Assessment of Ileostomy Output Using Telemedicine: A Feasibility Trial

Effectiveness of current perioperative telemonitoring on postoperative outcome in patients undergoing major abdominal surgery: A systematic review of controlled trials

BACKGROUND

Perioperative telemonitoring of patients undergoing major surgery might lead to improved postoperative outcomes. The aim of this systematic review is to evaluate the effectiveness of current perioperative telemonitoring interventions on postoperative clinical, patient-reported, and financial outcome measures in patients undergoing major surgery.

METHODS

For this systematic review, PubMed, CINAHL, and Embase databases were searched for eligible articles published between January 1, 2009 and March 15, 2021. Studies were eligible as they described: (P) patients aged 18 years or older who underwent major abdominal surgery, (I) perioperative telemonitoring as intervention, (C) a control group receiving usual care, (O) any type of postoperative clinical, patient-reported, or financial outcome measures, and (S) an interventional study design.

RESULTS

The search identified 2958 articles of which 10 were eligible for analysis, describing nine controlled trials of 2438 patients. Perioperative telemonitoring comprised wearable biosensors (n = 3), websites (n = 3), e-mail (n = 1), and mobile applications (n = 2). Outcome measures were clinical (n = 8), patient-reported (n = 5), and financial (n = 2). Results show significant improvement of recovery time, stoma self-efficacy and pain in the early postoperative phase in patients receiving telemonitoring. Other outcome measures were not significantly different between the groups.

CONCLUSION

Evidence for the effectiveness of perioperative telemonitoring in major surgery is scarce. There is a need for good quality studies with sufficient patients while ensuring that the quality and usability of the technology and the adoption in care processes are optimal.

The Impact of Health Technologies on Ostomy Care: A Systematic Review of Health Technologies Impact on Ostomy Care

PURPOSE

The purpose of this systematic review was to evaluate studies in which health information technology was used to improve ostomy care and management.

METHODS

Systematic literature review.

SEARCH STRATEGIES

The review was performed according to PRISMA Guidelines. Three scientific databases, Scopus, PubMed, and Web of Science, were searched with no time limitation using key words related to information technology and ostomy. The selection of articles and data collection were carried out by 2 reviewers and disagreements were resolved via discussion with a third, independent reviewer.

FINDINGS

The initial search of electronic databases retrieved 1679 elements; following removal of duplicate records, title and abstract review, and articles read in full for inclusion/exclusion criteria, 10 articles were included in the review. Analysis of findings from studies included in our review addresses technologies used to care for persons living with an ostomy. Elements were divided into 2 categories: (1) sensor-based wearable technologies, which were mostly used to assess the fecal output and fullness of ostomy pouching system, and (2) computer-based, tablet based, and smartphones platforms, which were used for teaching and learning. The most significant outcomes were increasing patients' knowledge and awareness of ostomy, enhancing patient's participation in self-care processes, and improving self-efficacy levels.

IMPLICATIONS FOR PRACTICE

We found limited research regarding the effectiveness of technology-based interventions on the management of ostomy patients. Findings of this systematic review suggest that the application of technologies has created a positive effect on the management of an ostomy, provided opportunities for enhancing self-efficacy, self-care, and self-management. The results of this study can be a basis for designing efficient technology-based systems for the management of ostomy.

A review of questionnaires used for the assessment of telemedicine

INTRODUCTION

Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires.

METHODS

We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication.

RESULTS AND DISCUSSION

We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.

A Single-Institution Analysis of Targeted Colorectal Surgery Enhanced Recovery Pathway Strategies That Decrease Readmissions

BACKGROUND

Decreasing readmissions is an important quality improvement strategy. Targeted interventions that effectively decrease readmissions have not been fully investigated and standardized.

OBJECTIVE

The purpose of this study was to assess the effectiveness of interventions designed to decrease readmissions after colorectal surgery.

DESIGN

This was a retrospective comparison of patients before and after the implementation of interventions.

SETTING

This study was conducted at a single institution dedicated enhanced recovery pathway colorectal surgery service.

