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Richardson MK, Wier J, Liu KC, Mayfield CK, Vega AN, Lieberman JR, Heckmann ND. Same-Day Total Joint Arthroplasty in the United States From 2016 to 2020: The Impact of the Medicare Inpatient Only List and the COVID-19 Pandemic. J Arthroplasty 2024; 39:858-863.e2. [PMID: 37871863 DOI: 10.1016/j.arth.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Same-day total hip arthroplasty (THA) and total knee arthroplasty (TKA) continue to gain popularity in the United States. The present study sought to quantify recent same-day outpatient trends taking into consideration the COVID-19 pandemic as well as the removal of these procedures from the Medicare inpatient only (IPO) list. METHODS Patients undergoing primary elective TKA and THA were identified using the Nationwide Ambulatory Surgery Sample and the National Inpatient Sample from January 1, 2016, to December 31, 2020. The same-day cohort included Nationwide Ambulatory Surgery Sample and National Inpatient Sample patients with a length of stay = 0 days. The inpatient cohort included patients with length of stay ≥1 day. National estimates were extrapolated using weight functions. RESULTS From January 2016 to December 2020, the proportion of same-day TKA increased from 1.2 (719) to 62.4% (31,293) and the proportion of same-day THA increased from 2.0 (599) to 54.5% (18,252). Following removal from the Medicare IPO list, same-day TKAs increased from 3.2% (1,895) in December 2017 to 13.8% (9,269) in January 2018, and same-day THAs increased from 10.7% (4,295) in December 2019 to 22.5% (8,708) in January 2020. Between February and March 2020, same-day TKAs increased from 42.4 (26,148) to 44.4% (16,972) and same-day THAs increased from 28.5 (10,729) to 30.2% (7,409). CONCLUSIONS The proportion of same-day TKA and THA dramatically increased following removal from the Medicare IPO list and in response to the COVID-19 pandemic. By December 2020, same-day TKA and THA accounted for >50% of all cases performed in the United States.
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Affiliation(s)
- Mary K Richardson
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Julian Wier
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Kevin C Liu
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Cory K Mayfield
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Andrew N Vega
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jay R Lieberman
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Bašković M, Markanović M, Ivanović S, Boričević Z, Alavuk Kundović S, Pogorelić Z. Risk Factors Leading to Overnight Stays in Pediatric Surgical Outpatients. Children (Basel) 2024; 11:382. [PMID: 38671599 PMCID: PMC11049595 DOI: 10.3390/children11040382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Same-day surgery implies patient discharge on the same day after the surgery. The main aim of the research was to determine which predisposing factors lead to children treated with same-day surgery not being able to be discharged on the same day. METHODS For the purposes of this research, the electronic records of patients in the hospital information system were reviewed retrospectively. The search included patients who were surgically treated through the Day Surgery Unit at the Children's Hospital Zagreb with various diagnoses from 1 January 2021 to 31 December 2023. The target group consisted of patients who could not be discharged on the same day (n = 68), while for the purposes of the control group (n = 68), patients were randomly selected, comparable by age and gender, who were discharged from the hospital on the same day in accordance with the principles of same-day surgery. RESULTS In relation to the parameters of interest between the groups, statistically significant differences were observed in the type of general anesthesia (p = 0.027), the use of analgesics (p = 0.016), the time of entering the operating room (p = 0.000), the time of leaving the operating room (p < 0.0001) and the duration of surgery (76.81 ± 37.21 min vs. 46.51 ± 22.46 min, p < 0.0001). When explanatory variables were included in the regression model, they explained 38% of the variability in the dependent variable. Only the variable "duration of surgery" provided significant information to explain the variability in the dependent variable (p = 0.004). CONCLUSIONS Although the duration of surgery was imposed as the main predictor of hospitalization after same-day surgery, and considering the extremely small number of studies on the mentioned topic, especially in the pediatric population, further, preferably multicenter research on the mentioned topic is needed.
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Affiliation(s)
- Marko Bašković
- Department of Pediatric Surgery, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia; (M.B.)
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
| | - Martina Markanović
- Department of Pediatric Surgery, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia; (M.B.)
