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Bloom L, Mazzella A, Flynn J, Panageas K. Symptoms, Surgical Events, and Length of Stay of Surgical Oncology Outpatients. J Perianesth Nurs 2022; 37:204-209. [PMID: 35067410 PMCID: PMC9392871 DOI: 10.1016/j.jopan.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE This study examined the incidence of postanesthesia symptoms, postoperative events, and length of stay (LOS) for surgical oncology outpatients in Phase II recovery during three time periods: before, one-month post, and one-year after the implementation of revised PACU I to PACU II transfer procedures and discharge criteria. DESIGN Data for this retrospective analysis was obtained from the organizations' electronic medical records during the timeframe April 3, 2017 through August 5, 2018 after enhanced PACU I to PACU II transfer procedures were implemented on June 5, 2017. Records of surgical outpatients transferred from PACU I to PACU II who received regional pain control or preoperative anti-emetics were excluded from the analysis. METHODS Study approval was obtained through the Institutional Review Board [#19-308]. The records [n = 1091] were sorted and analyzed according to symptoms, events, and length of recovery. Incidence of symptoms, use of IV fluids, and medications administered in PACU II was tabulated for each time-period. Kruskal-Wallis tests were used to detect differences in length of stay variables across the three time periods. FINDINGS A significant decrease in PACU II LOS was observed following the implementation of revised PACU I to PACU II transfer criteria (P< .001). Although blood pressure changes decreased between each time period: 1.4% (T-1), 0.3% (T-2), and 0.2% (T-3), postanesthesia symptoms [dizziness, pain, and nausea] decreased from T-1 to T-2, with a small increase in T-3. The use of fentanyl and continuous IV fluids decreased between all time periods. CONCLUSIONS Monitoring key variables related to patient outcomes involving LOS and symptom management ensures sustained practice changes, improves care, and optimizes surgical outpatient experience.
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Affiliation(s)
- Linda Bloom
- Department of Nursing Perioperative Services, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - AnnMarie Mazzella
- Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jessica Flynn
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine Panageas
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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Somani SN, Yu KM, Chiu AG, Sykes KJ, Villwock JA. Consumer Wearables for Patient Monitoring in Otolaryngology: A State of the Art Review. Otolaryngol Head Neck Surg 2021; 167:620-631. [PMID: 34813407 DOI: 10.1177/01945998211061681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Consumer wearables, such as the Apple Watch or Fitbit devices, have become increasingly commonplace over the past decade. The application of these devices to health care remains an area of significant yet ill-defined promise. This review aims to identify the potential role of consumer wearables for the monitoring of otolaryngology patients. DATA SOURCES PubMed. REVIEW METHODS A PubMed search was conducted to identify the use of consumer wearables for the assessment of clinical outcomes relevant to otolaryngology. Articles were included if they described the use of wearables that were designed for continuous wear and were available for consumer purchase in the United States. Articles meeting inclusion criteria were synthesized into a final narrative review. CONCLUSIONS In the perioperative setting, consumer wearables could facilitate prehabilitation before major surgery and prediction of clinical outcomes. The use of consumer wearables in the inpatient setting could allow for early recognition of parameters suggestive of poor or declining health. The real-time feedback provided by these devices in the remote setting could be incorporated into behavioral interventions to promote patients' engagement with healthy behaviors. Various concerns surrounding the privacy, ownership, and validity of wearable-derived data must be addressed before their widespread adoption in health care. IMPLICATIONS FOR PRACTICE Understanding how to leverage the wealth of biometric data collected by consumer wearables to improve health outcomes will become a high-impact area of research and clinical care. Well-designed comparative studies that elucidate the value and clinical applicability of these data are needed.
