Outpatient Care Research Articles

Early Palliative Care Following Aborted Cancer Surgery: Results of a Prospective Feasibility Trial

Background: Although resection is generally necessary for curative-intent treatment of most solid organ cancers, surgery is occasionally aborted due to intraoperative findings. Following aborted cancer surgery, patients have unique care needs that specialized palliative care (PC) providers may be best equipped to manage. We hypothesized that early ambulatory PC referral following aborted cancer surgery would be feasible and acceptable. Methods: This single-institution prospective clinical trial enrolled adult patients with gastrointestinal or hepatopancreatobiliary cancer with no prior PC exposure who had curative-intent oncologic surgery that was unexpectedly aborted. The primary endpoint was the completion of an ambulatory PC consultation within 30 days of enrollment. Secondary outcomes included changes in standardized measures of quality-of-life (QOL) and anxiety/depression during the 3-month follow-up. Results: Among 25 enrolled participants, the mean age was 65.3 ± 9.9 years, 68% were male, and 88% were White. The most common types of cancers were pancreatic (44%), hepatobiliary (20%), and colorectal (12%); reasons for aborting surgery were occult metastatic disease (52%) and local unresectability (36%). Only 13 of 25 (52%) met the primary endpoint of ambulatory PC within 30 days, less than the prespecified threshold of 70%. Overall, 16 (64%) patients completed ambulatory PC consultation a mean of 29.2 ± 15.8 days after enrollment. Of the 9 (36%) who did not, reasons included patient preference (n = 4), withdrawal from study (n = 1), lost to follow-up (n = 1), scheduling conflict (n = 1), and required inpatient PC before discharge (n = 2). Anxiety (4.94 ± 3.56 vs 3.35 ± 2.60, P = 0.06), depression (4.18 ± 4.02 vs 4.76 ± 3.44, P = 0.49), and QOL (82.44 ± 11.41 vs 82.03 ± 15.37, P = 0.92) scores did not significantly differ at 3-month follow-up compared to baseline. Conclusions: Barriers to early ambulatory palliative care consultation exist after aborted cancer surgery. Given the unique and complex care needs of this patient population, additional research is needed to optimize supportive care strategies.

Ambulatory management of acute uncomplicated diverticulitis (AmbUDiv study): a multicentre, propensity score matching study

Abstract Introduction Recent studies have suggested that ambulatory management is feasible for acute uncomplicated diverticulitis (AUD); however, there is still no consensus regarding the most appropriate management settings. This study presents a multi-centre experience of managing patients presenting with AUD, specifically focusing on clinical outcomes and comparing ambulatory treatment with in-patient management. Methods A retrospective multi-centre study was conducted across four hospitals in the UK and included all adult patients with computed tomography (CT) confirmed (Hinchey grade 1a) acute diverticulitis over a 12-month period (January – December 2022). Patient medical records were followed up for 1-year post-index episode, and outcomes were compared between those treated through the ambulatory pathway versus inpatient treatment using 1:1 propensity score matching (PSM). All statistical analysis was performed using the R Foundation for Statistical Computing, version 4.4. Results A total of 348 patients with Hinchey 1a acute diverticulitis were included (260 in-patients; 88 ambulatory pathway), of which nearly a third (31.3%) had a recurrent disease. Inpatient management was dominant (74.7%), with a median of 3 days of hospital stay. PSM resulted in 172 patients equally divided between the two care settings. Ambulatory management was associated with a lower readmission rate (P = 0.02 before PSM, P = 0.08 after PSM), comparable surgical (P = 0.57 before PSM, 0% in both groups after PSM) and radiological interventions (P = 0.99 before and after PSM) within one year. In both matched and non-matched groups, a strong association between readmissions and inpatient management was noted in univariate analysis (P = 0.03 before PSM, P = 0.04 after PSM) and multivariate analysis (P = 0.02 before PSM, P = 0.03 after PSM). Conclusion Our study supports the safety and efficacy of managing patients with AUD through a well-designed ambulatory care pathway. In particular, hospital re-admission rates are lower and other outcomes are non-inferior to in-patient treatment. This has implications for substantial cost-savings and better utilisation of limited healthcare resources.

