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Faessen JL, Stoot JHMB, Broos PPHL, Vijgen GHEJ, Reisinger KW, Bouvy ND, van Vugt R. Trans rectus sheath extra-peritoneal procedure (TREPP) for inguinal hernia repair under local anesthesia with sedation in the outpatient clinic: a feasibility study. Langenbecks Arch Surg 2024; 409:188. [PMID: 38896330 DOI: 10.1007/s00423-024-03383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) is an open procedure in which the mesh is placed in the preperitoneal space and is therefore associated with less chronic post-operative inguinal pain. TREPP is primarily performed under general or spinal anesthesia, however, it is also possible to perform under sedation and local anesthesia with potentially advantages. This retrospective feasibility pilot study investigates the safety and efficiency of TREPP under local anesthesia in the outpatient clinic in comparison with Lichtenstein. METHODS Between 2019 and 2022, all patients who underwent an elective inguinal hernia repair under local anesthesia in the outpatient clinic operation theatre were assessed. 34 patients in the TREPP group and 213 patients in the Lichtenstein group were included. Outcomes were complications, operating time, theatre time, and early inguinal hernia recurrence within 8 weeks and 6 months post-operatively. RESULTS No significant differences in complications such as wound infection, hematoma, seroma, urine retention and early recurrence between TREPP and Lichtenstein were found. Post-operative pain at 8 weeks was not significantly higher after Lichtenstein (8.8% vs. 18.8%, P = 0.22). Operating time (21.0 (IQR: 16.0-27.3) minutes vs. 39.0 (IQR: 31.5-45.0) minutes, P < 0.001) and theatre time (37.5 (IQR: 30.8-42.5) minutes vs. 54.0 (IQR: 46.0-62.0) minutes, P < 0.001) was significantly shorter for TREPP. CONCLUSION This pilot study showed that TREPP appears to be feasible to perform safely under local anesthesia with comparable complication rates and substantially shorter operation time than Lichtenstein. These results justify further research with a larger study population and a longer period of follow up in order to provide firm conclusions.
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Affiliation(s)
- J L Faessen
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands.
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - P P H L Broos
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - G H E J Vijgen
- Department of Surgery, Laurentius Hospital, Roermond, The Netherlands
| | - K W Reisinger
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
| | - N D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R van Vugt
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, The Netherlands
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Mainprize M, Spencer Netto FAC, Paasch C. Mis-identified complications after groin hernia repair: concerns for results, research, and registries? Hernia 2024:10.1007/s10029-024-03035-7. [PMID: 38592572 DOI: 10.1007/s10029-024-03035-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Affiliation(s)
- M Mainprize
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave. Thornhill, Markham, ON, L3T 4A3, Canada
| | - F A C Spencer Netto
- Department of Trauma Surgery, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - C Paasch
- Department of Surgery, Shouldice Hospital, 7750 Bayview Ave. Thornhill, Markham, ON, L3T 4A3, Canada.
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Hochstrasse 29, 14770, Brandenburg an der Havel, Germany.
