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Zhao X, Jin S, Peng M, Wang J. A retrospective study on the efficacy of the ERAS protocol in patients who underwent laparoscopic left and right colectomy surgeries. Front Surg 2024; 11:1395271. [PMID: 38983588 PMCID: PMC11231639 DOI: 10.3389/fsurg.2024.1395271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/25/2024] [Indexed: 07/11/2024] Open
Abstract
Objective Retrospective analysis and comparison of the effects of Enhanced Recovery After Surgery (ERAS) protocol for patients having left and right colectomy surgeries. Method Out of the patients admitted to Chengdu Shang Jin Nan Fu Hospital and West China Hospital from December 2019 to December 2022, a total of 498 who met the inclusion criteria were selected, 255 with right colectomy(RC) and 243 with left colectomy (LC). Under the conditions of strict compliance with ERAS protocol, the relevant physical indexes of RC and LC, including postoperative rehabilitation (especially median post-operative stay) and complications (especially prolonged postoperative ileus, PPOI), were statistically analyzed and compared. Results In terms of intraoperative variables, fluid doses were higher in the LC group than in the RC group (P < 0.05), and there was no significant difference between them in terms of operative time, blood loss, need for open surgery, peritoneal contamination, epidural catheter placement, or opioid use (P > 0.05). Compared with the RC group, the LC group had a higher intake of oral liquid at the second postoperative day (POD), and faster first flatulence (P < 0.05). 30 (11.76%) RC patients required nasogastric tube insertion, while only 3 (1.23%) patients in the LC group required the same (P < 0.05). Prolonged postoperative ileus (PPOI) occurred in 48 (18.82%) and 29 (11.93%) patients in the RC and LC groups, respectively (P < 0.05). No significant differences in terms of postoperative complications or length of hospital stay (LoS). stay were observed. Conclusion As the location of colon cancer changes, the effectiveness of ERAS also varies. More personalized and precise ERAS protocols can reduce the incidence of postoperative complications and promote rapid recovery after surgery.
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Affiliation(s)
- Xuemei Zhao
- Outpatient Department, Chengdu Shang Jin Nan Fu Hospital/Shang Jin Hospital of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Siyu Jin
- Outpatient Department, Chengdu Shang Jin Nan Fu Hospital/Shang Jin Hospital of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingxiu Peng
- Outpatient Department, Chengdu Shang Jin Nan Fu Hospital/Shang Jin Hospital of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingjing Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Li SQ, Luo CL, Qiu H, Liu YX, Chen JM. Effect of Orem's self-care model on discharge readiness of patients undergoing enterostomy: A randomized controlled trial. Eur J Oncol Nurs 2024; 70:102549. [PMID: 38692158 DOI: 10.1016/j.ejon.2024.102549] [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: 11/29/2023] [Revised: 02/18/2024] [Accepted: 03/03/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of Orem's self-care model in preparing hospitals for the discharge of patients with colorectal cancer who undergo enterostomy. METHODS 92 patients with enterostomy were recruited between February 2022 and February 2023 from a general tertiary hospital. The participants were assigned to either the intervention group or the control group randomly. The intervention group received Orem's self-care program and a three-month follow-up, whereas the control group received only routine care and a three-month follow-up. Discharge readiness, self-care ability, and stoma-quality-of-life data were collected at hospital discharge (T1), 30 days (T2), and 90 days (T3) after discharge. RESULTS The intervention group had substantially higher discharge readiness (knowledge, p < 0.001; coping ability, p = 0.006; personal status, p = 0.001; expected support, p = 0.021; total score, p < 0.001), better self-care ability at T1 (self-care knowledge, p < 0.001; self-care skills, p = 0.010), better total quality of life (QoL) at T1, T2, and T3 (p < 0.001; p = 0.006; p = 0.014); better stoma management and daily routine at T1 (p = 0.004; p < 0.001); and better daily routine at T2 (p = 0.009) than the control group. CONCLUSIONS The designed discharge readiness program based on Orem's self-care could promote effective patient discharge readiness, self-care knowledge, self-care skills, and QoL. TRIAL REGISTRATION The trial number ChiCTR2200056302 registered on ClinicalTrials.gov.
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Affiliation(s)
- Si-Qing Li
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Cui-Lian Luo
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Hong Qiu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Yu-Xia Liu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Jian-Min Chen
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
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Sier MAT, Godina E, Tweed TTT, Daher I, Stoot JHMB. Views and experiences of healthcare professionals and patients on the implementation of a 23-hour accelerated enhanced recovery programme: a mixed-method study. BMC Health Serv Res 2024; 24:330. [PMID: 38475839 DOI: 10.1186/s12913-024-10837-z] [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: 11/30/2023] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND An accumulating body of research suggests that an accelerating enhanced recovery after colon surgery protocol is beneficial for patients, however, to obtain these effects, adherence to all elements of the protocol is important. The implementation of complex interventions, such as the Enhanced Recovery After Surgery protocol (ERAS), and their strict adherence have proven to be difficult. The same challenges can be expected in the implementation of the accelerated Enhanced Recovery Pathways (ERPs). This study aimed to understand the perspectives of both healthcare professionals (HCPs) and patients on the locally studied acCelerated enHanced recovery After SurgEry (CHASE) protocol. METHODS For this mixed-method study, HCPs who provided CHASE care and patients who received CHASE care were recruited using purposive sampling. Ethical approval was obtained by the Medical Ethical Committee of the Zuyderland Medical Centre (NL71804.096.19, METCZ20190130, October 2022). Semi-structured, in-depth, one-on-one interviews were conducted with HCPs (n = 13) and patients (n = 11). The interviews consisted of a qualitative and quantitative part, the protocol evaluation and the Measurement Instrument or Determinant of Innovations-structured questionnaire. We explored the perspectives, barriers, and facilitators of the CHASE protocol implementation. The interviews were audiotaped, transcribed verbatim and analysed independently by two researchers using direct content analysis. RESULTS The results showed that overall, HCPs support the implementation of the CHASE protocol. The enablers were easy access to the protocol, the relevance of the intervention, and thorough patient education. Some of the reported barriers included the difficulty of recognizing CHASE patients, the need for regular feedback, and the updates on the implementation progress. Most patients were enthusiastic about early discharge after surgery and expressed satisfaction with the care they received. On the other hand, the patients sometimes received different information from different HCPs, considered the information to be too extensive and few experienced some discomfort with CHASE care. CONCLUSION Bringing CHASE care into practice was challenging and required adaptation from HCPs. The experiences of HCPs showed that the protocol can be improved further, and the mostly positive experiences of patients are a motivation for this improvement. These results yielded practical implications to improve the implementation of accelerated ERPs.
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Affiliation(s)
- Misha A T Sier
- Department of Surgery, Zuyderland Medical Centre, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands.
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands.
| | - Eva Godina
- Department of Surgery, Zuyderland Medical Centre, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
- Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
| | - Thaís T T Tweed
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
- Department of Surgery, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, the Netherlands
| | - Imane Daher
- Department of Gastroenterology, Zuyderland Medical Centre, Henri Dunantstraat 5, Heerlen, 6419 PC, the Netherlands
| | - Jan H M B Stoot
- Department of Surgery, Zuyderland Medical Centre, Henri Dunantstraat 5, Heerlen, 6419 PC, The Netherlands
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Roeung S, Lindgren TG, Carley A. Improving Discharge Teaching for Adult Patients with an Ileostomy. Am J Nurs 2024; 124:41-46. [PMID: 38126833 DOI: 10.1097/01.naj.0001004936.98276.ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
LOCAL PROBLEM Discharge teaching is essential to the self-care and successful recovery of colorectal surgery patients, yet the trend toward shorter hospital stays for patients with new ileostomies limits opportunities for patient education. As a result, discharged patients at our institution are initiating calls to providers with questions that could have been addressed prior to discharge. PURPOSE The aim of this quality improvement (QI) project was to decrease patient-initiated postdischarge inquiries using a frequently asked questions (FAQs) handout at discharge. METHODS A retrospective chart review of inquiries to the outpatient clinic over the six-month period between July 2020 and January 2021 revealed common concerns, among them bowel movements, home health care, medications, wound care, stoma issues, pathology reports, diet, and activity-related issues. Based on these concerns, a FAQs handout was developed to review with patients prior to discharge. Data from three postdischarge time periods (0 to 72 hours, 72 hours to 21 days, and 0 to 21 days) in the three months from June to September 2021 were analyzed to determine the impact of the intervention on the frequency and content of the patient inquiries. RESULTS Use of the FAQs handout led to a decrease in total patient-initiated postdischarge inquiries from 46 in the preintervention period to five in the postintervention period, and fewer topics of concern prompted patients' postintervention inquiries. There was also a pre-to-postintervention reduction in the proportion of patients who made calls to the outpatient clinic in each of the three postdischarge time periods, the greatest of which-from 49% to 15% of patients-was significant and occurred in the 72-hour-to-21-day period. CONCLUSION This QI project demonstrated that a change in discharge teaching by adding a FAQs handout to the protocol could be effective.
