Reasons for Elective Surgery Cancellations in a Senegalese Pediatric Surgery Department

Introduction: Cancellation of elective surgery is common in developing countries. This decision is difficult to make as it generates economic and organizational consequences for the healthcare facility and an additional source of stress for patients and their caregivers. This study aimed to analyze the various aspects of this medical problem. Patients and Methods: We conducted a prospective and descriptive study over six months (from January 1st, 2017, to June 30th, 2017) at the pediatric surgery department of Aristide Le Dantec University Teaching Hospital in Senegal. Results: Ninety-one cases were collected. The cancellation rate was 20.8%. Infants were affected in 36.3% of cases. Among anesthesiologists, 83.5% were residents, and 16.5% were specialists. Cancellation in nephroblastoma children with an indication for extended nephrectomy represented 15.4% of cases. Concerning reasons for cancellation, comorbidities, dominated by respiratory infections, accounted for 28.5% of cases, patient absences for 24.2%, and issues related to the anesthesiologist for 17.6%. Cancellations were avoidable in 33% of cases. Patients were responsible for cancellation in 37.4% of cases, the healthcare system in 33%, and medical reasons in 29.7%. Conclusion: Our findings suggest that one-third of cancellations could have been avoided with improvements in the healthcare system. Actions should be taken to reduce the cancellation rate in our context.

Change in Functional Status from Preoperative to One Year Postoperative in Patients Who Have Undergone Elective Open-Heart Surgery: A Repeated-Measures Study

Purpose: Although patient-related factors affect surgical outcomes, preoperative functional status is not measured by any cardiac risk score. Functional status can, however, be objectively measured using validated outcome tools such as the Late-Life Function and Disability Instrument (LLFDI). The purpose of this study was to determine 1) if there was a change over time in functional status, as measured by the LLFDI, in patients who underwent elective cardiac surgery, and if so, 2) what specific aspect(s) of functional status changed. Methods: A prospective longitudinal study of one year was conducted on elective cardiac surgery patients (n = 43) using the self-reported LLFDI, which measures Disability Frequency (frequency of participation in social tasks), Disability Limitation (ability to participate in social tasks) and Function Total (ease in performing routine activities). Higher scores indicate increased function and decreased disability. LLFDI scores were compared at three times (preoperative, six-week and one-year postoperative) using repeated measures ANOVA. Post hoc pairwise comparison was conducted for specific interactions. Results: Both Function Total and Disability Frequency significantly changed over time (p = 0.047 and p = 0.013, respectively). Specifically, patients’ function level was significantly higher one-year postoperative compared to preoperative (M difference = +3.48, SE = 1.48, p = 0.026). Likewise, Disability Frequency scores were significantly higher (i.e. more active) at one-year postoperative versus preoperative (M difference= +5.98, SE = 2.19, p = 0.033). Disability Limitation scores were not significantly different between any time points (p > 0.05). Conclusion: By one-year postoperative, patients demonstrated increased ease in their routine physical activities and were more participatory in social life tasks. Individuals who underwent elective cardiac surgery took more than six weeks to detect notable improvement in functional status, which was expected with a sternotomy approach. This study provides support for the use of the LLFDI as an effective tool to capture functional status in the cardiac population. These findings may assist cardiac patients in recovery timeline expectations.

Prevalence of Preoperative Anemia in Elective Rheumatic Valve Surgery at a Tertiary Care Center in Nepal

Background: Rheumatic Valvular Heart disease (RVHD) is common in developing countries often associated with anemia;however its burden is often overlooked. Anemic patients undergoing surgery are likely to receive blood transfusion, increasing morbidity and mortality. Prevalence of anemia in cardiac surgical patients are studied extensively, however its burden in RVHD is lacking. This study attempted to investigate the prevalence of preoperative anemia in RVHD and its effect on blood transfusion, morbidity and mortality in patients undergoing valve surgery. Methods: This is a retrospective observational study conducted at a tertiary care hospital in Nepal. We considered 340 patients who underwent Rheumatic valve replacement surgery from 2014 January to December 2016 and data on their socio-demographic and clinical characteristics were extracted from the patient’s records. The analyses meeting the study objectives were conducted using IBM SPSS v25 for Windows (IBM Statistical Package for Social Sciences, 2015IBM Corporation, New York, United States). Results: The prevalence of no anemia, mild, moderate, and severe anemia was 34.1%, 57.7%, 39.6%, 2.5%, respectively. The units of Red Blood Cell used for transfusion were 1.2 units, 2.0 units, 2.3 units, and 1.6 units in patients without anemia, and those with mild, moderate and severe anemia respectively. The incidence of reexploration was higher in patients with severe anemia as compared to the non anemic with an incidence of 66.6%. A proportion of the patients with no anemia, mild, moderate and severe anemia with less than 7 days stay in the intensive care unit were 89%, 82%, 84.7% and 100% respectively. The length of hospital stay more than 10 days was seen in 58.9%, 71.6%, 63% and 100% in patients with no anemia, mild, moderate and severe anemia. An overall incidence of mortality in anemic patients was 11% while in non anemic patients was 5.3%. Conclusions: The prevalence of anemia was high in the Nepalese patients with Rheumatic valvular heart disease planned for elective surgery. There was an increased incidence of blood transfusion, longer hospital stay, and increased mortality in anemic patients compared to their non anemic counterparts.

