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Mobile Application Follow-up Care Reduces Visits
Mobile applications can support discharge transitions and recovery after surgery. Armstrong et al conducted a randomized clinical trial to determine whether mobile application follow-up care can be used to avert in-person follow-up care visits in 65 patients compared with in-person care during first the 30 days after undergoing ambulatory surgery. Mobile applications avert in-person follow-up visits with no effect on complication rates or patient-reported satisfaction and improved convenience scores.
Variation in Outcomes at Bariatric Centers of Excellence
More than 88% of bariatric procedures are performed at accredited centers. In this analysis of 145 527 patients who underwent bariatric procedures at accredited centers, Ibrahim and colleagues observed a 17-fold variation in rates of patients experiencing serious complications nationally, ranging from 0.6% to 10.3%. These findings indicate that accreditation alone does not ensure uniform high-quality care for bariatric procedures.
Author Audio Interview and CME
Decision Support Systems and Venous Thromboembolism
This study was performed to determine whether clinical decision support systems decrease the risk of venous thromboembolisms among surgical patients. Borab et al performed a systematic review and meta-analysis that included 11 articles and more than 150 000 patients. They found that venous thromboembolism prophylaxis rates improved and actual venous thromboembolism events decreased with clinical decision support system use.
Unsupervised Residents Performing Appendectomies
The level of operating room autonomy given to surgical residents varies greatly between different institutions and countries. In this retrospective study, Siam et al compared the outcomes of 1101 appendectomy cases performed in the presence of a senior general surgeon with 548 cases performed by unsupervised residents. No difference in postoperative complication rates was demonstrated between the 2 groups.
Clinical Review & Education
Curbing Opioid Use in Surgery
With the increased use of enhanced recovery pathways, the concept of multimodal, opioid-sparing analgesia has experienced a broad uptake. Enhanced recovery pathways use a standardized multimodal analgesic regimen with nonopioid agents or techniques to minimize the use of perioperative opioids and to decrease opioid-related adverse effects with the goal of improving and expediting the recovery of patients after surgery. In this review, the authors outline elements of a multimodal analgesic plan for surgical patients.
Highlights. JAMA Surg. 2017;152(7):613. doi:10.1001/jamasurg.2016.3437
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