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Grygorian A, Montano D, Shojaa M, Ferencak M, Schmitz N. Digital Health Interventions and Patient Safety in Abdominal Surgery: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e248555. [PMID: 38669018 PMCID: PMC11053376 DOI: 10.1001/jamanetworkopen.2024.8555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance Over the past 2 decades, several digital technology applications have been used to improve clinical outcomes after abdominal surgery. The extent to which these telemedicine interventions are associated with improved patient safety outcomes has not been assessed in systematic and meta-analytic reviews. Objective To estimate the implications of telemedicine interventions for complication and readmission rates in a population of patients with abdominal surgery. Data Sources PubMed, Cochrane Library, and Web of Science databases were queried to identify relevant randomized clinical trials (RCTs) and nonrandomized studies published from inception through February 2023 that compared perioperative telemedicine interventions with conventional care and reported at least 1 patient safety outcome. Study Selection Two reviewers independently screened the titles and abstracts to exclude irrelevant studies as well as assessed the full-text articles for eligibility. After exclusions, 11 RCTs and 8 cohort studies were included in the systematic review and meta-analysis and 7 were included in the narrative review. Data Extraction and Synthesis Data were extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline and assessed for risk of bias by 2 reviewers. Meta-analytic estimates were obtained in random-effects models. Main Outcomes and Measures Number of complications, emergency department (ED) visits, and readmissions. Results A total of 19 studies (11 RCTs and 8 cohort studies) with 10 536 patients were included. The pooled risk ratio (RR) estimates associated with ED visits (RR, 0.78; 95% CI, 0.65-0.94) and readmissions (RR, 0.67; 95% CI, 0.58-0.78) favored the telemedicine group. There was no significant difference in the risk of complications between patients in the telemedicine and conventional care groups (RR, 1.05; 95% CI, 0.77-1.43). Conclusions and Relevance Findings of this systematic review and meta-analysis suggest that perioperative telehealth interventions are associated with reduced risk of readmissions and ED visits after abdominal surgery. However, the mechanisms of action for specific types of abdominal surgery are still largely unknown and warrant further research.
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Affiliation(s)
- Artem Grygorian
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Diego Montano
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Mahdieh Shojaa
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Maximilian Ferencak
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
| | - Norbert Schmitz
- Faculty of Medicine, Department of Population-Based Medicine, Tuebingen University, Tuebingen, Germany
- Faculty of Medicine, Department of Psychiatry, McGill University, Montreal, Québec, Canada
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Abbitt D, Choy K, Castle R, Bollinger D, Jones TS, Wikiel KJ, Barnett CC, Moore JT, Robinson TN, Jones EL. Telehealth for general surgery postoperative care. Am J Surg 2024; 229:156-161. [PMID: 38158263 DOI: 10.1016/j.amjsurg.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Telehealth utilization rapidly increased following the pandemic. However, it is not widely used in the Veteran surgical population. We sought to evaluate postoperative telehealth in patients undergoing general surgery. METHODS Retrospective review of Veterans undergoing general surgery at a level 1A VA Medical Center from June 2019 to September 2021. Exclusions were concomitant procedure(s), discharge with drains or non-absorbable sutures/staples, complication prior to discharge or pathology positive for malignancy. RESULTS 1075 patients underwent qualifying procedures, 124 (12 %) were excluded and 162 (17 %) did not have follow-up. 443 (56 %) patients followed-up in-person (56 %) vs 346 (44 %) via telehealth. Telehealth patients had a lower rate of complications, 6 % vs 12 %, p = 0.013. There were no significant differences in ED visits, 30-day readmission, postoperative procedures or missed adverse events. CONCLUSION Telehealth follow-up after general surgical procedures is safe and effective. Postoperative telehealth care should be considered after low-risk general surgery procedures.
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Affiliation(s)
- Danielle Abbitt
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO, USA.