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Affiliation(s)
- Shaan N Somani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Katherine M Yu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Alexander G Chiu
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jennifer A Villwock
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Ghio M, Vallès K, Aly S, Simpson JT, Guidry C, Rosenkranz P, McAneny D. I text for I COUGH: A clinical pilot study to evaluate the impact of text messaging upon postoperative ambulation in the hospital. Am J Surg 2021; 223:360-363. [PMID: 33879328 DOI: 10.1016/j.amjsurg.2021.04.006] [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] [Received: 02/09/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND The "I COUGH" protocol is associated with improved postoperative pulmonary outcomes, and ambulation is an essential component. I COUGH is an acronym for Incentive spirometry, Coughing, Oral care, Understanding (patient and staff education), Getting-out-of-bed, and Head-of-bed elevation. This trial sought to enhance one component, specifically ambulation after operations. METHODS Randomized trial of inpatients in a safety-net, academic medical center. The intervention group received standard I COUGH education along with text message reminders to ambulate postoperatively, whereas the control group received standard education alone. Postoperative walking frequency was compared to each participant's ambulation on the day prior to enrollment. RESULTS The intervention group had an average improvement of 1.8 ± 1.8 walks per day per patient, while the average change for the control group was 0.2 ± 1.0 walks per day per patient. This represents a 9-fold increase in ambulation for the intervention group (p = 0.03). CONCLUSIONS Implementation of text message reminders increased ambulation and improved adherence to the I COUGH protocol following operations. This system should be further investigated as an adjunct to postoperative care.
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Affiliation(s)
- Michael Ghio
- Tulane University, School of Medicine & Tulane Medical Center, 1415 Tulane Avenue, New Orleans, Louisiana, 70112, USA.
| | - Katherine Vallès
- Boston University, School of Medicine & Boston Medical Center, 1 Boston Medical Center Pl, Boston, Massachusetts, 02118, USA
| | - Sherif Aly
- Boston University, School of Medicine & Boston Medical Center, 1 Boston Medical Center Pl, Boston, Massachusetts, 02118, USA
| | - John Tyler Simpson
- Tulane University, School of Medicine & Tulane Medical Center, 1415 Tulane Avenue, New Orleans, Louisiana, 70112, USA
| | - Chrissy Guidry
- Tulane University, School of Medicine & Tulane Medical Center, 1415 Tulane Avenue, New Orleans, Louisiana, 70112, USA
| | - Pamela Rosenkranz
- Boston University, School of Medicine & Boston Medical Center, 1 Boston Medical Center Pl, Boston, Massachusetts, 02118, USA
| | - David McAneny
- Boston University, School of Medicine & Boston Medical Center, 1 Boston Medical Center Pl, Boston, Massachusetts, 02118, USA
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Nevo Y, Shaltiel T, Constantini N, Rosin D, Gutman M, Zmora O, Nevler A. Activity Tracking After Surgery: Does It Correlate With Postoperative Complications? Am Surg 2021; 88:226-232. [PMID: 33522277 DOI: 10.1177/0003134820988818] [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: 11/15/2022]
Abstract
BACKGROUND Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. METHODS Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. RESULTS 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission (P < .05). POD2 step count was an independent risk factor for severe complications (P = .026). DISCUSSION Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.
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Affiliation(s)
- Yehonatan Nevo
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
| | - Tali Shaltiel
- Division of General Surgery, 36632Rabin Medical Center, Petah Tikva, Israel
| | - Naama Constantini
- Sports Medicine Center, Department of Orthopedic Surgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Danny Rosin
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
| | - Mordechai Gutman
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
| | - Oded Zmora
- Division of General Surgery, 37256Assaf Harofeh Medical Center, Zerifin, Israel
| | - Avinoam Nevler
- Department of General Surgery (Surgery B), Chaim Sheba Medical Center, Tel-Aviv University, Tel Hashomer, Israel
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Amin T, Mobbs RJ, Mostafa N, Sy LW, Choy WJ. Wearable devices for patient monitoring in the early postoperative period: a literature review. Mhealth 2021; 7:50. [PMID: 34345627 PMCID: PMC8326951 DOI: 10.21037/mhealth-20-131] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/13/2020] [Indexed: 12/20/2022] Open
Abstract
The early postoperative period is a crucial stage in a patient's recovery as they are susceptible to a range of complications, with detection and management the key to avoiding long term consequences. Wearable devices are an innovative way of monitoring patient's post-intervention and may translate into improved patient outcomes, and reduced strain on healthcare resources, as they may facilitate safer and earlier discharge from the hospital setting. Several recent studies have investigated the use of wearable devices in postoperative monitoring. This review outlines the current literature including the range of wearable devices used for postoperative monitoring, the variety of surgeries investigated, and the outcomes assessed. A search of five electronic databases was performed. Data on the range of wearable devices, outcomes and surgeries investigated were extracted and synoptically analysed. Twenty-four articles were retrieved. Data on several different types of surgery were available and discussed. Most studies used wrist-mounted wearable devices and accelerometers or pedometers to assess physical activity metrics, including step counts and physical activity intensity (PAI), as markers of recovery. Wearable devices can provide objective data capture in the early postoperative phase to remotely monitor patients using various metrics including temperature, cardiac monitoring and physical activity. The majority of current research is focussed on wrist-mounted accelerometers and pedometers used to assess physical activity as a marker of postoperative function. Further research is required to demonstrate improved safety and cost-effectiveness of this technology.
