Accurate surgery duration estimation is necessary for optimal OR planning, which plays an important role in patient comfort and safety as well as resource optimization. It is, however, challenging to preoperatively predict surgery duration since it varies significantly depending on the patient condition, surgeon skills, and intraoperative situation. In this paper, we propose a deep learning pipeline, referred to as RSDNet, which automatically estimates the remaining surgery duration (RSD) intraoperatively by using only visual information from laparoscopic videos. Previous state-of-the-art approaches for RSD prediction are dependent on manual annotation, whose generation requires expensive expert knowledge and is time-consuming, especially considering the numerous types of surgeries performed in a hospital and the large number of laparoscopic videos available. A crucial feature of RSDNet is that it does not depend on any manual annotation during training, making it easily scalable to many kinds of surgeries. The generalizability of our approach is demonstrated by testing the pipeline on two large datasets containing different types of surgeries: 120 cholecystectomy and 170 gastric bypass videos. The experimental results also show that the proposed network significantly outperforms a traditional method of estimating RSD without utilizing manual annotation. Further, this work provides a deeper insight into the deep learning network through visualization and interpretation of the features that are automatically learned.

pdf/rsdnet-learning-to-predict-remaining-surgery-duration-from-3cx2fp573d.pdf

RSDNet: Learning to Predict Remaining Surgery Duration from Laparoscopic Videos Without Manual Annotations

Accurate surgery duration estimation is necessary for optimal OR planning, which plays an important role in patient comfort and safety as well as resource optimization. It is, however, challenging to preoperatively predict surgery duration since it varies significantly depending on the patient condition, surgeon skills, and intraoperative situation. In this paper, we propose a deep learning pipeline, referred to as RSDNet, which automatically estimates the remaining surgery duration (RSD) intraoperatively by using only visual information from laparoscopic videos. The previous state-of-the-art approaches for RSD prediction are dependent on manual annotation, whose generation requires expensive expert knowledge and is time-consuming, especially considering the numerous types of surgeries performed in a hospital and the large number of laparoscopic videos available. A crucial feature of RSDNet is that it does not depend on any manual annotation during training, making it easily scalable to many kinds of surgeries. The generalizability of our approach is demonstrated by testing the pipeline on two large datasets containing different types of surgeries: 120 cholecystectomy and 170 gastric bypass videos. The experimental results also show that the proposed network significantly outperforms a traditional method of estimating RSD without utilizing manual annotation. Further, this paper provides a deeper insight into the deep learning network through visualization and interpretation of the features that are automatically learned.

Internal fixation compared with total hip replacement for displaced femoral neck fractures in the elderly. Author's reply

In many hospitals there are patients who receive surgery later than what is medically indicated. In one of Europe’s largest hospitals, the University Hospital Leuven, this is the case for approximately every third patient. Serving patients late cannot always be avoided as a highly utilized OR department will sometimes suffer capacity shortage, occasionally leading to unavoidable delays in patient care. Nevertheless, serving patients late is a problem as it exposes them to an increased health risk and hence should be avoided whenever possible. In order to improve the current situation, the delay in patient scheduling had to be quantified and the responsible mechanism, the scheduling process, had to be better understood. Drawing from this understanding, we implemented and tested realistic patient scheduling methods in a discrete event simulation model. We found that it is important to model non-elective arrivals and to include elective rescheduling decisions made on surgery day itself. Rescheduling ensures that OR related performance measures, such as overtime, will only loosely depend on the chosen patient scheduling method. We also found that capacity considerations should guide actions performed before the surgery day such as patient scheduling and patient replanning. This is the case as those scheduling strategies that ensure that OR capacity is efficiently used will also result in a high number of patients served within their medically indicated time limit. An efficient use of OR capacity can be achieved, for instance, by serving patients first come, first served. As applying first come, first served might not always be possible in a real setting, we found it is important to allow for patient replanning.

