JMIR perioperative medicine最新文献

{"title":"A Novel Customizable Datamart and Tableau Dashboard to Monitor Multiple Enhanced Recovery After Surgery Programs: Development and Validation Study.","authors":"Sunitha Margaret Singh, Susannah Oster, Efrat Bolze, Aaron Sasson, James Nicholson, Elliott Bennett-Guerrero","doi":"10.2196/82472","DOIUrl":"10.2196/82472","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) programs bundle evidence-based interventions to standardize care, expedite recovery, and improve outcomes. As ERAS programs have expanded, it has become clear that a major challenge is monitoring the compliance of bundle elements and outcomes to feedback performance to stakeholders and guide changes. Manual data abstraction is onerous and not feasible. Reliance on receiving new reports from busy health system IT groups is challenging. Therefore, we sought to address this unmet need at our hospital by developing a novel ERAS Datamart system.</p><p><strong>Objective: </strong>Our objectives were to develop a novel Datamart and Tableau dashboard to (1) enable continuous analysis of data, harvested directly from the electronic medical record (EMR), measure compliance and outcomes, and (2) enable end users (e.g., an ERAS coordinator) to create reports customized based on surgical procedure types, requested data variables, and custom date ranges.</p><p><strong>Methods: </strong>After \"buy-in\" from hospital leadership and other stakeholders, data metrics were identified and categorized according to phase of care, that is, preoperative, intraoperative, and postoperative. A multidisciplinary team reviewed International Classification of Diseases, Tenth Revision procedure codes to capture EMR data for patients undergoing ERAS procedures. IT was given a master list with metric names, definitions, and screenshots of the discrete field in the EMR to assist with building the metrics. Validations of the novel Datamart were done against known ERAS patient populations maintained by the surgery clinic.</p><p><strong>Results: </strong>The Datamart and Tableau dashboard has been built, is functional, and contains over 17,000 patients across 5 ERAS service lines: colorectal (n=1742), joint replacement (n=4235), surgical oncology (n=941), bariatric (n=1130), and cesarean section (n=9390). Currently, 56 metrics spanning the perioperative period have been validated across these populations. Reports can be tailored according to patients, time frames, and metrics. If desired, patient-level raw data can be exported for statistical analyses. Two use cases (total joint replacement and surgical oncology ERAS programs) are presented showing how the Datamart can be used.</p><p><strong>Conclusions: </strong>Discrete fields within an EMR can be successfully captured into a novel Datamart and visualized using a custom Tableau dashboard for providing stakeholder feedback, facilitating quality improvement analyses, and auditing pathways.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e82472"},"PeriodicalIF":0.0,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12893707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forced-Air Warming Temperature Settings for Treating Postoperative Hypothermia in the Postanesthesia Care Unit: Randomized Controlled Trial.","authors":"Koravee Pasutharnchat, Rattaphol Seangrung, Sirikarn Sirisophaphong, Wilailuck Wongkum","doi":"10.2196/85045","DOIUrl":"10.2196/85045","url":null,"abstract":"<p><strong>Background: </strong>Hypothermia, defined as a core body temperature below 36 °C, is a common postoperative complication associated with adverse outcomes, including delayed wound healing, infections, and increased bleeding.</p><p><strong>Objective: </strong>This randomized controlled trial evaluated the efficacy of different forced-air warming system temperature settings in treating postoperative hypothermia in the postanesthesia care unit.</p><p><strong>Methods: </strong>A total of 132 patients undergoing elective surgery at Ramathibodi Hospital between April 2023 and May 2024 were randomized into 3 groups (n=44 per group): group C (warming set to 38 °C), group F1 (warming set to 42 °C), and group F2 (warming set to 42 °C, reduced to 38 °C after achieving 36 °C). Tympanic temperature was recorded at 5-minute intervals during rewarming and every 10 minutes after normothermia (≥36 °C) was achieved. The primary outcome was rewarming time. Secondary outcomes included the incidence of temperature drops, hemodynamic parameters, adverse events, and patient comfort scores.</p><p><strong>Results: </strong>Baseline characteristics and clinical variables, including vital signs, were comparable among groups (P>.05). Group F2 achieved the shortest mean rewarming time of 33.3 (SD 13.81) min; however, differences between groups were not statistically significant (P=.460). Group F2 had the lowest incidence of temperature drops below 36 °C after normothermia (1/44, 2.27%; P=.009). Group C had the highest incidence of rewarming exceeding 1 hour (10/44, 22.73%; P=.017).