Cancellation Causes of Elective Surgical Procedures in a Major Pediatric Surgery Department

Introduction: Cancellation of surgical operation is a surgical operation registered in the official schedule the day before or added to the list after and not carried out on the operating day. The purpose of this work was to determine the causes of cancellation of elective surgical operations in a major pediatric surgery department in Senegal. Patients and methods: It was a prospective and descriptive study of 278 patients scheduled during a period of 13 weeks. The study took place between April 3rd, 2017, and January 31st, 2018. Mean age was 2.9 years with extremes of 3 days and 15 years. The age group of 29 days to 30 months was the most represented (62.2%). Sex ratio was 1.41. Causes of cancellation were categorized into administrative and organizational causes, patient-related causes and staff-related causes. Results: Cancellation rate was 29.4%. Patient-related causes were most common (51.2%). Upper Respiratory tract infection (URTI) was commonest reason within this category (57.5%). Organizational causes (28.1%) came second and were mainly represented by the unavailability of the operating room (60.8%) related to breakdowns of anesthesia equipment. Finally, staff-related causes (20.7%) were due for most to the unavailability of the anesthesiologist (12 cases/17). Conclusion: Majority of causes that led to cancellation of elective surgical operations in our Pediatric surgery department are related to intercurrent illnesses affecting the patient, in particular URTI.

Factors influencing the surveillance of re-emerging intracranial infections in elective neurosurgical patients:A single-center retrospective study

BACKGROUND At present,many studies have reported the risk factors for postoperative intracranial reinfection,including age,sex,time to surgery,duration of postoperative catheterization,emergency procedures,type of disease and cerebrospinal fluid leakage,but the academic community has not reached a unified conclusion.AIM To find factors influencing the surveillance of re-emerging intracranial infections in elective neurosurgical patients.METHODS Ninety-four patients who underwent elective craniotomy from January 1,2015 to December 31,2022 in the Department of Neurosurgery,First Hospital of Jilin University,were included in this study.Of those,45 patients were enrolled in the infection group,and 49 were enrolled in the control group.The clinical data of the patients were collected and divided into three categories,including preoperative baseline conditions,intraoperative characteristics and postoperative infection prevention.The data were analyzed using SPSS 26.0 software.RESULTS There were 23 males and 22 females in the infection group with a mean age of 52.8±15.1 years and 17 males and 32 females in the control group with a mean age of 48.9±15.2 years.The univariate analysis showed that the infection group had higher systolic blood pressures and postoperative temperatures,fewer patients who underwent a supratentorial craniotomy,more patients with a history of hypertension and higher initial postoperative white blood cell counts than the control group,with statistically significant differences(P<0.05).The multifactorial logistic regression analysis showed that a history of hypertension and a high postoperative body temperature were independent risk factors for postoperative infection in neurosurgical patients.CONCLUSION The results obtained in this study indicated that a history of hypertension and a high postoperative body temperature were independent risk factors for postoperative neurological symptoms.

Prevalence of Pre-Operative Anxiety and Predictors among Elective Surgical Patients and Their Pre-Operative Hemodynamic Changes at Muhimbili National Hospital

Background: Surgery is a traumatic process that may subject patients to physiological and psychological responses leading to pre and post-operative effects. Preoperative anxiety, if severe may be associated with several complications including cancellation of surgery, poor intra- and post-operative analgesic control, altered post-operative healing, and longer hospital stays to mention a few. Objective: The main purpose was to determine the prevalence and predictors of pre-operative anxiety among elective surgical patients and their hemodynamic changes in these patients in the Surgical department in MNH. Methodology: This was a prospective descriptive and analytical study performed at MNH which involved patients admitted for elective surgical procedures from June 2021 to February 2022. Information was gathered in a structured questionnaire along with APAIS scores. Results: 169 patients for elective surgery in General Surgery and Urology units were included in the study. Among them, 94 males and 74 females. The overall pre-operative anxiety was 11.8%, 80.5% had moderate to severe Information-Related anxiety, while 26% and 17.2% had moderate-to-severe surgery-related and anesthesia-related types of anxiety respectively. Conclusion: Pre-operative anxiety was comparatively lower in our settings as well no factor was found with a significant relation to pre-operative anxiety, hence further and broader evaluation is recommended to result in the assessment and management of patients before elective surgery.

