Glasgow, Amy E.

Background: Telemedicine use has expanded rapidly across ambulatory care. Satisfaction with telemedicine services has been associated with social determinants of health (SDOH) such as socioeconomic status, ethnicity, and employment status. However, little is known about gender-specific patterns in patient experience. This study examined how demographic and SDOH are associated with telehealth satisfaction among women. Methods: A cross-sectional analysis was conducted using data from female patients who completed standardized post-telehealth surveys within the Mayo Clinic Health Care System between March 2020 and December 15, 2023. Logistic regression was used to evaluate the association between patient satisfaction and the following demographics and SDOH: age, race, ethnicity, marital status, Elixhauser score, mental health diagnosis, stress risk, financial risk, transportation risk, food insecurity risk, primary language, and physical activity risk. Results: Among 51,512 female patients, higher age was associated with less satisfaction with “ease of scheduling appointment” and “ease of contacting clinic,” but was associated with significantly higher satisfaction for other measures, including “care practitioners’ efforts to include” and “recommending healthcare office.” A high Elixhauser score was associated with lower satisfaction with “how well the audio and video connections worked.” Conclusion and Action Steps: A higher Elixhauser score and older age emerged as key factors associated with telehealth satisfaction among women. Targeted efforts to support patients with complex health needs and those requiring enhanced care coordination may improve satisfaction and equity in ambulatory telemedicine.

Introduction/Objectives The rise in screening for social drivers of health (SDoH) in primary care settings has led to questions about effective intervention design. A large primary care practice at Mayo Clinic developed a model centered on a full-time Health Equity Coordinator (HEC) to facilitate clinic-community partnerships in 2022. The goal of this analysis was to assess the model on process outcomes, resolution of SDoH needs, and changes in healthcare utilization. Methods Using a cohort study design, we identified primary care patients with unmet SDoH needs at the intervention clinic and two comparator clinics from March 2022 to December 2023. We assessed process outcomes descriptively and resolution of SDoH needs and healthcare utilization using multivariable regression. Results The HEC contacted 348 patients and conducted 748 meetings with community-based organization staff. While there were decreases for SDoH needs and missed or late cancelled appointments in intervention group, there were no significant difference in resolution of SDoH and healthcare utilization relative to comparator groups. Conclusions The HEC model for multi-stakeholder coordination showed promise in referring patients to services and engaging key stakeholders in a primary care setting. Longer term follow up may be needed to identify changes in SDoH needs and healthcare utilization.

Purpose: A variety of care pathways are offered to females with chronic pelvic pain (CPP) and pelvic floor myofascial pain (PFMP), which may affect treatment outcomes. This study aims to compare care pathways and describe health care utilization and characteristics of patients with CPP and PFMP referred for physical therapy (PT) at a tertiary care center. Methods: A retrospective cohort analysis was conducted on females with CPP and PFMP referred for PT. Patients received PT, medication management, injection therapy, or a combination of treatments. We collected data on health care utilization, comorbidities of interest, and patient-reported outcome measures (PROMs). Wilcoxon rank-sum tests were used to compare patients with pre- and posttreatment PROM scores. Results: A total of 1172 patients were referred for PT treatment, but 19.5% (n = 229) did not attend any PT sessions, and only 18% (n = 211) of patients attended the recommended number of PT sessions. Comorbid urinary (48.5%, n = 569) and bowel dysfunction (43%, n = 512) were prevalent. Patients consulted with multiple providers. Most patients (57.1%, n = 669) utilized opioid medications. Less than 20% completed both pre-and posttreatment PROMs. Discussion: Care pathways vary widely for the treatment of PFMP. Low adherence to PT and a trend toward greater than 5 subspecialty appointments indicating higher health care utilization reflect the range of inconsistent patient experience likely affecting outcomes. Outcomes of care are uncharted territory. Optimal care pathways for CPP and PFMP need to be established, along with further investigation of PROMs, to determine which treatments result in effective outcomes that matter to patients.