- Day Surgery Unit, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
| | - Sanja Ivanović
- Department of Pediatric Surgery, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia; (M.B.)
- Day Surgery Unit, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
| | - Zrinka Boričević
- Department of Surgery, General Hospital Karlovac, Ulica Andrije Štampara 3, 47000 Karlovac, Croatia
| | - Sandra Alavuk Kundović
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
- Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Children’s Hospital Zagreb, Ulica Vjekoslava Klaića 16, 10000 Zagreb, Croatia
| | - Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva Ulica 1, 21000 Split, Croatia
- Department of Surgery, School of Medicine, University of Split, Šoltanska Ulica 2a, 21000 Split, Croatia
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Qiu L, Cai J, Mei A, Wang X, Zhou Z, Sun J. Predictors of Postoperative Nausea and Vomiting After Same-Day Surgery: A Retrospective Study. Clin Ther 2023; 45:210-217. [PMID: 36781358 DOI: 10.1016/j.clinthera.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/06/2022] [Accepted: 01/22/2023] [Indexed: 02/14/2023]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) are main issues after same-day surgery. This study aimed to retrospectively evaluate the electronic medical records of patients who underwent same-day operations under general anesthesia to identify the potential risk factors for PONV. METHODS Records of 7759 adult patients who received general anesthesia with remifentanil were reviewed. The patients were assessed for the incidence and severity of PONV. Multiple logistic regression was used to identify risk factors for PONV. A nomogram was established to predict PONV after same-day operations. FINDINGS Of 7759 patients, 2317 (29.9%) experienced PONV. In multiple logistic regression analysis, female sex, nonsmoker status, history of motion sickness or nausea, high body mass index (BMI), long surgical duration, laparoscopic procedure, and preoperative analgesic intake within 30 days were independent risk factors for PONV. No correlation was found between the severity of PONV and remifentanil exposure (odds ratio = 1.018; 95% CI, 0.861-1.204; P = 0.834) or remifentanil dose (odds ratio = 1.294; 95% CI, 0.760-2.205; P = 0.343). For the nomogram, which involved sex, laparoscopic procedure, BMI, history of nausea or motion sickness, and analgesic intake within 30 days, the receiver operating characteristic analysis revealed that the AUC values in the training and validation cohorts were 0.81 and 0.83, respectively. IMPLICATIONS Predictors for PONV in same-day surgery include female sex, nonsmoker, history of motion sickness or nausea, high BMI, surgical duration >1 hour, laparoscopic procedure, and preoperative analgesic intake within 30 days. A new predictive model is feasible for predicting the incidence of PONV based on the preoperative and intraoperative predictors.
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Affiliation(s)
- Lili Qiu
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinxia Cai
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Aishuang Mei
- Postanesthesia Care Nursing, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaofeng Wang
- Department of Thyroid Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zijun Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
| | - Jiehao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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Reerds STH, Hey SY, van den Hoogen FJA, Takes RP, Ganesh V, Marres HAM, Manickavasagam J, Honings J. Outpatient parotidectomy with or without the use of a post-operative drain: A retrospective bi-institutional study. Clin Otolaryngol 2022; 48:430-435. [PMID: 36585381 DOI: 10.1111/coa.14028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 10/10/2022] [Accepted: 12/10/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Parotid surgery is historically performed as an inpatient procedure and suctions drains are predominantly used during surgery. Recent literature provides evidence that outpatient parotid surgery is safe and effective. Our study aims to describe the results of drainless outpatient parotidectomy and outpatient parotidectomy with drain placement and compare their outcomes. DESIGN Retrospective cohort study. SETTING Bi-institutional retrospective cohort study. PARTICIPANTS Patients that underwent outpatient drain-less parotidectomy and patients that underwent outpatient parotidectomy with post-operative drain placement. MAIN OUTCOME MEASURES Complication rates, unplanned post-operative visits, unplanned prolonged stay. RESULTS Three hundred eighty patients underwent outpatient parotidectomy with drain placement and 31 patients underwent outpatient drainless parotidectomy in two different hospitals. The incidence of haematoma (drain: 3.1% vs. drainless: 0%, p = 1), infection (drain: 14.3% vs. drainless: 13.8%, p = 1) and salivary fistula (drain: 5.6% vs. drainless: 3.4, p = 1) were comparable between both groups. Seroma or sialocele was more frequently seen in the drain-less group (27.6% vs. 6.2%, p < .001), but were all managed conservatively. Within 10 days after surgery, unplanned visits seemed more frequent in the drain group, although the difference was not statistically significant (14.9% vs. 3.4%, p = .16). CONCLUSIONS Outpatient parotid surgery with or without the use of a post-operative drain is safe, practical and feasible. Same-day discharge with and without drain placement yield comparable outcomes. However, the results need to be interpreted cautiously as this study was limited by a small cohort of parotidectomies without drain placement. Future studies should further compare both approaches.
