Assessing the Precision of Surgery Duration Estimation: A Retrospective Study.

Background and Objectives: The operating room (OR) is considered the highest source of cost and earnings. Therefore, measuring OR efficiency, which means how time and resources are allocated precisely for their intended purposes in the operating room is crucial. Both overestimation and underestimation negatively impact OR efficiency Therefore, hospitals defined metrics to Measuring OR Effeciency. Many studies have discussed OR efficiency and how surgery scheduling accuracy plays a vital role in increasing OR efficiency. This study aims to evaluate OR efficiency using surgery duration accuracy. Methods: This retrospective, quantitative study was conducted at King Abdulaziz Medical City. We extracted data on 97,397 surgeries from 2017 to 2021 from the OR database. The accuracy of surgery duration was identified by calculating the duration of each surgery in minutes by subtracting the time of leaving the OR from the time of entering the OR. Based on the scheduled duration, the calculated durations were categorized as either underestimation or overestimation. Descriptive and bivariate analyses (Chi-square test) were performed using the Statistical Package for the Social Sciences (SPSS) software. Results: Sixty percent out of the 97,397 surgeries performed were overestimated compared to the time scheduled by the surgeons. Patient characteristics, surgical division, and anesthesia type showed statistically significant differences (p <0.05) in their OR estimation. Conclusion: Significant proportion of procedures have overestimated. This finding provides insight into the need for improvement. Recommendations: It is recommended to enhance the surgical scheduling method using machine learning (ML) models to include patient characteristics, department, anesthesia type, and even the performing surgeon increases the accuracy of duration estimation. Then, evaluate the performance of an ML model in future studies.

Impact of a same day admission project in reducing the preoperative bed occupancy demand in a pediatric inpatient hospital.

Background: A same day admission approach was established for pediatric patients undergoing elective surgery owing to an increase in demand for bed availability and the need for medical, logistical, psychological, and fiscal improvements. This study aimed to assess the effectiveness of the same day admission approach for reducing demand for preoperative bed occupancy in pediatric inpatient units. Method: Data on elective surgery patients considered for same day admission were prospectively collected in an Excel spreadsheet. Results: Same day admission patients numbered 269 (25.87%; n = 1040), 461 (41.7%; n = 1104), 382 (38.67%; n = 998), and 560 (44.20%; n = 1267) in 2018, 2019, 2020, and 2021, respectively. Over the 4-year period between 2018 and 2021, pediatric orthopedic surgeries accounted for the majority of same day admissions (29.72%; n = 497), followed by ear, nose, and throat (21.30%; n = 356), general (16.99%; n = 284), plastic (14.53%; n = 243); urology (9.87%; n = 165); optometry and ophthalmology (3.77%; n = 63); neuro (2.51%; n = 42), and dental (1.31%; n = 22) surgeries. The total number of days of saved preoperative beds over the 4-year period was 1672 days (an average of 418 hospital days per year). Conclusions: This study showed that same day admission approach should be implemented in pediatrics institutions to reduce hospital bed demand. The implementation of this initiative is widely variable between specialties due to interlinked medical, operational, and logistical factors. Level of Evidence: III.

Electronic early notification of sepsis in hospitalized ward patients: a study protocol for a stepped-wedge cluster randomized controlled trial.

BACKGROUND: To evaluate the effect of screening for sepsis using an electronic sepsis alert vs. no alert in hospitalized ward patients on 90-day in-hospital mortality. METHODS: The SCREEN trial is designed as a stepped-wedge cluster randomized controlled trial. Hospital wards (total of 45 wards, constituting clusters in this design) are randomized to have active alert vs. masked alert, 5 wards at a time, with each 5 wards constituting a sequence. The study consists of ten 2-month periods with a phased introduction of the intervention. In the first period, all wards have a masked alert for 2 months. Afterwards the intervention (alert system) is implemented in a new sequence every 2-month period until the intervention is implemented in all sequences. The intervention includes the implementation of an electronic alert system developed in the hospital electronic medical records based on the quick sequential organ failure assessment (qSOFA). The alert system sends notifications of "possible sepsis alert" to the bedside nurse, charge nurse, and primary medical team and requires an acknowledgment in the health information system from the bedside nurse and physician. The calculated sample size is 65,250. The primary endpoint is in-hospital mortality by 90 days. DISCUSSION: The trial started on October 1, 2019, and is expected to complete patient follow-up by the end of October 2021. TRIAL REGISTRATION: ClinicalTrials.gov NCT04078594 . Registered on September 6, 2019.