BACKGROUND: End colostomy reversal with colorectal anastomosis (Hartmann’s reversal) is a technically challenging procedure associated with significant morbidity due to adhesions and distorted anatomy after the index surgery. OBJECTIVE: To compare perioperative outcomes of open, laparoscopic, and robotic approaches for Hartmann’s reversal. DESIGN: Retrospective analysis of prospectively maintained data. SETTINGS: High-volume tertiary referral center with specialized colorectal surgery expertise. PATIENTS: A total of 218 patients who underwent Hartmann’s reversal between May 2018 and April 2023. MAIN OUTCOME MEASURES: Primary outcomes included hospital length of stay and rate of conversion. Secondary outcomes included overall complication rates and time to return of bowel function. RESULTS: Of 218 patients, 139 (63.8%) underwent open surgery, 48 (22.0%) underwent laparoscopic surgery, and 31 (14.2%) underwent robotic surgery. Robotic surgery had the lowest estimated blood loss (median 77.5 vs 100 mL laparoscopic and 150 mL open, p < 0.0001). Conversion to open surgery occurred in 16.1% of robotic cases compared with 35.4% of laparoscopic cases ( p = 0.0618). Minimally invasive approaches were associated with shorter hospital length of stay (median 3.0 vs 4.0 days, p < 0.0001) and faster return of bowel function (median 2.0 vs 3.0 days, p = 0.0095) compared to open surgery. Overall 30-day morbidity was 23.4%, with no significant difference among approaches ( p = 0.30). The temporal trend showed increasing adoption of robotic techniques, from 0% in 2018 to 53.8% in 2023, and a decrease in the proportion of cases approached by open surgery, from 76.9% in 2018 to 23.1% in 2023. LIMITATIONS: Retrospective design and single-institution experience with limited follow-up duration. CONCLUSIONS: Minimally invasive approaches to Hartmann’s reversal are associated with improved short-term outcomes compared to open surgery. The robotic approach shows promise in reducing conversion rates, potentially extending the benefits of minimally invasive surgery to more patients undergoing this challenging procedure. See Video Abstract . COMPARACIÓN DE LOS ENFOQUES ABIERTO, LAPAROSCÓPICO Y ROBÓTICO PARA LA REVERSIÓN DE HARTMANN: LA EXPERIENCIA DE LA CLÍNICA MAYO ANTECEDENTES: La reversión de la colostomía terminal con anastomosis colorrectal (reversión de Hartmann) es un procedimiento técnicamente complejo asociado a una morbilidad significativa debido a las adherencias y la distorsión anatómica tras la cirugía inicial. OBJETIVO: Comparar los resultados perioperatorios de los abordajes abiertos, laparoscópicos y robóticos para la reversión de Hartmann. DISEÑO: Análisis retrospectivo de datos mantenidos prospectivamente. ENTORNO: Centro terciario de referencia de gran volumen con experiencia especializada en cirugía colorrectal. PACIENTES: Un total de 218 se sometieron a la reversión de Hartmann entre mayo de 2018 y abril de 2023. PRINCIPALES MEDIDAS DE RESULTADOS: Los resultados primarios incluyeron la duración de la estancia hospitalaria y la tasa de conversión. Los resultados secundarios incluyeron las tasas generales de complicaciones y el tiempo de recuperación de la función intestinal. RESULTADOS: De los 218 pacientes, 139 (63,8 %) se sometieron a cirugía abierta, 48 (22,0 %) a cirugía laparoscópica y 