Does 24/7 care result in better outcomes for adults with eating disorders? A comparison of inpatient/residential care to partial hospitalization/intensive outpatient care for patients at low BMIs

Does 24/7 care result in better outcomes for adults with eating disorders? A comparison of inpatient/residential care to partial hospitalization/intensive outpatient care for patients at low BMIs

Emergency hand surgery in the course of time : Clinical and economic aspects of inpatient and outpatient cases at auniversity hospital in the last decade

Hand surgery departments nowadays face the challenge of operating profitably, training new specialists, managing increasing case numbers and implementing the required shift towards outpatient care in clinical practice. The aim of this study was to describe the demographic and economic indicators of auniversity hospital and to examine the development of inpatient and outpatient case numbers over the past decade. Aretrospective data analysis was carried out for patients treated for hand injuries in the period from 2013 to 2023. The main diagnoses of cases were identified and descriptively analyzed using the International Classification of Diseases (ICD). In order to demonstrate acorrelation, alinear regression model was calculated and ap-value <0.05 was considered significant. In total, 2918 cases were included over adecade starting in 2013. Out of these 776 cases were treated on an outpatient basis and two thirds of the patients were male. The patients were generally healthy with an average American Society of Anesthesiologists (ASA) status of 1.6 ± 0.6 and with apatient clinical complexity level (PCCL) of 0 in 79% of cases. Patient numbers increased continuously from 161 cases in 2013 to 393 cases in 2022 (p < 0.001). The most common main diagnosis was infectious hand diseases (L02.4-M65.14). This resulted in the most frequently assigned diagnosis-related group (DRG) being I32E (319 cases). For inpatient cases the average incision-to-suture time was 51:51 min and for outpatient cases 26:03 min. The revenue was on average 4372.90 € per inpatient case and 300.77 € per outpatient case. The rate of examinations by the German Medical Service of Health Funds (Medizinischer Dienst) was 19% over the entire observational period. The increasing case numbers in the outpatient and inpatient sectors indicate acentralization and consolidation of hand surgical expertise in the region. There are significant revenue differences between outpatient and inpatient cases.

National Trends in Healthcare Expenditures for the Management of Skin Cancer in the United States.

Malignant melanoma and keratinocyte carcinomas account for a substantial proportion of healthcare expenditures in the United States. To estimate trends in the economic burden of skin cancer in the United States between 1996 and 2016. The Disease Expenditure Project and Global Burden of Disease databases were used to estimate annual total costs and population-standardized rates of change for skin cancer-related healthcare spending. Skin cancer expenditures totaled $23.4 billion in 2016, of which $1.4 billion (95% CI: $1.3-$1.6 billion) was melanoma-related and $22 billion (95% CI: $18-$28 billion) was keratinocyte carcinoma-related. Most spending on skin cancer management occurred in ambulatory care settings [60.7% (95% CI: 57.7%-64.3%) for melanoma and 87.8% (95% CI: 87.2%-88.2%) for keratinocyte carcinoma]. Pharmaceutical costs for melanoma have increased since 2010 to $365 million (95% CI: $327-$416 million), which represents 26.1% (95% CI: 22.6%-29.3%) of total melanoma expenditure. Skin cancer management in the United States is costly. Expenditures have increased substantially since 1996 without signs of plateauing in recent years.

Fear of movement interacts with trunk mobility, and pain intensity to predict disability in patients with chronic low back pain: a classification and regression tree (CART) analysis.

