Unplanned Visits Research Articles

Unplanned 30-Day ER Visit Rate and Factors Associated With ER Visits After Ambulatory Sinus Surgery.

Emergency room (ER) visits after surgery can be inconvenient and costly to the patient and the healthcare system. Estimates of the 30-day ER visit rate following ambulatory sinus procedures and their risk factors are largely unknown in the literature. To determine the 30-day postoperative ER visit rate following ambulatory sinus procedures and the causes and risk factors associated with ER visits. This is a retrospective, cohort study using data from the State Ambulatory Surgery and Services Databases (SASD) and the State Emergency Department Databases (SEDD) for California, New York, and Florida in 2019. We identified adult (18 years old) patients with chronic rhinosinusitis who underwent ambulatory sinus procedures from the SASD. Cases were linked to the SEDD to identify ER visits occurring within 30 days after the procedure. Logistic regression models were used to identify patient- and procedure-related risk factors associated with the 30-day postoperative ER visit. Among the 23 239 patients, the 30-day postoperative ER visit rate was 3.9%. The most common reason for ER visit was bleeding (32.7%). A total of 56.9% of the ER visits occurred within the first week. In the multivariate analysis, factors associated with ER visits included Medicare (odds ratio [OR] 1.29 [1.09-1.52], P = .003), Medicaid (OR 2.06 [1.69-2.51], P < .001), self-pay/no insurance (OR 1.44 [1.03-2.00], P = .031), chronic kidney disease/end-stage renal disease (OR 1.63 [1.06-2.51], P = .027), chronic pain/opioid use (OR 2.70 [1.02-7.11], P = .045), and a disposition other than home (OR 12.61 [8.34-19.06], P < .001). The most common reason for ER visit after ambulatory sinus procedures was bleeding. An increased ER visit rate was associated with certain demographic factors and medical comorbidities but not with procedure characteristics. This information can help us identify the patient populations who are at higher risk for ER visits to improve their postoperative recovery.

75P Electronic patient-reported outcomes and machine learning in predicting unplanned visits and hospitalisation rates in cancer patients undergoing systemic therapy

Electronic patient-reported outcomes (ePRO) have shown the potential to improve clinical practice for cancer patients. The collection of ePRO via smartphone apps is becoming more wide-spread. Such data, comprising of symptom and diary entries, could conceivably be utilised to predict the occurrence of unplanned hospitalisation events via machine learning algorithms. 226 cancer patients (mainly breast cancer) using the consilium care ePRO app under systemic therapy. A diary entry is associated with an “unplanned visit” flag if such a visit or a hospitalization of the patient occurred on or within 3 days. We assume that on these days, an alarm raised to the patient or her/his physician would have been helpful. Out of 16,670 entries, only 166 (1%) were flagged. To implement an early warning system, we trained a rule-based ML algorithm to predict critical situations, which we made more sensitive to the few flagged entries by applying cost-sensitive classification, assigning a 10-fold higher cost to missing a critical situation as compared to a false alarm. Rules are using are based on the strengths of symptoms captured by the patients, their perceived wellbeing, drugs they were taking, as well as keywords derived from free-text notes of patients and from their diagnosis; e.g. one of our rules suggests that an unplanned visit is likely to occur if a patient reports pain on a level of 38 or more and a wellbeing of 60 or less (both out of 100) and uses the word “today” in his/her notes of the given day. We intentionally used algorithms that are potentially inferior in prediction quality to modern deep learning approaches, but have the advantage of being not only human-interpretable, but even directly “human-modifiable” so that we can incorporate medical expertise into the machine-learned model at a later stage. We discovered a set of 55 rules which, as a whole, were able to correctly predict 47 of the 166 critical situations (28.3% recall), while raising 267 false alarms (15.2% precision). Preliminary analysis of this study suggests that ML based prediction models trained on ePRO data can predict unplanned hospitalisation events within cancer patients.

