A proactive outreach intervention that decreases readmission after hepatectomy

Narula, Nisha; Kim, Bradford J.; Davis, Catherine H.; Dewhurst, Whitney L.; Samp, Leigh A.; Aloia, Thomas A.

doi:10.1016/j.surg.2017.08.023

Cited by 10 publications

(7 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…17,18 A number of transitional care interventions including health services discharge coordination, active post-discharge patient telephone surveillance, and clinic visit and/or imaging surveillance strategies have been established. 17,[19][20][21] As an example of early surveillance strategy, a prospective nationwide trial is currently enrolling in the Netherlands to evaluate a series of algorithms for early detection and management strategies for pancreatic fistula associated complications in patients recovering from pancreatic resections. 22 Enhanced recovery pathways, improvements in patient selection, and perioperative care, have all been associated with a reduction in median length of hospital stay after major colorectal and hep-atopancreatobiliary operations.…”

Section: Discussionmentioning

confidence: 99%

Early Patient Discharge in Selected Patients is Not Associated With Higher Readmission After Major Abdominal Operations

et al. 2020

View full text Add to dashboard Cite

Objective: Our objective was to examine the associations between early discharge and readmission after major abdominal operations. Background: Advances in patient care resulted in earlier patient discharge after complex abdominal operations. Whether early discharge is associated with patient readmissions remains controversial. Methods: Patients who had colorectal, liver, and pancreas operations abstracted in 2011-2017 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files were included. Patient readmission was stratified by 6 operative groups. Patients who were discharged before median discharge date within each operative group were categorized as an early discharge. Analyses tested associations between early discharge and likelihood of 30-day postoperative unplanned readmission. Results: A total of 364,609 patients with major abdominal operations were included. Individual patient groups and corresponding median day of discharge were: laparoscopic colectomy (n = 152,575; median = 4), open colectomy (n =137,462; median = 7), laparoscopic proctectomy (n = 12,238; median = 5), open proctectomy (n = 24,925; median = 6), major hepatectomy (n = 9,805; median = 6), pancreatoduodenectomy (n = 27,604; median = 8). Early discharge was not associated with an increase in proportion of readmissions in any operative group. Early discharge was associated with a decrease in average proportion of patient readmissions compared to patients discharged on median date in each of the operative groups: laparoscopic colectomy 6% versus 8%, open colectomy 11% versus 14%, laparoscopic proctectomy 13% versus 16%, open proctectomy 13% vs 17%, major hepatectomy 8% versus 12%, pancreatoduodenectomy 16% versus 20% (all P ≤ 0.02). Serious morbidity composite was significantly lower in patients who were discharged early than those who were not in each operative group (all P < 0.001). Conclusions: Early discharge in selected patients after major abdominal operations is associated with lower, and not higher, rate of 30-day unplanned readmission.

show abstract

Section: Discussionmentioning

confidence: 99%

Early Patient Discharge in Selected Patients is Not Associated With Higher Readmission After Major Abdominal Operations

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Unmanaged UC results in chronic inflammation and ulcerations in the epithelial and submucosal layers restricted to the colon and rectum [ 36 , 48 ]. Approximately 15% of the patients may encounter toxic fulminant UC that may be admitted to hospital as emergence [ 48 , 49 ]. Establishing the UC diagnosis and disease state of a patient sample gastrointestinal pathologists depend on microscopic visual inspection and interpretation of distinct and/or stained tissue sections [ 50 , 51 ].…”

Section: Ulcerative Colitismentioning

confidence: 99%

Clinical Diagnosis and Phar-maceutical Management of Inflammatory Bowel Disease

M’Koma

2023

MRAJ

View full text Add to dashboard Cite

Inflammatory bowel disease have an enormous impact on public health, medical systems, economies, and social conditions. Biologic therapy has ameliorated the treatment and clinical course of patients with inflammatory bowel disease. The efficacy and safety profiles of currently available therapies are still less that optimal in numerous ways, highlighting the requirement for new therapeutic targets. A bunch of new drug studies are underway in inflammatory bowel disease with promising results. This is an outlined guideline of clinical diagnosis and pharmaceutical therapy of inflammatory bowel disease. Outline delineates the overall recommendations on the modern principles of desirable practice to bolster the adoption of best implementations and exploration as well as inflammatory bowel disease patient, gastroenterologist, and other healthcare provider education. Inflammatory bowel disease encompasses Crohn’s disease and ulcerative colitis, the two unsolved medical inflammatory bowel disease-subtypes condition with no drug for cure. The signs and symptoms on first presentation relate to the anatomical localization and severity of the disease and less with the resulting diagnosis that can clinically and histologically be non-definitive to interpret and establish criteria, specifically in colonic inflammatory bowel disease when the establishment is inconclusive is classified as indeterminate colitis. Conservative pharmaceuticals and accessible avenues do not depend on the disease phenotype. The first line management is to manage symptoms and stabilize active disease; at the same time maintenance therapy is indicated. Nutrition and diet do not play a primary therapeutic role but is warranted as supportive care. There is need of special guideline that explore solution of groundwork gap in terms of access limitations to inflammatory bowel disease care, particularly in developing countries and the irregular representation of socioeconomic stratification with a strategic plan, for the unanswered questions and perspective for the future, especially during the surfaced global COVID-19 pandemic caused by coronavirus SARS-CoV2 impacting on both the patient’s psychological functioning and endoscopy services. Establishment of a global registry system and accumulated experiences have led to consensus for inflammatory bowel disease management under the COVID-19 pandemic. Painstakingly, the pandemic has influenced medical care systems for these patients. I briefly herein viewpoint summarize among other updates the telemedicine roles during the pandemic and how operationally inflammatory bowel disease centers managed patients and ensured quality of care. In conclusion: inflammatory bowel disease has become a global emergent disease. Serious medical errors are public health problem observed in developing nations i.e., to distinguish inflammatory bowel disease and infectious and parasitic diseases. Refractory inflammatory bowel disease is a still significant challenge in the management of patients with Crohn’s disease and ulcerative colitis. There are gaps in knowledge and future research directions on the recent newly registered pharmaceuticals. The main clinical outcomes for inflammatory bowel disease were maintained during the COVID-19 pandemic period.

