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Despite its importance, there are no official guidelines for point of care ultrasound training during surgical critical care fellowship. The primary objective of this study was to evaluate the comfort and competency of fellows after implementation of a point of care ultrasound program. Surgical critical care fellows (n = 7) participated in an ultrasound rotation (2021–2022), including dedicated lectures and training with interventional and echocardiography technicians. Pre and post self-assessments were administered evaluating comfort in point of care ultrasound for focused assessment with sonography for trauma, vascular access, drainage procedures, volume status, cardiac activity during arrest, and global cardiac function. Technicians assessed fellow skill in probe orientation, location, image manipulation, machine adjustment, and image quality. All questions were answered on a 7-point Likert scale (1, not-at-all; 7, yes/very much). Pre and post cohorts were compared using Wilcoxon signed-rank tests. After the rotation, fellows reported improvement in comfort level for ultrasound-guided technique for focused assessment with sonography for trauma, drainage procedures, volume status, and cardiac assessment. Technician evaluations demonstrated improvement in probe orientation (5 [4–6] vs 7 [7–7], P =.02) and location (5 [3–6] vs 7 [7–7], P =.02), image manipulation (5 [4–5] vs 7 [7–7], P =.02), machine adjustment (5 [4–5] vs 7 [7–7], P =.02), and overall image quality (4 [4–6] vs 7 [7–7], P =.02) after the rotation. All fellows reported the course significantly improved their skill, comfort level, and was worthwhile. All fellows exhibited significant improvement in skill and comfort with point of care ultrasound after this rotation. This is the first study to describe a dedicated ultrasound curriculum for surgical critical care with significant skill acquisition. [ABSTRACT FROM AUTHOR]

Studies on early postoperative readmissions after bariatric surgery (BS) have examined readmissions as a single entity, regardless of urgency. Strategies to lower nonurgent readmissions would reduce unnecessary hospital utilization. To identify predictors of urgent readmissions (UR) versus nonurgent readmissions (NUR) at 30 days post-BS. Single academic institution. Patients undergoing primary BS over 2 years (n = 589) were retrospectively reviewed. Baseline demographic, medical, and hospitalization data were compared between readmitted patients, stratified by urgency, and nonreadmitted patients. Multivariate regression models of UR and NUR were created using variables with a P value ≤.2 on univariate analyses. A P value ≤.05 was considered statistically significant. There were 39 documented instances of 30-day readmissions, of which 44% (n = 17) were NUR; NUR patients were more likely to be female (100% versus 78.2% male; P =.03) and trended toward being younger, experiencing ≥2 perioperative complications, and having a longer index hospital length of stay (LOS). Patients with URs had a higher baseline BMI (52.5 ± 11.4 kg/m2 versus 48.7 ± 8.3 kg/m2, respectively; P =.04), were more likely to have sleep apnea (77.3% versus 56.1%, respectively; P =.05), had a longer LOS (3 versus 2 d, respectively; P =.007), and were more likely to have ≥2 postoperative complications (46% versus 17.0%, respectively; P =.003) compared with those with an NUR. Independent predictors of NUR included public insurance (odds ratio [OR] = 3.7; 95% confidence interval [CI], 1.17–11.67; P =.03), younger age (OR = 1.05; 95% CI, 1–1.01; P =.04), and female sex, while URs were independently predicted by LOS (OR = 1.3; 95% CI, 1.04–1.5; P =.02). Public insurance appears to be associated with NURs, while LOS predicts URs after BS. This suggests an important dichotomy within readmissions based on urgency, which has important implications for targeted quality initiatives. • Non-urgent readmissions account for 44% of 30-day readmission after primary bariatric surgery, for which public insurance is an independent risk factor. • Urgent readmissions comprise 56% of 30-day readmissions and are predicted by hospital length of stay. • Stratification by readmission urgency reveals distinct patient populations, which can guide quality initiatives [ABSTRACT FROM AUTHOR]