PATIENTS

The study group received quality review interventions that were designed to decrease readmissions: preadmission class upgrades, a mobile phone app, a pharmacist-led pain management strategy, and an early postdischarge clinic. The control group was composed of enhanced recovery patients before the interventions. Propensity score weighting was used to adjust patient characteristics and predictors for imbalances.

MAIN OUTCOME MEASURE

The primary outcome was 30-day readmissions. Secondary outcomes included emergency department visits.

RESULTS

There were 1052 patients in the preintervention group and 668 patients in the postintervention group. After propensity score weighting, the postintervention cohort had a significantly lower readmission rate (9.98% vs 17.82%, p < 0.001) and emergency department visit rate (14.58% vs 23.15%, p < 0.001) than the preintervention group, and surgical site infection type I/II was significantly decreased as a readmission diagnosis (9.46% vs 2.43%, p = 0.043). Median time to readmission was 6 (interquartile 3-11) days in the preintervention group and 8 (3-17) days in the postintervention group (p = 0.21). Ileus, acute kidney injury, and surgical site infection type III were common reasons for readmissions and emergency department visits.

LIMITATIONS

A single-institution study may not be generalizable.

CONCLUSION

Readmission bundles composed of targeted interventions are associated with a decrease in readmissions and emergency department visits after enhanced recovery colorectal surgery. Bundle composition may be institution dependent. Further study and refinement of bundle components are required as next-step quality metric improvements. See Video Abstract at http://links.lww.com/DCR/B849.

ANLISIS EN UNA SOLA INSTITUCIN DE LAS CIRUGAS COLORECTALES CON VAS DE RECUPERACIN DIRIGIDA AUMENTADA QUE REDUCEN LOS REINGRESOS

ANTECEDENTES:La reducción de los reingresos es una importante estrategia de mejora de la calidad. Las intervenciones dirigidas que reducen eficazmente los reingresos no se han investigado ni estandarizado por completo.OBJETIVO:El propósito de este estudio fue evaluar la efectividad de las intervenciones diseñadas para disminuir los reingresos después de la cirugía colorrectal.DISEÑO:Comparación retrospectiva de pacientes antes y después de la implementación de las intervenciones.ESCENARIO:Una sola institución dedicada al Servicio de cirugía colorrectal con vías de recuperación dirigida aumentadaPACIENTES:El grupo de estudio recibió intervenciones de revisión de calidad que fueron diseñadas para disminuir los reingresos: actualizaciones de clases previas a la admisión, una aplicación para teléfono móvil, una estrategia de manejo del dolor dirigida por farmacéuticos y alta temprana de la clínica. El grupo de control estaba compuesto por pacientes con recuperación mejorada antes de las intervenciones. Se utilizó la ponderación del puntaje de propensión para ajustar las características del paciente y los predictores de los desequilibrios.PARÁMETRO DE RESULTADO PRINCIPAL:El resultado primario fueron los reingresos a los 30 días. Los resultados secundarios incluyeron visitas al servicio de urgencias.RESULTADOS:Hubo 1052 pacientes en el grupo de preintervención y 668 pacientes en el grupo de posintervención. Después de la ponderación del puntaje de propensión, la cohorte posterior a la intervención tuvo una tasa de reingreso significativamente menor (9,98% frente a 17,82%, p <0,001) y una tasa de visitas al servicio de urgencias (14,58% frente a 23,15%, p <0,001) que el grupo de preintervención y la infección del sitio quirúrgico tipo I / II se redujo significativamente como diagnóstico de reingreso (9,46% frente a 2,43%, p = 0,043). La mediana de tiempo hasta la readmisión fue de 6 [IQR 3, 11] días en el grupo de preintervención y de 8 [3, 17] días en el grupo de posintervención (p = 0,21). El íleo, la lesión renal aguda y la infección del sitio quirúrgico tipo III fueron motivos frecuentes de reingresos y visitas al servicio de urgencias.LIMITACIONES:El estudio de una sola institución puede no ser generalizable.CONCLUSIÓNES:Los paquetes de readmisión compuestos por intervenciones dirigidas se asocian con una disminución en las readmisiones y las visitas al departamento de emergencias después de una cirugía colorrectal con vías de recuperación dirigida aumentada. La composición del paquete puede depender de la institución. Se requieren más estudios y refinamientos de los componentes del paquete como siguiente paso de mejora de la métrica de calidad. Consulte Video Resumen en http://links.lww.com/DCR/B849. (Traducción-Dr Yolanda Colorado).