The trends of obstetric anesthesia practice: In a tertiary care center in the Kingdom of Saudi Arabia.

INTRODUCTION: Obstetric anesthesia provides several methods for the analgesia of labor pain. The neuraxial technique is considered the standard of care for parturient women. The epidural block is widely used in vaginal delivery while the spinal block is the preferred method for cesarean section (C-section). We aim to know the practice of obstetric anesthesia in our center. METHODS: A retrospective cross-sectional study was conducted at a tertiary center in Riyadh, Saudi Arabia. The data of all delivery cases from 1/7/2019 to 30/9/2019 were reviewed. RESULTS: We identified a total of 2,140 cases during the 3 months, vaginal delivery was the most common with 72.4% (1550) while the C-section cases were 27.6% (590). Regarding the type of analgesia/anesthesia for vaginal deliveries, intramuscular analgesia was the commonest group with 34.8% (540), followed by the group of ladies who did not receive any analgesia/anesthesia with 31.9% (495), thirdly was epidural cases with 31.8% (493), and the fourth type was spinal 0.6% (10). Regarding C-section, the emergency cases were 65.4% (386). The types of anesthesia for all C-sections were as follows spinal 63.5% (375), GA 23.8% (141), and epidural 12% (74). Regarding anesthesia for elective cases, spinal was 85% (174), GA 14% (28), and epidural 1% (2). Regarding anesthesia for emergency cases, spinal was 52% (201), GA 29% (113), and epidural 19% (72). CONCLUSIONS: The use of epidural was low, and the spinal use was relatively on par if we compare with leading western countries. More focused studies and multicenter studies are needed in the country.

Hospital preparedness and management of pediatric population during COVID-19 outbreak.

With the recent pandemic of Coronavirus disease-2019 (COVID-19), there has been a higher number of reported cases in children more than to the prior Corona Virus-related diseases, namely, severe acute respiratory syndrome and the Middle East respiratory syndrome. The rate of COVID-19 in children is lower than adults; however, due to high transmission rate, the number of reported cases in children has been increasing. With the rising numbers among children, it is imperative to develop preparedness plans for the pediatric population at the hospital level, departmental level, and patient care areas. This paper summarizes important considerations for pediatric hospital preparedness at the hospital level that includes workforce, equipment, supply; capacity planning, and infection prevention strategies, it also span over the management of COVID-19 pediatric patients in high-risk areas such as critical care areas, Emergency Department and operative rooms.

Spinal anesthesia in a patient with Schwartz-Jampel syndrome.

BACKGROUND: Schwartz-Jampel syndrome (SJS) is a very rare inherited disorder characterized by multiple skeletal deformities, limited joint mobility, micrognathia, blepharophimosis, myotonia, and growth retardation. SJS is caused by mutations in the gene encoding perlecan (heparan sulfate proteoglycan). Anesthetic management of these patients is challenging. The use of spinal anesthesia in these patients has not been reported. CASE PRESENTATION: A 14-year-old boy was scheduled for inguinal hernia and hydrocele repair. The diagnosis of SJS was based on his dysmorphic features, electromyographic (EMG) pattern and genetic testing. General anesthesia may encounter difficult airway management, resistance to muscle relaxants, or possibility of malignant hyperthermia. Regional anesthesia may be difficult or even harmful due to skeletal deformities. We report successful management of spinal anesthesia and surgery was done. The patient had an uneventful recovery and was discharged home. We describe the special precautions against pitfalls for using this technique in patients with SJS. CONCLUSION: Spinal anesthesia may be an effective and safe technique for patients with SJS and it may.

