JMIR perioperative medicine最新文献

{"title":"The Role of Wearable Technology in Measuring and Supporting Patient Outcomes Following Total Joint Replacement: Review of the Literature.","authors":"Gregory Iovanel,&nbsp;David Ayers,&nbsp;Hua Zheng","doi":"10.2196/39396","DOIUrl":"https://doi.org/10.2196/39396","url":null,"abstract":"<p><strong>Background: </strong>The incidence rate of total joint replacement (TJR) continues to increase due to the aging population and the surgery that is very successful in providing pain relief to and improving function among patients with advanced knee or hip arthritis. Improving patient outcomes and patient satisfaction after TJR remain important goals. Wearable technologies provide a novel way to capture patient function and activity data and supplement clinical measures and patient-reported outcome measures in order to better understand patient outcomes after TJR.</p><p><strong>Objective: </strong>We examined the current literature to evaluate the potential role of wearable devices and compare them with existing methods for monitoring and improving patient rehabilitation and outcomes following TJR.</p><p><strong>Methods: </strong>We performed a literature search by using the research databases supported by the University of Massachusetts Chan Medical School's Lamar Soutter Library, including PubMed and Scopus, supplemented with the Google Scholar search engine. A specific search strategy was used to identify articles discussing the use of wearable devices in measuring and affecting postoperative outcomes of patients who have undergone TJR. Selected papers were organized into a spreadsheet and categorized for our qualitative literature review to assess how wearable data correlated with clinical measures and patient-reported outcome measures.</p><p><strong>Results: </strong>A total of 9 papers were selected. The literature showed the impact of wearable devices on evaluating and improving postoperative functional outcomes. Wearable-collected data could be used to predict postoperative clinical measures, such as range of motion and Timed Up and Go times. When predicting patient-reported outcomes, specifically Hip Disability and Osteoarthritis Outcome Scores/Knee Injury and Osteoarthritis Outcome Scores and Veterans RAND 12-Item Health Survey scores, strong associations were found between changes in sensor-collected data and changes in patient-reported outcomes over time. Further, the step counts of patients who received feedback from a wearable improved over time when compared to those of patients who did not receive feedback.</p><p><strong>Conclusions: </strong>These findings suggest that wearable technology has the potential to remotely measure and improve postoperative orthopedic patient outcomes. We anticipate that this review will facilitate further investigation into whether wearable devices are viable tools for guiding the clinical management of TJR rehabilitation.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"6 ","pages":"e39396"},"PeriodicalIF":0.0,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9880809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10687650","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":"Personal Devices to Monitor Physical Activity and Nutritional Intake After Colorectal Cancer Surgery: Feasibility Study.","authors":"Manouk J W van der Linden,&nbsp;Lenny M W Nahar van Venrooij,&nbsp;Emiel G G Verdaasdonk","doi":"10.2196/40352","DOIUrl":"https://doi.org/10.2196/40352","url":null,"abstract":"<p><strong>Background: </strong>The use of self-monitoring devices is promising for improving perioperative physical activity and nutritional intake.</p><p><strong>Objective: </strong>This study aimed to assess the feasibility, usability, and acceptability of a physical activity tracker and digital food record in persons scheduled for colorectal cancer (CRC) surgery.</p><p><strong>Methods: </strong>This observational cohort study was conducted at a large training hospital between November 2019 and November 2020. The study population consisted of persons with CRC between 18- and 75 years of age who were able to use a smartphone or tablet and scheduled for elective surgery with curative intent. Excluded were persons not proficient in Dutch or following a protein-restricted diet. Participants used an activity tracker (Fitbit Charge 3) from 4 weeks before until 6 weeks after surgery. In the week before surgery (preoperative) and the fifth week after surgery (postoperative), participants also used a food record for 1 week. They shared their experience regarding usability (system usability scale, range 0-100) and acceptability (net promoter score, range -100 to +100).