Physician Satisfaction With Telehealth: A Systematic Review and Agenda for Future Research

BACKGROUND AND OBJECTIVES

The use of telehealth has risen dramatically due to the Covid-19 pandemic and is expected to be a regular part of patient care moving forward. We know little currently about how satisfied physicians are with this type of patient care. The present systematic review examines physician satisfaction with telehealth, as physician acceptance remains vital to telehealth gaining wider and more permanent adoption.

METHODS

A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review of empirical articles published between 2010 and 2020 that contain a finding examining physician satisfaction with using telehealth, using 4 article databases (PubMed, Web of Science, COCHRANE, and CINAHL), to identify relevant studies. A standardized data abstraction Excel sheet was used to extract relevant information from each of the included studies. Relevant study findings related to physician satisfaction with telehealth were reviewed for each of the 37 studies by the coauthors.

RESULTS

A total of 37 published studies were included in the review. Thirty-three of the 37 (89%) studies reviewed were classified as having findings showing moderate to high levels of physician satisfaction with telehealth. Just under 60% of the studies focused on physician satisfaction with providing telemedicine to patients (21/37). Twelve other studies focused on physician satisfaction with teleconsultations with other providers. Four studies examined physician satisfaction with both. The type of patient telemedicine or provider teleconsultation performed varied greatly across the 37 studies, with several different diagnoses or care situations included. Research designs used in the studies were less robust, with all studies using primary data for assessing physician satisfaction but only one study providing any type of multivariate analysis of physician satisfaction with telehealth.

CONCLUSION

The results of this review support the observation that physicians across different specialties, geographic locations, practice locations, and care situations appear satisfied with engaging in telehealth for both patient care and consultations with other physicians. The research on telehealth should be enhanced, given how ubiquitous telehealth has become due to the Covid-19 pandemic. This enhancement should include larger physician sample sizes in studies of telehealth satisfaction; more research focused on telehealth in the primary care setting; and the types of virtual modalities that have become more commonplace for physicians to use due to the Covid-19 pandemic.

The Use of Telemedicine in Older Patients with Gastrointestinal Diseases

Purpose of Review

The COVID-19 pandemic helped us understand that telemedicine provides an alternative way to manage patients remotely, with an added benefit of saving time and travel costs. However, barriers may exist in an older population of patients such as inadequate technology availability and knowledge, and lack of internet connectivity. This systematic review and analysis of data at an academic medical center examines the current literature and investigates the efficacy of telemedicine for older adults requiring gastrointestinal care.

Recent Findings

In the systematic review, we included 22 manuscripts from an initial 120 that were identified based on inclusion and exclusion criteria. In this existing literature, telemedicine visits were equivalent or better than in-person visits based on many metrics, including patient satisfaction, time and money saved, and standard patient outcomes. At a rural academic medical center, there was a steady decrease in the failure rate of telemedicine visits from April 2020 to May 2022 in all age groups, including the 65 + age group, from 17% in April 2020 to 3% in May 2022.

Summary

Telemedicine offers a comparable alternative to in-person visits that is convenient, low-cost, and does not compromise quality of care for older patients obtaining GI care. The COVID-19 pandemic has accelerated progress and uptake of telemedicine, and the successful use by all ages including older patients opens the broader conversation about the continued use of telemedicine for care in various areas of medicine.