/pdf/due-time-driven-surgery-scheduling-3dlkh0tcxl.pdf

Due time driven surgery scheduling

Background A new method of scheduling anesthesia-controlled time (ACT) was implemented on July 1, 2012 in an academic inpatient operating room (OR) department. This study examined the relationship between this new scheduling method and OR performance. The new method comprised the development of predetermined time frames per anesthetic technique based on historical data of the actual time needed for anesthesia induction and emergence. Seven "anesthesia scheduling packages" (0 to 6) were established. Several options based on the quantity of anesthesia monitoring and the complexity of the patient were differentiated in time within each package. Study Design This was a quasi-experimental time-series design. Relevant data were divided into 4 equal periods of time. These time periods were compared with ANOVA with contrast analysis: an intervention, pre-intervention, and post-intervention contrast were tested. All emergency cases were excluded. A total of 34,976 inpatient elective cases performed from January 1, 2010 to December 31, 2014 were included for statistical analyses. Results The intervention contrast showed a significant decrease (p Conclusions Scheduling the 2 major components of a procedure (anesthesia- and surgeon-controlled time) more accurately leads to fewer case cancellations, lower prediction errors, and smoother OR workflow in a university hospital setting.

https://www.journalacs.org/article/S1072-7515(16)30041-2/pdf

Scheduling Anesthesia Time Reduces Case Cancellations and Improves Operating Room Workflow in a University Hospital Setting

To date, there has been little research into the clinical outcomes of total hip arthroplasty (THA) for intracapsular neck of femur (NOF) fracture in the very elderly. 44 patients over 75 years underwent THA for an intracapsular NOF fracture over a two year period. Oxford Hip Scores were obtained from 37 patients with a mean score of 39.7 (range 11–47). Katz Index Scores were collected from 36 patients with a mean pre-operative score of 5.9 and post operative score of 5.7. THA in this population gives patients the best opportunity to return to premorbid function. When complications occur there is a catastrophic effect on independence. Therefore it is important to select these patients' appropriately and to optimise their medical condition peri-operatively.

Clinical outcomes of total hip arthroplasty for fractured neck of femur in patients over 75 years.

Entrapment of the flexor digitorum profundus (FDP) is a recognized complication of paediatric both-bone forearm fractures. Although a rare complication, it is usually missed at the time of initial fracture management resulting in the need for corrective surgery. An attempted closed manipulation followed by immediate surgical correction of FDP entrapment in our hospital prompted a review of the evidence on this underreported problem. A comprehensive English language literature search was performed using Embase, Medline and Pubmed. Twenty cases have been reported in the literature and all were diagnosed post-operatively (range 2 days–16 years). Eighteen cases (90%) required surgical correction. Five cases (25%) were initially diagnosed as mild Volkmann's contracture yet at surgery no case was found to have evidence of previous muscle ischaemia. Although subclinical or mild Volkmann's ischaemic contracture is a recognized complication of closed forearm fracture, this report highlights the importance of considering a diagnosis of muscle entrapment in cases of flexion contracture.

Flexor digitorum profundus entrapment in paediatric forearm fractures

Objective To assess the accuracy of surgeons and anaesthetists in predicting the time it will take them to complete an operation or procedure and therefore explain some of the difficulties encountered in operating theatre scheduling.

Design Single centre, prospective observational study.

Setting Plastic, orthopaedic, and general surgical operating theatres at a level 1 trauma centre serving a population of about 370 000.

Participants 92 operating theatre staff including surgical consultants, surgical registrars, anaesthetic consultants, and anaesthetic registrars.

Intervention Participants were asked how long they thought their procedure would take. These data were compared with actual time data recorded at the end of the case.

Primary outcome measure Absolute difference between predicted and actual time.

Results General surgeons underestimated the time required for the procedure by 31 minutes (95% confidence interval 7.6 to 54.4), meaning that procedures took, on average, 28.7% longer than predicted. Plastic surgeons underestimated by 5 minutes (−12.4 to 22.4), with procedures taking an average of 4.5% longer than predicted. Orthopaedic surgeons overestimated by 1 minute (−16.4 to 14.0), with procedures taking an average of 1.1% less time than predicted. Anaesthetists underestimated by 35 minutes (21.7 to 48.7), meaning that, on average, procedures took 167.5% longer than they predicted. The four specialty mean time overestimations or underestimations are significantly different from each other (P=0.01). The observed time differences between anaesthetists and both orthopaedic and plastic surgeons are significantly different (P<0.05), but the time difference between anaesthetists and general surgeons is not significantly different.

Conclusion The inability of clinicians to predict the necessary time for a procedure is a significant cause of delay in the operating theatre. This study suggests that anaesthetists are the most inaccurate and highlights the potential differences between specialties in what is considered part of the “anaesthesia time.”

https://www.bmj.com/content/bmj/349/bmj.g7182.full.pdf

Operating theatre time, where does it all go? A prospective observational study.

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Clinical outcomes of total hip arthroplasty for fractured neck of femur in patients over 75 years.

Flexor digitorum profundus entrapment in paediatric forearm fractures

Operating theatre time, where does it all go? A prospective observational study.