Low back pain significantly impacts global health, particularly in low-income areas where primary care challenges are prevalent. Assessing both biophysical and psychological factors associated with low back pain-related disability is crucial for developing effective screening and management strategies. This study aimed to examine the association between fear of movement, trunk mobility, pain intensity, physical activity, and low back pain-related disability, and to identify key factors contributing to higher disability levels in patients with chronic low back pain. This cross-sectional study analyzed data from 381 chronic low back pain patients aged over 18, collected at a primary care ambulatory between 2015 and 2019. Variables measured included pain intensity, fear of movement, physical activity, trunk mobility, and disability. A Classification and Regression Tree approach was used to model disability predictors. Fear of movement was the main driver of high disability (OR = 17.3, 95%CI 8.9-33.7). Two profiles were particularly prone to higher disability: patients with high fear of movement (>47.5) and pain intensity > 1.5; and those with lower fear of movement but poor trunk mobility (>36.5 cm). Patients with better trunk mobility and low pain intensity (≤3.5) showed significantly less disability (OR = 0.06, 95%CI 0.02-0.17). The findings highlight the need for integrating better psychological and biophysical assessments in managing chronic low back pain. Understanding how fear of movement, trunk mobility, and pain interaction can improve screening accuracy and optimize care in resource-limited settings, using valid and feasible tools for these scenarios.

Association Between Standard Gait Measures and Anterior Quadriceps Muscle Thickness as Measured by Point of Care Ultrasound (POCUS)

Background: Gait parameters and sarcopenia both predict falls risk among older adults. Our objective was to evaluate whether fast, easy-to-obtain measures of anterior thigh muscle by point of care ultrasound (POCUS) are significantly associated with standard gait measures. Methods: All subjects were referred from ambulatory geriatric medicine clinics at an academic center. Quadriceps muscle thickness was measured by a portable ultrasound device. Gait variables were measured by the patient in comfortable walking shoes walking for six minutes. The primary response variables were gait variables, and the predictor variables were age, biological sex, body mass index, and muscle thickness. Univariate and multivariate regression analyses were performed. Results: A total of 150 participants were recruited from geriatric medicine clinics (65 women, 84 men). Muscle thickness was measured in 149 participants, and the mean (SD) was 1.91 (0.52) (median 1.82 cm, 0.96 to 3.68 cm). Univariate analysis of gait parameters with age showed a statistically significant correlation with gait speed (R2=0.16, P &lt; 0.000), average stride length (R2=0.142, P &lt; 0.000), and average stride velocity (R2=0.182, P &lt; 0.000). Among all the gait variables, average swing time (P = 0.010) and average stance time (P = 0.010) were correlated significantly with muscle thickness. For multivariate analysis with age and gait variables, age was a significant independent variable for all gait variables that were significant in univariate analysis. Conclusion: POCUS showed a significant association with average swing time, average stance time, and step time variability. Although more work needs to be done, POCUS has the potential to be a rapid screening tool for gait assessment.

Evaluation of safety criteria for enoxaparin bridging in patients with left ventricular assist devices in an outpatient care setting.

Appropriate anticoagulation is crucial for the success of left ventricular assist device patients. Currently, there is no consensus on the optimal management of their subtherapeutic INR in ambulatory setting. Our goal is to evaluate both the short-term adverse events and long-term outcomes of enoxaparin bridging at a major transplant center, following the implementation of bridging safety criteria. In total, 85 patients' medical records were reviewed between 7/2019 and 5/2022, with 51 patients meeting safety criteria were bridged with enoxaparin and 34 non-bridged. The primary endpoint was the occurrence of major bleeding/thrombosis events within 30 days of bridging. The secondary endpoint was freedom from events 30 days after enoxaparin initiation and overall patient survivability until the last follow-up. Within 30 days, no major bleeding/thrombotic events were noted. After 30 days, the major bleeding rate was 5.8% in bridged vs. 11.8% in non-bridged patients (p = 0.02). Overall, 3-year survival was 78% in the bridged vs. 49% in non-bridged patients (p < 0.001). In patients with no events, 3-year survival was 80% in bridged vs. 58% in non-bridged (p < 0.001). In the patients with bleeding events, 3-year survival was 55% in bridged vs. 51% in non-bridged (p = 0.11). At 1 year, freedom from bleeding in the bridged patients was 81% in patients with no events vs. 0% in those with an event (p < 0.0001). When eligibility criteria for safe bridging were applied, the use of enoxaparin bridging was associated with no major bleeding/thrombotic events during bridging and improved 3-year survival in LVAD patients. Economically, using outpatient enoxaparin resulted in substantial healthcare savings, fewer readmissions, and improved quality of life.

