BackgroundIt is standard practice to review all patients following discharge at a follow-up clinic but demands on all health services outweigh resources and unnecessary review appointments may delay or deny access to patients with greater needs.AimsThis randomised trial aimed to establish whether a virtual outpatient clinic (VOPC) was an acceptable alternative to an actual outpatient clinic (OPC) attendance for a broad range of general surgical patients following a hospital admission.Patients and methodsAll patients admitted under one general surgical service over the study period were assessed. If eligible for inclusion the rationale, randomisation and follow-up methods were explained, consent was sought and patients randomised to receive either a VOPC or an OPC appointment.ResultsTwo-hundred and nine patients consented to study inclusion, of which 98/107 (91.6%) in the VOPC group and 83/102 (81.4%) in the OPC group were successfully contacted. Only 6 patients in the OPC group and 10 in the VOPC group reported ongoing issues. A further follow-up indicated 78 of 82 (95%) VOPC patients were very happy with their overall experience compared with 34/61 (56%) in the actual OPC group (p<0.001). A significant proportion of both cohorts—68/82 (83%) in VOPC group and 41/61 (67%) in OPC group (p = 0.029)—preferred a VOPC appointment as their future follow-up of choice.ConclusionsThe majority of patients discharged from a surgical service could be better followed up by a virtual clinic with a significant proportion of patients reporting a preference for and a greater satisfaction with such a service.

Surgery is indicated for patients with RP for rectal obstruction, perforation, fistulae, or a failure of medical measures to control the symptoms of RP. Surgery centres mainly on diversion version resection. Diversion alone does not remove the damaged tissue leaving the patient at risk of continued complications including bleeding, perforation, occlusion, and abscess formation; however, major resectional surgery carries higher risks. Morbidity and mortality vary 0-44% and 0-11% for diversion only versus 0-100% and 0-14% for resectional surgery. There is no universally agreed surgical first-line approach. The data supports both resection with defunctioning stoma or diversion only as reasonable first-line surgical options for patients requiring surgery for RP.

DRG) coding. Net margins were calculated as the difference between hospital costs and reimbursements. RESULTS: A total of 167 patients were reviewed. Mean age was 41.2 years, with 53% male. Mean length of stay was 3.7 days (range 1e17 days). The 30-day and 90-day readmission rates were 4.8% and 6.0%, respectively. Average hospital costs were substantially higher for procedures with complicated principal diagnosis (MS-DRG 338e340, $8,521) compared to those with uncomplicated principal diagnosis (MS-DRG 341e343, $5,708), highlighting the variability in clinical presentation. The average cost among all patients was $7,885 (range $3,335e$25,541), resulting in a net margin (loss) of À$206 per patient, with 40% of patients contributing to an overall negative margin. Ninety-day readmissions increased the average cost per patient to $8283. Under a bundled payment model using the average reimbursement ($7,679) for the index admission, the net margin per patient would be (loss) À$604, with 42% of patients contributing to a net negative margin. CONCLUSIONS: Longer hospital stays and higher complication rates significantly increase the overall cost of appendectomy. Due to the heterogeneous nature of patients requiring appendectomy, current reimbursement systems may undercompensate hospitals delivering care to these patients, and future bundled payment models should reflect the true cost of care.