The prevalence of emergence delirium and its associated factors among children at a postoperative unit: A retrospective cohort at a Middle Eastern hospital.

BACKGROUND: Emergence delirium (ED) has been reported among children at a postoperative setting, which delays their recovery and exposes them to traumas. The aim of this study was to determine the prevalence of ED and its associated factors among children who underwent surgeries at a major tertiary healthcare facility in Saudi Arabia. MATERIALS AND METHODS: Between March and August 2018, a retrospective cohort study was conducted based on a review of 413 medical charts of children (<14 years) who underwent an elective/nonemergency surgery and then were admitted to a Post Anesthesia Care Unit. Patient and surgery-related characteristics were analyzed as potential factors associated with ED. The anxiety level was assessed preoperatively using the Modified Yale Preoperative Anxiety Scale (four domains), while the ED was detected after surgery using the Watcha scale (child is agitated and thrashing around). RESULTS: The leading surgery category was ear, nose, and throat surgeries [184 (44.6%)] and dental surgeries [109 (26.4%)]. Almost one-third received only general anesthesia (31.2%), while 271 (68.8%) received an additional regional block/skin infiltrate. The anxiety domains preop showed that the percentage mean score ± standard deviation of expression of emotions was 37.1 ± 21.6, apparent arousal 33.7 ± 20.4, activeness 30.1 ± 13.5, and vocalization 26.9 ± 20.3. The prevalence of ED among children who underwent surgeries during the 6-month period was 23 (6.6%). Almost 18.8% of those who received opioid analgesics (fentanyl alone) developed ED, while 12% of those who received both opioid and nonopioid analgesics (fentanyl/paracetamol) developed ED. ED was significantly associated with longer recovery duration 69.5 + 27.1 min, P = 0.007. Binary logistics regression analysis showed that participants who did not receive Precedex were adj. odds ratio = 10.3 (2.4-48.9) times more likely to develop ED, compared with those who received it, adj. P = 0.003. Lower preoperative scores of expression of emotions and higher scores of apparent arousal were significantly associated with ED, adj. P = 0.035 and adj. P = 0.023, respectively. CONCLUSION: ED appears to be inevitable in postoperative settings. It is crucial to address any preoperative anxiety assessment as it is associated with ED. Anxiety remains a modifiable factor that can be managed, as well as to the administration of Precedex and adjunct analgesic treatments.

Factors impacting anesthesiology residents in Saudi Arabia when they are planning their future.

PURPOSE: This study is undertaken to examine the factors that influence Saudi Board anesthesia residents' preferences in terms of future practice location, fellowship training, and research. METHODS: A cross-sectional study was conducted. Data on fellowship training, research, and future practice location preferences, as well as demographics, were collected using surveys distributed to all anesthesia residents enrolled at Saudi anesthesiology residency program (N = 302). RESULTS: A total of 117 residents (38.7%) responded to the survey. Of those 88.5% of residents planned on further subspecializing. The most highly sought fellowships were acute and chronic pain, regional anesthesia, simulation, and pediatric anesthesia. Residents pursuing fellowship training were mostly affected by personal interest, improving employment prospects, and future income. Only 11.5% of residents intended to incorporate research into their next practice-personal interest, employability, and lifestyle were the most influential in their decision. CONCLUSION: Most anesthesia residents training in Saudi Arabia choose to pursue fellowship training. However, less than one-fifth have an interest in incorporating research into their future careers.

A case series of different anesthesia approaches for single ventricular physiology patients in various stages of palliation underwent noncardiac procedures.