</p><p><strong>Results: </strong>In total, 28 persons were included (n=16, 57% male, mean age 61, SD 8 years), and 27 shared their experiences. Scores regarding the activity tracker were as follows: preoperative median system usability score, 85 (IQR 73-90); net promoter score, +65; postoperative median system usability score, 78 (IQR 68-85); net promotor score, +67. The net promoter scores regarding the food record were +37 (preoperative) and-7 (postoperative).</p><p><strong>Conclusions: </strong>The perioperative use of a physical activity tracker is considered feasible, usable, and acceptable by persons with CRC in this study. Preoperatively, the use of a digital food record was acceptable, and postoperatively, the acceptability decreased.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"5 1","pages":"e40352"},"PeriodicalIF":0.0,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9795396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10450600","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":"An Accessible Clinical Decision Support System to Curtail Anesthetic Greenhouse Gases in a Large Health Network: Implementation Study.","authors":"Priya Ramaswamy, Aalap Shah, Rishi Kothari, Nina Schloemerkemper, Emily Methangkool, Amalia Aleck, Anne Shapiro, Rakhi Dayal, Charlotte Young, Jon Spinner, Carly Deibler, Kaiyi Wang, David Robinowitz, Seema Gandhi","doi":"10.2196/40831","DOIUrl":"10.2196/40831","url":null,"abstract":"<p><strong>Background: </strong>Inhaled anesthetics in the operating room are potent greenhouse gases and are a key contributor to carbon emissions from health care facilities. Real-time clinical decision support (CDS) systems lower anesthetic gas waste by prompting anesthesia professionals to reduce fresh gas flow (FGF) when a set threshold is exceeded. However, previous CDS systems have relied on proprietary or highly customized anesthesia information management systems, significantly reducing other institutions' accessibility to the technology and thus limiting overall environmental benefit.</p><p><strong>Objective: </strong>In 2018, a CDS system that lowers anesthetic gas waste using methods that can be easily adopted by other institutions was developed at the University of California San Francisco (UCSF). This study aims to facilitate wider uptake of our CDS system and further reduce gas waste by describing the implementation of the FGF CDS toolkit at UCSF and the subsequent implementation at other medical campuses within the University of California Health network.</p><p><strong>Methods: </strong>We developed a noninterruptive active CDS system to alert anesthesia professionals when FGF rates exceeded 0.7 L per minute for common volatile anesthetics. The implementation process at UCSF was documented and assembled into an informational toolkit to aid in the integration of the CDS system at other health care institutions. Before implementation, presentation-based education initiatives were used to disseminate information regarding the safety of low FGF use and its relationship to environmental sustainability. Our FGF CDS toolkit consisted of 4 main components for implementation: sustainability-focused education of anesthesia professionals, hardware integration of the CDS technology, software build of the CDS system, and data reporting of measured outcomes.</p><p><strong>Results: </strong>The FGF CDS system was successfully deployed at 5 University of California Health network campuses. Four of the institutions are independent from the institution that created the CDS system. The CDS system was deployed at each facility using the FGF CDS toolkit, which describes the main components of the technology and implementation. Each campus made modifications to the CDS tool to best suit their institution, emphasizing the versatility and adoptability of the technology and implementation framework.</p><p><strong>Conclusions: </strong>It has previously been shown that the FGF CDS system reduces anesthetic gas waste, leading to environmental and fiscal benefits. Here, we demonstrate that the CDS system can be transferred to other medical facilities using our toolkit for implementation, making the technology and associated benefits globally accessible to advance mitigation of health care-related emissions.