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Affiliation(s)
- Sophany Roeung
- Sophany Roeung is an NP in the Department of Colorectal Surgery at the University of California San Francisco Medical Center. Teri G. Lindgren is an associate clinical professor at the University of California San Francisco School of Nursing, where Annette Carley is a clinical professor and associate director of the DNP program. Contact author: Sophany Roeung, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Süsstrunk J, Mijnssen R, von Strauss M, Müller BP, Wilhelm A, Steinemann DC. Enhanced recovery after surgery (ERAS) in colorectal surgery: implementation is still beneficial despite modern surgical and anesthetic care. Langenbecks Arch Surg 2023; 409:5. [PMID: 38091109 DOI: 10.1007/s00423-023-03195-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE Enhanced recovery after surgery (ERAS) protocols have shown beneficial outcomes in the last 20 years. Nevertheless, simultaneously implemented technical improvements such as minimally invasive access or modified anesthesia care may play a crucial role in optimizing patient outcome. The aim of the study was to investigate the effect of ERAS implementation in a highly specialized colorectal center. METHODS This is a propensity score matched single-center study comparing the short-term outcomes of patients undergoing elective colorectal surgery in a society-indepedent ERAS program from January 2021 to August 2022 to standard perioperative care from January 2019 to December 2020. RESULTS Four hundred fifty-six patients were included in the propensity score matched analysis with 228 patients per group (ERAS vs. standard care). Minimally invasive access was used in 80.2% vs. 77.6% (p = 0.88), and there were 16.6% vs. 18.8% (p = 0.92) rectal procedures in the ERAS and standard care group, respectively. Major complications occurred in 10.1% vs. 11.4% (p = 0.65) and anastomotic leakage demanding operative revision in 2.2% vs. 2.6% (p = 0.68) in the ERAS and standard care group, respectively. ERAS lead to a lower number of non-surgical complications compared to standard care (57 vs. 79; p = 0.02). Mean length of stay (LOS) and mean costs per case were lower in ERAS compared to standard care (9.2 ± 5.6 days vs. 12.7 ± 7.4 days, p < 0.01; costs 33,727 ± 15,883 USD vs. 40,309 ± 29,738 USD, p < 0.01). CONCLUSION The implementation of an ERAS protocol may lead to a reduction of LOS, costs, and a lower number of non-surgical complications even in a highly specialized colorectal unit using modern surgical and anesthetic care. ( ClinialTrials.gov number NCT05773248).
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Affiliation(s)
- Julian Süsstrunk
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4002, Basel, Switzerland.
- Department of Surgery, University Hospital Basel, 4031, Basel, Switzerland.
| | - Remo Mijnssen
- Medical Faculty, University of Basel, 4001, Basel, Switzerland
| | - Marco von Strauss
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4002, Basel, Switzerland
- Department of Surgery, University Hospital Basel, 4031, Basel, Switzerland
| | - Beat Peter Müller
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4002, Basel, Switzerland
- Department of Surgery, University Hospital Basel, 4031, Basel, Switzerland
| | - Alexander Wilhelm
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4002, Basel, Switzerland
- Department of Surgery, University Hospital Basel, 4031, Basel, Switzerland
- Surgical Outcome Research Center Basel, University Hospital Basel, 4002, Basel, Switzerland
| | - Daniel C Steinemann
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, 4002, Basel, Switzerland
- Department of Surgery, University Hospital Basel, 4031, Basel, Switzerland
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Bloc S, Alfonsi P, Belbachir A, Beaussier M, Bouvet L, Campard S, Campion S, Cazenave L, Diemunsch P, Di Maria S, Dufour G, Fabri S, Fletcher D, Garnier M, Godier A, Grillo P, Huet O, Joosten A, Lasocki S, Le Guen M, Le Saché F, Macquer I, Marquis C, de Montblanc J, Maurice-Szamburski A, Nguyen YL, Ruscio L, Zieleskiewicz L, Caillard A, Weiss E. Guidelines on perioperative optimization protocol for the adult patient 2023. Anaesth Crit Care Pain Med 2023; 42:101264. [PMID: 37295649 DOI: 10.1016/j.accpm.2023.101264] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The French Society of Anesthesiology and Intensive Care Medicine [Société Française d'Anesthésie et de Réanimation (SFAR)] aimed at providing guidelines for the implementation of perioperative optimization programs. DESIGN A consensus committee of 29 experts from the SFAR was convened. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Four fields were defined: 1) Generalities on perioperative optimization programs; 2) Preoperative measures; 3) Intraoperative measures and; 4) Postoperative measures. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. The recommendations were formulated according to the GRADE® methodology and then voted on by all the experts according to the GRADE grid method. As the GRADE® methodology could have been fully applied for the vast majority of questions, the recommendations were formulated using a "formalized expert recommendations" format. RESULTS The experts' work on synthesis and application of the GRADE® method resulted in 30 recommendations. Among the formalized recommendations, 19 were found to have a high level of evidence (GRADE 1±) and ten a low level of evidence (GRADE 2±). For one recommendation, the GRADE methodology could not be fully applied, resulting in an expert opinion. Two questions did not find any response in the literature. After two rounds of rating and several amendments, strong agreement was reached for all the recommendations. CONCLUSIONS Strong agreement among the experts was obtained to provide 30 recommendations for the elaboration and/or implementation of perioperative optimization programs in the highest number of surgical fields.
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Affiliation(s)
- Sébastien Bloc
- Clinical Research Department, Ambroise Pare Hospital Group, Neuilly-sur-Seine, France; Department of Anesthesiology, Clinique Drouot Sport, Paris, France.