(Cost-)effectiveness and implementation of a combined lifestyle intervention for outpatients with severe mental illness (GOAL!): a hybrid quasi-experimental study protocol.

People with severe mental illness (SMI) face not only impaired mental health, but also a greater risk of physical comorbidities and a shorter life expectancy compared to the general population. A poor lifestyle plays a substantial role in this disparity. Combined Lifestyle Interventions targeting multiple lifestyle behaviors can improve mental and physical health, and quality of life. However, there is currently no appropriate structural support for people with SMI in outpatient care in the Netherlands. The Combined Lifestyle Intervention for Outpatients with SMI (GOAL!) is developed to address this gap. This study examines the (cost-)effectiveness and implementation of GOAL!. In a type 1 hybrid quasi-experimental study with a mixed-method matched design, GOAL! participants (N = 50) are compared to people receiving care as usual (N = 50). The GOAL! program includes group and individual sessions, given by allied health professionals, over a period of two years. The first year starts with a 3-month intensive course on physical activity and nutrition, followed by 9 months of aftercare covering various lifestyle topics tailored to the group's needs. There is close collaboration with local stakeholders to facilitate transfer to the community setting. The second year focuses on maintaining established activities in one's daily living environment. Our primary outcome will be the change in physical activity, comparing GOAL! participants to those receiving care as usual. Secondary outcomes are changes in other lifestyle behaviors, physical health, mental well-being, and healthcare and societal costs. Additionally, achieving lifestyle-related goals, adverse effects, and barriers and facilitators to implementation are examined. Measurements are obtained at start (T0), and after 3 (T1), 12 (T2) and 24 months (T3). This study investigates the effects of GOAL! on lifestyle behaviors, health outcomes, implementation factors and cost-effectiveness after two years, aiming to offer valuable insights into the effectiveness and implementation outcomes of lifestyle interventions for outpatients with SMI. ClinicalTrials.gov (Identifier: NCT05600205). Prospectively registered on October 26, 2022.

Management of venous aneurysms and the vascular surgical treatment options : Selection of representative case constellations illustrating experiences at acenter for vascular surgery

Venous aneurysms are arare entity in vascular surgery, which are mostly described in individual case series and meta-analyses generated from them. The treatment concepts are diverse and surgical treatment is highlighted due to the risk of thrombosis and pulmonary embolism. There is still an ongoing debate regarding the postoperative necessity and duration of anticoagulation. Case series of aconsecutive patient cohort with venous aneurysms from the last 18years in acenter of (highly specialized care) vascular surgery including i)own experiences obtained in daily vascular surgical practice and ii)aselected and current literature search of relevant references on possible and, in particular, established diagnosis-specific therapeutic concepts. Between 2005 and 2023, atotal of 11cases of venous aneurysms were reported in patients aged 30-84years (mean: 52.5, median: 50), with 1 patient requiring surgery for a recurrence after 2years. The gender ratio was 7:3 (m:f) and the popliteal vein was the most frequently affected anatomical region with 36.4%, followed by the internal jugular vein and axillary/subclavian vein each with 18.2%. Aneurysms of the inferior vena cava, the common iliac vein and the cubital vein occurred only once. Surgical treatment of the aneurysms was performed in 9cases. The surgical methods used were i)tangential resection of the aneurysm wall and continuous purse-string suture, ii)resection of the aneurysm and interposition of an 8‑mm GORE-TEX® vascular graft prosthesis (Gore, Putzbrunn, Germany), iii)ligation of the aneurysm and iv)ligation with subsequent resection of the aneurysm. The rarity of venous aneurysms should be a reason to register these cases centrally (possibly, nationwide diagnosis-related register). Surgical treatment is usually unproblematic and associated with few complications. The risk of pulmonary embolism appears to be significantly increased in venous aneurysms of the extremities, pelvic veins and inferior vena cava, while venous aneurysms of the head and neck are significantly less prone to this. Perioperative and postoperative anticoagulation has been adapted to the development of specific anticoagulants and novel drugs, in favor of treatment with direct oral anticoagulants (DOAC). In personal experience, immediate postoperative heparin perfusion (low dose) and subsequent therapeutic bridging with low-molecular-weight heparin before switching to an anticoagulant for outpatient clinic-based care appears to safeguard the perioperative phase with respect to keeping the surgery-related complication rate (e.g., thrombosis, bleeding) low.