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"5 1","pages":"e40831"},"PeriodicalIF":0.0,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9782391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10419394","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":"Experiences of Health Care Professionals Working Extra Weekends to Reduce COVID-19-Related Surgical Backlog: Cross-sectional Study.","authors":"Clyde Matava, Jeannette P So, Alomgir Hossain, Simon Kelley","doi":"10.2196/40209","DOIUrl":"10.2196/40209","url":null,"abstract":"<p><strong>Background: </strong>During the quiescent periods of the COVID-19 pandemic in 2020, we implemented a weekend-scheduled pediatric surgery program to reduce COVID-19-related backlogs. Over 100 staff members from anesthesiologists to nurses, surgeons, and administrative and supporting personnel signed up to work extra weekends as part of a novel weekend elective pediatric surgery program to reduce COVID-19-related backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends-Extra Lists (ORRACLE-Xtra).</p><p><strong>Objective: </strong>In this study, we sought to evaluate staff perceptions and their level of satisfaction and experiences with working extra scheduled weekend elective surgical cases at the end of the 3-month pilot phase of ORRACLE-Xtra and identify key factors for participation.</p><p><strong>Methods: </strong>Following the pilot of ORRACLE-Xtra, all perioperative staff who worked at least 1 weekend list were invited to complete an online survey that was developed and tested prior to distribution. The survey collected information on the impact of working weekends on well-being, overall satisfaction, and likelihood of and preferences for working future weekend lists. Logistic regression was used to estimate the association of well-being with satisfaction and willingness to work future weekend lists.</p><p><strong>Results: </strong>A total of 82 out of 118 eligible staff responded to the survey for a response rate of 69%. Staff worked a median of 2 weekend lists (IQR 1-9). Of 82 staff members, 65 (79%) were satisfied or very satisfied with working the extra weekend elective lists, with surgeons and surgical trainees reporting the highest levels of satisfaction. Most respondents (72/82, 88%) would continue working weekend lists. A sense of accomplishment was associated with satisfaction with working on the weekend (odds ratio [OR] 19.97, 95% CI 1.79-222.63; P=.02) and willingness to participate in future weekend lists (OR 17.74, 95% CI 1.50-200.70; P=.02). Many (56/82, 68%) were willing to work weekend lists that included longer, more complex cases, which was associated with a sense of community (OR 0.12, 95% CI 0.02-0.63; P=.01).</p><p><strong>Conclusions: </strong>Staff participating in the first 3 months of the ORRACLE-Xtra program reported satisfaction with working weekends and a willingness to continue with the program, including doing longer, more complex cases. Institutions planning on implementing COVID-19 surgical backlog work may benefit from gathering key information from their staff.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"5 1","pages":"e40209"},"PeriodicalIF":0.0,"publicationDate":"2022-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9746672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10344034","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":"Determining the Reliable Measurement Period for Preoperative Baseline Values With Telemonitoring Before Major Abdominal Surgery: Pilot Cohort Study.","authors":"Marjolein E Haveman,&nbsp;Rianne van Melzen,&nbsp;Mostafa El Moumni,&nbsp;Richte C L Schuurmann,&nbsp;Hermie J Hermens,&nbsp;Monique Tabak,&nbsp;Jean-Paul P M de Vries","doi":"10.2196/40815","DOIUrl":"https://doi.org/10.2196/40815","url":null,"abstract":"<p><strong>Background: </strong>Preoperative telemonitoring of vital signs, physical activity, and well-being might be able to optimize prehabilitation of the patient's physical and mental condition prior to surgery, support setting alarms during in-hospital monitoring, and allow personalization of the postoperative recovery process.</p><p><strong>Objective: </strong>The primary aim of this study was to evaluate when and how long patients awaiting major abdominal surgery should be monitored to get reliable preoperative individual baseline values of heart rate (HR), daily step count, and patient-reported outcome measures (PROMs). The secondary aim was to describe the perioperative course of these measurements at home.