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Affiliation(s)
- Sam T H Reerds
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Shi Ying Hey
- Department of Otorhinolaryngology and Head and Neck Surgery, NHS Lothian, Edinburgh, UK
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Vaishnevy Ganesh
- Department of Otorhinolaryngology and Head and Neck Surgery, Ninewells Hospital, Dundee, UK.,NHS Tayside, University of Dundee, Dundee, UK
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Jaiganesh Manickavasagam
- Department of Otorhinolaryngology and Head and Neck Surgery, Ninewells Hospital, Dundee, UK.,NHS Tayside, University of Dundee, Dundee, UK
| | - Jimmie Honings
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, The Netherlands
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Pallauf M, Herrmann T, Oswald D, Törzsök P, Deininger S, Lusuardi L. Electrosurgery or laser for benign prostatic enlargement: trumpcard or pitfalls. Curr Opin Urol 2021; 31:444-450. [PMID: 34265843 PMCID: PMC8373441 DOI: 10.1097/mou.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize and comment on publications of the last 2 years in the field of endoscopic surgery for benign prostatic enlargement, focusing on similarities and differences of laser and electrosurgery. RECENT FINDINGS Because of good hemostasis and safety, invasive endoscopic surgery has evolved to a choice of treatment for vulnerable patients with ongoing antithrombotic medication and in same-day surgery. Recent publications show a good perioperative course and no deterioration in the postoperative outcome. Furthermore, alterations to the original surgical techniques of resection, enucleation, and vaporization have increased the preservation rate for antegrade ejaculation, advancing them to an appealing choice of treatment for sexually active men. Favorable outcomes can be achieved in both laser and electrosurgery. Only the choice of the surgical technique determines the outcome. SUMMARY Various invasive endoscopic surgical techniques are available, offering different advantages and disadvantages for the patient. All of them can be performed with laser and electrosurgery. Therefore, focusing on the proper choice of surgical technique instead of the energy source will guarantee the patient to benefit most.
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Affiliation(s)
- Maximilian Pallauf
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
| | - David Oswald
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Peter Törzsök
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Susanne Deininger
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
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Zillioux J, Werneburg GT, Goldman HB. Same-day discharge across FPMRS surgical cases is safe and feasible: A 10-year single-surgeon experience. Neurourol Urodyn 2021; 40:1754-1760. [PMID: 34224599 DOI: 10.1002/nau.24739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Enhanced recovery after surgery protocols and increased attention to value-based care have led to the reconsideration of routine postoperative admission in female pelvic medicine and reconstructive surgery (FPMRS) cases. We aimed to assess trends in same-day discharge (SDD) and associated readmissions and emergency room visits in a single-surgeon 10-year experience. METHODS The electronic medical record was queried for 30-day outcomes (readmission and emergency department visits with associated indications) for all cases performed between June 2010 and August 2020 by a single FPMRS surgeon. Non-FPMRS specialty cases were excluded. Patient characteristics and 30-day outcomes were compared based on SDD status for the overall cohort as well as the subset of cases traditionally involving an overnight stay (i.e., robotic transabdominal, apical prolapse repair). RESULTS 1793 surgeries were identified and analyzed, including 357 apical prolapse repairs, 370 slings, 392 neuromodulation and 114 complex mesh excisions. The majority (79.1%) had SDD. For admitted patients, mean length of stay was 1.5 (1.3) days. Among cases traditionally involving overnight stay, rates of SDD were significantly higher in 2020 than 2010 (84% vs. 32%, p < 0.001), and increased over time. Overall rates of 30-day readmission and ED visits were low (1.9% and 2.6%, respectively) and did not differ based on SDD status (p = 0.76). Readmissions occurred at mean 11.6 (7.0) days, most commonly for urinary tract infection (13/34). CONCLUSIONS SDD is not associated with increased 30-day readmission or ED visits across a wide breadth of FPMRS cases. SDD is safe and feasible in the majority of FPMRS cases.