| | - Pascal Alfonsi
- Department of Anesthesia, University of Paris Descartes, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, F-75674 Paris Cedex 14, France
| | - Anissa Belbachir
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Marc Beaussier
- Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France
| | - Lionel Bouvet
- Department of Anaesthesia and Intensive Care, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France
| | | | - Sébastien Campion
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie-Réanimation, F-75013 Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005 Paris, France
| | - Laure Cazenave
- Department of Anaesthesia and Critical Care, Hospices Civils de Lyon, Lyon, France; Groupe Jeunes, French Society of Anaesthesia and Intensive Care Medicine (SFAR), 75016 Paris, France
| | - Pierre Diemunsch
- Unité de Réanimation Chirurgicale, Service d'Anesthésie-réanimation Chirurgicale, Pôle Anesthésie-Réanimations Chirurgicales, Samu-Smur, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1, Avenue Molière, 67098 Strasbourg Cedex, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Dufour
- Service d'Anesthésie-Réanimation, CHU de Pitié-Salpêtrière, 47-83, Boulevard de l'Hôpital, 75013 Paris, France
| | - Stéphanie Fabri
- Faculty of Economics, Management & Accountancy, University of Malta, Malta
| | - Dominique Fletcher
- Université de Versailles-Saint-Quentin-en-Yvelines, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise-Paré, Service d'Anesthésie, 9, Avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marc Garnier
- Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France
| | - Anne Godier
- Department of Anaesthesiology and Critical Care, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, France
| | | | - Olivier Huet
- CHU de Brest, Anesthesia and Intensive Care Unit, Brest, France
| | - Alexandre Joosten
- Department of Anesthesiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium; Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Villejuif, France
| | | | - Morgan Le Guen
- Paris Saclay University, Department of Anaesthesia and Pain Medicine, Foch Hospital, 92150 Suresnes, France
| | - Frédéric Le Saché
- Department of Anesthesiology, Clinique Drouot Sport, Paris, France; DMU DREAM Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Isabelle Macquer
- Bordeaux University Hospitals, Bordeaux, Anaesthesia and Intensive Care Medicine Department, Bordeaux, France
| | - Constance Marquis
- Clinique du Sport, Département d'Anesthésie et Réanimation, Médipole Garonne, 45 rue de Gironis - CS 13 624, 31036 Toulouse Cedex 1, France
| | - Jacques de Montblanc
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | | | - Yên-Lan Nguyen
- Anesthesiology and Critical Care Medicine Department, Cochin Academic Hospital, APHP, Université de Paris, 75014 Paris, France
| | - Laura Ruscio
- Departments of Anesthesiology and Intensive Care Paris-Saclay University, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France; INSERM U 1195, Université Paris-Saclay, Saint-Aubin, Île-de-France, France
| | - Laurent Zieleskiewicz
- Service d'Anesthésie Réanimation, Hôpital Nord, AP-HM, Marseille, Aix Marseille Université, C2VN, France
| | - Anaîs Caillard
- Centre Hospitalier Universitaire La Cavale Blanche Université de Bretagne Ouest, Anaesthesiology, Critical Care and Perioperative Medicine Department, Brest, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Nord, Clichy, France; University of Paris, Paris, France; Inserm UMR_S1149, Centre for Research on Inflammation, Paris, France
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Jacobs MA, Tetley JC, Kim J, Schmidt S, Brimhall BB, Mika V, Wang CP, Manuel LS, Damien P, Shireman PK. Association of Cumulative Colorectal Surgery Hospital Costs, Readmissions, and Emergency Department/Observation Stays with Insurance Type. J Gastrointest Surg 2023; 27:965-979. [PMID: 36690878 PMCID: PMC10133377 DOI: 10.1007/s11605-022-05576-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/17/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND/PURPOSE Medicare's Hospital Readmission Reduction Program disproportionately penalizes safety-net hospitals (SNH) caring for vulnerable populations. This study assessed the association of insurance type with 30-day emergency department visits/observation stays (EDOS), readmissions, and cumulative costs in colorectal surgery patients. METHODS Retrospective inpatient cohort study using the National Surgical Quality Improvement Program (2013-2019) with cost data in a SNH. The odds of EDOS and readmissions and cumulative variable (index hospitalization and all 30-day EDOS and readmissions) costs were modeled adjusting for frailty, case status, presence of a stoma, and open versus laparoscopic surgery. RESULTS The cohort had 245 private, 195 Medicare, and 590 Medicaid/uninsured cases, with a mean age 55.0 years (SD = 13.3) and 52.9% of the cases were performed on male patients. Most cases were open surgeries (58.7%). Complication rates were 41.8%, EDOS 12.0%, and readmissions 20.1%. Medicaid/uninsured had increased odds of urgent/emergent surgeries (aOR = 2.15, CI = 1.56-2.98, p < 0.001) and complications (aOR = 1.43, CI = 1.02-2.03, p = 0.042) versus private patients. Medicaid/uninsured versus private patients had higher EDOS (16.6% versus 4.1%) and readmissions (22.9% versus 14.3%) rates and higher odds of EDOS (aOR = 4.81, CI = 2.57-10.06, p < 0.001), and readmissions (aOR = 1.62, CI = 1.07-2.50, p = 0.025), while Medicare patients had similar odds versus private. Cumulative variable cost %change was increased for Medicare and Medicaid/uninsured, but Medicaid/uninsured was similar to private after adjusting for urgent/emergent cases. CONCLUSIONS Increased urgent/emergent cases in Medicaid/uninsured populations drive increased complications odds and higher costs compared to private patients, suggesting lack of access to outpatient care. SNH care for higher cost populations, receive lower reimbursements, and are penalized by value-based programs. Increasing healthcare access for Medicaid/uninsured patients could reduce urgent/emergent surgeries, resulting in fewer complications, EDOS/readmissions, and costs.
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Affiliation(s)
- Michael A Jacobs
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jasmine C Tetley
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jeongsoo Kim
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Bradley B Brimhall
- Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
- University Health, San Antonio, TX, USA
| | | | - Chen-Pin Wang
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Laura S Manuel
- Business Intelligence and Data Analytics, University of Texas Health Physicians, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Paul Damien
- Department of Information, Risk, and Operations Management, School of Business, University of Texas, Red McCombs, Austin, TX, USA
| | - Paula K Shireman
- Department of Surgery, University of Texas Health San Antonio, San Antonio, TX, USA.
- University Health, San Antonio, TX, USA.
- Departments of Primary Care & Rural Medicine and Medical Physiology, School of Medicine, Texas A&M Health, Bryan, TX, USA.
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8
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Jacobs MA, Kim J, Tetley JC, Schmidt S, Brimhall BB, Mika V, Wang CP, Manuel LS, Damien P, Shireman PK. Association of Insurance Type with Inpatient Surgical 30-day Readmissions, Emergency Department Visits/Observation Stays, and Costs. ANNALS OF SURGERY OPEN 2023; 4:e235. [PMID: 37588413 PMCID: PMC10427129 DOI: 10.1097/as9.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/19/2022] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To assess the association of Private, Medicare, and Medicaid/Uninsured insurance type with 30-day Emergency Department visits/Observation Stays (EDOS), readmissions, and costs in a safety-net hospital (SNH) serving diverse socioeconomic status patients. SUMMARY BACKGROUND DATA Medicare's Hospital Readmission Reduction Program (HRRP) disproportionately penalizes SNHs. METHODS This retrospective cohort study used inpatient National Surgical Quality Improvement Program (2013-2019) data merged with cost data. Frailty, expanded Operative Stress Score, case status, and insurance type were used to predict odds of EDOS and readmissions, as well as index hospitalization costs. RESULTS The cohort had 1,477 Private; 1,164 Medicare; and 3,488 Medicaid/Uninsured cases with a patient mean age 52.1 years [SD=14.7] and 46.8% of the cases were performed on male patients. Medicaid/Uninsured (aOR=2.69, CI=2.38-3.05, P<.001) and Medicare (aOR=1.32, CI=1.11-1.56, P=.001) had increased odds of urgent/emergent surgeries and complications versus Private patients. Despite having similar frailty distributions, Medicaid/Uninsured compared to Private patients had higher odds of EDOS (aOR=1.71, CI=1.39-2.11, P<.001), and readmissions (aOR=1.35, CI=1.11-1.65, P=.004), after adjusting for frailty, OSS, and case status, while Medicare patients had similar odds of EDOS and readmissions versus Private. Hospitalization variable cost %change was increased for Medicare (12.5%) and Medicaid/Uninsured (5.9%), but Medicaid/Uninsured was similar to Private after adjusting for urgent/emergent cases. CONCLUSIONS Increased rates and odds of urgent/emergent cases in Medicaid/Uninsured patients drive increased odds of complications and index hospitalization costs versus Private. SNHs care for higher cost populations while receiving lower reimbursements and are further penalized by the unintended consequences of HRRP. Increasing access to care, especially for Medicaid/Uninsured patients, could reduce urgent/emergent surgeries resulting in fewer complications, EDOS/readmissions, and costs.
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Affiliation(s)
- Michael A. Jacobs
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Jeongsoo Kim
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Jasmine C. Tetley
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Susanne Schmidt
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX
| | - Bradley B. Brimhall
- Department of Pathology and Laboratory Medicine, University of Texas Health San Antonio, San Antonio, TX
- University Health, San Antonio, TX
| | | | - Chen-Pin Wang
- Department of Population Health Sciences, University of Texas Health San Antonio, San Antonio, TX
| | - Laura S. Manuel
- Business Intelligence and Data Analytics, University of Texas Health Physicians, University of Texas Health San Antonio, San Antonio, TX
| | - Paul Damien
- Department of Information, Risk, and Operations Management, Red McCombs School of Business, University of Texas, Austin, TX
| | - Paula K. Shireman
- From the Department of Surgery, University of Texas Health San Antonio, San Antonio, TX
- University Health, San Antonio, TX
- Departments of Primary Care & Rural Medicine and Medical Physiology, School of Medicine, Texas A&M Health, Bryan, TX
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Discharge within 24 hours following colonic surgery-a distant dream or near reality? A scoping review. Surgery 2022; 172:869-877. [PMID: 35840425 DOI: 10.1016/j.surg.2022.04.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/11/2022] [Accepted: 04/29/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Enhanced recovery after surgery programs have improved patient outcomes following colorectal surgery. This has provided a platform for the consideration of ambulatory colectomies where patients are discharged within 24 hours after surgery. Although some studies have demonstrated its feasibility, the safety profile and patient eligibility criteria for discharge within 24 hours after surgery remain relatively ill-defined. This study provided a review of the patient selection criteria and postoperative outcomes shown in patients discharged within 24 hours after surgery. METHODS Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were adhered to. A comprehensive search was performed on 3 electronic databases, and the relevant articles were identified. The primary outcome measures were postoperative morbidity and readmission rates. The different domains relevant to the selection of patients and perioperative care of patients discharged within 24 hours after surgery were also qualitatively assessed. RESULTS Eight studies were included, which involved a total of 1,229 patients. The majority of selected patients underwent elective laparoscopic colonic surgeries. The patient characteristics, such as age, comorbidities, obesity, and psychosocial environment, were important considerations. A close follow-up with home-based medical services was ideal in patients discharged within 24 hours after surgery. The readmission rates ranged from 0.0% to 9.0%. Despite morbidity rates of up to 26.7%, the majority of them were minor and classified as Clavien-Dindo Grade I to II. CONCLUSION The use of programs related to discharge within 24 hours after surgery in colorectal surgery is safe, feasible, and practical in a select group of patients within a well-designed clinical framework and pathway. Future studies should compare patient outcomes following discharge within 24 hours after surgery with conventional enhanced recovery after surgery protocols. In addition, patient and caregiver perceptions, quality of life, and cost-effectiveness analysis should also be performed.