| | - Kevin Choy
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO, USA
| | - Rose Castle
- School of Medicine, University of Colorado, 13001 E 17th Pl, Aurora, CO, USA
| | - Dan Bollinger
- School of Medicine, University of Colorado, 13001 E 17th Pl, Aurora, CO, USA
| | - Teresa S Jones
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO, USA; Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, USA
| | - Krzysztof J Wikiel
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO, USA; Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, USA
| | - Carlton C Barnett
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO, USA; Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, USA
| | - John T Moore
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO, USA; Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, USA
| | - Thomas N Robinson
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO, USA; Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, USA
| | - Edward L Jones
- Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, Aurora, CO, USA; Rocky Mountain Regional VA Medical Center, 1700 N Wheeling St, Aurora, CO, USA
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5
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Estridge P, Stell D, Bowles M, Kanwar A, Aroori S, Briggs C. Telephone assessment of new hernia referrals-is it possible? Hernia 2024; 28:3-7. [PMID: 37597106 DOI: 10.1007/s10029-023-02850-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE Utilisation of remote clinics is increasing in healthcare settings worldwide. During the height of the COVID pandemic, our UK-based teaching hospital has trialled telephone assessment for new patients presenting with primary hernias. Selected cases are listed for elective repair of primary hernia direct from telephone clinic assessment. In March 2021, after this process had been in place for 13 months, departmental triage criteria were introduced, allocating patients to initial assessment in Face to Face or Telephone Clinics. Here, we evaluate the effectiveness of telephone assessment, with specific attention to 'Day of Surgery' cancellation. We also assess the effect of our triage criteria on rate of 'Day of Surgery' cancellation. METHODS Departmental diaries were studied retrospectively to identify patients listed for hernia repair between February 2020 and February 2022. Data were obtained from clinic letters, discharge paperwork and operating lists, as well as from management teams. Fishers Exact test was used to compare groups seen either face to face or remotely as well and pre- and post-intervention. RESULTS 325 patients were listed for hernia repair, 56 after telephone assessment. 6 (11%) of those listed from telephone clinic were cancelled on the day of surgery, compared with 34 (13%) of those seen face to face. With triage criteria in place, listing from telephone clinic increased significantly from 14 to 27%. Overall day of surgery cancellations reduced from 13 to 9%. Rate of day of surgery cancellation in those assessed in telephone clinic reduced from 12 to 9%. CONCLUSIONS There is no significant difference between day of surgery cancellations after face to face or telephone clinic assessment. Triage criteria for telephone assessment appear to increase the numbers being listed after remote clinics. This did not significantly impact the number of day of surgery cancellations.
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Affiliation(s)
- P Estridge
- Royal Devon and Exeter Hospital (Affiliated to University Hospitals Plymouth Hospitals NHS Trust), Exeter, Devon, UK.
| | - D Stell
- Plymouth NHS Hospitals Trust, Plymouth, UK
| | - M Bowles
- Plymouth NHS Hospitals Trust, Plymouth, UK
| | - A Kanwar
- Plymouth NHS Hospitals Trust, Plymouth, UK
| | - S Aroori
- Plymouth NHS Hospitals Trust, Plymouth, UK
| | - C Briggs
- Plymouth NHS Hospitals Trust, Plymouth, UK
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Chen L, Hu M, Huang S. Analysis of influencing factors of complications after laparoscopic inguinal hernia repair: An observational study. Medicine (Baltimore) 2023; 102:e36516. [PMID: 38065845 PMCID: PMC10713130 DOI: 10.1097/md.0000000000036516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
To explore the influencing factors of complications after laparoscopic inguinal hernia repair (LIHR). A case retrospective analysis was conducted to collect clinical data of 212 patients with inguinal hernia who underwent LIHR in our hospital from July 2020 to October 2022. The patients were followed up by telephone and subsequent visit, and the enrolled patients were divided into the complication group (n = 36) and the non-complication group (n = 176) according to the presence or absence of complications. Chi-square test was used for univariate analysis, and the data with statistical significance between groups were included in the multivariate Logistic regression analysis model to investigate the risk factors for complications associated with LIHR. Common complications in patients undergoing LIHR included seroma, hematoma, urinary retention, unexplained chronic pain, etc. Body mass index (BMI), intraoperative blood loss, medical history time, hernia sac management, intraoperative adhesions, abnormal coagulation function, recurrent hernia, and hypertension were the influencing factors for complications after LIHR (χ2 = 6.809, 13.393, 5.371, 5.775, 4.128, 5.331, 4.920, and 6.675, P < .05). Multivariate analysis showed that BMI (odd ratio [OR] = 5.201, 95% confidence interval [CI] = 0.816-6.965, P < .05), intraoperative blood loss (OR = 2.512, 95% CI = 1.712-3.689, P < .05), intraoperative adhesions (OR = 6.352, 95% CI = 0.162-6.669, P < .05), abnormal coagulation function (OR = 6.352, 95% CI = 0.162-6.669, P < .05), recurrent hernia (OR = 2.208, 95% CI = 1.415-3.446, P < .05), and hypertension (OR = 3.365, 95% CI = 0.009-6.326, P < .05) were independent risk factors for complications after LIHR (P < .05). Common complications of LIHR included seroma, hematoma, urinary retention, etc. BMI, intraoperative blood loss, intraoperative adhesions, abnormal coagulation function, recurrent hernia, and hypertension were risk factors for complications after LIHR.