PO-1427 Risk factors for unplanned acute care visits in gynecologic oncology patients receiving radiotherapy

PO-1427 Risk factors for unplanned acute care visits in gynecologic oncology patients receiving radiotherapy

A cross-sectional analysis of paediatric urologists’ current practices, opinions and areas of perceived importance in the delivery of adolescent & transitional care

Complex urological anomalies often require continued care as patients reach adulthood. Adequate transition for adolescents with ongoing urological care needs is critical to allow for seamless care in adult hospitals. Studies have shown that this can lead to improved patient and parental satisfaction, and lower utilisation of unplanned inpatient beds and emergency department visits. There is currently no ESPU-EAU consensus on the adequate mechanism and very few individual papers examining the role of urological transition for these patients in a European setting. This study aimed to identify current practice patterns in paediatric urologists providing adolescent/transitional care, to assess their opinions towards formal transition and to look for variations in care. This has implications for long-term patient health and specialist care. An 18-item cross-sectional survey was compiled and pre-approved through the EAU-EWPU and ESPU board offices prior to dissemination to all registered ordinary members affiliated with the ESPU. This was created using a mini-Delphi method through the EWPU research meetings to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. A total of 172 respondents (55% paediatric general surgery; 45% urology) across 28 countries completed the survey. The majority of respondents were in practice >10 years and spent >80% time in paediatric urology. There was no formal transition process according to 50% respondents and over half of those that did have less than 1/month, with <10% using validated questionnaires. More than two-thirds respondents continued to provide care after transition, as >70% units had no designated corresponding adult service. Furthermore, 93% paediatric believe a formal transition service to be very important, using a multidisciplinary framework. A pareto chart demonstrated 10 specific conditions to be of most interest in transition to adulthood. This is the first study to assess the requirements of paediatric urologists for adequate transitional care, however due to the nature of the survey's distribution, this was a non-scientific poll based on a convenience sample of respondents. It is critical that dual-trained or adult-trained urologists with a specific interest in paediatric urology work with current paediatric urologists in a multidisciplinary fashion to facilitate early transition based on the adolescent's developmental and biopsychosocial requirements. National urological and paediatric surgical societies need to make transitional urology a priority. The ESPU and EAU should collaboratively consider developing transitional urology guidelines to allow a framework by which this can occur.

Elements affecting emergency department rate of return within 72 hours: a retrospective cross-sectional study

Background: Many patients view emergency departments (EDs) as their top choice for medical problems because they act as an easily accessible entry point into the healthcare system. The frequency of ED visits, the causes, and the burden must be considered to evaluate the quality and outcome of care. The researcher aimed to investigate the elements that affect the rate of return to the emergency department within 72 hours. In addition, to determine the underlying factors associated with unplanned ED return visits. Methods: It was a retrospective cross-sectional study. Results: The result of this study shows that 1535 unplanned ED return visits out of 53387. The rate was 2.9%. A total of 339 (22%) patients of unplanned ED returned visits were admitted to the hospital which is representing 8% of the total hospital admission from ED. Conclusions: The study found that certain types of presenting complaints, such as fever, cough, and throat pain related to respiratory tract infection, were associated with a higher rate of unplanned return at a rate of 33% (513). The results of this study suggest that interventions aimed at improving access to follow-up care, and patient education with effective communication. In addition, continuously monitoring the rate of unplanned ED return and linking that rate to the ED physician's individual performance review might effectively reduce the rate and improve the quality and outcome of care.

