From Emergency Department Visit to Readmission After Esophagectomy: Analysis of Burden and Risk Factors

Kidane, Biniam; Higgins, Sean; Hirpara, Dhruvin H.; Kaaki, Suha; Shen, Yu; Allison, Frances; Waddell, Thomas K.; Darling, Gail

doi:10.1016/j.athoracsur.2020.11.020

Cited by 3 publications

(2 citation statements)

References 13 publications

(23 reference statements)

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“…Of all patients undergoing single-level ACDF, 11.9% visited the ED at least once in the ninety days following their surgery, while only 3.7% were readmitted. The gap between ED visits and readmissions in the current study aligns with those for other procedures and highlights the need for the current study [ 17 , 18 ].…”

Section: Discussionsupporting

confidence: 56%

Emergency department visits within 90 days of single-level anterior cervical discectomy and fusion

Kammien

Galivanche

Gouzoulis

et al. 2022

North American Spine Society Journal (NASSJ)

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Section: Discussionsupporting

confidence: 56%

Emergency department visits within 90 days of single-level anterior cervical discectomy and fusion

Kammien

Galivanche

Gouzoulis

et al. 2022

North American Spine Society Journal (NASSJ)

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“…Multiple studies have shown improved early weight gain in patients who have a concurrent JTs placed; however, long‐term weight seems to be similar to those who did not receive a JT [10, 12, 13, 18]. Evidence supporting JTs has noted that most complications are minor, including emergency room visits not leading to inpatient admissions, bedside tube replacements, and tube leakage associated with JTs [19, 20]. However, these studies fail to account for the significant “time‐toxicity” associated with these “minor” complications [21].…”

Section: Discussionmentioning

confidence: 99%

Feeding Jejunostomy Tube in Patients Undergoing Esophagectomy: Utilization and Outcomes in a Nationwide Cohort

Turner,

Delman,

Griffith

et al. 2023

World j. surg.

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Background Feeding jejunostomy (JT) tubes are often utilized as an adjunct to optimize nutrition for successful esophagectomy; however, their utility has come into question. The aim of this study was to evaluate utilization and outcomes associated with JTs in a nationwide cohort of patients undergoing esophagectomy. Methods The NSQIP database was queried for patients who underwent elective esophagectomy. JT utilization was assessed between 2010 and 2019. Post-operative outcomes were compared between those with and without a JT on patients with esophagectomy-specific outcomes (2016-2019), with results validated using a propensity score-matched (PSM) analysis based on key clinicopathologic factors, including tumor stage. Results Of the 10,117 patients who underwent elective esophagectomy over the past decade, 53.0% had a JT placed concurrently and 47.0% did not. Utilization of JTs decreased over time, accounting for 60.0% of cases in 2010 compared to 41.7% in 2019 (m = -2.14 95%CI: [-1.49]-[-2.80], p \ 0.01). Patients who underwent JT had more composite wound complications (17.0% vs. 14.1%, p = 0.02) and a higher rate of all-cause morbidity (40.4% vs. 35.5%, p = 0.01). Following PSM, 1007 pairs were identified. Analysis of perioperative outcomes demonstrated a higher rate of superficial skin infections (6.1% vs. 3.5%, p = 0.01) in the JT group. However, length of stay, reoperation, readmission, anastomotic leak, composite wound complications, all-cause morbidity, and mortality rates were similar between groups. Conclusions Among patients undergoing elective esophagectomy, feeding jejunostomy tubes were utilized less frequently over the past decade. Similar perioperative outcomes among matched patients support the safety of esophagectomy without an adjunct feeding jejunostomy tube.

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Enhancing Quadruple Health Outcomes after Thoracic Surgery: A Feasibility Pilot Randomized Controlled Trial Utilizing Digital Home Monitoring. (Preprint)

Nagappa,

Subramani,

Yang

et al. 2024

Preprint

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BACKGROUND Surgical recovery after hospital discharge often presents challenges for patients and caregivers. Postoperative complications and poorly managed pain at home can lead to unexpected visits to the emergency department and/or readmission to the hospital. Digital home monitoring (DHM) may improve postoperative care compared to standard methods. OBJECTIVE We conducted a feasibility study for a randomized controlled trial (RCT) to assess DHM's effectiveness following thoracic surgical procedures compared to standard care. METHODS We conducted a two-arm parallel-group pilot RCT at a single tertiary care center. Adult patients undergoing thoracic surgical procedures were randomized 1:1 into two groups: the digital home monitoring (DHM group) and the standard of care (control group). We adhered to the intention-to-treat analysis principle. The primary outcome was predetermined RCT feasibility criteria. The trial would be feasible if more than 75% of trial recruitment, protocol adherence, and data collection were achieved. Secondary outcomes included 30-day emergency department visit rates, 30-day readmission rates, postoperative complications, length of stay, post-discharge 30-day opioid consumption, 30-day quality of recovery (QOR-40), patient/program satisfaction, caregiver satisfaction, healthcare provider satisfaction and cost-per-case. RESULTS All RCT feasibility criteria were met. The trial recruitment rate was 87.9% (95% CI: 79.4% – 93.8%). Protocol adherence and outcome data collection rates were 96.3% (95% CI: 89.4% - 99.2%) and 98.7% (95% CI: 92.9% - 99.9%), respectively. Eighty patients were randomized, with 40 (50%) in the DHM group and 40 (50%) in the control group. Baseline patient and clinical characteristics were comparable between the two groups. The DHM group had fewer unplanned ED visits (2.7% vs. 20.5%; p=.02), fewer unplanned admission rates (0% vs. 7.6%; p=.24), lower rates of postoperative complications (20% vs. 47.5%, p=.01) shorter hospital stays (4.0 vs. 6.9 days; p=.05), but more opioid consumption (111.6 ± 110.9 vs. 74.3 ± 71.9 mg morphine equivalents; p=.08) compared to the control group. DHM also resulted in shorter ED visit times (130 ± 0 vs. 1048 + 1093 minutes; p=.48) and lower cost per case ($12,145 ± 8,779 vs. $17,247 ± 15,313; p=.07). The quality of recovery scores was clinically significantly better than the controls (185.4 ± 2.6 vs. 178.3 ± 3.3; p<.0001). All 37 patients who completed the intervention answered the program satisfaction survey questionnaires (100%; 95% CI: 90.5% - 100%). Only 36 out of 80 caregivers responded to the caregiver satisfaction questionnaires at the end of the 4th week post-hospital discharge (47.7%; 95% CI: 35.7% to 59.1%). Healthcare providers reported a 100% satisfaction rate. CONCLUSIONS This pilot RCT demonstrates the feasibility of conducting a full-scale trial to assess DHM's efficacy in improving postoperative care following thoracic surgery. DHM shows promise for enhancing continuity of care and warrants further investigation. CLINICALTRIAL This study was registered with ClinicalTrials.gov (NCT04340960)

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From Emergency Department Visit to Readmission After Esophagectomy: Analysis of Burden and Risk Factors

Cited by 3 publications

References 13 publications

Emergency department visits within 90 days of single-level anterior cervical discectomy and fusion

Emergency department visits within 90 days of single-level anterior cervical discectomy and fusion

Feeding Jejunostomy Tube in Patients Undergoing Esophagectomy: Utilization and Outcomes in a Nationwide Cohort

Enhancing Quadruple Health Outcomes after Thoracic Surgery: A Feasibility Pilot Randomized Controlled Trial Utilizing Digital Home Monitoring. (Preprint)

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