Day-of-surgery (DOS) cancellations are a common and frustrating phenomenon for surgical patients globally. They are both costly to health systems and patients, causing inconvenience, decreased ...productivity, and emotional distress. In Australia, there are only few published literature that have explored DOS cancellations.
This study aimed to evaluate the frequency and reasons for DOS cancellations in a South-East Queensland tertiary hospital. Secondly, the study aimed to understand the characteristics of patients who have been cancelled on day of surgery.
A retrospective observational design was used to investigate elective day of surgery cancellations over one year, from January to December 2019. Variables collected included patients’ age, gender, ethnicity, socio-demographic status, carer responsibilities, attendance at pre-admission clinic (PAC), American Society of Anaesthesiologists status; surgical specialty; category of surgery; date of placement on elective surgery waitlist; ethnicity; suburb of residence; socio-demographic status derived from postcode, employment status, carer responsibilities for other(s); number of times of failure to attend past appointments; presentation at PAC; referrals to other services such as the pre-anaesthetic assessment nurse, nurse navigator or social worker and indigenous liaison health officer during the surgery planning phase, and reasons for cancellation. Mean and standard deviation were calculated to describe age. Frequencies and percentages were also reported.
Over 1 year, 5334 elective surgeries occurred: of these, 412 patients (8%) were affected by DOS cancellations. Hospital-initiated cancellations accounted for 32% (113/412) of total cancellations, including reasons such as patients’ condition, treatment no longer required or surgeons opting not to perform the procedure. The mean age of patients affected by cancellation was 58 years (SD 17.5). Male patients accounted for a greater proportion of cancellations than females (251 versus 161; 61% versus 39%). Almost half of cancellations were patients who were booked as inpatient admissions (47%, 193/412). Cardiothoracic comprised the specialty most affected by DOS cancellations (43%, 177/412 of cancelled patients).
By identifying the reasons for cancellation, and the characteristics of patients who are prone to being cancelled on the day of surgery, we have highlighted that DOS cancellations may be preventable in some cases. Further, quality improvement projects or root cause analysis are required to investigate and further address preventable DOS cancellation.
Objective: The association of coarctation of aorta (CoA) and coronary artery disease is rare. To formulate single stage safe strategy for redo repair of aortic coarctation and simultaneous coronary ...artery bypass grafting (CABG). Case presentation: The present case report describes a 55-year-old male, who underwent a redo safe single -stage surgical repair for both pathologies. CoA was tackled by ventral aortic repair followed by coronary artery bypass grafting under cardiopulmonary bypass. The vascular prosthesis was anastomosed to descending thoracic aorta in end-to- side fashion, and it was located posterior to the inferior vena cava through the oblique sinus but inferior to the superior vena cava and curved around the right atrium, anastomosed to ascending aorta. Conclusion: Ventral aortic repair through a midline approach is our preferred technique for redo surgical repair of CoA. Dual arterial cannulation ensures adequate perfusion of both upper and lower extremities.
The focus of this book is on detailed case histories of patients with severe traumas. The author takes us through the successive stages of analysis and gives us a graphic impression of the progress ...of her diagnostic and therapeutic insights into traumatic processes and their treatment. Her main interest is in the development of the transference/countertransference relationship. Traumatic experience has to be actualised within that relationship if it is to be treated successfully, only in this way can therapeutic change become a feasible proposition. Traumatic micro-processes and trauma-sequel phenomena in transference and countertransference are described and conceptualized. The author demonstrates her point with examples taken from clinical practice: illnesses experienced as traumatic; separation traumas; childhood experiences of violence; adult experiences of violence: war, torture, and displacement that can engender PTSD. This book is a genuinely original contribution to psychoanalytic treatment of traumas.