Patients with single ventricle physiology (SVP) are a particularly challenging population with congenital heart disease (CHD); they will go for staged, palliation ending in the Fontan circulation. Nowadays, with improvement in surgical procedures for CHD, these patients become growing population, and noncardiac surgeries become not uncommon. The authors report different anesthesia approaches for four pediatric patients with SVP underwent ten noncardiac procedures done under general anesthesia following the different stages of palliation at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia, between 2009 and 2015 and do a brief review of the literature on this topic. The aim of this study is to highlight that anesthesia approach for patients with SVP varies according to the patient physical situation at the time of the procedure, stage of palliation, and type of surgery. Therefore, every anesthesiologist should have thorough knowledge about SVP, different stages of palliative surgery, anesthesia concern in each one and risk factors associated with perioperative morbidity before anesthetizing patients for a noncardiac procedure to keep patient safety as well as avoiding unnecessary cancellation, rescheduling, and admissions to the ward or the Intensive Care Unit.

Association between troponin-I levels and outcome in critically ill patients admitted to non-cardiac intensive care unit with high prevalence of cardiovascular risk factors.

BACKGROUND: The association of troponin-I levels and outcome in medical-surgical ICU patients has been studied before in populations with low to moderate prevalence of cardiovascular risk factors. The objective in this article is to examine the association of troponin-I levels with hospital mortality in patients with high prevalence of cardiovascular risk factors who were admitted with medical-surgical indications to a non-cardiac intensive care unit. METHODS: This was a retrospective study of adult patients admitted to a tertiary medical-surgical ICU between July 2001 and November 2011. Data were extracted from prospectively collected ICU and clinical laboratory databases. Patients were stratified based on the highest troponin-I level in the first 72 h of admission into four groups (Group I < 0.03, Group II = 0.03-0.3, Group III = 0.3-3 and Group IV > 3 ng/mL). Hospital mortality was the primary outcome. To study the association between elevated troponin-I and hospital mortality, we carried out multivariate logistic regression analyses with Group I as a reference group. RESULTS: During the study period, 3368 patients had troponin-I levels measured in the first 72 h, of whom 1293 (38.3%) were diabetic and 1356 (40.2%) were chronically hypertensive. Among the study population, 2719 (81%) had elevated troponin-I levels (0.03 ng/mL and higher). Hospital mortality increased steadily as the troponin-I levels increased. Hospital mortality was 23.4% for Group I, 33.2% for Group II (adjusted odds ratio (aOR) 1.08, 95% confidence interval (CI) 0.84, 1.38), 49.6% for Group III (aOR = 1.64, 95% CI 1.24, 2.17), and 57.4% for Group IV (aOR 1.80, 95% CI 1.30, 2.49). The association of increased mortality with increased troponin level was observed whether patients had underlying advanced heart failure or not. Subgroup analysis showed an increased mortality in patients aged < 50 years, non-diabetics and not on vasopressors. CONCLUSION: In a population with high prevalence of diabetes and hypertension, elevated troponin-I was frequently observed in medical-surgical critically ill patients, and showed a level-dependent association with hospital mortality.

Medical students' attitude toward anesthesia as a future career.

OBJECTIVES: The purpose of this study is to understand the attitude of medical students at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) toward anesthesia as a specialty and to determine common factors influencing their career choice options. STUDY DESIGN: This was a cross-sectional study. METHODS: The study was conducted between March 25, and April 20, 2017, at KSAU-HS. The survey was distributed among 5th and 6th years medical students. Data were collected through a validated hardcopy questionnaire of 16 multiple choice questions. The questionnaire included demographic characteristics, specialty preferences, what factors attract Saudi medical students to choose their preferred specialty and how they view the option of choosing anesthesiology as a career. RESULTS: A total of 236 students completed the questionnaire. The majority of respondents were in their 5th year of medical school representing (62%). The distribution of medical field interest ranged from (38%) surgery to (1%) anesthesiology. approximately, (60%) thought that controllable lifestyle was an important factor to consider in choosing a residency program. Only (45%) of respondents thought that prestige of specialty is a major factor that would influence their choice for a specialty. CONCLUSION: Based on the outcome of the study, it is recommended that medical undergraduate students exposure to anesthesia specialty should be magnified. Greater efforts have to be made to increase the number of medical students preferring anesthesia through emphasizing on the positive aspects of the specialty.

