Handbergdouglas8364

The spring of 2020 has been a trying time for the global medical community as it has faced the latest pandemic, COVID-19. This contagious and lethal virus has impacted patients and health care workers alike. Elective surgeries have been suspended, and the very core of our health care system is being strained. The following brief communication reviews pertinent details about the virus, delaying elective surgeries, and what patients can do during this time. The goal is to disseminate factual data that surgeons can then use to educate their patients. BACKGROUND Patients and healthcare systems are increasingly focused on evaluating interventions that increase the value of care delivered. Our objective of this study is to evaluate early post-operative outcomes among those patients who underwent total joint arthroplasty with and without the participation in our piloted Outpatient Physical Therapy Home Visits (OPTHV) program. METHODS A retrospective analysis of patients undergoing total hip arthroplasty and total knee arthroplasty at a single institution from July 2016 to September 2017 was performed. Matched cohorts were compared according to OPTHV enrollment status. RESULTS In total, 1729 patients were included in this study. Two hundred ninety-three patients were enrolled in OPTHV, while 1436 patients received institutional standard care. Patients were matched by gender (56.7% vs 57.7% female, P = .751), age (67.75 vs 66.95 years, P = .167), body mass index (30.18 vs 30.12 kg/m2, P = .859), and average American Society of Anesthesiologists score (2.31 vs 2.36, P = .131). OPTHV patients had a shorter length of stay (1.39 vs 1.64 days, P less then .001) and were more likely to discharge to home (89.8% vs 74.7%, P less then .001). Ninety-day re-admissions (2.7% vs 2.6%, P = .880) and emergency room visits (4.1% vs 4.3%, P = .864) were equivalent. CONCLUSION OPTHV is a novel program that facilitates discharge home and decreased length of stay after total joint arthroplasty without increasing re-admissions or emergency room visits. Utilization of OPTHV may contribute toward reducing the episode of care costs by reducing utilization of skilled nursing facility and home health services. Further prospective studies are needed to evaluate the effect of OPTHV on the total cost of care and functional outcomes. BACKGROUND UK hospitals nationally report venous thromboembolism (VTE) within 90 days of hospital admission, with hospital-acquired thrombosis (HAT) registers at each center used for this. We assessed the accuracy of our HAT register in identifying VTE following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS We assessed 982 elective admissions for primary THA and TKA at a large tertiary center during 2018. The primary outcome was any VTE (deep vein thrombosis and/or pulmonary embolism) within 90 days postsurgery. VTEs were identified by systematically searching hospital databases (including discharge and outpatient letters, readmissions, emergency department visits, and imaging) for every patient. VTEs were also collected using the HAT database at our center, which is maintained regularly by a specialist nursing team and used to report VTEs nationally. BLZ945 mw Diagnostic test characteristics were assessed for HAT in identifying VTEs compared to the gold standard (ie, VTEs from the hospital databases). RESULTS The prevalence of VTE was 2.7% (n = 27), with 20 VTEs identified by HAT. The accuracy of HAT in identifying VTEs were as follows sensitivity = 74.1% (95% confidence interval [CI] = 53.7-88.9), specificity = 100% (CI = 99.6-100), positive predictive value = 100% (CI = 83.2-100), and negative predictive value = 99.3% (CI = 98.5-99.7). CONCLUSION One-quarter of VTEs occurring after THA and TKA were not identified by the HAT register. These cases would be missing when our hospital's data are sent for national VTE reporting, and therefore would have substantial implications if HAT was primarily used to identify VTEs in a trial. Further work is needed to improve the accuracy of HAT VTE reporting before this could be relied upon in this setting. BACKGROUND With the recent reevaluation of surgeon reimbursement for total hip arthroplasty (THA) by the Centers for Medicare and Medicaid Services, there is increasing need for information regarding trends in operative time. While single-institutional analyses exist, there is a lack of large-scale, nationally representative, multi-institutional data. Therefore, the purpose of our study is to (1) evaluate past/present operative time trends for THA and (2) investigate factors influencing operative times from a 10-year, large multi-institutional database. METHODS All primary THAs conducted between 2008 and 2018 were queried using Current Procedural Terminology code 27130 from the American College of Surgeons-National Surgical Quality Improvement Program database, yielding 157,574 patients. Operative time, demographics, and comorbidity data were collected and analyzed. Multivariable linear models were created, and trend analyses were used where appropriate. RESULTS Median operative time was 87 minutes. Operative time was stable across included study years, with all calculated values within 5 minutes of the median (range, 86-92 minutes). Operative time was statistically stable over the last 3 years (P = .121). Age, body mass index, resident involvement, modified Charlson comorbidity index, and preoperative laboratory values influenced operative time (P less then .001). Length of stay, readmission, superficial wound infection, and sepsis decreased over the study period. Nonelective procedures were statistically longer than elective (P less then .0001). CONCLUSION While numerous factors influence the duration of THA, this study found that THA operative time has remained stable in recent years. Therefore, revaluation for THA based on intraservice time is not supported. Future analyses should continue to analyze factors that influence operative time in order to ensure patient safety and maintain positive