Dataset Information

Remote patient monitoring to facilitate same-day discharge after laparoscopic sleeve gastrectomy: a pilot evaluation.

ABSTRACT:

Background

Limited hospital inpatient capacity, exacerbated by SARS-CoV-2 (COVID-19) and associated staffing shortages, has driven interest in converting surgeries historically done as inpatient procedures to same-day surgeries (SDS). Remote patient monitoring (RPM) has the potential to increase safety and confidence in SDS but has had mixed success in a bariatric population.

Objectives

Assess the feasibility of and adherence to a protocol offering patients same-day laparoscopic sleeve gastrectomy (SG) supported by RPM with an updated wearable device. Secondary outcomes were readmissions, costs, adherence, and clinical alarm rates.

Setting

Academic, military tertiary referral center (United States).

Methods

A single-center, retrospective case control study of patients undergoing SG, comparing SDS with RPM to patients admitted to the hospital for SG during this time. Patients for SDS were selected by set inclusion/exclusion criteria and patient/surgeon preference, and perioperative management was standardized.

Results

Twenty patients were enrolled in the SDS group, then compared with 53 inpatients. Inpatients were older (46 versus 39, P = .006), but with no significant differences in sex, preoperative body mass index, or co-morbidities. RPM wearable and blood pressure adherence was found to be 97% and 80%, respectively. Readmission rates were similar (10% versus 7.5%, P > .05). RPM alarm rates were .5 (0-1.3) per patient for each 24-hour home monitoring period. SDS patients also demonstrated the potential for cost savings over inpatient SG, depending on the number of patients monitored per day as well as the healthcare setting.

Conclusions

SG as SDS with RPM was a feasible approach. It should be evaluated in other surgical procedures and higher-risk patient populations.

SUBMITTER: Schaffner TJ

PROVIDER: S-EPMC10015823 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

Remote patient monitoring to facilitate same-day discharge after laparoscopic sleeve gastrectomy: a pilot evaluation.

Schaffner Timothy J TJ Wilkes Matt M Laverty Robert R Schwab Stephen D SD Zahradka Nicole N Pugmire Juliana J Yourk Dan D Masella Pamela C PC Walter Robert R

Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery 20230315 9

<h4>Background</h4>Limited hospital inpatient capacity, exacerbated by SARS-CoV-2 (COVID-19) and associated staffing shortages, has driven interest in converting surgeries historically done as inpatient procedures to same-day surgeries (SDS). Remote patient monitoring (RPM) has the potential to increase safety and confidence in SDS but has had mixed success in a bariatric population.<h4>Objectives</h4>Assess the feasibility of and adherence to a protocol offering patients same-day laparoscopic s ...[more]

PMID: 37105773

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Project description:BackgroundLaparoscopic sleeve gastrectomy (LSG) modifies the upper gastrointestinal tract motility. Controversial data currently exist. The aim of the study was to evaluate esophageal motility before and after LSG.Patients and methodsMorbid obese patients scheduled for LSG underwent reflux symptoms evaluation and manometry preoperatively and postoperatively. The preoperative and postoperative results were compared and analyzed.ResultsEighteen patients were enrolled. Heartburn and regurgitation improved in 38.9% and 11.1% of the patients, but deteriorated in 11.1% and 27.8% of the patients, respectively. Lower esophageal sphincter (LES) total length decreased postoperatively (p=0.002). Resting and residual pressures tended to decrease postoperatively (mean difference [95% confidence interval]: -4 [-8.3/0.2] mmHg, p=0.060; -1.4 [-3/0.1] mmHg, p=0.071, respectively). Amplitude pressure decreased from 95.7±37.3 to 69.8±26.3 mmHg at the upper border of LES (p=0.014), and tended to decrease at the distal esophagus from 128.5±30.1 to 112.1±35.4 mmHg (p=0.06) and mid-esophagus from 72.7±34.5 to 49.4±16.7 mmHg (p=0.006). Peristaltic normal swallow percentage increased from 47.2±36.8 to 82.8±28% (p=0.003). Postoperative regurgitation was strongly negatively correlated with LES total length (Spearman's r=-0.670). When groups were compared according to heartburn status, statistical significance was observed between the groups of improvement and deterioration regarding postoperative residual pressure and postoperative relaxation (p<0.002, p<0.002, respectively). With regard to regurgitation status, there was statistically significant difference between groups regarding preoperative amplitude pressure at the upper border of LES (p<0.056).ConclusionPatients developed decreased LES length and weakened LES pressure after LSG. Esophageal body peristalsis was also affected in terms of decreased amplitude pressure, especially at the upper border of LES. Nevertheless, body peristalsis was normalized postoperatively. LSG might not deteriorate heartburn. Regurgitation might increase following LSG due to shortening of LES length, particularly in patients with range of preoperative amplitude pressure at the upper border of LES of 38.9-92.6 mmHg.