</p><p><strong>Methods: </strong>In this observational single-center cohort study, patients used a wearable sensor during waking hours and reported PROMs (pain, anxiety, fatigue, nausea) on a tablet twice a day. Intraclass correlation coefficients (ICCs) were used to evaluate the reliability of mean values on 2 specific preoperative days (the first day of telemonitoring and the day before hospital admission) and randomly selected preoperative periods compared to individual reference values. Mean values of HR, step count, and PROMs per day were visualized in a boxplot from 14 days before hospital admission until 30 days after surgery.</p><p><strong>Results: </strong>A total of 16 patients were included in the data analyses. The ICCs of mean values on the first day of telemonitoring were 0.91 for HR, 0.71 for steps, and at least 0.86 for PROMs. The day before hospital admission showed reliability coefficients of 0.76 for HR, 0.71 for steps, and 0.92-0.99 for PROMs. ICC values of randomly selected measurement periods increased over the continuous period of time from 0.68 to 0.99 for HR and daily step counts. A lower bound of the 95% CI of at least 0.75 was determined after 3 days of measurements. The ICCs of randomly selected PROM measurements were 0.89-0.94. Visualization of mean values per day mainly showed variable preoperative daily step counts (median 2409, IQR 1735-4661 steps/day) and lower postoperative daily step counts (median 884, IQR 474-1605 steps/day). In addition, pain was visually reduced until 30 days after surgery at home.</p><p><strong>Conclusions: </strong>In this prospective pilot study, for patients awaiting major abdominal surgery, baseline values for HR and daily step count could be measured reliably by a wearable sensor worn for at least 3 consecutive days and PROMs during any preoperative day. No clear conclusions were drawn from the description of the perioperative course by showing mean values of HR, daily step count, and PROM values over time in the home situation.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":"5 1","pages":"e40815"},"PeriodicalIF":0.0,"publicationDate":"2022-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9745646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10336160","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":"Identifying Risk Factors, Patient-Reported Experience and Outcome Measures, and Data Capture Tools for an Individualized Pain Prediction Tool in Pediatrics: Focus Group Study.","authors":"Michael D Wood,&nbsp;Nicholas C West,&nbsp;Rama S Sreepada,&nbsp;Kent C Loftsgard,&nbsp;Luba Petersen,&nbsp;Julie M Robillard,&nbsp;Patricia Page,&nbsp;Randa Ridgway,&nbsp;Neil K Chadha,&nbsp;Elodie Portales-Casamar,&nbsp;Matthias Görges","doi":"10.2196/42341","DOIUrl":"https://doi.org/10.2196/42341","url":null,"abstract":"<p><strong>Background: </strong>The perioperative period is a data-rich environment with potential for innovation through digital health tools and predictive analytics to optimize patients' health with targeted prehabilitation. Although some risk factors for postoperative pain following pediatric surgery are already known, the systematic use of preoperative information to guide personalized interventions is not yet widespread in clinical practice.</p><p><strong>Objective: </strong>Our long-term goal is to reduce the incidence of persistent postsurgical pain (PPSP) and long-term opioid use in children by developing personalized pain risk prediction models that can guide clinicians and families to identify targeted prehabilitation strategies. To develop such a system, our first objective was to identify risk factors, outcomes, and relevant experience measures, as well as data collection tools, for a future data collection and risk modeling study.</p><p><strong>Methods: </strong>This study used a patient-oriented research methodology, leveraging parental/caregiver and clinician expertise. We conducted virtual focus groups with participants recruited at a tertiary pediatric hospital; each session lasted approximately 1 hour and was composed of clinicians or family members (people with lived surgical experience and parents of children who had recently undergone a procedure requiring general anesthesia) or both. Data were analyzed thematically to identify potential risk factors for pain, as well as relevant patient-reported experience and outcome measures (PREMs and PROMs, respectively) that can be used to evaluate the progress of postoperative recovery at home. This guidance was combined with a targeted literature review to select tools to collect risk factor and outcome information for implementation in a future study.