Backgrounds/Aims
Traditional outcome measures (e.g., length of hospital stay, morbidity, and mortality) are used to determine the quality of care, but these may not be most important to patients. It is unclear which outcomes matter to patients undergoing elective laparoscopic cholecystectomy (ELC). We aim to identify patient-reported outcome measures (PROM) which patients undergoing ELC valued most.
Methods
A 45-item questionnaire with Four-point Likert-type questions developed from prior literature review, prospectively administered to patients treated with ELC at a tertiary institution in Singapore.
Results
Seventy-five patients participated. Most essential factors were technical skill and experience level of a surgeon, long-term quality of life (QoL), patient involvement in decision-making, communication skill of a surgeon, cleanliness of the ward environment, and standards of nursing care. Least important factors were hospitalization leave duration, length of hospital stay, a family's opinion of the hospital, and scar cosmesis. Employed patients were more likely to find hospitalization leave duration (
p
<0.001) and procedure duration (
p
=0.042) important. Younger patients (
p
=0.048) and female gender (
p
=0.003) were more likely to perceive scar cosmesis as important.
Conclusions
Patients undergoing ELC value long-term QoL, surgeon technical skill and experience level, patient involvement in decision-making, surgeon communication skill, cleanliness of the ward environment, and nursing care standards. Day-case surgery, medical leave, family opinion of hospital, and scar cosmesis were least important. Understanding what patients value will help guide patient-centric healthcare delivery.
BackgroundThe obesity epidemic continues to increase around the world with its attendant complications of metabolic syndrome and increased risk of malignancies (1), including pancreatic malignancy (2,3). The Roux-en-Y gastric bypass (RYGB) effectively treats obesity and its associated morbidities including metabolic syndrome (4). RYGB creates a gastric pouch with alimentary limb, as well as a biliopancreatic (BP) limb that joins the alimentary limb to form a common channel. Thus, it has both restrictive and mal-absorptive components. Patients with a mass in the head of pancreas are recommended pancreaticoduodenectomy (PD) for suspected malignancy (5). As bariatric surgery is increasingly adopted in recent years (6), more reports of PD following RYGB are published. Post-surgical adhesions and altered anatomy following RYGB poses not only a diagnostic challenge by making endoscopy difficult, but also unique challenge of reconstruction following PD. There are many different techniques of reconstruction proposed. Here we describe a patient where the remnant BP limb was used for a venting anterior gastrojejunostomy. The pancreaticojejunostomy and hepaticojejunostomy was created with a new loop of jejunum and a new distal jejunojejunostomy was performed.
MethodsA 59-year-old male presented with painless obstructive jaundice of one week's duration. He had a history of RYGB
Introduction Diabetes foot disease (DFD) contributes to poor quality of life, clinical and economic burden. Multidisciplinary diabetes foot teams provide prompt access to specialist teams thereby improving limb salvage. We present a 17-year review of an inpatient multidisciplinary clinical care path (MCCP) for DFD in Singapore. Methods This was a retrospective cohort study of patients admitted for DFD and enrolled in our MCCP to a 1700-bed university hospital from 2005 to 2021. Results There were 9279 patients admitted with DFD with a mean of 545 (±119) admissions per year. The mean age was 64 (±13.3) years, 61% were Chinese, 18% Malay and 17% Indian. There was a higher proportion of Malay (18%) and Indian (17%) patients compared to the country's ethnic composition. A third of the patients had end stage renal disease and prior contralateral minor amputation. There was a reduction in inpatient major lower extremity amputation (LEA) from 18.2% in 2005 to 5.4% in 2021 (odds ratio 0.26, 95% confidence interval 0.16-0.40, P < .001) which was the lowest since pathway inception. Mean time from admission to first surgical intervention was 2.8 days and mean time from decision for revascularization to procedure was 4.8 days. The major-to-minor amputation rate reduced from 1.09 in 2005 to 0.18 in 2021, reflecting diabetic limb salvage efforts. Mean and median length of stay (LOS) for patients in the pathway was 8.2 (±14.9) and 5 (IQR = 3) days, respectively. There was a gradual trend of increase in the mean LOS from 2005 to 2021. Inpatient mortality and readmission rate was stable at 1% and 11%. Conclusion Since the institution of a MCCP, there was a significant improvement in major LEA rate. An inpatient multidisciplinary diabetic foot care path helped to improve care for patients with DFD.
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