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Affiliation(s)
- Lexiang Chen
- Department of General Surgert, Yongjia County Traditional Chinese Medicine Hospital, Wenzhou, China
| | - Mingfu Hu
- Department of General Surgert, Yongjia County Traditional Chinese Medicine Hospital, Wenzhou, China
| | - Shanhu Huang
- Department of General Surgert, Yongjia County Traditional Chinese Medicine Hospital, Wenzhou, China
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7
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Abbitt D, Choy K, Castle R, Jones TS, Wikiel KJ, Barnett CC, Moore JT, Robinson TN, Jones EL. Telehealth Follow-Up After Inguinal Hernia Repair in Veterans. J Surg Res 2023; 287:186-192. [PMID: 36940640 DOI: 10.1016/j.jss.2023.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/13/2023] [Accepted: 02/17/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Telehealth has been increasingly utilized with a renewed interest by surgical specialties given the COIVD-19 pandemic. Limited data exists evaluating the safety of routine postoperative telehealth follow-up in patients undergoing inguinal hernia repair, especially those who present urgent/emergently. Our study sought to evaluate the safety and efficacy of postoperative telehealth follow-up in veterans undergoing inguinal hernia repair. METHODS Retrospective review of all Veterans who underwent inguinal hernia repair at a tertiary Veterans Affairs Medical Center over a 2-year period (9/2019-9/2021). Outcome measures included postoperative complications, emergency department (ED) utilization, 30-day readmission, and missed adverse events (ED utilization or readmission occurring after routine postoperative follow-up). Patients undergoing additional procedure(s) requiring intraoperative drains and/or nonabsorbable sutures were excluded. RESULTS Of 338 patients who underwent qualifying procedures, 156 (50.6%) were followed-up by telehealth and 152 (49.4%) followed-up in-person. There were no differences in age, sex, BMI, race, urgency, laterality nor admission status. Patients with higher American Society of Anesthesiologists (ASA) classification [ASA class III 92 (60.5%) versus class II 48 (31.6%), P = 0.019] and open repair [93 (61.2%) versus 67 (42.9%), P = 0.003] were more likely to follow-up in-person. There was no difference in complications, [telehealth 13 (8.3%) versus 20 (13.2%), P = 0.17], ED visits, [telehealth 15 (10%) versus 18 (12%), P = 0.53], 30-day readmission [telehealth 3 (2%) versus 0 (0%), P = 0.09], nor missed adverse events [telehealth 6 (33.3%) versus 5 (27.8%), P = 0.72]. CONCLUSIONS There were no differences in postoperative complications, ED utilization, 30-day readmission, or missed adverse events for those who followed-up in person versus telehealth after elective or urgent/emergent inguinal hernia repair. Veterans with a higher ASA class and who underwent open repair were more likely to be seen in person. Telehealth follow-up after inguinal hernia repair is safe and effective.
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Affiliation(s)
- Danielle Abbitt
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado.