A National Evaluation of Surgeon Experiences in Telemedicine for the Care of Hernia and Abdominal Core Health Patients

Background

Surgeons are increasingly utilizing telemedicine to provide perioperative services to patients. Safety, satisfaction, and feasibility of these programs in general populations have been established, but it is unclear how telemedicine can be integrated into subspecialty care. We report results of a national survey related to telehealth practices among members of the Abdominal Core Health Quality Collaborative (ACHQC).

Methods

Survey responses were analyzed to determine current strategies in telemedicine utilization. Surgeon preferences, perceptions of validity, and identified barriers to implementation of telemedicine were assessed.

Results

Forty surgeons within the ACHQC responded, with 90% of respondents reporting use of telemedicine to deliver perioperative care to patients with hernias and abdominal core health concerns. Surgeons appeared to be more comfortable managing preoperative patients with image-confirmed diagnoses of hernias. Surgeons were universally more comfortable delivering postoperative care via telemedicine. Connectivity, patient engagement, and reimbursement were identified as potential barriers to expansion of telemedicine. Seventy-eight percent of respondents reported that they would increase telemedicine utilization if current regulations were maintained in the future.

Conclusions

This study found that hernia specialists are utilizing telemedicine at a higher rate than before the COVID-19 pandemic, with surgeons reporting interest in continued use of this modality beyond the pandemic. These findings suggest that future work in telemedicine optimization may improve the quality of care that can be delivered to patients with abdominal core health concerns.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00268-021-06332-9.

Patient Perception and Preferences for Virtual Telemedicine Visits for Hand and Upper Extremity Surgery

Background: Telemedicine in upper extremity surgery is an evolving modality that provides a viable alternative to the traditional in-person visit for achieving convenient, safe, and cost-effective health care. Our study aimed to identify patient preferences for virtual visits for hand and upper extremity surgery. Methods: An institutional review board approved survey was prospectively administered to all patients >18 years of age, presenting for any complaint to an orthopedic hand and upper extremity clinic at a Level I academic trauma center from September to December 2019. This survey included questions about access and literacy of technology as well as patient preferences regarding virtual visits. The medical record was reviewed to collect demographics, insurance type, and reasons for their visit. Bivariate and multivariate analyses were performed according to survey responses. Results: Two hundred consecutive patients (n) completed surveys. Surveys revealed that >88% of patients own a computer or smartphone, have WiFi access at home, and own a device capable of video chat. In total, 75% of patients reported that they would be moderately or highly comfortable in their ability to use a device for a virtual visit. In bivariate and multivariate analyses, technological literacy and access to a private space to conduct a visit were associated with high interest in virtual visits. Discussion: Telemedicine is a viable alternative to in-person patient visits. Our study demonstrates that most patients are willing and able to participate in a virtual visit for a hand or upper extremity issue.

Risk factors for developing high-output ileostomy in CRC patients: a retrospective study

BACKGROUND

Anastomotic leakage is one of the most serious postoperative complications of rectal cancer. Prophylactic ileostomy has been widely used to reduce the risk and severity of complications of anastomotic leakage. However, prophylactic ileostomy itself has some complications, and ileostomy high output syndrome (HOS) is one of them. This study was performed to explore the risk factors of HOS in ileostomy.

METHODS

A total of 114 patients with HOS were screened out from 494 eligible ileostomy patients in the last 5 years. The relationship between HOS and the clinicopathological data was analyzed using the Chi-square test and Fisher's exact probability. Multivariate analysis was performed by logistic regression.

RESULTS

The incidence of HOS was 23.07% in this study. Dehydration was the most common symptom of HOS (37.7%). There was no clear correlation between HOS occurrence with sex, age, gross typing, histological grade, tumor location, lymph node metastasis, and TNM stage (p > 0.05). The incidence of HOS was 14/18 in inflammatory bowel disease patients, 18/28 in diabetes mellitus patients, and 23/72 in neoadjuvant chemoradiotherapy patients, 13/17 in total colectomy and abdominal infection patients. Multivariate analysis showed that they are risk factors for HOS (p < 0.05).

