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Journal of Shoulder and Elbow... 2021Recent reports have shown that outpatient shoulder arthroplasty (SA) may be a safe alternative to inpatient management in appropriately selected patients. The purpose... (Review)
Review
OBJECTIVE
Recent reports have shown that outpatient shoulder arthroplasty (SA) may be a safe alternative to inpatient management in appropriately selected patients. The purpose was to review the literature reporting on outpatient SA.
METHODS
A systematic review of publications on outpatient SA was performed. Included publications discussed patients who were discharged on the same calendar day or within 23 hours from surgery. Articles were categorized by discussions on complications, readmissions, and safety, patient selection, pain management strategies, cost effectiveness, and patient and surgeon satisfaction.
RESULTS
Twenty-six articles were included. Patients undergoing outpatient SA were younger and with a lower BMI than those undergoing inpatient SA. Larger database studies reported more medical complications for patients undergoing inpatient compared to outpatient SA. Articles on pain management strategies discussed both single shot and continuous interscalene blocks with similar outcomes. Both patients and surgeons reported high levels of satisfaction following outpatient SA, and cost analysis studies demonstrated significant cost savings for outpatient SA.
CONCLUSION
In appropriately selected patients, outpatient SA can be a safe, cost-saving alternative to inpatient care and may lead to high satisfaction of both patients and physicians, though further studies are needed to clarify appropriate utilization of outpatient SA.
PubMed: 34993380
DOI: 10.1177/24715492211028025 -
Head & Neck Feb 2021The primary aim of this study was to conduct a systematic review and meta-analysis to compare complications between outpatient vs inpatient parotidectomy. A systematic... (Meta-Analysis)
Meta-Analysis Review
The primary aim of this study was to conduct a systematic review and meta-analysis to compare complications between outpatient vs inpatient parotidectomy. A systematic review was performed to identify patients undergoing either outpatient or inpatient partodiectomy, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, using PUBMED, SCOPUS, CINAHL, and the Cochrane library. Risk of bias was assessed using the Newcastle-Ottawa Scale. Postoperative complications (hematoma, seroma/sialocele, salivary fistula formation, Frey syndrome, surgical site infection [SSI]) were compared. Our search yielded 4958 nonduplicate articles, of which 13 studies were ultimately included (11 retrospective cohort, 2 prospective cohort), encompassing a total of 1323 patients (outpatient 46.33% vs inpatient 53.67%). There was no significant difference in total complications, hematoma, seroma, salivary fistula, or SSI rates between outpatient and inpatient groups. No significant difference in total complications was found between outpatient and inpatient groups when stratified by surgical approach (partial/superficial and total parotidectomy). Our findings suggest outpatient parotidectomy may be as safe as inpatient parotidectomy in appropriately selected patients.
Topics: Humans; Inpatients; Outpatients; Parotid Gland; Postoperative Complications; Prospective Studies; Retrospective Studies
PubMed: 33009691
DOI: 10.1002/hed.26482 -
Diagnostics (Basel, Switzerland) Apr 2021The evidence indicates that the optimal observation period following renal biopsy ranges between 6 and 8 h. This systematic review and meta-analysis explored whether... (Review)
Review
The evidence indicates that the optimal observation period following renal biopsy ranges between 6 and 8 h. This systematic review and meta-analysis explored whether differences exist in the complication rates of renal biopsies performed in outpatient and inpatient settings. We searched the MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from 1985 to February 2020. Two reviewers independently selected studies evaluating the bleeding risk from renal biopsies performed in outpatient and inpatient settings and reviewed their full texts. The primary and secondary outcomes were risks of bleeding and major events (including mortality) following the procedure, respectively. Subgroup analysis was conducted according to the original study design (i.e., prospective or retrospective). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effect meta-analysis. Heterogeneity was assessed using the test. Data from all 10 eligible studies, which included a total of 1801 patients and 203 bleeding events, were included for analysis. Renal biopsies in outpatient settings were not associated with a higher bleeding risk than those in inpatient settings (OR = 0.81; 95% CI, 0.59-1.11; = 0%). The risk of major events was also comparable across both groups (OR = 0.45; 95% CI, 0.16-1.29; = 4%). Similar rates of bleeding and major events following renal biopsy in outpatient and inpatient settings were observed.
