The Cost of Prolonged Time in the Operating Room

“The cost to run an operating room can be divided into direct costs such as staff wages and consumable items, indirect costs such as building maintenance, leasing/mortgage payments and laundry services, professional fees such as anesthesia and surgeon fees, and specialty service fees such as intraoperative fluoroscopy, blood bank, lab, and orthopaedic implants.  Most of these figures can be estimated from purchase orders and salaries payable by hospital accounting systems. More recently, time driven activity-based costing (TDABC) has allowed a more accurate way to assign cost in a complex environment where staff are often multi-tasking and thousands of consumables are utilized.  TDABC divides complex care into discrete cycles allowing micro-costing assessment and assignment of cost based ontime. In either of these methods, decisions must be made when attempting to measure and/or conceptualize the actual cost of a surgery. It should be noted that data in the current literature pertaining to the cost of the operating room often, but not always, excludes the costs associated with anesthesia services, perioperative services, surgeon fees, blood bank expenses, radiology services, and implants. Consistent data on operating room costs is needed for effective healthcare resource allocation.”

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Diagnosis and Management of Morel-Lavallée Lesion

“The diagnosis of an MLL ideally is made by physical examination of the patient, but advanced imaging modalities can be used to provide additional information. Typically, CT of the area of interest is obtained, especially when a pelvic or acetabular injury is present. Small and large lesions often can be identified in this manner.”

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Pathogenesis and management of Polycystic liver disease

“Polycystic liver disease (PLD) is the result of embryonic ductal plate malformation of the intrahepatic biliary tree.The phenotype consists of numerous cysts spread throughout the liver parenchyma. Cystic bile duct malformations originating from the peripheral biliary tree are called Von Meyenburg complexes (VMC). In these patients embryonic remnants develop into small hepatic cysts and usually remain silent during life. Symptomatic PLD occurs mainly in
the context of isolated polycystic liver disease (PCLD) and autosomal dominant polycystic kidney disease (ADPKD).”
“Management of adult PLD is based on liver phenotype, severity of clinical features and quality of life. Conservative treatment is recommended for the majority of PLD patients. The primary aim is to halt cyst growth to allow abdominal decompression and ameliorate symptoms. Invasive procedures are required in a selective patient group with advanced PCLD, ADPKD or
liver failure. Pharmacological therapy by somatostatin analogues lead to beneficial outcome of PLD in terms of symptom relief and liver volume reduction.”

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