Patient Characteristics Associated with Access to Minimally Invasive Gynecologic Surgery: Changes during the COVID-19 Pandemic

Silverstein, R.G.; McClurg, A.B.; Moore, Kristin J.; Fliss, Mike Dolan; Louie, Michelle

doi:10.1016/j.jmig.2022.06.016

Cited by 9 publications

(28 citation statements)

References 19 publications

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“…After title and abstract review, 70 manuscripts were identified for full-text review. After full-text review, 29 studies met the inclusion criteria (eTable 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…All included studies were observational, and 26 of 29 studies were retrospective. All were cohort studies except for 1 cross-sectional study.…”

Section: Resultsmentioning

confidence: 99%

“…Studies reported findings from academic hospital settings and community hospitals. Eighteen of 29 studies were performed at a single center, whereas 5 studies were multicenter and 6 studies used a statewide or nationwide database (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…This review found substantial variation in the methods used to define language proficiency and LEP. Most included studies defined LEP using self-report measures that were documented in electronic medical records. Many studies used a non-English preferred language as a proxy for LEP.…”

Section: Resultsmentioning

confidence: 99%

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Association of Language Barriers With Perioperative and Surgical Outcomes

Joo,

Fernández,

Wick

et al. 2023

JAMA Netw Open

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ImportanceEnglish language proficiency has been reported to correlate with disparities in health outcomes. Therefore, it is important to identify and describe the association of language barriers with perioperative care and surgical outcomes to inform efforts aimed at reducing health care disparities.ObjectiveTo examine whether limited English proficiency compared with English proficiency in adult patients is associated with differences in perioperative care and surgical outcomes.Evidence ReviewA systematic review was conducted in MEDLINE, Embase, Web of Science, Sociological Abstracts, and CINAHL of all English-language publications from database inception to December 7, 2022. Searches included Medical Subject Headings terms related to language barriers, perioperative or surgical care, and perioperative outcomes. Studies that investigated adults in perioperative settings and involved quantitative data comparing cohorts with limited English proficiency and English proficiency were included. The quality of studies was evaluated using the Newcastle-Ottawa Scale. Because of heterogeneity in analysis and reported outcomes, data were not pooled for quantitative analysis. Results are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline.FindingsOf 2230 unique records identified, 29 were eligible for inclusion (281 266 total patients; mean [SD] age, 57.2 [10.0] years; 121 772 [43.3%] male and 159 240 [56.6%] female). Included studies were observational cohort studies, except for a single cross-sectional study. Median cohort size was 1763 (IQR, 266-7402), with a median limited English proficiency cohort size of 179 (IQR, 51-671). Six studies explored access to surgery, 4 assessed delays in surgical care, 14 assessed surgical admission length of stay, 4 assessed discharge disposition, 10 assessed mortality, 5 assessed postoperative complications, 9 assessed unplanned readmissions, 2 assessed pain management, and 3 assessed functional outcomes. Surgical patients with limited English proficiency were more likely to experience reduced access in 4 of 6 studies, delays in obtaining care in 3 of 4 studies, longer surgical admission length of stay in 6 of 14 studies, and more likely discharge to a skilled facility than patients with English proficiency in 3 of 4 studies. Some additional differences in associations were found between patients with limited English proficiency who spoke Spanish vs other languages. Mortality, postoperative complications, and unplanned readmissions had fewer significant associations with English proficiency status.Conclusions and RelevanceIn this systematic review, most of the included studies found associations between English proficiency and multiple perioperative process-of-care outcomes, but fewer associations were seen between English proficiency and clinical outcomes. Because of limitations of the existing research, including study heterogeneity and residual confounding, mediators of the observed associations remain unclear. Standardized reporting and higher-quality studies are needed to understand the impact of language barriers on perioperative health disparities and identify opportunities to reduce related perioperative health care disparities.

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“…After title and abstract review, 70 manuscripts were identified for full-text review. After full-text review, 29 studies met the inclusion criteria (eTable 2 in Supplement 1).…”

Section: Resultsmentioning

confidence: 99%

“…All included studies were observational, and 26 of 29 studies were retrospective. All were cohort studies except for 1 cross-sectional study.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Association of Language Barriers With Perioperative and Surgical Outcomes

Joo,

Fernández,

Wick

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…A 2022 retrospective cohort study found that time from referral to first appointment was shorter after the introduction of telemedicine in a MIGS surgical practice during the COVID-19 pandemic [27 ▪▪ ]. However, not speaking English emerged as a new risk factor for decreased access after implementation of a telemedicine program.…”

Section: Perioperative Telemedicine and Equitymentioning

confidence: 99%

Perioperative visits in minimally invasive gynecologic surgery

Ingraham

Makai

2023

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewPerioperative visits for gynecologic surgery patients have traditionally included in-person examinations and counseling, but the advent of telemedicine has prompted clinicians to consider varying approaches to perioperative care. We aim to educate readers on the optimal setting and context of perioperative visits and provide insight from our experience to optimize care. Recent findingsThe widespread adoption of telemedicine and a focus on equity and access has prompted gynecologic surgeons to reconsider traditional preoperative and postoperative visits.

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The environmental impact of surgical telemedicine: life cycle assessment of virtual vs. in-person preoperative evaluations for benign foregut disease

et al. 2023

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Background Health care accounts for almost 10% of the United States’ greenhouse gas emissions, accounting for a loss of 470,000 disability-adjusted life years based on the health effects of climate change. Telemedicine has the potential to decrease health care’s carbon footprint by reducing patient travel and clinic-related emissions. At our institution, telemedicine visits for evaluation of benign foregut disease were implemented for patient care during the COVID-19 pandemic. We aimed to estimate the environmental impact of telemedicine usage for these clinic encounters. Methods We used life cycle assessment (LCA) to compare greenhouse gas (GHG) emissions for an in-person and a telemedicine visit. For in-person visits, travel distances to clinic were retrospectively assessed from 2020 visits as a representative sample, and prospective data were gathered on materials and processes related to in-person clinic visits. Prospective data on the length of telemedicine encounters were collected and environmental impact was calculated for equipment and internet usage. Upper and lower bounds scenarios for emissions were generated for each type of visit. Results For in-person visits, 145 patient travel distances were recorded with a median [IQR] distance travel distance of 29.5 [13.7, 85.1] miles resulting in 38.22–39.61 carbon dioxide equivalents (kgCO 2 -eq) emitted. For telemedicine visits, the mean (SD) visit time was 40.6 (17.1) min. Telemedicine GHG emissions ranged from 2.26 to 2.99 kgCO 2 -eq depending on the device used. An in-person visit resulted in 25 times more GHG emissions compared to a telemedicine visit ( p < 0.001). Conclusion Telemedicine has the potential to decrease health care’s carbon footprint. Policy changes to facilitate telemedicine use are needed, as well as increased awareness of potential disparities of and barriers to telemedicine use. Moving toward telemedicine preoperative evaluations in appropriate surgical populations is a purposeful step toward actively addressing our role in health care’s large carbon footprint.

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Patient Characteristics Associated with Access to Minimally Invasive Gynecologic Surgery: Changes during the COVID-19 Pandemic

Cited by 9 publications

References 19 publications

Association of Language Barriers With Perioperative and Surgical Outcomes

Association of Language Barriers With Perioperative and Surgical Outcomes

Perioperative visits in minimally invasive gynecologic surgery

The environmental impact of surgical telemedicine: life cycle assessment of virtual vs. in-person preoperative evaluations for benign foregut disease

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