Robotic Subtotal Cholecystectomy in a Geriatric Acute Care Surgery Patient with Super Obesity

Introduction. Unique challenges exist with conventional laparoscopic operations in patients with super obesity ( BMI > 50 ). Limited literature is available regarding use of the robotic platform to treat patients with super obesity or acute care surgery patients. This case describes an interval robotic subtotal cholecystectomy in an elderly patient with super obesity and multiple comorbidities. Case Description. A 74-year-old male with a BMI of 59.9 developed acute cholecystitis. He was deemed excessively high risk for operative intervention due to concurrent comorbid conditions and underwent percutaneous cholecystostomy. After a few months, a cholangiogram demonstrated persistent cystic duct occlusion. The patient expressed interest in tube removal and elective interval cholecystectomy. After preoperative risk stratification and optimization, he underwent a robotic subtotal cholecystectomy with near infrared fluorescence cholangiography. The patient was discharged on postoperative day one and recovered without complications. Discussion. Obesity is a risk factor for acute cholecystitis, which is most commonly treated with conventional laparoscopy (CL). CL is technically restraining and difficult to perform in patients with super obesity. The body habitus of patients with super obesity can impair proper instrumentation and increase perioperative morbidity. In this case, robotic assisted cholecystectomy console improved surgeon ergonomics and provided support for proper instrumentation. Robotic, minimally invasive cholecystectomy approaches may reduce perioperative morbidity in patients with super obesity. Further studies are necessary to address the role of robotic surgery in acute care surgery patients with super obesity.

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An Acute Care Surgery Model Improves Timeliness of Care and Reduces Hospital Stay for Patients with Acute Cholecystitis

The American Surgeon ◽

10.1177/000313481107701009 ◽

2011 ◽

Vol 77 (10) ◽

pp. 1318-1321 ◽

Cited By ~ 31

Author(s):

Briana Lau ◽

L. Andrew Difronzo

Keyword(s):

Acute Cholecystitis ◽

Acute Care ◽

Acute Care Surgery ◽

Complication Rates ◽

Significant Difference ◽

After Hours ◽

Timeliness Of Care ◽

Care Surgery ◽

The Impact ◽

Length Of Hospitalization

In October 2009, an acute care surgery (ACS) model was implemented to facilitate urgent surgical consults. This study examines the impact of ACS on the timeliness of care and length of hospitalization for patients with acute cholecystitis. A retrospective cohort study was performed of patients presenting to the emergency department (ED) with acute cholecystitis who underwent early cholecystectomy. Patients with choledocholithiasis, pancreatitis, biliary colic, or cholelithiasis without cholecystitis were excluded. There were two study cohorts: ACS (October 2009 to July 2010) and pre-ACS (October 2008 to September 2009). Primary outcome measures were length of stay (LOS) and time from the ED to the operating room (OR). One hundred fifty-two cases were identified: 71 in the ACS group and 81 in the pre-ACS group. Patient demographics were similar. The ACS group had a significantly shorter average time from the ED to the OR (24.6 vs 35.0 hours, P = 0.0276). Overall LOS was reduced by a mean of 14.7 hours in the ACS group (mean 3.23 vs 2.63 days, P = 0.11). There was no significant difference in OR time (2.45 vs 2.38 hours, P = 0.562). There was a significant decrease in after-hours cases in the ACS group (5.6 vs 21%, P = 0.004) and a decrease in complication rates (18.5 vs 7.0%, P = 0.032). In conclusion, the ACS model decreased time from the ED to the OR, decreased after-hours cases, decreased length of hospitalization, and decreased complications for patients with acute cholecystitis.

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An Acute Care Surgery Model Improves Timeliness of Care and Reduces Hospital Stay for Patients with Acute Cholecystitis

Yearbook of Surgery ◽

10.1016/j.ysur.2012.04.024 ◽

2012 ◽

Vol 2012 ◽

pp. 35-36 ◽

Cited By ~ 1

Author(s):

D.W. Mozingo

Keyword(s):

Hospital Stay ◽

Acute Cholecystitis ◽

Acute Care ◽

Acute Care Surgery ◽

Timeliness Of Care ◽

Care Surgery

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Impact of Acute Care Surgery Service on Acute Cholecystitis Management and Outcomes at a Single Canadian Academic Network

10.26226/morressier.596648e4d462b80290b521d7 ◽

2017 ◽

Author(s):

Sydney Godzisz

Keyword(s):

Acute Cholecystitis ◽

Acute Care ◽

Acute Care Surgery ◽

Academic Network ◽

Care Surgery

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Diagnosis-related group (DRG)-based prospective hospital payment system can be well adopted for acute care surgery: Taiwanese experience with acute cholecystitis

10.21203/rs.3.rs-39863/v1 ◽

2020 ◽

Author(s):

Yu-Tung Wu ◽

Yu-Ning Lin ◽

Chi-Tung Cheng ◽

Chih-Yuan Fu ◽

Chien-Hung Liao ◽

...

