Root causes of first-case start time delays for elective surgical procedures: a prospective multicenter observational cohort study in Ethiopia.

BACKGROUND: Delays in surgery start times can lead to poor patient outcomes and considerable increases in healthcare expenditures. This is especially true in developing countries that often face systemic inefficiencies, such as a shortage of operating rooms and trained surgical personnel. With substantial effects on patient outcomes, healthcare efficiency, and resource allocation, identifying delays in first-case elective surgery is a crucial area of research. METHODS: A multicenter observational study was conducted at three comprehensive and specialized hospitals in the Amhara region of Ethiopia from May 1 to October 30, 2023. The primary aim of the study was to determine the occurrence of late first-case start times, defined as a patient being in the operating room at or after the hospital's incision time of 2:30 a.m. The secondary aim was to discover potential root causes of delayed first-case start times. All patients scheduled for elective surgery as the first case on the operating list throughout the study period were included in the study. Every emergency, day case, after-hours case, and canceled case was excluded. RESULTS: A total of 530 surgical patients were included during the study window from May 1 to October 1, 2023. Of these, 41.5% were general surgeries, 20.4% were gynecology and obstetrics surgeries, and 13.2% were orthopedic surgery procedures. Before the procedure started, nine (1.7%) of the participants had prolonged discussion with a member of the surgical team. Patients who arrived in the operating room waiting area at or after 2:30 a.m. were 2.5 times more likely to experience a first-case start time delay than those who arrived before or at 2:00 a.m. (AOR = 2.50; 95% CI: 1.13-5.14). Furthermore, participants with abnormal investigation results were 2.4 times more likely to have a late first-case start time (AOR = 2.41; 95% CI: 1.06, 5.50). Moreover, the odds of a late first-case start time were increased by 10.53 times with the surgeon being in the operating room at or after 2:30 a.m. (AOR = 10.53; 95% CI: 5.51, 20.11). CONCLUSION: The research highlights a significant occurrence of delayed start times for the first elective surgical procedures. Therefore, directing attention to aspects such as ensuring patients and surgical teams arrive promptly (by or before 2:00 a.m.) and timely evaluation and communication of investigative findings before the scheduled surgery day could facilitate efforts to maximize operating room efficiency and enhance patient health outcomes.

Incidence and associated factors of post-dural puncture headache among orthopaedic patients after spinal anesthesia: a prospective cohort study.

Background: Post-dural puncture headache (PDPH) is one of a complication of spinal anaesthesia, influenced mostly by various factors including the patient's age, spinal needle size and design and sex. This headache can be severe and debilitating, preventing ambulation and limiting daily living activities. Objective: This study assessed the incidence and associated factors of PDPH among patients who received spinal anaesthesia for orthopaedic procedures at the Debre Tabor Comprehensive Specialized Hospital from June to August 2022. Methods: Prospective cohort study design was employed using Consecutive sampling method among patients who received spinal anaesthesia for orthopaedics procedure at Debre Tabor Comprehensive Specialized Hospital from June to August 2022. Data were collected by face to face interview and direct observation based on questionnaire. The data were entered to epidata 4.6 and analyzed by SPSS version 20 software. A total 95 patients aged 16-75 was participated in study. Those independent variable that were significant on binary logistic regression at P less than 0.2, were analyzed on multivariate regression, and considered significant association with PDPH at P value less than 0.05. Result: Ninety-five study participants were included in our study of which 19 (20%) had developed PDPH. Among patients who develop PDPH; 9.5% of the patients reported moderate pain while 10.5% experience mild PDPH and 80% of patient has no pain. The BMI and age were found to have significant association with PDPH [(P value 0.018, adjusted odds ratio 8.738, 95% CI, 1.461-52.269) and (P value 0.011, adjusted odds ratio 12.146, 95% CI, 1.753-84.170)], respectively) to PDPH. Conclusion and recommendation: The incidence of PDPH was found to be higher in Debre Tabor Comprehensive Specialized Hospital. The hospital management and the anaesthetists should minimize the magnitude of by strictly following different preventive strategies.

The analgesic efficacy of erector spinae plane block versus paravertebral block in thoracic surgeries: a meta-analysis.