Highlights • Patients who attend the preoperative weight management program (WMP) had significantly fewer comorbidities prior to surgery. • Patients who attended the WMP had significantly higher %EWL at 12 months post-surgery if they had the RYGB procedure, compared to patients who did not attend the WMP. • There was a positive, but non-significant effect, from the WMP on pre-surgery BMI, and post-surgery 6 month %EWL and BMI change at 6 and 12 months post-surgery. Abstract Background The benefits of presurgery weight management programs (WMPs) for bariatric patients are mixed; some show a positive impact on percent excess weight loss (%EWL) at 12 months postsurgery, while others show no effect. Objectives The purpose of this study was to compare pre- and postoperative 6- and 12-month outcomes between patients who attended a 12-week presurgery WMP and patients who did not participate. Setting Ohio State Wexner Medical Center, University Hospital, United States. Methods A retrospective medical record analysis was conducted to compare preoperative and 6- and 12-month postoperative outcomes for patients who attend the presurgery WMP (n = 56) and patients who did not (n = 441) within a 2-year time period (N = 497). Descriptive statistics and independent t tests were conducted to determine mean differences between groups, while controlling for surgery type, for weight status outcomes (%EWL, change in body mass index) preoperatively and 6 and 12 months postsurgery, and length of stay and readmission rate. Results Patients who attended the preoperative WMP had significantly higher %EWL at 12 months postsurgery compared with patients who did not attend the WMP. Additional findings indicated a positive, but nonsignificant effect, from the WMP on presurgery body mass index, and postsurgery %EWL at 6 months and body mass index change at 6 and 12 months postsurgery. Conclusions Patients attending the WMP had better 12-month %EWL and outcomes compared with those who did not attend the WMP, though this was not true for 6-month outcomes and differed based on surgery type. [ABSTRACT FROM AUTHOR]

Background Bariatric surgery is well established as an effective means of treating obesity; however, 30-day readmission rates remain high. The Bariatric Care Coaching Program was developed in response to a perceived need for better communication with patients upon discharge from hospital and prior to being seen at their first postoperative visit. The lack of communication was apparent from the number of patient phone calls to clinic and readmissions to hospital. Objectives The aim of this study was to evaluate the impact of the care coaching program on hospital length of stay (LOS), readmission rates, patient phone calls, and patient satisfaction. Setting The study was conducted at The Ohio State University Wexner Medical Center. Methods A retrospective review was conducted on patients who had primary bariatric surgery from July 1, 2013 to June 30, 2015. The control group included patients who underwent surgery from July 1, 2013 to June 30, 2014, before development of the program, and the experimental group was composed of patients who received care coaching from July 1, 2014 to June 30, 2015. Demographics, postoperative complications, LOS, clinic phone calls, and hospital readmissions, prior to the first postoperative visit, were collected from medical records. Patient satisfaction scores were collected from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey [HCAHPS]. Differences between study groups were assessed and P values <0.05 were considered statistically significant. Results There were 261 and 264 patients in the care-coach and control groups, respectively. The care-coached group had fewer patients with intractable nausea/vomiting ( P = .0164) and a shorter mean LOS ( P = .032). Subgroup analysis indicated that the difference in LOS was evident for laparoscopic sleeve gastrectomy ( P = .002). There was no difference in readmission rates ( P = .841) or phone calls to clinic ( P = .407). HCAHPS scores demonstrated an improvement in patients’ perception of communication regarding medications (59th versus 27th percentile), discharge information (98th versus 93rd percentile), and likelihood of recommending the hospital (85th versus 74th percentile). Conclusion The Bariatric Care Coaching Program is an important new adjunct in the care of our bariatric inpatients. It has had the greatest impact on postoperative nausea/vomiting, LOS for sleeve gastrectomy, and patient satisfaction. Further studies are needed to evaluate how to use this program to reduce readmission rates and phone calls to the clinic. [ABSTRACT FROM AUTHOR]