Bridging the continuity: Practice-enhancing publications about the ambulatory care medication-use process in 2022.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. This article identifies, summarizes, and prioritizes literature on the ambulatory care medication-use process (ACMUP) published in 2022 that can describe ambulatory pharmacy practice. The medication-use process (MUP) is the foundational system that provides the framework for safe medication utilization within the healthcare environment and was reimagined to focus on new innovations and advancements in ambulatory pharmacy practice. The ACMUP is defined in this article as having the following components: transitions of care, prescribing, access, dispensing, adherence, and evaluating. Articles evaluating at least one step of the ACMUP were assessed for their usefulness toward practice improvement. A PubMed search for articles published in 2022 was conducted in January 2023 using targeted Medical Subject Headings (MeSH) keywords and the table of contents of selected pharmacy journals, providing a total of 4,125 articles. A thorough review identified 49 potentially practice-enhancing articles: 6 for transitions of care, 9 for prescribing, 5 for access, 2 for dispensing, 6 for adherence, and 21 articles for evaluating. Trends from the impact articles are described. It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article continues a series of articles defining and evaluating the currently published literature around the ACMUP. As healthcare continues to advance and care shifts to ambulatory settings, the ACMUP will continue to be a crucial process to evaluate.

Real world application of the 2023 ACR/EULAR antiphospholipid antibody syndrome classification criteria in a pharmacist directed anticoagulation clinic.

To determine the number of patients that met classification for antiphospholipid antibody syndrome (APS) after applying the 2023 American College of Rheumatology and the European Alliance for Associations of Rheumatology (ACR/EULAR) classification criteria, to identify reasons patients did not meet the new criteria, and determine the number of patients who were single, double, or triple positive based on laboratory criteria. A single center, retrospective chart review of patients with APS on anticoagulation managed by ambulatory care clinical pharmacists. Data collected included patient demographics, type of anticoagulation, and clinical and laboratory criteria for APS as defined by the 2023 ACR/EULAR criteria. Data is presented using descriptive statistics. A total of 51 patients previously diagnosed with APS were included. There were 42 patients on warfarin (82.3%), 4 patients on direct oral anticoagulants (19%), 3 patients on low molecular weight heparin (5.8%), and 2 patients on fondaparinux (3.9%). Of the 51 patients, 12 (23.5%) met classification criteria, 33 (64.7%) did not meet classification criteria and 6 (11.7%) had insufficient data. Of the 27 patients that did not meet criteria, 13 patients did not meet the laboratory criteria (39.4%), 6 patients did not meet the clinical criteria (18.2%) and 14 patients did not meet both laboratory and clinical criteria (42.4%). Of the 12 patients that met classification criteria, 2 patients were triple positive (16.7%), 3 were double positive (25%), and 7 were single positive (58.3%). Results from this study indicate that APS continues to be a complex disease state with challenges in diagnosis and classification. Since only a small number of patients in our clinic continued to meet the classification criteria, opportunities for patient re-evaluation of management strategies at our institution could be considered.

Quality of Outpatient Care in Lebanon: A Cross-Sectional Survey

Quality of Outpatient Care in Lebanon: A Cross-Sectional Survey

Patients' preferences for virtual outpatient consultations and health care professionals' assessment of suitability for their patients: A single-centre survey.