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10
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Nizum N, Jacob G. Systematic Review of Ostomy Care Pathways. Adv Skin Wound Care 2022; 35:290-295. [PMID: 35442921 DOI: 10.1097/01.asw.0000823976.96962.b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate if ostomy care pathways improve outcomes for adults anticipating or living with an ostomy. DATA SOURCES In this systematic review, the authors searched the MEDLINE, CINAHL, Cochrane Central, and EMBASE databases. STUDY SELECTION Studies were included if they met the following criteria: written in English, targeted adults anticipating or currently living with an ostomy, evaluated the impact of two or more components of an ostomy care pathway, and included one or more of the pertinent outcomes (patient satisfaction, hospital length of stay, hospital readmission rates, and staff satisfaction). DATA EXTRACTION Details recorded included design, setting, descriptions of intervention and control groups, patient characteristics, outcomes, data collection tools, effect size, and potential harms. DATA SYNTHESIS Of 5,298 total records, 11 met the inclusion criteria: 2 randomized controlled trials and 9 nonrandomized studies. The overall quality of the studies was low. Of the four studies that examined patient satisfaction, all studies reported improvement or positive satisfaction rates. Of the six studies that evaluated hospital length of stay, five noted a decrease in length of stay. Of the eight studies that evaluated hospital readmission rates, five found a reduction in hospital readmission rates. No studies reported on staff satisfaction. CONCLUSIONS Ostomy care pathways included preoperative education and counseling, postoperative education and discharge planning, and outpatient home visits and telephone follow-ups. Ostomy care pathways may contribute to patient satisfaction and decrease both hospital length of stay and hospital readmission rates. However, higher-quality literature is needed to be confident in the effectiveness of ostomy care pathways.
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Affiliation(s)
- Nafsin Nizum
- At the Registered Nurses' Association of Ontario in Toronto, Ontario, Canada, Nafsin Nizum, MN, RN, is Senior Manager, Research and Guideline Development, and Greeshma Jacob, MScN, RN, is Guideline Development Methodologist, Best Practice Guideline Development & Research Team
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11
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Yu HY, Xu SH, Chen YL, Li YX, Yang QH. Nurses' perceptions regarding barriers to implementing the Internet Plus Nursing Service programme: A qualitative study. J Nurs Manag 2021; 30:511-520. [PMID: 34890482 DOI: 10.1111/jonm.13533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/11/2021] [Accepted: 12/07/2021] [Indexed: 01/06/2023]
Abstract
AIM The aim of this work is to investigate nurses' perceptions of barriers constraining the implementation of the Internet Plus Nursing Service program. BACKGROUND The Internet Plus Nursing Service programme helps meet the demands of an ageing population, people with chronic diseases, the disabled, and home convalescents, and affirms the value of nurses. However, this programme has failed to elicit nurses' active participation, and there is limited knowledge regarding nurses' perceptions of the barriers to the programme's implementation. METHODS A qualitative study was conducted. Thematic analysis of the data was performed. RESULTS The analysis yielded three main themes: a sense of insecurity, role conflict, and a lack of support. CONCLUSION This study explores nurses' perspectives on the factors impeding the implementation of the programme, which are identified as being insufficient protection and support on nurses at personal, sociocultural, infrastructural, and organizationallevels. IMPLICATIONS FOR NURSING MANAGEMENT The study results will guide the department of nursing management to foster supportive work and social environment for nurses, which will decrease their feeling of insecurity and role conflicts and provides them enough infrastructural and organizational supports through proposing emergency code system and improving training system and team collaboration.
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Affiliation(s)
- Hong-Yu Yu
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Shi-Hai Xu
- Department of Emergency, Shenzhen People's Hospital (The Second Clinical Medical College of Jinan University), Shenzhen, Guangdong, China
| | - Yan-Ling Chen
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Yao-Xia Li
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
| | - Qiao-Hong Yang
- School of Nursing, Jinan University, Guangzhou, Guangdong, China
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12
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A WeChat-Based Mobile Platform for Perioperative Health Education for Gastrointestinal Surgery. Emerg Med Int 2021; 2021:6566981. [PMID: 34868685 PMCID: PMC8639266 DOI: 10.1155/2021/6566981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022] Open
Abstract
Appropriately instructing and guiding patients before and after surgery is essential for their successful recovery. In recent years, however, the development of the enhanced recovery after surgery (ERAS) protocol has restricted the opportunity for healthcare professionals to spend time with their patients before and after surgery because of efficiency-driven, shortened hospital stay. Here, we embedded health education information of the perioperative period for gastrointestinal surgery on a WeChat-based mobile platform and evaluated the platform through medical staff evaluation, patient volunteer evaluation, and quantitative grading rubric. Clinicians and nurses believed that the mobile platform was attractively designed and easy to navigate, valuable, and adequate for patient health education. The content of health education was embedded into the WeChat-based mobile platform, thereby allowing patients and caregivers to access information at their own pace and enable repeat reading.
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13
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Ruel M, Ramirez Garcia M, Arbour C. Transition from hospital to home after elective colorectal surgery performed in an enhanced recovery program: An integrative review. Nurs Open 2021; 8:1550-1570. [PMID: 34102021 PMCID: PMC8186688 DOI: 10.1002/nop2.730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/29/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
AIM This study aimed to investigate the transition from hospital to home after elective colorectal surgery performed in an Enhanced Recovery After Surgery (ERAS) programme. DESIGN An integrative review. METHODS A search of ten electronic databases was conducted. Data extraction and quality assessment were performed independently by two authors. Data analysis and synthesis were based on Meleis' Transitions Theory (2010). RESULTS Forty-two articles were included, and most (N = 27) were of good or very good quality. The researchers identified five categories to document the nature of transition postsurgery, three conditions affecting such transition, eleven indicators informing about the quality of the transition and several nursing interventions. Overall, this review revealed that the transition from hospital to home after ERAS colorectal surgery is complex. A holistic understanding of this phenomenon may help nurses to recognize what they need to do to optimize the in-home recovery of this clientele.
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Affiliation(s)
| | - Maria‐Pilar Ramirez Garcia
- Faculty of NursingUniversité de MontréalMontréalQCCanada
- Research CenterCentre Hospitalier de l’Université de MontréalMontréalQCCanada
| | - Caroline Arbour
- Faculty of NursingUniversité de MontréalMontréalQCCanada
- Research CenterHôpital du Sacré‐Cœur de MontréalCIUSSS du Nord‐de‐l’Île‐de‐MontréalMontréalQCCanada
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14
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Byrne MHV, Mehmood A, Summers DM, Hosgood SA, Nicholson ML. A systematic review of living kidney donor enhanced recovery after surgery. Clin Transplant 2021; 35:e14384. [PMID: 34101263 DOI: 10.1111/ctr.14384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/26/2021] [Accepted: 05/27/2021] [Indexed: 12/20/2022]
Abstract
Enhanced recovery after surgery (ERAS) reduces complications and shortens hospital stay without increasing readmission or mortality. However, its role in living donor nephrectomy (LDN) has not yet been defined. Medline, Embase, CINAHL, PsycINFO, and Cochrane Central were searched prior to 08/01/21 for all randomized controlled and cohort studies comparing ERAS to standard of care in LDN. The study was registered on PROSPERO (CRD: CRD42019141706). One thousand, three hundred seventy-seven patients were identified from 14 studies (698 patients with ERAS and 679 patients without). There were considerable differences in the protocols used, and compliance with general ERAS recommendations was poor. Meta-analysis of laparoscopic procedures (including hand- and robot-assisted) revealed that duration of stay was significantly reduced by 0.98 days with ERAS (95% CI = 0.36-1.60, P = .002) and opiate requirement by 32.4 mg (95% CI = 1.1-63.7, P = .04). There was no significant difference n readmission rates or complications. Quality of evidence was low to moderate assessed using the GRADE tool. This review suggests there is a positive benefit of ERAS in laparoscopic LDN. However, there was considerable variation in ERAS protocols used, and the quality of evidence was low; as such, a guideline for ERAS in LDN should be developed and validated.
