Author: fidelmac

This study investigated whether common elective surgeries have returned to expected levels. The  analysis shows that the volume of elective surgeries dropped steeply at the beginning of the pandemic and then increased dramatically when states began reopening and hospitals started offering elective services again for all categories.

No surgical procedure appear to have fully made up the deficit of missed surgeries from early in the pandemic. Knee prosthesis and thyroid or parathyroid surgeries showed the lowest volumes compared to expected in the post-lockdown period, in addition to some of the largest drops in volume during the lockdown period (as defined as July 2021).

https://ehrn.org/articles/elective-surgeries-approach-pre-pandemic-volumes

Researchers provide lessons learned after nationwide pause of most elective operations during 2020. Curtailing surgical services for even a short time can seriously impact a hospital’s financial security. Maintaining access to surgical care is not all about revenue; it’s about how to efficiently manage surgical patients’ needs

Results of study were presented at the virtual American College of Surgeons (ACS) Clinical Congress 2021.

Lessons learned

• Hospital systems must assess their operations management strategies to optimize the availability of surgical resources for patients with the greatest need.
• Hospitals need to optimize any excess resource capacity that existed before the pandemic or increase their capacity for performing procedures based on their resources, such as expanding hours for operations.
• Increase hospital bed and resource capacity through alternate solutions, such as sending an overflow of surgical patients to other patient care units or facilities that can accommodate them.
• Appropriately triage elective operations following ACS guidelines4 and other published surgical triage tools.
• Ensure sufficient PPE for health care workers and patients. 
• Help keep staff healthy by mandating COVID-19 vaccines or frequently testing them against the virus.

https://www.eurekalert.org/news-releases/932389

A cholecystectomy under complete fluorescence guidance (C-CFG) was performed. C-CFG was performed without switching to the white light mode. All procedures can be performed while visualizing the common bile duct. Peeling around the cystic duct was appropriately guided by ICG fluorescence. The line to be peeled is clearly recognized while being exfoliated from the liver. We report the execution of a cholecystectomy under complete fluorescence guidance using near-infrared camera images without switching to the white light mode, a method that has not been reported previously.

https://www.sciencedirect.com/science/article/pii/S221026122101035X

Indocyanine green (ICG) fluorescence angiography has recently been reported useful as a method for predicting intestinal blood flow and may reduce anastomotic leakage. However, the quantification method for ICG fluorescence angiography has not been established. We usually measure the tissue oxygen saturation (StO2 ) in the intestinal tract via near-infrared spectroscopy, as it is able to measure the oxygen concentration accurately and immediately shows objective data. In this study, we propose that the time to reach the anastomotic site after intravenous ICG injection is an effective parameter for quantifying ICG fluorescence angiography from the comparison to the data of StO2 in the intestinal tract.

https://pubmed.ncbi.nlm.nih.gov/34672106/

Laparoscopic anatomic mesohepatectomy for patients with hepatocellular carcinoma (HCC) remains technically challenging, especially for those with a massive tumor larger than 10 cm. In this study, a 65-year-old man with a 13 × 10-cm2 solitary liver tumor located at segments 4, 5, and 8 underwent laparoscopic mesohepatectomy. To reduce the possibility of releasing cancer cells from the primary tumor, the in situ resection strategy for tumor removal was implemented. Indocyanine green (ICG) then was applied using “reverse staining” to visualize the resection extent and the right posterior hepatic duct (RPHD). During parenchymal resection, the right anterior Glissonean pedicle was adequately exposed and transected via the extrafascial approach above the plane of the RPHD. Finally, the right coronary ligament was dissected, and the tumor was removed. The operation was completed in 360 min, with a blood loss of 200 mL. The patient was discharged on postoperative day 8 without any complications. Laparoscopic in situ anatomic mesohepatectomy with ICG navigation may be feasible for patients with a centrally located solitary massive HCC.

https://link.springer.com/article/10.1245/s10434-021-10886-2

Introduction and aim: Anastomosis leak occurs in 1-19% of colorectal surgeries. Our objective was to present the first Mexican case series on colorrectal surgery using indocyanine green fluorescence angiography to evaluate perfusion prior to carrying out the anastomosis.