outcomes. BACKGROUND Robotic surgery is increasingly being used in bariatric surgery; however, the benefits of robotic surgery in bariatrics remain controversial. OBJECTIVES The objective of this study was to compare the outcomes of robotic bariatric surgery with laparoscopic surgery over a 3-year period between 2015 and 2017 using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. SETTING University Hospital, United States. METHODS Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the years 2015 to 2017, we included patients who underwent primary robotic or laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass procedures. Patients were divided into either robotic or laparoscopic groups. Primary outcomes included serious adverse events, organ space infection (OSI), readmissions, reoperations, and interventions at 30 days. Secondary outcomes included operation length and hospital stay. We performed propensity score matchino = 1.16). The incidence of 30-day intervention for robotic cases also dropped from 2.2% in 2015 to 1.3% in 2017 (P less then .05, odds ratio = 1.37). Using a Student's t test, there was also a statistically significant decrease in serious adverse events in the robotic group between 2015 and 2017 (incidence of serious adverse events in 2015 was 5.2% versus 3.7% in 2017, P less then .05). Rate of 30-day reoperation for the robotic group did change over time but was comparable to the laparoscopic group (1.4% versus 1.3%). CONCLUSIONS Our study showed between 2015 and 2017 the outcomes of robotic bariatric surgery have improved as evidenced by the significant decrease in the rate of OSI, readmissions, and interventions at 30 days. BACKGROUND The Pediatric Emergency Care Applied Research Network (PECARN) criteria identify children at low risk of clinically important traumatic brain injury (ciTBI) in whom CT head (CTH) is unnecessary. We assessed compliance with PECARN at outside hospitals (OSH) among children transferred to our pediatric trauma center. METHODS Patients 24 h, neurosurgical intervention, or causing death. RESULTS 202 children were transferred after CTH. 53 were excluded for incomplete records (16), suspected abuse (33), or penetrating injury (4). Of the 149 included children, PECARN recommended CTH in 39 (26.2%), shared decision making in 79 (53.0%), and no imaging in 31 (20.8%). 26 children (17.4%) had a radiographic traumatic brain injury (rTBI) while only 6 (4.0%) had ciTBIs. Of those with ciTBIs, PECARN recommended CTH in 4 and shared decision making in 2. No child in whom CTH was not recommended had a ciTBI. 45 (30.2%) children had isolated extracranial injuries requiring transfer and 83 (55.7%) were transferred despite normal CTHs and no associated injuries. 2 (1.3%) children underwent non-emergent surgery for ciTBI. CONCLUSIONS Compliance with PECARN was low among referring facilities with nearly 75% of CTHs being potentially avoidable with proper adherence and parental counseling. Deferring imaging until after transfer appears safe as no child underwent emergent intervention upon arrival. Early transfer and improved compliance with PECARN may reduce the number of CTHs performed. OBJECTIVE The extent of intervention reporting in emergency medicine journals remains unclear. The primary objective is to assess overall completion of the Template for Intervention Description and Replication (TIDieR) checklist described in emergency medicine randomized clinical trials (RCTs). The secondary outcomes were to (1) compare reporting before and after TIDieR publication; (2) evaluate factors associated with intervention reporting. METHODS Our cross-sectional study used Google Scholar's metrics to identify seven emergency medicine journals; of which, we randomly sampled 300 articles. Using two PubMed searches, we extracted 150 RCTs before and after publications of TIDieR. Two investigators independently extracted data. The primary analysis to measure overall completion included descriptive statistics for each checklist item. Our secondary analysis used an interrupted time series analysis and generalized estimating equations to determine the effect of TIDieR publication on intervention reporting. RESULTS Our initial search yielded 635 articles; from which, we randomly sampled 300 articles. We excluded 67 articles, leaving 233 for analysis. The mean number of TIDieR items reported was 5.4 (standard deviation = 1.18). Of the 233 trials, 42.9% provided information about materials, 67% provided intervention procedures, and 99.1% provided intervention delivery. The least reported items were intervention modifications (2.6%), intervention adherence assessment methods (3.4%), and intervention adherence assessment outcomes (2.2%). CONCLUSIONS The completeness of intervention reporting is suboptimal in emergency medicine journals, necessitating improvement. The current state of adherence could be improved through the combined efforts of journal editors, major editorial organizations, and authors. BACKGROUND Clinicians often encounter agitated patients, and current treatment options include benzodiazepines and antipsychotics. Ketamine rapidly induces dissociation, maintains cardiovascular stability, spontaneous respirations, and airway reflexes. There are no prospective, randomized studies comparing ketamine to other agents in the initial management of acute agitation in the Emergency Department (ED). OBJECTIVE Determine the efficacy and safety of ketamine compared to parenteral haloperidol plus lorazepam for initial control of acute agitation. METHODS This study was a prospective, single-institution, randomized, open-label, real world, standard of care pilot study. Adult patients with combative agitation were randomized to ketamine (4 mg/kg IM or 1 mg/kg IV) or haloperidol/lorazepam (haloperidol 5-10 mg IM or IV + lorazepam 1-2 mg IM or IV). The primary outcome was sedation within 5 min, and secondary outcomes included sedation within 15 min, time to sedation, and safety. RESULTS Ninety three patients were enrolled from January 15, 2018 to October 10, 2018.