Retrieval of Embolized WATCHMAN® Flex Atrial Appendage Occlusion Device.

This case report documents the management of a 66-year old man with atrial fibrillation with recent placement of a WATCHMAN® Flex atrial appendage occlusion device. The patient presented with renal failure, abdominal pain, and difficulty walking 2 months after placement. The WATCHMAN® Flex device was found to have embolized to his abdominal aorta at the level of the renal arteries with associated thrombus. Extensive workup revealed reduced left ventricular cardiac function and decreased renal function, both of which were felt to be potentially reversible with device removal. The patient then underwent retrieval of the device and all associated thrombus via an open retroperitoneal approach. This case demonstrates a potential consequence of implanting devices such as an atrial appendage occlusion device and describes a technique for removal.

How Much is Enough? Public Perception of Minimum Surgeon Volumes.

BACKGROUND: A large body of literature supports an association between surgical volumes and outcomes. Research on this subject has resulted in attempts to quantify minimum volume standards for specific surgeries. However, the extent to which the public takes interest in or is able to interpret surgical volume information is not known. METHODS: We designed a 38-question online survey to assess respondents' knowledge and beliefs about minimum surgical volume standards, and other factors influencing choice of surgeon. Participants, recruited through Amazon Mechanical Turk, an online crowdsourcing marketplace, were specifically asked to estimate minimum volume standards for four different operations (hernia repair, knee replacement, mitral valve repair, and Whipple) and to assess the implications of specific surgeon volumes for decision-making in two hypothetical scenarios. RESULTS: Among 2024 participants, 81% attested that surgeons should be subject to minimum volume standards. A small minority (19%) reported having prior knowledge of a link between surgeon volumes and outcomes. Respondents' mean estimates for appropriate minimum annual volumes across four operations were directly correlated with surgical complexity (5 for inguinal hernia repair, 25 for Whipple), while published minimum standards fall with increasing surgical complexity (25 for hernia repair, 5 for Whipple). These findings were validated by participants' stated intentions: 55% would proceed with a hernia repair by a surgeon with annual volume of 25, while 13% would proceed with a Whipple when annual volume was 5. CONCLUSION: The concept of minimum surgical volumes is intuitively important to the lay public. However, the general public's skewed expectations of minimum volume standards demonstrate an inability to interpret surgical volume numbers meaningfully in clinical settings without appropriate context.

Telemedicine for Surgical Consultations - Pandemic Response or Here to Stay?: A Report of Public Perceptions.

OBJECTIVE: This study aims to determine the public's perception of telemedicine surgical consultations, during the COVID-19 pandemic and beyond. SUMMARY BACKGROUND DATA: With rapid expansion and uptake of telemedicine during the pandemic, many have posited that virtual visits will endure even as in-person visits are reinstated. The public's perception of telemedicine for an initial surgical consultation has not been previously studied. METHODS: A 43-question survey assessed respondents' attitudes toward telemedicine for initial consultations with surgeons, both in the context of COVID-19 and during "normal circumstances." Participants were recruited through Amazon Mechanical Turk, an online crowd-sourcing marketplace. RESULTS: Based on 1827 analyzable responses, we found that a majority (86%) of respondents reported being satisfied (either extremely or somewhat) with telemedicine encounters. Interestingly, preference for in-person versus virtual surgical consultation reflected access to care, with preference for telemedicine decreasing from 72% to 33% when COVID-related social distancing ends. Preferences for virtual visits decreased with increasing complexity of the surgical intervention, even during the pandemic. A majority felt that "establishing trust and comfort" was best accomplished in person, and the vast majority felt it was important to meet their surgeons before the day of surgery. CONCLUSIONS: The public views telemedicine as an acceptable substitute for in-person visits, especially during the pandemic. However, it seems that an in-person interaction is still preferred when possible for surgical consultations. If telemedicine services are to persist beyond social distancing, further exploration of its impact on the patient-surgeon relationship will be needed.