Reservation Planning for Elective Surgery Under Uncertain Demand for Emergency Surgery
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This work concerns the advance scheduling of elective surgery when the operating rooms' capacity utilization by emergency surgery, as well as by elective procedures, is uncertain. New requests for bookings of elective surgery arrive each day. Such procedures preferably would be performed as soon as possible, but admitting too many patients may result in exceeding a day's capacity, possibly necessitating turning away some emergency cases. So the problem facing the hospital at the start of each day is how many of the additional requests for elective surgery to assign for that day. We provide a stochastic dynamic programming model for this aggregate advance scheduling problem. The model has some novel mathematical features. We analyze it and characterize the nature of the optimal policy, which is not necessarily of a control-limit type. Plausible numerical examples which confirm our theoretical results and provide additional insights are reported.Keywords:
Elective surgery
Emergency Surgery
We reviewed a consecutive series of 16 patients above 60 years of age (mean age 71 years) who underwent reconstruction with pedicled flaps in the lower extremity. The soft tissue defects ranged from 9 to 50 cm and were caused in 11 patients (70%) by surgical complications from previous surgeries. Of these, 5 patients underwent a total joint replacement of the knee (4 cases) and of the ankle (1 case). Surgery consisted of 19 muscular flaps, and 3 fasciocutaneous flaps. Six patients were treated with a combination of 2 flaps. The overall surgical complication rate after reconstruction was 44%. There was no perioperative mortality and there were no medical complications. One patient required an above-the-knee amputation because of uncontrollable postoperative bleeding. A thrombectomy was performed in another patient to treat a postoperative popliteal artery occlusion with critical ischemia of the leg. Other complications included recurrent total joint replacement infections (2 cases), marginal flap necrosis (4 cases), and skin necrosis at the donor site (1 case). The mean hospitalization stay was 46 days. All patients but 1 completely healed, although secondary surgery was performed in 7 patients. The occurrence of complications was not correlated with the preoperative morbidity or an age above 75 years. The local complication rate was higher than reported for free flap in the same age category, but the lack of perioperative mortality and medical complications make it a low-risk option for reconstruction of small- to middle-sized defects in the elderly.
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Abstract Frequent updates of planning forecasts and scheduling would permit a company to head‐off impending layoffs, as well as to take advantage of changes in sales forecasts to eliminate or reduce over‐ and under‐shoot in manning schedules. With the computer to minimize time and cost, such updates are practical.
Manpower planning
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M hotel rooms are available at a date n periods from now. Reservations are made by customers for that date, which is at the peak of the high season. Typically, for such a time period, a policy of overbooking is exercised by the hotel management. Customers, however, may cancel their previously confirmed reservations at any time prior to their arrival, with no penalty. On the other hand, new requests for rooms for that particular date are generated anew. At the end of each period the hotel management reviews both the “inventory” level of remaining uncanceled (previously confirmed) reservations and the total number of not-yet-confirmed new requests. At that time a decision is made regarding the inventory level of confirmed reservations with which to start the next period. A decision is one of three actions: (i) to keep the inventory at its present level (i.e., declining all new requests); (ii) to increase the level of overbooking by confirming some of the new requests and, if necessary, by trying to obtain some additional reservations (at some extra cost); (iii) to decrease the level of inventory by canceling some of the previously confirmed reservations (incurring a penalty for each such cancellation). Each occupied room at the target day carries a given profit, while each unhonored reservation at that time incurs a penalty. The problem is to find the optimal over-booking strategy that will maximize net profit. For both criteria, maximization of the expected total net profit, and maximization of the expected discounted net profit, it is shown that the optimal strategy is a 3-region policy as follows: For each period there exist upper and lower bounds and an intermediate point such that, (a) if the overbooking level at the end of a period is greater than the upper bound, it should be decreased to that bound; (b) if the inventory level is below the lower bound, two cases may occur: (i) if the discrepancy is greater than the number of new requests, all new requests should be confirmed and additional reservations should be acquired such that the inventory level will be equal to the lower bound; and (ii) if the discrepancy is smaller than the number of new requests, some of the new requests are confirmed but the inventory level may not exceed the intermediate point; (c) if the inventory level is between the two bounds there are two possibilities: (i) if it is above the intermediate point none of the new requests are confirmed, but (ii) if it is below that point, some of the new requests should be confirmed provided that the new inventory level will not exceed the intermediate point.
Profit maximization
Maximization
Net profit
Hotel management
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This work concerns the advance scheduling of elective surgery when the operating rooms' capacity utilization by emergency surgery, as well as by elective procedures, is uncertain. New requests for bookings of elective surgery arrive each day. Such procedures preferably would be performed as soon as possible, but admitting too many patients may result in exceeding a day's capacity, possibly necessitating turning away some emergency cases. So the problem facing the hospital at the start of each day is how many of the additional requests for elective surgery to assign for that day. We provide a stochastic dynamic programming model for this aggregate advance scheduling problem. The model has some novel mathematical features. We analyze it and characterize the nature of the optimal policy, which is not necessarily of a control-limit type. Plausible numerical examples which confirm our theoretical results and provide additional insights are reported.