To explore patients' preferences regarding virtual consultations (via telephone or video) and to explore healthcare professionals' assessment of whether virtual consultations can maintain the same clinical quality as in-person consultations for outpatient care. A cross-sectional survey was conducted among patients with an in-person consultation at the outpatient clinic for internal medicine and among healthcare professionals who treated the patients. The prevalence of preference was determined using descriptive statistics based on cross-tabulated frequencies. Percentages are presented with 95% confidence intervals (95%CI). In total, 218 patients (response rate 67%) completed the questionnaire; 79 patients (36%) preferred a virtual consultation (95%CI: 30%-43%); telephones were the most popular and preferred by 72 patients (33%; 95%CI: 27%-39%) followed by video preferred by 54 patients (25%; 95%CI: 19%-31%). Regarding contextual factors, male gender and previous experiences with telephone or video consultations were statistically significant predictors in favour of virtual consultations. Healthcare professionals estimated that 58 consultations (21%; 95%CI: 17%-26%) could have been conducted virtually with the same professional and clinical quality as the current in-person consultations. Current practice does not fully align with patient preferences for virtual visits in internal medicine outpatient clinics. Patients should be given the choice of virtual consultations whenever they are deemed professionally and clinically possible to enhance patient autonomy and satisfaction, while being mindful of speciality-specific considerations.

EGS SO10 - Restructuring of emergency surgical service in DGH leads to significant reduction in time to cholecystectomy for gallstone pancreatitis in line with international guidance

Abstract Background The International Association of Pancreatology guidelines suggest that patients with mild biliary pancreatitis undergo cholecystectomy during their initial hospital admission. A single-center retrospective study was conducted to examine adherence to this guideline following a significant overhaul of emergency surgical services. Our team, with support from the surgical ambulatory emergency care network, revolutionized care through an Emergency Surgery Unit (EmSU) system. This included surgical assessments with ambulation, coordinated radiology appointments, semi-emergency theatre lists twice a week in addition to NCEPOD theatre sessions, and an emergency roster split by patient gender, ensuring a balanced caseload for the surgeons on duty each week. Method A retrospective study of patients with mild biliary pancreatitis for three years before (n = 107) and after (n=108) the EmSU system. Cholecystectomy on index admission was recorded, as was overall time to surgery (days). Data was analysed using GraphPad Prism Version 9.5.1. Data is expressed as Mean ± SEM. Percentages underwent Arcsine transformation prior to inferential analysis. Groups of data were analysed using Students T-Tests. Results The percentage of patients operated on index admission increased 13.1-fold (4.8% to 62.9%; P &amp;lt; 0.01). Days to surgery saw a 10.1-fold reduction (332.5 ± 41.1 to 32.9 ± 6.3 days; P &amp;lt; 0.0001). Conclusion The adoption of our EmSU system has drastically improved care for patients with gallstone pancreatitis, bringing it much closer to best practice guidance. Further improvement is likely with increased buy-in from all members of staff.

OGC SO27 - Management of oesophageal defects with Microtech VAC stents (MVS): A single centre case series

Abstract Background Oesophageal defects following cancer resection, dilatation or Boerhaave’s syndrome are increasingly managed with endoscopic approaches. Surgical management is associated with high morbidity and mortality. Pigtails stents (PS), oesophageal stents and negative pressure therapy (eso-sponge) have all been described with variation in efficacy. Microtech VAC stents (MVS) have emerged as a means of providing an oesophageal luminal stent and negative pressure to the mediastinum. Method Between June 2023 to June 2024, 19 MVS have been used in four patients with transmural oesophageal defects. Two patients had anastomotic leak (one was a quaternary referral) following Ivor Lewis Oesophagectomy. One patient had a perforation from a dilatation of a gastro-jejunostomy anastomotic stricture post-gastric bypass at another centre, then admitted as an emergency. One patient had Boerhaave’s syndrome. Results Four patients were treated with MVS. In two patients, one post dilatation perforation and one with Boerhaave’s, one MVS was sufficient to resolve the mucosal defect after seven and 11 days respectively. The other two patients with anastomotic leak required seven and 10 MVS respectively. In these patients MVS and antibiotics controlled mediastinitis, but did not completely resolve the mucosal defect. For chronic leak management MVS were exchanged for PS to enable ambulatory care. No complications with MVS changes within seven days. One patient had ingrowth of mucosa into the MVS after 11 days, but was successfully removed. Conclusion MVS therapy has been demonstrated to be safe and feasible in the management of oesophago-gastric perforations in a UK centre. Exchange of VS every 5-7 days does have additional burden to a busy endoscopy unit. No adverse events were observed.

