Unplanned emergency department visits after mastectomy in Alberta: Informing a quality improvement initiative.
Notice bibliographique
Résumé
412 Background: Same day surgery (SDS) for mastectomy increased in Alberta from 1.7% to 73% in 2022, after implementation of a perioperative care pathway in 2016. However, unplanned visits to the emergency department (ED) remained high at 22-27% with <5% requiring readmission. Our study aims to explore factors associated with unplanned ED visits by 1) describing patients with unplanned ED visits within 30 days of mastectomy, and 2) exploring characteristics for unplanned ED visits from the patient perspective. Methods: A survey study was conducted of patients who underwent a mastectomy in Alberta between 07/01/2021 to 06/30/2022 by a general surgeon, and had an unplanned ED visit within 30 days. Patients were identified from the CIHI database; chart review was performed to confirm ED visit details. Patients were excluded if their presentation was unrelated to surgery. Survey questions evaluated 3 domains: medical, socioeconomic, and psychologic, as well as patient-reported experiences of post-operative care. Results: Of 549 patients who underwent mastectomy during the study period, 132 (24%) presented to ED within 30 days. The survey was sent to 87 patients meeting inclusion criteria; 38% responded. Average age was 56. Most patients had no comorbidities (30%) or 2+ (27%), and 85% had prior surgery. The majority (79%) had college education or higher. Treatment included neoadjuvant chemotherapy (24%), sentinel lymph node biopsy (39%), axillary dissection (12%), concurrent reconstruction (24%), and mastectomy alone (27%). Most patients had 2+ drains (70%). Many patients (38%) presented on a weekend, 50% stating the ED was the only choice available at the time. Comparatively, 22% reported being told to go, and 16% felt the ED was the best place for their problem. Patients were seen by an ED physician (89%), nurse (40%) and/or surgeon (28%). Most common reasons for ED visit were infection (38%) and drain concerns (38%). Re-operation and readmission rates were 25% and 19%, respectively. Overall, 84% felt prepared for surgery; only 15% felt uncomfortable with drain management. Patients identified peer support and wound information as areas lacking. While 78% of patients were mostly or very satisfied with surgery, difficulty accessing their surgical team post-operatively was reported as the main flaw. Conclusions: Our study cohort identified infection and drain concerns as the most common reason for unplanned ED visit after mastectomy. Overall, patients were satisfied with education and surgical care, but identified problems with accessing medical/surgical care after discharge. Future initiatives should focus on improved access to outpatient care, and education on post-mastectomy emergencies.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».