Informed Consent Prior to Elective Gynaecological Surgery in Two Reference Hospitals in Yaoundé, Cameroon: A Mixed Methods Study

Introduction: Informed consent is a process that enshrines respect for patients’ autonomy, their dignity, and their rights to determine what happens to their own bodies. We set out to describe the surgical informed consent process and evaluate its quality in patients undergoing elective gynaecological surgeries in two University Teaching Hospitals in Yaounde, Cameroon. Methods: This was a cross-sectional, prospective study over 9 month period, from October 1st, 2018, to June 30th, 2019 at the Yaounde Gynaeco-Obstetric and Paediatric Hospital (YGOPH) and the Yaounde Central Hospital (YCH). By administering a modified Brezis questionnaire 48 hours after surgery, we obtained data which enabled us to evaluate and score the informed consent process and obtained written reports of patients’ appreciation of key aspects of the informed consent process prior to surgery. We then called each participant 6 months after their surgery date to obtain information on the occurrence or not of post-operative complications. Results: We recruited 72 patients aged 24 to 68 years old (61 at YGOPH, 11 at YCH). The operating gynaecologist sought patient consent in 65.3% (49/72) of cases, while 61.1% (44/72) of the subjects would have loved to have more information on surgical risks;69.4% (50/72) were satisfied with the consent process;and 56.9% (41/72) could recall and repeat the information they received prior to surgery. While 37.5% (27/72) had poor quality (non-valid consent), 40.3% had good quality consent (valid). Consent administered by the gynaecologist (OR = 0.172;95% CI = 0.060 - 0.049) was a strong determinant of valid consent. Also, patients with non-valid consent significantly reported more complications (OR = 4.469;95% CI = 1.412 - 14.147) than those with valid consent. Conclusion: Informed consent prior to elective gynaecological surgeries in our study was poor. The timing of the consent process, as well as the person involved in the process affect the validity of the consent.

Patient Satisfaction after Elective Major Gynaecological Surgery in 2 Reference Hospitals in Yaounde: A Cross-Sectional Study

Introduction: Patient satisfaction is a quality-of-care measure and reveals patients’ appreciation of healthcare delivery. We sought to measure patient satisfaction following major gynaecological surgeries in 2 University Teaching Hospitals in Yaounde, Cameroon. Methods: This study was a cross-sectional, prospective study over 9 months (October 1st, 2018, to June 30th, 2019) at the Yaounde Gynaeco-Obstetric and Paediatric Hospital (YGOPH) and the Yaounde Central Hospital (YCH). By administering a modified Surgical Satisfaction Questionnaire (SSQ-8) via phone call 6 months after surgery, we appreciated and scored key aspects linked to patient satisfaction and obtained information on post-operative complications. Data were analysed using Microsoft Excel 18 and SPSS 21 setting significance at p Results: We recruited 72 patients aged 24 to 68 years. Our participants had a mean satisfaction score of 26 ± 7.854 (59.7% satisfied and 40.3% dissatisfied). All aspects tested on the SSQ-8 questionnaire influenced patient satisfaction. Patients who said they were satisfied with pain control after surgery (OR = 0.207 CI = 0.070 - 0.609, p = 0,003), and with surgical results in the SSQ-8 questionnaire (OR = 0.053, CI = 0.011 - 0.254, p < 0.001) achieved statistically significant post-operative satisfaction. Contrarily, patients who were dissatisfied with surgery results (OR = 132.000, CI = 15.256 - 114.131, p < 0.001) and those who developed complications (OR = 7.922, CI = 2.241 - 28.004, p < 0.001) were significantly dissatisfied with surgery. Additionally, 47.2% declared a poor post-operative current health status versus 52.8% who claimed a good post-operative current health status. Following multivariate analysis, satisfaction with the results of surgery (OR = 0.071, CI = 0.008 - 0.657, p = 0.020) and the occurrence of complications (OR = 7.284, CI = 1.146 - 46.273, p = 0.035) were the main determinants of patient satisfaction. Patient current health status evolved similarly to patient satisfaction and especially by satisfaction with time taken to resume work (OR = 0.039, CI = 0.004 - 0.398, p = 0.006) and pre-operative exercise routine (OR = 0.038, CI = 0.002 - 0.678, p-value = 0026). Conclusion: Patient satisfaction with elective gynaecological surgery is low and determined by post-operative experiences and the occurrence of complications. Also, patients self-reported current health status tends to evolve similarly to satisfaction following surgery.

