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.

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

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.

Differences in organization of care are associated with mortality, severe complication and failure to rescue in emergency colon cancer surgery

Background Emergency colon cancer surgery is associated with increased mortality and complication risk, which can be due to differences in the organization of hospital care. This study aimed. Objective To explore which structural factors in the preoperative, perioperative and postoperative periods influence outcomes after emergency colon cancer surgery. Methods An observational study was performed in 30 Dutch hospitals. Medical records from 1738 patients operated in the period 2012 till 2015 were reviewed on the type of referral, intensive care unit (ICU) level, surgeon specialization and experience, duration of surgery and operating room time, blood loss, stay on specialized postoperative ward, complication occurrence, reintervention and day of surgery and linked to case-mix data available in the Dutch Colorectal Audit. Multivariate logistic regression analysis was used to estimate the influence of these factors on 30-day mortality, severe complication and failure to rescue (FTR), after adjustment for case-mix. Results Patients operated by a non-Gastro intestinal/oncology specialized surgeon have significantly increased mortality (Odds Ratio (OR) 2.28 [95% confidence interval (95% CI) 1.23–4.23]) and severe complication risk (OR 1.61 [95% CI 1.08–2.39]). Also, duration of stay in the operating room was significantly associated with increased risk on severe complication (OR 1.03 [95% CI 1.01–1.06]). Patients admitted to a non-specialized ward have significantly increased mortality (OR 2.25 [95% CI 1.46–3.47]) and FTR risk (OR 2.39 [95% CI 1.52–3.75]). A low ICU level (basic ICU) was associated with a lower severe complication risk (OR 0.72 [95% CI 0.52–1.00]). Surgery on Tuesday was associated with a higher mortality risk (OR 2.82 [95% CI 1.24–6.40]) and a severe complication risk (OR 1.77, [95% CI 1.19–2.65]). Conclusion This study identified a non-specialized surgeon and ward, operating room, time and day of surgery to be risk factors for worse outcomes in emergency colon cancer surgery.

Operating room time as a limited resource: ethical considerations for allocation

Scheduling surgical procedures among operating rooms (ORs) is mistakenly regarded as merely a tedious administrative task. However, the growing demand for surgical care and finite hours in a day qualify OR time as a limited resource. Accordingly, the objective of this manuscript is to reframe the process of OR scheduling as an ethical dilemma of allocating scarce medical resources. Recommendations for ethical allocation of OR time—based on both familiar and novel ethical values—are provided for healthcare institutions and individual surgeons.