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Purpose: The COVID-19 pandemic posed a worldwide challenge, leading to radical changes in surgical services. The primary objective of the study was to assess the impact of COVID-19 on elective and emergency surgeries in a Brazilian metropolitan area. The secondary objective was to compare the postoperative hospital mortality before and during the pandemic. Patients and Methods: Time-series cohort study including data of all patients admitted for elective or emergency surgery at the hospitals in the Public Health System of Federal District, Brazil, between March 2018 and February 2022, using data extracted from the Hospital Information System of Brazilian Ministry of Health (SIH/DATASUS) on September 30, 2022. A causal impact analysis was used to evaluate the impact of COVID-19 on elective and emergency surgeries and hospital mortality. Results: There were 174,473 surgeries during the study period. There was a reduction in overall (absolute effect per week: -227.5; 95% CI: -307.0 to -149.0), elective (absolute effect per week: -170.9; 95% CI: -232.8 to -112.0), and emergency (absolute effect per week: -57.7; 95% CI: -87.5 to -27.7) surgeries during the COVID-19 period. Comparing the surgeries performed before and after the COVID-19 onset, there was an increase in emergency surgeries (53.0% vs 68.8%, P < 0.001) and no significant hospital length of stay (P = 0.112). The effect of the COVID-19 pandemic on postoperative hospital mortality was not statistically significant (absolute effect per week: 2.1, 95% CI: -0.01 to 4.2). Conclusion: Our study showed a reduction in elective and emergency surgeries during the COVID-19 pandemic, possibly due to disruptions in surgical services. These findings highlight that it is crucial to implement effective strategies to prevent the accumulation of surgical waiting lists in times of crisis and improve outcomes for surgical patients.

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BACKGROUND: Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System (BUHS). We describe the implementation of the "Patients with Surgical Indication" (PSI) in a Brazilian public tertiary hospital, the impact on waiting time, and its use in rationing oncological surgeries during the COVID-19 Pandemic. METHODS: Retrospective observational study of elective surgical requests (2016-2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. RESULTS: We enrolled 82,844 indications in the PSI (2016-2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p < 0.01). The same occurred with the backlog that ranged from 6,884 in 2016 to 844 in 2022 (p < 001). During the Pandemic, there was a reduction in the number of non-oncological surgeries per month (95% confidence interval) of -10.9(-18.0;-3.8) during Phase I (January 2019-March 2020), maintenance in Phase II (April 2020-August 2021) 0.1(-10.0;10.4) and increment in Phase III (September 2021-December 2022) of 23.0(15.3;30.8). In the oncological conditions, these numbers were 0.6(-2.1;3.3) for Phase I, an increase of 3.2(0.7;5.6) in Phase II and 3.9(1,4;6,4) in Phase III. CONCLUSION: Implementing a centralized list of surgical indications and developing queue management principles proved feasible, with effective rationing. It unprecedentedly demonstrated the decrease in the median waiting time in Brazil.

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Objetivo: Identificar cómo se informó a los pacientes sometidos a cirugías oncológicas electivas sobre la preparación antes de la cirugía y, con base en esta información, desarrollar una lista educativa de pautas preoperatorias. Método: Investigación retrospectiva y transversal desarrollada en una institución de oncología del interior de São Paulo. Se utilizaron dos cuestionarios, uno para datos sociodemográficos y de perfil de salud, y otro para identificar retrospectivamente pautas preoperatorias. Se realizó análisis estadístico descriptivo. Resultados: De las 38 pacientes, el 65,8% eran mujeres y el 42% fueron sometidas a mastectomía. Prevaleció la orientación brindada de forma verbal y presencial, especialmente en lo que respecta al examen solicitado por el cirujano y la documentación personal, que presentó el mismo porcentaje, 78,9%. Hubo lagunas en la información brindada sobre la posibilidad de utilizar sonda, drenajes o tubos para el 63,2%. Conclusión: Los autoinformes de los pacientes sobre las guías preoperatorias revelaron fallas en la forma en que se transmitió esa información y apoyaron la construcción de la lista de guías educativas, destacando la importancia de herramientas escritas estructuradas para el equipo multidisciplinario que puedan mejorar la calidad y seguridad de las guías preoperatorias y la atención quirúrgica.Palabras clave: Oncología Quirúrgica, Procedimientos Quirúrgicos Electivos, Lista de Verificación, Seguridad del Paciente, Enfermería Perioperatoria. (AU)

Objective: To identify how patients who underwent elective oncological surgeries were informed about preparation before surgery and, based on this information, develop an educational checklist of preoperative guidelines. Method: This is a retrospective and cross-sectional research developed at an oncology institution in a small city in the state of São Paulo, Brazil. Two questionnaires were used, one for sociodemographic and health profile data, and the other to retrospectively identify preoperative guidelines. Descriptive statistical analysis was performed. Results: Of the 38 patients, 65.8% were women, with 42% undergoing mastectomy. The guidance provided verbally and in person prevailed, especially regarding the examination requested by the surgeon and personal documentation, which presented the same percentage: 78.9%. There were gaps in information provided about the possibil-ity of using a probe, drains, or tubes for 63.2%. Conclusion: Patients' self-reports on preoperative guidelines showed flaws in the way this information was passed on and supported the development of the checklist of educational guidelines, highlighting the importance of structured written tools for the multidisciplinary team that can improve the quality and safety of preoperative care.