31 (14,2 %) a cirugía robótica. La cirugía robótica tuvo la menor pérdida de sangre estimada (mediana, 77,5 ml frente a 100 ml en laparoscopia y 150 ml en cirugía abierta, p < 0,0001). La conversión a cirugía abierta se produjo en el 16,1 % de los casos robóticos frente al 35,4 % de los casos laparoscópicos ( p = 0,0618). Los abordajes mínimamente invasivos se asociaron con una estancia hospitalaria más corta (mediana de 3,0 días frente a 4,0 días, p < 0,0001) y un retorno más rápido de la función intestinal (mediana de 2,0 días frente a 3,0 días, p = 0,0095) en comparación con la cirugía abierta. La morbilidad global a los 30 días fue del 23,4 %, sin diferencias significativas entre los distintos enfoques ( p = 0,30). La tendencia temporal mostró un aumento en la adopción de técnicas robóticas, del 0 % en 2018 al 53,8 % en 2023, y una disminución en la proporción de casos abordados mediante cirugía abierta, del 76,9 % en 2018 al 23,1 % en 2023. LIMITACIONES: Diseño retrospectivo y experiencia de una sola institución con una duración de seguimiento limitada. CONCLUSIONES: Los enfoques mínimamente invasivos para la reversión de Hartmann se asocian con mejores resultados a corto plazo en comparación con la cirugía abierta. El enfoque robótico es prometedor para reducir las tasas de conversión, lo que podría ampliar los beneficios de la cirugía mínimamente invasiva a más pacientes que se someten a este procedimiento tan complejo. ( AI-generated translation ).

Background: The COVID-19 pandemic brought profound changes to health care systems worldwide. This study examines the adaptive responses of a sleep medicine practice that successfully pivoted to telemedicine, remote diagnostics, and agile operations, resulting in sustained growth and improved patient accessibility. Methods: We analyzed organizational and cultural elements enabling responsiveness, including telemedicine infrastructure, adaptive leadership, quality-focused processes, and effective communication. Objective outcomes were assessed by analyzing patient demographics, telemedicine visits, and sleep testing patterns during three phases: pre-pandemic (June 1, 2018 to March 8, 2020), acute COVID-19 (March 9, 2020 to April 19, 2020), and post-acute COVID-19 (April 20, 2020 to December 31, 2021). Results: Across 105,199 encounters, monthly sleep medicine visits and testing declined ∼50% during acute COVID-19, but rebounded to surpass baseline in the post-acute phase. Virtual visits increased significantly, replacing many face-to-face encounters. Home sleep apnea test use rose sharply, driven by disposable WatchPAT tests, while polysomnography use decreased. Testing volumes increased overall post-acute compared with pre-pandemic. Patients served during acute and post-acute phases were younger, more often female, non-White, and postgraduate-educated (all p < 0.001). Nonlocal patients increased during the post-acute phase, reflecting telemedicine expansion. Conclusions: Proactive telemedicine investments, adaptive leadership, quality-focused processes, and effective communication enabled this practice to adapt successfully during the pandemic. These resilience strategies provide a model for navigating future health care challenges, underscoring telemedicine and e-health’s critical roles in maintaining care delivery during crises.

