Page 4 - CUA2018 Abstracts - Pediatric Urology

2018 CUA AbstrACts

Poster Session 7: Pediatrics

June 25, 2018; 0800–0930

MP–7.1 MP–7.2
Improving operating room efficiency by decreasing turnover times Scrotal vs. inguinal orchidopexy impact on postoperative pain and
using a dedicated “Fastlane” protocol complications: A randomized controlled trial
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Jenny Li , Walid Farhat , Tobias Everett , Travis Beamish , Martin Koyle 1,2 Luis Braga 1,2 , Melissa McGrath , Bethany Easterbrook , Kizanee
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1 Division of Urology, University of Toronto, Toronto, ON, Canada; Division Jegatheeswaran , Natasha Brownrigg , Jorge DeMaria , Armando Lorenzo 3
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of Pediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada; 1 Department of Surgery, McMaster University, Hamilton, ON, Canada;
3 Department of Anesthesia, The Hospital for Sick Children, Toronto, ON, 2 McMaster Pediatric Surgery Research Collaborative, McMaster University,
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Canada; Senior Business Manager, Operating Room, The Hospital for Sick Hamilton, ON, Canada; Department of Urology, The Hospital for Sick
Children, Toronto, ON, Canada Children, Toront , ON, Canada
Introduction: In a value–driven healthcare system, decisions involving Introduction: We sought to compare the impact of orchidopexy approach
resource allocation and asset management are often made based on cost. (scrotal [SO] vs. inguinal [IO]) on analgesic requirements, postoperative
Operating room (OR) cancellations or delays frequently occur due to patient pain scores, and complication rates.
and system factors, resulting in inefficacy and loss of operating time. The Methods: A superiority randomized controlled trial including boys 10–95
objective of our study was to investigate a model, “Fastlane,” for improv- months of age at surgery diagnosed with palpable undescended testicles
ing efficiency by increasing OR throughput for outpatient, low–complexity (UDT) was conducted. Patients with non–palpable or bilateral UDTs, previ-
pediatric urology cases at a tertiary children’s hospital. ous orchidopexies, and concurrent procedures were excluded. Block ran-
Methods: “Fastlane” was a six–week pilot model, during which a selected domization with 1:1 allocation ratio was employed, as was a standardized
team of core surgeons, anesthesiologists, and nursing staff committed to anesthesia protocol with peri/postoperative analgesia. The primary outcome
shorter turnover times was tested compared to historic controls. Patients was postoperative pain and analgesic use in hospital and at home using vali-
included were low–risk (American Society of Anesthesiologists [ASA] 1–2) dated pain scales. A two–point difference in pain scales was considered as
outpatient, inguinal–genital surgeries that were anticipated to take less a minimally important difference. Secondary outcomes included operative
than one hour by the surgeon. Patients were to arrive three hours prior to time (OT), conversion and success rates, and complications at 6–8 weeks.
surgery, instead of the usual two–hour period, and fast an additional hour. A Results: Of 1170 screened patients, 174 (15%) were eligible and 128(74%)
dedicated postoperative location for patients to be received in the recovery recruited. Of the 106 boys who completed assessment, 54 had IO and 52
area was created, and having the same nurse complete both preoperative SO. Baseline demographics are presented in Table 1 (available at https://cua.
and postoperative assessments to minimize handover time between nursing guide/). No significant differences in number of in hospital analgesic doses
staff was instituted. Data was prospectively collected, including: the time or mean pain scores over the 48–hour postoperative period were observed.
that the patient arrived in the OR (AT), surgery start time (SST), surgery end Mean analgesic use at home was higher for SO (p<0.01). Mean OT were
time (SET), and time that patient left the OR (LT). Induction time (IT) was not significantly different with an intention to treat (ITT) approach. Per treat-
calculated as SST–AT. Turnover time was calculated as the time that the ment (including conversions) analyses showed that IO was 7 minutes faster
previous patient left the OR (LT) to the next patient’s arrival to the OR (AT). (40±11 vs. 33±15; p<0.01). Conversions occurred in 17/106 (16%) testes.
Case length time was calculated as LT–AT. Patient controls for the study Overall complication rates were low and similar (3% [1–reascent/1–incision
cohort were randomly selected from the prior two year’s OR activity logs dehiscence–SO; 1–wound infection–IO]).
on the same surgery by the same surgeon. Conclusions: SO is not superior to IO on postoperative pain, analgesic con-
Results: In total, 33 pediatric urology patients, managed by two surgeons, sumption, OT (ITT) or complications. SO may not be a suitable approach
were evaluated over the six–week period. The mean case length time was for all patients with canalicular testes. Selection of surgical approach should
significantly shorter for “Fastlane” patients (47 vs. 68 minutes for the control not be based on assumed benefits in terms of analgesia or complications.
group; p<0.00014). Mean IT was longer in the control group (21 vs. 17
minutes in the pilot group; p=0.047). Turnover time was significantly lower MP–7.3
in the “Fastlane” group compared to the control cohort, with turnover times Urinary tract dilation classification system: Natural history and
of 17 vs. 26 minutes, respectively (p=0.0008; standard deviation 9.08). hydronephrosis outcome according to risk groups
Conclusions: A defined, committed team and standardized OR handoff 1 1 1 1
protocol results in improved OR efficiency by reducing turnover times. This Amr Hodhod , J.–P. Capolicchio , Roman Jednak , Mohamed El–Sherbiny
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potentially increases the opportunity for optimizing the number of selected Pediatric Urology, McGill University Health Centre, Montreal, QC, Canada
pediatric urological outpatient surgeries on a given operating schedule. Introduction: The urinary tract dilation (UTD) system was introduced in
2014 as a risk–based grading for congenital hydronephrosis. It does not aim
to diagnose the underlying pathology, but to stratify hydronephrosis based
on the need of surgery and complication rate. In our study, we reviewed
the natural history and the fate of hydronephrosis for each risk group of
the UTD system.
Methods: A retrospective review was conducted for patients who presented
with postnatal hydronephrosis from 2008–2014. Reviewed data included
patients’ characteristics, fate of hydronephrosis, febrile urinary tract infec-
tions (fUTI), rate of surgical interventions, and final diagnoses. Fate of
hydronephrosis was resolved, improved, stable, or worsening. Resolved
hydronephrosis was defined as collapsed pelvicalyceal system with non–
CUAJ • June 2018 • Volume 12(6Suppl2) S101
© 2018 Canadian Urological Association