show abstract

“…A consequence of untreated UC is chronic inflammation and ulcerations in the mucosal and to a lesser degree submucosal linings confined to the large intestine (colon and rectum) [ 39 , 46 ]. Approximately 15% of patients may encounter hostile development, and these patients may require hospital admission for fulminant disease [ 46 , 47 ]. To establish the diagnosis and disease state of a patient sample, gastrointestinal pathologists depend most on nanoscopic visual examination and the elucidation of marked and/or colored tissue sections [ 48 , 49 ].…”

Section: Clinical Diagnosis and Manifestationmentioning

confidence: 99%

“…Pelvic pouch reconstruction surgery, RPC-IPAA, is the criterion standard surgical procedure for patients with UC [ 74 , 75 ]. The 5- and 10-year cumulative risk of colectomy (emergence or elective) is 10–15%, primarily limited to patients with moderate to severe disease activity; a subset of hospitalized patients with acute severe UC (ASUC), also called fulminant UC, have short-term colectomy rates of 25–30% [ 47 , 78 , 79 , 80 , 81 ]. In some cases, it is not possible to maintain a pouch due to subsequent complications; in this case, a permanent terminal ileostomy may be required [ 44 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Inflammatory Bowel Disease: Clinical Diagnosis and Surgical Treatment-Overview

M’Koma

2022

Medicina

View full text Add to dashboard Cite

This article is an overview of guidelines for the clinical diagnosis and surgical treatment of predominantly colonic inflammatory bowel diseases (IBD). This overview describes the systematically and comprehensively multidisciplinary recommendations based on the updated principles of evidence-based literature to promote the adoption of best surgical practices and research as well as patient and specialized healthcare provider education. Colonic IBD represents idiopathic, chronic, inflammatory disorders encompassing Crohn’s colitis (CC) and ulcerative colitis (UC), the two unsolved medical subtypes of this condition, which present similarity in their clinical and histopathological characteristics. The standard state-of-the-art classification diagnostic steps are disease evaluation and assessment according to the Montreal classification to enable explicit communication with professionals. The signs and symptoms on first presentation are mainly connected with the anatomical localization and severity of the disease and less with the resulting diagnosis “CC” or “UC”. This can clinically and histologically be non-definitive to interpret to establish criteria and is classified as indeterminate colitis (IC). Conservative surgical intervention varies depending on the disease phenotype and accessible avenues. The World Gastroenterology Organizations has, for this reason, recommended guidelines for clinical diagnosis and management. Surgical intervention is indicated when conservative treatment is ineffective (refractory), during intractable gastrointestinal hemorrhage, in obstructive gastrointestinal luminal stenosis (due to fibrotic scar tissue), or in the case of abscesses, peritonitis, or complicated fistula formation. The risk of colitis-associated colorectal cancer is realizable in IBD patients before and after restorative proctocolectomy with ileal pouch-anal anastomosis. Therefore, endoscopic surveillance strategies, aimed at the early detection of dysplasia, are recommended. During the COVID-19 pandemic, IBD patients continued to be admitted for IBD-related surgical interventions. Virtual and phone call follow-ups reinforcing the continuity of care are recommended. There is a need for special guidelines that explore solutions to the groundwork gap in terms of access limitations to IBD care in developing countries, and the irregular representation of socioeconomic stratification needs a strategic plan for how to address this serious emerging challenge in the global pandemic.

show abstract

A proactive outreach intervention that decreases readmission after hepatectomy

Cited by 10 publications

References 29 publications

Early Patient Discharge in Selected Patients is Not Associated With Higher Readmission After Major Abdominal Operations

Early Patient Discharge in Selected Patients is Not Associated With Higher Readmission After Major Abdominal Operations

Clinical Diagnosis and Phar-maceutical Management of Inflammatory Bowel Disease

Inflammatory Bowel Disease: Clinical Diagnosis and Surgical Treatment-Overview

Contact Info

Product

Resources

About