The United States is ranked first for health care expenditure and 11th for quality of care. Surgical care is complex, multifactorial, and medical expenses continue to increase. The necessity for surgery normally disconnects the patient from their primary care provider, frequently resulting in uncoordinated care between medical providers regarding surgical care. A fragmented healthcare system results in unnecessary diagnostic labs and tests, insufficient surgical care resources, and patients experiencing a lapse in their medical care. If adopted, the Perioperative Surgical Home (PSH) model has the opportunity to improve patient outcomes by increasing patient satisfaction rates while decreasing surgical complications and hospital stay duration. The PSH model is patient-centered, and directed by anesthesia providers coordinating surgical care by adequately optimizing patients for surgery. The five model components are: patient involvement, comprehensiveness, coordination of care, accessibility, and commitment to quality and safety. Purpose: The purpose of this project was to perform a needs assessment at a Central Phoenix Hospital to identify if there was a need to implement the PSH model to decrease surgical complications and 30-day surgical hospital readmission rates. Methods: This was a non-experimental needs assessment. Retrospective data collection was used to explore and identify if the PSH model was needed at this Phoenix hospital. A needs assessment tool was created guided by the Rothwell and Kazana's needs assessment model utilizing their five key phases. The General Systems Theory was used to assess the complexity of an open surgical system to identify gaps in performance and results. Results: Data collected from fiscal year 2015 demonstrated a total of 7,829 surgical cases were performed at this hospital. The number of patients with a surgical complication was 826 (10.6%). A reported 147 (1.9%) patients had a surgical hospital readmission at this facility. Data from fiscal year 2016 demonstrated 7,778 (10.3%) total surgical cases. The number of surgical complications reported was 800 (1.5%). A reported 116 patients had a hospital surgical readmission at this facility. Conclusion: The reported high health care expenditure and low quality of care received in the U.S. supports the need to improve our health care delivery system with models such as the PSH. There was not an obvious problem in performance of surgical complications and 30-day surgical hospital readmission rates. There were identified system gaps in data collection of surgical reporting that correlate with clinical practice. These findings were the starting point for a needs analysis to follow by focusing on development and implementation of the PSH model if adopted.

The application of advanced robotics to surgical tasks can help to improve the delivery and quality of treatment, reduce the cost of surgery, and increase safety. Despite these advantages, robots have not found their niche in the surgical setting to the extent that they have in many industries. For the health care industry and society to reap the benefits offered by advanced surgical robots, technological challenges related to the application of advanced surgical robots to surgical tasks must be met, and the barriers to clinical acceptance must be overcome. Surgical retraction is a technique employed in most surgical procedures to expose the anatomical structures of interest to the surgeon. Many problems associated with this common surgical task could be addressed by advanced surgical robots which could be easily repositioned, and could accept a variety of retractors for different applications. Using a robot could liberate surgical assistants for other tasks, and could allow the retraction pressure to be monitored and the surgeon alerted to excessive pressures. In this thesis two approaches to automated surgical retraction are developed with the overall objective of demonstrating each approach in the surgical setting to determine the feasibility of the approaches as alternatives to current retraction techniques. The first approach involves the development of an automated effector for operating from a pre-robotic platform. Gross positioning of the retractor is performed manually with the pre-robotic device, while the automated effector provides fine positioning control to adjust the surgical exposure, as well as three automated modes of operation: 1) maintaining the retractor position within a desired position window, 2) maintaining the retraction pressure within safe limits, and 3) periodically releasing the retraction pressure. The second approach involves the development of an advanced surgical robot for retraction that provides both gross and fine positioning, as well as the automated modes of operation. In contrast to the first system, this system is fully robotic. This thesis describes the development of two systems based on these approaches. As a significant part of the development, a new physiologic sensor was developed for monitoring the retraction pressure. A model of retraction pressures was established based on measurements made during hip replacement and abdominal surgeries. Using this model, an improved retraction pressure sensor with multiple sensing sites was developed, and control algorithms for automating retraction were developed. As part of the system development, requirements for an operator interface were identified and a versatile operator interface system was adapted and integrated into the robotic system to provide intuitive control. An important part of the work involved the identification of the crucial need for a safety standard for surgical robots, and the further identification of the critical issues that such a standard would have to address. From this, a set of general design requirements for surgical robots was developed, and specific approaches for addressing the safety issues in a prototype of an advanced surgical robot for retraction were developed and integrated into the systems. The feasibility of each approach was demonstrated during successful surgical trials of the automated pre-robotic system and the advanced surgical robot during abdominal surgery. A comparative evaluation of the systems, in terms of quality of treatment, costs and payback, and safety, led to an identification of advantages that each approach offered and of problems associated with the implementations. The automated pre-robotic system was found to have advantages over the fully robotic approach in terms of cost, use, and safety, for the task of bilateral retraction during abdominal surgery. / Applied Science, Faculty of / Electrical and Computer Engineering, Department of / Graduate