Keyword(s):

Acute Cholecystitis ◽

Acute Care ◽

Lower Threshold ◽

Acute Care Surgery ◽

Successful Implementation ◽

Included Patient ◽

Clinical Trail ◽

Hospital Stays ◽

Hospital Payment ◽

Care Surgery

Abstract BackgroundDiagnostic-related groups (DRGs) are a principle type of hospital payment systems worldwide. Laparoscopic cholecystectomy (LC) is a common surgical procedure for cholelithiasis paid by DRGs. However, acute cholecystitis (AC) patients usually have heterogeneous conditions that can negatively impact the successful implementation of DRGs. We evaluated the quality and efficiency of treating AC patients under the DRG system in Taiwan.MethodsAll AC patients who underwent LC between October 2015 and December 2016 were included. Patient demographics, comorbidities, laboratory tests, AC severity, treatment outcomes and financial results were recorded and compared. Patients were reimbursed by one of the two DRG schemes based on their comorbidities or complications (CC): DRG-1, LC without CC; and DRG-2, LC with CC. Hospitals were reimbursed with the lower threshold if costs were below the lower threshold (sector A); with the outlier threshold if costs were between the lower and outlier thresholds (sector B); and with the outlier threshold plus 80% of the exceeding cost if costs were higher than the outlier threshold (sector C). The lower and outlier thresholds for DRG-1 and DRG-2 were TWD 38,716 and TWD 64,146 and TWD 39,997 and TWD 81,843, respectively (TWD = Taiwan dollars, one US dollar is approximately 30 TWD).ResultsAmong 246 patients, 114 were paid by DRG-1, and 132 were paid by DRG-2. The sex ratio and AC severity were similar between groups, but DRG-2 patients were older and had more comorbidities. In total, 195 of 246 patients (79.3%) underwent LC within one day after admission, and patients with mild AC had shorter hospital stays than those with moderate or severe AC. The complication rate was 7.3%, and there was only one mortality. In total, 105 of 114 patients in DRG-1 and 120 of 132 patients in DRG-2 fell into sector B (the profitable sector). The average margin per patient was 11,032 TWD for DRG-1 and 24,993 TWD for DRG-2.ConclusionsDRGs can be well adopted for acute care surgery. Under such a system, hospitals can still provide efficient and quality medical services without losing profit.Trial registration:None, the current study is not a clinical trail

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Patterns of Fracture Site and Management of Maxillofacial Trauma Cases in The Department of Trauma and Acute Care Surgery in Sanglah General Hospital

JBN (Jurnal Bedah Nasional) ◽

10.24843/jbn.2019.v03.i02.p05 ◽

2019 ◽

Vol 3 (2) ◽

pp. 50

Author(s):

I Ketut Wiargitha ◽

AAGA Anom Arie Wiradana

Keyword(s):

General Hospital ◽

Acute Care ◽

Medical Records ◽

Fracture Site ◽

The Body ◽

Maxillofacial Trauma ◽

Acute Care Surgery ◽

Common Site ◽

Gender Patterns ◽

Care Surgery

Aim: To know the patterns of fracture site and management of maxillofacial cases in the Department of Trauma and Acute Care Surgery in Sanglah General Hospital Denpasar Bali. Methods: this is a retrospective study, based on medical record were concluded, samples taken in Sanglah General Hospital from January 2012 to December 2018. All of maxillofacial trauma medical records were taken. The data of age, gender, patterns of fractures site and management were taken and described. Results: There were total of 257 cases of maxillofacial trauma managed in the Department of Trauma and Acute Care Surgery in Sanglah General Hospital. Two-hundred and forty-one medical records of maxillofacial trauma were included in this study. About 16 medical records were excluded due to incomplete medical records and could not be contacted. Mostly cases found in male, aged 18-40 years old. The site of fractures majorly located in the mandible (60.12%). About 48% fractures were identified at symphysis or parasymphysis of mandible, followed by the body and angular of mandible. Open reduction and internal fixation (ORIF) were the gold standard of the treatment (83,73%) followed by Archbarr (16,27%). Conclusion: The most common site of maxillofacial fracture was mandible, specifically at symphysis or parasymphysis part. ORIF miniplate, together with Archbarr and interdental wiring fixation were the most common modality of management.

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Diagnosis-Related Group (DRG)-Based Prospective Hospital Payment System can be well adopted for Acute Care Surgery: Taiwanese Experience with Acute Cholecystitis

World Journal of Surgery ◽

10.1007/s00268-020-05904-5 ◽

2021 ◽

Author(s):

Yu-Tung Wu ◽

Yu-Ning Lin ◽

Chi-Tung Cheng ◽

Chih-Yuan Fu ◽

Chien-Hung Liao ◽

...

Keyword(s):

Acute Cholecystitis ◽

Acute Care ◽

Payment System ◽

Diagnosis Related Group ◽

Acute Care Surgery ◽

Related Group ◽

Hospital Payment ◽

Care Surgery

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Acute Care Surgery Billing, Coding and Documentation Series Part 3: Coding of Additional Select Procedures; Modifiers; Telemedicine Coding; Robotic Surgery

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000587 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000587

Author(s):

Thomas Esposito ◽

Robert Reed ◽

Raeanna C Adams ◽

Samir Fakhry ◽

Dolores Carey ◽

...

Keyword(s):

Complex System ◽

Robotic Surgery ◽

Acute Care ◽

Acute Care Surgery ◽

Formal Training ◽

Experienced Surgeon ◽

Care Surgery

This series of reviews has been produced to assist both the experienced surgeon and coder, as well as those just starting practice that may have little formal training in this area. Understanding this complex system will allow the provider to work “smarter, not harder” and garner the maximum compensation for their work. We hope we have been successful in achieving and that goal that this series will provide useful information and be worth the time invested in reading it by bringing tangible benefits to the efficiency of practice and its reimbursement. This third section deals with coding of additional select procedures, modifiers, telemedicine coding, and robotic surgery.

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