</p><p><strong>Results: </strong>In total, 22 participants (n=12, 55%, clinicians and n=10, 45%, family members) attended 10 focus group sessions; participants included 12 (55%) of 22 persons identifying as female, and 12 (55%) were under 50 years of age. Thematic analysis identified 5 key domains: (1) demographic risk factors, including both child and family characteristics; (2) psychosocial risk factors, including anxiety, depression, and medical phobias; (3) clinical risk factors, including length of hospital stay, procedure type, medications, and pre-existing conditions; (4) PREMs, including patient and family satisfaction with care; and (5) PROMs, including nausea and vomiting, functional recovery, and return to normal activities of daily living. Participants further suggested desirable functional requirements, including use of standardized and validated tools, and longitudinal data collection, as well as delivery modes, including electronic, parent proxy, and self-reporting, that can be used to capture these metrics, both in the hospital and following discharge. Established PREM/PROM questionnaires, pain-catastrophizing scales (PC","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":" ","pages":"e42341"},"PeriodicalIF":0.0,"publicationDate":"2022-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9709673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40703225","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":"The Use of Machine Learning to Reduce Overtreatment of the Axilla in Breast Cancer: Retrospective Cohort Study.","authors":"Felix Jozsa,&nbsp;Rose Baker,&nbsp;Peter Kelly,&nbsp;Muneer Ahmed,&nbsp;Michael Douek","doi":"10.2196/34600","DOIUrl":"https://doi.org/10.2196/34600","url":null,"abstract":"<p><strong>Background: </strong>Patients with early breast cancer undergoing primary surgery, who have low axillary nodal burden, can safely forego axillary node clearance (ANC). However, routine use of axillary ultrasound (AUS) leads to 43% of patients in this group having ANC unnecessarily, following a positive AUS. The intersection of machine learning with medicine can provide innovative ways to understand specific risks within large patient data sets, but this has not yet been trialed in the arena of axillary node management in breast cancer.</p><p><strong>Objective: </strong>The objective of this study was to assess if machine learning techniques could be used to improve preoperative identification of patients with low and high axillary metastatic burden.</p><p><strong>Methods: </strong>A single-center retrospective analysis was performed on patients with breast cancer who had a preoperative AUS, and the specificity and sensitivity of AUS were calculated. Standard statistical methods and machine learning methods, including artificial neural network, naive Bayes, support vector machine, and random forest, were applied to the data to see if they could improve the accuracy of preoperative AUS to better discern high and low axillary burden.</p><p><strong>Results: </strong>The study included 459 patients; 142 (31%) had a positive AUS; among this group, 88 (62%) had 2 or fewer macrometastatic nodes at ANC. Logistic regression outperformed AUS (specificity 0.950 vs 0.809). Of all the methods, the artificial neural network had the highest accuracy (0.919). Interestingly, AUS had the highest sensitivity of all methods (0.777), underlining its utility in this setting.</p><p><strong>Conclusions: </strong>We demonstrated that machine learning improves identification of the important subgroup of patients with no palpable axillary disease, positive ultrasound, and more than 2 metastatically involved nodes. A negative ultrasound in patients with no palpable lymphadenopathy is highly indicative of low axillary burden, and it is unclear whether sentinel node biopsy adds value in this situation. Further studies with larger patient numbers focusing on specific breast cancer subgroups are required to refine these techniques in this setting.