Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies Project - Phase III Outcomes.

BACKGROUND: Our institution initiated the Orthopedic Surgery and Anesthesiology Surgical Improvement Strategies (OASIS) project in 2017 to improve the quality and efficiency for hip and knee arthroplasties. Phase III of this project aimed to: 1) increase same-day discharge (SDD) of primary total joint arthroplasties (TJAs) to 20%; 2) maintain or improve 30-day readmission rates; and 3) realize cost savings and revenue increases. METHODS: All primary TJAs performed between 2021 and 2022 represented our study cohort, with those in 2019 (prepandemic) establishing the baseline cohort. A multidisciplinary team met weekly to track project tactics and metrics through the entire episode of care from preoperative surgical visit through 30 days postoperatively. RESULTS: The SDD rate increased from 4% at baseline to 37%, with mean lengths of stay (LOS) decreasing from 1.5 to 0.9 days for all primary TJAs. The 30-day readmission rate decreased to 1.2 from 1.3%. Composite changes in surgical volume and cost reductions equaled $5 million. CONCLUSION: Application of a multidisciplinary team with health systems engineering tools and methods allowed SDD to increase from 4 to 37% with a mean LOS <1 day, resulting in a $5 million incremental gain in profit at a major academic medical center. Importantly, patient safety was not compromised as 30-day readmission rates remained stable. LEVEL OF EVIDENCE: III Therapeutic.

Histopathological diagnoses of adnexal masses: which parameters are relevant in preoperative assessment?

OBJECTIVE: The aim of the study was to assess which clinical, laboratory and ultrasound characteristics of adnexal masses might predict the histopathological nature of the disease. MATERIALS AND METHODS: The study involved all women treated at the Clinic of Gynecology and Obstetrics Clinical Centre of Serbia for adnexal tumors between July 1, 2010 and December 31, 2011. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan performed and RMI was calculated for all patients. Data were related to histopathological findings and statistically analyzed. RESULTS: The study included 540 women out of which 85 had malignant (seven diagnoses), 435 benign (seven diagnoses) and 20 borderline tumors. All types of malignant and borderline tumors were more frequent in postmenopausal women (p=0.000). Only papillary adenocarcinoma significantly more often produced early metastases (p=0.000). Ascites is a common finding in Krukenberg tumors, granulose cell tumors and papillary adenocarcinomas. There were significant differences between tumor diagnoses regarding the levels of Ca 125 and CEA, erythrocyte sedimentation rate (ESR) and risk of malignancy index (RMI) (p<0.05). No significant differences were found within the group of malignant tumor types regarding the levels of all examined tumor markers, ESR as well as RMI (p>0.05). CONCLUSIONS: In the light of our results, patient age, menopausal status, blood levels of Ca 125, CEA and ESR, as well as calculated RMI, can predict the nature of adnexal masses. Unfortunately none of the examined parameters can accurately determine the exact histopathological diagnosis of the adnexal tumor.

Current diagnostic approach to patients with adnexal masses: which tools are relevant in routine praxis?

OBJECTIVE: The aim of the study was to investigate which anamnestic, laboratory and ultrasound parameters used in routine practice could predict the nature of adnexal mass, thus enabling referral to relevant specialist. METHODS: Study involved the women treated for adnexal tumors throughout a period of 2 years. On admission, detailed anamnestic and laboratory data were obtained, expert ultrasound scan was performed, and power Doppler index (PDI), risk of malignancy index (RMI) and body mass index (BMI) were calculated for all patients. Obtained data were related to histopathological findings, and statistically analyzed. RESULTS: The study included 689 women (112 malignant, 544 benignant, and 33 borderline tumors). Malignant and borderline tumors were more frequent in postmenopausal women (P=0.000). Women who had benignant tumors had the lowest BMI (P=0.000). There were significant (P<0.05) differences among tumor types regarding erythrocyte sedimentation rate, CA125 and carcinoembryonic antigen (CEA) levels. Among ultrasound findings, larger tumor diameter and ascites were more frequent in malignant tumors (P=0.000). Women with malignant tumors had highest values of RMI and PDI (P=0.000). CONCLUSIONS: Anamnestic data, ultrasound parameters and laboratory analyses were all found to be good discriminating factors among malignant, benignant and borderline tumors.