Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement

PURPOSE: To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. METHODS: Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. RESULTS: During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). CONCLUSION: This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes and recommended interventions were suggested accordingly. Future research, available resources, hospital policies, and strategic measures directed to tackle these reasons should take priority.

Anesthetic management of simultaneous coronary artery bypass grafting with cardiopulmonary bypass and extended thymectomy in a patient with myasthenia gravis

A 61-yr-old male having myasthenia gravis MG [Osserman IIB], Hypertension HTN, hyperlipidemia, type II diabetes mellitus DM II, a single pelvic kidney, chronic obstructive pulmonary disease COPD with a positive history of smoking and coronary artery disease, was admitted for uncontrolled myasthenic symptoms, cardiology team was consulted, cardiac catheterization was performed and revealed a three vessel coronary artery disease. All the findings dictated the management, a combined coronary artery bypass graft CABG and an extended thymectomy was performed. Optimization of the patient was achieved preoperatively. Total intravenous anesthesia using propofol and remifentanyl was applied to this patient. Continuous monitoring of the neuromuscular transmission NMT was maintained throughout the perioperative period. Although neither muscle relaxants nor inhalational agents were used in the anesthetic management of this patient; the patient developed postoperative atelectasis and lung collapse; which was managed successfully, and extubation of the trachea was done after ensuring adequate recovery of the NMT and respiratory function. Myasthenic therapy was continued throughout the perioperative period

Solitary fibrous tumor arising from the mediastinal pleura: case report

Solitary fibrous tumor is a rare mesenchymal tumor affecting mainly the pleura, the visceral pleura is the most commonly affected. It is usually a benign tumor but may have an unpredictable behavior and a malignant potential, complete excision is the standard of treatment. We present a case of solitary fibrous tumor of the mediastinal pleura which is a very rare incidence. Also, we reviewed the literature related to the condition

Difficult CABG in the era of stenting

For the past three decades, coronary artery bypass grafting has been the standard treatment for patients with severe multivessel ischemic heart disease. In the past few years, however, it has been increasingly challenged by precutaneous coronary intervention. The increasing tendency to report interventional treatments being based on "patient or physician preference" is both inadequate and inappropriate, discussion of all interventions by a multidisciplinary team should be a minimum standard of care. In this report we present a patient with coronary artery disease who underwent coronary catheterization and stenting many times, and finally the decision was to do a coronary artery bypass grafting in which the saphenous vein anastomosis to the distal right coronary artery was done over an old stent