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Introduction: With the strain placed on the medical system by the ongoing surges of the Covid-19 pandemic, inpatient surgery is often suspended, and same day discharge rates are increasing. Sacrospinous ligament fixation (SSLF) is an apical suspension procedure performed retroperitoneally;retroperitoneal hemorrhage and nerve injury are potential severe complications. Given these risks, providers vary in their preference for same day discharge vs. routine overnight admission after this procedure. Objective: To establish the safety of outpatient SSLF and evaluate the frequency of complications identified during the hospital stay. Methods: This is a retrospective cohort study of women who underwent SSLF by Urogynecologists at our large, academic institution between March 2018 and October 2021. Patients were identified from the Gynecologic Enhanced Recovery Surgical database, which includes all surgical patients in the department of OBGYN. The data was collected from the electronic medical record (EMR) to track compliance and outcomes in real time for quality improvement purposes during implementation of our enhanced recovery protocol. Institutional IRB approval was obtained. Descriptive statistics were performed. Student's t-test and two-sample tests-of-proportions were used, with a p-value <0.05 denoting statistical significance. Results: A total of 165 patients underwent SSLF;23 were outpatient, and 142 were admitted for at least one night. Over 90% of patients in both groups identified as white, non-Hispanic, and English-speaking. The mean BMI for both groups was 28.8 kg/m2. The outpatient group was younger (57.9 years compared to 64.7 years;P = 0.0051);outpatients were more likely to have commercial insurance (P = 0.0143) and inpatients to have Medicare (P = 0.0282). Almost double the proportion of those in the inpatient group had anxiety and depression, but this did not achieve statistical significance. Outpatients were more likely to be never smokers (P = 0.0175) and use narcotics preoperatively (P = 0.0385). They had a lower mean ASA score (P = 0.0067), Charleston Comorbidity Index score (P = 0.0452), total length of surgery (P < 0.001), total length of anesthesia (P < 0.001), and estimated blood loss (P = 0.0142). Those who went home the same day were more likely to have been the first case (P = 0.0123), and same-day discharge rates increased significantly after the onset of the Covid-19 pandemic (P = 0.0039). Both complications that required operative intervention were identified in the post-anesthesia care unit on the day of surgery. Notably, 30-day post-operative complications were proportionally lower in the outpatient group, but this did not achieve significance. Most of the complications were urinary tract infections, including the sole complication identified in the outpatient group. Conclusions: With the ongoing Covid-19 pandemic and rapidly evolving practice patterns, it is important to establish the safety of outpatient surgery. Our study demonstrates that outpatient SSLF is safe for appropriately selected patients after routine post-operative monitoring including serial vital signs and assessment of neuropathic pain. Severe complications requiring reoperation can often be identified immediately after surgery. Thirty-day post-operative complication rates did not significantly differ between patients undergoing outpatient versus inpatient SSLF.
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Background and Aims: Connecting in-person with patients is challenging during COVID, potentially undermining the frequency and quality of consultations with health care professionals (HCPs). Telemedicine offers a way to support patient provider connectivity. Methods: Survey data was collected from 22 HCPs from 20 institutions who then participated in one of four virtual meetings to share telemedicine insights using the professional version of One Touch Reveal® (OTR Pro) ecosystem. Results: Remote consultations increased 46% in these institutions during COVID, divided 52% and 48% between patients with type 1 and type 2 diabetes. Methods included telephone (60%), email (19%), video (10%), texting (3%), or combinations (8%). HCPs reviewed OTR Pro data during (45%) or before (25%) consultations, every 3 months (20%) or every 2 weeks (5%). 55% of HCPs said going forward, OTR Pro would become their standard of care, 30% for current or new patients, 10%during face-to-face visits and only 5% returning to face-to-face consultations without OTR Pro. For managing patients, HCPs ranked ''allows me to make treatment/therapy decisions,'' ''helps me schedule consultations/ reminders,'' ''access 24/7 to status of my patients,'' as the top 3 benefits of OTR Pro. 95% of HCPs agreed OTR Pro identified patterns, trends and trouble spots for more meaningful conversations with patients, facilitating clinical practice during COVID. Conclusions: The One Touch Reveal® ecosystem supported telemedicine during the pandemic and will continue to play a valuable role beyond the pandemic.
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The majority of Poland's COVID-19 medical advisory body have quit, saying that their advice has been ignored. Ed Holt reports.