From
StayCurrentMD
Journal of Pediatric Surgery Article Review: May 2019
With Dr. Todd Ponsky · hosted by Dr. Todd Ponsky
Chapter 1 of 3 · Evidence & Research
Post-op follow-up
Post-operative Follow-up Optimization and Telemedicine
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Telemedicine follow-up allows surgeons to fit more new patients into clinic and get more cases.
Telemedicine follow-up feasibility depends on patient population resources and education level.
Children do excellent with both intracorporeal and extracorporeal appendectomy techniques, and outcomes are ultimately similar.
At Todd Ponsky's hospital, a certain SIPPA number triggers immediate patient evaluation rather than using trauma score classification.
Guyan and Yonker from Alberta Children's Hospital studied optimizing post-operative follow-up by examining why patients show up, clinical relevance, and costs.
More complex cases were associated with higher likelihood of post-operative follow-up attendance.
Orchidopexy was one of the most common reasons why patients wanted to follow up post-operatively.
Follow-up visits were more clinically relevant if the patient had a more complex operation or something happened requiring earlier-than-expected follow-up.
D'Antonio and Lanning at Children's Hospital Richmond used iPads for telemedicine post-operative follow-up and found patients and families were happy with it.
There was no difference in diagnosis between telemedicine and in-person follow-up in the Richmond study's small cohort.
Al Bahiri and Merritt from Western University in London, Ontario conducted a retrospective review of appendectomy techniques for simple appendicitis with over 200 patients in the intracorporeal 3-port group and about 70 in the extracorporeal group.
There was no difference in wound infection rates between intracorporeal and extracorporeal appendectomy methods.
Extracorporeal appendectomy was shorter than intracorporeal by about 17 minutes.
Extracorporeal appendectomy was cheaper than intracorporeal by about 30%.
In the Western University study, about 80% of intracorporeal appendectomies used a retrieval bag and 20% pulled the appendix out through the port.
Only one of four surgeons in the Western University study performed extracorporeal appendectomy; the other three did exclusively intracorporeal, which is a study limitation.
A study calculated shock index pediatric adjusted (SIPPA) using EMS pre-hospital information and tracked short and longer-term outcomes.
Pre-hospital SIPPA and the delta change between pre-hospital and ED SIPPA were statistically and clinically significant for predicting need for ICU, intubation, ventilation, and transfusions.
The SIPPA study was limited to patients with injury severity score (ISS) of 16 or greater.