| | - Kevin Choy
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Rose Castle
- School of Medicine, University of Colorado, Aurora, Colorado
| | - Teresa S Jones
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Krzysztof J Wikiel
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Carlton C Barnett
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - John T Moore
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Thomas N Robinson
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Edward L Jones
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado; Rocky Mountain Regional VA Medical Center, Aurora, Colorado
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O'Connor AL, Shettig A, Santucci NM, Sutton TL, Bray JO, Borzy C, Orenstein SB, Nikolian VC. Bedside vs webside: Assessing patient-reported experiences for in-person and telemedicine-based perioperative evaluations. Am J Surg 2023; 225:847-851. [PMID: 36870791 DOI: 10.1016/j.amjsurg.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/24/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Though telemedicine has been identified as safe and feasible, data on patient reported experiences (PREs) are lacking. We sought to compare PREs between in-person and telemedicine-based perioperative care. METHODS Patients evaluated from August-November 2021 were prospectively surveyed to assess experiences and satisfaction with care rendered during in-person and telemedicine-based encounters. Patient and hernia characteristics, encounter related plans, and PREs were compared between in-person and telemedicine-based care. RESULTS Of 109 respondents (86% response rate), 55% (n = 60) utilized telemedicine-based perioperative care. Indirect costs were lower for patients using telemedicine-based services, including work absence (3% vs. 33%, P < 0.001), lost wages (0% vs. 14%, P = 0.003), and requirements for hotel accommodations (0% vs. 12%, P = 0.007). PREs related to telemedicine-based care were non-inferior to in-person care across all measured domains (P > 0.4). CONCLUSIONS Telemedicine-based care yields significant cost-savings over in-person care with similar patient satisfaction. These findings suggest that systems should focus on optimization of perioperative telemedicine services.
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Affiliation(s)
| | | | | | | | - Jordan O Bray
- Oregon Health & Science University, Portland, OR, USA
| | - Charlie Borzy
- Oregon Health & Science University, Portland, OR, USA
| | | | - Vahagn C Nikolian
- Oregon Health & Science University, Portland, OR, USA. https://twitter.com/VNikolian
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9
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Faessen JL, van Vugt R, Veldhuizen R, Stoot JHMB. Using an E-Health Application for Post-operative Monitoring After Inguinal Hernia Repair: A Feasibility Study. World J Surg 2023; 47:182-189. [PMID: 35604449 PMCID: PMC9125961 DOI: 10.1007/s00268-022-06590-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND E-Health care is already well established in some (non-) surgical specialties and is considered as a means of improving patient-centred care. Considering the demand of remote health care changes, especially in the COVID-19 pandemic, it is essential to investigate the feasibility of e-Health care within one of the most performed surgery procedures: inguinal hernia repair. METHODS A total of 60 patients used the e-Health application in this study compliant. Primary objectives were to investigate the accuracy of the "deviating post-operative course" alerting by the e-Health application. Secondary objectives included patient perspective and e-Health costs analysis. RESULTS Forty-four patients reported no deviation in the post-operative course using the e-Health application of which 93.2% (n = 41) was in concordance with the findings during standard follow-up. Within 16 patients reporting a deviating post-operative course, a true complication was found in 25% (n = 4). Based on in-hospital costs, a hypothetical e-Health follow-up scenario was more expensive (€59.5 per patient) than current standard follow-up care (€28.2 per patient). Usage of the e-Health application showed a high perceived overall patient satisfaction: 4.2 (on a Likert-scale of 1-5). CONCLUSION An e-Health application is a promising tool for identifying patients who require in-person or phone follow-up assessment. Patients' perspectives surveys revealed high potential and willingness of using this application. A hypothetical e-Health follow-up scenario showed to be more expensive compared to current standard follow-up. If the identified (dis)advantages can be improved, e-Health follow-up care appears to be promising in terms of safety and feasibility. Future studies can leverage on this study and further investigate the use of e-Health within the field of general surgery.
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Affiliation(s)
- J L Faessen
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands.
