR adequately by nursing staff could possibly lead in effective utilization of the Operating room time

Wildfire Burn Patients: A Unique Population

In the past ten years wildfires have burned an average of 6.8 million acres per year and this is expected to increase with climate change. Wildfire burn patient outcomes have not been previously well characterized. Wildfire burn patients from the Tubbs or Camp wildfires and non-wildfire burn matched controls were identified from the burn center database and outcomes were compared. The primary outcome was mortality. Secondary outcomes included length of stay (LOS), intensive care unit (ICU) LOS, readmission and development of wound infections. Time of presentation and operating room use after wildfires was evaluated. Sixteen wildfire burn patients were identified and matched with 32 controls. Wildfire burn patients trended towards higher mortality (19% wildfire vs. 9% non-wildfire, p=0.386), longer LOS (18 days wildfire vs. 15 days non-wildfire, p=0.406), longer ICU LOS (17 days wildfire vs. 11 days non-wildfire, p=0.991), increased readmission (19% wildfire vs. 3% non-wildfire, p=0.080) and higher rates of wound infection (31% wildfire vs. 19% non-wildfire, p=0.468). The majority of wildfire patients (88%) presented within 24 hours of the wildfire reaching a residential area. Operating room time within the first week was 13 hours 44 minutes for the Tubbs Fire and 19 hours 1 minute for the Camp Fire. Patients who sustain burns in wildfires are potentially at increased risk of mortality, prolonged LOS, wound infection and readmission.

Impact of Urinary Catheterization on Postoperative Outcomes After Roux-En-Y Gastric Bypass Surgery in Propensity-Matched Cohorts

Background The impact of urinary catheter avoidance in bariatric enhanced recovery after surgery (ERAS) protocols is yet to be established. The purpose of the current study is to determine whether urinary catheter use in patients undergoing Roux-en-Y gastric bypass (RYGB) procedures has an effect on postoperative outcomes. Methods An institutional database was utilized to identify adult patients undergoing primary minimally invasive RYGB surgery. Outcomes included incidence of urinary tract infection (UTI) within 30 days postoperatively, 30-day readmission rates, proportion of patients discharged after postoperative day 1 (delayed discharge), length of stay (LOS), and operating room time. These were compared between propensity-matched groups with and without urinary catheter placement. Results There were no significant differences in postoperative UTI’s (2.2% for both cohorts, P = .593) or 30-day readmission rates for patients with and without urinary catheters (6.6% and 4.4%, respectively, P = .260). Mean LOS (1.7 vs. 1.5 days, P = .001) and the proportion of patients having a delayed discharge (47.3% vs. 33.7%, P = .001) was greater in patients with a catheter. Operating room time was longer in the urinary catheter group (221.8 vs. 207.9 minutes, P = .002). Discussion Avoidance of indwelling urinary catheters in RYGB surgical patients decreased delayed discharges and LOS without affecting readmission or reoperation rates. Therefore, we recommend that avoidance of urinary catheters in routine RYGB surgery be considered for inclusion into standardized ERAS protocols. Urinary catheters should continue to be utilized in select cases, however, as these were not shown to affect rate of UTIs.

WALANT Technique versus Sedation for Endoscopic Carpal Tunnel Release

Background This study sought to investigate complication rates/perioperative metrics after endoscopic carpal tunnel release (eCTR) via wide-awake, local anesthesia, no tourniquet (WALANT) versus sedation or local anesthesia with a tourniquet. Methods Patients aged 18 years or older who underwent an eCTR between April 28, 2018, and December 31, 2019, by 1 of 2 fellowship-trained surgeons at our single institution were retrospectively reviewed. Patients were divided into 3 groups: monitored anesthesia care with tourniquet (MT), local anesthesia with tourniquet (LT), and WALANT. Results Inclusion criteria were met by 156 cases; 53 (34%) were performed under MT, 25 (16%) under LT, and 78 (50%) under WALANT. The MT group (46.1 ± 9.7) was statistically younger compared with LT (56.3 ± 14.1, P = .007) and WALANT groups (53.5 ± 15.8, P = .008), F(2, 153) = 6.465, P = .002. Wide-awake, local anesthesia, no tourniquet had decreased procedural times (10 minutes, SD: 2) compared with MT (11 minutes, SD: 2) and LT (11 minutes, SD: 2), F(2, 153) = 5.732, P = .004). Trends favored WALANT over MT and LT for average operating room time (20 minutes, SD: 3 vs 32 minutes, SD: 6 vs 23 minutes, SD: 3, respectively, F(2, 153) = 101.1, P < .001), postanesthesia care unit time (12 minutes, SD: 7 vs 1:12 minutes, SD: 26 vs 20 minutes, SD: 22, respectively, F(2, 153) =171.1, P < .001), and door-to-door time (1:37 minutes, SD: 21 vs 2:51 minutes, SD: 40 vs 1:46 minutes, SD: 33, respectively, F(2, 153) = 109.3, P < .001). There were no differences in complication rates. Conclusions Our data suggest favorable trends for patients undergoing eCTR via WALANT versus MT versus LT.