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Affiliation(s)
- Matthew H V Byrne
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Ahmed Mehmood
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Dominic M Summers
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Sarah A Hosgood
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Michael L Nicholson
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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15
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High incidence of potentially preventable emergency department visits after major elective colorectal surgery. Surg Endosc 2021; 36:2653-2660. [PMID: 33959806 DOI: 10.1007/s00464-021-08514-x] [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: 11/02/2020] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Emergency department (ED) visits after surgery represent a significant cost burden on the healthcare system. Furthermore, many ED visits are related to issues of healthcare delivery services and may be avoidable. Few studies have assessed the reasons for ED visits after colorectal surgery. The main objectives of this study were to: (1) identify the reasons why patients presented to the ED within 30 postoperative days and (2) determine if these visits were potentially preventable. METHODS A retrospective chart review was conducted on elective major colorectal surgery cases performed in a single center between 01/2017 and 07/2019. Data collected included demographics, medical history, intraoperative details, postoperative complications, ED visits within 30 postoperative days, and readmissions. Each ED visit was assessed by two reviewers and graded on a scale adapted from the New York University ED algorithm. The gradings were: (1) non-emergent, (2) emergent but treatable in an ambulatory setting, (3) emergent/ED-care required but preventable if timely outpatient care was available, and (4) emergent/ED-care required and non-preventable. Grades 1-3 were deemed potentially preventable. Logistic regression identified independent predictors of potentially preventable visits. RESULTS Six hundred and twenty five patients were included in the final analysis. 110 (17.6%) patients presented to the ED within 30 days. The most common cause of ED visit were ileus/small bowel obstruction (SBO) (16.4%), superficial wound infection (15.5%), genitourinary issues (10.9%), and non-infectious gastrointestinal issues (nausea, malnutrition, diarrhea, high output stomas) (10.9%). After review, 51.8% of visits were considered potentially preventable (Grade 1-3). The most common causes of preventable ED visits were superficial wound infection (24.6%), non-infectious gastrointestinal issues (19.3%), and minor bleeding (14.0%). Creation of a new stoma was the only independent risk factor for potentially preventable ED visits (OR 2.14, 95%CI 1.03-4.47). CONCLUSION Approximately half of ED visits within 30 days of discharge were potentially preventable. These findings indicate a need to improve access to outpatient care to reduce preventable ED visits after elective colorectal surgery.
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16
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Reid TD, Shrestha R, Stone L, Gallaher J, Charles AG, Strassle PD. Socioeconomic disparities in ostomy reversal among older adults with diverticulitis are more substantial among non-Hispanic Black patients. Surgery 2021; 170:1039-1046. [PMID: 33933283 DOI: 10.1016/j.surg.2021.03.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/01/2021] [Accepted: 03/22/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND While ostomies for diverticulitis are often intended to be temporary, ostomy reversal rates can be as low as 46%. There are few comprehensive studies evaluating the effects of socioeconomic status as a disparity in ostomy reversal. We hypothesized that among the elderly Medicare population undergoing partial colectomy for diverticulitis, lower socioeconomic status would be associated with reduced reversal rates. METHODS Retrospective cohort study using a 20% representative sample of Medicare beneficiaries >65 years old with diverticulitis who received ostomies between January 1, 2010, to December 31, 2017. We evaluated the effect of neighborhood socioeconomic status, measured by the Social Deprivation Index, on ostomy reversal within 1 year. Secondary outcomes were complications and mortality. RESULTS Of 10,572 patients, ostomy reversals ranged from 21.2% (low socioeconomic status) to 29.8% (highest socioeconomic status), with a shorter time to reversal among higher socioeconomic status groups. Patients with low socioeconomic status were less likely to have their ostomies reversed, compared with the highest socioeconomic status group (hazard ratio 0.83, 95% confidence interval 0.74-0.93) and were more likely to die (hazard ratio 1.21, 95% confidence interval 1.10-1.33). When stratified by race/ethnicity and socioeconomic status, non-Hispanic White patients at every socioeconomic status had a higher reversal rate than non-Hispanic Black patients (White patients 32.0%-24.8% vs Black patients 19.6%-14.7%). Socioeconomic status appeared to have a higher relative impact among non-Hispanic Black patients. CONCLUSION Among Medicare diverticulitis patients, ostomy reversal rates are low. Patients with lower socioeconomic status are less likely to undergo stoma reversal and are more likely to die; Black patients are least likely to have an ostomy reversal.
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Affiliation(s)
- Trista D Reid
- The University of North Carolina-Chapel Hill, Department of Surgery, Chapel Hill, NC.
| | - Riju Shrestha
- The University of North Carolina-Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC
| | - Lucas Stone
- The University of North Carolina-Chapel Hill, Department of Surgery, Chapel Hill, NC
| | - Jared Gallaher
- The University of North Carolina-Chapel Hill, Department of Surgery, Chapel Hill, NC
| | - Anthony G Charles
- The University of North Carolina-Chapel Hill, Department of Surgery, Chapel Hill, NC
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health
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Donsel PO, Missel M. What's going on after hospital? - Exploring the transition from hospital to home and patient experiences of nurse-led follow-up phone calls. J Clin Nurs 2021; 30:1694-1705. [PMID: 33616272 DOI: 10.1111/jocn.15724] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the transition from hospital to home and patient experiences of nurse-led post-operative follow-up phone calls after thoracic surgery. BACKGROUND Enhanced Recovery After Surgery protocol places new demands on patients after hospital. Need for a proactive approach to improve the post-operative follow-up process in the home is required. DESIGN Qualitative intervention study. METHODS Interviews were conducted with patients who had received a post-operative phone call after hospital discharge (n = 15). The analysis was inspired by Gadamer and Meleis. COREQ guidelines were followed. RESULTS Two overall themes emerged: (1) The follow-up phone call, which concerns experiences involving the actual call and (2) Transitioning from hospital to home, which through four subthemes illuminates; how patients describe their initial time at home, that patients experience a changed body after surgery, that patients feel alone after returning home and that a call from a nurse can help patients not to feel left out and finally why it is absolutely essential that nurses initiate the phone call. CONCLUSION Patients are at different stages in their transition process after hospital, making timing of follow-up tricky. Being part of an Enhanced Recovery After Surgery programme has implications for the initial period after discharge; dominated by fatigue, pain and experiences of a changed body. Patients experience being left alone with their illness, and the phone call helps to relieve this isolation. It is essential that the nurse call the patient since the patients want to avoid disturbing the staff. RELEVANCE TO CLINICAL PRACTICE Healthcare workers can use the findings to understand how patients experience the transition from hospital to home when enrolled in an Enhanced Recovery After Surgery programme. Need for support from a nurse following discharge is suggested.