| | - R van Vugt
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands
| | - R Veldhuizen
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands
| | - J H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, Sittard-Geleen, 6162 BG, Heerlen, The Netherlands
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10
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Iqbal E, Bray JO, Sutton T, Akhter M, Orenstein SB, Nikolian VC. Perioperative Telemedicine Utilization Among Geriatric Patients Being Evaluated for Abdominal Wall Reconstruction and Hernia Repair. Telemed J E Health 2022. [PMID: 36255440 DOI: 10.1089/tmj.2022.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Perioperative telemedicine services have increasingly been utilized for ambulatory care, although concerns exist regarding the feasibility of virtual consultations for older patients. We sought to review telemedicine encounters for geriatric patients evaluated at a hernia repair and abdominal wall reconstruction center. Methods: A retrospective review of telemedicine encounters between May 2020 and May 2021 was performed. Patient characteristics and encounter-specific outcomes were compared among geriatric (older than65 years old) and nongeriatric patients. Clinical care plans for encounters were reviewed to determine potential downstream care utilization. Patient-derived benefits related to time saved in travel time was calculated using geo-mapping. Outcomes for postoperative encounters were assessed to determine if complication rates differed between geriatric and nongeriatric populations. Results: A total of 313 telemedicine encounters (geriatric: 41.9%) were conducted among 251 patients. Reviewing preoperative factors for hernia care, geriatric patients presented with higher rates of recurrent or incisional hernias (87.9% vs. 70.7%, p < 0.01). Potential travel time was longer for geriatric patients (104 min vs. 42 min, p = 0.03) in the preoperative setting. No differences in clinical care plans were found. Only 8.6% of preoperative encounters resulted in recommendations for supplemental in-person evaluation. Operative plans were coordinated for 42.5% of all preoperative telemedicine encounters. There was no difference in complication rate between geriatric and nongeriatric patients (p > 0.05) in the postoperative setting, with no complications directly attributable to telemedicine-based care. Conclusions: Telemedicine-based evaluations appear to function well among geriatric patients seeking hernia repair and abdominal wall reconstruction. Clinical care plans rendered following telemedicine-based encounters are appropriate with a low rate of supplemental in-person evaluations. Telemedicine use resulted in significantly more time saved in commuting to and from clinic for geriatric patients.
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Affiliation(s)
- Emaad Iqbal
- Columbia University Irving Medical Center, New York, New York, USA
| | - Jordan O Bray
- Oregon Health and Science University, Portland, Oregon, USA
| | - Thomas Sutton
- Oregon Health and Science University, Portland, Oregon, USA
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11
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Uppal A, Kothari AN, Scally CP, Roland CL, Bednarski BK, Katz MHG, Vauthey JN, Chang GJ. Adoption of Telemedicine for Postoperative Follow-Up After Inpatient Cancer-Related Surgery. JCO Oncol Pract 2022; 18:e1091-e1099. [PMID: 35263166 DOI: 10.1200/op.21.00819] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The COVID-19 pandemic has resulted in significant changes in health care delivery, including the rapid adoption of telemedicine across multiple specialties and practice environments. This includes postoperative visits (POV), despite limited data on outcomes following these telemedicine POV. We sought to determine whether these types of visits successfully identify and address postoperative complications when compared with in-person POV. METHODS This was a retrospective cohort study of patients undergoing elective inpatient cancer-related surgery from March 2020 through December 2020. The exposure variable was type of POV (telemedicine v in-person). The primary outcome was unplanned hospital readmission within 90 days, and secondary outcomes included 30-day readmission, length of stay of first readmission, and mortality. RESULTS Five-hundred thirty-five patients underwent elective inpatient operations and met our inclusion criteria. Of these, 98 (18.5%) had an initial telemedicine POV. There was no difference in 90-day readmission on the basis of POV type (16.3% telemedicine v 16.5% in-person, P = .99). Reasons for readmission did not differ between patients who underwent a telemedicine POV compared with in-person POV (all P > .05). After adjustment for patients' demographic and clinical factors, telemedicine POV was not associated with 90-day readmission (odds ratio, 0.89; 95% CI, 0.43 to 1.70; P = .77). CONCLUSION Telemedicine POV use adopted during the COVID-19 pandemic did not increase risk of readmission when compared with in-person visits following inpatient oncologic surgery. These data can help inform policy on the continued use and application of telemedicine after the pandemic.