CONCLUSION

HOS occurred occasionally but rarely studied and lacks attention. Inflammatory bowel disease, diabetes mellitus, neoadjuvant radiotherapy chemotherapy, total colectomy and abdominal infection are the risk factors for HOS.

Practical Advices for Treating Chronic Pain in the Time of COVID-19: A Narrative Review Focusing on Interventional Techniques

BACKGROUND

Since the management of chronic pain has become even more challenging secondary to the occurrence of SARS-CoV-2 outbreaks, we developed an exhaustive narrative review of the scientific literature, providing practical advices regarding the management of chronic pain in patients with suspected, presumed, or confirmed SARS-CoV-2 infection. We focused particularly on interventional procedures, where physicians are in closer contact with patients.

METHODS

Narrative Review of the most relevant articles published between June and December of 2020 that focused on the treatment of chronic pain in COVID-19 patients.

RESULTS

Careful triage of patients is mandatory in order to avoid overcrowding of hospital spaces. Telemedicine could represent a promising tool to replace in-person visits and as a screening tool prior to admitting patients to hospitals. Opioid medications can affect the immune response, and therefore, care should be taken prior to initiating new treatments and increasing dosages. Epidural steroids should be avoided or limited to the lowest effective dose. Non urgent interventional procedures such as spinal cord stimulation and intrathecal pumps should be postponed. The use of personal protective equipment and disinfectants represent an important component of the strategy to prevent viral spread to operators and cross-infection between patients due to the SARS-CoV-2 outbreaks.

Risk factors for readmission with dehydration after ileostomy formation: A systematic review and meta-analysis

AIM

Ileostomy formation is a commonly performed procedure with substantial associated morbidity. Patients with an ileostomy experience high rates of unplanned hospital readmission with dehydration, and such events have a long-term health and economic impact. Reports of the significant risk factors associated with these readmissions have been inconsistent. This study aimed to identify the significant risk factors for readmission with dehydration following ileostomy formation.

METHOD

A systematic search was conducted using the Medline, Embase, Cochrane and CINAHL databases. All original research articles reporting risk factors for readmission with dehydration following ileostomy formation in adults were included. The primary outcome was the pooled risk ratio of clinically relevant variables potentially associated with dehydration-related readmission following ileostomy formation. The secondary outcome was the incidence of dehydration-related readmission.

RESULTS

Ten studies (27 089 patients) were included. The incidences of 30- and 60-day readmission with dehydration were 5.0% (range 2.1%-13.2%) and 10.3% (range 7.3%-14.1%), respectively. Eight variables were found to be significantly associated with dehydration-related readmission: age ≥65 years, body mass index ≥30 kg/m² , diabetes mellitus, hypertension, renal comorbidity, regular diuretic use, ileal pouch-anal anastomosis procedure and length of stay after index admission. A preoperative diagnosis of colorectal cancer was less likely to result in readmission with dehydration.

CONCLUSION

Readmission with dehydration following ileostomy formation is a significant issue with several risk factors. Awareness of these risk factors will help inform the design of future studies addressing risk prediction, allow risk stratification of ileostomates and aid in the development of personalized prevention strategies.

Telemedicine for postoperative follow-up, virtual surgical clinics during COVID-19 pandemic

Summary and background data

Recent coronavirus outbreak and “stay at home” policies have accelerated the implementation of virtual healthcare. Many surgery departments are implementing telemedicine to enhance remote perioperative care. However, concern still arises regarding the safety of this modality in postoperative follow-up after gastrointestinal surgery. The aim of the present prospective study is to compare the use of telemedicine clinics to in-person follow-up for postoperative care after gastrointestinal surgery during COVID-19 outbreak.

Methods

Prospective study that included all abdominal surgery patients operated since the COVID-19 outbreak. On discharge, patients were given the option to perform their postoperative follow-up appointment by telemedicine or by in-person clinics. Demographic, perioperative, and follow-up variables were analyzed.