Project description:BackgroundBariatric weight-loss surgery rates are increasing internationally. Endoscopic sleeve gastroplasty (ESG) is a novel, minimally invasive endoscopic procedure thought to mimic some of the effects of a more common surgery, laparoscopic sleeve gastrectomy (LSG). Patient factors affecting procedural choice are unexplored.ObjectiveThis formative study aimed to determine the preoperative and early postoperative characteristics of adults matched for age, sex, and BMI who chose ESG versus LSG.MethodsThis prospective cohort study recruited ESG and matched LSG adults in Australia. Preoperative outcomes were medical history, glycemic biomarkers, blood lipids, liver function enzymes, albumin, blood pressure, hepatic steatosis index, the Gastrointestinal Symptom Rating Scale, the Impact of Weight on Quality of Life-Lite questionnaire, and body composition via dual-energy x-ray absorptiometry. Adverse events were recorded preoperatively and up to 2 weeks postoperatively. SPSS was used to test if there were differences between cohorts by comparing means or mean ranks, and binary regression was used to understand how characteristics might predict procedure choice.ResultsA total of 50 (including 25 ESG and 25 LSG) patients were recruited, who were primarily White (45/50, 90%) and female (41/50, 82%) with a mean age of 41.7 (SD 9.4) years. Participants had a mean of 4.0 (SD 2.2) active comorbid conditions, with the most common being nonalcoholic fatty liver disease (38/50, 76%), back pain (32/50, 64%), anxiety or depression (24/50, 48%), and joint pain (23/50, 46%). The LSG cohort had higher hemoglobin A1c (5.3%, SD 0.2%) than the ESG cohort (5%, SD 0.2%; P=.008). There was a 2.4 kg/m2 difference in median BMI (P=.03) between the groups, but fat and fat-free mass had no meaningful differences. Comparing the LSG and ESG groups showed that the LSG group had lower total quality of life (49.5%, SD 10.6% vs 56.6%, SD 12.7%; P=.045), lower weight-related self-esteem (10.7%, IQR 3.6%-25% vs 25%, IQR 17.9%-39.3%; P=.02), and worse abdominal pain (38.9%, IQR 33.3%-50% vs 53.9%, SD 14.2%, P=.01). For every percent improvement in weight-related self-esteem, the odds for selecting ESG increased by 4.4% (95% CI 1.004-1.085; P=.03). For every percent worsening in hunger pain, the odds for selecting ESG decreased by 3.3% (95% CI 0.944-0.990; P=.004).ConclusionsThere was very little evidence that Australian adults who chose an endoscopic versus surgical sleeve had different rates of comorbidities, body fat percentage, or weight-related quality of life. There was evidence against the test hypothesis, that is, there was evidence suggesting that lower self-esteem predicted choosing a more invasive sleeve (ie, LSG rather than ESG).Trial registrationAustralia New Zealand Clinical Trials Registry ACTRN12618000337279; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374595.

Dataset Information

Remote patient monitoring to facilitate same-day discharge after laparoscopic sleeve gastrectomy: a pilot evaluation.

Background

Objectives

Setting

Methods

Results

Conclusions

Publications

Remote patient monitoring to facilitate same-day discharge after laparoscopic sleeve gastrectomy: a pilot evaluation.

Similar Datasets

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