Electronic patient-reported outcome measures using mobile health technology in rheumatology: A scoping review.

OBJECTIVE: This scoping review aims to characterize the current literature on electronic patient-reported outcome measures (ePROMs) in rheumatology and assess the feasibility and utility of ePROMs and mobile health technology in the management of rheumatic disease. INTRODUCTION: Patient-reported outcome measures (PROMs) are commonly used in rheumatology as they are important markers of disease activity and overall function, encourage shared decision-making, and are associated with high rates of patient satisfaction. With the widespread use of mobile devices, there is increasing interest in the use of mobile health technology to collect electronic PROMs (ePROM). INCLUSION CRITERIA: All primary studies that involve the collection of ePROMs using mobile devices by individuals with a rheumatic disease were included. Articles were excluded if ePROMs were measured during clinic appointments. METHODS: A scoping review was performed using Medline, Embase, PsycINFO, and CINAHL with index terms and key words related to "patient-reported outcome measures", "rheumatic diseases", and "mobile health technology". RESULTS: A total of 462 records were identified after duplicates were removed. Of the 70 studies selected for review, 43% were conference proceedings and 57% were journal articles, with the majority published in 2016 or later. Inflammatory arthritis was the most common rheumatic disease studied. Generic ePROMs were used over three times more often than disease-specific ePROMs. A total of 39 (56%) studies directly evaluated the feasibility of ePROMs in clinical practice, 19 (27%) were clinical trials that used ePROMs as study endpoints, 9 (13%) were focus groups or surveys on smartphone application development, and 3 (4%) did not fit into one defined category. CONCLUSION: The use of ePROMs in rheumatology is a growing area of research and shows significant utility in clinical practice, particularly in inflammatory arthritis. Further research is needed to better characterize the feasibility of ePROMs in rheumatology and their impact on patient outcomes.

Implications of Technical Factors in Development of Early Sleeve Stenosis After Laparoscopic Sleeve Gastrectomy: an Analysis Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database.

PURPOSE: Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure worldwide. Sleeve stenosis (SS) is a rare complication of LSG and is associated with significant morbidity and economic burden. The objective of this study was to determine the prevalence and impact of early SS and identify technical factors which may predict its development. MATERIALS AND METHODS: Data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2018. Patients undergoing primary LSG were included, while patients undergoing revisional bariatric surgery were excluded. A multivariable logistic regression analysis was performed to identify technical factors associated with SS. RESULTS: A total of 389,839 patients (79.4% female) were included with a mean age of 44.2 ± 12.0 years and mean body mass index of 45.1 ± 7.8 kg/m2. SS was rare, occurring in only 0.09% (n=345) of patients within 30 days of the operation. Following multivariable analysis, technical factors associated with early SS included prolonged operative time > 60 min (OR 1.32, 95% CI 1.17-1.48, p < 0.001) and a shorter PD (OR 0.864, 95% CI 0.784-0.951, p=0.003). For every 1-cm increase in PD, the odds of SS decreased by 13.6%. CONCLUSION: Overall, early SS is a rare complication, affecting only 0.09% of patients undergoing primary LSG. Technical factors associated with 30-day SS included PD and operative time. Though current guidelines suggest a PD as short as 2 cm, our findings suggest this may be associated with an increased risk of early postoperative SS.

Trends and Outcomes of Laparoscopic Sleeve Gastrectomy Between 2015 and 2018 in the USA and Canada.

BACKGROUND: Given there are approximately 100,000 primary laparoscopic sleeve gastrectomy (LSG) procedures performed a year in North America, there is a need to evaluate recent trends in LSG. The objective of this study was to analyze the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to identify trends in technical factors and patient outcomes over time. METHODS: The MBSAQIP prospectively collects data from 854 centers in the USA and Canada. Patients undergoing primary LSG were included. Statistical analysis was performed to characterize trends in patient factors, technical factors, and 30-day postoperative outcomes. RESULTS: A total of 434,030 patients underwent primary LSG. The mean age was 44.2 (SD 12.0) years and mean body mass index was 45.1 (SD 7.8) kg/m2. Baseline demographics did not vary appreciably by year. Operative time decreased from 2015 to 2018 (75.4 to 70.6 min, p < 0.001). Bougie size and stapling distance from the pylorus did not change by year. However, staple line reinforcement (66.8 to 63.2%, p < 0.001) and oversewing of the staple line (23.1 to 20.1%, p < 0.001) were less commonly performed. Postoperatively, from 2015 to 2018, there was a 45.8% relative reduction in leaks (0.48 to 0.26%, p < 0.001). There were also reductions in 30-day major complications (2.87 to 2.28%, p < 0.001), length of stay (1.72 to 1.44 days, p < 0.001), and readmissions (3.39 to 2.77%, p < 0.001). CONCLUSIONS: From 2015 to 2018, there was a decrease in staple line reinforcement and oversewing. These changes correlated with reductions in operative time, length of stay, readmission, and major complications.