Implications of using home urine pregnancy tests versus facility-based tests for assessment of outcome following medication abortion provided via telemedicine

ObjectivesTo assess whether planning high-sensitivity urine pregnancy tests (HSPT) rather than facility-based tests for medication abortion follow-up may increase risk of unplanned clinical visits or procedural completion of the abortion. Study designWe used data from the TelAbortion Project, a 5-year study assessing the safety and feasibility of providing mifepristone and misoprostol by telemedicine and mail in the United States. We categorized participants by whether the pretreatment follow-up plan included HSPT at home 3–5 weeks after treatment or facility-based tests (ultrasound or serum human chorionic gonadotropin) within 2 weeks after treatment. We used multivariable logistic regression to compare likelihood of post-treatment unplanned, abortion-related clinical visits and procedural intervention in these groups. ResultsOf 1324 patients who planned HSPT follow-up and 576 who planned facility-based tests, 85% and 83%, respectively, provided outcome information. Post-treatment clinical visits were less frequent in the HSPT group (19%) than in the facility-based test group (79%); most of the latter were to obtain the planned test. However, unplanned, abortion-related visits were significantly more common in the HSPT group (adjusted risk difference: 6.5%; p < 0.01). The likelihood of procedural completion did not differ by group. Planned follow-up test was not associated with delay in procedural completion or detection of ongoing pregnancy. ConclusionsFollow-up of medication abortion with home HSPT was associated with fewer post-treatment clinical visits, modestly more unplanned, abortion-related clinical visits, and no increase in the risk of procedural interventions or delayed identification or management of treatment failures. This option is an appropriate follow-up approach after medication abortion. ImplicationsUse of home high-sensitivity pregnancy tests rather than facility-based tests for outcome assessment after medication abortion is associated with a modest increase in unplanned clinical visits but does not lead to an increase in procedural interventions or delays identification and management of treatment failure.

A nationwide study of initiation of antidepressant pharmacotherapy and the risk of seizures

ObjectiveThe present study aimed to examine whether antidepressant initiation increases the risk of hospitalizations and unplanned outpatient visits for seizures. Research has provided conflicting evidence as to whether antidepressant initiation causes seizures. Because epilepsy and depression are comorbid, this remains an important question, particularly in the care of those already at-risk for seizures. MethodsWe used Swedish-register data, including 658,766 antidepressant initiators and 1:1 age-, region-, and sex-matched non-initiators, ages 12–65. We used filled prescriptions to identify any antidepressant and serotonergic antidepressant and inpatient hospitalizations and unplanned outpatient (to avoid coding routine epilepsy maintenance as a seizure) visits to identify seizures, respectively. We first compared seizure visit incidence between antidepressant-initiators and matched non-users in the year following initiation from 2006 to 2013. To examine seizure risk over months pre- and post-initiation, within-individual analyses compared risk during the month one year prior to initiation with all subsequent months. We examined associations for any antidepressant and serotonergic antidepressants, as well as for any initiator and initiators with a history of seizures. ResultsOur matched-cohort results showed higher incidence of seizure visits among antidepressant users compared with non-users (e.g., adjusted incidence rate ratio [IRR]=3.14, 95% confidence interval [CI]=2.83–3.49). In within-individual analyses, the months after initiation were associated with higher incidence of seizure visits when compared with the month one year prior to initiation (e.g., one month after initiation IRR=1.96, 95%CI=1.64–2.34), but in individuals with a seizure history we observed weaker or no associations in the months after initiation (e.g., two months after initiation IRR=1.12, 95%CI=0.87–1.45). Notably, irrespective of potential seizure history, the months preceding initiation were associated with the greatest risk (e.g., one month before initiation IRR=2.86, 95% CI=2.42–3.38). ConclusionsOur findings suggest that there may be an elevated risk of seizures during antidepressant treatment, though the period of highest risk was before the initiation of antidepressants. Risk for seizure visits was lower among individuals with a history of prior seizures, which may be reassuring for the clinical care of these patients or indicate lack of treatment seeking following seizures. This study highlights the need to consider seizure risk across time; the failure to account for these dynamics may help account for discrepant findings in previous studies.

