The Relationship Between Surgical and Operating Room Practice During Hajj Season, Makkah, Saudi Arabia, 2024: A Comparative Study

Introduction: There is a remarkable paucity of research that studies the surgical and operating room (O.R.) practice during Hajj, as well as research that compares such practice before and during Hajj, since most of the available reports concentrated on other topics. Surgical problems, either acute surgical emergencies or precipitation of chronic disease, are not uncommon during the Hajj season. Prolonged surgical wait times have been associated with reduced quality of life. Cancellation of surgical operations in hospitals is a significant problem with many undesirable consequences. Cancelled operations can annoy patients and their families. They are a major drain on health resources, increase theater costs, result in wasted operating room time, and decrease efficiency. Therefore, the objective of the current study is to compare the surgical and O.R. practice in Makkah Healthcare Cluster (MHCC) hospitals before and during Hajj 2024. Methodology: A retrospective data analysis using all medical records of the operation rooms departments in MHCC hospitals before Hajj 2024 (Jan-Feb-March) and during Hajj 2024 (April-May-June) (including both pilgrims and non-pilgrims) Results: There is a statistically significant difference between surgery waiting lists for different specialties. P = 0% as well as between surgery waiting lists and different MHCC hospitals. P = 0% The highest waiting list was for general surgery (8735 cases), and the lowest was for the vascular surgery waiting list (490 cases). The highest waiting list was in KAMC (15,473 cases), followed by Al-Noor Specialist Hospital (15,471 cases), and the lowest was in Al-Kamel Hospital (0 cases). There is a statistically significant difference between the type of surgery performed for different specialties (P = 0%) as well as between the type of surgery performed and different MHCC hospitals (P = 0%). General surgery operations are the most common type of operation done in MHCC (1753 cases) compared to oral surgery, which was the least common type of surgical operation performed (74 cases). KAMC was the highest hospital in surgery performance (2704 cases), followed by the maternal and children's hospital (2273 cases). No statistically significant differences between elective surgeries and emergency surgeries are noted between different MHCC hospitals. P = 14% Statistically significant differences between the Operation Room (OR) Surgical Cancellation Rate and the Operation Room (OR) Utilization Rate are noted between different MHCC hospitals (P-Value = 1%). The ratio of emergent surgery to elective surgery (Ee ratio) = 7010.05 / 8802 = 0.7964 = 79.64%. No statistically significant differences between the operating room (OR) surgical cancellation rate and the day surgery cancellation rate are noted between different MHCC hospitals. P-Value = 7% No statistically significant differences between day of admission to day of surgery (percent) and day surgery (percent) are noted between different MHCC hospitals. P-Value = 8% Statistically significant differences between unplanned admission following discharge and day surgery conversion to admission are noted between different MHCC hospitals. P-Value = 1% There is a statistically significant difference among elective surgeries performed regularly before Hajj compared to such practice during Hajj season (P=0.049), as well as for emergency surgeries (P=0.002), day surgery (P=0.02), day surgery conversion to admission (P=0.02), vascular surgery (P=0.025), orthopedics (P=0.006), neurosurgery (P=0.04), general surgery (P=0.0004), and ear-nose-throat (ENT) (P=0.039). Conclusion & Recommendations: Approaches to improving the surgical and O.R. practice in MHCC hospitals can occur on many levels based on the required level of resources and institutional support. Data transparency and communication are critical to improvements, and any intervention should be conducted in the context of overall patient care, especially during Hajj seasons. Such interventions may include improving the quantities and quality of that practice as well as improving the equity and equality distribution of surgical and O.R. manpower, materials, and machines in order to shorten the O.R. waiting list and surgery cancellation rates and improve the O.R. utilization rates in order to attain the goals of value-based health care and a new model of care. To measure operating room (OR) performance and efficiency, hospitals need scorecards or dashboards displaying and tracking core performance indicators. Scorecards should be monitored on an ongoing basis and benchmarked both internally against performance over time and externally against established best practices with the intent of continuous performance improvement. Among the lessons learned from the current study is the need for large-scale scientific studies, including qualitative and quantitative ones, to quantify the factors related to surgical and OR practice. Different types of surgery represent a threat in light of the expected increasing number of pilgrims after the completion of construction in the Grand Mosque and Al-Mashaeer areas of the Hajj. The vast development in surgery problem surveillance after the development of the web-based healthcare network is a welcome achievement of the Saudi Ministry of Health. The optimal utilization of the collected data is yet to be achieved. The existing international collaboration needs to be strengthened and expanded. Application of a new metric for surgical care access and delivery, the ratio of emergent surgery to elective surgery (Ee ratio), is essential.