BACKGROUND: Cancellation of scheduled surgical procedures is an issue of healthcare quality as well as a major cause of waste of health resources. This results in emotional trauma and inconvenience to the patients and their families. AIM: The objective of this audit was to find out the prevalence and causes of cancellation so that solutions can be made out to improve the quality of healthcare. SETTINGS AND DESIGN: It was an observational study carried out in 400 bedded Teaching hospital in South India. METHODS AND MATERIALS: Elective surgeries scheduled in 400 bedded teaching hospital were studied from June 2014 to January 2015. On the day of surgery, the completed surgeries that were scheduled and the list of cancellations with the reason for cancellation were entered in separate registers, by the anaesthesiologist. STATISTICAL ANALYSIS: These data were analysed using Epi info software version 7. RESULTS: 2067 patients were scheduled for surgeries out of which 269 got cancelled resulting in 13.01% cancellations. The most common cause of cancellation was lack of operating time which was 43.12% of cancelled cases. CONCLUSION: Most of the reasons for cancellation were avoidable by judicious scheduling of lists and careful planning by the team involved in surgeries. KEYWORDS: Cancellation, Elective surgeries, Reasons, Lack of operating time, Overscheduling of cases. INTRODUCTION:Surgery remains one of the main modalities of treatment for some diseases and it is a team work involving the surgeons, anaesthesiologists and paramedical staff requiring a lot of planning and preparation. All patients scheduled for surgery undergo pre anaesthetic checkup well before surgery. Last moment cancellations of scheduled surgeries are arguably an issue of health care quality as well as a major cause of waste of health resources. 1 The resulting prolonged hospitalization causes anxiety, frustration, anger, emotional involvement and inconvenience to patients and their families, 1 quite apart from increasing the cost in terms of working days lost and disruption to daily life. 1,2 The simplistic approach to solve the problem of late cancellations focuses on finding the reasons for these cancellations, and then to provide a solution for each cause individually, or collectively for all identified causes. The rates and causes of cancellations are diverse and differ from one hospital to another. 3 Between 10% and 40% of booked elective operations may be cancelled before surgery takes place. 1,2,3,4,5 The most common cause of cancellations was lack of theatre time (i.e. over-running operating lists). 2,3,4,6,7 The other reasons include cancellation due to patient factors, cancellation for poorly optimized medical conditions, or cancellations due to administrative reasons. 2,3,4,6,8 An operating list may over-run because of delayed starts, slow turnover, unanticipated surgical/ anaesthetic problems or staff shortages. 9 Many of these are difficult to quantify. This study was designed to find out the prevalence of and the reasons f...
ObjectivesSubmental intubation has been advocated as an alternative to classical tracheostomy for certain indicated panfacial trauma surgeries. Surgeons should have various options for airway management in maxillofacial trauma patients. Most maxillofacial injuries involve occlusal derangements, which might require intraoperative occlusal corrections; hence, orotracheal intubation is not ideal. Maxillofacial surgeons generally prefer nasotracheal intubation; however, in cases with concomitant skull base fracture or nasal bone fracture, nasotracheal intubation might not be suitable; in these situations, tracheostomy is typically performed. However, the possible complications of tracheostomy are well known. Due to trauma situations and to avoid the complications of tracheostomy, submental intubation would be an ideal alternative procedure in selected maxillofacial trauma surgery patients. This study aimed to evaluate the safety and usefulness of a submental intubation technique for panfacial trauma surgery. Moreover, we intended to share our experience of submental intubation and to recommend this simple, safe procedure for certain panfacial trauma surgeries.Materials and MethodsIn five panfacial trauma patients, we performed submental intubation for airway management; the mean time required for the procedure was only eight minutes.ResultsWe were able to execute this procedure safely in a short time without any intraoperative or postoperative complications.ConclusionSubmental intubation is a safe and simple technique for airway management in indicated panfacial trauma surgery patients.
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