Early unplanned return visits to pediatric emergency departments in Israel during the SARS-CoV-2 pandemic

IntroductionDuring the SARS-CoV-2 pandemic there was a considerable drop in the number of visits to Pediatric Emergency Departments (PED). Unplanned return visits (URV) might represent inadequate emergency care. We assessed the impact of the pandemic on early URV to PEDs in Israel. MethodsThis multicenter cross-sectional study analyzed the 72-h URV to PEDs among patients under the age of 18 years during a one-year pandemic period (March 1st, 2020, to February 28th, 2021), and compared them with the 72-h URV of the corresponding pre-pandemic period (March 1st, 2019, to February 28th, 2020). Data was extracted from Clalit Health Services (CHS), the largest public health care organization in Israel. ResultsThe pandemic and pre-pandemic early URV rates were 5465 (5.1%) and 8775 (5.6%), respectively (OR = 0.90, 95% CI 0.92–0.99). The rate of return-visit admissions to hospital wards during these periods were 29.5% and 32.1%, respectively (OR = 0.83, 95% CI 0.86–0.98). The rate of return-visit admissions to ICUs during these periods were 0.64% and 0.52%, respectively (OR = 1.11, 95% CI 0.67–1.62). On return-visit, 3 (0.055%) and 5 (0.057%) URV patients were declared dead on arrival during the pandemic and pre-pandemic periods, respectively (OR = 0.96, 95% CI 0.23–4.03). The distributions of the time interval from index visit to return visit remained consistent between the periods. DiscussionIn our study, early URV to PED's were only mildly influenced by the SARS-CoV-2 pandemic.

Unplanned 120-Day ED Visits and Readmission Rates Following Common Stone Procedures

ObjectiveTo quantify emergency department (ED) visits and hospital admissions (HA) after common urologic stone procedures including ureteroscopy (URS), shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCL) which are a concern of payors, providers, and patients. Materials and MethodsThis is a retrospective cohort study using claims data from the IBM MarketScan Commercial and Medicare Supplement databases. Adults with a urologic stone diagnosis and no history of stone procedure in prior 12 months who underwent stone procedures between 2012 and 2017 were included. All-cause ED visits and HA were evaluated during 30, 60, 90, and 120-day periods following the index urologic stone procedure. ResultsA total of 166,287 patients were included in the analytic cohort. For inpatient-indexed procedures, cumulative ED visits rates following stone procedure at 120 days was 18.8% for URS, 19.2% for SWL, and 23.6% for PCL. A similar trend was observed with ED visit rates, following outpatient indexed procedures at 120 days with a cumulative rate of 14.2% of SWL patients, 14.9% of URS patients, and 17.3% of PCL. A similar trend was found when examining HA. ED and HA rates increased steadily through the 120-day time period. ConclusionRates of ED visits and HA following common stone procedures continue to rise at least up to 120 days following the index procedure whether in the outpatient or inpatient settings. While rates of unplanned care are similar for URS and SWL, patients undergoing PCL return to the hospital at higher rates.

Patients' experiences and reasons for unplanned return visits to the emergency department: A qualitative study.

The aim of this study was to explore the reasons for and experiences of patients who make an unplanned return visit to the emergency department. This study forms the qualitative phase of a larger explanatory sequential mixed methods study and is informed by interpretive description. The paper was prepared using the consolidated criteria for reporting qualitative research. Semi-structured patient interviews were conducted over a 3-month period (July-September 2021). Data were analysed using reflexive thematic analysis. Interviews from 13 participants generated findings related to experiences at and following their initial visit that contributed to their decision to return to the emergency department. Four themes were developed: (1) Patients experience barriers to feeling heard and having their concerns addressed; (2) Patients have little choice but to place their trust in clinicians; (3) Patients unexpectedly experience persistent symptoms which cannot be managed at home; and (4) Patients develop a sense of urgency about having their condition treated. A negative experience at the initial ED visit may have dual conflicting impacts. It can contribute to patients' perceived need for a return visit because they are ill-equipped to manage their condition at home, and it can also contribute to their initial reluctance to return to the ED when symptoms persist. Nurses and other clinicians working in ED need to actively build patient's experiential trust through clear communication, timely consultation and shared decision-making at discharge, which in turn can increase patient's confidence and capability to self-manage their condition. This study adds to the current body of literature about return visits by highlighting that a more positive experience of ED may assist patients to make better-informed decisions about when and how to seek treatment and minimize unnecessary and unplanned return visits. Whilst not an intended topic for exploration in this study, the COVID-19 pandemic influenced patients' experiences at both initial and return ED visits and limited their ability to access primary healthcare options. These experiences contributed to patients' decisions to make a return visit.

