JMIR perioperative medicine最新文献

Background: Reducing the time to surgery for patients requiring cholecystectomy may lessen the risk of adverse outcomes. Dedicated day-surgery lists supported by out-of-hospital remote monitoring have been explored as a potential solution; however, the cost-effectiveness of such innovative care models remains largely unexplored.

Objective: This study presents a cost-effectiveness analysis comparing an acute day-surgery care model with remote patient monitoring to a conventional inpatient-centric care model for high-acuity cases of cholecystitis.

Methods: Post-surgical complications, effectiveness (measured by bed days saved and quality-adjusted life years [QALYs]), and health care costs associated with the two models of care were compared over a 1-year time horizon using a decision tree model. Health care costs were estimated from the Australian health care funder perspective and expressed in 2023 Australian dollars. Uncertainty was assessed using both deterministic and probabilistic sensitivity analyses.

Results: The acute day-surgery care model dominated the conventional inpatient-centric care model by saving a mean of 1.7 inpatient days per patient (3.2 days for the conventional model versus 1.5 days for the acute day-surgery model) and lowering net health care costs by a mean of AU $1,416 (US $935) per case over the 1-year time horizon. There was no meaningful difference in QALYs between the care models. These results remained robust in both deterministic and probabilistic sensitivity analyses.

Conclusions: An acute day-surgery care model with remote patient monitoring for individuals with acute cases of cholecystitis requiring cholecystectomy would likely free bed days and provide economic benefits to the health care system compared to inpatient-centric practice. Uncertainty in QALY estimates remains a limitation.

Background: Increasing arthroplasty volumes are testing health care system capacity, budgets, and workforce resilience. Clinical pathways (CPWs) provide a practical, evidence-based structure that aligns perioperative actions from preparation through follow-up. In this review, we treat three aims as coprimary: quality (patient outcomes and adherence to best practice); resource management and efficiency at the episode level (eg, length of stay, perioperative flow, direct costs); and sustainability, defined as the ability to maintain high-quality services over time by optimizing financial, human, and environmental resources while safeguarding equitable access.

Objective: This study aimed to describe the main CPW subtypes used in hip and knee arthroplasty and synthesize evidence on their effects on quality of care, resource management, and sustainability.

Methods: We conducted a narrative review of studies indexed in PubMed and Cochrane (2013-2024) that evaluated CPWs in total hip and knee arthroplasty. Screening and selection were documented with a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-style flow diagram for transparency, and findings were synthesized thematically.

Results: Across CPW models, consistent signals of benefit were identified. Enhanced Recovery After Surgery (ERAS) pathways accelerate recovery and enable earlier discharge without increasing complications, often reducing opioid exposure and time to mobilization. Integrated Clinical Pathways improve standardization and multidisciplinary coordination across settings, reducing unwarranted variability and supporting safer transitions of care. Fast-track programs emphasize early mobilization and streamlined perioperative processes, improving patient flow and satisfaction while decreasing length of stay. Outpatient arthroplasty pathways allow same-day discharge in carefully selected, low-risk patients, reducing bed occupancy and freeing inpatient capacity. Virtual clinics support remote follow-up, patient education, and complication surveillance, decreasing unnecessary in-person visits and optimizing clinician time. Collectively, these pathways align quality improvement with sustainability by lowering bed-days, improving adherence to evidence-based practices, and enabling more efficient use of operating rooms, wards, and workforce.

Conclusions: This review highlights the importance of CPWs in improving care delivery and patient outcomes in orthopedic surgery. Future efforts should refine CPWs, integrate digital tools and platforms, adopt standardized sustainability metrics, and stay flexible to evolving service demands.

[This corrects the article DOI: 10.2196/34453.].

Background: Social media has reshaped health care decision-making; however, its influence on maxillofacial surgeon selection in non-Western contexts such as Iran remains underexplored. Understanding how patients balance digital platforms (eg, Google, Instagram) with traditional referral networks can inform trust dynamics and patient-centered care strategies.

Objective: This study aimed to evaluate the impact of social media compared to personal recommendations on maxillofacial surgeon selection among Iranian patients, assessing decision-making factors, trust perceptions, accuracy concerns, and demographic influences.

Methods: A cross-sectional survey of 384 patients at maxillofacial surgery clinics in Isfahan, Iran (September-November 2023), was conducted using structured questionnaires to collect data on demographics, surgeon selection pathways, social media use, trust, and accuracy concerns. Descriptive statistics, χ2 tests, one-sample t tests, and multiple linear regression were conducted using SPSS Version 26 to analyze platform impact and predictive variables.