Apnoeic oxygenation by nasal cannula during airway management in children undergoing general anaesthesia: a pilot randomised controlled trial.

BACKGROUND: Airway management is a core clinical skill in anaesthesia. Pre-oxygenation prior to induction of anaesthesia is a standard practice to prevent desaturation. Apnoeic oxygenation in adults is effective and prolongs the time to desaturation. The effectiveness of apnoeic oxygenation in the adult is well documented; however, evidence in the paediatric is lacking. Therefore, the aim of this study was to investigate the effectiveness of apnoeic oxygenation during airway management in children. METHODS: This was a pilot randomised controlled trial. Patients were randomised to receive either apnoeic oxygenation or standard care during the induction of anaesthesia. The primary outcome was the duration of safe apnoea, defined as a composite of the time to first event, either time for SpO2 to drop to 92% or time to successfully secure the airway, and the lowest SpO2 observed during airway management. Secondary outcomes were the number of patients whose SpO2 dropped below 95% and the number of patients whose SpO2 dropped below 92%. RESULTS: A total of 30 patients were randomised, 15 to apnoeic oxygenation and 15 to standard care. No significant difference was observed in the time to first event (p = 0.870). However, patients randomised to apnoeic oxygenation had significantly higher SpO2 observed compared to the standard care group (p = 0.004). All patients in the apnoeic oxygenation group maintained SpO2 of 100% during airway management, compared to only six in the standard care group. SpO2 dropped below 92% in one patient, with the lowest SPO2 recorded 73%. CONCLUSION: This study suggests that providing 3 l/min oxygen by nasal cannula following pre-oxygenation contributes to maintaining high levels of oxygen saturation during airway management in children, contributing to increased patients' safety during general anaesthesia. TRIAL REGISTRATION: Retrospectively registered at ClinicalTrials.gov, NCT03271827. Registered: 4 September 2017.

Integration of simulation in postgraduate studies in Saudi Arabia: The current practice in anesthesia training program.

The educational programs in the Saudi Commission for Health Specialties are developing rapidly in the fields of technical development. Such development is witnessed, particularly in the scientific areas related to what is commonly known as evidence-based medicine. This review highlights the critical need and importance of integrating simulation into anesthesia training and assessment. Furthermore, it describes the current utilization of simulation in anesthesia and critical care assessment process.

Building capacity for quality and safety in critical care: A roundtable discussion from the second international patient safety conference in April 9-11, 2013, Riyadh, Saudi Arabia.

This paper summarizes the roundtable discussion from the Second International Patient Safety Conference held in April 9-11, 2013, Riyadh, Saudi Arabia. The objectives of the roundtable discussion were to: (1) review the conceptual framework for building capacity in quality and safety in critical care. (2) examine examples of leading international experiences in building capacity. (3) review the experience in Saudi Arabia in this area. (4) discuss the role of building capacity in simulation for patient safety in critical care and (5) review the experience in building capacity in an ongoing improvement project for severe sepsis and septic shock.

End-of-life practices in a tertiary intensive care unit in Saudi Arabia.

Our aim was to evaluate end-of-life practices in a tertiary intensive care unit in Saudi Arabia. A prospective observational study was conducted in the medical-surgical intensive care unit of a teaching hospital in Riyadh, Saudi Arabia. Over the course of the one-year study period, 176 patients died and 77% of these deaths were preceded by end-of-life decisions. Of these, 66% made do-not-resuscitate decisions, 30% decided to withhold life support and 4% withdrew life support. These decisions were made after a median time of four days (Q1 to Q3: 1 to 9) and at least one day before death (Q1 to Q3: 1 to 4). The patients' families or surrogates were informed for 88% of the decisions and all decisions were documented in the patients' medical records. Despite religious and cultural values, more than three-quarters of the patients whose deaths were preceded by end-of-life decisions gave do-not-resuscitate decisions before death. These decisions should be made early in the patients' stay in the intensive care unit.