Postoperative Telehealth Visits Reduce Emergency Department Visits and 30-Day Readmissions in Elective Thoracic Surgery Patients.

BACKGROUND: Preventing postoperative 30-day readmissions requires an investment in patient care. The use of postdischarge telehealth visits to prevent potential adverse events or hospital visits has been shown in previous studies. PURPOSE: We aim to determine the impact of postoperative telehealth visits (PTV) on reducing emergency department visits (EDV) and readmissions within 30 days postdischarge (30DR). METHODS: All elective thoracic surgery patients opted-in or opted-out of PTV. Postoperative telehealth visits assessed patients' overall health status and addressed patient concerns. Patients were also seen at their postoperative clinic follow-up. Emergency department visits and 30DR were recorded. RESULTS: Three hundred fourty-one patients were included-295 and 46 patients opted-in and opted-out of PTV. Opting-out of PTV, being discharged with chest tubes or drains, and the inability to perform activities of daily living at their postoperative follow-up were associated with increased EDV (OR = 8.7, 5.3, 6.3; p ≤ .05) and 30DR (OR = 5.1, 6.3, 7.1; p ≤ .05). CONCLUSION: Postoperative telehealth visits were able to reduce EDV and 30DR in our study, although further studies establishing the range of interventions that can be feasibly provided remotely should be performed to identify limitations of these PTV. IMPLICATIONS: Telehealth could be used postoperatively to reduce EDV and 30DR, improving quality and cost-effectiveness of healthcare delivery to patients.

Debility Risk Model as a Predictor for Postsurgical Outcomes.

BACKGROUND: Decreased patient functional status is associated with higher rates of postoperative morbidity and mortality. The Vizient program recently implemented a debility risk model to identify patients with impaired functional status. We examined the relationship between this novel model and inpatient postsurgical outcomes in a large urban tertiary care center. METHODS: The Vizient database was accessed to compare surgical outcomes between patients coded with debility and patients without debility between January 2017 and December 2018. Data for each surgical specialty were obtained, and a chi-squared analysis was used to detect differences in readmission rates, mortality, and postoperative complications (defined by Vizient). These complications include pneumonia, postoperative infection, anesthesia complications, and shock. RESULTS: We found patients with debility have a higher mortality rate (3%) than patients without debility (2%) across all surgical specialties (P = .0103). Patients with debility have a higher 30-day readmission rate (16%) than those without debility (8%) across all specialties (P < .0001). Patients with debility had a higher rate of inpatient complications for neurosurgery (12.11% vs. 8%, P = .008), trauma surgery (11.9% vs. 6%, P =.025), general surgery (17.67% vs. 7%, P = .013), and cardiac surgery (47.06% vs. 18%, P =.0025). CONCLUSIONS: Our study supports the use of the Vizient debility code to predict postsurgical outcomes and risk stratify patients. By extension, functional status assessments in preoperative evaluation of patients remain important. Further, studies can build upon this data to measure the impact of preoperative, outpatient debility assessments in surgical patients.

Correction to: Safety of orogastric tubes in foregut and bariatric surgery.

The article "Safety of orogastric tubes in foregut and bariatric surgery," written by Kulvir Nandra and Richard Ing, was originally published Online First without Open Access. After publication in volume 32, issue 10, pages 4068-4070, the authors decided to opt for Open Choice and to make the article an Open Access publication. Therefore, the copyright of the article has been changed to © The Author(s) 2018 and the article is forthwith distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Telehealth provides a comprehensive approach to the surgical patient.

BACKGROUND: This study describes telehealth use within the Department of Surgery in a large urban academic medical center and its role in diverse surgical patients. METHODS: We performed a retrospective descriptive study of video telehealth visits conducted by an academic urban surgery department from February 2017 to November 2017. We report our experience in accordance with the National Quality Forum recommended domains of access, experience and effectiveness. RESULTS: Six hundred and fifty-five (655) video telehealth encounters were performed during the study period: 152 were immediate postoperative visits, 424 were established patient visits, and 79 were group sessions. Our 30-day readmission rate of the post-operative visits was very low (4 of 152). One hundred and forty-one (141) patient survey responses show very high satisfaction and time savings. CONCLUSIONS: Our results demonstrate a single institution's successful experience in offering telehealth to surgical patients in an urban setting.

Safety of orogastric tubes in foregut and bariatric surgery.

BACKGROUND: Orogastric tubes have traditionally aided foregut procedures with sizing and organ protection. The rise of bariatric surgery has led to the creation of novel medical devices aimed at facilitating the laparoscopic sleeve gastrectomy. While approved by the FDA, the long-term safety profile of these devices in the general population is often unknown. This review looks at complications associated with novel Orogastric Tubes compared to the traditional bougie. METHODS: We performed a review of the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database for complications associated with the traditional bougie, Boehringer Labs ViSiGi 3D® and the Medtronic GastriSail™ since 2011. In addition, we looked for reported cases in the literature of complications with these devices. RESULTS: Overall complication rates reported in the MAUDE database varied in number and severity. The bougie had seven reported complications, one of which was an organ perforation. The ViSiGi 3D® had zero reported complications. The GastriSail™ had 36 total reported complications with 17 perforations. A literature review shows that rates of bougie complications are extremely rare with no case reports or reviews of complications from the novel orogastric tubes. CONCLUSIONS: The complication rates between the traditional bougie and novel devices vary in number and severity, with the GastriSail™ having the highest reported complication rate. Despite rigorous testing for FDA approval, ongoing research into performance of new medical devices in the general population remains important.

Successful Reinnervation of the Diaphragm After Intercostal to Phrenic Nerve Neurotization in Patients With High Spinal Cord Injury.

OBJECTIVE: Our objective in this study was to extend diaphragmatic pacing therapy to include paraplegic patients with high cervical spinal cord injuries between C3 and C5. INTRODUCTION: Diaphragmatic pacing has been used in patients experiencing ventilator-dependent respiratory failure due to spinal cord injury as a means to reduce or eliminate the need for mechanical ventilation. However, this technique relies on intact phrenic nerve function. Recently, phrenic nerve reconstruction with intercostal nerve grafting has expanded the indications for diaphragmatic pacing. Our study aimed to evaluate early outcomes and efficacy of intercostal nerve transfer in diaphragmatic pacing. METHODS: Four ventilator-dependent patients with high cervical spinal cord injuries were selected for this study. Each patient demonstrated absence of phrenic nerve function via external neck stimulation and laparoscopic diaphragm mapping. Each patient underwent intercostal to phrenic nerve grafting with implantation of a phrenic nerve pacer. The patients were followed, and ventilator dependence was reassessed at 1 year postoperatively. RESULTS: Our primary outcome was measured by the amount of time our patients tolerated off the ventilator per day. We found that all 4 patients have tolerated paced breathing independent of mechanical ventilation, with 1 patient achieving 24 hours of tracheostomy collar. CONCLUSIONS: From this study, intercostal to phrenic nerve transfer seems to be a promising approach in reducing or eliminating ventilator support in patients with C3 to C5 high spinal cord injury.