Elective surgery
Emergency Surgery
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Objective: Volvulus of the colon is a rare cause of intestinal obstruction that has had many types of management proposed over time. This study was designed to analyze results of various treatments through a review of patients with volvulus who were treated at our hospital. Methods: A total of 50 patients diagnosed with volvulus of the colon between 1982 and 2004 was collected, and each was assigned to one of four groups according to the mode of treatment. Results: Group 1 contained 10 patients who received colonoscopic decompression only; Group 2 contained 21 patients who underwent colonoscopic decompression followed by elective surgery; Group 3 contained 12 patients who received colonoscopic decompression followed by emergency surgery; and Group 4 contained 7 patients who underwent emergency surgery. Group 1 had no deaths, but the disease recurred in 7 of the 10 cases, requiring repeat colonoscopic decompression. Group 2, decompression followed by elective surgery, had one death and one patient who experienced significant morbidity (insufficiency of anastomosis requiring a diversion procedure). Group 3, decompression followed by emergency surgery, had three deaths and one patient with significant morbidity (with insufficiency of anastomosis requiring colostomy or ileostomy diversion). Finally, Group 4, initial emergency surgery, had three deaths and two patients with significant morbidity (colon obstruction and intra-abdominal abscess, each requiring an additional operative procedure for treatment). The overall mortality rate was 14% (7 of 50 patients). Conclusions: Colonoscopic decompression is the technique of choice for reducing volvulus of the colon if the patient has not yet developed peritonitis. However, decompression should be followed by definitive colectomy with anastomosis when the patient is medically fit to undergo surgery.
Elective surgery
Ileostomy
Emergency Surgery
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Бұл зерттеужұмысындaКaно моделітурaлы жәнеоғaн қaтыстытолықмәліметберілгенжәнеуниверситетстуденттерінебaғыттaлғaн қолдaнбaлы (кейстік)зерттеужүргізілген.АхметЯссaуи университетініңстуденттеріүшін Кaно моделіқолдaнылғaн, олaрдың жоғaры білімберусaпaсынa қоятынмaңыздытaлaптaры, яғнисaпaлық қaжеттіліктері,олaрдың мaңыздылығытурaлы жәнесaпaлық қaжеттіліктерінеқaтыстыөз университетінқaлaй бaғaлaйтындығытурaлы сұрaқтaр қойылғaн. Осы зерттеудіңмaқсaты АхметЯсaуи университетіндетуризмменеджментіжәнеқaржы бaкaлaвриaт бaғдaрлaмaлaрыныңсaпaсынa қaтыстыстуденттердіңқaжеттіліктерінaнықтaу, студенттердіңқaнaғaттaну, қaнaғaттaнбaу дәрежелерінбелгілеу,білімберусaпaсын aнықтaу мен жетілдіружолдaрын тaлдaу болыптaбылaды. Осы мaқсaтқaжетуүшін, ең aлдыменКaно сaуaлнaмaсы түзіліп,116 студенткеқолдaнылдыжәнебілімберугежәнеоның сaпaсынa қaтыстыстуденттердіңтaлaптaры мен қaжеттіліктерітоптықжұмыстaрaрқылыaнықтaлды. Екіншіден,бұл aнықтaлғaн тaлaптaр мен қaжеттіліктерКaно бaғaлaу кестесіменжіктелді.Осылaйшa, сaпa тaлaптaры төрт сaнaтқa бөлінді:болуытиіс, бір өлшемді,тaртымдыжәнебейтaрaп.Соңындa,қaнaғaттaну мен қaнaғaттaнбaудың мәндеріесептелдіжәнестуденттердіңқaнaғaттaну мен қaнaғaттaнбaу деңгейлерінжоғaрылaту мен төмендетудеосытaлaптaр мен қaжеттіліктердіңрөліaйқын aнықтaлды.Түйінсөздер:сaпa, сaпaлық қaжеттіліктер,білімберусaпaсы, Кaно моделі.
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The nationally-recognized Susquehanna
Chorale will delight audiences of all
ages with a diverse mix of classic and
contemporary pieces. The ChoraleAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂA¢AÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂs
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music making, successful in their
aim to make the audience feel,
to be moved, to be part of the
performance - and all this while
working at an extremely high
musical level.AÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂA¢AÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂA Experience choral
singing that will take you to new
heights!
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Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients (16M:19F) have been treated. The original operation was bowel related in 19 cases, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic aneurysm repair in 2 and involved a thoraco-laparotomy in 3. The incisions were midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one patient. The hernias were considered subjectively to be large in 15, medium in 14 and small in 6 of the patients. A proforma was completed for each patient noting intra-operative and post-operative complications, post-operative hospital stay and analgesic requirements. Post-operative complications included seroma formation in 6 patients, deep vein thrombosis in one and a non-fatal pulmonary embolism in another. One patient developed a wound haematoma and one had a superficial wound infection. Post-operative in-hospital stay ranged from 1 to 27 days with a mean of 6.2 days. Of the 35 patients 33 were available for follow-up. Follow-up was for a median of 20.3 months (range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent lump and one (3%) reported persistent pain but none of the remaining 33 was found to have a recurrence. We advocate this technique because it is applicable to all hernias, most of the mesh is behind the rectus sheath and has 2 points of fixation, it is relatively pain-free allowing early mobilisation, has a modest complication rate and a low recurrence rate.
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Incisional Hernia
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Elective surgery
Emergency Surgery
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Between 1978 and 1987, 587 cases of abdominal aortic aneurysm were operated on in the Vascular Unit of the Royal Infirmary of Edinburgh. Over this ten-year period there was a dramatic increase in the number of patients treated. Rupture had occurred in 278 patients. Of the 309 patients with non-ruptured aneurysm 175 were asymptomatic, 84 were symptomatic and 50 were acutely symptomatic. Two hundred and fifty-nine patients underwent elective operation and the 50 acutely symptomatic patients were operated on as emergencies. The overall mortality for the non-ruptured series was 2.9 per cent. The mortality in patients undergoing elective surgery was 1.9 per cent (1.1 per cent in asymptomatic and 3.6 per cent in symptomatic patients) and 4.0 per cent for patients undergoing emergency surgery.
Elective surgery
Emergency Surgery
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