BACKGROUND: Rising health care costs necessitate a reassessment of routine preoperative practices. Despite low transfusion rates in elective colorectal operations, many hospitals continue to perform routine preoperative type and screen testing. OBJECTIVE: To assess perioperative blood transfusion rates and determine preoperative and surgical factors associated with transfusions to determine whether the routine preoperative type and screen testing are necessary for elective abdominal colorectal surgeries, particularly in the setting of minimally invasive surgery. DESIGN: Retrospective cohort study. SETTINGS: Mayo Clinic, 2019–2023. PATIENTS: Adult patients undergoing elective abdominal colorectal operations. Exclusion criteria included emergent operations and nonabdominal procedures. INTERVENTIONS: None. MAIN OUTCOME MEASURES: The primary outcome was the incidence of intraoperative and immediate postoperative (≤72 hours) blood product transfusion. Secondary outcomes assessed associations between transfusion rates, surgical approach, and preoperative variables. RESULTS: Among 4652 patients, 2770 underwent minimally invasive surgery and 1882 underwent open procedures. Perioperative red blood cell transfusion rates were lower in minimally invasive procedures (3.0% colectomy, 4.5% proctectomy) compared to open procedures (8.7% colectomy, 21.5% proctectomy). Open proctectomy was the strongest predictor of transfusion (OR 12.05; 95% CI, 8.94–16.26; p < 0.0001) followed by open colectomy (OR 2.59; 95% CI, 2.04–3.30; p < 0.0001). Preoperative factors including ASA class IV (OR 5.21; 95% CI, 1.09–24.82; p < 0.0382) and anemia (OR 4.14; 95% CI, 3.09–5.55; p < 0.0001) were also significantly associated with red blood cell transfusion. LIMITATIONS: The retrospective nature of the study may introduce selection bias. In addition, institutional practice patterns may limit the generalizability of findings. CONCLUSIONS: Patients undergoing elective minimally invasive colorectal surgery have very low rates of perioperative blood transfusions; thus, routine preoperative type and screen testing is likely unnecessary for this patient cohort. However, patients undergoing planned open operations, likely due to procedural complexity, and those who are ASA class IV, have preoperative anemia, or have anal cancer have higher transfusion risks and may benefit from selective testing. Implementing a risk-stratified approach based on surgical technique and patient comorbidities could potentially reduce unnecessary testing and associated health care costs. See Video Abstract. RE-TIPIFICACIÓN Y EVALUACIÓN PREOPERATORIAS: CÓMO IDENTIFICAR CUÁNDO ES NECESARIA UNA CIRUGÍA COLORRECTAL ELECTIVA ANTECEDENTES: El aumento en los costos de la atención médica exigen la reevaluación de las practicas preoperatorias de rutina. A pesar de las bajas tasas de transfusión en la cirugía colorrectal electiva, muchos hospitales continúan realizando pruebas de tipo y de cribado preoperatorios de forma rutinaria. El poresente estudio evalúa las tasas de transfusiones sanguíneas perioperatorias e identifica los factores asociados con éstas transfusiones para determinar la necesidad de pruebas de tipo y de cribado preoperatorios de forma rutinaria en cirugías colorrectales abdominales electivas. OBJETIVO: Evaluar las tasas de transfusión sanguínea perioperatoria y determinar los factores preoperatorios y quirúrgicos asociados con las transfusiones, con el fin de determinar si las pruebas de tipo y de cribado preoperatorias de forma rutinaria son necesarias en cirugías colorrectales abdominales electivas, en particular en el contexto de la cirugía mínimamente invasiva. DISEÑO: Estudio de cohortes retrospectivo. ESCENARIO: Clínica Mayo, 2019-2023. PACIENTES: Pacientes adultos sometidos a cirugías colorrectales abdominales electivas. Los criterios de exclusión incluyeron operaciones de emergencia y procedimientos no abdominales. INTERVENCIONES: Ninguna. PRINCIPALES MEDIDAS DE RESULTADOS: El resultado primario fue la incidencia de transfusión de hemoderivados intraoperatoriamente y postoperatoria inmediata (≤72 horas). Los resultados secundarios evaluaron la asociación entre las tasas de transfusión, el abordaje quirúrgico y las variables preoperatorias. RESULTADOS: De 4652 pacientes, 2770 se sometieron a cirugía mínimamente invasiva y 1882 a laparotomía. Las tasas de transfusión eritrocitaria perioperatoria fueron menores en los procedimientos mínimamente invasivos (3,0 % colectomía, 4,5 % proctectomía) que en los procedimientos abiertos (8,7 % colectomía, 21,5 % proctectomía). La proctectomía abierta fue el predictor más sólido de transfusión (OR: 12,05; IC del 95 %: 8,94-16,26; p < 