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Affiliation(s)
- Tajrian Amin
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
- Wearables and Gait Assessment Research (WAGAR) Group, Prince of Wales Private Hospital, Randwick, Australia
| | - Ralph J. Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
- Wearables and Gait Assessment Research (WAGAR) Group, Prince of Wales Private Hospital, Randwick, Australia
| | - Niyaz Mostafa
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
| | - Luke W. Sy
- Wearables and Gait Assessment Research (WAGAR) Group, Prince of Wales Private Hospital, Randwick, Australia
- School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Wen Jie Choy
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Neuro Spine Clinic, Prince of Wales Private Hospital, Randwick, Australia
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia
- Wearables and Gait Assessment Research (WAGAR) Group, Prince of Wales Private Hospital, Randwick, Australia
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Venkatesan U, Sruthikamal V, Jasmine J. Effectiveness of early ambulation on postoperative anxiety and co-operation among laparotomy surgical patients. JOURNAL OF NURSING AND MIDWIFERY SCIENCES 2021. [DOI: 10.4103/jnms.jnms_71_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
INTRODUCTION Burnout is an occupational hazard for physicians at all stages of training and medical practice. The purpose of the current study was to determine whether residency factors, with the use of an activity monitor, including the amount of exercise, have any impact on burnout among orthopaedic surgery residents in varying years of training. METHODS Orthopaedic residents at a single institution were recruited immediately before beginning a new clinical rotation and followed for four weeks. On enrollment, the participants were given a wrist-worn activity monitor (Fitbit Flex) and instructed on its use for tracking physical activity. REDCap was used to collect burnout levels (as assessed by using the Maslach Burnout Inventory and the Patient Health Questionnaire-9), which were completed a total of five times, once at enrollment and weekly during the study period. RESULTS Twenty-seven residents were enrolled, including 13 junior residents (interns and second years) and 14 senior residents (third, fourth, and fifth years). Seven residents were on fracture rotations, whereas 20 were not. As measured by using the Maslach Burnout Inventory, juniors were more emotionally exhausted (P = 0.01) and depersonalized (P = 0.027). No difference in the objective physical activity data as measured by using the Fitbit Flex and no difference in the self-reported hours of sleep were observed. Residents on orthopaedic trauma rotations also reported significantly higher rates of emotional exhaustion and depersonalization (P < 0.001) than other residents and were more physically active on average (P < 0.030). DISCUSSION Although depersonalization and depression are common symptoms seen among orthopaedic surgery residents, this study demonstrated that quality of life improves markedly as they progress through their residency training. Residents on orthopedic trauma rotations have greater levels of emotional exhaustion and depersonalization. This pilot study suggests that burnout prevention programs should begin at the start of training to provide residents with strategies to combat and then reinforced while on orthopaedic trauma rotations. LEVEL OF EVIDENCE Level III Diagnostic Study.