Results: Personal recommendations dominated surgeon selection (239/384, 62.2%), significantly outweighing Google (75/384, 19.5%) and Instagram (11/384, 2.9%; χ²=214.3, P<.001). Google and Instagram were used by 160 (41.7%) and 119 (31.0%) patients, respectively; however, their decision-making impact was low with (mean scores: Google 2.27 (0.82), Instagram 2.14 (SD 0.79) on a 1-5 scale; t tests: P<.001). Patient-generated content drove trust, with reviews valued by 144 (37.5%) for Google and 157 (40.9%) for Instagram, and testimonials by 174 (45.3%) for Instagram. Professional credentials influenced 116 (30.2%) participants for Google. Accuracy concerns were moderate; (means values of Google 2.84 (SD 0.91), Instagram 2.85 (SD) 0.88; P<.05). Regression identified recommendations (β=.42, P<.001), credential trust (β=.19, P=.002), and review authenticity (β=.14, P=.02) as predictors, while social media use was not a significant predictor (P=.32). Participants were predominantly female (233/384, 60.7%), aged 21-30 years (117/384, 30.5%), employed (159/384, 41.4%), with moderate income (201/384, 52.3%), and no prior surgery (205/384, 53.4%). Instagram use was higher among younger patients (21-30 years: 48/117, 41.0%; χ²=12.4, P=.006).

Conclusions: Social media plays a supplementary role in the selection of maxillofacial surgeons in Iran, with traditional networks prevailing due to cultural trust and low health literacy (adequacy in 43% patients). The emphasis on credible reviews and credentials underscores the need for verified digital content. Contrasting with the digital reliance on aesthetic surgery, these findings advocate for verified profiles, patient education portals, and culturally tailored strategies to enhance trust and patient-centered care.

Background: Large language models (LLMs) are revolutionizing natural language processing, increasingly applied in clinical settings to enhance preoperative patient education.

Objective: This study aimed to evaluate the effectiveness and applicability of various LLMs in preoperative patient education by analyzing their responses to superior capsular reconstruction (SCR)-related inquiries.

Methods: In total, 10 sports medicine clinical experts formulated 11 SCR issues and developed preoperative patient education strategies during a webinar, inputting 12 text commands into Claude-3-Opus (Anthropic), GPT-4-Turbo (OpenAI), and Gemini-1.5-Pro (Google DeepMind). A total of 3 experts assessed the language models' responses for correctness, completeness, logic, potential harm, and overall satisfaction, while preoperative education documents were evaluated using DISCERN questionnaire and Patient Education Materials Assessment Tool instruments, and reviewed by 5 postoperative patients for readability and educational value; readability of all responses was also analyzed using the cntext package and py-readability-metrics.

Results: Between July 1 and August 17, 2024, sports medicine experts and patients evaluated 33 responses and 3 preoperative patient education documents generated by 3 language models regarding SCR surgery. For the 11 query responses, clinicians rated Gemini significantly higher than Claude in all categories (P<.05) and higher than GPT in completeness, risk avoidance, and overall rating (P<.05). For the 3 educational documents, Gemini's Patient Education Materials Assessment Tool score significantly exceeded Claude's (P=.03), and patients rated Gemini's materials superior in all aspects, with significant differences in educational quality versus Claude (P=.02) and overall satisfaction versus both Claude (P<.01) and GPT (P=.01). GPT had significantly higher readability than Claude on 3 R-based metrics (P<.01). Interrater agreement was high among clinicians and fair among patients.

Conclusions: Claude-3-Opus, GPT-4-Turbo, and Gemini-1.5-Pro effectively generated readable presurgical education materials but lacked citations and failed to discuss alternative treatments or the risks of forgoing SCR surgery, highlighting the need for expert oversight when using these LLMs in patient education.

Background: Quality of vision in patients with idiopathic epiretinal membranes (iERMs) is closely linked to distorted vision (metamorphopsia), which is often underestimated in clinical settings. Current surgical decision-making relies heavily on visual acuity and optical coherence tomography findings, which do not adequately reflect the patient's functional vision or the severity of metamorphopsia. There is a clinical need for tools that can reliably quantify this symptom to improve patient outcomes and streamline care pathways.

Objectives: This study is the first to assess the use of a novel smartphone-based hyperacuity test (SHT) in quantifying metamorphopsia before and after surgical intervention for iERMs, comparing it with a conventional printed chart.

Methods: This prospective observational study included 27 patients with iERMs with symptomatic metamorphopsia detected on the Amsler grid scheduled for vitrectomy with membrane peeling. The SHT (Alleye, Oculocare Medical Inc) and the horizontal (MH) and vertical (MV) M-chart (Inami & Co, Ltd) tests were performed 3 times before and 3 months after surgery. Pre- and postoperative metamorphopsia scores, changes in distance-corrected visual acuity, optical coherence tomography biomarkers, and subjective perception of metamorphopsia were evaluated.

Results: The mean SHT score significantly (r=0.686; P<.001) improved from 55.2 (SD 18.9) before surgery to 63.5 (SD 16.3) after surgery while the improvement of the M-chart scores were insignificant (MH r=0.37, P=.06; MV r=0.18, P=.36). Pre- and postoperative SHT scores showed very weak and insignificant correlations with the MH, MV, and MH+MV scores. Both metamorphopsia tests showed good reliability (intraclass correlation coefficients >0.75).