Objetivo: Identificar como os pacientes que passaram por cirurgias oncológicas eletivas foram informados sobre o preparo antes da cirurgia e, com base nessas informações, elaborar uma lista educativa de orientações pré-operatórias. Método: Pesquisa retrospectiva e transversal desenvolvida em uma instituição de oncologia no interior de São Paulo. Dois questionários foram utilizados, um para os dados do perfil sociodemográfico e de saúde, e outro para identificar retrospectivamente as orientações pré-operatórias. Realizada análise estatística descritiva. Resultados: Dos 38 pacientes, 65,8% eram do sexo feminino, sendo 42% submetidas à mastectomia. Prevaleceram as orientações fornecidas de maneira verbal e presencial, especialmente sobre o exame solicitado pelo cirurgião e a documentação pessoal, que apresentaram o mesmo percentual: 78,9%. Houve lacunas de informação for-necida sobre a possibilidade de uso de sonda, drenos ou tubos para 63,2%. Conclusão: O autorrelato dos pacientes sobre as orientações pré-operatórias revelou falhas na forma de transmissão dessas informações e fundamentaram a construção da lista de orientações educativas, ressaltando a importância de ferramentas estruturadas de modo escrito para equipe multiprofissional que podem aprimorar a qualidade e a segurança do cuidado pré-cirúrgico. (AU)

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Introduction: The pandemic caused by the spread of the SARS-CoV-2 virus posed unprecedented challenges to health systems and societies worldwide. Among the greatest challenges was the importance of balancing the treatment of patients with potentially lethal diseases alongside the pandemic. Treatment for breast cancer, a time-dependent disease, was also compromised, as financial resources, supplies, medicines, and, especially, hospital beds needed to be allocated to assist those infected with the new coronavirus. Surgeries were suspended and surgical centers closed. To compare the number of breast surgical procedures before and during the pandemic and assess their impact on the proportional number of surgeries performed. Methods: This is a retrospective cohort study, reviewing procedures recorded from January 2015 to June 2021. Results: A total of 899 patients were included, the majority of whom were female; 58.5% of cases were oncological. The most prevalent surgery in both periods was conservative oncology (sectorectomy or quadrantectomy). There was a significant difference in the number of procedures performed before and during the COVID-19 outbreak, with a 43% drop during the pandemic. There was no significant difference in the pattern of surgeries. Conclusion: The pandemic caused a significant reduction in the total number of elective surgical interventions in the period analyzed ­ a delay that the literature identifies as a potential risk factor for disease progression and increased death rates. (AU)

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Objetivo: evaluar el desperdicio generado por el procesamiento de instrumental quirúrgico consignado en cirugías ortopédicas electivas y proponer un modelo para el cálculo del desperdicio asociado al procesamiento de instrumental quirúrgico consignado. Método: estudio de caso, cuantitativo, descriptivo-exploratorio, realizado en un hospital universitario grande, en dos fases: (1) retrospectiva, mediante la consulta de registros administrativos de cirugías ortopédicas electivas canceladas, con previsión de uso de materiales consignados, para identificar las subespecialidades con mayor demanda; y (2) prospectiva, por medio de observaciones directas, no participantes, del procesamiento de instrumental quirúrgico consignado preparado para las cirugías identificadas, y de la propuesta de un modelo para el cálculo del desperdicio asociado al procesamiento de estos materiales. Resultados: se identificaron las cirugías de artroplastia de cadera, artrodesis de columna y artroplastia de rodilla con mayor demanda, resultando en 854 cajas de instrumental quirúrgico consignado procesado y sin uso. El desperdicio del procesamiento se estimó en R$ 34.340,18 (US$ 6,359.30). Conclusión: la ecuación propuesta permitió calcular el desperdicio relacionado con la producción y la no utilización de cajas de instrumental quirúrgico consignado para procedimientos ortopédicos, y puede equipar a los enfermeros para la planificación basada en datos institucionales, asistenciales y financieros, con el objetivo de aprovechar mejor los recursos por medio de la identificación del desperdicio.

Objective: to evaluate the waste generated from processing surgical instruments consigned in elective orthopedic surgeries and propose a model for calculating waste associated with processing consigned surgical instruments. Method: a quantitative, descriptive-exploratory case study carried out in a large university hospital in two phases: (1) retrospective by consulting administrative records of canceled elective orthopedic surgeries, with provision for the use of consigned materials for identification of the sub-specializations with the greatest demand; and (2) prospective through direct, non-participant observations of processing consigned surgical instruments prepared for the identified surgeries and proposition of a model for calculating waste associated with processing these materials. Results: hip arthroplasty, spine arthrodesis and knee arthroplasty surgeries were identified as presenting the greatest demand, resulting in 854 boxes of consigned surgical instruments processed and unused. Processing waste was estimated at R$34,340.18 (US$6,359.30). Conclusion: the proposed equation made it possible to calculate the waste related to the production and non-use of boxes of surgical instruments consigned for orthopedic procedures and can equip nurses for planning based on institutional, care and financial data, aiming to make better use of resources through waste identification.

Objetivo: avaliar o desperdício gerado pelo processamento de instrumentais cirúrgicos consignados em cirurgias ortopédicas eletivas e propor um modelo de cálculo de desperdício associado ao processamento de instrumentais cirúrgicos consignados. Método: estudo quantitativo, descritivo-exploratório, do tipo estudo de caso, realizado em hospital universitário de grande porte, em duas fases: (1) retrospectiva pela consulta aos registros administrativos de cirurgias ortopédicas eletivas canceladas, com previsão de uso de materiais consignados para identificação das subespecialidades com maior demanda e (2) prospectiva por meio de observações diretas, não participantes, do processamento de instrumentais cirúrgicos consignados preparados para as cirurgias identificadas e proposição de modelo de cálculo de desperdício associado ao processamento desses materiais. Resultados: foram identificadas as cirurgias de artroplastia de quadril, artrodese de coluna e artroplastia de joelho, com maior demanda, resultando em 854 caixas de instrumentais cirúrgicos consignados processados e não utilizados. O desperdício do processamento foi estimado em R$ 34.340,18 (US$ 6,359.30). Conclusão: a equação proposta permitiu calcular o desperdício relacionado à produção e não utilização de caixas de instrumentais cirúrgicos consignados para procedimentos ortopédicos e pode instrumentalizar os enfermeiros para o planejamento pautado em dados institucionais, assistenciais e financeiros, visando ao melhor aproveitamento dos recursos através da identificação do desperdício.