Background: Acute postoperative pain after thoracic surgery might lead to chronic postsurgical pain (PSP), which lowers quality of life. The literature suggests thoracic paravertebral block (PVB) as a pain management approach. The ESPB (erector spinae plane block) is regarded to be an effective PVB alternative. The analgesic efficacy of the two analgesic therapies is controversial. The purpose of this study is to compare the analgesic efficacy of ESPB and PVB in preventing acute PSP. Methods: We searched relevant articles in PubMed, Cochrane Library, Embase, Web of Science, and Google Scholar databases. The primary outcome was postoperative pain score, with secondary outcomes including analgesic consumption, the frequency of rescue analgesia, and postoperative nausea and vomiting. Results: This meta-analysis included ten RCTs with a total of 670 patients. PVB significantly lowered the pain scores at movement at 12 h following surgery as compared to the ESPB. The PVB group used much less opioids within 24 h after surgery compared to the ESPB group. However, there were no significant differences between the groups in terms of postoperative rescue analgesia or in the incidence of postoperative nausea and vomiting (p > 0.05). Conclusion: PVB produced superior analgesia than ESPB in patients who underwent thoracic surgeries. In addition, PVB demonstrated greater opioid sparing effect by consuming much less opioids. Systematic review registration: This trial is registered on PROSPERO, number CRD42023412159.

Magnitude and associated factors of unplanned extubation in intensive care unit: A multi-center prospective observational study.

Background: Unplanned extubation is the removal of an endotracheal tube accidently during procedural activities or by the action of the patient. It is one of the commonly reported complications among mechanically ventilated patients in the intensive care unit. This study aimed to assess the magnitude and associated factors of unplanned extubation in intensive care units at referral hospitals in Addis Ababa, Ethiopia, 2021. Methods: Institutional based prospective observational study was conducted on 317 intubated patients in the intensive care unit at referral hospitals of Addis Ababa, Ethiopia, from January 8, 2021-May 9, 2021. Data were collected using a structured questionnaire. Descriptive statics were expressed in percentages and presented with tables and figures. Both Bivariable and multivariable logistic analysis was done to identify factors associated with unplanned extubation in intensive care unit. P < 0.05 with 95% CI was set as Statistical significance. Result: The prevalence of unplanned extubation in this study was 19.74%. Being male (AOR = 3.132, 95%CI: 1.276-7.69), duration of intubation <5days (AOR = 2.475, 95% CI: 1.039-5.894), managed by junior resident (AOR = 5.25, 95% CI: 2.125-12.969), being physically restrained (AOR = 4.356, 95%CI: 1.786-10.624), night shift (AOR = 3.282, 95%CI:1.451-7.424)and agitation (AOR = 4.934,95%CI:1.934-12.586) were significantly contribute to the occurrence of unplanned extubation. Conclusion: and recommendation: This study showed that the prevalence of unplanned extubation was high in the intensive care unit. We suggest to intensive care unit staff to give special attention to early intubated patients, especially male individuals and the stakeholders of hospitals should rearrange the time of shift and physician schedules in the intensive care unit.

Patterns of presentation, prevalence and associated factors of mortality in ICU among adult patients during the pandemic of COVID 19: A retrospective cross-sectional study.

Background: There is concern that patients admitted to the intensive care unit (ICU) with Corona Virus Disease 2019 (COVID-19) have variable prevalence reports of mortality. The survival rates are also inconsistently reported due to varying follow-up periods. Even if data on outcomes and baseline characteristics of ICU patients with COVID-19 is essential for action planning to manage complications, it is still left undisclosed in our study setting. Materials and method: This cross-sectional study was conducted on 402 samples using a retrospective chart review of patient's data who were admitted in the past 2 years of the adult ICUs. All the data were entered and analyzed with SPSS version 21. A multivariable Logistic regression analysis was used to identify the association between outcome variables with independent factors and a p-value of less than 0.05 was taken as statistically significant with a 95% confidence interval. We used text, tables, and figures for the result. Result: The overall prevalence of mortality among adult patients admitted to ICU during COVID-19 pandemics was 67.4%. From the multivariable logistic regression analysis, factors that were shown to have an association with an increase in ICU patient mortality were; lack of Vasopressor support, patients who had confirmed COVID 19 infection, core body temperature at admission greater than 37.5 °c, SPO2 at admission less than 90%, patients who had diagnosed ischemic heart disease (IHD), patients with acute respiratory distress syndrome (ARDS), patients who were intubated and mechanically ventilated (MV), and patient's ICU length of stay longer than two weeks. Conclusion: The prevalence of ICU mortality in adult patients was higher in Debre Tabor Comprehensive specialized hospital. Therefore, clinicians need to minimize factors that maximize patient mortalities like ARDS, hyperthermia, Desaturation, Covid infection, IHD, intubation and MV, lack of Vasopressor use, and prolonged ICU stay.

