Objective To explore the causes of conversion to thoracotomy in patients with minimally invasive esophagectomy (MIE) in a surgical team, and to obtain a deeper understanding of the timing of conversion in MIE. Methods The clinical data of patients who underwent MIE between September 9, 2011 and February 12, 2022 by a single surgical team in the Department of Thoracic Surgery of the Fourth Hospital of Hebei Medical University were retrospectively analyzed. The main influencing factors and perioperative mortality of patients who converted to thoracotomy in this group were analyzed. Results In the cohort of 791 consecutive patients with MIE, there were 520 males and 271 females, including 29 patients of multiple esophageal cancer, 156 patients of upper thoracic cancer, 524 patients of middle thoracic cancer, and 82 patients of lower thoracic cancer. And 46 patients were converted to thoracotomy for different causes. The main causes for thoracotomy were advanced stage tumor (26 patients), anesthesia-related factors (5 patients), extensive thoracic adhesions (6 patients), and accidental injury of important structures (8 patients). There was a statistical difference in the distribution of tumor locations between patients who converted to thoracotomy and the MIE patients (P<0.05). The proportion of multiple and upper thoracic cancer in patients who converted to thoracotomy was higher than that in the MIE patients, while the proportion of lower thoracic cancer was lower than that in the MIE patients. The perioperative mortality of the thoracotomy patients was not significantly different from that of the MIE patients (P=1.000). Conclusion In MIE, advanced-stage tumor, anesthesia-related factors, extensive thoracic adhesions, and accidental injury of important structures are the main causes of conversion to thoracotomy. The rate varies at different tumor locations. Intraoperative conversion to thoracotomy does not affect the perioperative mortality of MIE.
ObjectiveTo summarize and analyze the causes of temporarily rescheduled selective operations in hospital and to find out improvements via statistical analysis. MethodsBy referring to the specialized anesthesia log, the rescheduled operations among all the selective operations in 2012 were retrospectively studied, and the rescheduled situations in different ages, sex and departments were analyzed. The specific causes of rescheduling and improvements were also discussed. ResultsThere were 582 rescheduled cases among all the 9 670 selective operations from January to December in 2012, with a rescheduling rate of 6.02%. The top three departments were orthopedics, thoracic surgery, and neurosurgery. Main causes for rescheduled cases were diseases, inadequate preoperational preparations, requests of patients or relatives and accidents. ConclusionMedical workers should get preoperational patients fully prepared materially, physically and psychologically via reinforcement of preoperative evaluation and preparation and avoidance of unexpected situations, so as to reduce rescheduling phenomena of selective operations.
Objective To explore strategies to reduce the same-day cancellation rate of gynecological day surgery. Methods The same-day cancellation status of gynecological surgery in the Department of Day Surgery, West China Second University Hospital, Sichuan University from January to December 2021 (before improvement) was investigated. The causes of cancellation were analyzed from three aspects: patient-related factors, medical factors, and examination factors. Subsequently, management countermeasures were formulated for the controllable factors and continuous quality improvement was implemented. After improvement, the same-day cancellation rate of gynecological day surgery from September 2022 to January 2023 was collected and compared with that before improvement. Results Continuous quality improvement was implemented targeting three factors in day surgery, namely the short interval between patient’s visit time and pre-scheduled time, the irrational sequence of preoperative examinations for patients, and the non-standardized treatment of patients with abnormal vaginal discharge by physicians. The same-day cancellation rates of gynecological day surgery before and after the continuous quality improvement were 3.70% (156/4211) and 2.13% (30/1411), respectively, and the difference was statistically significant (χ2=8.231, P=0.004). ConclusionOptimizing the preoperative examination and admission process, effective preoperative education and physician-patient communication, establishing unified standards for the approval of vaginal discharge tests and standardized treatment protocols, and clarifying the responsibilities of the preoperative comprehensive assessment outpatient clinic along with the supervision system are effective measures to reduce the same-day cancellation rate of gynecological day surgery.