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Objetivo:Classificar o risco de desenvolvimento de lesão por posicionamento cirúrgico. Método: Estudo observacional, longitudinal, prospectivo, de abordagem quantitativa realizado em hospital público, com 135 pacientes submetidos à cirurgia eletiva. Utilizaram-se instrumentos contendo caracterização sociodemográfica, clínica e cirúrgica e escala de avaliação de risco para desenvolvimento de lesões decorrentes do posicionamento cirúrgico. Empregaram-se análise descritiva, teste exato de Fisher ou teste χ2 e a medida de associação odds ratio, conforme apropriado. Resultados: A maioria dos participantes era do sexo masculino (51,11%), adulta (52,59%) e foi classificada como maior risco para o desenvolvimento de lesões por posicionamento cirúrgico (51,85%). Ser idoso, hipertensão, diabetes mellitus e cirurgias urológicas foram estatisticamente significativos (p < 0,05) para maior risco de desenvolvimento de lesões. A incidência de lesão por pressão foi de 0,74%, com observação apenas na região sacra. Conclusão: Verificou-se maior risco para desenvolvimento de lesão em decorrência do posicionamento cirúrgico e baixa incidência de lesão por pressão. A enfermagem perioperatória deve incorporar à prática assistencial ferramentas validadas de mensuração de risco para um cuidado seguro, individualizado e de qualidade aos pacientes cirúrgicos.

Objective:To classify the risk of developing injury due to surgical positioning. Method: Observational, longitudinal, prospective study with a quantitative approach carried out in a public hospital, with 135 patients undergoing elective surgery. Instruments containing sociodemographic, clinical, and surgical characteristics and a risk assessment scale for the development of injuries due to surgical positioning were used. Descriptive analysis, Fisher's exact test or χ2 test and odds ratio association measure were used as appropriate. Results: Most participants were male (51.11%), adults (52.59%) and were classified as having a higher risk for developing injuries due to surgical positioning (51.85%). Elderly, hypertension, diabetes mellitus and urological surgeries were statistically significant (p < 0.05) for a higher risk of developing lesions. The incidence of pressure injuries was 0.74%, with observation only in the sacral region. Conclusion: There was a greater risk of developing lesions due to surgical positioning and low incidence of pressure injury. Perioperative nursing should incorporate validated risk measurement tools into care practice for safe, individualized and quality care for surgical patients,

Objetivo:Clasificar el riesgo de desarrollar lesión por posicionamiento quirúrgico. Método: Estudio observacional, longitudinal, prospectivo, con abordaje cuantitativo, realizado en un hospital público, con 135 pacientes sometidos a cirugía electiva. Se utilizaron instrumentos que contenían características sociodemográficas, clínicas y quirúrgicas y una Escala de Evaluación de Riesgo para el Desarrollo de Lesiones por Posicionamiento Quirúrgico. Se utilizó el análisis descriptivo, la prueba exacta de Fisher, o chi-cuadrado y la medida de asociación odds ratio, según corresponda. Resultados: La mayoría de los participantes eran hombres (51,11 %), adultos (52,59 %) y se clasificaron con mayor riesgo de desarrollar lesiones debido al posicionamiento quirúrgico (51,85 %). Ancianos, hipertensión, diabetes mellitus y cirugías urológicas fueron estadísticamente significativos (p ˂ 0,05) para mayor riesgo de desarrollar lesiones. La incidencia de lesiones por presión fue del 0,74%, observándose solo en la región sacra. Conclusión: Hubo un mayor riesgo de desarrollar lesiones debido al posicionamiento quirúrgico y una baja incidencia de lesión presión. La enfermería perioperatoria debe incorporar herramientas validadas de medición del riesgo en la práctica asistencial para una atención segura, individualizada y de calidad a los pacientes quirúrgicos.

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Objectives This study evaluated the radiographic progressions of scoliotic curves higher than 40° in patients with adolescent idiopathic scoliosis (AIS). These subjects waited for the surgical procedure while elective surgeries were on hold during the COVID-19 pandemic. In addition to radiographic progressions, this study described the quality of life of these patients. Methods This study is a retrospective cohort assessing 29 AIS patients with surgical indications registered in the Brazilian public healthcare service. We compared the scoliotic radiographic measurements in two moments: at the beginning of the interruption of elective surgeries due to the COVID-19 pandemic and when these procedures resumed. Results When comparing the radiographic measurements before and after the suspension of assessments for elective surgeries, we observed a significant increase in main curve angles ( p < 0.001), with variations ranging from 0 to 68° and a median value of 10°. In secondary curves, we observed an increase in angles from the proximal thoracic ( p < 0.001) and lumbar ( p = 0.001) regions. However, the increase in the main thoracic region was not significant ( p = 0.317). Conclusion The suspension of elective surgeries for AIS resulted in a significant increase in the radiographic values of patients' spine deformities. This increase harmed the quality of life of these subjects and their families.

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Objective To analyze the profile and perception of patients on the waiting list for total hip arthroplasty (THA) about performing elective surgeries during the COVID-19 pandemic. Methods From July to November 2021, patients on the THA waiting list were interviewed during outpatient consultations. To compare the groups regarding categorical variables, the Chi-square test or Fisher's exact test was applied, and for quantitative variables the Mann-Whitney test was applied. The results were calculated using the Statistica program version 7. Results 39 patients answered the questionnaire. The mean age was 58.95 years, with 53.85% male. Approximately 60% expressed concern about contracting or transmitting COVID-19 to their family members after hospitalization for THA. 58.9% of patients felt hampered by the delay in scheduling elective surgeries during the pandemic. 23% lost or had a family member who lost their job during the pandemic, with a statistical difference for the group under 60 years old (p = 0.04). Conclusion Most patients were concerned about becoming infected and exposing family members to COVID-19 after surgery and noted damage due to suspensions and delay in scheduling elective surgeries. The economic impact of the pandemic was revealed by the rate of 23% of respondents who lost or had a family member who lost their job during the pandemic, being higher in patients under 60 years of age (p = 0.04).