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":" ","pages":"e34600"},"PeriodicalIF":0.0,"publicationDate":"2022-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9709674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40475430","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":"Outcomes With a Mobile Digital Health Platform for Patients Undergoing Spine Surgery: Retrospective Analysis","authors":"Vishal Venkatraman, Elayna P Kirsch, Emily Luo, Sameer Kunte, M. Ponder, Z. Gellad, Beiyu Liu, Hui-Jie Lee, S. Jung, M. Haglund, S. Lad","doi":"10.2196/38690","DOIUrl":"https://doi.org/10.2196/38690","url":null,"abstract":"Background Digital health solutions have been shown to enhance outcomes for individuals with chronic medical illnesses, but few have been validated for surgical patients. The digital health platform ManageMySurgery (MMS) has been validated for spine surgery as a feasible method for patients along their surgical journey through in-app education and completion of patient-reported outcomes surveys. Objective The aim of this study is to determine the rates of 90-day emergency room (ER) visits, readmissions, and complications in patients undergoing spine surgery using MMS compared to patients using traditional perioperative care alone. Methods Patients undergoing spine surgery at a US-based academic hospital were invited to use MMS perioperatively between December 2017 and September 2021. All patients received standard perioperative care and were classified as MMS users if they logged into the app. Demographic information and 90-day outcomes were acquired via electronic health record review. The odds ratios of having 90-day ER visits, readmissions, mild complications, and severe complications between the MMS and non-MMS groups were estimated using logistic regression models. Results A total of 1015 patients were invited, with 679 using MMS. MMS users and nonusers had similar demographics: the average ages were 57.9 (SD 12.5) years and 61.5 (SD 12.7) years, 54.1% (367/679) and 47.3% (159/336) were male, and 90.1% (612/679) and 88.7% (298/336) had commercial or Medicare insurance, respectively. Cervical fusions (559/1015, 55.07%) and single-approach lumbar fusions (231/1015, 22.76%) were the most common procedures for all patients. MMS users had a lower 90-day readmission rate (55/679, 8.1%) than did nonusers (30/336, 8.9%). Mild complications (MMS: 56/679, 8.3%; non-MMS: 32/336, 9.5%) and severe complications (MMS: 66/679, 9.7%; non-MMS: 43/336, 12.8%) were also lower in MMS users. MMS users had a lower 90-day ER visit rate (MMS: 62/679, 9.1%; non-MMS: 45/336, 13.4%). After adjustments were made for age and sex, the odds of having 90-day ER visits for MMS users were 32% lower than those for nonusers, but this difference was not statistically significant (odds ratio 0.68, 95% CI 0.45-1.02; P=.06). Conclusions This is one of the first studies to show differences in acute outcomes for people undergoing spine surgery who use a digital health app. This study found a correlation between MMS use and fewer postsurgical ER visits in a large group of spine surgery patients. A planned randomized controlled trial will provide additional evidence of whether this digital health tool can be used as an intervention to improve patient outcomes.","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48026643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Postoperative Pain at 7 Days After Day Surgery Reported Using a Text Messaging Platform: Retrospective Observational Study.","authors":"Vincent Compère,&nbsp;Alban Mauger,&nbsp;Etienne Allard,&nbsp;Thomas Clavier,&nbsp;Jean Selim,&nbsp;Emmanuel Besnier","doi":"10.2196/33276","DOIUrl":"https://doi.org/10.2196/33276","url":null,"abstract":"<p><strong>Background: </strong>The most frequent complication observed after ambulatory surgery is acute postoperative pain.</p><p><strong>Objective: </strong>The purpose of this study was to evaluate the late incidence of postoperative pain at 7 days after day surgery.</p><p><strong>Methods: </strong>We retrospectively included patients who underwent day surgery under general or regional anesthesia and those who underwent local anesthesia in Rouen University Hospital from January 2018 to February 2020. Data collected were moderate-to-severe pain reports defined as numeric rating scale (NRS)>3/10 at 1 day (secondary end point) and 7 days (primary end point) after surgery. These data were collected using a semi-intelligent SMS text messaging platform to follow up with the patient at home after ambulatory surgery. Univariate and multivariate analyses were performed to analyze the risk factors for pain.