Journal of the American College of Surgeons
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Inefficient operating room (OR) use wastes resources. Studies have suggested "first case on-time starts" (FCOTS) reduce OR "idle time," yet no direct association between FCOTS and markers of OR efficiency, like "last case on-time end" (LCOTE) or overtime costs, have been reported. We performed this study to evaluate factors associated with FCOTS, LCOTE, and OR overtime costs. ⋯ The FCOTS initiative was associated with higher frequency of FCOTS, which was independently associated with LCOTE. This achieved an estimated 6-month cost savings of more than $80,000 in direct OR expenditures.
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Supermicrosurgical lymphaticovenous anastomosis (LVA) alleviates lymphedema by draining stagnant lymph from the lymphatic vessels into the venous system. Nevertheless, LVA is believed to be unsuitable for treating moderate-to-severe lymphedema presenting diffuse-pattern dermal backflow (DB). Dermal backflow is considered to be the sign of superficial lymphatic functional failure that renders LVA ineffective. Based on a current algorithm, a more invasive vascularized lymph node flap transfer is recommended instead of LVA. This retrospective study aimed to further investigate and possibly challenge this concept. ⋯ The use of supermicrosurgical LVA is as effective at treating moderate-to-severe lymphedema as milder lymphedema. The indication for LVA should be broadened to include such cases.
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Observational Study
Telephone Follow-Up for Emergency General Surgery Procedures: Safety and Implication for Health Resource Use: Telephone Follow-Up after Surgery.
It is unknown whether replacing clinic follow-up visits with telephone follow-up for low-risk core emergency general surgery (cEGS) procedures is safe. We measured the efficacy of telephone follow-up to determine if it could safely reduce the need for routine postoperative clinic visits in this population. ⋯ Post-discharge telephone follow-up in cEGS patients reduced the need for clinic follow-up visits by 68%. Missed complications were infrequent and low grade; telephone screening identified the single high-grade complication. Telephone follow-up for low-risk EGS patients is safe and increases efficiency of postoperative resource use.