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McLaughlin MT, Moura SP, Edalatpour A, Seitz AJ, Michelotti BF. Insurance Status Predicts Hand Therapy Adherence following Flexor Tendon Repair: A Retrospective Cohort Study. Plast Reconstr Surg 2024; 153:942e-951e. [PMID: 37189235 DOI: 10.1097/prs.0000000000010702] [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: 05/17/2023]
Abstract
BACKGROUND Many patients are not adherent to hand therapy rehabilitation following surgical repair of traumatic flexor tendon injuries, which can negatively affect surgical outcomes and long-term hand function. The authors aimed to identify the factors that predict patient nonadherence to hand therapy following flexor tendon repair surgery. METHODS This retrospective cohort study included 154 patients who underwent surgical repair of flexor tendon injuries at a level I trauma center between January of 2015 and January of 2020. A manual chart review was performed to collect demographic data, insurance status, injury characteristics, and details of the postoperative course, including health care use. RESULTS Factors significantly associated with occupational therapy no-shows included Medicaid insurance (OR, 8.35; 95% CI, 2.91 to 24.0; P < 0.001), self-identified Black race (OR, 7.28; 95% CI, 1.78 to 29.7; P = 0.006), and current cigarette smoker status (OR, 2.69; 95% CI, 1.18 to 6.15; P = 0.019). Patients without insurance attended 73.8% of their occupational therapy visits, and patients with Medicaid attended 72.0% of their visits, rates significantly lower than the rate of those with private insurance (90.7%; P = 0.026 and P = 0.001, respectively). Patients with Medicaid were eight times more likely to seek emergency department care postoperatively than patients with private insurance ( P = 0.002). CONCLUSIONS Significant disparities in hand therapy adherence following flexor tendon repair surgery exist between patients with different insurance statuses, races, and tobacco use. Understanding these disparities can help providers identify at-risk patients to improve hand therapy use and postoperative outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Matthew T McLaughlin
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Steven P Moura
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
- Boston University School of Medicine
| | - Armin Edalatpour
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
| | - Allison J Seitz
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
- McGovern Medical School, University of Texas Health Science Center
| | - Brett F Michelotti
- From the Division of Plastic and Reconstructive Surgery, University of Wisconsin School of Medicine and Public Health
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Levy L, Villavisanis DF, Sarosi AJ, Taub PJ. Pediatric Plastic Surgery in the COVID-19 Era. Ann Plast Surg 2024; 92:335-339. [PMID: 38394272 DOI: 10.1097/sap.0000000000003810] [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: 02/25/2024]
Abstract
ABSTRACT The COVID-19 pandemic has forced the healthcare system to adopt novel strategies to treat patients. Pediatric plastic surgeons are uniquely exposed to high rates of infections during examinations and surgeries via aerosol-generating procedures, in part because of the predilection of viral particles for the nasal cavities and pharynx. Telemedicine has emerged as a useful virtual medium for encouraging prolonged patient follow-up while maintaining physical distance. It has proven beneficial in mitigating infection risks while decreasing the financial burden on patients, their families, and healthcare teams. New trends driven by the pandemic added multiple elements to the patient-physician relationship and have left a lasting impact on the field of pediatric plastic surgery in clinical guidelines, surgical care, and patient outcomes. Lessons learned help inform pediatric plastic surgeons on how to reduce future viral infection risk and lead a more appropriately efficient surgical team depending on early triage.
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Affiliation(s)
- Lior Levy
- From the Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Smith SM, Jacobsen JHW, Atlas AP, Khoja A, Kovoor JG, Tivey DR, Babidge WJ, Clancy B, Jacobson E, O'Neill C, North JB, Wu R, Maddern GJ, Frydenberg M. Telehealth in surgery: an umbrella review. ANZ J Surg 2021; 91:2360-2375. [PMID: 34766688 DOI: 10.1111/ans.17217] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Telehealth use has increased worldwide during the COVID-19 pandemic. However, hands-on requirements of surgical care may have resulted in slower implementation. This umbrella review (review of systematic reviews) evaluated the perceptions, safety and implementation of telehealth services in surgery, and telehealth usage in Australia between 2020 and 2021. METHODS PubMed was searched from 2015 to 2021 for systematic reviews evaluating real-time telehealth modalities in surgery. Outcomes of interest were patient and provider satisfaction, safety, and barriers and facilitators associated with its use. Study quality was appraised using the AMSTAR 2 tool. A working group of surgeons provided insights into the clinical relevance to telehealth in surgical practice of the evidence collated. RESULTS From 2025 identified studies, 17 were included, which were of low to moderate risk of bias. Patient and provider satisfaction with telehealth was high. Time savings, decreased healthcare resource use and lower costs were reported as key advantages of the service. Inability to perform comprehensive examinations was noted as the primary barrier. In Australia, peak telehealth usage coincided with the introduction of temporary telehealth services and increased lockdown measures. CONCLUSIONS Patients and providers are broadly satisfied with telehealth and its benefits. Barriers may be overcome via multidisciplinary collaboration. Telehealth may benefit surgical care long-term if implemented correctly both during and after the COVID-19 pandemic.
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Affiliation(s)
- Sarah M Smith
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Jonathan Henry W Jacobsen
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Alvin P Atlas
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Adeel Khoja
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - David R Tivey
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Wendy J Babidge
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Bridget Clancy
- Department of Surgery, St. John of God Warrnambool Hospital, Warrnambool, Victoria, Australia
| | - Erica Jacobson
- Department of Paediatric Neurosurgery, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Christine O'Neill
- Surgical Services, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.,Cancer and Public Health Research, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - John B North
- Royal Australasian College of Surgeons, Queensland Audit of Surgical Mortality, Brisbane, Queensland, Australia
| | - Roxanne Wu
- Department of Surgery, Cairns Private Hospital, Cairns, Queensland, Australia
| | - Guy J Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Mark Frydenberg
- Department of Urology, Cabrini Institute, Cabrini Health, Melbourne, Victoria, Australia.,Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Timm B, O'Connor E, Liodakis P, Jayarajan J, Bolton D. We still need the clinic; patient perceptions on doctor-in-training delivered telehealth versus in-person consultation. ANZ J Surg 2021; 90:658-659. [PMID: 32421936 DOI: 10.1111/ans.15884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Brennan Timm
- Department of Urology, Austin Health, Melbourne, Victoria, Australia.,North Eastern Urology, Melbourne, Victoria, Australia
| | - Ellen O'Connor
- Department of Urology, Austin Health, Melbourne, Victoria, Australia
| | - Peter Liodakis
- Department of Urology, Austin Health, Melbourne, Victoria, Australia.,North Eastern Urology, Melbourne, Victoria, Australia
| | - Jyotsna Jayarajan
- Department of Urology, Austin Health, Melbourne, Victoria, Australia.,North Eastern Urology, Melbourne, Victoria, Australia
| | - Damien Bolton
- Department of Urology, Austin Health, Melbourne, Victoria, Australia
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