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Ganer Herman H, Ben Zvi M, Tairy D, Kleiner I, Gonen N, Kuper Sason L, Bar J, Kovo M. Enhancing patient mobility following cesarean-delivery - the efficacy of an improved postpartum protocol assessed with pedometers. BMC Pregnancy Childbirth 2020; 20:353. [PMID: 32517733 PMCID: PMC7285598 DOI: 10.1186/s12884-020-03046-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/03/2020] [Indexed: 12/23/2022] Open
Abstract
Background The incidence of thromboembolic complications is highest in the immediate postpartum period, especially following caesarean delivery (CD). Ambulation following CD is important in their prevention. We examined the effect of an educational protocol on patients’ mobility following CD, with the use of digital step counters (pedometers). Methods Starting February 2018, we implemented an educational protocol at the maternity ward, which included nurses’ tutoring and subsequent patients’ education, regarding the importance of early ambulation. Following CD, ambulation was initiated 4 h following surgery (as compared to 6 h prior). Scheduled IV acetaminophen was administered at six-hour intervals for 48 h (as compared to only 24 h prior), while additional analgesics were given upon patient request. We compared maternal demographics, delivery and postpartum course between the pre-protocol group (n = 101) and the post-protocol group (n = 100). All patients were asked to wear pedometers for 48 h following the delivery to assess ambulation. Results Patients’ demographics, surgical and post-partum course were non-significant between the groups, except for surgical length (48.5 ± 14.6 vs. 53.5 ± 15.3 min in the pre and post protocol groups, respectively, p = 0.02). The pre-protocol group was treated with more additional analgesics (p = 0.02). A higher number of steps was taken in the post-protocol group as compared to the pre-protocol group (4394 ± 2985 vs.3551 ± 2931, respectively p = 0.04). In a linear regression analysis in which the number of steps served as the dependent variable, this educational protocol was independently associated with a higher number of steps [coefficient 988 steps, 95% CI 137–1838, p = 0.02], as was smoking, after adjustment for surgical length, emergent surgery, maternal age and body mass index. Conclusion An educational protocol which included earlier ambulation and regular interval pain control was associated with improved ambulation following CD.
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Affiliation(s)
- Hadas Ganer Herman
- Departments of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Masha Ben Zvi
- Departments of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Tairy
- Departments of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Kleiner
- Departments of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Gonen
- Departments of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Limor Kuper Sason
- Departments of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Bar
- Departments of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Departments of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Schwab M, Brindl N, Studier-Fischer A, Tu T, Gsenger J, Pilgrim M, Friedrich M, Frey PE, Achilles C, Leuck A, Bürgel T, Feisst M, Klose C, Tenckhoff S, Dörr-Harim C, Mihaljevic AL. Postoperative complications and mobilisation following major abdominal surgery with vs. without fitness tracker-based feedback (EXPELLIARMUS): study protocol for a student-led multicentre randomised controlled trial (CHIR-Net SIGMA study group). Trials 2020; 21:293. [PMID: 32293519 PMCID: PMC7092422 DOI: 10.1186/s13063-020-4220-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Postoperative complications following major abdominal surgery are frequent despite progress in surgical technique and perioperative care. Early and enhanced postoperative mobilisation has been advocated to reduce postoperative complications, but it is still unknown whether it can independently improve outcomes after major surgery. Fitness trackers (FTs) are a promising tool to improve postoperative mobilisation, but their effect on postoperative complications and recovery has not been investigated in clinical trials. METHODS This is a multicentre randomised controlled trial with two parallel study groups evaluating the efficacy of an enhanced and early mobilisation protocol in combination with FT-based feedback in patients undergoing elective major abdominal surgery. Participants are randomly assigned (1:1) to either the experimental group, which receives daily step goals and a FT giving feedback about daily steps, or the control group, which is mobilised according to hospital standards. The control group also receives a FT, however with a blackened screen; thus no FT-based feedback is possible. Randomisation will be stratified by type of surgery (laparoscopic vs. open). The primary endpoint of the study is postoperative morbidity within 30 days measured via the Comprehensive Complication Index. Secondary endpoints include number of steps as well as a set of functional, morbidity and safety parameters. A total of 348 patients will be recruited in 15 German centres. The study will be conducted and organised by the student-led German Clinical Trial Network SIGMA. DISCUSSION Our study aims at investigating whether the implementation of a simple mobilisation protocol in combination with FT-based feedback can reduce postoperative morbidity in patients undergoing major abdominal surgery. If so, FTs would offer a cost-effective intervention to enhance postoperative mobilisation and improve patient outcomes. TRIAL REGISTRATION Deutsches Register Klinischer Studien (DRKS, German Clinical Trials Register): DRKS00016755, UTN U1111-1228-3320. Registered on 06.03.2019.
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Affiliation(s)
- Marius Schwab
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Niall Brindl
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | | | - Thomas Tu
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Julia Gsenger
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Max Pilgrim
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Mirco Friedrich
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Pia-Elena Frey
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Christina Achilles
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Alexander Leuck
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Thore Bürgel
- Health Data Science Unit, University Hospital Heidelberg, BioQuant, Im Neuenheimer Feld 267, 69120, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Solveig Tenckhoff
- CHIR-Net Coordination Centre at the Study Centre of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Colette Dörr-Harim
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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