Conclusions: The SHT showed a significant improvement in postoperative metamorphopsia scores, indicating that it could be a valuable tool for quantifying visual distortion in patients with iERMs. While discrepancies with M-chart results were observed, both tests demonstrated good reliability. Clinically, the SHT may offer a practical solution for monitoring metamorphopsia and guiding complex surgical decision-making, particularly in telemedicine settings. Its accessibility could improve patient management, potentially enhancing preoperative triaging and reducing unnecessary visits.

Background: Quality of vision in patients with idiopathic epiretinal membranes (iERM) is closely linked to distorted vision (metamorphopsia), which is often underestimated in clinical settings. Current surgical decision-making relies heavily on visual acuity and OCT findings, which do not adequately reflect the patient's functional vision or the severity of metamorphopsia. There is a clinical need for tools that can reliably quantify this symptom to improve patient outcomes and streamline care pathways.

Objective: This study is the first to assess the utility of a novel smartphone-based hyperacuity test (SHT) in quantifying metamorphopsia before and after surgical intervention for iERM, comparing it to a conventional printed chart.

Methods: This prospective observational study included 27 iERM patients with symptomatic metamorphopsia detected on the Amsler grid scheduled for vitrectomy with membrane peeling. The SHT (Alleye, Oculocare medical Inc., Zurich, Switzerland) and the horizontal (MH) and vertical (MV) M-chart (Inami & Co., Ltd., Tokyo, Japan) tests were performed three times before and three months after surgery. Pre- and postoperative metamorphopsia scores, changes in distance-corrected visual acuity (DCVA), optical coherence tomography (OCT) biomarkers and subjective perception of metamorphopsia were evaluated.

Results: The mean SHT score significantly (r=.686, P<.001) improved from 55.2 ± 18.9 before surgery to 63.5 ± 16.3 after surgery while the improvement of the M-chart scores were insignificant (MH r=.37, P=.06; MV r=.18, P=.36). Pre- and postoperative SHT scores showed very weak and insignificant correlations with the MH, MV, and MH+MV scores. Both metamorphopsia tests showed good reliability (intraclass correlation coefficients >0.75).

Conclusions: The smartphone-based hyperacuity test (SHT) showed a significant improvement in postoperative metamorphopsia scores, indicating that it could be a valuable tool for quantifying visual distortion in iERM patients. While discrepancies with M-chart results were observed, both tests demonstrated good reliability. Clinically, the SHT may offer a practical solution for monitoring metamorphopsia and guiding complex surgical decision-making, particularly in telemedicine settings. Its accessibility could improve patient management, potentially enhancing pre-operative triaging and reducing unnecessary visits.

Clinicaltrial: ClinicalTrials.gov NCT05138315.

Background: The mainstay of colorectal cancer care is surgical resection, which carries a significant risk of complications. Efforts to improve outcomes have recently focused on intensive multimodal prehabilitation programs to better prepare patients for surgery, which make the perioperative process even more complex and demanding for patients. Digital applications (eCoaches) seem promising tools to guide patients during their care journey. We developed a comprehensive eCoach to support, guide, and monitor patients undergoing elective colorectal surgery through the perioperative phase of the care pathway.

Objective: The primary aim of this study was to determine its feasibility, in terms of recruitment rate, retention rate, and compliance. Also, usability and patient experience were examined.

Methods: A single-center cohort study was conducted from April to September 2023 in a tertiary teaching hospital in the Netherlands. All elective colorectal surgery patients were offered an eCoach that provided preoperative coaching of the prehabilitation protocol, guidance by giving timely information, and remote monitoring of postoperative recovery and complications. Recruitment and retention rate, as well as compliance for each part of the care pathway, were determined. Secondary, patient-reported usability measured by the Usefulness, Satisfaction, and Ease of Use questionnaire and patient experiences were reported.

Results: The recruitment rate for the eCoach was 74% (49/66). Main reasons for exclusion were digital illiteracy (n=10), not owning a smartphone (n=3), and the expected burden of use being too high (n=2). The retention rate was 80% (37/46). Median preoperative compliance with required actions in the app was 92% (IQR 87-95), and postoperative compliance was 100% (IQR 100-100). Patient-reported usability was good and patient experiences were mostly positive, although several suggestions for improvement were reported.

Conclusions: Our results demonstrate the feasibility of a comprehensive eCoach for guiding and monitoring patients undergoing colorectal surgery encompassing the entire perioperative pathway, including prehabilitation and postdischarge monitoring. Compliance was excellent for all phases of the care pathway and recruitment and retention rates were comparable with rates reported in the literature. The study findings provide valuable insights for the further development of the eCoach and highlight the potential of digital health applications in perioperative support.