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Affiliation(s)
- Jacqueline Zillioux
- Department of Urology, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Glenn T Werneburg
- Department of Urology, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Howard B Goldman
- Department of Urology, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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Parker B, Beard K, Fletcher R, Sharata A, Muller D, Haisley K, Reavis K, Davila Bradley D, DeMeester S, Swanström L, Dunst C. Can We Identify Patients Appropriate for Same-Day Discharge After Laparoscopic Fundoplication? J Laparoendosc Adv Surg Tech A 2021; 32:132-136. [PMID: 33797982 DOI: 10.1089/lap.2020.0929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Patients, surgeons, and payers are interested in reducing hospital length of stay. Outpatient laparoscopic fundoplication (LF) can be done safely and cost effectively. There is low acceptance of this practice due to fear of readmission and patient dissatisfaction. Our aim was to identify factors predicting failure of same-day discharge after LF. Methods and Procedures: We simulated an outpatient setting for patients who underwent LF from 2017 to 2018 and collected the data prospectively. A perioperative pain and nausea protocol was utilized. Postoperatively, patients were given a liquid diet and oral medications, observed overnight, and then discharged after standard criteria were met. Failure was defined by the need for physician intervention after 3 hours or failure to discharge. Univariate and multivariable logistic regression analyses were performed assessing factors associated with failure. Two-sample t-test and chi-squared tests were used for significance. Results: Ninety-eight patients were included. Twenty patients failed, primarily due to the need for intravenous medications. Seven were discharged on postoperative day 1 but required physician intervention after 3 hours. Thirteen patients stayed >23 hours. Two patients were readmitted within 1 week of discharge. There was one acute recurrence, requiring reoperation, and one conversion to laparotomy. We found no statistically significant patient risk factor, comorbidity, or perioperative variable that could reliably predict failure of same-day discharge. Conclusion: This study suggests that same-day discharge after LF is safe and feasible. However, 20% of patients will unpredictably fail to meet discharge criteria.
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Affiliation(s)
- Brett Parker
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA.,Division of Minimally Invasive Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kristin Beard
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Reid Fletcher
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Ahmed Sharata
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Dolores Muller
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Kelly Haisley
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Kevin Reavis
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Daniel Davila Bradley
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Steven DeMeester
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Lee Swanström
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
| | - Christy Dunst
- Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, Oregon, USA
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Annie Lo HY, Young S, Andrew DiFronzo L. Laparoscopic Liver Resection: A 7-Year Experience of 123 Resections in a Single Institution. Am Surg 2020; 86:1330-1336. [PMID: 33124880 DOI: 10.1177/0003134820964442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
There has been a significant increase in the use of laparoscopic liver resection (LLR) over the past 2 decades. This study aimed to analyze the outcomes associated with LLR at a single tertiary care hospital. Patients with benign or malignant tumors who underwent LLR by a single surgeon from January 2012 to November 2019 were identified. There were 123 patients who underwent LLR in the study period; 52% were men, and the median age was 61 (24-90) years. Five patients (4.1%) had unplanned conversion to open resection. Ninety-five patients (77.2%) had a wedge resection or single segmentectomy, and 28 (22.8%) underwent resection of 2+ liver segments. Seventy-one cases (57.7%) were for hepatocellular carcinoma (HCC), 24 (19.5%) for colorectal metastasis, and 28 (22.8%) were for other benign and malignant tumors. Median operative time was 239 (range 89-526) minutes. Mean estimated blood loss was 192 (range 0-1800) mL. The median length of stay (LOS) overall was 2 (range 0-9) days. From 2017 to 2019, the mean LOS was 1.2 days, compared to a mean LOS of 3.3 days from 2012 to 2016. More cases were performed as same-day surgery from 2017 onward; 19 patients (33.9%) had same-day surgery from 2017 to 2019, in comparison to only 1 patient (1.5%) in the period of 2012-2016 (P < .0001). Overall, 28 patients (22.8%) experienced postoperative morbidity; major postoperative morbidity occurred in 4 patients (3.3%). The 90-day mortality was .8%, and the 30-day readmission rate was 5.7%. In conclusion, LLR can be performed safely to treat liver tumors, and LOS decreased over time. Although overall morbidity is moderate, serious morbidity is low, as was the readmission rate. Laparoscopic wedge resection may be a feasible option as an outpatient procedure in select patients.
