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Gordon L, Soenens G, Doyen B, Sunavsky J, Wheatcroft M, de Mestral C, Palter V, Grantcharov T, Van Herzeele I. Step, Error, and Event Frameworks in Endovascular Aortic Repair. J Endovasc Ther 2022; 29:937-947. [PMID: 35012393 DOI: 10.1177/15266028211068768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Competency-based surgical education requires detailed and actionable feedback to ensure adequate and efficient skill development. Comprehensive operative capture systems such as the Operating Room Black Box (ORBB; Surgical Safety Technologies, Inc), which continuously records and synchronizes multiple sources of intraoperative data, have recently been integrated into hybrid rooms to provide targeted feedback to endovascular teams. The objective of this study is to develop step, error, and event frameworks to evaluate technical performance in elective endovascular aortic repair (EVAR) comprehensively captured by the ORBB (Surgical Safety Technologies, Inc; Toronto, Canada). METHODS This study is based upon a modified Delphi consensus process to create evaluation frameworks for steps, errors, and events in EVAR. International experts from Vascular Surgery and Interventional Radiology were identified, based on their records of publications and invited presentations, or serving on relevant journal editorial boards. In an initial open-ended survey round, experts were asked to volunteer a comprehensive list of steps, errors, and events for a standard EVAR of an infrarenal aorto-iliac aneurysm (AAA). In subsequent survey rounds, the identified items were presented to the expert panel to rate on a 5-point Likert scale. Delphi survey rounds were repeated until the process reached consensus with a predefined agreement threshold (Cronbach α>0.7). The final frameworks were constructed with items achieving an agreement (responses of 4 or 5) from greater than 70% of experts. RESULTS Of 98 invited proceduralists, 38 formed the expert consensus panel (39%), consisting of 29 vascular surgeons and 9 interventional radiologists, with 34% from North America and 66% from Europe. Consensus criteria were met following the third round of the Delphi consensus process (Cronbach α=0.82-0.93). There were 15, 32, and 25 items in the error, step, and event frameworks, respectively (within-item agreement=74%-100%). CONCLUSION A detailed evaluation tool for the procedural steps, errors, and events in infrarenal EVAR was developed. This tool will be validated on recorded procedures in future work: It may focus skill development on common errors and hazardous steps. This tool might be used to provide high-quality feedback on technical performance of trainees and experienced surgeons alike, thus promoting surgical mastery.
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Affiliation(s)
- Lauren Gordon
- Division of Vascular Surgery, University of Toronto, Toronto, ON, Canada.,International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,BioMedical Engineering, University of Toronto, ON, Canada
| | - Gilles Soenens
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Bart Doyen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Juliana Sunavsky
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Mark Wheatcroft
- Division of Vascular Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Charles de Mestral
- Division of Vascular Surgery, University of Toronto, Toronto, ON, Canada.,Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Vanessa Palter
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Teodor Grantcharov
- International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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de Mestral C, Gomez D, Wilton AS, Lee DS, Albalawi Z, Austin PC, Jacob-Brassard J, Urbach DR, Al-Omran M, Baxter NN. A Population-Based Analysis of Diabetes-Related Care Measures, Foot Complications, and Amputation During the COVID-19 Pandemic in Ontario, Canada. JAMA Netw Open 2022; 5:e2142354. [PMID: 34985514 PMCID: PMC8733837 DOI: 10.1001/jamanetworkopen.2021.42354] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
IMPORTANCE Deferred diabetic foot screening and delays in timely care of acute foot complications during the COVID-19 pandemic may have contributed to an increase in limb loss. OBJECTIVE To evaluate the association of the COVID-19 pandemic with diabetes-related care measures, foot complications, and amputation. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included all adult residents of Ontario, Canada, with diabetes and compared the rates of selected outcomes from January 1, 2020, to February 23, 2021, vs January 1, 2019, to February 23, 2020. MAIN OUTCOMES AND MEASURES Comprehensive in-person diabetes care assessment, including foot examination; hemoglobin A1c (HbA1c) measurement; emergency department visit or hospitalization for diabetic foot ulceration, osteomyelitis, or gangrene; lower extremity open or endovascular revascularization; minor (toe or partial-foot) amputation; and major (above-ankle) leg amputation. Rates and rate ratios (RRs) comparing 2020-2021 vs 2019-2020 for each measure were calculated for 10-week periods, anchored relative to onset of the pandemic on March 11, 2020 (11th week of 2020). RESULTS On March 11, 2020, the study included 1 488 605 adults with diabetes (median [IQR] age, 65 [55-74] years; 776 665 [52.2%] men), and on March 11, 2019, the study included 1 441 029 adults with diabetes (median [IQR] age, 65 [55-74] years; 751 459 [52.1%] men). After the onset of the pandemic, rates of major amputation in 2020-2021 decreased compared with 2019-2020 levels. The RR for the prepandemic period from January 1 to March 10 was 1.05 (95% CI, 0.88-1.25), with RRs in the pandemic periods ranging from 0.86 (95% CI, 0.72-1.03) in May 20 to July 28 to 0.95 (95% CI, 0.80-1.13) in October 7 to December 15. There were no consistent differences in demographic characteristics or comorbidities of patients undergoing amputation in the 2020-2021 vs 2019-2020 periods. Rates of comprehensive in-person diabetes care assessment and HbA1c measurement declined sharply and remained below 2019-2020 levels (eg, in-person assessment, March 11 to May 19: RR, 0.28; 95% CI, 0.28-0.28). The rates of emergency department visits (eg, March 11 to May 19: RR, 0.67; 95% CI, 0.61-0.75), hospitalization (eg, March 11 to May 19: RR, 0.77; 95% CI, 0.68-0.87), open revascularization (eg, March 11 to May 19: RR, 0.66; 95% CI, 0.56-0.79), endovascular revascularization (March 11 to May 19: RR, 0.70; 95% CI, 0.61-0.81), and minor amputation (March 11 to May 19: RR, 0.70; 95% CI, 0.60-0.83) initially dropped but recovered to 2019-2020 levels over the study period. CONCLUSIONS AND RELEVANCE In this population-based cohort study, disruptions in care related to the COVID-19 pandemic were not associated with excess leg amputations among people living with diabetes. As the pandemic ends, improved prevention and treatment of diabetic foot complications will be necessary to maintain these positive results.