Intravenous ferric carboxymaltose versus oral ferrous sulfate replacement in elderly patients after acute non-variceal gastrointestinal bleeding (FIERCE): protocol of a multicentre, open-label, randomised controlled trial

IntroductionAcute gastrointestinal bleeding (GIB) is a life-threatening emergency with a critical economic burden. As a result of bleeding, anaemia often requires intravenous or oral iron supplementation. Elderly patients are even...

Use of Remote Cardiorespiratory Monitoring is Associated with a Reduction in Hospitalizations for Subjects with COPD.

Chronic obstructive pulmonary disease (COPD) is prevalent and results in high healthcare resource utilization. The largest impact on health status and proportion of healthcare costs in COPD are related to hospitalizations for acute exacerbations. Accordingly, the Centers for Medicare & Medicaid Services have advocated for remote patient monitoring (RPM) to aid in chronic disease management. However, there has been a lack of evidence for the effectiveness of RPM in reducing the need for unplanned hospitalizations for patients with COPD. This pre/post study was a retrospective analysis of unplanned hospitalizations in a cohort of COPD subjects started on RPM at a large, outpatient pulmonary practice. The study included all subjects with at least one unplanned, all-cause hospitalization or emergency room visit in the prior year, who had elected to enroll in an RPM service for assistance with clinical management. Additional inclusion criteria included being on RPM for at least 12 months and a patient of the practice for at least two years (12 months pre- and post-initiation of RPM). The study included 126 subjects. RPM was associated with a significantly lower rate of unplanned hospitalizations per patient per year (1.09 ± 0.07 versus 0.38 ± 0.06, P<0.001). Unplanned, all-cause hospitalization rates were lower in subjects started on RPM for COPD when compared to their prior year. These results support the potential of RPM to improve the long-term management of COPD.

Implementation Science in Surgery: Translating Outcomes to Action.

Implementation Science in Surgery: Translating Outcomes to Action.

Patient-Reported Symptom Complexity and Acute Care Utilization Among Patients With Cancer: A Population-Based Study Using a Novel Symptom Complexity Algorithm and Observational Data

Patients with cancer in Canada are often effectively managed in ambulatory settings; however, patients with unmanaged or complex symptoms may turn to the emergency department (ED) for additional support. These unplanned visits can be costly to the healthcare system and distressing for patients. This study used a novel patient-reported outcomes (PROs)-derived symptom complexity algorithm to understand characteristics of patients who use acute care, which may help clinicians identify patients who would benefit from additional support. This retrospective observational cohort study used population-based linked administrative healthcare data. All patients with cancer in Alberta, Canada, who completed at least one PRO symptom-reporting questionnaire between October 1, 2019, and April 1, 2020, were included. The algorithm used ratings of 9 symptoms to assign a complexity score of low, medium, or high. Multivariable binary logistic regressions were used to evaluate factors associated with a higher likelihood of having an ED visit or hospital admission (HA) within 7 days of completing a PRO questionnaire. Of the 29,133 patients in the cohort, 738 had an ED visit and 452 had an HA within 7 days of completing the PRO questionnaire. Patients with high symptom complexity had significantly higher odds of having an ED visit (OR, 3.10; 95% CI, 2.59-3.70) or HA (OR, 4.20; 95% CI, 3.36-5.26) compared with low complexity patients, controlling for demographic covariates. Given that patients with higher symptom complexity scores were more likely to use acute care, clinicians should monitor these more complex patients closely, because they may benefit from additional support or symptom management in ambulatory settings. A symptom complexity algorithm can help clinicians easily identify patients who may require additional support. Using an algorithm to guide care can enhance patient experiences, while reducing use of acute care services and the accompanying cost and burden.