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Affiliation(s)
- Abhineet Uppal
- University of Texas MD Anderson Cancer Center, Department of Colon and Rectal Surgery, Division of Surgery, Houston, TX
| | - Anai N Kothari
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, TX.,Medical College of Wisconsin, Department of Surgery, Division of Surgical Oncology, Madison, WI
| | - Christopher P Scally
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, TX
| | - Christina L Roland
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, TX
| | - Brian K Bednarski
- University of Texas MD Anderson Cancer Center, Department of Colon and Rectal Surgery, Division of Surgery, Houston, TX
| | - Matthew H G Katz
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, TX
| | - Jean-Nicholas Vauthey
- University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Division of Surgery, Houston, TX
| | - George J Chang
- University of Texas MD Anderson Cancer Center, Department of Colon and Rectal Surgery, Division of Surgery, Houston, TX
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- Data-Driven Determinants for COVID-19 Oncology Discovery Effort (D3CODE) Team, University of Texas, MD Anderson Cancer Center, Houston, TX
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Bray JO, Sutton TL, Akhter MS, Iqbal E, Orenstein SB, Nikolian VC. Outcomes of Telemedicine-Based Consultation among Rural Patients Referred for Abdominal Wall Reconstruction and Hernia Repair. J Am Coll Surg 2022; 235:128-137. [PMID: 35703970 DOI: 10.1097/xcs.0000000000000213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perioperative telemedicine use has increased as a result of the COVID-19 pandemic and may improve access to surgical care. However, studies assessing outcomes in populations at risk for digital-health disparities are lacking. We sought to characterize the pre- and postoperative outcomes for rural patient populations being assessed for hernia repair and abdominal wall reconstruction with telehealth. METHODS Patients undergoing telehealth evaluation from March 2020 through May 2021 were identified. Rurality was identified by zip code of residence. Rural and urban patients were compared based on demographics, diagnosis, treatment plan, and visit characteristics and outcomes. Downstream care use related to supplementary in-person referral, and diagnostic testing was assessed. RESULTS Three hundred-seventy-three (196 preoperative, 177 postoperative) telehealth encounters occurred during the study period (rural: 28% of all encounters). Rural patients were more likely to present with recurrent or incisional hernias (90.0 vs 72.7%, p = 0.02) and advanced comorbidities (American Society of Anesthesiologists status score > 2: 73.1 vs 52.1%, p = 0.009). Rural patients derived significant benefits related to time saved commuting, with median distances of 299 and 293 km for pre- and postoperative encounters, respectively. Downstream care use was 6.1% (N = 23) for additional in-person evaluations and 3.4% (N = 13) for further diagnostic testing, with no difference by rurality. CONCLUSIONS Perioperative telehealth can safely be implemented for rural populations seeking hernia repair and may be an effective method for reducing disparities. Downstream care use related to additional in-person referral or diagnostic testing was minimally impacted in both the preoperative and postoperative settings. These findings suggest that rurality should not deter surgeons from providing telemedicine-based surgical consultation for hernia repair.
