The Journal of surgical research
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Unintended rehospitalizations after surgical procedures represent a large percentage of readmissions and have been associated with increased morbidity and cost of care. Beginning in 2017, Medicare will expand diagnostic categories subject to financial penalties for excess postoperative readmissions to include coronary revascularization procedures. Arrhythmias and pulmonary complications comprise the largest categories for readmission after cardiac surgery. Technologic advances in remote monitoring have led to the use of web-based digital health kits (DHK) aimed at reducing readmissions and improving postoperative outcomes. The present study was performed to determine the added benefit of incorporating DHK's into a formal readmissions reduction program (RRP) in preventing 30-d readmissions and to evaluate patient and provider satisfaction with the use of these devices. ⋯ In our study, adding DHKs to a formal RRP was not associated with a significant decrease in 30-d readmission rates. We also found that notifications because of abnormal biometric measures were significantly correlated with required interventions. In contrast, notifications due to abnormal health survey responses were not associated with increased interventions. Both patients and members of the healthcare team were highly satisfied with this technology. DHKs appear to extend care beyond the inpatient period and provide a portal for telemonitoring of surgical patients. However, this modality is highly resource intensive and may not significantly reduce readmissions. Further studies are warranted to evaluate the efficacy of such kits in reducing readmissions and costs of care.
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Immediate postoperative admission to the intensive care unit (ICU) after pancreaticoduodenectomy (PD) is still a standard practice at many institutions. Our aim was to examine whether omission of an immediate postoperative ICU admission would be safe and result in improved outcomes and cost after robotic pancreaticoduodenectomy (RPD). ⋯ A standard policy of omitting a postoperative ICU admission on post operative day 0 after RPD is safe and can result in reduced LOS and overall savings in total hospital cost.
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Black men are disproportionately overrepresented among victims of repeat violent injury. However, little is known about the risk factors that influence violent trauma recidivism among black men. We hypothesize that the following risk factors would be significant among black male victims of repeat violent injury: disrespect; being under the influence; being in a fight and using a weapon in the past year; and previous incarceration when comparing trauma recidivists versus nonrecidivists. ⋯ Trauma recidivism among urban black male victims of violent injury is a major public health issue. Hospital-based violence intervention programs should be engaged in reducing trauma recidivism among this population.
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Damage to the recurrent laryngeal nerve (RLN) can lead to vocal cord paralysis, resulting in hoarseness, aspiration, stridor, and respiratory distress. The purpose of this study was to examine the impact of intraoperative nerve monitoring (IONM) on RLN injury during thyroidectomy when it is used as an adjunct to confirm the functional integrity of the RLN during delineation of its anatomic course after it has been visually identified. ⋯ The use of IONM had no impact on the rate of permanent RLN injury during thyroidectomy. Because of the low rate of RLN injury, a much larger sample size is needed to determine if IONM will a valuable adjunct in thyroid surgery, especially in specific high-risk subgroups.