PubMed: 33916860
DOI: 10.3390/diagnostics11040651 -
Journal of Shoulder and Elbow Surgery Aug 2021Amid rising health care costs and recent advances in surgical and anesthetic protocols, the rate of outpatient joint arthroplasty has risen steadily in recent years.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Amid rising health care costs and recent advances in surgical and anesthetic protocols, the rate of outpatient joint arthroplasty has risen steadily in recent years. Although the safety of outpatient total knee arthroplasty and total hip arthroplasty has been well established, outpatient shoulder arthroplasty is still in its infancy. The purpose of this study was to synthesize the current literature and provide further data regarding the outcomes and safety of outpatient shoulder arthroplasty.
METHODS
A systematic review was conducted following the standard PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were studies that evaluated the outcomes of patients undergoing outpatient total shoulder arthroplasty (TSA) or reverse TSA. Meta-analysis was conducted using Mantel-Haenszel statistics to generate odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) comparing outpatient and inpatient shoulder arthroplasty.
RESULTS
Twelve studies were included, with a total of 194,513 patients, of whom 7162 were outpatients. Of the studies, 8 were level III and 4 were level IV. The average age of the outpatients was 66.6 years, and the average age of the inpatients was 70.1 years. The overall OR for complications was significantly lower in outpatients (OR, 0.40; 95% CI, 0.35-0.45) than in inpatients. There was no significant difference in rates of 90-day readmission (OR, 0.88; 95% CI, 0.75-1.03), revision (OR, 0.96; 95% CI, 0.65-1.41), and infection (OR, 0.93; 95% CI, 0.64-1.35) when comparing outpatients with inpatients.
CONCLUSION
Outpatient TSA, in an appropriately selected patient population, is safe and results in comparable patient outcomes to those of inpatient shoulder arthroplasty. Given the expected increase in the number of patients requiring TSA, surgeons, hospital administrators, and insurance carriers should strongly consider the merits of a cost- and care-efficient approach to total shoulder replacement.
Topics: Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Shoulder; Humans; Inpatients; Outpatients; Postoperative Complications; Retrospective Studies
PubMed: 33675972
DOI: 10.1016/j.jse.2021.02.007 -
SAGE Open Medicine 2022Healthcare coding and billing are an important aspect of practice management that directly impacts the financial stability of a health care practice. To financially... (Review)
Review
OBJECTIVES
Healthcare coding and billing are an important aspect of practice management that directly impacts the financial stability of a health care practice. To financially sustain or grow a medical practice, it is imperative that resident and faculty physicians have knowledge and skills for accurate billing in every patient encounter.
METHODS
A systematic review was conducted to identify recently published studies that report on improvements in medical coding and billing accuracy, clinical documentation, and reimbursement rate. A search of three databases yielded a total of 5754 records. After screening, 41 records were sought for retrieval and a total of 18 records were obtained for review.
RESULTS
Following a thorough review of literature, the most common reasons for inaccurate or inappropriate billing were a lack of formal education within residency curriculum, inadequate clinical documentation supporting level of billing, and lack of a feedback system aimed to correct billing errors.
CONCLUSION
A formal education curriculum implemented in training could enhance knowledge and application of accurate billing and coding and further benefit practice longevity. The purpose of this systematic review is to apply knowledge gained to the development and implementation of a quality improvement study intended to improve accuracy of coding and billing within an academic pediatric outpatient center.
PubMed: 35646364
DOI: 10.1177/20503121221099021 -
Journal of Minimally Invasive Gynecology Jan 2022The aim was to investigate whether outpatient hysterectomy (OH) has benefits when compared with inpatient hysterectomy (IH) regarding postoperative complications,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim was to investigate whether outpatient hysterectomy (OH) has benefits when compared with inpatient hysterectomy (IH) regarding postoperative complications, readmissions, operative outcomes, cost, and patient quality of life.
DATA SOURCES
A systematic search for studies comparing OH with IH was conducted through PubMed, SAGE, and Scopus from January 2010 to March 2020, without limitations regarding language and study design.
METHODS OF STUDY SELECTION
Studies reporting on the differences between same-day discharge and overnight stay after hysterectomy were included. The study outcomes were overall complication rate, type of complication, readmission after discharge, surgery duration, estimated blood loss, payer savings, hospital savings, and health-related quality of life (HrQoL). Median and range are used to describe non-normal data, while mean ± SD and confidence interval are used to descibe data with normal distribution. A meta-analysis with sensitivity analysis and subgroup analyses was performed.