</p><p><strong>Conclusions: </strong>While rewarming times were similar across groups, the protocol using an initial setting of 42 °C followed by a reduction to 38 °C (group F2) effectively minimized temperature drops after normothermia, suggesting its superiority for managing postoperative hypothermia in the postanesthesia care unit.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e85045"},"PeriodicalIF":0.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12851521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the User Experience of a Perioperative Digital Health Tool for Information Exchange Using a Human-Centered Design Thinking Approach: Qualitative Observational Study.","authors":"Charlé Steyl, Carljohan Orre, Greg Foster, Hanel Duvenage, Michelle S Chew, Hyla Louise Kluyts","doi":"10.2196/79349","DOIUrl":"10.2196/79349","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Perioperative patient-reported outcomes (PROs) allow patients to share their experiences of surgical procedures with their health care teams using standardized measures. Despite increasing recognition of their value, PROs are not routinely used in clinical practice, partly due to limited evidence of their impact on traditional clinical outcomes and uncertainty among clinicians about their use. Digital health tools offer a promising way to integrate PROs into clinical workflows and enhance patient-clinician interaction, but their success depends on person-centered design to ensure usability and relevance. Safe Surgery South Africa, a nonprofit organization, developed the Perioperative Shared Health Record (PSHR), a secure web-based tool that enables patients to share personal health information and PROs with their anesthetist and surgeon before and after surgery. Initial implementation revealed significant user experience challenges, which contributed to poor uptake.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to explore factors influencing the PSHR user experience in a low- and middle-income country (LMIC) using human-centered design principles.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This observational qualitative user experience study followed the 5 design thinking stages: empathize, define, ideate, prototype, and test. Semistructured interviews were conducted with postoperative patients from both the public and private health care sectors, including those with and with no prior experience using the PSHR. Thematic analysis followed the 6-phase framework described by Braun and Clarke and was structured using Karagianni's Optimized Honeycomb user experience model. A problem statement was developed, followed by ideation to explore solutions. Paper prototypes were created, refined, and tested through observation, interviews, and validated usability questionnaires.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the empathize stage, 22 interviews were conducted in the private and public health care sectors in South Africa; 7 participants had previous experience using the PSHR. In the define stage, participants emphasized the need for connection, feedback, information, and support through their surgical journey. Contrary to expectations, patients were not discouraged by the length of questionnaires if they perceived them as purposeful. In the ideate stage, the team considered user expectations and PSHR integration into care processes. In the prototype stage, low-fidelity mock-ups were created and refined into paper prototypes. In the test stage, testing with 5 participants highlighted the importance of trust, communication, and user-friendly interfaces. Feedback loops and clinician engagement were identified as key motivators for sustained use. The mean usability questionnaire scores indicated excellent usability and high levels of user satisfaction across most domains.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study is one of the fi","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e79349"},"PeriodicalIF":0.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12795411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Effects of eHealth Literacy and the Area Deprivation Index on Barriers to Electronic Patient Portal Use for Orthopedic Surgery: Cross-Sectional Observational Study.","authors":"Audrey Lynn Litvak, Nicholas Lin, Kelly Hynes, Jason Strelzow, Jeffrey G Stepan","doi":"10.2196/72035","DOIUrl":"10.2196/72035","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;As electronic patient portals (EPPs) continue to gain popularity and systems transition to online tools for scheduling, communication, and telehealth, patients without access or skills to use these tools may be overlooked.