Results

Among 219 patients who underwent abdominal surgery, 106 (48%) had their postoperative follow-up using telemedicine. There were no differences in age, gender, ASA score, and COVID-19 positive rate between groups. Patients who preferred telemedicine over in-person follow-up were more likely to have undergone laparoscopic surgery (71% vs. 51%, P = 0.037) and emergency surgery (55% vs. 41%; P = 0.038). Morbidity rate for telemedicine and in-person group was 5.7% and 8%, (P = 0.50). Only 2.8% of patients needed an in-person visit following the telemedicine consult, and 1.9% visited the emergency department.

Conclusions

In the current pandemic, telemedicine follow-up can be safely and effectively performed in selected surgical patients. Patients who underwent laparoscopic and emergency procedures opted more for telemedicine than in-person follow-up.

Would patients undergo postoperative follow-up by using a smartphone application?

Background

eHealth applications have been proposed as an alternative to monitor patients in frequent intervals or over long distances. The aim of this study was to assess whether patients would accept an application on their smartphone to be monitored by their physicians.

Methods

During September 2017 and December 2017 a survey amongst smartphone users was conducted via paper and web-based questionnaires.

Results

More than half of the 962 participants (54%) were older than 55 years of age. The majority of the participants (68.7%) would accept a follow-up by a smartphone application obtaining personal healthcare data. 72.6% of all patients older than 55 years of age would use the application. The most prevalent reason against installing the application was data protection. Patients being currently treated in an orthopaedic practice and pedestrians were more eager to accept a follow-up by a mobile app than participants from social media.

Conclusion

The majority of participants would accept a mobile application, collecting personal health-related data for postoperative follow-up, and saw a direct benefit for the patient in such an application.

Emergence From the COVID-19 Pandemic and the Care of Chronic Pain: Guidance for the Interventionalist

BACKGROUND:

The current Coronavirus Disease (COVID-19) pandemic led to a significant disruption in the care of pain from chronic and subacute conditions. The impact of this cessation of pain treatment may have unintended consequences of increased pain, reduced function, increased reliance on opioid medications, and potential increased morbidity, due to the systemic impact of untreated disease burden. This may include decreased mobility, reduction in overall health status, and increase of opioid use with the associated risks.

METHODS:

The article is the study of the American Society of Pain and Neuroscience (ASPN) COVID-19 task force to evaluate the policies set forth by federal, state, and local agencies to reduce or eliminate elective procedures for those patients with pain from spine, nerve, and joint disease. The impact of these decisions, which were needed to reduce the spread of the pandemic, led to a delay in care for many patients. We hence review an emergence plan to reinitiate this pain-related care. The goal is to outline a path to work with federal, state, and local authorities to combat the spread of the pandemic and minimize the deleterious impact of pain and suffering on our chronic pain patients.

RESULTS:

The article sets forth a strategy for the interventional pain centers to reemerge from the current pandemic and to set a course for future events.

CONCLUSIONS:

xxx.

Telemedicine and Gynecologic Cancer Care

Patients with gynecologic cancers experience better outcomes when treated by specialists and institutions with experience in their diseases. Unfortunately, high-volume centers tend to be located in densely populated regions, leaving many women with geographic barriers to care. Remote management through telemedicine offers the possibility of decreasing these disparities by extending the reach of specialty expertise and minimizing travel burdens. Telemedicine can assist in diagnosis, treatment planning, preoperative and postoperative follow-up, administration of chemotherapy, provision of palliative care, and surveillance. Telemedical infrastructure requires careful consideration of the needs of relevant stakeholders including patients, caregivers, referring clinicians, specialists, and health system administrators.

Readmissions After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: a US HIPEC Collaborative Study

BACKGROUND

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) results in significant morbidity and readmissions. Previous studies have been limited by single-institution design or lack of tumor details in the database used.

METHODS

The 12-institution US HIPEC Collaborative Database was queried between 1999 and 2017. Preoperative and intraoperative patient and tumor details were analyzed for associations with readmissions.