0,0001), seguida de la colectomía abierta (OR: 2,59; IC del 95 %: 2,04-3,30; p < 0,0001). Los factores preoperatorios, incluyendo la clase ASA IV (OR 5,21; IC del 95 %: 1,09-24,82; p < 0,0382) y la anemia (OR 4,14; IC del 95 %: 3,09-5,55; p < 0,0001), también se asociaron significativamente con la transfusión de glóbulos rojos. LIMITACIONES: La naturaleza retrospectiva del estudio puede introducir sesgo de selección. Además, los patrones de práctica institucional pueden limitar la generalización de los hallazgos. CONCLUSIONES: Los pacientes sometidos a cirugía colorrectal mínimamente invasiva electiva tienen tasas muy bajas de transfusiones sanguíneas perioperatorias, por lo que las pruebas de detección y tipo de sangre preoperatorias de rutina probablemente sean innecesarias para esta cohorte de pacientes. Sin embargo, los pacientes sometidos a cirugías abiertas planificadas, probablemente debido a la complejidad del procedimiento, y aquellos con clase ASA IV, anemia preoperatoria o cáncer anal, tienen mayor riesgo de transfusión y podrían beneficiarse de pruebas selectivas. La implementación de un enfoque estratificado por riesgo basado en la técnica quirúrgica y las comorbilidades del paciente puede reducir las pruebas innecesarias y los costos de atención médica asociados. (Traducción—Dr. Xavier Delgadillo)

AbstractObjectiveLow‐grade parotid malignancies have high overall survival rates; however, controversy remains about the appropriate extent of surgery. We aim to explore the trends in the extent of parotidectomy performed over time in low‐grade parotid malignancies in the United States, with a hypothesis that there has been a trend towards less aggressive surgery.Study DesignRetrospective cohort study of all low‐grade (grade I) acinic cell carcinoma (ACC) and mucoepidermoid carcinoma (MEC) in the Surveillance, Epidemiology, and End Results (SEER) from 2004 to 2020.SettingGeographic areas served by SEER.MethodsTrends were assessed using Cochran‐Armitage tests and logistic regression; Kaplan‐Meier survival curves were used to analyze overall and cancer‐specific survival, and chi‐square tests were used to analyze patient characteristics.ResultsIn total, 1288 patients were identified (916 MEC; 372 ACC). Most patients (n = 772, 60%) were non‐Hispanic white, with an average age of 50.6 years and had a slight female predominance (1.58:1). Most of the cohort presented with tumor stage T1 or T2 (84%), N0 (90.1%), and M0 (96.9%). Treatment with total parotidectomy decreased significantly (34.6 vs 17.7%, P = .02) whereas sacrificing the facial nerve (FN) slightly decreased (20 vs 15.7%, P = .1). A significant increase in N0 patients (71%‐94%, P < .0001) was observed, whereas T staging remained stable (61%‐64%, P = .3). Overall, both ACC and MEC had excellent cancer‐specific survival.ConclusionOver the last 17 years, there has been a significant de‐escalation in the extent of parotidectomy for low‐grade parotid malignancy in the United States.

Objectives: Surgical site infections (SSIs) are the most common hospital-acquired infections in the United States, of which methicillin-resistant Staphylococcus aureus (MRSA) accounts for 43%. Preoperative povidone-iodine nasal swab (PNS) is considered an effective and cost-saving treatment for Staphylococcus aureus decolonization. We aim to assess the impact of preoperative PNS on SSI incidence. Materials and Methods: This retrospective observational study utilized elective surgical cases between January 1, 2018 and May 31, 2023, at a single academic medical center. The cohort was divided into PNS and no PNS groups. The cohort was propensity-matched, and Pearson χ2/Kruskal-Wallis tests were performed to compare group differences. Multivariable logistic regression was utilized to compare events between cohorts before and after matching. An alpha of <0.05 was considered significant. Results: A total of 45,998 (22,999 per group) matched participants were evaluated. On multivariate regression, the non-PNS treatment group was associated with an increase in hospital overall SSI occurrence (OR: 1.48, P = 0.02) but not specifically in-hospital methicillin-sensitive Staphylococcus aureus SSI, MRSA-SSI, or any 30-day SSI (P > 0.05). Compared with PNS treatment and prophylactic antibiotics, in-hospital SSI was higher in the absence of PNS treatment (OR: 1.83, P < 0.001), antibiotic (OR: 2.63, P < 0.001), or both (OR: 2.06, P < 0.01). Compared with PNS treatment plus prophylactic antibiotic, in-hospital MRSA-SSI was only higher in the absence of antibiotic (OR: 2.92, P < 0.01) treatment. Conclusions: Preoperative treatment with PNS may reduce overall in-hospital SSI but has no independent impact on MRSA SSI.