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study analyzed patient and neighborhood-level factors, including eHealth literacy level and the Area Deprivation Index (ADI), that may limit EPP access for orthopedic surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A cross-sectional, survey-based study was performed at a single urban tertiary academic medical center in the United States across foot and ankle, hand and upper extremity, and orthopedic trauma subspecialty clinics from June 21, 2022, to August 12, 2022. Survey responses (N=287) provided information on sociodemographic characteristics; barriers to EPP use and frequency of EPP use; the eHealth Literacy Scale; and the ADI, which is an address-generated national census measure of neighborhood-level disadvantage. Barriers to EPP use were inductively coded into barrier types, classified as physical access, technology discomfort, or preference. The primary outcome measure was patient-reported barriers to EPP use, which was treated as a binary outcome (1=barrier; 0=no barrier). Bivariate analyses and multivariable binary logistic regressions were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The percentage of patients who self-reported barriers to EPP access was 43.2% (124/287), which related to physical access (13/124, 10.4%), technology discomfort (55/124, 44.3%), and preference (78/124, 63.0%). In the adjusted regressions, only low eHealth literacy and older age predicted barriers to EPP use (low eHealth literacy, adjusted odds ratio [AOR] 1.32, 95% CI 1.13-1.54; P&lt;.001; older age, AOR 1.007, 95% CI 1.003-1.009; P&lt;.001), including barriers of technology discomfort (low eHealth literacy, AOR 1.25, 95% CI 1.11-1.40; P&lt;.001; older age, AOR 1.004, 95% CI 1.002-1.007; P&lt;.001) and preference (low eHealth literacy, AOR 1.33, 95% CI 1.17-1.51; P&lt;.001; older age, AOR 1.004, 95% CI 1.00-1.01; P&lt;.01). Patients with physical access-related barriers as opposed to technology discomfort or preference barriers had the lowest median eHealth literacy scores (17.0, IQR 12.0-14.0 vs 27.0, IQR 16.0-32.0 vs 27.0, IQR 20.0-32.0, respectively) and roughly a quartile higher median ADI (73.0, IQR 41.0-92.0 vs 53.5, IQR 31.2-76.0 vs 58.0, IQR 38.8-83.8, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Low eHealth literacy was the most significant determinant of overall barriers to EPP use for orthopedic surgery, followed by older age. Neighborhood-level disadvantage as measured through the ADI had no mediating effect on patient-reported barriers to EPP use when adjusting for eHealth literacy level. While patients with physical access barriers had higher ADIs, overall, few patients reported physical access barriers compared to barriers related to technology discomfort or preference. Pa","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"9 ","pages":"e72035"},"PeriodicalIF":0.0,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12779103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitated Peer Discussion for Promoting Better Resident Wellness in Anesthesia Trainees: Qualitative Program Evaluation.","authors":"Miku Wake, Nicholas West, Jessica Luo, Nancy Wang, James D Taylor, Kyra Moura, Theresa Newlove, Zoë Brown","doi":"10.2196/78575","DOIUrl":"10.2196/78575","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anesthesia residents experience nonroutine clinical events during perioperative patient care, including workplace stressors or adverse incidents that may cause physical and emotional stress. These events can lead to burnout and negative mental health outcomes. Burnout and depression rates are lower when residents have adequate support systems within their workplace. Better resident wellness (BREW) Rounds are a weekly 1-hour peer discussion for anesthesia residents, facilitated by a registered psychologist at our institution. Although shown to improve residents' well-being, a deeper understanding of the benefits of such programs may support their expansion to other residency programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to explore the benefits and most effective features of BREW Rounds to guide the development of similar programs at other institutions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following research ethics board approval, we conducted a qualitative descriptive study based on semistructured interviews with anesthesia residents who had participated in one or more BREW sessions and with the main BREW Rounds facilitator. Topics of discussion included community building, belonging, mentorship, facilitation, discussion of nonclinical aspects, and removal of hierarchy. Interviews were conducted on videoconferencing software by researchers who were not involved in supervising or assessing the trainees. Audio recordings were auto-transcribed, deidentified, verified, and interpreted using thematic content analysis. Further perspectives on BREW Rounds were obtained from staff anesthesiologists through an anonymous online survey.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We interviewed 10 residents (6 junior, 3 senior, and 1 transition-to-practice) and 1 facilitator. Emerging themes included (1) access to a safe space free of judgment, allowing participants to be vulnerable about clinical or nonclinical aspects of their training, (2) building a sense of community in a fast-paced and often isolating environment, (3) providing opportunities for mentorship between junior and senior residents in a frequently changing colleague network, (4) the characteristics that create a \"BREW culture\", such as behavior norms during sessions and staff respect for protected time, (5) the importance of a good facilitator from outside the anesthesia department, especially during smaller sessions, (6) expanding BREW Rounds to other institutions, and (7) areas for improvement for the current program. Sixteen anesthesiology staff survey responses were available for analysis: 12/16 (75%) anesthesiologists supported residents leaving their clinical duties early for BREW Rounds and 12/16 (75%) believed BREW Rounds benefitted residents' well-being.