Remote patient monitoring to facilitate same-day discharge after laparoscopic sleeve gastrectomy: a pilot evaluation.

BACKGROUND: Limited hospital inpatient capacity, exacerbated by SARS-CoV-2 (COVID-19) and associated staffing shortages, has driven interest in converting surgeries historically done as inpatient procedures to same-day surgeries (SDS). Remote patient monitoring (RPM) has the potential to increase safety and confidence in SDS but has had mixed success in a bariatric population. OBJECTIVES: Assess the feasibility of and adherence to a protocol offering patients same-day laparoscopic sleeve gastrectomy (SG) supported by RPM with an updated wearable device. Secondary outcomes were readmissions, costs, adherence, and clinical alarm rates. SETTING: Academic, military tertiary referral center (United States). METHODS: A single-center, retrospective case control study of patients undergoing SG, comparing SDS with RPM to patients admitted to the hospital for SG during this time. Patients for SDS were selected by set inclusion/exclusion criteria and patient/surgeon preference, and perioperative management was standardized. RESULTS: Twenty patients were enrolled in the SDS group, then compared with 53 inpatients. Inpatients were older (46 versus 39, P = .006), but with no significant differences in sex, preoperative body mass index, or co-morbidities. RPM wearable and blood pressure adherence was found to be 97% and 80%, respectively. Readmission rates were similar (10% versus 7.5%, P > .05). RPM alarm rates were .5 (0-1.3) per patient for each 24-hour home monitoring period. SDS patients also demonstrated the potential for cost savings over inpatient SG, depending on the number of patients monitored per day as well as the healthcare setting. CONCLUSIONS: SG as SDS with RPM was a feasible approach. It should be evaluated in other surgical procedures and higher-risk patient populations.

Remote patient monitoring to facilitate same-day discharge following laparoscopic sleeve gastrectomy: a pilot evaluation

Background Limited hospital inpatient capacity, exacerbated by SARS-CoV-2 (COVID-19) and associated staffing shortages, has driven interest in converting surgeries historically done as inpatient procedures to same-day surgeries (SDS). Remote patient monitoring (RPM) has the potential increase safety and confidence in SDS but has had mixed success in a bariatric population. Objective Assess the feasibility of, and adherence to, a protocol offering patients same-day laparoscopic sleeve gastrectomy (SG) supported by RPM with an updated wearable device. Secondary outcomes were readmissions, costs, adherence, and clinical alarm rates. Setting Academic, military tertiary referral center (United States) Methods A single center, retrospective case control study of patients undergoing laparoscopic sleeve gastrectomy, comparing SDS with RPM to patients admitted to the hospital for SG during this time. Patients for SDS were selected by set inclusion/exclusion criteria and patient/surgeon preference, and perioperative management was standardized. Results Twenty patients were enrolled into the SDS group, then compared to 53 inpatients. Inpatients were older (46 vs 39, p=0.006), but with no significant differences in sex, pre-operative BMI or comorbidities. RPM wearable and blood pressure adherence was found to be 97 and 80 %, respectively. Readmission rates were similar (10 vs 7.5 %, p > 0.05). RPM alarm rates were 0.5 (0 – 1.3) per patient for each 24-hour home monitoring period. SDS patients also demonstrated the potential for cost savings over inpatient SG, depending on the number of patients monitored per day, as well as the healthcare setting. Conclusion SG as SDS with RPM was a feasible approach. It should be evaluated in other surgical procedures and higher risk patient populations.

Could global surgery overcome a decline in surgical cases?

•There have been three distinct landmarks for the US surgical trainees leading to a decline in surgical volume and in open number of cases.•Global surgery experiences have been adopted to expose trainees to surgical problems not routinely seen in the Global North.•Global Surgery also exposes trainees to empathic and collaborative approaches.•Benefits of global surgery to compensate for the decline in volume, variety and open surgical cases need to be studied through an academic, ethical, and economic lens.•LMICs trainees could travel to HIC for research and clinical training in exchange for the skills and case volume that HIC trainees would obtain in LMICs.