practice model may be instructive regarding efficiencies to reduce costly cancellations, we also sought to identify areas for improvement. The primary outcome was percent DOS cancellations. Secondary measures include avoidable versus unavoidable DOS cancellations, patient versus hospital/provider related cancellations, and the most common reasons in each category. Material and Methods After institutional review board approval, we reviewed 12 months (July 2009-June 2010) of day of surgery cancellation data in our mixed in-and outpatient hospital surgical practice. Our suite consists of 18 operating rooms and a mix of general, urology, cardiac, ENT, plastic/reconstructive, gynecologic, transplant, orthopedic and neurosurgical cases. All of these services can and do book emergency cases. Our facility includes an emergency department, but pediatric surgery and obstetric services are not provided in our hospital. The majority of our surgical patients come from the local area, although we care for regional and even national and international
Robot-assisted cystectomy surgery may be advantageous for patients. The purpose of this study was to compare anesthetic management and outcomes in patients undergoing robot-assisted versus open radical cystectomy. In a retrospective review of 256 cystectomy procedures, procedure duration, blood loss, respiratory parameters, recovery room opiate consumption, pain scores and antiemetic use in the recovery room, and hospital length of stay were compared. After exclusions, 96 robot-assisted and 102 open procedures were analyzed. Anesthesia and surgery duration were significantly longer in the robot-assisted group, while the length of hospital stay was significantly shorter in the robot-assisted group: 7.1 ± 5.8 versus 9.8 ± 5.03 days, p = 0.0005. Estimated blood loss was 601.8 ± 491.4 ml in the open group versus 257.7 ± 164.3 ml in the robot-assisted group, p < 0.0001. Recovery room opiate consumption was significantly less in the robot-assisted group: 9.5 ± 8.9 versus 12.6 ± 9.9 mg (morphine equivalents), p = 0.02. The highest recorded respiratory rate was significantly higher in the robot-assisted group, as was the highest recorded peak airway pressure. Among patients with arterial blood gas data, the highest arterial partial pressure of CO2 was significantly greater in the robot-assisted group than in the open surgery group: 42.6 ± 5.6 versus 37.4 ± 4.8 mmHg CO2, p = 0.0001. Surgeons and anesthesia providers can expect robot-assisted radical cystectomy surgery to last longer than traditional open surgery, but to be associated with less pain and blood loss. Positioning and abdominal insufflation for robot-assisted surgery may contribute to ventilation challenges.
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