RESULTS

A total of 2017 of 2372 cases were included in the analysis. The 30-day readmission rate was 15.9% (n = 321). Common indications for readmission included failure to thrive (29.9%), infection (23.6%), and ileus/bowel obstruction (15.1%). The readmitted cohort had more complications, including intra-abdominal abscess (21.2% vs 6.2%), ileus (28.0% vs 17.2%), anastomotic leak (11.2% vs 2.2%), enteric fistula (5.6% vs 1.5%), deep venous thrombosis (6.2% vs 2.5%), and pulmonary embolism (6.9% vs 2.5%). Factors independently associated with readmission (p < 0.05) included ECOG score ≥ 3 (OR 3.4), depression (OR 2.4), total parenteral nutrition (OR 3.6), low anterior resection or partial colectomy (OR 2.0), and stoma creation (OR 2.2). Factors not associated included neoadjuvant chemotherapy, peritoneal cancer index, and completeness of cytoreduction. Readmission rate between 31 and 90 days was 3.9% (n = 78). Independent predictors (p < 0.05) included operative time (OR 1.1), low anterior resection or partial colectomy (OR 1.7), and stoma creation (OR 2.2).

CONCLUSIONS

In the largest study to date examining readmissions after CRS-HIPEC, 30-day readmission rate was 15.9%. Tumor factors failed to predict readmission, whereas preoperative functional status and depression along with individual cytoreductive procedures predicted readmission. Patients with these risk factors or postoperative complications may benefit from closer post-discharge monitoring.

The virtual physical exam in the 21st century

The modern Western medical encounter follows a strict framework that weaves subjective and objective components into a unifying diagnosis. As health care changes to incorporate new technology, such as virtual health care, the components that lead to diagnosis must likewise evolve. The virtual physical exam has limitations compared with the traditional exam. Despite this limitation, every year more patients are seen virtually with high satisfaction. Data have shown that supplementary real-time patient-provider video telemedicine increases access and extends established patient-physician relationships which will likely fuel increased telemedicine adoption even further. However, to date, there are limited data regarding the validity of the virtual examination compared with the traditional physical exam. In this paper, we review the use of developing technology related to the virtual physical exam.

The use of telemedicine in the preoperative management of pheochromocytoma saves resources

BACKGROUND

Surgical management of pheochromocytomas involves appropriate pre-operative alpha blockade. This process often results in multiple clinic visits, substantial delay in resection, and use of limited resources. We sought to evaluate the benefit of patient participation and doctor-patient telecommunication in pre-operative alpha blockade.

METHODS

A "study group" of patients, retrospectively collected, with pheochromocytoma requiring alpha-blockade therapy, during their initial clinic visit were educated on the use of a sphygmomanometer and the accurate detection of orthostatic blood pressure (BP). Subsequently, orthostatic evaluation and dose escalation were conducted through e-mail correspondence between the patient and the surgeon on a biweekly basis. This group of patients was compared with an historical "control group" consisting of 14 patients, whose preoperative treatment was titrated during clinic visits.

RESULTS

The two groups were similar in terms of operation performed (laparoscopic versus open), estimated blood loss, tumor size, and post-operative length of stay. Active patient participation in pre-operative alpha blockade therapy resulted in significantly fewer preoperative visits (mean 1.52 vs. 3.20 visits; P=0.02) and a significantly shorter time from initiation of blockade to resection (33 vs. 82 days; P=0.03).

CONCLUSIONS

Titration of alpha blockade therapy through patient and surgeon e-mail correspondence is efficacious and saves limited resources and time. This process eliminates unnecessary travel time and expenses for the patient. Due to the benefits of telemedicine for pheochromocytoma preoperative care, our method should be implemented in the routine surgical care of pheochromocytomas.

Improving Health-Related Quality of Life of Patients With an Ostomy Using a Novel Digital Wearable Device: Protocol for a Pilot Study

BACKGROUND

Ostomy surgeries involving the placement of an ostomy bag (eg, colostomy, ileostomy, urostomy, etc) have been shown to have a negative impact on health-related quality of life. To date, no studies have been conducted examining what impact, if any, wearable biosensors have on the health-related quality of life of ostomy patients.