A retrospective study of characteristics and burden of heart failure in Thailand: an interim analysis

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Novartis (Thailand) Limited Background/Introduction Heart failure (HF) is a major health problem due to its significant prevalence, disease burden and cost, mainly driven by high rates of hospitalization and mortality. Although numerous studies have demonstrated HF burden in western countries, data on current burden of HF in Thailand are limited. Purpose To describe characteristics and burden of HF, in terms of HF subgroups, hospital visits/hospitalization from HF and mortality, in participating hospitals in Thailand in 2019. Methods We retrospectively reviewed hospital profiles and medical records of HF adult patients at the five study sites which located in different regions across Thailand. All patients were diagnosed (newly and existing) with HF during 2018-2019, as identified by the International Classification of Diseases (ICD)-10 coding "I50". The interim data cutoff was scheduled when 4,000 patients were included. Hospital burden and the patients’ clinical and outcome data were collected and analyzed with descriptive statistics. Results From 4,000 patients, a total of 2,826 patients had follow-up visits in 2019 and then included in this analysis. Most of them were female (51.8%) and the overall patients’ mean (SD) age was 67.6 (15.0). Among 1,668 patients with available baseline left ventricular ejection fraction (LVEF), HF with preserved EF (HFpEF) was the most common subgroup (47.3%), followed by HF with reduced EF (HFrEF (39.0%) and HF with mid-range EF (HFmrEF) (13.7%). Of the total hospital visits from HF, 11.5% (95% CI 10.8-12.3) were from unscheduled visits to emergency or outpatient departments. HFpEF accounted for the highest number of hospital visits for HF, both scheduled and unplanned visits (46.4%, 48.9%), followed by HFrEF (39.0%, 41.5%) and HFmrEF (14.6, 9.6%), respectively. Among these 2,826 HF patients, the numbers of hospitalizations and rehospitalization from HF were 2,553 and 447. The total rate of HF rehospitalization was highest at 30 days (39.1%, 95% CI 34.6-43.7), followed by at 180 days (26.8%, 95% CI 22.7, 30.9), and 60 days (23.5%, 95% CI 19.6-27.4), respectively. The rates of all-cause and CV deaths within identified HF patients were 8.6% (95% CI 7.6-9.7) and 7.2% (95% CI 6.3-8.2). HFrEF accounted for the highest proportions of both (re) hospitalization and deaths (all-cause and CV) while HFpEF had the highest number of total beds. Conclusion Among the studied patients, HFpEF was the most common form of HF and HF was associated with a substantial healthcare burden in Thailand. The hospitalization rates from HF were especially high during the first 30 days after discharge, with a number of visits being unplanned or emergency visits leading to high hospital resource utilization.

Intermittent inotropic support with levosimendan in advanced heart failure as destination therapy: The LEVO-D registry.