TABULATION, INTEGRATION, AND RESULTS
Eight studies published between 2011 and 2019 with 104,466 patients who underwent hysterectomy were included in this systematic review and meta-analysis. All included studies except 1 were found to have a high risk of bias. OH in comparison with IH had a lower overall complication rate (odds ratio [OR] 0.70; 95% confidence interval [CI], 0.60-0.82) and lower rates of wound infection (OR 0.60; 95% CI, 0.43-0.84), urinary tract infection (OR 0.64; 95% CI, 0.52-0.78), need for transfusion (OR 0.36; 95% CI, 0.22-0.59), sepsis (OR 0.33; 95% CI, 0.17-0.64), uncontrolled pain (OR 0.79; 95% CI, 0.66-0.95), and bleeding requiring medical attention (OR 0.82; 95% CI, 0.73-0.94). In addition, patients who underwent OH had a lower readmission rate (OR 0.81; 95% CI, 0.75-0.87), surgery duration (standardized mean difference -0.35; 95% CI, -0.61 to -0.08), and estimated blood loss (standardized mean difference -0.63; 95% CI, -0.93 to -0.33) than those who underwent IH. A qualitative analysis found that OH had a poorer patient HrQoL and a lower cost for the hospital as well as the payer.
CONCLUSION
OHs present fewer complications and have a lower readmission rate and estimated blood loss as well as a shorter surgery duration than IHs. OHs also have a cost benefit in comparison with IHs. But patients seem to have a worse HrQoL in the first postoperative week after OH. The high risk of bias of the included studies indicates that well-designed clinical trials and standardization of surgical complication reporting are essential to better address this issue.
Topics: Female; Humans; Hysterectomy; Inpatients; Outpatients; Postoperative Complications; Quality of Life
PubMed: 34182138
DOI: 10.1016/j.jmig.2021.06.012 -
Interactive Journal of Medical Research Nov 2022Inpatient portals are online platforms that allow patients to access their personal health information and monitor their health while in the acute care setting. Despite... (Review)
Review
BACKGROUND
Inpatient portals are online platforms that allow patients to access their personal health information and monitor their health while in the acute care setting. Despite their potential to improve quality of care and empower patients and families to participate in their treatment, adoption remains low. Outpatient portal studies have shown that physician endorsement can drive patients' adoption of these systems. Insights on physicians' perspectives on use of these platforms can help improve patient and physician satisfaction and inpatient portal uptake.
OBJECTIVE
The purpose of this systematic review is to better understand physicians' perspectives toward inpatient portals.
METHODS
A systematic literature review was conducted for studies published between 1994 and November 2021 using keywords for physicians' perspectives toward patient portals and personal health records. Databases included PubMed, MEDLINE, Web of Science, and Scopus. Articles solely focused on nonphysician clinicians or addressing only outpatient settings or shared notes were excluded from this review. Two reviewers performed title, abstract, and full-text screening independently. Bias assessment was performed using the JBI SUMARI Critical Appraisal Tool (Joanna Briggs Institute). Inductive thematic analysis was done based on themes reported by original authors. Data were synthesized using narrative synthesis and reported according to overarching themes.
RESULTS
In all, 4199 articles were collected and 9 included. All but 2 of the studies were conducted in the United States. Common themes identified were communication and privacy, portal functionality and patient use, and workflow. In studies where physicians had no prior patient portal experience, concerns were expressed about communication issues created by patients' access to laboratory results and potential impact on existing workflow. Concerns about negative communication impacts were not borne out in postimplementation studies.
CONCLUSIONS
Physicians perceived inpatient portals to be beneficial to patients and saw improvement in communication as a result. This is consistent with outpatient studies and highlights the need to improve training on portal use and include physicians during the design process. Health care organizations and information technology entities can take steps to increasing clinician comfort. Physician concerns involving patient portal usage and managing patient expectations also need to be addressed. With improved clinician support, initial pessimism about communication and workload issues can be overcome. Limitations of this review include the small number of pre- and postimplementation studies found. This is also not a review of perspectives on open notes, which merits separate discussion.
PubMed: 36378521
DOI: 10.2196/39542 -
CMAJ : Canadian Medical Association... Nov 2020
Meta-Analysis
Topics: COVID-19; Glucocorticoids; Humans; Outpatients; Pandemics; Respiratory Distress Syndrome; SARS-CoV-2; Treatment Outcome; COVID-19 Drug Treatment
PubMed: 33229355
DOI: 10.1503/cmaj.200645-f -
Safety and efficacy of outpatient hip and knee arthroplasty: a systematic review with meta-analysis.Archives of Orthopaedic and Trauma... Aug 2022This systematic review aimed to assess the safety and efficacy of outpatient joint arthroplasty (OJA) pathways compared to inpatient pathways. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
This systematic review aimed to assess the safety and efficacy of outpatient joint arthroplasty (OJA) pathways compared to inpatient pathways.
