The impact of operating room scheduling on perioperative outcomes after pancreatoduodenectomy

Abstract

Objective: To determine the optimal perioperative care strategy for hepatectomy patients by measuring patient reported outcomes. Methods: One-hundred seventy-four patients with liver malignancy were administered a validated patient reported outcomes tool before and after hepatectomy to assess symptom scores (core and GI-specific symptoms) and life interference ratings. The median age was 56 years (range: 22e98 yrs), 54% were male, and 94% were ASA score 3. 51 patients (29%) had 4 liver segments resected and 51 patients (29%) were operated with a minimally-invasive approach. Anesthetic approaches included epidural (94 pts, 54%), TAP block (63 pts, 36%), non-narcotic intraoperative IV analgesia (36 pts, 21%) and enhanced recovery protocol (ERP, 123 pts, 71%), consisting of nonnarcotic oral analgesia, early feeding and early ambulation. Results: The median length of hospital stay was 5 days (range: 1e19 days), with 11 patients (6%) experiencing major complications, including 1 patient (0.6%) with liver failure and 5 patients (3%) with postoperative bile leak. Within 90 days of surgery, 3 patients required reoperation, 3 were readmitted and there were no mortalities. In multivariate analysis, return to baseline for core symptoms was associated with LOS <6 days (OR: 2.78, p = 0.004) and absence of complications (OR: 2.63, p = 0.007), return of GI function was only associated with smaller magnitude of surgery (OR: 5.1, p = 0.001), and return to overall functional status was associated with absence of complications (OR: 2.32, p = 0.03) and ERP-directed care (OR: 2.29, p = 0.04). Conclusion: Independent of surgical approach and perioperative anesthetic technique, patients report that the strongest predictor of rapid return to normal function after hepatectomy is management on an enhanced recovery protocol.

Assessing the Delays in Patients Undergoing Orthopedic Surgery and the Associated Factors at Taleghani Hospital

“…Another important duration investigated in the present study was T6, commonly neglected, which delays could be prevented by the timely presence of the surgeon, cooperation, and teamwork of the OR staff. Therefore, OR scheduling is required to ensure timely performance of surgery (11,12). The two final durations investigated in the present study included T8 and T9 (with a mean of 11.85 ± 5.20 and 13.37 ± 4.95 minutes, respectively), indicating that the surgical team should inform the anesthetic team about the exact time of ending the procedure so that the anesthetic team can punctually awaken the patients in the recovery room.…”