Clinical Scorecard: Optimizing Operating Room Utilization Through Low-Complexity Surgical Procedures During the COVID-19 Pandemic

At a Glance

Key Highlights

• Port-a-cath procedures can be safely and efficiently performed in outpatient surgical centres under local anesthesia.
• OSC showed significantly shorter preparation-to-incision times and overall quicker incision-to-suture times compared to COR.
• Patient satisfaction with OSC scheduling and management was high, with over 75% recommending the OSC for surgery.

Guideline-Based Recommendations

Diagnosis

• Confirm cancer diagnosis requiring chemotherapy necessitating Port-a-cath implantation.
• Preoperative SARS-CoV-2 PCR testing for all patients prior to surgery during the pandemic.

Management

• Perform Port-a-cath implantation using cut down technique (open strategy) or subclavian vein puncture (closed strategy) under local anesthesia.
• Assign urgent port implantations or explantations during on-call hours to the central OR.
• Schedule low-complexity procedures in outpatient surgical centres to optimize OR utilization.

Monitoring & Follow-up

• Follow-up outpatient clinic visits 7–10 days post-surgery for all patients.
• Additional 3-month postoperative follow-up for patients with Port-a-cath implantation for tumor assessment.
• Use postoperative X-ray to exclude pneumothorax if subclavian vein puncture was performed.

Risks

• Monitor for perioperative complications such as inadvertent arterial puncture (2.1–2.2%).
• Watch for long-term complications including infection and thrombosis (3.1–5.2%).
• No grade IV or V complications (severe morbidity or mortality) were observed in the study.

Patient & Prescribing Data

524 consecutive patients undergoing Port-a-cath implantation or explantation, majority with cancer diagnosis.

Low-complexity Port-a-cath procedures performed in OSC had comparable safety and efficacy to COR with improved time efficiency and high patient satisfaction.

Clinical Best Practices

• Randomize patient assignment to OSC or COR except for urgent cases directed to COR.
• Use local anesthesia for all Port-a-cath procedures to facilitate outpatient management.
• Optimize scheduling and communication in OSC to reduce preparation-to-incision time.
• Ensure experienced surgeons perform or assist procedures in OSC to improve efficiency.
• Implement preoperative SARS-CoV-2 testing to minimize COVID-19 transmission risk.

References

• Hospital capacity constraints and COVID-19 risks
• Impact of COVID-19 on elective surgeries worldwide
• Urgency of Port-a-cath implantation for oncologic treatment
• Workflow differences between central OR and outpatient surgical centres
• Benefits of outpatient surgical centres for low-complexity procedures
• Use of local anesthesia in Port-a-cath procedures