A retrospective, analytic, descriptive study was conducted. We studied the case records of consecutive patients that underwent colorectal surgery with indocyanine green angiography performed by the same group of colorectal surgeons. Twenty-one case records were reviewed. Eleven (52.3%) of the patients were women, mean patient age was 57 years (38-82), and mean body mass index was 25 kg/m2 (17-34). Fifteen (71.4%) patients were diagnosed with malignant disease. Indocyanine green angiography changed our therapeutic decision in three (14.2%) patients. Two colorrectal anastomoses (14.2%) were performed at fewer than 5 cm from the anal verge and 13 (61.9%) were performed at more than 5 cm from the anal verge. Three of the anastomoses were ileocolic (14.2%), two were coloanal (9.5%), and one was ileoanal (4.7%). There were six (28.5%) complications, no cases of anastomotic leak, and no complications associated with the use of indocyanine green. The mortality rate was 0%. The present case series is the first on colorectal surgery conducted in Mexico using indocyanine green fluorescence angiography, with excellent results.

https://pubmed.ncbi.nlm.nih.gov/34656502/

Their July survey of 25 large US hospital systems—representing a quarter of the country’s hospital beds—showed large decreases in surgeries this year as compared with 2019. The trend is expected to continue at least through the end of 2020.

The onset of COVID-19 caused some patients throughout the United States to delay their surgeries as many hospital systems postponed nonemergent procedures. This led to a potentially large backlog of case volume. In a recent McKinsey survey of health system leaders, hospital executives said they may struggle to address this backlog given workforce availability, enhanced sanitation protocols, and reserved inpatient capacity. Without healthcare systems recalibrating demand and capacity, patients could face long backlogs for procedures, and potentially experience higher morbidity and mortality rates.

Solutions may include 1) reducing the unnecessary deferral of care, 2) effectively addressing new throughput challenges, 3) using advanced analytics to better forecast demand and manage capacity in real time, and 4) reimagining operating room operations to increase long-term capacity.

https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/cutting-through-the-covid-19-surgical-backlog

Highlights

• An increased number of emergency vascular and trauma surgical procedures occurred.
• The number of emergency oncological and general surgical procedures remained stable.
• Age, ASA, and surgical discipline were factors for increased risk of complications.
• No increase in the number of postoperative complications was observed.

https://www.sciencedirect.com/science/article/pii/S2405857221000887

Mastectomy skin flap necrosis (MSFN) is a major complication after skin- or nipple-sparing mastectomy with a prevalence of 11–24%. 1 Indocyanine green angiography (ICGA) has been used in the last ten years in breast reconstruction surgery. ICGA involves real-time fluorescence imaging utilising a near-infrared camera after intravenous administration of the fluorophore, indocyanine green. There has been evidence that it has greater sensitivity than just clinical assessment to identify skin flaps with reduced perfusion.

https://www.jprasurg.com/article/S1748-6815(21)00400-9/fulltext#relatedArticles

Abstract

In assessing the severity of lower extremity arterial disease (LEAD), physicians rely on clinical judgements supported by conventional measurements of macrovascular blood flow. However, current diagnostic techniques provide no information about regional tissue perfusion and are of limited value in patients with chronic limb-threatening ischemia (CLTI). Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) has been used extensively in perfusion studies and is a possible modality for tissue perfusion measurement in patients with CLTI. In this prospective cohort study, ICG NIR fluorescence imaging was performed in patients with CLTI and control patients using the Quest Spectrum Platform® (Middenmeer, The Netherlands). The time–intensity curves were analyzed using the Quest Research Framework. Fourteen parameters were extracted. Successful ICG NIR fluorescence imaging was performed in 19 patients with CLTI and in 16 control patients. The time to maximum intensity (seconds) was lower for CLTI patients (90.5 vs. 143.3, p = 0.002). For the inflow parameters, the maximum slope, the normalized maximum slope and the ingress rate were all significantly higher in the CLTI group. The inflow parameters observed in patients with CLTI were superior to the control group. Possible explanations for the increased inflow include damage to the regulatory mechanisms of the microcirculation, arterial stiffness, and transcapillary leakage.

https://www.mdpi.com/2227-9059/9/10/1417/htm