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Affiliation(s)
- Pernille Orloff Donsel
- Department of Cardiothoracic Surgery, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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18
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State of Recovery 6 Months After Rectal Cancer Surgery: Postoperative Symptoms and Differences With Regard to Surgical Procedure. Gastroenterol Nurs 2021; 44:98-105. [PMID: 33675597 DOI: 10.1097/sga.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 03/31/2020] [Indexed: 11/26/2022] Open
Abstract
Rectal cancer surgery has developed to be highly technological and precise. Nevertheless, postoperative symptoms can affect patients for a long time after surgery and might also be persistent. The purpose of this study was to describe the level of postoperative symptoms 6 months after rectal cancer surgery as well as differences in symptoms with regard to surgical procedure. Data from 117 patients recovering from rectal cancer surgery were collected 6 months after surgery using the Postoperative Recovery Profile (PRP) questionnaire measuring self-reported postoperative symptoms. Results showed that the majority of patients had no or mild problems with the 19 symptoms recorded in the questionnaire. There was a significant difference between surgical procedures: patients after anterior resection experienced mild problems in gastrointestinal function (physical domain) and interest in their surroundings (social domain), whereas most patients after abdominoperineal resection and abdominoperineal resection with myocutaneous flap showed no problems. In all groups, a considerably high proportion of patients reported severe problems in sexual activity (physical domain). Findings in this study emphasize that healthcare professionals should pay attention to patients recovering from anterior resection especially regarding problems in the gastrointestinal function. Moreover, there is a need to acknowledge eventual sexual dysfunctions in all rectal cancer patients.
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Boden I, Peng C, Lockstone J, Reeve J, Hackett C, Anderson L, Hill C, Winzer B, Gurusinghe N, Denehy L. Validity and Utility Testing of a Criteria-led Discharge Checklist to Determine Post-operative Recovery after Abdominal Surgery: an International Multicentre Prospective Cohort Trial. World J Surg 2020; 45:719-729. [PMID: 33231731 DOI: 10.1007/s00268-020-05873-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Criteria-led discharge (CLD) has promising potential to reduce unnecessary hospital stay after abdominal surgery; however, the validity and utility of CLD is uncertain as studies are limited to small single-centre studies involving predominantly elective colorectal surgery. METHODS This prospective international multicentre cohort study explored the relationship between a CLD checklist, post-operative recovery, and hospital length of stay using patient-level data from four clinical trials involving 1071 adults undergoing all types of emergency and elective abdominal surgery at five hospitals across Australia and New Zealand. Patients were assessed daily for 21 post-operative days using a standardised CLD checklist. Surgeons and hospital clinicians were masked to findings. Criterion, construct, and content validity of the checklist to accurately reflect discharge decisions by surgical teams, assess physiological recovery, and encompass parameters signalling physiological readiness to discharge were tested. Potential utility of CLD to minimise unnecessary hospital stay was assessed by comparing day of readiness to discharge to actual day of discharge. RESULTS The CLD checklist had concordance with existing discharge planning practices and accurately measured a longer post-operative recovery in more complex clinical situations. The CLD checklist in its current format did not detect all legitimate medical and surgical reasons necessitating a continued stay in hospital. Day of readiness to discharge was 0.8 days (95% CI 0.7 to 0.9, p < 0.001) less than actual day of discharge. CONCLUSION A CLD checklist has excellent criterion and construct validity in measuring physiological recovery following all types of major elective and emergency abdominal surgery. Content validity could be improved. The use of CLD has the potential to reduce unnecessary hospital stay although the safety of discharging patients according to the criteria requires investigation prior to implementation. TRIAL REGISTRATION Trials were prospectively registered at the Australian New Zealand Clinical Trials Registry (LIPPSMAck POP 12613000664741, ICEAGE 12615000318583, PLASTIC 12619001344189, NIPPER PLUS 12617000269336).
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Affiliation(s)
- Ianthe Boden
- Department of Physiotherapy, Launceston General Hospital, Clifford Craig Foundation, TAS, PO BOX 1963, Launceston, 7250, Australia.
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
| | - Calvin Peng
- Department of Surgery, Launceston General Hospital, Launceston, TAS, Australia
| | - Jane Lockstone
- Department of Physiotherapy, Launceston General Hospital, Clifford Craig Foundation, TAS, PO BOX 1963, Launceston, 7250, Australia
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Julie Reeve
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
- Physiotherapy Department, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Claire Hackett
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Physiotherapy Department, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, Australia
| | - Lesley Anderson
- Physiotherapy Department, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Cat Hill
- Physiotherapy Department, North West Regional Hospital, Burnie, TAS, Australia
| | - Brooke Winzer
- Physiotherapy Department, Northeast Health Wangaratta, Wangaratta, VIC, Australia
| | | | - Linda Denehy
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Allied Health Research, Peter McCallum Cancer Centre, Melbourne, VIC, Australia
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Routine Postoperative Hemoglobin Assessment Poorly PredictsTransfusion Requirement among Patients Undergoing Minimally Invasive Radical Prostatectomy. UROLOGY PRACTICE 2020; 7:299-304. [PMID: 32551332 DOI: 10.1097/upj.0000000000000108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Introduction An advantage of minimally invasive radical prostatectomy over open surgery is decreased blood loss. At our institution hemoglobin is routinely checked 4 and 14 hours postoperatively. We assessed the relevance of this practice in a contemporary cohort undergoing minimally invasive radical prostatectomy. Methods We retrospectively reviewed data from patients undergoing laparoscopic or robotic radical prostatectomy at our institution between January 2010 and September 2018. We identified 3,631 patients with preoperative and postoperative hemoglobin values, and assessed the role of routine hemoglobin assessment in determining need for transfusion within 30 days. Medicare reimbursement rates for 2019 were used for cost analysis. Results Of 3,631 patients in our cohort 44 (1.2%) required transfusion. At 4 hours following surgery the median hemoglobin decrease was 8.0% (IQR 4.8 to 11.4) for patients who did not receive transfusion and 12.5% (9.5 to 19.2) for those who received transfusion. At 14 hours the median decrease was 14.2% (IQR 10.0 to 18.4) vs 33.1% (22.6 to 38.6). Routine hemoglobin assessment had no role in the decision to transfuse in 18 patients (41%). No patient was transfused based on 4-hour values alone. Omitting 1 hemoglobin assessment could have resulted in institutional savings of $37,000 during this period. Conclusions As transfusion following minimally invasive radical prostatectomy is rare, scheduled postoperative hemoglobin assessments in the absence of symptoms are unnecessary to recognize bleeding events. The largest hemoglobin difference between men who did vs did not receive transfusion was seen at 14 hours postoperatively. Thus, this single hemoglobin evaluation is sufficient.
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Childs BR, Breslin MA, Nguyen MP, Simske NM, Whiting PS, Vasireddy A, Vallier HA. Implementation of a mobile app for trauma education: results from a multicenter study. Trauma Surg Acute Care Open 2020; 5:e000452. [PMID: 32548309 PMCID: PMC7279673 DOI: 10.1136/tsaco-2020-000452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 11/04/2022] Open
Abstract
Background In an era of shared decision making, patient expectations for education have increased. Ideal resources would offer accurate information, digital delivery and interaction. Mobile applications have potential to fulfill these requirements. The purpose of this study was to demonstrate adoption of a patient education application (app: http://bit.ly/traumaapp) at multiple sites with disparate locations and varied populations. Methods A trauma patient education application was developed at one trauma center and subsequently released at three new trauma centers. The app contains information regarding treatment and recovery and was customized with provider information for each institution. Each center was provided with promotional materials, and each had strategies to inform providers and patients about the app. Data regarding utilization was collected. Patients were surveyed about usage and recommendations. Results Over the 16-month study period, the app was downloaded 844 times (70%) in the metropolitan regions of the study centers. The three new centers had 380, 89 and 31 downloads, while the original center had 93 downloads. 36% of sessions were greater than 2 min, while 41% were less than a few seconds. The percentage of those surveyed who used the app ranged from 14.3% to 44.0% for a weighted average of 36.8% of those having used the app. The mean patient willingness to recommend the app was 3.3 on a 5-point Likert scale. However, the distribution was bimodal: 60% of patients rated the app 4 or 5, while 32% rated it 1 or 2. Discussion The adoption of a trauma patient education app was successful at four centers with disparate patient populations. The majority of patients were likely to recommend the app. Variations in implementation strategies resulted in different rates of download. Integration of the app into patient education by providers is associated with more downloads. Level of evidence Level III care management.