Patients with advanced heart failure (AHF) who are not candidates to advanced therapies have poor prognosis. Some trials have shown that intermittent levosimendan can reduce HF hospitalizations in AHF in the short term. In this real-life registry, we describe the patterns of use, safety and factors related to the response to intermittent levosimendan infusions in AHF patients not candidates to advanced therapies. Multicentre retrospective study of patients diagnosed with advanced heart failure, not HT or LVAD candidates. Patients needed to be on the optimal medical therapy according to their treating physician. Patients with de novo heart failure or who underwent any procedure that could improve prognosis were not included in the registry. Four hundred three patients were included; 77.9% needed at least one admission the year before levosimendan was first administered because of heart failure. Death rate at 1year was 26.8% and median survival was 24.7 [95% CI: 20.4-26.9] months, and 43.7% of patients fulfilled the criteria for being considered a responder lo levosimendan (no death, heart failure admission or unplanned HF visit at 1year after first levosimendan administration). Compared with the year before there was a significant reduction in HF admissions (38.7% vs. 77.9%; P<0.0001), unplanned HF visits (22.7% vs. 43.7%; P<0.0001) or the combined event including deaths (56.3% vs. 81.4%; P<0.0001) during the year after. We created a score that helps predicting the responder status at 1year after levosimendan, resulting in a score summatory of five variables: TEER (+2), treatment with beta-blockers (+1.5), Haemoglobin >12g/dL (+1.5), amiodarone use (-1.5) HF visit 1year before levosimendan (-1.5) and heart rate >70b.p.m. (-2). Patients with a score less than -1 had a very low probability of response (21.5% free of death or HF event at 1year) meanwhile those with a score over 1.5 had the better chance of response (68.4% free of death or HF event at 1year). LEVO-D score performed well in the ROC analysis. In this large real-life series of AHF patients treated with levosimendan as destination therapy, we show a significant decrease of heart failure events during the year after the first administration. The simple LEVO-D Score could be of help when deciding about futile therapy in this population.

Parental caregivers' perception of their transition from hospital to home in children with cerebral palsy who have undergone orthopedic surgery

PurposeEvaluate parental perception of the quality of discharge teaching, readiness for discharge, and the impact of these on post discharge coping difficulty and resource utilization in children with cerebral palsy (CP) following surgery. Design and methodsProspective cohort study conducted from September 2017–March 2021 at a pediatric academic medical center. Demographics were collected pre-operatively. Parents completed the Readiness for Hospital Discharge Scale (RHDS) and Quality of Discharge Teaching Scale (QDTS) within four hours of discharge. Four weeks post-discharge, parents completed the Post-discharge Coping Difficulty Scale (PDCDS). Utilization of healthcare resources were extracted from the electronic health record for 90 days post-operatively. Associations among demographics, RHDS, QDTS, PDCDS and resource utilization were assessed using general linear models; PDCDS's open-ended questions were analyzed using directed content analysis. Results114 parental caregivers participated. Post discharge coping was significantly associated with additional resource utilization: length of stay (p = 0.046), readmissions (p = 0.001), emergency department visits (p = 0.001), clinic calls (p = 0.001) and unplanned clinic visits (p = 0.006). PDCDS was negatively correlated with the QDTS Quality of Teaching Delivered subscale (r = −0.32; p = 0.004) and three of five RHDS subscales: 1) Child's Personal Status (r = −0.24; p = 0.02); 2) Knowledge (r = −0.30; p = 0.005); and 3) Coping Ability (r = −0.39; p < 0.001). Four themes explicated parental coping difficulties. ConclusionParents experiencing coping difficulties were more likely to have difficulty managing their child's care needs at home and required additional health care resources. Practice implicationsRecognizing that parents' readiness for discharge may not reflect their coping abilities post-discharge requiring nurses to coordinate pre- and post-discharge education and support services.

Outpatient parotidectomy with or without the use of a post-operative drain: A retrospective bi-institutional study.

Parotid surgery is historically performed as an inpatient procedure and suctions drains are predominantly used during surgery. Recent literature provides evidence that outpatient parotid surgery is safe and effective. Our study aims to describe the results of drainless outpatient parotidectomy and outpatient parotidectomy with drain placement and compare their outcomes. Retrospective cohort study. Bi-institutional retrospective cohort study. Patients that underwent outpatient drain-less parotidectomy and patients that underwent outpatient parotidectomy with post-operative drain placement. Complication rates, unplanned post-operative visits, unplanned prolonged stay. Three hundred eighty patients underwent outpatient parotidectomy with drain placement and 31 patients underwent outpatient drainless parotidectomy in two different hospitals. The incidence of haematoma (drain: 3.1% vs. drainless: 0%, p= 1), infection (drain: 14.3% vs. drainless: 13.8%, p= 1) and salivary fistula (drain: 5.6% vs. drainless: 3.4, p= 1) were comparable between both groups. Seroma or sialocele was more frequently seen in the drain-less group (27.6% vs. 6.2%, p< .001), but were all managed conservatively. Within 10 days after surgery, unplanned visits seemed more frequent in the drain group, although the difference was not statistically significant (14.9% vs. 3.4%, p= .16). Outpatient parotid surgery with or without the use of a post-operative drain is safe, practical and feasible. Same-day discharge with and without drain placement yield comparable outcomes. However, the results need to be interpreted cautiously as this study was limited by a small cohort of parotidectomies without drain placement. Future studies should further compare both approaches.

