Publications by authors named "Joseph A Lin"
The period of time before an elective operation may be an opportune time to engage older adults in advance care planning (ACP). Past interventions have not been readily incorporated into surgical workflows leaving a need for ACP tools that are generalizable, easy to implement, and effective. This is a qualitative study.
View Article and Find Full Text PDFBackground: Unanticipated changes in health status and worsening of chronic conditions often prompt the need to consider emergency general surgery (EGS). Although discussions about goals of care may promote goal-concordant care and reduce patient and caregiver depression and anxiety, these conversations, as well as standardized documentation, remain infrequent for EGS patients.
Methods: We conducted a retrospective cohort study using electronic health record data from patients admitted to an EGS service at a tertiary academic center to determine the prevalence of clinically meaningful advance care planning (ACP) documentation (conversations and legal ACP forms) during the EGS hospitalization.
Patients experiencing homelessness face significant barriers to screening and treatment for colorectal cancer, leading to worse outcomes. In this perspective, we use an exemplar patient case to highlight potential policy solutions for reducing this health care disparity by increasing access to early detection and treatment in this population.
View Article and Find Full Text PDFImportance: Advance care planning (ACP) prepares patients and caregivers for medical decision-making, yet it is underused in the perioperative surgical setting, particularly among older adults undergoing high-risk procedures who are at risk for postoperative complications. It is unknown what patient factors are associated with perioperative ACP documentation among older surgical patients.
Objective: To assess ACP documentation among high-risk patients 65 years and older undergoing elective surgery.
Article Synopsis
- Homelessness is increasingly affecting older individuals who face chronic health issues, yet research on their surgical care is limited.
- A scoping review analyzed studies from 1990 to 2020, focusing on the surgical care concerns unique to homeless patients, ultimately identifying 23 relevant studies out of 553 reviewed.
- The findings highlighted that most research focused on pre- and postoperative phases of care, with a significant gap in understanding intraoperative challenges, and emphasized the need for clear definitions of homelessness to enhance surgical care policies.
Importance: Hospice care is associated with improved quality of life and goal-concordant care. Limited data suggest that provision of hospice services after surgery is suboptimal; however, literature in this domain is in its nascency, leaving gaps in our understanding of patients who enroll in hospice after surgery.
Objective: To characterize the transition to hospice after gastrointestinal tract surgery and identify areas that warrant further attention and intervention.
Context: Palliative care (PC) benefits critically ill patients but remains underutilized. Important to developing interventions to overcome barriers to PC in the ICU and address PC needs of ICU patients is to understand how, when, and for which patients PC is provided in the ICU.
Objectives: Compare characteristics of specialty PC consultations in the ICU to those on medical-surgical wards.
Background: Robotic technology affords surgeons many novel and useful features, but two stereotypes continue to prevail: robotic surgery is expensive and inefficient. To identify educational opportunities and improve operative efficiency, we analyzed expert commentary on videos of robotic surgery.
Methods: Expert robotic surgeons, identified through high case volumes and contributions to the surgical literature, reviewed eight anonymous video clips portraying key portions of two robotic general surgery procedures.
Robotic proctectomy has become increasingly popular for both benign and malignant indications. The purpose of this study was to determine if the robotic approach has a distinct advantage over laparoscopy in obese patients, which has been suggested by previous subgroup analyses. We performed a retrospective review of 2016-2018 National Surgery Quality Improvement Program (NSQIP) data to compare outcomes between patients who underwent robotic versus laparoscopic proctectomy, stratified by Body Mass Index (BMI) subgroups.
View Article and Find Full Text PDFBackground: Guidelines recommend limiting minimally invasive pancreaticoduodenectomy (MIPD) to high-volume centers. However, the definition of high-volume care remains unclear. We aimed to objectively define a minimum number of MIPD performed annually per hospital associated with improved outcomes in a contemporary patient cohort.
View Article and Find Full Text PDFBackground: Serious illness communication skills are important tools for surgeons, but training in residency is limited.
Methods: Thirteen senior surgical residents at an academic center were interviewed about their experiences with serious illness communication. Conventional content analysis was performed using established communication frameworks and inductive development of themes.
Objective: To explore the use of electronic health record (EHR) data to estimate surgery resident duty hours and monitor real time workload.
Design: Retrospective analysis of resident duty hours logged using a voluntary global positioning system (GPS)-based smartphone application compared to duty hour estimates by an EHR-based algorithm. The algorithm estimated duty hours using EHR activity data and operating room logs.
Context: Critically ill patients have important palliative care (PC) needs in the intensive care unit (ICU), but specialty PC is often underutilized.
Objective: To evaluate changes in utilization and reasons for PC consultation over time.
Methods: Data from a national multi-site network of inpatient PC visits were used to identify patients age ≥18 years admitted to an ICU between 2013 and 2019.
Objective: To examine potential disparities in patient access to elective procedures during the recovery phase of the COVID-19 pandemic.
Summary Of Background Data: Elective surgeries during the pandemic were limited acutely. Access to surgical care was restored in a recovery phase but backlogs and societal shifts are hypothesized to impact surgical access.
Seriously ill surgical patients require complex and integrated surgical, interventional, and medical management to balance the risks and benefits that complicate decision-making. Palliative care principles can aid surgeons in these cases. To illustrate this, we describe a scenario of a patient with unresectable hepatocellular carcinoma with portal vein tumor thrombus causing portal hypertension.
View Article and Find Full Text PDFBackground: Teaching rounds are rarely featured in the surgery clerkship. Senior students interested in surgery are suited to precept teaching rounds. Near-peer teaching can provide benefits to both learners and preceptors.
View Article and Find Full Text PDFBackground: Although pancreaticoduodenectomy (PD) outcomes have improved, complications including surgical site infection (SSI) remain common. We present a stratification tool to predict risk for SSI after PD.
Methods: Data was retrospectively reviewed on all patients undergoing PD at a tertiary hospital (9/2011-8/2014).
Objective: The objective of this study is to analyze time to surgery as both a continuous and discrete variable to determine its association with outcomes in cauda equina syndrome (CES).
Methods: Patients at a single center whose medical record allowed precise calculation of time to surgery were included. CES was defined as at least four of the following: bladder dysfunction, saddle anesthesia, lower extremity weakness, lower extremity sensory disturbance, bowel dysfunction, or acute lower back or leg pain.
Background: Over the past decade, assessments of surgical capacity in low- and middle-income countries (LMICs) have contributed to our understanding of barriers to the delivery of surgical services in a number of countries. It is yet unclear, however, how the findings of these assessments have been applied and built upon within the published literature.
Methods: A systematic literature review of surgical capacity assessments in LMICs was performed to evaluate current levels of understanding of global surgical capacity and to identify areas for future study.
Object: This study was undertaken to compare surgical outcomes between patients with atlantoaxial versus subaxial cervical synovial cysts (CSCs) and to compare outcomes between patients who underwent decompression alone versus decompression and fusion for the treatment of CSCs.
Methods: The authors present a series of 17 cases involving patients treated at their institution and report the surgical outcomes. Due to the rarity of CSCs, a meta-analysis was conducted, and results of the literature search were combined with the case series to enhance the power of the study.