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Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2006. / Härtill 5 uppsatser.

ABSTRACT Background: Two-dimensional surgical planning does not adequately show the 3D aspect, which is important to assess in the planning of orthognathic surgery (OGS). In the last decade, 3D virtual surgical planning (VSP) has become an advantageous method and may replace conventional planning. Aim: To determine if the experience and implementation of VSP in OGS among professionals in oral and maxillofacial surgery in northern Sweden differs from the literature on the subject. Methods: A questionnaire was created for evaluation of the experience and implementation of VSP and a literature search was conducted through PubMed. Results: Fourteen of 17 respondents answered. Only fifty percent used VSP, even though all respondents were familiar with it. A bigger proportion of respondents would use VSP, but availability and lack of training prevented use. A sample of 33 articles were collected and described 1107 patients undergoing OGS, of which 1083 patients had undergone OGS with incorporation of VSP. Sixty-eight percent underwent bimaxillary surgery, 17 % maxillary surgery and 15 % mandibular surgery. Additionally, 169 patients were treated with genioplasty as well. Conclusion: The experience and implementation of VSP in northern Sweden are both in accordance and discordance with the literature. VSP has the advantage of accurate hard tissue prediction, but the literature describes the need of improvement concerning soft tissue imaging and postoperative assessment in VSP. More studies evaluating the accuracy and reliability of VSP software are needed. Disadvantages of VSP need to be resolved before VSP can replace conventional planning.

Orofacial clefts are extremely common birth defects. Orofacial clefts affect a multitude of different areas including feeding, speech, proper tooth development, as well as personality. There are many causes associated with the many different presentations of the birth defect. There have been a multitude of different surgical procedures over time that have dealt with the complications associated with repairing the various clefts. There is no current accepted standard for orofacial cleft repair. In more recent times the focus of the various orofacial clefts procedures have gone from a major procedure where survival was the objective to a more streamline procedure with a man goal of restoring normal human anatomy. Presurgical nasoalveolar molding (PNAM) is more recent procedure that takes advantage of the malleability and rapid growth of facial tissue during the first months of life. This procedure uses a custom acrylic plate that brings the right and left halves of the cleft closer together. This procedure is currently not accepted by all because the long-term effects are unclear. The aim of this study is to point out the short term successes of the PNAM procedure, compare our results to current published studies, and suggest further study that should be completed. A case report was completed on the first five months of treatment on a bilateral cleft lip/ cleft palate case. The case report followed the patient from birth through the first cleft lip closure surgery. The notes taken at weekly appliance adjustment appointments will be reviewed for information on progress as well as behavior and parent involvement. Pictures were also reviewed in order to review progress as well as surgical procedure. After review of the appointment notes and various pictures from throughout the process it was deemed that this PNAM procedure was a success. It was found that there was an overall increase in symmetry in facial structure as well and an increase in facial tissue. After reviewing pictures of the surgical procedure it can be concluded that the overall process was made easier by the PNAM procedure. It is concluded that the PNAM procedure is extremely successful in the short term but in order to receive more concrete results more cases must be reviewed with future follow-ups in order to see consistent long-term results.

published_or_final_version / Dentistry / Master / Master of Dental Surgery

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No description available.