Background The objective of this study was to evaluate the current body of evidence on the use of telemedicine in surgical subspecialties during the COVID‐19 pandemic. Methods This was a scoping review conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for scoping reviews (PRISMA‐ScR). MEDLINE via Ovid, PubMed, and EMBASE were systematically searched for any reports discussing telemedicine use in surgery and surgical specialties during the first period (February 2020–August 8, 2020) and second 6‐month period (August 9–March 4, 2021) of the COVID‐19 pandemic. Results Of 466 articles screened through full text, 277 articles were included for possible qualitative and/or quantitative data synthesis. The majority of publications in the first 6 months were in orthopedic surgery, followed by general surgery and neurosurgery, whereas in the second 6 months of COVID‐19 pandemic, urology and neurosurgery were the most productive, followed by transplant and plastic surgery. Most publications in the first 6 months were opinion papers (80%), which decreased to 33% in the second 6 months. The role of telemedicine in different aspects of surgical care and surgical education was summarized stratifying by specialty. Conclusion Telemedicine has increased access to care of surgical patients during the COVID‐19 pandemic, but whether this practice will continue post‐pandemic remains unknown.

Background: Gastroparesis, a chronic disorder distinguished by delays in gastric emptying, has been a concern for both health providers and hospitals due to several of its characteristics. Gastroparesis is heterogeneous in nature and is associated with several comorbidities and increasing mortality rates. It can often be caused by underlying conditions, most of which are not well understood. This lack of knowledge regarding its underlying mechanisms creates a need to better understand the risk factors involved in this patient population. This study was undertaken to understand the risk factors involved in the mortality of patients who present with gastroparesis. Methods: This retrospective study considered data from the National Inpatient Sample for patients who were admitted with a primary diagnosis of gastroparesis from 2005 to 2014. The data were stratified according to various factors of interest to identify risk factors involved in mortality using statistical tools, including a multivariable logistic regression model with backward elimination. Results: A total of 27,000 patients were admitted emergently with a primary diagnosis of gastroparesis. The mortality rate in adult patients (0.18%, N=39) was much lower than that in elderly patients (1.27%, N=71). Females accounted for the majority of patients in both the adult (73.7%) and elderly (71%) populations. The mean age of patients in the adult and elderly groups was 43 and 75 years, respectively. The association between mortality and age was significant in both adults (OR=1.04, 95%CI=1.005-1.08, p<0.025) and the elderly (OR=1.08, 95%CI=1.04-1.12, p<0.001). The hospital length of stay (HLOS, days) in adult females (5.08, SD=5.04) was significantly longer than that in adult males (4.41, SD=5.10) (p<0.001). The association between mortality and HLOS was significant in both adults (OR=1.12, 95%CI=1.09-1.15, p<0.001) and elderly patients (OR=1.10, 95%CI=1.06-1.14, p<0.001). A lower percentage of adults (6.6%, N=1,402) underwent an operation compared to the elderly (9.6%, N=538). The mean time to operation was 4.76 days for adult patients who survived and 17.50 days for adult patients who did not survive (SD=5.37 and 9.37, respectively, p=0.006). On the other hand, this value was 5.57 and 9.10 days for elderly patients (SD=6.50 and 7.15, respectively, p=0.037). Among patients who underwent an operation, the association between mortality and time to operation was significant for both adults (OR=1.17, 95%CI=1.094-1.247, p<0.001) and elderly patients (OR=1.05, 95%CI=1.005-1.124, p<0.001). Conclusion: The risk of mortality in elderly patients with emergent gastroparesis was 7-fold greater than that in adult patients. The odds of mortality increased by 8% for every year increase in age in elderly patients and by 4% in adults.

Highlights One of the potentially beneficial tools in reducing the risks for overwhelming the healthcare system is telemedicine. The current state of the implementation of telemedicine in surgery and surgical subspecialties has not been adequately evaluated. This review identifies challenges and potential solutions in the use of telemedicine. The findings may potentially help in understanding the challenges and future directions of telemedicine use in surgery.

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Background: Ventral hernia is a common occurrence in patients undergoing solid organ transplant (SOT) and who require complex abdominal wall reconstruction (CAWR). The aim of this study was to analyze the outcomes of CAWR in SOT patients in a tertiary center. Methods: We performed a prospective cohort study in patients who underwent CAWR with biological mesh at our center from January 2016 to November 2021. As per the study protocol, all patients will be followed for 3 years. Results: During the study period, we performed CAWR in 38 SOT patients. The mean age (Standard Deviation: SD) was 61 (9.5) years and the majority were males (68%). Mean body mass index (SD) was 30.3 (5.5) kg/m2 and hernia repair was performed electively in 33 patients. The majority (82%) of the hernias were less than class 2 with a median mesh size (interquartile range) of 600 (400-800) cm2. Seventy-nine percent of patients were liver transplant recipients and the mesh was placed sub-lay (retro-rectus) (82%); the most common technique was posterior component separation (82%). Five patients (13.2%) had surgical site infection and 4 (10.5%) had unplanned reoperations. None of the patients died postoperatively and the 30-day readmission rate was 21%. Three patients (7.9%) had recurrence during follow-up and all of them underwent reoperation. Conclusions: Complex abdominal wall reconstruction (CAWR) using biologic mesh for solid organ transplant patients with ventral hernia is safe and has low recurrence when performed by a dedicated CAWR team.

Background The aim of this study was to comparatively evaluate the sustainability and cost-benefit of the Operation Giving Back Bohol surgical volunteerism mission (SVM) carried out in Bohol Province, Philippines, over twelve consecutive missions. Methods This was a cost-benefit analysis of prospectively collected financial data from twelve consecutive surgical volunteerism missions held between 2006 and 2018. The overall cost of an SVM and cost per patient were the endpoints of interest. Disability-adjusted life years (DALYs) and costs thereof were calculated for each patient undergoing surgery in the twelve SVMs. Results A mean of 112 ± 22 patients were included per year of the SVM. A statistically significant increasing trend in the overall cost of SVMs over time was found ( R2 = .469; P = .014). A nonsignificant decreasing trend in the cost per patient over time was found ( R2 = .007; P = .795). A total of 8811.71 DALYs were averted in the twelve SVMs. DALYs averted per year ranged between 474.02 (2009) and 969.16 (2012). Cost per a DALY averted ranged between $466.9 (2006) and $865.6 (2009). Comparison of the latter with GDP per capita showed that this SVM was “very cost-effective.” Conclusion The SVM contributes substantially to the health care system both clinically and financially. A total of 8812 DALYs were averted in these twelve SVMs. Costs per a DALY averted did not significantly change over the mission years. Increasing the number of patients served has increased the total cost of the mission with no impact on the cost per patient.