MATERIALS AND METHODS
An electronic literature search was conducted to identify eligible studies. Studies comparing OJA with inpatient pathways-following hip and/or (partial) knee arthroplasty-were included. Included studies were assigned-based on OJA definition-to one of the following two groups: (1) outpatient surgery (OS); outpatient defined as discharge on the same day as surgery; and (2) semi-outpatient surgery (SOS); outpatient defined as discharge within 24 h after surgery with or without an overnight stay. Methodological quality was assessed. Outcomes included (serious) adverse events ((S)AEs), readmissions, successful same-day discharge rates, patient-reported outcome measures (PROMs) and costs. Meta-analyses and subgroup analyses by type of arthroplasty were performed when deemed appropriate.
RESULTS
A total of 41 studies (OS = 26, SOS = 15) met the inclusion criteria. One RCT and 40 observational studies were included, with an overall risk-of-bias of moderate to high. Forty studies were included in the meta-analysis. Outpatients (both OS and SOS) were younger and had a lower BMI and ASA class compared to inpatients. Overall, no significant differences between outpatients and inpatients were found for overall complications and readmission rates, and improvement in PROMs. By type of arthroplasty, only THAs in OS pathways were associated with fewer AEs [OR = 0.55 (0.41-0.74)] compared to inpatient pathways. 92% of OS patients were discharged on the day of surgery. OJA resulted in an average cost reduction of $6.797,02.
CONCLUSION
OJA pathways are as safe and effective as inpatient pathways in selected populations, with a potential reduction of costs. Considerable risk of bias in the majority of studies emphasizes the need for further research.
Topics: Ambulatory Surgical Procedures; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Outpatients; Patient Discharge; Patient Readmission; Postoperative Complications; Retrospective Studies
PubMed: 33587170
DOI: 10.1007/s00402-021-03811-5 -
Obstetrics and Gynecology Jun 2021To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient compared with the inpatient setting, or different methods of ripening... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient compared with the inpatient setting, or different methods of ripening in the outpatient setting alone.
DATA SOURCES
Searches for articles in English included MEDLINE, EMBASE, CINAHL, Cochrane Library, ClinicalTrials.gov, and reference lists (up to August 2020).
METHODS OF STUDY SELECTION
Using predefined criteria and DistillerSR software, 10,853 citations were dual-reviewed for randomized controlled trials (RCTs) and cohort studies of outpatient cervical ripening using prostaglandins and mechanical methods in pregnant women at or beyond 37 weeks of gestation.
TABULATION, INTEGRATION, AND RESULTS
Using prespecified criteria, study data abstraction and risk of bias assessment were conducted by two reviewers, random-effects meta-analyses were conducted and strength of evidence was assessed. We included 30 RCTs and 10 cohort studies (N=9,618) most generalizable to women aged 25-30 years with low-risk pregnancies. All findings were low or insufficient strength of evidence and not statistically significant. Incidence of cesarean delivery was not different for any comparison of inpatient and outpatient settings, or comparisons of different methods in the outpatient setting (most evidence available for single-balloon catheters and dinoprostone). Harms were inconsistently reported or inadequately defined. Differences were not found for neonatal infection (eg, sepsis) with outpatient compared with inpatient dinoprostone, birth trauma (eg, cephalohematoma) with outpatient compared with inpatient single-balloon catheter, shoulder dystocia with outpatient dinoprostone compared with placebo, maternal infection (eg, chorioamnionitis) with outpatient compared with inpatient single-balloon catheters or outpatient prostaglandins compared with placebo, and postpartum hemorrhage with outpatient catheter compared with inpatient dinoprostone. Evidence on misoprostol, hygroscopic dilators, and other outcomes (eg, perinatal mortality and time to vaginal birth) was insufficient.
CONCLUSION
In women with low-risk pregnancies, outpatient cervical ripening with dinoprostone or single-balloon catheters did not increase cesarean deliveries. Although there were no clear differences in harms when comparing outpatient with inpatient cervical ripening, the certainty of evidence is low or insufficient to draw definitive conclusions.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42020167406.
Topics: Ambulatory Care; Catheters; Cervical Ripening; Cesarean Section; Dilatation; Dinoprostone; Female; Hospitalization; Humans; Labor, Induced; Obstetric Labor Complications; Oxytocics; Pregnancy
PubMed: 33752219
DOI: 10.1097/AOG.0000000000004382