Evaluation of the utilization of the preanaesthetic clinics in a University teaching hospital

BACKGROUND: Dedicated out-patient preanaesthetic clinics are relatively recent phenomenon and information is sparse from developing world. This study attempted to evaluate the utilization of adult and paediatric preanaesthetic clinics and its impact on the cancellations of surgery in Trinidad. METHODS: All patients scheduled to have elective surgery during the period of twelve weeks were enrolled for prospective collection of data including demographics, the admitting diagnoses, surgical procedure, category of surgery and specialty, and the patients' attendance to preanaesthetic clinics. Cancellations on the day of surgery along with reasons were recorded. The difference between patients who attended and did not attend the clinic was analysed. RESULTS: Of 424 patients scheduled for procedures during the study period, 213 were adults and 211 were children. Overall 39 percent of adults and 46 percent of the children scheduled for surgery had previously attended the preanaesthetic clinic. Among adults, general surgery patients were the largest majority to attend the preanaesthetic clinic. The paediatric preanaesthetic clinic was mostly utilized by paediatric general surgery. Overall 30 percent of procedures in adults and 26 percent of those in children were cancelled. There was a statistically significant difference in cancellations between patients who attended and did not attend the preanaesthetic clinic (p = 0.004). There was a 52 percent more chance of the procedure getting cancelled if the patient did not attend the clinic. CONCLUSION: The study highlights the inadequate use of the preanaesthetic clinics and the impactof the clinics on last-minute cancellations.

Evaluation of the reasons for cancellations and delays of surgical procedures in a developing country

Data on all patients scheduled to have elective and emergency surgeries during the period of 6 weeks from September 1999 to October 1999 were prospectively collected to determine scheduled starting times, actual starting times, completion times, causes for delays and cancellations. Of 840 procedures scheduled during the study period, 594 (71 per cent) were available for analysis. Eighty-nine per cent of cancellations occurred in patients undergoing elective surgery. The common causes of cancellations were non-availability of beds in recovery room (RR) (15 per cent), patients not showing up (9 per cent), improper pre-operative patient preparation (13 per cent), unavailability of nurses (11 per cent) and anaesthetists (8 per cent). Twenty-three per cent of the cancellations were day cases. Public patients were cancelled more frequently than private patients. Surgical procedures started on time in only 7 per cent of patients. The most common cause of delay was due to delayed transport of patients to the operating theatre (17 per cent). Optimal utilisation of operating theatres in our situation may be effected by increasing the bed-strength of ICUs to free the RR, proper pre-operative work up, adequate counselling of day-care surgery patients and efficient floor management of the operating theatre.

General surgery in Paramaribo University Hospital

Specific health problems in Suriname include high prevalence of infections, mostly gastrointestinal infections in young children, malaria and injuries due to violence. The public health care and medical and surgical training are hampered by a lack of funds, as are most things in the country. Relatively much of the surgery in Paramaribo University Hospital in 1991-1998 was performed because of complications of a diabetic foot (128.17 percent) and breast lessions (76.10 percent). No scientific research is being carried out either in the hospital or at the Faculty of Anton de Kom University. Retrospective registration of operations may give a new impulse to scientific research. (AU)

Itinerant Surgery: its effect on local development

The cost of any goods or service is the amount of resources given up in order to obtain it. A service is considered free when the recipient does not give up any resource in exchange for obtaining it, but is free only to the recipient, because someone else pays for it. Itinerant surgery is often justified on the grounds that it is free to the recipient, and this is considered good. But compromises in standards often appear acceptable because the service is free and, after all. "beggars can't be choosers". A discussion of monetary matters borders on the unethical and is traditionally avoided when medical issues are considered, but cost is probably the most limiting factor in the provision of health care in the West Indies. If the itinerant surgeons provides the cost of the surgery it aids the community economically in the short run. In the long run the community will be better able to support its need for surgery and will be more developed if it has its own surgeon. "Give a man fish and he'll eat for a day; teach a man to fish and he'll eat for longtime."(AU) [truncated]

