Background Absorbable or non-absorbable sutures can be used for superficial skin closure following excisional skin surgery. There is no consensus among clinicians nor high-quality evidence supporting the choice of suture. The aim of the present study was to determine current suture use and complications at 30 days after excisional skin surgery. Methods An international, prospective service evaluation of adults undergoing excision of skin lesions (benign and malignant) in primary and secondary care was conducted from 1 September 2020 to 15 April 2021. Routine patient data collected by UK and Australasian collaborator networks were uploaded to REDCap©. Choice of suture and risk of complications were modelled using multivariable logistic regression. Results Some 3494 patients (4066 excisions) were included; 3246 (92.9 per cent) were from the UK and Ireland. Most patients were men (1945, 55.7 per cent), Caucasian (2849, 81.5 per cent) and aged 75–84 years (965, 27.6 per cent). The most common clinical diagnosis was basal cell carcinoma (1712, 42.1 per cent). Dermatologists performed most procedures, with 1803 excisions (44.3 per cent) on 1657 patients (47.4 per cent). Most defects were closed primarily (2856, 81.9 per cent), and there was equipoise in regard to use of absorbable (2127, 57.7 per cent) or non-absorbable (1558, 42.2 per cent) sutures for superficial closure. The most common complications were surgical-site infection (103, 2.9 per cent) and delayed wound healing (77, 2.2 per cent). In multivariable analysis, use of absorbable suture type was associated with increased patient age, geographical location (UK and Ireland), and surgeon specialty (oral and maxillofacial surgery and plastic surgery), but not with complications. Conclusion There was equipoise in suture use, and no association between suture type and complications. Definitive evidence from randomized trials is needed.
There has been a significant decrease in publication rates between new and old GS pathways. No significant changes were identified between new and old T&O pathways. There was no difference between H-index and average citations between specialties.
Lower extremity joint replacement (LEJR) is the most common inpatient surgery for Medicare beneficiaries with substantial variation in cost and quality. Remote monitoring and insights from behavioral science have the potential to improve outcomes and value of care. We evaluated the impact of activity monitoring and bidirectional text messaging on the rate of patient discharge to home and clinical outcomes. This was a three‐arm pragmatic randomized controlled trial conducted between February 2018 and April 2019 at two urban hospitals in a large academic health system (clinicaltrials.gov NCT0335549). Eligible patients were randomized evenly, with a waiver of informed consent, and stratified by hospital location and joint type (knee or hip) to receive (1) usual care, or (2) HomeConnect + . Intervention patients were invited to participate in HomeConnect+ by mailed invitation followed by up to 4 phone calls. Those who agreed received a wearable activity monitor (Withings) to track step counts, pain score tracking, messaging about post‐operative goals and milestones, and connection to clinicians as needed. Those in HomeConnect+ were further randomized evenly to (2a) remote monitoring alone or (2b) remote monitoring with gamification and social support. HomeConnect+ was offered before surgery, began at hospital discharge, and continued for 45 days post‐discharge. The primary outcome was discharge to home. Pre‐specified secondary outcomes included change in average daily step count from week 2 to week 6, rehospitalizations, and outpatient visits. We included patients aged 18‐85 scheduled to undergo lower extremity joint replacement surgery (knee or hip) with a Risk Assessment and Prediction Tool score of 6‐8. We excluded patients with dementia, end‐stage renal disease, cirrhosis, metastatic cancer, and those scheduled for bilateral or revision surgery. A total of 242 patients were included in the analysis (124 usual care, 118 intervention) with a mean age of 66, including 78% female, 46% white, and 43% black patients. 81% in the intervention arm agreed to receive monitoring. There was no significant difference in the rate of discharge to home between the usual care (58%) and intervention (57%) arms; no difference in office visits between arms; and no significant increase in step count in those receiving remote monitoring plus gamification and social support compared to remote monitoring alone. There was a statistically significant reduction in rehospitalization rate in the intervention arm compared to the usual care arm (3.4% vs 12.2%; P = .01). The HomeConnect+ automated hovering program did not increase discharge to home from the hospital after LEJR surgery, and there was no difference in activity levels among those receiving gamification and social support compared to remote monitoring alone. However, there was a significant reduction in rehospitalizations among those receiving the intervention, which may have resulted from goal setting and connection to the care team. Automated hovering was not sufficient to increas...
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