AbstractObjectiveThe extent of parotidectomy for benign tumors has de‐escalated in the United States. We aim to define modern benchmarks for operative time and hospital length of stay (LOS) in parotidectomy and identify risk factors that may prolong these benchmarks.Study DesignThis is a retrospective cross‐sectional study of all adults who underwent parotidectomy for a primary parotid neoplasm between January 2011 and December 2021 using the American College of Surgeons National Surgical Quality Improvement Program database.MethodsThe extent of parotidectomy was defined using Current Procedural Terminology codes. Prolonged operative time and LOS were defined as above the 75th percentile (longer than 194 minutes and more than 1 day, respectively). Multivariable logistic regression was used to identify patient and surgical risk factors that predict prolonged operative time or LOS.ResultsBenign parotidectomies are mostly performed as outpatient procedures in the United States (average LOS <1 day). Prolonged operative time was independently associated with malignant tumors versus benign tumors (adjusted odds ratio [aOR]: 2.7, 95% confidence interval [CI]: 2.4‐3.0), total parotidectomy with facial nerve sacrifice versus lesser extent of parotidectomy (aOR: 2.3, 95% CI: 1.7‐3.0), and simultaneous reconstructive procedures versus none (P < .001 for all). These features were similarly independently associated with prolonged LOS (P < .001 for all). Complication rates were universally low.ConclusionThe majority of superficial parotidectomies in this country are performed as outpatient procedures requiring <3 hours of operative time, with low complication rates. Malignant tumors, greater extent of parotidectomy, and simultaneous procedures were independently associated with prolonged operative time and LOS. These national benchmarks can inform operating room and hospital bed resource assignments.

ABSTRACT Background Surgical resection for pancreas ductal adenocarcinoma (PDAC) remains the mainstay of treatment. Regardless of enhanced survival rates, disparities in patient outcomes and experiences driven by the social determinants of health (SDH) persist. The area deprivation index (ADI) comprises 17 indicators related to education, employment, housing‐quality, and poverty. We sought to examine the impact of ADI on surgical outcomes of PDAC patients. Methods Patients who underwent pancreatoduodenectomy or distal pancreatectomy for PDAC between January 2011 and December 2022 were identified. ADI was calculated using patient zip codes and categorized into quartiles, with the highest indicating the most marginalized. The primary outcome was loss to follow‐up after surgical resection. To account for confounders, a competing risk multivariable regression analysis was used. Results A total of 1001 patients had a mean age of 66.6 (±9.64), with 46.3% ( n = 463) of patients being female. A majority, 94.6% ( n = 947), identified as white, and 64.1% ( n = 641) had at least a college degree. The median length of follow‐up after surgery was 1.8 years (interquartile range: 0.9–3.5). Multivariable analysis adjusting for competing risk of death, showed that patients who are least marginalized are 1.57 times more likely to have their follow‐up than those most marginalized (hazard ratio: 1.57, 95% confidence interval: 1.08–2.29, p = 0.017). Conclusion SDH impact many aspects of patient's care including a higher risk of loss to follow‐up for marginalized patients after surgery for PDAC. Future efforts should seek to identify and lower barriers faced by marginalized patients with system‐level changes to ensure equitable access.