</p><p><strong>Results: </strong>We analyzed 6099 patients. On the day after the surgery, 5.2% (318/6099) of the patients presented with moderate-to-severe pain: 5.9% (248/4187) in the general or regional anesthesia group and 3.7% (70/1912) in the local anesthesia group. At 7 days after the surgery, 18.6% (1135/6099) of the patients presented with moderate-to-severe pain, including 21.3% (892/4187) of the patients in the general or regional anesthesia group and 12.7% (243/1912) of the patients in the local anesthesia group. General surgery (odds ratio [OR] 1.54, 95% CI 1.23-1.92; P<.01) and orthopedic surgery (OR 1.66, 95% CI 1.42-1.94; P<.01) were associated with more late postoperative pain risk. Male gender (OR 0.66, 95% CI 0.57-0.76; P<.01), ophthalmology surgery (OR 0.51, 95% CI 0.42-0.62; P<.01), and gynecologic surgery (OR 0.67, 95% CI 0.50-0.88; P=.01) were associated with less late postoperative pain risk. The rate of emergency consultation or rehospitalization at 7 days after the surgery was 11.1% (679/6099). Late postoperative pain (OR 2.54, 95% CI 1.98-3.32; P<.001), general surgery (OR 2.15, 95% CI 1.65-2.81; P<.001), and urology surgery (OR 1.62, 95% CI 1.06-2.43; P=.02) increased the risk of emergency consultation or rehospitalization. Orthopedic surgery (OR 0.79, 95% CI 0.63-0.99; P=.04) and electroconvulsive therapy (OR 0.43, 95% CI 0.27-0.65; P<.001) were associated with less rates of emergency consultation or rehospitalization.</p><p><strong>Conclusions: </strong>Our study shows that postoperative pain at 7 days after ambulatory surgery was reported in more than 18% of the cases, which was also associated with an increase in the emergency consultation or rehospitalization rates.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":" ","pages":"e33276"},"PeriodicalIF":0.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9644244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40587215","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":"Definition and Classification of Postoperative Complications After Cardiac Surgery: Pilot Delphi Study.","authors":"Linda Lapp,&nbsp;Matt-Mouley Bouamrane,&nbsp;Marc Roper,&nbsp;Kimberley Kavanagh,&nbsp;Stefan Schraag","doi":"10.2196/39907","DOIUrl":"https://doi.org/10.2196/39907","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complications following cardiac surgery are common and represent a serious burden to health services and society. However, there is a lack of consensus among experts on what events should be considered as a \"complication\" and how to assess their severity.</p><p><strong>Objective: </strong>This study aimed to consult domain experts to pilot the development of a definition and classification system for complications following cardiac surgery with the goal to allow the progression of standardized clinical processes and systems in cardiac surgery.</p><p><strong>Methods: </strong>We conducted a Delphi study, which is a well-established method to reach expert consensus on complex topics. We sent 2 rounds of surveys to domain experts, including cardiac surgeons and anesthetists, to define and classify postoperative complications following cardiac surgery. The responses to open-ended questions were analyzed using a thematic analysis framework.</p><p><strong>Results: </strong>In total, 71 and 37 experts' opinions were included in the analysis in Round 1 and Round 2 of the study, respectively. Cardiac anesthetists and cardiac critical care specialists took part in the study. Cardiac surgeons did not participate. Experts agreed that a classification for postoperative complications for cardiac surgery is useful, and consensus was reached for the generic definition of a postoperative complication in cardiac surgery. Consensus was also reached on classification of complications according to the following 4 levels: \"Mild,\" \"Moderate,\" \"Severe,\" and \"Death.\" Consensus was also reached on definitions for \"Mild\" and \"Severe\" categories of complications.</p><p><strong>Conclusions: </strong>Domain experts agreed on the definition and classification of complications in cardiac surgery for \"Mild\" and \"Severe\" complications. The standardization of complication identification, recording, and reporting in cardiac surgery should help the development of quality benchmarks, clinical audit, care quality assessment, resource planning, risk management, communication, and research.</p>","PeriodicalId":73557,"journal":{"name":"JMIR perioperative medicine","volume":" ","pages":"e39907"},"PeriodicalIF":0.0,"publicationDate":"2022-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9607909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33500882","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}