OBJECTIVE

In the present study, we plan to assess the quality of life of ostomy patients using the Ostom-i alert sensor, a portable, wearable, Bluetooth-linked biosensor that facilitates easier ostomy bag output measurements. We hypothesize that using the Ostom-i alert sensor will result in an improved, ostomy-specific, health-related quality of life as compared to baseline measurement before the use of the sensor.

METHODS

A total of 20 ostomy patients will be screened and recruited to participate in this prospective, observational, cross-over pilot study using an Ostom-i alert sensor for one month. The primary outcome of this study will compare ostomy-specific, health-related quality of life at baseline (prior to Ostom-i alert sensor use) to ostomy-specific, health-related quality of life after 2 and 4 weeks of Ostom-i use by utilizing the City of Hope Quality of Life Questionnaire for Patients with an Ostomy. Secondary outcomes of general health-related quality of life and adjustment to ostomy will be evaluated using the Medical Outcomes Study 36-item short form health survey and the Olbrisch Ostomy Adjustment Scale Short Form 2.

RESULTS

The project was funded by the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine. Enrollment is currently underway and data analysis is expected to be completed in 2018.

CONCLUSIONS

Proposed benefits of mobile, internet-linked personal health monitors, such as the Ostom-i, include a reduction in the cost of care by reducing resource utilization and infection rates, improving patient-provider communication, reducing time spent as an inpatient as well as improved quality of life. Prior studies have demonstrated decreased health-related quality of life in patients with an ostomy bag. We aim to examine the extent to which the Ostom-i alert sensor affects the health-related quality of life of its users. The Ostom-i alert sensor has the potential to improve quality of life of users by giving them the freedom and confidence to partake in daily activities with the knowledge that they can check how full their ostomy bag is in a private, discrete manner.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02319434; https://clinicaltrials.gov/ct2/show/NCT02319434 (Archived at WebCite at http://www.webcitation.org/6xhFDThmq).

The Use of Telemedicine in Surgical Care: a Systematic Review

Introduction:

Telemedicine describes a healthcare service where physicians communicate with patients remotely using telecommunication technologies. Telemedicine is being used to provide pre-/postoperative surgical consultation and monitoring as well as surgical education.

Aim:

Our purpose was to investigate the broad range of telemedicine technologies used in surgical care.

Material and methods:

MEDLINE, EMBASE, CINAHL, and Science Direct were searched for available literature from inception to March 30, 2018 with no language restrictions. The search terms included: cell phones, telemedicine, telecommunications, video, online, videoconferencing, remote consultation, surgery, preoperative, perioperative, postoperative, and surgical procedures. Studies were included if they used telemedicine in surgery for pre-, peri-, or post-surgery periods, and if they compared traditional surgical care with surgical telemedicine. We excluded case series, case reports, and conference abstracts from our review.

Results:

A total of 24 studies were included in our review. The study found that the use of telemedicine in preoperative assessment and diagnosis, evaluation after surgery and follow-up visits to be beneficial. Patients reported benefits to using telemedicine such as avoiding unnecessary trips to hospitals, saving time and reducing the number of working days missed.

Conclusion:

Telemedicine in surgical care can provide benefits to both patients and clinicians.

The role of telemedicine in postoperative care

Telemedicine has become one of the most rapidly-expanding components of the health care system. Its adoption has afforded improved access to care, greater resource efficiency, and decreased costs associated with traditional office visits and has been well established in a wide array of fields. Telemedicine has been adopted in several domains of surgical care. In recent years, the role of telemedicine in postoperative care has caught attention as it has demonstrated excellent clinical outcomes, enhanced patient satisfaction, increased accessibility along with reduced wait times, and cost savings for patients and health care systems. In this narrative review, we describe the history of telemedicine, its adoption in the field of surgery and its various modalities, its use in the postoperative setting, and the potential benefits to both patients and healthcare systems. As telemedicine continues to emerge as a powerful tool for health care delivery, we also discuss several barriers to its widespread adoption as well as the future utility of telemedicine in postoperative care.