ABSTRACT
Introduction: There is growing recognition that bladder outlet obstruction (BOO) surgery can often be safely performed as a day case procedure. The BOO surgery day case rate (DCR) is a Getting It Right First Time (GIRFT) quality metric. Patients awaiting BOO surgery represent the largest group awaiting elective surgical treatment in urology. This unmet need has expanded considerably due to the Covid-19 pandemic. Patients and Methods: Model Hospital (MH) is a datadriven improvement tool for English NHS trusts, which utilises routinely collected national level data. MH describes performance metrics for transurethral resection of prostate, laser prostatectomy, prostatic urethral lift, and bladder neck incision. MH data were analysed for all 115 trusts performing BOO surgery over 12 months to October 2021. Associations between service delivery and outcome metrics were tested. Results: Table 1 shows national Trust-level metrics for DCR, length of stay (LOS), 30-day readmission rate (30D), annual centre volume (ACV), and waiting list time (WLT). Analysis indicated no significant association between any of the following;DCR and 30D (Spearman rank correlation coefficient (rs)=-0.085, p=0.37), ACV and 30D (rs=- 0.019, p=0.84), DCR and WLT (rs=0.16, p=0.096). Conclusion: There is wide variation in DCR and WLT nationally. The absence of association between DCR and 30D suggests that many trusts can safely increase DCR for BOO surgery. Optimising DCR could help to facilitate the post-Covid Elective Recovery for surgery. The lack of association between DCR and WLT, however, suggests that further resource constraints beyond elective inpatient bed availability influence the provision of BOO surgery.
ABSTRACT
INTRODUCTION: With the emergence of the COVID-19 pandemic, all elective surgery was temporarily suspended in the UK, allowing for diversion of resource to manage the anticipated surge of critically unwell patients. Continuing to deliver time-critical surgical care is important to avoid excess morbidity and mortality from pathologies unrelated to COVID-19. We describe the implementation and short-term surgical outcomes from a system to deliver time-critical elective surgical care to patients during the COVID-19 pandemic. MATERIALS AND METHODS: A protocol for the prioritisation and safe delivery of time-critical surgery at a COVID-19 'clean' site was implemented at the Nuffield Health Exeter Hospital, an independent sector hospital in the southwest of England. Outcomes to 30 days postoperatively were recorded, including unplanned admissions after daycase surgery, readmissions and complications, as well as the incidence of perioperative COVID-19 infection in patients and staff. RESULTS: A total of 128 surgical procedures were performed during a 31-day period by a range of specialties including breast, plastics, urology, gynaecology, vascular and cardiology. There was one unplanned admission and and two readmissions. Six complications were identified, and all were Clavien-Dindo grade 1 or 2. All 128 patients had preoperative COVID-19 swabs, one of which was positive and the patient had their surgery delayed. Ten patients were tested for COVID-19 postoperatively, with none testing positive. CONCLUSION: This study has demonstrated the implementation of a safe system for delivery of time-critical elective surgical care at a COVID-19 clean site. Other healthcare providers may benefit from implementation of similar methodology as hospitals plan to restart elective surgery.