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Affiliation(s)
- Hoi Y Annie Lo
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Stephanie Young
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
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Berardinelli A, Bernhofer EI. Postsurgical Follow-Up Phone Calls: Worth the Investment? J Perianesth Nurs 2020; 35:665-70. [PMID: 32682669 DOI: 10.1016/j.jopan.2020.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To analyze differences in health confidence levels regarding discharge instructions between two groups of same-day surgery patients. DESIGN Comparative and descriptive design. METHODS Phone surveys to two groups: those who received follow-up phone calls from a registered nurse (RN) and those who received standard care instructions at discharge only. FINDINGS In 74 same-day surgery patients (n = 37 per group), all participants expressed high health confidence in implementing discharge instructions. Results revealed no higher health confidence levels in patients who received RN follow-up phone calls, no difference between groups attending postoperative appointments, and no relationships between subject demographics, health confidence level, and postoperative complications between groups. CONCLUSIONS The use of specialized RNs to conduct postoperative phone calls may not be cost effective. When RNs provide excellent instructions to patients in person, it may lead to sufficient patient health confidence. Personal and nurse-provided education should be considered a standard, and the outcomes of costly follow-up phone calls should be examined.
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Johnson DJ, Castle JP, Hartwell MJ, D'Heurle AM, Manning DW. Risk Factors for Greater Than 24-Hour Length of Stay After Primary Total Knee Arthroplasty. J Arthroplasty 2020; 35:633-637. [PMID: 31757697 DOI: 10.1016/j.arth.2019.10.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recently, the Center for Medicare Services removed total knee arthroplasty (TKA) from the inpatient-only procedure list. The purpose of this study is to assess the role of demographics, medical comorbidities, and postsurgical complications in predicting safe discharge to home within 24 hours after TKA. METHODS Patients undergoing primary TKA between 2011 and 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program. Patients were grouped into those whose length of stay (LOS) was less than 24 hours after surgery vs those greater than 24 hours. Demographics, preoperative comorbidities, operative variables, and postoperative adverse events were studied as risk factors for LOS greater than 24 hours. RESULTS A total of 210,075 patients undergoing primary TKA met the inclusion criteria, and of those, 18,134 (8.6%) patients were discharged within 24 hours postoperatively. In a risk-adjusted multivariate analysis, patients with increasing age, obesity, preoperative comorbidities of smoking, diabetes, dyspnea, chronic obstructive pulmonary disease, hypertension, bleeding disorder, corticosteroid use preoperatively, and dependent functional status conferred a greater risk for discharge greater than 24 hours. Male gender, spinal anesthesia, and monitored anesthesia care were protective against LOS greater than 24 hours. CONCLUSION This study suggests that dependent functional status, preoperative comorbidities, and postoperative complications are all associated with a LOS greater than 24 hours after TKA. Surgeons and patients should be aware of the clinical and demographic variables associated with risk for LOS greater than 24 hours when considering outpatient status for patients undergoing TKA.