EGS SO12 - A District General Hospital experience for setting up a "Hot Gallbladder" pathwayBackground

Abstract Background This project details a quality improvement initiative at Chesterfield Royal Hospital (CRH) to establish a “Hot Gallbladder” pathway (HGP) amidst immense NHS pressures. Before this service, CRH performed emergency cholecystectomies solely in an NCEPOD emergency theatre shared with other specialities, resulting in low case volumes, unpredictability, long patient waiting times with extended inpatient stays. The new service now dedicates two half-day lists per week to suitable patients admitted acutely and managed by five dedicated surgeons. Method This quality improvement project involves two separate yearly retrospective audits analysing patients who underwent gallbladder removal through the HGP in 2022 and 2023 at CRH. The primary objective was to assess the HGP's efficacy in terms of the number of cases performed and list completion (2 cases per half-day list). The secondary objective evaluatedadherence to the HGP protocol, appropriate patient selection, indications, and completion of adequate pre-operative investigations. The final objective assessed the HGP's safety by comparing incidence of complications and length of stay with patients undergoing cholecystectomy on the emergency NCEPOD list. Results 268 patients had gallbladder removal through the HGP and 84 cases in the emergencyNCEPOD theatre. The median age was 51, with a 3:1 female-to-male ratio. 75% of patients were managed through surgical ambulatory care. The HGP saw a 30% increase in cases and list completion rates rose from 41% to 61% in one year. NCEPOD emergency theatre usage reduced to 37%. All patients had appropriate indications and pre-operative investigations. 70% of cholecystitis patients were operated within 7 days. The HGP had a lower complication rate (6.2%) compared to emergencies (8%) and shorter post-operative stays (2 days vs 2.5 days). Conclusion This project demonstrates the benefits of establishing a HGP in a DGH. Inpatient stays were significantly reduced as 75% of patients were managed through the ambulatory carepathway. This led to financial benefits and greater patient satisfaction. Timely operations by dedicated surgeons resulted in a lower complication rate and shorter length of stay. The pathway increased the number of cases performed. The reduction in emergency theatre cases allowed better care for patients requiring emergency theatre access.

Associations Between Hearing Loss and Health-Related Costs: A Retrospective Population-Based Cohort Study

Purpose: Hearing loss (HL) is a leading cause of disability worldwide, but its health-related costs have been incompletely studied. Our objective was to examine the association between HL and direct health care costs and identify subgroups in which costs associated with HL are especially high. Method: This was a retrospective population-based cohort study of adults treated in a universal health care system between April 2008 and March 2019. HL was identified using administrative health data. We estimate health care costs in 2023 Canadian dollars, including costs for hospitalization, provider claims, ambulatory care visits, prescription medications, and long-term care (LTC). Results: Of 4,424,632 participants, 146,644 (3.3%) had HL. Participants with HL were older ( Mdn = 55 years [interquartile range: 43–68] vs. 35 years [24–50]) and had more comorbidities (1 [0–2] vs. 0 [0–1]) at baseline than participants without, whereas the likelihood of female sex, rural residence, and material deprivation were similar between groups with and without HL. Over median follow-up of 11.0 years, total age–sex adjusted annual health costs and each of its component costs were significantly higher in participants with HL compared to those without (annual total costs: $6,871, 95% confidence interval [CI] [$6,778, $6,962] vs. $4,716, 95% CI [$4,729, $4,763]). After full adjustment (a maximum of 29 comorbidities), annual costs remained significantly higher in participants with HL overall and for certain subcomponents (provider claims, ambulatory visits, and medications), whereas adjusted costs of hospitalization and LTC were lower among people with HL. The magnitude of the incremental costs among participants with HL was most pronounced for younger participants, men, or those with less comorbidity. Total projected annual direct health costs for Alberta residents with HL were $1.01 billion in 2023, of which $125 million (95% CI [$116, $135 million]) was attributable to HL specifically. Conclusions: Compared to those without HL, health costs were markedly higher among participants with HL, partially due to a higher burden of comorbidity. The relatively high population attributable costs of HL suggest that better prevention, recognition, and management of this condition could yield substantial economic benefits. Supplemental Material: https://doi.org/10.23641/asha.27353439

Repurposing Semaglutide and Liraglutide for Alcohol Use Disorder.