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Affiliation(s)
- Charles de Mestral
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| | - David Gomez
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | | | - Douglas S. Lee
- ICES, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Zaina Albalawi
- Division of Endocrinology and Metabolism, Faculty of Medicine, Memorial University, St John’s, Newfoundland and Labrador, Canada
| | | | - Jean Jacob-Brassard
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - David R. Urbach
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| | - Nancy N. Baxter
- Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Erman A, Ramsay LC, Sander B, Haj-Ali W, Wu D, Setterfield M, Rahal M, Woodward G, Al-Omran M, de Mestral C. Impact of COVID-19 on scheduled lower extremity revascularization for chronic limb-threatening ischemia. Br J Surg 2021; 109:e5-e7. [PMID: 34878108 PMCID: PMC9383050 DOI: 10.1093/bjs/znab404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/27/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Aysegul Erman
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Lauren C Ramsay
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | | | - Deanna Wu
- CorHealth Ontario, Toronto, Ontario, Canada
| | | | | | | | - Mohammed Al-Omran
- Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Charles de Mestral
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Rajesh J, Valentelyte G, McNamara DA, Sorensen J. Impact of the COVID-19 pandemic on provision and outcomes of emergency abdominal surgery in Irish public hospitals. Ir J Med Sci 2021; 191:2275-2282. [PMID: 34822021 PMCID: PMC8613337 DOI: 10.1007/s11845-021-02857-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
Background The SARS-CoV-2 pandemic caused severe disruption to scheduled surgery in Ireland but its impact on emergency abdominal surgery (EAS) is unknown. Aims The primary objective was to identify changes in volume, length of stay (LOS), and survival outcomes following EAS during the pandemic. A secondary objective was to evaluate differences in EAS patient flow including admission source, ITU utilisation, discharge destination, and readmission rates. Methods Using a national administrative dataset, demographic, comorbidity, and patient flow data on 5611 patients admitted for EAS between 2018 and 2020 were extracted. Pre-pandemic and pandemic timeframes were compared using graphic and regression analyses, and bivariate logistic regression, adjusting for demographics and case-mix. Results There was a 19.9% decrease in EAS during the 2020 COVID-19 pandemic with no difference in comorbidity, nor in the commonest procedures. Most patients (92.4%) were admitted from home. In-hospital post-operative mortality was unchanged (7.6%). Patients over 80 comprised 16.3% of EAS pre-COVID, but 17.9% during COVID. Average total LOS reduced significantly by 4.9 days and 3.5 days during COVID-19 waves 1 (29 Feb 2020–30 June 2020) and 2 (1 July 2020–30 Nov 2020), respectively. During wave 1, pre-operative LOS reduced (1 day) and ICU LOS was significantly shorter (0.8 days), but similar change was not observed during wave 2. Conclusions Significant improvements in patient flow following admission for EAS during the pandemic were observed. These changes were not associated with greater mortality nor increased readmission rates and offer important insights into optimal delivery of EAS services.
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Affiliation(s)
- Joel Rajesh
- National Clinical Programme in Surgery (NCPS), Royal College of Surgeons in Ireland (RCSI), 2 Proud's Lane, Dublin, Ireland
| | - Gintare Valentelyte
- Healthcare Outcomes Research Centre (HORC), Royal College of Surgeons in Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, Ireland
| | - Deborah A McNamara
- National Clinical Programme in Surgery (NCPS), Royal College of Surgeons in Ireland (RCSI), 2 Proud's Lane, Dublin, Ireland.
| | - Jan Sorensen
- Healthcare Outcomes Research Centre (HORC), Royal College of Surgeons in Ireland (RCSI), Beaux Lane House, Mercer Street Lower, Dublin, Ireland
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