Non-medical risk factors associated with postponing elective surgery: a prospective observational study

Background

Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons.

Methods

In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR’s patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann–Whitney U test and Fisher's exact test/χ²-test.

Results

Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer.

Conclusions

Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery.

Trial registration DRKS00015836. Retrospectively registered.

Soft x-ray radiation from laser-produced plasmas: characterization of radiation emission and its use in x-ray lithography

Laser pulses of 15 ns and </=3 J at 1064nm and </=1.2 J at 532 nm were focused onto steel targets to produce plasmas emitting intense soft x-ray radiation pulses. The plasma generation is described, and the x-ray emission is spectrally and spatially characterized. Using this plasma as an x-ray source, FBM120 resist was exposed through a gold patterned 2-microm silicon mask. Exposing the same resist to a primary standard source (electron storage ring BESSY) the plasma x-ray emission was evaluated resulting in conversion efficiencies (laser into x-ray radiation) of up to 3.4% for 1064 nm and up to 5.0% for 532-nm laser radiation pulses.

Soft-x-ray generation in a helium environment using laser-produced plasmas

Soft-x-ray radiation was generated by focusing the beam of a Q-switched Nd:glass laser on a steel target in a chamber filled with He at pressures of 10(-5)mbar </= p </= 500 mbar. The radiation at lambda </= 1.5 nm was detected using a P-I-N diode behind a 25-microm Be foil. For He pressures p <100 mbar and laser pulse energies </=2 J, the soft-x-ray emission of the laser-produced plasma was reduced by less than 10% compared with the emission under high-vacuum conditions. The half-width tau(x-ray) of the soft-x-ray emission time was independent of p and of the same order as the laser pulse half-width tau(LASER) asymptotically equal to 17 nsec.