The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Novel Scheme of Fuzzy based Concealing Sink Node with Fake Holes (F-CSH)

AbstractDue to the sink node crucial position, its location privacy is becoming one of the major issues in wireless sensor networks (WSNs) which requires ultimate protection. Particularly, the WSNs successfulness is endanger as the wireless transmission nodes are susceptive to illicit tracing and detection. While privacy of the message can be ensured through encryption content, this paper formalizes a novel efficient privacy preserving scheme to secure sink node location. The aim is to keep the location privacy of the sink node from being tracked using the traffic flow passive analysis. F-CSH is based on the concealing of the location of the main sink using fake sink holes been elected using fuzzy score function. In addition, comprehensive simulations proved that the proposed scheme significantly upgrades both delivery time and conservation energy cost compared with existing strategies

Post refractory CPR due to STEMI with three vessels disease complicated cardiac arrest, is it possible to recover the heart after revascularization by PCI post extracorporeal cardio pulmonary resuscitation (ECPR)?

High-risk percutaneous coronary intervention (PCI) remains a viable revascularization strategy for complex coronary arteries diseases. Selective PCI supported by extracorporeal membrane oxygenation (ECMO) is also a viable alternative for patients those are at very high risk for coronary artery bypass grafting (CABG). Extracorporeal membrane oxygenation (ECMO) can direct blood flow from the body to membrane oxygenator then return it back to the body. Thus completely/partially replacing the function of the heart and lungs to increasing the likelihood of functional recovery. We will present a case of refractory CPR post STMI rescued by ECPR with revascularization of three coronary vessels after percutaneous coronary intervention (PCI) under mechanical support of extracorporeal membrane oxygenation (ECMO) after exclusion of surgical choice due to patient risk condition. We think that in selected group of highly critical cases PCI with MCS could replace the need of major surgical intervention like CABG. Keywords: High risk PCI, ECMO, ECPR, Multi vessels disease