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This qualitative study confirms previous findings that BREW Rounds are beneficial to anesthesia training, improve the psychological wellness of residents, and may posi","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e78575"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12670191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Wellness Among General Surgery Residents During the COVID-19 Pandemic: Qualitative Analysis of Survey Responses.","authors":"Idil Bilgen, Matthew Castelo, Emma Reel, May-Anh Nguyen, Brittany Greene, Justin Lu, Savtaj Brar, Tulin Cil","doi":"10.2196/72819","DOIUrl":"10.2196/72819","url":null,"abstract":"<p><strong>Background: </strong>Health care provider burnout worsened during the COVID-19 pandemic.</p><p><strong>Objective: </strong>This qualitative study described general surgery residents' perceptions of burnout and the impact of the COVID-19 pandemic and their attitudes toward wellness initiatives.</p><p><strong>Methods: </strong>General surgery residents at a large training program in Canada completed a 21-item survey focused on self-reported burnout, mental health, perceptions of wellness resources, and the effects of the COVID-19 pandemic. Free-text responses were extracted for qualitative thematic content analysis. A coding framework was established, and emergent themes were identified.</p><p><strong>Results: </strong>A total of 62% (51/82) of the residents completed the survey. Most respondents were senior residents (21/51, 41%) and identified as male (32/51, 63%). In total, 65% (33/51) of the residents met the criteria for burnout. Three themes were identified: (1) the culture of general surgery does not promote wellness, (2) the COVID-19 pandemic worsened existing access to vacation days and rest, and (3) wellness education in general surgery is ineffective and onerous to complete. General surgery residents emphasized the rigid lifestyle and culture of the specialty. Residents said that the idea of wellness was poorly executed. COVID-19 protocols increased the acceptance of taking sick days, but this was offset by staff shortages during the pandemic. Finally, residents emphasized the inefficacy of wellness education. They felt that they did not lack knowledge on reaching wellness but simply lacked the adequate time and resources to improve their well-being.</p><p><strong>Conclusions: </strong>There are persistent concerns within the culture of general surgery that were further impacted by workload and stress during the pandemic. These results may inform future programmatic efforts to decrease resident burnout.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e72819"},"PeriodicalIF":0.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12643399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual Reality Exposure Therapy and Patient Education for Preoperative Anxiety in Pediatrics: Randomized Controlled Trial.","authors":"Sebastian Amaya, Sidhant Kalsotra, Sibelle Aurelie Yemele Kitio, Joseph Drew Tobias, Brittany Willer","doi":"10.2196/73392","DOIUrl":"10.2196/73392","url":null,"abstract":"<p><strong>Background: </strong>The perioperative environment is complex and may be challenging for patients and guardians to navigate. The emotional burden and stressors inherent to the perioperative process commonly result in preoperative anxiety. Many studies have demonstrated the usefulness of virtual reality (VR) in various patient populations.</p><p><strong>Objective: </strong>The aim of this study is to evaluate the impact of a VR-based preoperative education tool on anxiety levels in pediatric patients undergoing ambulatory ear, nose, and throat surgery, as well as in their guardians.</p><p><strong>Methods: </strong>We performed a single-center prospective randomized controlled trial including children 6-12 years of age, presenting for ambulatory tonsillectomy and/or adenoidectomy, with or without bilateral ear tube insertion. The patients were randomized to receive VR instruction of the perioperative workflow or standard preoperative experience (non-VR). The primary outcome was patient and guardian preoperative anxiety, as measured by the 6-item State-Trait Anxiety Inventory.