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Affiliation(s)
| | | | - Mai P Nguyen
- Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Paul S Whiting
- Department of Orthopaedic Surgery, University of Wisconsin System, Madison, Wisconsin, USA
| | | | - Heather A Vallier
- Department of Orthopaedic Surgery, MetroHealth System, Cleveland, Ohio, USA
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Scientific and Clinical Abstracts From WOCNext 2020 Reimagined. J Wound Ostomy Continence Nurs 2020. [DOI: 10.1097/won.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Minimizing the impact of colorectal surgery in the older patient: The role of enhanced recovery programs in older patients. Eur J Surg Oncol 2020; 46:338-343. [DOI: 10.1016/j.ejso.2019.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/04/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023] Open
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Dru RC, Curtis NJ, Court EL, Spencer C, El Falaha S, Dennison G, Dalton R, Allison A, Ockrim J, Francis NK. Impact of anaemia at discharge following colorectal cancer surgery. Int J Colorectal Dis 2020; 35:1769-1776. [PMID: 32488418 PMCID: PMC7415032 DOI: 10.1007/s00384-020-03611-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Preoperative anaemia is common in patients with colorectal cancer and increasingly optimised prior to surgery. Comparably little attention is given to the prevalence and consequences of postoperative anaemia. We aimed to investigate the frequency and short- or long-term impact of anaemia at discharge following colorectal cancer resection. METHODS A dedicated, prospectively populated database of elective laparoscopic colorectal cancer procedures undertaken with curative intent within a fully implemented ERAS protocol was utilised. The primary endpoint was anaemia at time of discharge (haemoglobin (Hb) < 120 g/L for women and < 135 g/L for men). Patient demographics, tumour characteristics, operative details and postoperative outcomes were captured. Median follow-up was 61 months with overall survival calculated with the Kaplan-Meier log rank method and Cox proportional hazard regression based on anaemia at time of hospital discharge. RESULTS A total of 532 patients with median 61-month follow-up were included. 46.4% were anaemic preoperatively (cohort mean Hb 129.4 g/L ± 18.7). Median surgical blood loss was 100 mL (IQR 0-200 mL). Upon discharge, most patients were anaemic (76.6%, Hb 116.3 g/L ± 14, mean 19 g/L ± 11 below lower limit of normal, p < 0.001). 16.7% experienced postoperative complications which were associated with lower discharge Hb (112 g/L ± 12 vs. 117 g/L ± 14, p = 0.001). Patients discharged anaemic had longer hospital stays (7 [5-11] vs. 6 [5-8], p = 0.037). Anaemia at discharge was independently associated with reduced overall survival (82% vs. 70%, p = 0.018; HR 1.6 (95% CI 1.04-2.5), p = 0.034). CONCLUSION Anaemia at time of discharge following elective laparoscopic colorectal cancer surgery and ERAS care is common with associated negative impacts upon short-term clinical outcomes and long-term overall survival.
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Affiliation(s)
- Rebecca C. Dru
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK ,University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU UK
| | - Nathan J. Curtis
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK ,Department of Surgery and Cancer, Imperial College London, Praed Street, London, W2 1NY UK
| | - Emma L. Court
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Catherine Spencer
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Sara El Falaha
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Godwin Dennison
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Richard Dalton
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Andrew Allison
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Jonathan Ockrim
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK
| | - Nader K. Francis
- Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, Somerset BA21 4AT UK ,Division of Surgery and Interventional Science, University College London, London, UK ,Northwick Park Institute of Medical Research, Y Block, Northwick Park Hospital, Harrow, HA1 3UJ UK
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Practice and Training Needs of Staff Nurses Caring for Patients With Intestinal Ostomies in Primary and Secondary Hospitals in China. J Wound Ostomy Continence Nurs 2019; 46:408-412. [DOI: 10.1097/won.0000000000000557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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van Beekum C, Stoffels B, von Websky M, Ritz JP, Stinner B, Post S, Schwenk W, Kalff JC, Vilz TO. Implementierung eines Fast-Track-Programmes. Chirurg 2019; 91:143-149. [DOI: 10.1007/s00104-019-1009-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Wu JM, Ho TW, Chang YT, Hsu C, Tsai CJ, Lai F, Lin MT. Wearable-Based Mobile Health App in Gastric Cancer Patients for Postoperative Physical Activity Monitoring: Focus Group Study. JMIR Mhealth Uhealth 2019; 7:e11989. [PMID: 31012858 PMCID: PMC6658307 DOI: 10.2196/11989] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/13/2018] [Accepted: 03/24/2019] [Indexed: 12/14/2022] Open
Abstract
Background Surgical cancer patients often have deteriorated physical activity (PA), which in turn, contributes to poor outcomes and early recurrence of cancer. Mobile health (mHealth) platforms are progressively used for monitoring clinical conditions in medical subjects. Despite prevalent enthusiasm for the use of mHealth, limited studies have applied these platforms to surgical patients who are in much need of care because of acutely significant loss of physical function during the postoperative period. Objective The aim of our study was to determine the feasibility and clinical value of using 1 wearable device connected with the mHealth platform to record PA among patients with gastric cancer (GC) who had undergone gastrectomy. Methods We enrolled surgical GC patients during their inpatient stay and trained them to use the app and wearable device, enabling them to automatically monitor their walking steps. The patients continued to transmit data until postoperative day 28. The primary aim of this study was to validate the feasibility of this system, which was defined as the proportion of participants using each element of the system (wearing the device and uploading step counts) for at least 70% of the 28-day study. “Definitely feasible,” “possibly feasible,” and “not feasible” were defined as ≥70%, 50%-69%, and <50% of participants meeting the criteria, respectively. Moreover, the secondary aim was to evaluate the clinical value of measuring walking steps by examining whether they were associated with early discharge (length of hospital stay <9 days). Results We enrolled 43 GC inpatients for the analysis. The weekly submission rate at the first, second, third, and fourth week was 100%, 93%, 91%, and 86%, respectively. The overall daily submission rate was 95.5% (1150 days, with 43 subjects submitting data for 28 days). These data showed that this system met the definition of “definitely feasible.” Of the 54 missed transmission days, 6 occurred in week 2, 12 occurred in week 3, and 36 occurred in week 4. The primary reason for not sending data was that patients or caregivers forgot to charge the wearable devices (>90%). Furthermore, we used a multivariable-adjusted model to predict early discharge, which demonstrated that every 1000-step increment of walking on postoperative day 5 was associated with early discharge (odds ratio 2.72, 95% CI 1.17-6.32; P=.02). Conclusions Incorporating the use of mobile phone apps with wearable devices to record PA in patients of postoperative GC was feasible in patients undergoing gastrectomy in this study. With the support of the mHealth platform, this app offers seamless tracing of patients’ recovery with a little extra burden and turns subjective PA into an objective, measurable parameter.
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Affiliation(s)
- Jin-Ming Wu
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.,Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Te-Wei Ho
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Yao-Ting Chang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - ChungChieh Hsu
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Chia Jui Tsai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Feipei Lai
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ming-Tsan Lin
- Department of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.,Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
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Nelson G, Bakkum-Gamez J, Kalogera E, Glaser G, Altman A, Meyer LA, Taylor JS, Iniesta M, Lasala J, Mena G, Scott M, Gillis C, Elias K, Wijk L, Huang J, Nygren J, Ljungqvist O, Ramirez PT, Dowdy SC. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. Int J Gynecol Cancer 2019; 29:651-668. [PMID: 30877144 DOI: 10.1136/ijgc-2019-000356] [Citation(s) in RCA: 387] [Impact Index Per Article: 77.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This is the first updated Enhanced Recovery After Surgery (ERAS) Society guideline presenting a consensus for optimal perioperative care in gynecologic/oncology surgery. METHODS A database search of publications using Embase and PubMed was performed. Studies on each item within the ERAS gynecologic/oncology protocol were selected with emphasis on meta-analyses, randomized controlled trials, and large prospective cohort studies. These studies were then reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS All recommendations on ERAS protocol items are based on best available evidence. The level of evidence for each item is presented accordingly. CONCLUSIONS The updated evidence base and recommendation for items within the ERAS gynecologic/oncology perioperative care pathway are presented by the ERAS® Society in this consensus review.