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Abstract Objectives This study evaluated the radiographic progressions of scoliotic curves higher than 40° in patients with adolescent idiopathic scoliosis (AIS). These subjects waited for the surgical procedure while elective surgeries were on hold during the COVID-19 pandemic. Inadditiontoradiographicprogressions, this studydescribed the quality of life of these patients. Methods This study is a retrospective cohort assessing 29 AIS patients with surgical indications registered in the Brazilian public healthcare service. We compared the scoliotic radiographic measurements in two moments: at the beginning of the interruption of elective surgeries due to the COVID-19 pandemic and when these procedures resumed. Results When comparing the radiographic measurements before and after the suspension of assessments for elective surgeries, we observed a significant increase in main curve angles ( p < 0.001), with variations ranging from 0 to 68° and a median valueof10°.Insecondary curves, weobserved anincreaseinangles fromthe proximal thoracic ( p < 0.001) and lumbar ( p = 0.001) regions. However, the increase in the main thoracic region was not significant ( p = 0.317). Conclusion The suspension of elective surgeries for AIS resulted in a significant increase in the radiographic values of patients' spine deformities. This increase harmed the quality of life of these subjects and their families.

Resumo Objetivos Neste estudo foram avaliadas as progressões radiográficas das curvas escolióticas, acima de 40 graus em pacientes com escoliose idiopática do adolescente (EIA). Os indivíduos analisados aguardavam o procedimento cirúrgico, em período de suspensão das cirurgias eletivas, durante a pandemia de covid-19. Além das progressões radiográficas, nestapesquisafoi descritaaqualidadedevidadestes pacientes. Métodos O artigo refere-se a um estudo de coorte retrospectivo, que avaliou 29 pacientes com EIA com indicação cirúrgica, todos cadastrados no serviço público de saúde brasileiro. As medidas radiográficas escolióticas dos pacientes foram comparadas em dois momentos: no início do período da interrupção de cirurgias eletivas, devido à pandemia de covid-19, e logo após a liberação destas. Resultados A partir da comparação das medidas radiográficas entre as avaliações pré e pós suspensão das cirurgias eletivas, observamos o aumento significativo dos valores angulares da curva principal (p < 0,001), com variações entre 0 e 68°, e mediana de 10°. Em relação às curvas secundárias, observamos um aumento dos valores angulares da região torácica proximal (p < 0,001) e lombar (p = 0,001). Entretanto, o aumento da região torácica principal não foi considerado significativo (p = 0,317). Conclusão A suspensão das cirurgias eletivas, para a correção da EIA resultou em um aumento significativo no valor radiográfico das deformidades das colunas dos pacientes, fator que promoveu um impacto negativo na qualidade de vida de pacientes e familiares.

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Abstract Objective To analyze the profile and perception ofpatients on the waiting list for total hip arthroplasty (THA) about performing elective surgeries during the COVID-19 pandemic. Methods From July to November 2021, patients on the THA waiting list were interviewed during outpatient consultations. To compare the groups regarding categorical variables, the Chi-square test or Fisher's exact test was applied, and for quantitative variables the Mann-Whitney test was applied. The results were calculated using the Statistica program version 7. Results 39 patients answered the questionnaire. The mean age was 58.95 years, with 53.85% male. Approximately 60% expressed concern about contracting or transmitting COVID-19 to their family members after hospitalization for THA. 58.9% of patients felt hampered by the delay in scheduling elective surgeries during the pandemic. 23% lost or had a family member who lost their job during the pandemic, with a statistical difference for the group under 60 years old (p = 0.04). Conclusion Most patients were concerned about becoming infected and exposing family members to COVID-19 after surgery and noted damage due to suspensions and delay in scheduling elective surgeries. The economic impact of the pandemic was revealed by the rate of 23% of respondents who lost or had a family member who lost their job during the pandemic, being higher in patients under 60 years of age (p = 0.04).

Resumo Objetivo Analisar o perfil e a percepção dos pacientes em lista de espera para artroplastia total do quadril (ATQ) sobre a realização das cirurgias eletivas durante a pandemia pela COVID-19. Métodos De julho a novembro de 2021, foram entrevistados pacientes em lista de espera para ATQ durante consultas ambulatoriais. Para comparar os grupos com relação às variáveis categóricas foi aplicado o Teste Qui-quadrado ou Teste exato de Fisher e para as variáveis quantitativas foi aplicado o teste de Mann-Whitney. Os resultados foram calculados utilizando o programa Statistica versão 7. Resultados 39 pacientes responderam ao questionário. A média de idade foi de 58,95 anos, sendo 53,85% do sexo masculino. Aproximadamente, 60% manifestaram preocupação em contrair ou transmitir COVID-19 aos seus familiares após internação hospitalar para ATQ. 58,9% dos pacientes sentiram-se prejudicados pelo atraso no agendamento das cirurgias eletivas durante a pandemia. 23% perderam ou tiveram algum familiar que perdeu o emprego durante a pandemia, havendo diferença estatística para o grupo com menos de 60 anos (p = 0,04). Conclusão A maioria dos pacientes sentiram preocupação em infectar-se e expor familiares à COVID-19 após a cirurgia e notaram prejuízo pelas suspensões e atraso no agendamento de cirurgias eletivas. O impacto econômico da pandemia revelou-se pela taxa de 23% de entrevistados que perderam ou tiveram algum familiar que perdeu seu emprego durante a pandemia, sendo maior nos pacientes menores de 60 anos (p = 0,04).

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Abstract Background and objectives: Contribution margin per hour (CMH) has been proposed in healthcare systems to increase the profitability of operating suites. The aim of our study is to propose a simple and reproducible model to calculate CMH and to increase cost-effectiveness. Methods: For the ten most commonly performed surgical procedures at our Institution, we prospectively collected their diagnosis-related group (DRG) reimbursement, variable costs and mean procedural time. We quantified the portion of total staffed operating room time to be reallocated with a minimal risk of overrun. Moreover, we calculated the total CMH with a random reallocation on a first come-first served basis. Finally, prioritizing procedures with higher CMH, we ran a simulation by calculating the total CMH. Results: Over a two-months period, we identified 14.5 hours of unutilized operating room to reallocate. In the case of a random ''first come -first serve'' basis, the total earnings were 87,117 United States dollars (USD). Conversely, with a reallocation which prioritized procedures with a high CMH, it was possible to earn 140,444 USD (p < 0.001). Conclusion: Surgical activity may be one of the most profitable activities for hospitals, but a cost-effective management requires a comprehension of its cost profile. Reallocation of unused operating room time according to CMH may represent a simple, reproducible and reliable tool for elective cases on a waiting list. In our experience, it helped improving the operating suite cost-effectiveness.

