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Management of Enlarging tracheoesophageal fistula (TEF) with Voice Prosthesis in Laryngectomized Head and Neck Cancer Patients. Objectives: An enlarging TEF following voice prosthesis placement impacts patient quality of life, risks airway compromise, and can lead to aspiration pneumonia. Pharyngoesophageal strictures have previously been reported to be associated with TEF enlargement and leakage. We describe a series of patients with enlarging TEFs after Tracheoesophageal puncture (TEP) for voice prosthesis who required pharyngoesophageal reconstruction. Methods: Retrospective case series of laryngectomized H&N cancer patients with primary or secondary TEP who underwent surgical management for enlarging TEF site between 6/2016–11/2022. Results: Eight patients were included. The mean age was 62.8 years old. Seven patients had a history of hypothyroidism. Of seven with prior H&N radiation history, two had both historical and adjuvant radiation. Two of the eight TEPs were placed secondarily. Mean time from TEP to enlarging TEF diagnosis was 891.3 days. Radial forearm‐free flaps were used in five patients. Six had stenosis proximal to the TEF whereas one had distal stenosis and one had no evidence of stenosis. Mean length of stay was 12.3 days. Mean follow‐up was 400.4 days. Two required a second free flap for persistent fistula. Conclusion: Surgical reconstruction of enlarging TEFs due to TEP/VP placement is effective in combination with addressing underlying pharyngeal/esophageal stenosis contributing to TEF enlargement and leakage. Radial forearm‐free flaps have the additional benefit of a long vascular pedicle to access more distant and less‐irradiated recipient vessels. Many fistulae are resolved after the first flap reconstruction, but some may require subsequent reconstruction in case of failure. Level of Evidence: 4 Laryngoscope, 134:198–206, 2024 [ABSTRACT FROM AUTHOR]

Though the role of chronic kidney disease (CKD) has been studied previously in primary arthroplasty procedures of the hips and knees, there is a paucity of literature analyzing CKD's impact on surgical outcomes in revision total knee arthroplasty (rTKA) patients. As the number of patients with CKD requiring revision surgery increases, more vigilant pre-operative and post-operative measures can be taken to ensure successful outcomes. This retrospective study sought to 1) determine differences in demographics and preoperative comorbidities of patients with normal or mild CKD and those with moderate/severe CKD and 2) establish moderate/severe CKD as an independent risk factor for complications in the 30-day postoperative period in patients undergoing rTKA. The ACS-NSQIP database was queried for patients who had undergone rTKA from 2005 to 2016. Patient were assigned to one of five CKD severity classes after eGFR calculation and were further stratified into two cohorts: stages 1/2 vs. stages 3/4/5. After propensity matching to generate a matched normal/mild CKD cohort of rTKA patients, univariate and multivariate analyses were used to assess differences and the impact of severe CKD on the risk for complications. There were significant differences in several demographic features, comorbidities, and complications between the two cohorts upon univariate analyses. Upon multivariate analyses, CKD of moderate/severe/failure status was found to be a significant independent risk factor for acute renal failure (OR 18.097, 95% CI 4.970–65.902, p < 0.001), blood transfusions (OR 1.697, 95% CI 1.500–1.919, p < 0.001), return to the operating room (OR 1.257, 95% CI 1.009–1.566, p = 0.041), extended length of stay (OR 1.707, 95% CI 1.292–2.255, p < 0.001), and mortality (OR 2.165, 95% CI 1.116–4.200, p = 0.022) in the 30-day postoperative period. This current study found moderate/severe CKD to be an independent risk factor for several complications and should guide healthcare professionals for better patient-optimization. Orthopaedic surgeons should factor in CKD severity in the management of patients undergoing rTKA to effectively mitigate the effects of adverse events. [ABSTRACT FROM AUTHOR]

Byline: William E. Spangler, David P. Strum, Luis G. Vargas and Jerrold H. May In the face of increasing demands for services and tighter constraints on resources, medical centres are searching for ways to improve efficiencies and reduce costs. This paper describes the design and development of a system, called Resource Coordination for Surgical Services (RCSS), that is intended to help managers improve overall utilisation of surgical suites.

Byline: William E. Spangler, David P. Strum, Luis G. Vargas, Jerrold H. May This chapter explores cost reduction and capacity planning in surgical services. Classical operating suite (OR) utilisation is defined as the ratio of total OR time used to total OR time budgeted, but that definition of utilisation allows scheduling inefficiencies and costs to go undetected. Instead, a more accurate description of the overall use of resources can be achieved by dividing classical utilisation into under-utilisation and over-utilisation, and incorporating those measures within a minimal cost analysis model. The model, which was developed from a study of surgical case records collected over six years, indicates that the potential cost savings are significant.

A new study investigates how the lognormal distribution, proposed for modeling surgical data, can be fitted to surgical procedure times.

This paper reviews the general problem of surgical scheduling. We organize the literature based on the time frame or planning horizon of the schedule into six categories: capacity planning, process reengineering/redesign, the surgical services portfolio, procedure duration estimation, schedule construction, and schedule execution, monitoring, and control. We survey past work and suggest topics for potential future research in each of those areas. [ABSTRACT FROM AUTHOR]

This research describes a constraint-based heuristic model of capacity segmentation for outpatient facilities used to estimate the effect of segmentation constraints on stakeholders. Growth of free-standing ambulatory surgery centres has been dramatic in recent years with institutions being urged by governments and insurers to segment inpatients (IP) and outpatients (OP) to reduce costs and improve services. Critics of segmentation argue it is a false economy to separate inpatients and outpatients since pooling of patients in large IP facilities offers economies of scale and opportunities for parallel processing, not to mention elimination of infrastructure. We implemented a constraint-based heuristic model of capacity segmentation for OP facilities and used it to estimate the effect of segmentation on stakeholders. [ABSTRACT FROM AUTHOR]

The plans for Resource Coordination for Surgical Services system (RCSS) incorporate a distributed objectbase with a coordinating server. User-centered information screens are customized for each geographic location in surgical services. User interfaces are designed to mimic paper lists and worksheets used by health care providers. Patient-specific and site-specific data will be entered and maintained by providers at each geographic location, but also rebroadcast and displayed for all providers. Although RCSS is primarily a communications system, it will also support review of surgical utilization and operative scheduling. [ABSTRACT FROM PUBLISHER]