The value of routine radiographic follow up in the postoperative management of canine medial patellar luxation.

To determine the influence of radiographic examination on the recommendations made at the time of planned re-evaluation of dogs after medial patellar luxation (MPL) surgery. Retrospective multi-institutional case series. Client-owned dogs (N=825) that underwent MPL surgery. Records of 10 referral institutions were searched for dogs that had been treated surgically for unilateral MPL and underwent a planned follow-up visit, including radiographs. The frequency of, and reasons for, changes in further recovery recommendations were investigated. Follow up was performed at a median of 6 (range, 4-20) weeks postoperatively. Isolated radiographic abnormalities were identified in 3.3% (27/825) of dogs following MPL surgery and led to a change in recommendations in 3% (13/432) of dogs that were presented without owner or clinician concerns. Lameness, administration of analgesia at follow up, and history of unplanned visits prior to routine re-examination were associated with a change in postoperative plan (P < .001). In the absence of owner and clinician concerns, the odds of having a change in convalescence plans were not different, whether or not isolated radiographic abnormalities were present (P=.641). Routine radiographs at follow up did not influence postoperative management of most dogs after MPL surgery in the absence of abnormalities on clinical history or orthopedic examination. Dogs that were presented for routine follow up after unilateral MPL surgery without owner concerns, lameness, analgesic treatment or a history of unplanned visits, and for which examination by a surgical specialist was unremarkable, were unlikely to benefit from radiographs.

Tracking Complications and Unplanned Healthcare Utilization in Aesthetic Surgery: An Analysis of 214,504 Patients Using the TOPS Database.

Tracking surgical complications and unplanned healthcare utilization is essential to inform quality initiatives in aesthetic surgery. This study used the Tracking Operations and Outcomes for Plastic Surgeons database to characterize rates and predictors of surgical complications and unplanned healthcare utilization across common aesthetic surgery procedures. The Tracking Operations and Outcomes for Plastic Surgeons database was queried for all patients undergoing breast augmentation, liposuction, blepharoplasty, rhinoplasty, and abdominoplasty from 2008 to 2019. Incidence and risk factors for complications and unplanned readmission, reoperation, and emergency room visits were determined. A total of 214,504 patients were identified. Overall, 94,618 breast augmentations, 56,756 liposuction procedures, 29,797 blepharoplasties, 24,946 abdominoplasties, and 8387 rhinoplasties were included. A low incidence of perioperative complications was found, including seroma (1.1%), hematoma (0.7%), superficial wound complication (0.9%), deep surgical-site infection (0.2%), need for blood transfusion (0.05%), and deep venous thrombosis/pulmonary embolism (0.1%). Incidence of unplanned readmission, emergency room visits, and reoperation were 0.34%, 0.25%, and 0.80%, respectively. Patients who underwent an abdominoplasty more commonly presented to the emergency room and had unplanned readmissions or reoperations compared with other studied procedures. Furthermore, increased age, diabetes, higher body mass index, American Society of Anesthesiologists class, longer operative times, and pursuit of combined aesthetic procedures were associated with increased risk for unplanned health care use. There is a low incidence of perioperative complications and unplanned healthcare utilization following common aesthetic surgery procedures. Continued entry into large national databases in aesthetic surgery is essential for internal benchmarking and quality improvement. Risk, III.