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Objective: To evaluate and validate the medically necessary and time sensitive score by testing the variables, in order to create a surgical preoperative score for procedure prioritization in COVID-19 pandemic in Colombia. Methods: A multicenter retrospective cross-sectional study of instrument validation with a cultural adaptation and translation into the Spanish language was carried out in Bogota, Colombia. Patients over 18 years of age who had undergone elective procedures of general surgery and subspecialties were included. The translation of the medically necessary and time sensitive score into Spanish was performed independently by two bilingual surgeons fluent in both English and Spanish. A final version of the Spanish questionnaire (MeNTS Col) for testing was then produced by an expert committee. After translation and cultural adaptation, it was submitted to evaluate the psychometric properties of the medically necessary and time sensitive score. Cronbach's α was used to represent and evaluate the internal consistency and assess reliability. Results: A total of 172 patients were included, with a median age of 54 years; of which 96 (55.8%) patients were females. The vast majority of patients were treated for general surgery (n = 60) and colon and rectal surgery (n = 31). The evaluation of the internal consistency of the scale items in Spanish version was measured, and values of 0.5 for 0.8 were obtained. In the reliability and validation process, Cronbach's α values in all items remained higher than 0.7. The new MeNTS Col model was analyzed, and a result of 0.91 was obtained. Conclusions: The Spanish version of the medically necessary and time sensitive, the MeNTS Col score, and its respective Spanish translation perform similarly to the original version. Therefore, they can be useful and reproducible in Latin American countries.

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BACKGROUND: The efficiency of blood products (BP) requisition in elective non-cardiac surgeries is inherently complex. Moreover, it is aggravated in the pediatric population. This study aimed to identify the factors associated with using less than the requested BP during the transoperative period in pediatric patients undergoing elective non-cardiac surgery. METHODS: We conducted a cross-sectional comparative study including 320 patients undergoing elective non-cardiac surgery for whom BPs were requested. Low requirements were considered when less than 50% of the requested amount or no BPs were used, and high requirements when more than the requested amount was used. The Mann-Whitney's U test was applied for comparative analysis, and multiple logistic regression was used to adjust for factors associated with lower requirements. RESULTS: The median age of the patients was 3 years. From 320 patients, 68.1% (n = 218) received less than the requested amount of BP, while only 1.25% (n = 4) received more than the requested amount of BP. Factors associated with transfusion of less than the requested BPs were prolonged clotting time (odds ratio (OR) = 2.66) and anemia (OR = 0.43). CONCLUSIONS: Factors associated with lower than requested BP transfusion were prolonged clotting time and anemia.

INTRODUCCIÓN: La eficiencia de la solicitud de productos sanguíneos (PS) en las cirugías electivas no cardiacas es, de por sí, compleja. No obstante, se agrava para la población pediátrica. El objetivo de este estudio fue identificar los factores asociados con la utilización de una cantidad de PS menor a la solicitada durante el transoperatorio en pacientes pediátricos sometidos a cirugía electiva no cardiaca. MÉTODOS: Se realizó un estudio transversal comparativo donde se incluyeron 320 pacientes sometidos a cirugía electiva no cardiaca para quienes se solicitaron PS. Los requerimientos de hemoderivados se consideraron como menores cuando no se utilizaron o se utilizó menos del 50% de lo solicitado y como mayores cuando se utilizó una cantidad mayor a la solicitada. Se aplicó la prueba U de Mann-Whitney para el análisis comparativo y regresión logística múltiple para ajustar los factores asociados a la presencia de menores requerimientos. RESULTADOS: La mediana para la edad de los pacientes fue de 3 años. Se transfundió una cantidad de PS menor a la solicitada en el 68.1% (n = 218) de los pacientes, mientras que se transfundió una cantidad mayor a la solicitada solo en el 1.25% de los pacientes (n = 4). Los factores asociados con la transfusión de una cantidad de PS menor a la solicitada fueron tiempos de coagulación alargados (TCA) (razón de momios (RM) = 2.66) y anemia (RM = 0.43). CONCLUSIONES: Los factores asociados a una transfusión de PS inferior a la solicitada fueron el tiempo de coagulación prolongado y la anemia.

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Abstract Objective The COVID-19 pandemic led to an unprecedented pause in elective surgeries, including shoulder arthroplasty. We sought to determine whether clinical and/or demographic differences would be seen between patients who presented for shoulder arthroplasty during the pandemic compared with the previous year (2019). Methods Institutional records were queried for patients who underwent shoulder replacement between March 1 and July 1 of 2019 and 2020. Demographics, range of motion, surgical duration, hospitalization time, discharge disposition, and postoperative management were analyzed. Results The mean duration of surgery was 160 ± 50 minutes in 2020 and 179 ± 54 minutes in 2019 (p= 0.13). The mean hospitalization time was 36 ± 13 hours in 2020 and 51 ± 40 hours in 2019 (p= 0.04). In 2019, 96% of the patients participated in physical therapy, while 71% did it in 2020 (p= 0.003). A total of 100% of the 2019 patients and 86% of the 2020 patients participated in an in-person postoperative follow-up (p= 0.006). The 2019 patients reported for an office visit on average 14 ± 11 days after surgery; the 2020 patients waited 25 ± 25 days to return for a follow-up (p= 0.10). Range of motion, age, American Society of Anesthesiologists (ASA) scores, and complication rates did not differ between the cohorts. Conclusion Patients presenting for surgery during the initial phase of the pandemic were demographically and clinically similar to 2019 patients. However, the length of stay was significantly reduced during the COVID-19 pandemic. Postoperative follow-up and physical therapy were delayed in 2020, but this did not lead to differences in complication or readmission rates compared with those of the 2019 cohort. Level of EvidenceIII.