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Affiliation(s)
- Jordan O Bray
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Thomas L Sutton
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Mudassir S Akhter
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Emaad Iqbal
- Department of Surgery, Columbia University Medical Center, New York, NY (Iqbal)
| | - Sean B Orenstein
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
| | - Vahagn C Nikolian
- From the Department of Surgery, Oregon Health and Science University, Portland, OR (Bray, Sutton, Akhter, Orenstein, Nikolian)
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13
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Telemedicine-based new patient consultations for hernia repair and advanced abdominal wall reconstruction. Hernia 2022; 26:1687-1694. [PMID: 35723771 PMCID: PMC9207428 DOI: 10.1007/s10029-022-02624-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/23/2022] [Indexed: 11/05/2022]
Abstract
Purpose Telemedicine has emerged as a viable option to in-person visits for the evaluation and management of surgical patients. Increased integration of telemedicine has allowed for greater access to care for specific patient populations but relative outcomes are unstudied. Given these limitations, we sought to evaluate the efficacy of telemedicine-based new patient preoperative encounters in comparison to in-person encounters. Methods We performed a retrospective analysis of adult patients undergoing new patient evaluations from April 2020 to October 2021. Telemedicine visits consist of both video and telephone-based encounters. Visit types, patient demographics, preoperative diagnosis, travel time to the hospital, and prior imaging availability were reviewed. Results A total of 276 new patient encounters were conducted (n = 108, 39% telemedicine). Indications for evaluation included inguinal hernia (n = 81, 30%), ventral hernia (n = 149, 54%) and groin or abdominal pain (n = 30, 11%). Patients undergoing telehealth evaluations were more likely to have greater travel distance to the hospital (91 km vs 29 km, p = 0.002) and have CT image-confirmed diagnoses at the initial visit (73 vs 47%, p < 0.001). Patients who were evaluated for a recurrent or incisional hernia were more likely to be seen through a telemedicine encounter (69 vs 45%, p < 0.001). Conclusions We report the efficacy of telemedicine-based consultations for new patient preoperative evaluations related to hernia repair and abdominal wall reconstruction. Telemedicine is a useful modality for preoperative evaluation of new patients with hernia and advanced abdominal wall reconstruction needs. Understanding this patient population will allow us to optimize telemedicine encounters for new patients and improve access to care for patients in remote locations.
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Eruchalu CN, Bergmark RW, Smink DS, Tavakkoli A, Nguyen LL, Bates DW, Cooper Z, Ortega G. Demographic Disparity in Use of Telemedicine for Ambulatory General Surgical Consultation During the COVID-19 Pandemic: Analysis of the Initial Public Health Emergency and Second Phase Periods. J Am Coll Surg 2022; 234:191-202. [PMID: 35213441 DOI: 10.1097/xcs.0000000000000030] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgical patients with limited digital literacy may experience reduced telemedicine access. We investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultation during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN Retrospective analysis of new visits within the Division of General & Gastrointestinal Surgery at an academic medical center occurring between March 24 through June 23, 2020 (Phase I, Massachusetts Public Health Emergency) and June 24 through December 31, 2020 (Phase II, relaxation of restrictions on healthcare operations) was performed. Visit modality (telemedicine/phone vs in-person) and demographic data were extracted. Bivariate analysis and multivariable logistic regression were performed to evaluate associations between patient characteristics and visit modality. RESULTS During Phase I, 347 in-person and 638 virtual visits were completed. Multivariable modeling demonstrated no significant differences in virtual compared with in-person visit use across racial/ethnic or insurance groups. Among patients using virtual visits, Latinx patients were less likely to have video compared with audio-only visits than White patients (OR, 0.46; 95% CI 0.22-0.96). Black race and insurance type were not significant predictors of video use. During Phase II, 2,922 in-person and 1,001 virtual visits were completed. Multivariable modeling demonstrated that Black patients (OR, 1.52; 95% CI 1.12-2.06) were more likely to have virtual visits than White patients. No significant differences were observed across insurance types. Among patients using virtual visits, race/ethnicity and insurance type were not significant predictors of video use. CONCLUSION Black patients used telemedicine platforms more often than White patients during the second phase of the COVID-19 pandemic. Virtual consultation may help increase access to surgical care among traditionally under-resourced populations.
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Affiliation(s)
- Chukwuma N Eruchalu
- From the Harvard Medical School, Boston, MA (Eruchalu)
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Regan W Bergmark
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Douglas S Smink
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of General and Gastrointestinal Surgery, Department of Surgery (Smink, Tavakkoli), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ali Tavakkoli
- Division of General and Gastrointestinal Surgery, Department of Surgery (Smink, Tavakkoli), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Laboratory for Surgical and Metabolic Research (Tavakkoli), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Louis L Nguyen
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Vascular and Endovascular Surgery, Department of Surgery (Nguyen), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David W Bates
- Division of General Internal Medicine, Department of Medicine (Bates), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (Bates)
| | - Zara Cooper
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery (Cooper), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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