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Affiliation(s)
- Daniel J Johnson
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua P Castle
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew J Hartwell
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Albert M D'Heurle
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David W Manning
- Department of Orthopedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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11
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Feder OI, Lygrisse K, Hutzler LH, Schwarzkopf R, Bosco J, Davidovitch RI. Outcomes of Same-Day Discharge After Total Hip Arthroplasty in the Medicare Population. J Arthroplasty 2020; 35:638-42. [PMID: 31668527 DOI: 10.1016/j.arth.2019.09.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/15/2019] [Accepted: 09/26/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is an increasing utilization of same-day discharge total hip arthroplasty (SDD THA). As the Center for Medicare and Medicaid Services considers removing THA from the inpatient-only list, there is likely to be a significant increase in the number of Medicare patients undergoing SDD THA. Thus, there is a need to report on outcomes of SDD THA in this population. METHODS A retrospective review was performed on 850 consecutive SDD THA patients including 161 Medicare patients. We compared failure to launch, complication, emergency department visit, and 90-day readmission rates between the Medicare and non-Medicare cohorts. RESULTS The Medicare group was older and had less variability in their admission diagnosis. There was no significant difference in failure to launch, complication, emergency department visit, or 90-day readmission rates between Medicare and non-Medicare groups. CONCLUSION The benefits of SDD THA can be safely extended to the carefully indicated and motivated Medicare patient.
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Sershon RA, McDonald JF, Ho H, Goyal N, Hamilton WG. Outpatient Total Hip Arthroplasty Performed at an Ambulatory Surgery Center vs Hospital Outpatient Setting: Complications, Revisions, and Readmissions. J Arthroplasty 2019; 34:2861-2865. [PMID: 31445867 DOI: 10.1016/j.arth.2019.07.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/16/2019] [Accepted: 07/22/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Outpatient total hip arthroplasty (THA) utilization continues to grow. Literature suggests outpatient THA may result in low rates of complications and readmission. There are no studies comparing safety profiles of THA performed at ambulatory surgery centers (ASC) vs hospital outpatient (HOP) settings. METHODS Prospectively collected data were reviewed on all patients who underwent THA from 2013 to 2018. ASC and HOP subgroups were compared, investigating difference in demographics, comorbidities, American Society of Anesthesiologists subgroups, all complications, revisions, emergency department (ED) visits, and readmissions within the first 90 days of surgery. An additional subgroup analysis of patients younger than 65 years was performed. RESULTS Two surgeons performed 3063 THAs during the study period, including 965 outpatient cases (ASC = 335; HOP = 630). Thirty-seven (3.8%) complications occurred within 90 days. No differences were found between groups for 90-day complication rates (ASC = 13, 3.9%; HOP = 24, 3.8%; P = .48), revision rates (ASC = 0, 0%; HOP = 2, .3%; P = .30), all-cause reoperation rates (ASC = 1, 0.3%; HOP = 5, 0.8%; P = .35), ED visits (ASC = 3, 0.9%; HOP = 2, 0.3%; P = .23), or readmission rates (ASC = 2, 0.6%; HOP = 9, 1.4%; P = .25). CONCLUSION THA can be safely performed in both ASC and HOP settings with low 90-day postoperative complication, revision, reoperation, ED visit, and readmission rates. Based on the populations studied, we identified no statistically significant differences in rates of complications between ASC and HOP groups.
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Affiliation(s)
- Robert A Sershon
- Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA; Anderson Orthopaedic Research Institute, Alexandria, VA
| | | | - Henry Ho
- Anderson Orthopaedic Research Institute, Alexandria, VA
| | - Nitin Goyal
- Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA; Anderson Orthopaedic Research Institute, Alexandria, VA
| | - William G Hamilton
- Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA; Anderson Orthopaedic Research Institute, Alexandria, VA
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Abstract
Spine surgery continues to move into the ambulatory setting in an effort to pair high-quality care delivery with low-cost facilities. The purpose of this review was to assess the current literature for trends in the practice of ambulatory spine surgery. A systematic review of the English language literature from the past five years was performed utilizing PRISMA standards. The results demonstrate that current focus of research emphasizes the safety of ambulatory surgery-with several studies commenting on complication rates, patient selection, and postoperative protocols to prevent readmissions or complications. Research is also focused on quality of care, and ensuring non-inferiority of ambulatory surgery when compared with traditional inpatient hospitalizations. Importantly, no level I or II literature has been published on the topic in the past five years, suggesting a renewed need for high quality prospective studies.