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Affiliation(s)
- Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jamie Bakkum-Gamez
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eleftheria Kalogera
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Gretchen Glaser
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Alon Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Larissa A Meyer
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jolyn S Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria Iniesta
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Javier Lasala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gabriel Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael Scott
- Department of Anesthesia, Virginia Commonwealth University Hospital, Richmond, Virginia, USA
| | - Chelsia Gillis
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Elias
- Division of Gynecologic Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Lena Wijk
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jeffrey Huang
- Department of Anesthesiology, Oak Hill Hospital, Brooksville, Florida, USA
| | - Jonas Nygren
- Departments of Surgery and Clinical Sciences, Ersta Hospital and Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Olle Ljungqvist
- Department of Surgery, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Borsuk DJ, Al-Khamis A, Geiser AJ, Zhou D, Warner C, Kochar K, Marecik SJ. S128: Active post discharge surveillance program as a part of Enhanced Recovery After Surgery protocol decreases emergency department visits and readmissions in colorectal patients. Surg Endosc 2019; 33:3816-3827. [PMID: 30859488 DOI: 10.1007/s00464-019-06725-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 03/01/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) programs aim to standardize perioperative care to reduce morbidity and cost. Our study examined an Active Post-Discharge Surveillance (APDS) program in reducing avoidable readmissions and emergency department (ED) visits in postoperative colorectal ERAS patients. METHODS Colectomy (right, subtotal and total) and low anterior resection cases performed at a tertiary care hospital between 2015 and 2018 were reviewed. ED visits, 30-day readmissions, and patients' APDS participation were assessed. Our APDS followed a modern text messaging paradigm offered to all patients free-of-charge. RESULTS Of 236 patients that underwent colectomy, 123 utilized APDS and 113 did not. Overall, both non-surveillance (NS) and active surveillance (AS) groups had similar preoperative characteristics. Length of hospital stay at index surgery was longer in the NS compared to AS group, 4.7 ± 2.6 vs. 2.6 ± 2.8 days, respectively (p < 0.001). In the NS group, 16 patients visited the ED, of which 14 (14/16, 87.5%) were ultimately readmitted. One patient was directly readmitted from the surgeon's office, resulting in a total of 15 (15/113, 13.3%) total patients readmitted by postoperative day (POD) 30. In the AS group, 9 patients visited the ED, of which 7 (7/9, 77.8%) were ultimately readmitted. One patient was directly readmitted, resulting in a total of 8 (8/123, 6.5%) total patients readmitted by POD 30. AS patients had significantly lower odds of visiting the ED when compared to NS patients (OR: 0.356; 95% CI: 0.138-0.919; p = 0.0328). Similarly, AS patients had significantly lower odds of readmission when compared to NS patients (OR: 0.343; 95% CI: 0.132-0.892; p = 0.0283). CONCLUSIONS APDS allows many postoperative issues to be resolved in outpatient settings without ER visits or readmission. This indicates APDS is a valuable ERAS adjunct by establishing a cost-effective and convenient communication line between patients and their surgical team.
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Affiliation(s)
- Daniel J Borsuk
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, 60068, IL, USA. .,Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Ahmed Al-Khamis
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, 60068, IL, USA
| | - Andrew J Geiser
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, 60068, IL, USA
| | - Dimin Zhou
- Chicago Medical School, North Chicago, IL, USA
| | - Christina Warner
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, 60068, IL, USA
| | - Kunal Kochar
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, 60068, IL, USA
| | - Slawomir J Marecik
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 1550 N. Northwest Highway, Suite 107, Park Ridge, 60068, IL, USA.,University of Illinois College of Medicine, Chicago, IL, USA
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Berger I, Xia L, Wirtalla C, Guzzo TJ, Kelz RR. Early Discharge After Radical Nephrectomy: An Analysis of Complications and Readmissions. Clin Genitourin Cancer 2018; 17:e293-e305. [PMID: 30587406 DOI: 10.1016/j.clgc.2018.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 11/24/2018] [Accepted: 11/25/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Length of stay (LOS) is increasingly being viewed as a quality metric, and efforts to reduce LOS are present across most surgical subspecialties. However, data on whether reducing LOS is safe in patients who undergo radical nephrectomy (RN) are lacking. The purpose of this study was to assess whether early discharge after RN affects readmission rates and postdischarge complications using a national cohort of patients. PATIENTS AND METHODS The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent RN from 2012 to 2015. Procedures were stratified as minimally invasive or open. Early discharge was defined as less than or equal to the procedure-specific 25th percentile for LOS. Multivariable analysis was used to identify factors associated with readmission and postdischarge complications. A sensitivity analysis excluded patients with a LOS >75th percentile. RESULTS A total of 11,429 patients were included. The 25th percentile for LOS was 2 days in the minimally invasive group and 3 days in the open group. In multivariable analysis, early discharge did not increase the risk of postdischarge complications (odds ratio, 0.88; 95% confidence interval, 0.71-1.08; P = .214) and decreased the risk of readmission (odds ratio, 0.72; 95% confidence interval, 0.59-0.87; P = .001). CONCLUSION Early discharge after RN does not increase the risk of postdischarge complications or readmission. With the appropriate patient selection, decreasing LOS might lead to decreased surgical costs and improved patient flow. This work provides a foundation for future research that might optimize perioperative care pathways to decrease LOS.
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Affiliation(s)
- Ian Berger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Christopher Wirtalla
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Rachel R Kelz
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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Wang H, Wang Y, Xing H, Zhou Y, Zhao J, Jiang J, Liu Q. Laparoscopic Surgery Within an Enhanced Recovery after Surgery (ERAS) Protocol Reduced Postoperative Ileus by Increasing Postoperative Treg Levels in Patients with Right-Side Colon Carcinoma. Med Sci Monit 2018; 24:7231-7237. [PMID: 30303179 PMCID: PMC6192453 DOI: 10.12659/msm.910817] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this study was to determine the effects of laparoscopic surgery within an ERAS program on outcomes and immunological function in patients with a carcinoma in the right colon. Material/Methods Patient data were acquired from a prospectively maintained database, and 176 patients diagnosed with right colon carcinoma with surgery were selected from the database. These patients were divided into a laparoscopic group (Lap group, n=86) and an open operation group (Open group, n=90). All patients received treatment according to a standardized ERAS protocol. We collected data on CRP levels, CD4+/CD8+ ratios, and Treg values in peripheral blood, baseline and surgical characteristics, postoperative complications, and postoperative ileus (POI). Results Circulating CD4+/CD8+ ratios and Treg values were decreased and CRP levels were increased in both groups after the operation. However, the values in the Lap group patients recovered much more quickly than those of patients in the Open group (P<0.05). Patients undergoing laparoscopic surgery had significantly less preoperative bleeding (P<0.01), reduced ratio of overall POI (mainly early ileus), and shorter postoperative hospital stay (P=0.03). Multivariate logistic regression analysis showed that POD1 Treg value was an independent predicator for postoperative ileus in patients with right colon carcinoma resection. Conclusions In patients with a carcinoma in the right colon, laparoscopic surgery within an ERAS protocol leads to better immunity preservation after surgery, and POD1 Treg value may be an independent predicator for postoperative ileus, which could, at least in part, explain the shorter hospital stay after surgery.
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Affiliation(s)
- Honggang Wang
- Department of General Surgery, Taizhou People's Hospital, Taizhou Clinical Medical College of Nanjing Medical University, Taizhou, Jiangsu, China (mainland)
| | - Yong Wang
- Department of General Surgery, Taizhou People's Hospital, Taizhou Clinical Medical College of Nanjing Medical University, Taizhou, Jiangsu, China (mainland)
| | - Hailin Xing
- Department of Anesthesiology, Taizhou People's Hospital, Taizhou Clinical Medical College of Nanjing Medical University, Taizhou, Jiangsu, China (mainland)
| | - Yaxing Zhou
- Department of General Surgery, Taizhou People's Hospital, Taizhou Clinical Medical College of Nanjing Medical University, Taizhou, Jiangsu, China (mainland)
| | - Jie Zhao
- Department of General Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jianguo Jiang
- Department of General Surgery, Taizhou People's Hospital, Taizhou Clinical Medical College of Nanjing Medical University, Taizhou, Jiangsu, China (mainland)
| | - Qinghong Liu
- Department of General Surgery, Taizhou People's Hospital, Taizhou Clinical Medical College of Nanjing Medical University, Taizhou, Jiangsu, China (mainland)
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Wierdak M, Pisarska M, Kuśnierz-Cabala B, Witowski J, Major P, Ceranowicz P, Budzyński A, Pędziwiatr M. Serum Amyloid A as an Early Marker of Infectious Complications after Laparoscopic Surgery for Colorectal Cancer. Surg Infect (Larchmt) 2018; 19:622-628. [DOI: 10.1089/sur.2018.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Beata Kuśnierz-Cabala
- Department of Diagnostics, Chair of Clinical Biochemistry, Jagiellonian University Medical College, Kraków, Poland
| | - Jan Witowski
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Piotr Ceranowicz
- Department of Physiology, Jagiellonian University Medical College, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
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