Resumo Objetivo A pandemia de COVID-19 causou uma pausa sem precedentes em cirurgias eletivas, inclusive artroplastia de ombro. Procuramos determinar as possíveis diferenças clínicas e/ou demográficas entre os pacientes que realizaram artroplastia de ombro durante a pandemia em comparação com o ano anterior (2019). Métodos Os registros institucionais foram consultados para obtenção de informações sobre pacientes submetidos a artroplastia de ombro entre 1° de março a 1° de julho de 2019 e 2020. Dados demográficos, amplitude de movimento, duração da cirurgia, tempo de hospitalização, condições à alta e manejo pós-operatório foram analisados. Resultados O tempo médio de cirurgia foi de 160 ± 50 minutos em 2020 e de 179 ± 54 minutos em 2019 (p= 0,13). O tempo médio de internação foi de 36 ± 13 horas em 2020 e de 51 ± 40 horas em 2019 (p= 0,04). Em 2019, 96% dos pacientes fizeram fisioterapia, enquanto 71% o fizeram em 2020 (p= 0,003). Todos os pacientes de 2019 e 86% dos pacientes de 2020 participaram do acompanhamento pós-operatório presencial (p= 0,006). Os pacientes de 2019 retornaram para a consulta médica em média 14 ± 11 dias após a cirurgia; os pacientes de 2020 retornaram para o acompanhamento em 25 ± 25 dias (p= 0,10). A amplitude de movimento, a idade, a pontuação da American Society of Anesthesiologists (ASA, na sigla em inglês) e as taxas de complicações não diferiram entre as coortes. Conclusão Os pacientes submetidos a cirurgia na fase inicial da pandemia eram demográfica e clinicamente semelhantes aos pacientes de 2019. No entanto, o tempo de internação diminuiu de forma significativa durante a pandemia de COVID-19. O acompanhamento pós-operatório e a fisioterapia foram adiados em 2020, mas isso não levou a diferenças nas taxas de complicações ou de reinternações em comparação às da coorte de 2019. Nível de EvidênciaIII.

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Abstract Background: The efficiency of blood products (BP) requisition in elective non-cardiac surgeries is inherently complex. Moreover, it is aggravated in the pediatric population. This study aimed to identify the factors associated with using less than the requested BP during the transoperative period in pediatric patients undergoing elective non-cardiac surgery. Methods: We conducted a cross-sectional comparative study including 320 patients undergoing elective non-cardiac surgery for whom BPs were requested. Low requirements were considered when less than 50% of the requested amount or no BPs were used, and high requirements when more than the requested amount was used. The Mann-Whitney's U test was applied for comparative analysis, and multiple logistic regression was used to adjust for factors associated with lower requirements. Results: The median age of the patients was 3 years. From 320 patients, 68.1% (n = 218) received less than the requested amount of BP, while only 1.25% (n = 4) received more than the requested amount of BP. Factors associated with transfusion of less than the requested BPs were prolonged clotting time (odds ratio (OR) = 2.66) and anemia (OR = 0.43). Conclusions: Factors associated with lower than requested BP transfusion were prolonged clotting time and anemia.

Resumen Introducción: La eficiencia de la solicitud de productos sanguíneos (PS) en las cirugías electivas no cardiacas es, de por sí, compleja. No obstante, se agrava para la población pediátrica. El objetivo de este estudio fue identificar los factores asociados con la utilización de una cantidad de PS menor a la solicitada durante el transoperatorio en pacientes pediátricos sometidos a cirugía electiva no cardiaca. Métodos: Se realizó un estudio transversal comparativo donde se incluyeron 320 pacientes sometidos a cirugía electiva no cardiaca para quienes se solicitaron PS. Los requerimientos de hemoderivados se consideraron como menores cuando no se utilizaron o se utilizó menos del 50% de lo solicitado y como mayores cuando se utilizó una cantidad mayor a la solicitada. Se aplicó la prueba U de Mann-Whitney para el análisis comparativo y regresión logística múltiple para ajustar los factores asociados a la presencia de menores requerimientos. Resultados: La mediana para la edad de los pacientes fue de 3 años. Se transfundió una cantidad de PS menor a la solicitada en el 68.1% (n = 218) de los pacientes, mientras que se transfundió una cantidad mayor a la solicitada solo en el 1.25% de los pacientes (n = 4). Los factores asociados con la transfusión de una cantidad de PS menor a la solicitada fueron tiempos de coagulación alargados (TCA) (razón de momios (RM) = 2.66) y anemia (RM = 0.43). Conclusiones: Los factores asociados a una transfusión de PS inferior a la solicitada fueron el tiempo de coagulación prolongado y la anemia.

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BACKGROUND AND OBJECTIVES: Contribution margin per hour (CMH) has been proposed in healthcare systems to increase the profitability of operating suites. The aim of our study is to propose a simple and reproducible model to calculate CMH and to increase cost-effectiveness. METHODS: For the ten most commonly performed surgical procedures at our Institution, we prospectively collected their diagnosis-related group (DRG) reimbursement, variable costs and mean procedural time. We quantified the portion of total staffed operating room time to be reallocated with a minimal risk of overrun. Moreover, we calculated the total CMH with a random reallocation on a first come-first served basis. Finally, prioritizing procedures with higher CMH, we ran a simulation by calculating the total CMH. RESULTS: Over a two-months period, we identified 14.5 hours of unutilized operating room to reallocate. In the case of a random "first come-first serve" basis, the total earnings were 87,117 United States dollars (USD). Conversely, with a reallocation which prioritized procedures with a high CMH, it was possible to earn 140,444 USD (p < 0.001). CONCLUSION: Surgical activity may be one of the most profitable activities for hospitals, but a cost-effective management requires a comprehension of its cost profile. Reallocation of unused operating room time according to CMH may represent a simple, reproducible and reliable tool for elective cases on a waiting list. In our experience, it helped improving the operating suite cost-effectiveness.