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Affiliation(s)
- Edward M DelSole
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Heeren S Makanji
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mark F Kurd
- Department of Spine Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
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Chartrand J, Tourigny J, MacCormick J. The effect of an educational pre-operative DVD on parents' and children's outcomes after a same-day surgery: a randomized controlled trial. J Adv Nurs 2016; 73:599-611. [PMID: 27681601 DOI: 10.1111/jan.13161] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/27/2022]
Abstract
AIMS To examine the effect of a pre-operative DVD on parents' knowledge, participation and anxiety and on children's distress, pain, analgesic requirements and length of recovery after same-day surgery. BACKGROUND Very few parents are adequately prepared to participate in their child's care during a same-day surgery. An educational DVD was developed to educate parents on how to actively support their child in the recovery room. DESIGN Single-blind, post-test randomized controlled trial. Study is registered at ClinicalTrials.gov NCT02766452. METHODS Between September 2011-September 2012, 123 parent-child dyads where the child underwent an ENT or dental same-day surgery were recruited in a Canadian paediatric hospital. Dyads were randomly assigned to either the intervention (DVD and standard preparation) or control group (standard preparation). Parents and children were videotaped in the recovery room where parental participation and anxiety and children's distress were measured. Data on parents' knowledge, children's postoperative pain, analgesic requirements and length of recovery were measured. Independent and paired t-tests, chi square and repeated measures anova were used to analyse the data. RESULTS Parents in the intervention group gained greater knowledge of and used more positive reinforcement and distraction and relaxation methods than those in the control group. Children's postoperative pain in the day-care surgery unit was significantly lower among the intervention group compared with the control group. CONCLUSION A pre-operative DVD can increase parents' participation in the recovery room and decrease children's postoperative pain.
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Affiliation(s)
| | | | - Johnna MacCormick
- Faculty of Medicine, University of Ottawa, Ontario, Canada.,Division Pediatric Otolaryngology, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
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Grewal H, Sweat J, Vazquez WD. Laparoscopic appendectomy in children can be done as a fast-track or same-day surgery. JSLS 2004; 8:151-4. [PMID: 15119660 PMCID: PMC3015535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Laparoscopic surgery has reduced the length of hospital stay for common operations like cholecystectomy, gastric fundoplication, and appendectomy. We have noticed a reduction in length of hospital stay for children undergoing laparoscopic appendectomy. We, therefore, looked at our data to assess whether laparoscopic appendectomy in children could be performed as fast-track or same-day surgery (< or = 24-hour postoperative stay). METHODS We performed a retrospective review of the records of all children who underwent laparoscopic appendectomy for suspected appendicitis during a 3-year period (7/97 to 7/00). RESULTS Laparoscopic appendectomy was performed in 79 children (44 boys and 35 girls), between 2 to 17 years of age (mean, 11 years). In 4 (5%) children with perforated appendicitis, the laparoscopic appendectomy was converted to an open appendectomy. At operation, 51 (64.5%) had acute appendicitis, 22 (27.8%) had perforated appendicitis, 4 (5%) had ruptured ovarian cysts, and 2 (2.5%) had no pathology. The median operative time was 54 minutes. Total length of stay for all 79 patients was a median of 58 hours, and median postoperative LOS was 35 hours. Complications included wound infection (2), abdominal abscess (4), drug rash (2), and epididymo-orchitis (1). In 57 (72%) children without perforated appendicitis, the total length of hospital stay was a median of 42 hours, while median postoperative length of stay was only 28 hours. Thirty-two (56%) children went home in < or = 24 hours following laparoscopic appendectomy. No significant morbidity was noted in the nonperforated group (drug rash, 1 fever > 24 hrs, 3); and no readmissions or reoperations were necessary on follow-up. CONCLUSION Laparoscopic appendectomy is safe and effective for treating children with appendicitis. Laparoscopic appendectomy may be safely performed as fast-track or same-day surgery, in select children without perforated appendicitis, with a postoperative stay of < or = 24 hours.
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Affiliation(s)
- Harsh Grewal
- Section of Pediatric Surgery, Temple University Children's Medical Center, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.
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