The Effect of the COVID 19 Pandemic on Elective Surgical Services in Jos, North Central, Nigeria

Background. The COVID 19 pandemic affected healthcare delivery systems worldwide. There was a redistribution of health care resources in order to deal with the effects of the pandemic, with a corresponding consequence on other clinical services rendered. The extent of this effect on other non COVID 19 related services has been reported in other centres worldwide. In our own setting, health care resources are limited with suboptimal access even in normal situations. Objective. We sought to evaluate the effects of the COVID 19 pandemic on elective surgical services in our hospital. Methods. This was a cross sectional comparative study carried out at the Jos University Teaching hospital, (North central, Nigeria) of the elective surgical services rendered during the first wave of the COVID 19 pandemic lockdown covering the period April to June 2020 with a corresponding period of the preceding year 2019. Data was obtained from the hospital records department, theatres and service areas for clinic attendance, elective surgeries and ward occupancy. The paired sample t-test was used to compare the assessed variables across the three months of both years with a level of significance of P < 0.05. Results. There was mean clinic attendance of 2859.33 ± 223.36 covering the three months in 2019 as against a mean attendance of 648.67 ± 578.24 covering a similar period in 2020, P = 0.037. The elective surgical procedures carried out across the surgical specialties over the period in 2019 gave a mean of 352.33 ± 44.60 as opposed to 64.001 ± 7.32 over the corresponding period in 2020, P = 0.018. Ward occupancy over April to June 2019 was a mean 297.33 ± 18.58 across the various surgical wards and 158.33 ± 25.70 in the same period in 2020, P = 0.007. Conclusion. There was a significant reduction in the elective surgical services rendered in the hospital during the first wave of the COVID 19 pandemic compared to a corresponding period in the preceding year. This decline in elective surgical services would have negatively affected the access to health care. Thus measures to clear the backlog of elective surgical procedures would be required.

Effects of Continuous Non-Invasive Blood Pressure Monitoring on Intraoperative Hemodynamics and Postoperative Myocardial Injury in Craniotomy:Comparison Between Groups Based on Self-Control and Propensity Score Matching

Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divided into the self-control group(continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring,CNAP group)and propensity score matching group(only intermittent cuff non-invasive blood pressure measurement in previous craniotomy,PSM group);Goal-directed hemodynamic management in CNAP group included heart rate(HR),blood pressure(BP),stroke volume(SV),stroke variability(SVV),and systemic vascular resistance index(SVRI).The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group;The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points.Results:The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group(12%vs.30%,P=0.01);in the CNAP group hypotensive episodes(6 vs.3,P=0.01),positive balance of fluid therapy(700 vs.500 mL,P<0.001),more use of vasoactive drugs(29 vs.18,P=0.04),more stable hemodynamics medical status(P=0.03)were recorded.Conclusion:The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.

Clinical presentation,management,screening and surveillance for colorectal cancer during the COVID-19 pandemic

Management of colorectal cancer(CRC)was severely affected by the changes implemented during the pandemic,and this resulted in delayed elective presentation,increased emergency presentation,reduced screening and delayed definitive therapy.This review was conducted to analyze the impact of the coronavirus disease 2019(COVID-19)pandemic on management of CRC and to identify the changes made in order to adapt to the pandemic.We performed a literature search in PubMed,Medline,Index Medicus,EMBASE,SCOPUS,Reference Citation Analysis(https://www.referencecitationanalysis.com/)and Google Scholar using the following keywords in various combinations:Colorectal cancer,elective surgery,emergency surgery,stage upgrading,screening,surveillance and the COVID-19 pandemic.Only studies published in English were included.To curtail the spread of COVID-19 infection,there were modifications made in the management of CRC.Screening was limited to high risk individuals,and the screening tests of choice during the pandemic were fecal occult blood test,fecal immunochemical test and stool DNA testing.The use of capsule colonoscopy and open access colonoscopy was also encouraged.Blood-based tests like serum methylated septin 9 were also encouraged for screening of CRC during the pandemic.The presentation of CRC was also affected by the pandemic with more patients presenting with emergencies like obstruction and perforation.Stage migration was also observed during the pandemic with more patients presenting with more advanced tumors.The operative therapy of CRC was altered by the pandemic as more emergencies surgeries were done,which may require exteriorization by stoma.This was to reduce the morbidity associated with anastomosis and encourage early discharge from the hospital.There was also an initial reduction in laparoscopic surgical procedures due to the fear of aerosols and COVID-19 infection.As we gradually come out of the pandemic,we should remember the lessons learned and continue to apply them even after the pandemic passes.