Preliminary studies suggest that glucagon-like peptide-1 receptor (GLP-1) agonists, used to treat type 2 diabetes and obesity, may decrease alcohol consumption. To test whether the risk of hospitalization due to alcohol use disorder (AUD) is decreased during the use of GLP-1 agonists compared with periods of nonuse for the same individual. This cohort study was an observational study conducted nationwide in Sweden using data from January 2006 to December 2023. The population-based cohort was identified from registers of inpatient care, specialized outpatient care, sickness absence, and disability pension. Participants were all residents aged 16 to 64 years who had a diagnosis of AUD. The primary exposure was use of individual GLP-1 agonists (compared with nonuse of GLP-1 agonists), and the secondary exposure was medications with indication for AUD. The primary outcome was AUD hospitalization analyzed in a Cox regression within-individual model. Secondary outcomes were any substance use disorder (SUD)-related hospitalization, somatic hospitalization, and suicide attempt. The cohort included 227 866 individuals with AUD; 144 714 (63.5%) were male and 83 154 (36.5%) were female, with a mean (SD) age of 40.0 (15.7) years. Median (IQR) follow-up time was 8.8 (4.0-13.3) years. A total of 133 210 individuals (58.5%) experienced AUD hospitalization. Semaglutide (4321 users) was associated with the lowest risk (AUD: adjusted hazard ratio [aHR], 0.64; 95% CI, 0.50-0.83; any SUD: aHR, 0.68; 95% CI, 0.54-0.85) and use of liraglutide (2509 users) with the second lowest risk (AUD: aHR, 0.72; 95% CI, 0.57-0.92; any SUD: aHR, 0.78; 95% CI, 0.64-0.97) of both AUD and SUD hospitalization. Use of any AUD medication was associated with a modestly decreased risk (aHR, 0.98; 95% CI, 0.96-1.00). Semaglutide (aHR, 0.78; 95% CI, 0.68-0.90) and liraglutide (aHR, 0.79; 95% CI, 0.69-0.91) use were also associated with decreased risk of somatic hospitalizations but not associated with suicide attempts (semaglutide: aHR, 0.55; 95% CI, 0.23-1.30; liraglutide: aHR, 1.08; 95% CI, 0.55-2.15). Among patients with AUD and comorbid obesity/type 2 diabetes, the use of semaglutide and liraglutide were associated with a substantially decreased risk of hospitalization due to AUD. This risk was lower than that of officially approved AUD medications. Semaglutide and liraglutide may be effective in the treatment of AUD, and clinical trials are urgently needed to confirm these findings.

Correlation Between Vitamin D Levels and Charlson Comorbidity Index with Sarcopenia in Geriatric Patients

Introduction: Elderly individuals are particularly susceptible to malnutrition due to the physiological changes associated with aging, one of which is often vitamin D deficiency. Several studies have indicated a potential association between vitamin D concentrations and sarcopenia; however, the results remain inconsistent. Furthermore, there is limited knowledge regarding the impact of comorbid diseases on this relationship. Methods: This was an analytical observational study with a cross-sectional design, aimed at determining the relationship between vitamin D levels and the Charlson Comorbidity Index with sarcopenia in geriatric patients. The research subjects were geriatric patients receiving outpatient care at the geriatric clinic of Ulin Hospital Banjarmasin, who met the inclusion criteria and were selected using a consecutive sampling technique. Measurements of sarcopenia components, Charlson Comorbidity Index scores, and vitamin D levels were performed. The degree of sarcopenia was then calculated, tabulated, and analyzed using correlation tests. Results: A total of 77 subjects participated in the study. There was no significant association between vitamin D levels and the incidence of sarcopenia. Similarly, no significant relationship was found between the Charlson Comorbidity Index and sarcopenia. Conclusion: Vitamin D levels are not associated with the incidence of sarcopenia in geriatric patients. Similarly, the Charlson Comorbidity Index score is not associated with the incidence of sarcopenia in this population.