Balantidium coli; Rare and Accidental Finding in the Urine of Pregnant Woman: Case Report.

Background: Balantidium coli is a ciliated protozoan parasite, which causes intestinal and extraintestinal infections in humans. It is transmitted feco-orally by ingesting infective cysts with food and water. Urinary balantidiasis may occur through contamination (direct spread from the anal area), secondarily to rectovaginal fistula and following immune suppression. Data about cases of urinary balantidiasis are rare in the world. Currently, there are no documented reports of urinary balantidiasis in Ethiopia. As our understanding, there are only eleven documented reports of urinary balantidiasis globally. However, cases of urinary balantidiasis among pregnant women have not been documented yet. The aim of this report is to alarm health professionals for considering the occurrence of such rare cases and conduct diagnosis. Case Presentation: A 24-year old pregnant woman was admitted due to severe preeclampsia and preterm delivery at Debre Tabor Comprehensive Specialized Hospital, gynecology ward. Her urine was presented to inpatient laboratory for routine urinalysis. We detected unusual and ciliated parasite from her urine sediment characterized by its active and rotary motility through its cilia and possessing macro- and micro-nuclei, several food vacuoles and ingested red blood cells inside the cytoplasm. Hematuria, many white blood cells and epithelial cells were also detected from the urine sediment, which suggests genito-urinary tract infection due to this parasite. This rare parasite finding was confirmed to be B. coli. Conclusion: The route of transmission and extraintestinal existence from this woman's urine was unclear. It might be due to feco-oral transmission and spread to the genitourinary tract through direct anal contact. Moreover, it might be associated with immune suppression as she is pregnant woman.

Magnitude and associated factors of intra-operative hypothermia among pediatric patients undergoing elective surgery: A multi-center cross-sectional study.

BACKGROUND: Hypothermia is a core body temperature of less than 36 c0 that could increase perioperative morbidity & mortality of pediatric patients operated under general anesthesia. This study aimed to assess the magnitude and associated factors of intra-operative hypothermia among pediatric patients undergoing elective surgery. METHOD: Institutional based cross-sectional study was conducted on 339 pediatric patients undergoing elective surgery in referral hospitals of Addis Ababa, Ethiopia. Data were collected using a structured questionnaire. Descriptive statics were expressed in percentage and presented with tables. Both Bivariable and multivariable logistic analysis was done to identify factors associated with intra-operative hypothermia among pediatric patients undergoing elective surgery. P < 0.05 with 95% CI was set as statistical significance. RESULT: The magnitude of intra-operative hypothermia in this study was 39.8 [95% CI= (34.5-45.1)]. Multivariable logistic analyses showed that ambient temperature less than 26c0 [AOR = 6; 95%CI=(2.859-13.23)], volume of fluid administered greater than half a liter [AOR = 3.6; 95%CI=(1.83-7.23)], Patients who were received un-warm fluid [AOR = 2.2; 95%CI=(1.28-4.04)] and duration of surgery and anesthesia greater than 120 min [AOR = 3.4; 95%CI=(1.29-8.79)] and [AOR = 3.8; 95%CI=(1.25-11.53)] respectively were factors significantly associated with intra-operative hypothermia. CONCLUSION: The magnitude of intra-operative hypothermia in this study was high. So, adherence must be done in the prevention of intraoperative hypothermia by health professionals such as increasing operation room temperature, warming administered fluid, optimal fluid administration, and reduction of the duration of surgery and anesthesia.