</p><p><strong>Results: </strong>The study cohort included 107 patient-guardian dyads-51 in the intervention (VR) group and 56 in the control (non-VR) group. Baseline characteristics between the study and control groups were comparable; however, patients in the control group were more likely to report feeling upset compared to the VR group. The VR intervention was associated with reduced preoperative anxiety in patients and guardians compared to the control group. Patients exposed to the VR intervention had higher odds of feeling calm (OR 4.95, 95% CI 2.32-10.61; P<.001) and lower odds of feeling worried (OR 0.25, 95% CI 0.12-0.53; P<.001) compared to the control group. Similarly, guardians in the VR group had higher odds of feeling calm (OR 3.55, 95% CI 1.69-7.49; P=.001) and lower odds of feeling worried (OR 0.45, 95% CI 0.22-0.93; P=.03) compared to the control group. Both patients and guardians exposed to VR were significantly less likely to have moderate or high levels of preoperative anxiety than the control group (patients: OR 0.15, 95% CI 0.05-0.41, P<.001; guardians: OR 0.14, 95% CI 0.06-0.38, P<.001).</p><p><strong>Conclusions: </strong>VR exposure may be effective in reducing pediatric and guardian anxiety. VR may be a suitable alternative to pharmacologic anxiolysis and future studies should compare the effect to premedication techniques.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e73392"},"PeriodicalIF":0.0,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12558565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145379996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Day Surgery With Remote Patient Monitoring for Acute Cholecystitis: Economic Modeling Study.","authors":"John Paul Kuwornu, David Brain, Kheng-Seong Ng, Amina Tariq, Melissa Baysari, Sundresan Naicker, Adeola Bamgboje-Ayodele, Adrian Boscolo, Peter J Lee, Steven M McPhail","doi":"10.2196/76807","DOIUrl":"10.2196/76807","url":null,"abstract":"<p><strong>Background: </strong>Reducing the time to surgery for patients requiring cholecystectomy may lessen the risk of adverse outcomes. Dedicated day-surgery lists supported by out-of-hospital remote monitoring have been explored as a potential solution; however, the cost-effectiveness of such innovative care models remains largely unexplored.</p><p><strong>Objective: </strong>This study presents a cost-effectiveness analysis comparing an acute day-surgery care model with remote patient monitoring to a conventional inpatient-centric care model for high-acuity cases of cholecystitis.</p><p><strong>Methods: </strong>Post-surgical complications, effectiveness (measured by bed days saved and quality-adjusted life years [QALYs]), and health care costs associated with the two models of care were compared over a 1-year time horizon using a decision tree model. Health care costs were estimated from the Australian health care funder perspective and expressed in 2023 Australian dollars. Uncertainty was assessed using both deterministic and probabilistic sensitivity analyses.</p><p><strong>Results: </strong>The acute day-surgery care model dominated the conventional inpatient-centric care model by saving a mean of 1.7 inpatient days per patient (3.2 days for the conventional model versus 1.5 days for the acute day-surgery model) and lowering net health care costs by a mean of AU $1,416 (US $935) per case over the 1-year time horizon. There was no meaningful difference in QALYs between the care models. These results remained robust in both deterministic and probabilistic sensitivity analyses.</p><p><strong>Conclusions: </strong>An acute day-surgery care model with remote patient monitoring for individuals with acute cases of cholecystitis requiring cholecystectomy would likely free bed days and provide economic benefits to the health care system compared to inpatient-centric practice. Uncertainty in QALY estimates remains a limitation.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e76807"},"PeriodicalIF":0.0,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12536997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Anxiety and Information Desire Among Patients Undergoing Elective Surgery in Northern Sudan: Multicenter Cross-Sectional Study.","authors":"Abeer Ahmed, Mohamed Nasur, Eman Mohamed, Amna Faragalla, Mustafa Ahmed, Murouj Mohammed, Abdinur Yusuf, Mohamed Issak","doi":"10.2196/75736","DOIUrl":"10.2196/75736","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Preoperative anxiety is a common psychological condition, and many patients express a desire for more information before surgery. Understanding the prevalence and associated factors of both preoperative anxiety and the desire for information can improve patient care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to assess the prevalence of preoperative anxiety and desire for information, as well as their associated sociodemographic, medical, and surgical factors, among patients undergoing elective surgery in Northern State, Sudan.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A hospital-based, multicenter, cross-sectional study was conducted from November 2024 to February 2025 in Northern State, Sudan, involving patients undergoing elective surgery. Data were collected through face-to-face interviews using a structured questionnaire and the validated Arabic version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Chi-square tests and univariate and multivariate logistic regression were performed to identify the associated factors and the magnitude, with statistical significance set at P&lt;.