Pain and function deteriorate in patients awaiting total joint arthroplasty that has been postponed due to the COVID-19 pandemic

BACKGROUND Elective total joint arthroplasty(TJA)procedures have been postponed as part of the coronavirus disease 2019(COVID-19)response to avert healthcare system collapse.Total hip arthroplasty(THA)and total knee arthroplasty(TKA)procedures comprise the highest volume of elective procedures performed at health care facilities worldwide.AIM To determine the demand for TJA despite the pandemic and the impact of surgery postponement on physical and mental health.METHODS We conducted a prospective cross-sectional telephonic interview-based study on patients awaiting THA and TKA at an academic institution in South Africa.The questionnaire consisted of four sections.The first section recorded baseline demographic data and medical co-morbidities,the length of time spent awaiting TJA,and the patients’desire to undergo elective surgery despite the COVID-19 pandemic.Section 2 and Section 3 assessed the patients’current physical and mental health,respectively,as a consequence of deferred surgical intervention.The last section established the patients’perception of the healthcare system’s response to the COVID-19 pandemic and necessity to postpone elective surgery.Patients received counseling and education on the current state of surgery during the COVID-19 pandemic and associated risks.Thereafter,patients were once again asked about their desire to undergo TJA during the COVID-19 pandemic.RESULTS We included 185 patients(65.95%female;mean age:50.28 years)awaiting TJA for a mean of 26.42±30.1 mo.Overall,88.65%of patients wanted TJA despite the COVID-19 pandemic.Patients awaiting TJA for 1-3 years were 3.3-fold more likely to want surgery than those waiting<1 year(P<0.000).Patients with comorbidities were 8.4-fold less likely to want TJA than those with no comorbidities(P=0.013).After receiving education,the patients wanting TJA decreased to 54.05%.Patients who changed their opinion after education had less insight on the increased morbidity(P=0.046)and mortality(P=0.001)associated with COVID-19.Despite awaiting TJA for shorter period(24.7±20.38 mo),patients who continued to demand TJA had greater pain(P<0.000)and decreased function(P=0.043)since TJA postponement.CONCLUSION There is deterioration in health for patients,who have had elective procedures postponed during the COVID-19 pandemic.Waiting lists should be prioritized for urgency with the re-initiation of elective surgery.

Anxiety and depression in older adult patients undergoing elective liver surgery in allopatry medical treatment

Background:Allopatry medical treatment is common in China.However,allopatry medical therapy can result in many problems,including a negative psychological impact on patients.Patients undergoing liver surgery often experience anxiety and depression.To understand the psychological status of older adult patients undergoing surgery better,this study was designed to investigate the incidence of anxiety and depression in older adult patients undergoing elective liver surgery and to analyze factors associated with it in allopatry medical therapy.Methods:A total of 173 older adult patients undergoing elective liver surgery were included in the study.Patients were evaluated using the hospital anxiety and depression scale(HADS).The contributing factors affecting the psychological state of older adult patients undergoing elective surgery were analyzed using a linear regression method.Results:The HADS-A(hospital anxiety and depression scale-anxiety).The correlation(scale)score of the older adult patients undergoing elective liver surgery was(8.69
2.38),including 53 asymptomatic patients,86 suspicious patients,and 34 symptomatic patients.The HADS-D(hospital anxiety and depression scale-depression)score was(8.31
2.90),including 83 asymptomatic patients,56 suspicious patients,and 34 symptomatic patients.Multivariate analysis showed that residence and complication grade(Clavien–Dindo Classification of Surgical Complications or Accordion Severity Grading System)significantly correlated with the anxiety level of patients undergoing elective surgery.Residence,a requirement of blood transfusion,total transfusion volume,and Accordion complication grade showed a significant correlation with depression in patients undergoing elective surgery.Conclusions:Anxiety and depression in older adult patients undergoing elective liver surgery were common.Regional differences(local patients vs non local patients)and the severity of complications were the risk factors for anxiety and depression in older adult patients undergoing elective liver surgery.Reducing both regional differences and the severity of complications would be beneficial to alleviate the risk of anxiety and depression in older adult patients undergoing elective liver surgery and thus promote their physical and mental health.