Does surgery have to be expensive? - abstract

Because of increasing cost in health care, it was thought valuable to examine critically our current pratice of surgery with specific reference to measures that could result in cost reduction, while maintaining quality surgical care. Our study at Port-of-Spain General Hospital revealed that routine admission of minor head injuries results in necessary hospitalization and X-rays in over 1,000 patients per year. Review of routine chest X-ray and ECG in 1063 consecutive pre-operative cases showed that 95 percent of these indicated. Group and cross-matching of blood, though performed, was found to be unnecessary in 430 major, consecutive cases. In 2946 consecutive minor operations, an haemoglobin assay was found to be indicated in only 8 cases though it was done in all. Nasogastric tubes, urinary catheters and drains were found unnecessary in over 500 cases in one year. Vigilance in other areas such as use of I.V. fluids, I.V. drugs, antibiotics and wound dressings could significantly reduce health care cost. Attention must be paid to cost attainment if we are to continue to provide good care at affordable cost (AU)

Making do - abstract

This study recounts the experience of a general surgeon in 'making do' for 27 years in the Island of St. Vincent, West Indies. There were avoidable chronic shortages of personnel, equipment, space and ancillary facilities. In the absence of specialists, the surgeon had to fulfil several roles, having to rely on clinical acumen in the absence of ancillary facilities. A nurse-anaesthetist administered more than 80 percent of the anaesthetics for his operations, and spinal and ketamine hydrochloride anaesthesia were of inestimable value. The former was used for 1,273 and the latter for 1,236 operations of diverse range and complexity. It was necessary to practise several forms of thrift. Free ends of foam reduced the gauze requirement by about 90 percent, and local strong rum and rain water replaced methylated spirits and distilled water, respectively. Disposable items such as gloves, needles, syringes and sutures were recycled in the early days. Several orthopaedic items for operations were borrowed from neighbouring islands, and others were made locally. Moreover, some operations were improvised to allow the use of available equipment in the absence of the 'proper' ones. Thrift extended also to the sparing use of intravenous solutions and blood transfusion. Fifteen premature babies were managed successfully by simple measures only. With determination and commonsense, the general surgeon can manage satisfactorily in medically indigent circumstances, as 'making do' teaches resourcefulness (AU)

Same day surgery: is this the direction West Indian surgery should take? - abstract

A free standing, separate, self-contained same day surgery with 2 operating theatres and a 12-bed recovery room at the Eric Williams Medical Sciences Complex came into use on August 20th, 1990. This paper describes the first 3 months' experience of this unit. General, paediatric, orthopaedic and plastic surgeons, together with anaesthetists, a head nurse, 5 registered nurses, 8 nursing assistants, 2 anaesthetic technicians, 2 clerks and 3 attendants comprise the personnel. Five hundred and eighteen (518) cases were done over a 3-month period for an average of 88 cases per theatre per month. The average for the gross operating time (from entry to exit of patient) was 74 minutes while the net operating time (from incision to final closure) was 37 minutes. Patients ranged in age from 4 months to 83 years with 135 (26 percent) under 11 years. General anaesthesia was used in 71 percent of cases, and local in 26.5 percent. Herniorrhaphy was the most common procedure (16 percent). The transfer rate was 2.8 percent but no major complications occurred post-operatively. Health care workers and patients have a high appreciation for same day surgery. It is strongly recommended as a possible solution to many of the problems facing patients and surgeons in the Caribbean region (AU)

The role of radiotherapy in cancer management

A brief look at the aims of radiation therapy, interactions with other modalities and recent advances. Although an ideal radiation beam capable of destroying only the cancer cells has not yet been found, the author examines the existing beams and the specific types of treatment for which they are used

Is it necessary to dress the surgical incision? a prospective analysis of 118 cases - abstract

Applications of a surgical dressing to the surgical incision is perhaps the most consistent ritual practised throughout the history of surgery. While trials have been done to find the most suitable dressing, there appears to be little work investigating the need for any dressing whatsoever. This prospective study examines the feasibility of leaving the surgical wound exposed. This resulted in 12 cases of wound infection. In 5 of these cases, the entire incision was infected, while in 4 cases infection occurred in the dressed portion, and in 3 cases the exposed area became infected. The remaining 106 patients showed no major complication although 6 of them had allergic reactions to the adhesive tape. The dressing surgical wound appears to offer no particular advantage. The benefits of wound exposure include cost containment, early recognition of wound infection, absence of allergic reactions to adhesive tape and elimination of the discomfort of dressing removal, especially in hair-bearing areas (AU)

University of the West Indies: Doctor of Medicine(Surgery); case book

Cases were collected throughout the authors surgical training on the basis that they were found to be the more interesting ones encountered. Some of the cases presented are in the subspecialty of the thoracic surgeon or thoracic surgery related general surgical problems. The last four papers were published in the West Indian Medical Journal or presented at the Annual Conference of the Commonwealth Caribbean Medical Council