Naval Medical Center San Diego

The rapid adoption of telemedicine has transformed healthcare delivery in the U.S., enhancing access and communication for surgical patients across wide geographic areas. However, a critical challenge persists: the need to define and standardize quality metrics specifically for telemedicine in surgery. Existing studies suggest that telemedicine can yield equivalent or improved outcomes compared to in-person visits. Nevertheless, literature remains limited in evaluating patient satisfaction, cost-effectiveness, and diagnostic accuracy. Through expert consensus within the American College of Surgeons Board of Governors Telehealth Pillar, we propose a structured framework for defining and implementing quality metrics for surgical telemedicine. This is based on the Donabedian model, addressing structure, process, and outcome, while also considering the distinct phases of surgical care: pre-operative, intra-operative, and post-operative. This framework identifies unique domains of telemedicine in surgical care, emphasizing hospital and organizational structure, patient and provider readiness, and policy alignment. Comparative analysis against existing AHRQ and WHO frameworks highlights gaps in surgical applicability. Finally, we propose an implementation roadmap prioritizing immediate, feasible metrics while identifying areas for future validation. Collaboration among researchers, clinicians, and policymakers will be essential to establish these metrics and ensure that telemedicine delivers on its potential to improve surgical care delivery while addressing disparities in access and outcomes.

Nonbiodegradable metal screws used for fixation in the Latarjet procedure can cause complications, including irritation from prominent hardware and the need for revision surgery. Magnesium-based, bioabsorbable screws may address these concerns. This study compared the biomechanical performance of magnesium screws to titanium screws with the hypothesis that there is no statistically significant difference between both groups. Fourteen fresh-frozen cadaveric shoulders were matched by age and sex. Seven shoulders underwent a standard Latarjet procedure using two 5 mm cannulated partially threaded magnesium screws (average age 70.6 ± 9.4 years). The other 7 were fixed with two 4.5 mm cannulated partially threaded titanium screws (average age 71.4 ± 14). All shoulders underwent biomechanical testing with direct pressure on the graft: cyclic loading (100 cycles 10 N- 100 N) was performed to assess displacement, stiffness and load-to-failure. Those were measured using force-displacement data obtained through a mechanical testing system. Maximum cyclic displacement was 1.2 ± 0.6 mm for magnesium and 1.4 ± 1.1 mm for titanium screws (P = .643). Cyclical stiffness was 329 ± 147 N/mm (magnesium) vs. 402 ± 220 N/mm (titanium, P = .489). Construct stiffness was 327 ± 141 N/mm vs. 408 ± 207 N/mm (P = .425), and ultimate load to failure was 414 ± 128 N vs. 475 ± 271 N (P = .605). Bone block failure with screw bending was the most common failure mode in both groups. No statistically significant differences in biomechanical performance were found between magnesium and titanium screws in this time-zero biomechanical study. Magnesium screws may offer a viable bioabsorbable alternative that reduces complications from permanent hardware.

We evaluated the incidence of anxiety, depression, and suicidality amongst TC survivors and the impact of chemotherapy on these outcomes. We conducted a retrospective cohort study of men diagnosed with TC in the United States Veterans Affairs Health System from 1990 to 2016. De novo anxiety or depression was a composite endpoint comprised of diagnosis codes for anxiety, depression, or medications used to treat these diagnoses. Incident suicidality was defined as a diagnosis code for suicidal ideation. 2022 TC patients were compared in a 1:3 ratio to 6375 controls. Cox proportional hazards models were employed for statistical analysis. Mean age at diagnosis was 42.6 years. 5-year cumulative incidence of anxiety or depression was 53.4% in TC patients and 35% for controls (p < 0.001). TC patients were more likely to develop anxiety or depression (HR 1.66, 95% CI 1.56-1.78, p < 0.001) and suicidality (HR 22.99, 95% CI 17.52-30.17, p < 0.001). In the TC cohort, factors associated with a higher risk of anxiety or depression were divorce (HR 1.15, 95% CI 1.00-1.32, p = 0.044), unemployment (HR 1.68, 95% CI 1.47-1.9, p < 0.001), and receipt of chemotherapy (HR 1.20, 95% CI 1.06-1.35, p < 0.001). Psychological morbidity due to depression, anxiety, and suicidality is high among TC survivors. In our analysis chemotherapy increases the rates of psychosocial morbidity. Clinicians should be proactive in screening and intervening for these diagnoses in TC survivors to provide early intervention and improve health comes.

Abstract Purpose Although laparoscopy has been adopted by other surgical specialties, laparotomy remains the standard in trauma. We evaluated the use of laparoscopy in patients following blunt abdominal trauma. Methods Stable patients (systolic blood pressure ≥ 100mmHg and Glasgow coma score ≥ 13) and an abdominal operation for blunt trauma within 24 h were identified from the Trauma Quality Improvement Program database over 2016–2021. Individuals with a non-abdominal AIS ≥ 3 were excluded. Patients were categorized by index procedure: Open only (OPEN), laparoscopy only (LAP), or laparoscopy converted to open (LCO). Patients were further stratified by low (&lt; 3) and high ( ≥ 3) abdominal-AIS. Clinical characteristics and outcomes including in-hospital complications and ICU and hospital length of stay (LOS) were compared. Results A total of 14,637 patients were included: 83% OPEN, 11% LAP, 6% LCO. Patients were primarily male (67%) with a median age of 36 years. Groups did not clinically differ by ISS and abdominal-AIS. LAP had significantly fewer subsequent abdominal procedures (4% vs. 14%OPEN, p &lt; 0.001) and fewer complications, including infections and unplanned returns to the operating room ( p &lt; 0.001). LAP also had shorter ICU and hospital LOS, which persisted even when stratifying by low and high abdominal-AIS ( p &lt; 0.01). Conclusion Lap is rarely used but associated with fewer complications and subsequent procedures in stable patients with blunt abdominal trauma. These results from a large, nationwide database suggest an opportunity to safely increase LAP use in stable trauma patients.