Objective To analyze the causes for day surgery cancellations before admission or on the same day of operation, and put forward targeted measures to improve the medical resource utilization and patient satisfaction. Methods The basic information and clinical data of patients who had been scheduled for surgery in the Day Surgery Center of West China Hospital, Sichuan University between January 2018 and September 2021 were collected. The reasons for the surgery cancellations before admission or on the same day of operation were analyzed. Results From January 2018 to September 2021, a total of 45176 patients were successfully scheduled for day surgery, and 44300 patients completed surgery as planned. A total of 876 operations (1.94%) were cancelled after being scheduled, including 546 (1.21%) before admission and 330 (0.73%) on the surgery day. Ranked from high to low according to the cancellation rates, the top five departments were Department of Dermatology, Department of Vascular Surgery, Department of Hepatobiliary Surgery, Department of Otorhinolaryngology, Head and Neck Surgery, and Department of Gastroenterology, with a cancellation rate of 3.38% (8/237), 2.90% (25/863), 2.85% (101/3548), 2.48% (171/6893), and 1.91% (260/13578), respectively. In the reasons for cancellations, patient factors accounted for 57.31% (502/876) and medical management factors accounted for 42.69% (374/876). Conclusions The cancellations of day surgery mainly occur before admission, and are mainly caused by patient factors. It is necessary to strengthen the preoperative education for day surgery patients, and enhance the communication and cooperation between surgery physicians, nurses and technicians, in order to reduce the operation cancellation rate and make reasonable and efficient use of medical resources.
To investigate the causes and the cl inical treatment methods of postoperative wound compl ications following total knee arthroplasty (TKA). Methods From June 2005 to August 2008, 486 cases (576 knees, including 314 left knees and 262 right knees) underwent primary TKA using standard midl ine incision and medial parapatellar arthrotomy. There were 146 males (172 knees) and 340 females (404 knees) aged 51-86 years old (average 61.3 years old). The duration of disease was 3-35 years. Primary diseases included: 138 cases (156 knees) of rheumatoid arthritis, 282 cases (348 knees) of osteoarthritis, 46 cases (49 knees) of traumatic arthritis, 20 cases (23 knees) of pigmented villonodular synovitis. The factors of etiology, deformity correction, duration of tourniquet use and wound drainage were analyzed to determine the cause of postoperative wound compl ication. Results Postoperatively, 37 cases (43 knees) had wound compl ications and the rate of incidence was 7.5%, including 13 cases (15 knees) of aseptic exudation, 3 cases (4 knees) of fat l iquefaction, 4 cases (4 knees) of subcutaneous hematoma, 8 cases (9 knees) of flap margin necrosis, 6 cases (7 knees) of superficial infection, 3 cases (4 knees) of red swollen joint with increased skin temperature and deepinfection. All 37 patients recoveried after symptomatic treatment. Among those 37 cases, patients with rheumatoidarthritis had a higher incidence rate of wound compl ication than the patients with other primary diseases (P lt; 0.05). Theincidence rate of patients with deformity correction more than or equal to 20 degree was significantly higher than that ofother patients (P lt; 0.05). The duration of using tourniquet was (86 ± 15) minutes for patients with wound compl ication,and (78 ± 8) minutes for patients without wound compl ication, indicating there was a significant difference (P lt; 0.01).Wound compl ication occurred in 22 knees (5.1%) with autologous blood transfusion absorber, 11 knees (11.5%) withnegative pressure attraction, and 10 knees (19.2%) receiving no drainage. The incidence rate of postoperative woundcompl ication in patients without drainage was obviously higher than that in patients with drainage (P lt; 0.05). ConclusionPatients with rheumatoid arthritis are more l ikely to have wound compl ication after TKA. Postoperative wound drainage and short duration of tourniquet appl ication help decrease the incidence of compl ications. It is necessary to make early definitive diagnosis of postoperative wound compl ication, and provide proactive treatment.