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ABSTRACT Pediatric surgery receives great demand for referrals from primary care services in order to evaluate the need for surgical intervention. However access to this specialized evaluation and in intervention does not always occur at the appropriate time. This study aims to characterize the profile of pediatric patients electively operated in the western Paraná state region, between 2018 and 2020, and identify those who were lately referred to surgical evaluation. This is a descriptive, cross-sectional and retrospective study through the review of electronic medical records. The variables evaluated were sociodemographic data, information on underlying diseases, referral data, specialist assessment and surgical procedure. During this period, 410 patients underwent an elective surgical procedure, of which 289 were included in the research. The sample was predominantly male (72.3%) with a mean age of 57.9 months at the surgeons assessment and 59 months at the date of surgery. Most of the patients came from primary care (75%) and the most common pathology was inguinal hernia (39.1%). The mean time interval between referral through primary care and surgery was 4.98 months, and between the surgeons assessment and surgery was 1.21 months. Of the total sample, 77 (26.6%) patients were identified as being referred late for the surgical procedure. Knowing the profile of patients and the problems experienced in this region in relation to the care provided in pediatric surgery provides subsidies to propose improvement strategies not only for the health system in this location, but for several inner regions of Brazil in a similar situation.

RESUMO Introdução: a cirurgia pediátrica representa especialidade com demanda significativa de encaminhamentos dos serviços de atenção primária para avaliação da necessidade de intervenção cirúrgica. Contudo, nem sempre o acesso a essa intervenção ocorre no momento adequado. Nesse sentido, objetivou-se caracterizar o perfil dos pacientes pediátricos operados eletivamente, no recorte temporal 2018-2020, e identificar pacientes que foram encaminhados em atraso para a avaliação com o cirurgião. Métodos: Estudo descritivo, transversal e retrospectivo mediante a revisão de prontuários eletrônicos. As variáveis avaliadas foram dados sociodemograficos, informações das doenças de base, dados do encaminhamento, da avaliação do especialista e do procedimento cirúrgico. Resultados: neste período 410 pacientes foram submetidos a procedimento cirúrgico eletivo, dos quais 289 foram incluídos na pesquisa. O sexo masculino (72,3%%) foi predominante, com idade média de 57,9 meses na avaliação pelo cirurgião e 59 meses na data da cirurgia. A procedência dos pacientes foi na maioria da atenção básica (75%) e a patologia mais incidente foi a hérnia inguinal (39,1%). O intervalo de tempo médio entre o encaminhamento pela atenção primária até a realização da cirurgia foi 4,98 meses e entre a avaliação pelo cirurgião e a realização da cirurgia foi 1,21 meses. Do total, 77 (26,6%) pacientes foram identificados como encaminhados em atraso para a realização do procedimento cirúrgico. Conclusão: conhecer o perfil dos pacientes e os problemas vivenciados nesta região em relação aos atendimentos prestados na cirurgia pediátrica apresenta subsídios para propor estratégias de melhoria não só do sistema de saúde local, mas de diversas regiões interioranas do Brasil em situação semelhante. .

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Objetivo: Analisar a ocorrência de pacientes cirúrgicos assintomáticos com teste para COVID-19 positivo, delimitar o perfil epidemiológico, identificar o tipo de cirurgia e a especialidade, bem como determinar o tempo de execução do procedimento cirúrgico após testagem positiva. Método: Trata-se de um estudo de coorte retrospectiva, em um hospital de grande porte, filantrópico, de São Paulo, realizado no período de março a setembro de 2020, baseado na análise de dados de prontuário. Resultados: Foram 4.870 procedimentos cirúrgicos, dos quais 3.688 pacientes tiveram coleta de exame PCR. A ocorrência de pacientes cirúrgicos posi-tivos e assintomáticos foi de 1,7%; no perfil epidemiológico, observa-se predominância de sexo masculino, meia-idade, com classificação de risco anestésico ASA II e em procedimentos das especialidades de ortopedia, urologia, ginecologia e gastroenterologia. A execução do teste foi de dois dias pré-procedimento e a presença de pacientes com sintomas em até 14 dias após testagem foi de 0,5%. Conclusão: A ocorrência de pacientes cirúrgicos positivos e assintomáticos foi pequena dentro do quantitativo analisado, os achados deste estudo são similares aos de estudos nacionais e internacionais em relação a especialidade, comorbidades e idade

Objective: To analyze the occurrence of asymptomatic surgical patients with a positive COVID-19 test, delimit the epidemiological profile, iden-tify the type of surgery and specialty, as well as determine the time for performing the surgical procedure after a positive test. Method: This is a retrospective cohort study, in a large, philanthropic hospital in São Paulo, carried out from March to September 2020, based on the analysis of medical records. Results:There were 4,870 surgical procedures, of which 3,688 patients underwent a PCR test. The occurrence of positive and asymptomatic surgical patients was 1.7%; in the epidemiological profile, there is a predominance of males, middle-aged, with ASA II anesthetic risk classification and in procedures of the spe-cialties of orthopedics, urology, gynecology, and gastroenterology. The test was carried out two days before the procedure and the presence of patients with symptoms within 14 days after testing was 0.5%. Conclusion: The occurrence of positive and asymptomatic surgical patients was small within the quantita-tive analyzed, the findings of this study are similar to those of national and international studies in relation to specialty, comorbidities, and age

Objetivo: Analizar la ocurrencia de pacientes quirúrgicos asintomáticos con prueba COVID-19 positiva, delimitar el perfil epidemiológico, iden-tificar el tipo de cirugía y especialidad, así como determinar el tiempo para realizar el procedimiento quirúrgico luego de una prueba positiva. Método:Este es un estudio de cohorte retrospectivo, en un gran hospital filantrópico de São Paulo, realizado de marzo a septiembre de 2020, basado en el análi-sis de registros médicos. Resultados: Se realizaron 4.870 procedimientos quirúrgicos, de los cuales se recolectó examen PCR a 3.688 pacientes. La ocur-rencia de pacientes quirúrgicos positivos y asintomáticos fue de 1,7%; en el perfil epidemiológico predomina el sexo masculino, de mediana edad, con clasificación de riesgo anestésico ASA II y en procedimientos de las especialidades de ortopedia, urología, ginecología y gastroenterología. La prueba se realizó dos días antes del procedimiento y la presencia de pacientes con síntomas dentro de los 14 días posteriores a la prueba fue del 0,5%. Conclusión:La ocurrencia de pacientes quirúrgicos positivos y asintomáticos fue pequeña dentro de lo cuantitativo analizado, los hallazgos de este estudio son simi-lares a los de estudios nacionales e internacionales en relación a especialidad, comorbilidades y edad