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 380 patients approached, 305 participated in the study (response rate=80.3%): 173 of the 305 participants (56.7%) were male, and the median age was 43 (IQR 30-64) years. Most participants were married (n=207, 67.9%), educated (n=248, 81.3%), and had family support (n=253, 83.0%). Regarding surgical characteristics, the majority underwent either intermediate (n=136, 44.6%) or major (n=142, 46.6%) procedures. General anesthesia was the most common type used (n=159, 52.2%), and most participants (n=169, 55.4%) underwent surgery in public hospitals. Most participants reported that their surgeries were not covered by insurance (n=264, 86.6%) and described good sleep quality the night before surgery (n=221, 72.5%). Of the 305 participants, 75 (24.6%) experienced preoperative anxiety, whereas 92 (30.1%) expressed a moderate to high desire for information. Preoperative anxiety was significantly associated with family support (adjusted odds ratio [aOR] 7.12, 95% CI 2.64-19.23; P&lt;.001), surgery in public hospitals (aOR 4.31, 95% CI 2.30-8.07; P&lt;.001), poor sleep quality the night before surgery (aOR 2.85, 95% CI 1.51-5.38; P=.001), and American Society of Anesthesiologists (ASA) classification III/IV (aOR 2.36, 95% CI 1.00-5.54; P=.049). Similarly, a higher desire for information was significantly associated with being educated (aOR 2.48, 95% CI 1.00-6.11; P=.049), having family support (aOR 4.10, 95% CI 1.81-9.30; P=.001), undergoing surgery in a public hospital (aOR 3.57, 95% CI 1.93-6.61; P&lt;.001), and being classified as ASA III/IV (aOR 3.26, 95% CI 1.39-7.64; P=.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Preoperative anxiety and desire for information are common among Sudanese patients. Family involvement may paradoxically increase anxiety and the desire for more information due to sha","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e75736"},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12526657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Pathways in Knee and Hip Arthroplasty: Narrative Review on Sustainability, Quality, and Resource Management.","authors":"Manuel Godinho, Filipe Maçães, Helena Gonçalves, Firmino Silva","doi":"10.2196/78174","DOIUrl":"10.2196/78174","url":null,"abstract":"<p><strong>Background: </strong>Increasing arthroplasty volumes are testing health care system capacity, budgets, and workforce resilience. Clinical pathways (CPWs) provide a practical, evidence-based structure that aligns perioperative actions from preparation through follow-up. In this review, we treat three aims as coprimary: quality (patient outcomes and adherence to best practice); resource management and efficiency at the episode level (eg, length of stay, perioperative flow, direct costs); and sustainability, defined as the ability to maintain high-quality services over time by optimizing financial, human, and environmental resources while safeguarding equitable access.</p><p><strong>Objective: </strong>This study aimed to describe the main CPW subtypes used in hip and knee arthroplasty and synthesize evidence on their effects on quality of care, resource management, and sustainability.</p><p><strong>Methods: </strong>We conducted a narrative review of studies indexed in PubMed and Cochrane (2013-2024) that evaluated CPWs in total hip and knee arthroplasty. Screening and selection were documented with a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-style flow diagram for transparency, and findings were synthesized thematically.</p><p><strong>Results: </strong>Across CPW models, consistent signals of benefit were identified. Enhanced Recovery After Surgery (ERAS) pathways accelerate recovery and enable earlier discharge without increasing complications, often reducing opioid exposure and time to mobilization. Integrated Clinical Pathways improve standardization and multidisciplinary coordination across settings, reducing unwarranted variability and supporting safer transitions of care. Fast-track programs emphasize early mobilization and streamlined perioperative processes, improving patient flow and satisfaction while decreasing length of stay. Outpatient arthroplasty pathways allow same-day discharge in carefully selected, low-risk patients, reducing bed occupancy and freeing inpatient capacity. Virtual clinics support remote follow-up, patient education, and complication surveillance, decreasing unnecessary in-person visits and optimizing clinician time. Collectively, these pathways align quality improvement with sustainability by lowering bed-days, improving adherence to evidence-based practices, and enabling more efficient use of operating rooms, wards, and workforce.</p><p><strong>Conclusions: </strong>This review highlights the importance of CPWs in improving care delivery and patient outcomes in orthopedic surgery. Future efforts should refine CPWs, integrate digital tools and platforms, adopt standardized sustainability metrics, and stay flexible to evolving service demands.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"8 ","pages":"e78174"},"PeriodicalIF":0.0,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12520643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}