Background: Acute care surgical services provide comprehensive emergency general surgical care while potentially using health care resources more efficiently. We assessed the volume and distribution of emergency general surgery (EGS) procedures before and after the implementation of the Acute Care and Emergency Surgery Service (ACCESS) at a Canadian tertiary care hospital and its effect on surgeon billings.Methods: This single-centre retrospective case-control study compared adult patients who underwent EGS procedures between July and December 2009 (pre-ACCESS), to those who had surgery between July and December 2010 (post-ACCESS). Case distribution was compared between day (7 am to 3 pm), evening (3 pm to 11 pm) and night (11 pm to 7 am). Frequencies were compared using the χ 2 test.Results: Pre-ACCESS, 366 EGS procedures were performed: 24% during the day, 55% in the evening and 21% at night. Post-ACCESS, 463 operations were performed: 55% during the day, 36% in the evening and 9% at night. Reductions in night-time and evening EGS were 57% and 36% respectively (p < 0.001). Total surgeon billings for operations pre-and post-ACCESS were $281 066 and $287 075, respectively: remuneration was $6008 higher post-ACCESS for an additional 97 cases (p = 0.003). Using cost-modelling analysis, post-ACCESS surgeon billing for appendectomies, segmental colectomies, laparotomies and cholecystectomies all declined by $67 190, $125 215, $66 362, and $84 913, respectively (p < 0.001). Conclusion:Acute care surgical services have dramatically shifted EGS from nighttime to daytime. Cost-modelling analysis demonstrates that these services have costsavings potential for the health care system without reducing overall surgeon billing.
IntroductionAcute care surgical services provide timely comprehensive emergency general surgical care while optimizing the use of limited resources. At our institution, 50% of the daily dedicated operating room (OR) time allocated to the Acute Care Emergency Surgery Service (ACCESS) came from previous elective general surgery OR time. We assessed the impact of this change in resource allocation on wait-times for elective general surgery cancer cases.MethodsWe retrospectively reviewed adult patients who underwent elective cancer surgeries in the pre-ACCESS (September 2009 to June 2010) and post-ACCESS (September 2010 to June 2011) eras. Wait-times, calculated as the time between booking and actual dates of surgery, were compared within assigned priority classifications. Categorical and continuous variables were compared using chi-square and Mann–Whitney U tests respectively.ResultsA total of 732 cases (367 pre-ACCESS and 365 post-ACCESS) were identified, with no difference in median wait-times (25 versus 23 days) between the eras. However, significantly fewer cases exceeded wait-time targets in the post-ACCESS era (p <0.0001). There was a significant change (p = 0.027) in the composition of cancer cases, with fewer breast cancer operations (22% versus 28%), and more colorectal (41% versus 32%) and hepatobiliary cancer cases (5% versus 2%) in the post-ACCESS era.ConclusionThese results suggest that shifting OR resources towards emergency surgery does not affect the timeliness of surgical cancer care. This study may encourage more centres to adopt acute care surgical services alongside their elective or subspecialty practices.
Objectives: As of December 2020, COVID19 has infected over 13 million Americans and killed over 275,000. Each infection surge leads to increased emergency department (ED) utilization and subsequent critical care admission for patients with acute respiratory distress syndrome (ARDS). Not all COVID19 patients necessitate a ventilator and therefore can remain at home to minimize infection spread and manage hospital capacity concerns. Remote Bluetooth-enabled pulse-oximeter monitoring of moderate-to-severely ill COVID19 patients can be used to closely monitor symptoms and trigger necessary visits to the hospital. Our objective was to analyze remote pulse-oximeter monitoring cost-effectiveness to reduce facility burden and health expenditures. Methods: We analyzed home-monitoring with pulse-oximetry cost-utility using a Markov model over a 3-week time horizon in daily cycles from a US health sector perspective. Cost and outcome measures were derived from real-world evidence from University Hospitals. Pulse-oximetry monitoring was implemented for patients presenting at the ED with ARDS-like symptoms but not necessitating immediate care; patients were then remotely monitored by experts for up to 4-days until recovery or a second ED visit. Additional parameters were extracted from literature. Costs (2020 U.S. dollars) and quality-adjusted life years (QALYs) were used to determine the incremental cost-effectiveness ratio (ICER) at a $100,000/QALY cost-effectiveness threshold. Model uncertainty was assessed using one-way and probabilistic sensitivity analysis. Results: Results demonstrated that pulse-oximetry monitoring dominated current standard care for COVID19 patients based on reduced costs and increased QALYs. Individuals with access to remote pulse-oximetry monitoring averaged $49,176 and 0.03 QALYs, whereas standard care increased costs to $113,792 and 0.02 QALYs. Resulting ICER was not sensitive to uncertainty ranges. Conclusions: Remote pulse-oximetry monitoring of symptomatic COVID19 patients increases the specificity of those requiring immediate followup. We recommend adoption of this technology across health systems to costeffectively manage COVID19 volume surges, maintain patients' comfort, reduce infection spread, and simultaneously monitor multiple patients.
Bariatric patients are difficult to assess clinically for signs of postoperative complication. Diagnostic laparoscopy (DL) is used to investigate patients suspicious for complications such as anastomotic leak (AL) and intra-abdominal hemorrhage (IH). Most bariatric surgeons use DL in the presence of sustained tachycardia; however, the rate of this procedure and its clinical value have not been sufficiently investigated.A retrospective review of patients undergoing bariatric surgery from January 2010 to December 2011 was performed. Data from 4 collaborative bariatric centres of excellence were included in this analysis. From among all elective bariatric procedures, cases that required early reoperation were selected for further evaluation.A total of 1001 elective bariatric procedures were identified. Of these, 952 (95%) were primary bariatric procedures, including 866 (91%) Roux-en-Y gastric bypasses and 86 (9%) sleeve gastrectomies. The remaining 48 cases represented revisional proced ures. Of these, 11 patients (1.1%) returned to the operating room within 72 hours for DL: 64% were primary cases (n = 7) and 36% revisional cases (n = 4). Intraoperative findings included AL (45%, n = 5), IH (27%, n = 3), no pathology identified (18%, n = 2) and small bowel obstruction (9%, n = 1). Of the 9 patients with complications, all were tachycardic (heart rate > 100 beats/min), and 4 of the 5 patients with AL were febrile (t > 37.5). There were no reported adverse events directly related to the use of DL.Diagnostic laparoscopy is a useful and safe option for both the diagnosis and treatment of suspected complications after bariatric surgery. The majority of patients returning to operating room had significant findings, and all were treated laparoscopically. Persistent postoperative tachycardia or fever were highly predictive of positive findings during DL. An emphasis on early decisionmaking and expeditious return to the operating room for laparoscopy should be the standard for bariatric patients on clinical suspicion of a postoperative complication. 4Changes of active and total ghrelin, GLP-1 and PYY following restrictive bariatric surgery and their impact on satiety: comparison of sleeve gastrectomy and adjustable gastric banding. A
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.