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ABSTRACT: Objective: To describe the epidemiological profile of the list of patients with pediatric scoliosis (0 to 18 years old) treated at a tertiary public hospital in the Midwest Region. Methods: A cross-sectional analytical study of patients with scoliosis from the orthopedic service of a reference center was carried out, and data collected on age, sex, date of menarche, weight, height, etiology, curve classification, form of referral, treatment performed before and after care and waiting time for surgery after indication. The sample consisted of 60 patients randomly selected among those treated. Results: 60 patients were evaluated, 44 (73.3%) were female, and 16 (26.7%) were male, with a mean age of 13.4 years. Until the moment of the study, six patients underwent surgery after being treated at the reference center. Idiopathic scoliosis was the most frequent in 38 (63%) patients. No conduct had been performed in 47 (78.3%) patients before referral to the reference center. Aftercare at the reference center, surgical treatment was indicated in 44 (73.3%) patients. The mean waiting time for surgery after the indication was 22 months, ranging from 6 to 40 months. Conclusions: The list of patients with pediatric scoliosis treated at the reference center in the Midwest region is composed of young girls with idiopathic scoliosis who, for the most part, did not have the indication of using a brace before being referred to the reference center, and most of them had an indication for surgery for adequate treatment. Level of Evidence IV; Descriptive Study.

RESUMO: Objetivo: Descrever o perfil epidemiológico da lista de pacientes com escoliose pediátrica (0 a 18 anos) atendidos em hospital público terciário da Região Centro-Oeste. Métodos: Foi realizado estudo analítico transversal de pacientes com escoliose do serviço de ortopedia do centro de referência e coletados dados de idade, sexo, data da menarca, peso, altura, etiologia, classificação da curva, forma de encaminhamento, tratamento realizado antes e após o atendimento e tempo de espera para cirurgia após indicação. A amostra foi composta por 60 pacientes selecionados randomicamente. Resultados: Dos 60 pacientes avaliados, 44 (73,3%) eram do sexo feminino e 16 (26,7%) do sexo masculino, com idade média de 13,4 anos. Até o momento do estudo, seis pacientes foram submetidos a cirurgia após o atendimento no centro de referência. A escoliose idiopática foi a mais frequente em 38 (63%) pacientes. Nenhuma conduta havia sido realizada em 47 (78,3%) pacientes antes do encaminhamento ao centro de referência. Após o atendimento no centro de referência, o tratamento cirúrgico foi indicado em 44 (73,3%) pacientes. O tempo médio de espera pela cirurgia após a indicação foi de 22 meses, variando de 6 a 40 meses. Conclusões: A lista de pacientes com escoliose pediátrica atendidos no único centro de referência da região Centro-oeste é composta por meninas jovens, com escoliose idiopática, que em grande parte não tiveram a indicação do uso de colete antes do encaminhamento ao centro de referência, e tiveram em sua maioria indicação de cirurgia para tratamento adequado. Nível de Evidência IV; Estudo Descritivo.

RESUMEN: Objetivo: Describir el perfil epidemiológico de pacientes con escoliosis pediátrica (0 a 18 años) atendidos en un hospital público terciario de la Región Centro Oeste. Métodos: Se realizó un estudio analítico transversal de pacientes con escoliosis del servicio de ortopedia del centro de referencia y se recogieron datos sobre edad, sexo, fecha de la menarquia, peso, talla, etiología, clasificación de la curva, forma de derivación, tratamiento realizado antes y después de la atención y el tiempo de espera para la cirugía después de la indicación. La muestra estuvo constituida por 60 pacientes seleccionados aleatoriamente. Resultados: De los 60 pacientes, 44 (73,3%) eran mujeres y 16 (26,7%) hombres, con edad media de 13,4 años. Hasta el momento del estudio, seis pacientes fueron intervenidos quirúrgicamente. La escoliosis idiopática fue la más frecuente, en 38 (63%) pacientes. En 47 (78,3%) pacientes no se había realizado ninguna conducta antes de la derivación al centro de referencia. Tras la atención en el centro de referencia, se indicó tratamiento quirúrgico en 44 (73,3%) pacientes. El tiempo medio de espera de la cirugía fue de 22 meses, con un rango de 6 a 40 meses. Conclusiones: La lista de pacientes con escoliosis pediátrica atendidos en el único centro de referencia de la región Centro Oeste está compuesta por niñas jóvenes, quienes en su mayor parte no tenían indicación de uso de ortesis, y la mayoría tenía indicación de cirugía para un adecuado tratamiento. Nivel de evidencia IV; Estudio Descriptivo.

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ABSTRACT Introduction: Postoperative atrial fibrillation (poAF) is a common complication of coronary artery bypass grafting, and its reasons are still the subject of research. The aim of this study was to evaluate whether QT interval is related to new onset of poAF occurrence. Methods: This study included 167 patients undergoing elective isolated off-pump coronary artery bypass grafting (OPCAB) surgery. Patients were divided into two groups as poAF (+) and poAF (-), according to the development of poAF, and the results of the measurements were compared between the groups. Results: PoAF was detected in 37 (22.1%) of 167 patients who underwent OPCAB surgery. When QT interval measurements were compared, preoperative and postoperative QT and corrected QT interval (QTc) values were significantly longer in the group with atrial fibrillation. Mean values of preoperative QT were 407.5±27.1 in the poAF (-) group vs. 438.5±48.5 in the poAF (+) group (P<0.001). Mean values of preoperative QTc were 419.1±14.5 in the poAF (-) group vs. 448.5±26.6 in the poAF (+) group (P<0.001). Mean values of postoperative QT were 416.3±48.3 in the poAF (-) group vs. 439.2±45.8 in the poAF (+) group (P=0.005). And mean values of postoperative QTc were 419.8±12.5 in the poAF (-) group vs. 452.0±23.3 in the poAF (+) group (P<0.001). Conclusion: QT interval measurement may be a new parameter in predicting poAF development after OPCAB surgery.