Background and Aims The postoperative management of gastric peroral endoscopic myotomy (G-POEM) lacks standardization. This study aimed to evaluate adverse events, readmission rates, and feasibility of same-day discharge (SDD) after G-POEM. Methods A multicenter retrospective review of prospectively collected G-POEM data was conducted. The primary outcome was the 15-day readmission rates in SDD and admitted patients. Secondary outcomes included readmission risk factors, clinical success, and adverse events (AEs). Results We found a 4.1% 15-day readmission rate in 482 patients (95% CI, 3.2%-5.4%). SDD clinical success rates at 6 to 12 months were 54.1% versus 59.7% for the admitted group. The overall AE rate was 4.1%. SDD patients tended to have shorter procedure times and higher frequencies of double myotomy and endoscopic suturing for closure. Conclusions G-POEM is safe with low incidence of AEs and 15-day readmission rates. SDD appears safe in uncomplicated cases, suggesting that upper gastrointestinal studies after G-POEM may be unnecessary. ClinicalTrials.gov (NCT04434781).

Thomas Jefferson University Hospital, USA; Foundation for Interventional and Therapeutic Endoscopy, USA; Hackensack Meridian Health, USA; Methodist Dallas Medical Center, USA; West Virginia University, USA.

Indiana University School of Medicine, USA; Stanford University School of Medicine, USA; The University of Texas Medical Branch at Galveston, USA; Vanderbilt University Medical Center, USA; The University of Kansas Medical Center, USA; NorthShore University HealthSystem, USA; The University of Mississippi Medical Center, USA; Thomas Jefferson University, USA; Institut klinicke a experimentalni mediciny, Czechia; University of Virginia School of Medicine, USA; Sharp Healthcare, USA.

Purpose: Esophageal Peroral Endoscopic Myotomy (E-POEM) has become an important treatment option for patients with esophageal disorders, but there is limited data about factors that lead to a same day discharge (SDD) or overnight admission (OA) for outpatient E-POEM. We aimed to assess preprocedural factors and clinical outcomes associated with SDD compared to OA. Methods: This is a retrospective analysis of patient demographics, pre-, intra-, and postprocedural characteristics, and procedure charges of patients who received outpatient E-POEM at a single institution. Results: 218 patients underwent outpatient E-POEM (36 SDD, 182 OA). Technical success was 100%. There were no statistically significant differences in prior Heller myotomy or procedure length (p = 0.979, 0.534). SDD patients were younger on average (54.1 vs 62.4, p = 0.0068), had fewer afternoon procedures (p = 0.0194), and were less likely to require postprocedural opioids (p = 0.00114). Average times of day for esophagrams performed the day of the procedure were 1515 and 1508 in the SDD and OA groups, respectively, and 1035 when performed the day after the procedure. There was no difference in closure technique, adverse events, or additional treatments required between SDD and OA groups. The average charge per patient in the SDD group was $6,799 and $7,942 in the OA group (p = 0.171). Discussion: SDD was associated with younger patients, morning procedures, and lower opiate usage. Costs trended lower for SDD, though the difference was not statistically significant in our sample. Standardizing morning E-POEMs with same day post-procedural esophagrams may facilitate SDD for patients who do not require opiates for pain control.

Aims The optimal management of patients who fail G-POEM is not known. We aimed to compare the outcomes of different management strategies in patients who had failed G-POEM.

BACKGROUND:Scientists, surgeons, and trainees are increasingly taking an active role on Twitter to find, disseminate, and exchange knowledge. The purpose of this study was to determine if peer-reviewed journal articles shared on Twitter using visual abstracts (VAs) improve user engagement compared with plain-text tweets. METHODS:A two-arm randomized controlled trial with crossover was performed. Manuscripts from the Journal of Arthroplasty were allocated to one of two arms and disseminated via the journal Twitter account (@JArthroplasty) as either a text-based tweet or a VA. The primary outcome was online engagement (a composite of retweets, replies, and likes) at 7 and 30 days after posting. Univariate analysis for nonparametric and parametric data was performed using Mann-Whitney test or Student t-tests, respectively; alpha was set at 0.05. RESULTS:20 in-press manuscripts were randomized to standard tweets (10) or VAs (10) the same day of online publication. The mean number of engagements was higher in the VA group at seven (412 ± 216 vs 195 ± 133; P = .016) and 30 days (495 ± 204 vs 244 ± 162; P = .007). After the crossover, similar results were reported. Overall, VAs attracted a significantly greater number of engagements than standard tweets. Most engagement for both plain-text tweets and VAs occurred shortly after the tweet is posted. CONCLUSION:Online, public engagement with orthopedic research is generally low. However, when VAs are used to communicate research through social media outlets such as Twitter, the overall research engagement significantly increases compared with plain-text tweets.

Background: Unexpected cancelation of scheduled total joint arthroplasty (TJA) procedures creates patient distress and disruption for the clinical team. The purpose of this study is to identify the etiology and fate of cancelations for scheduled TJAs. Methods: A consecutive series of 11,670 patients at a single institution from 2013 to 2017 was reviewed in March 2020. All patients who were scheduled for a primary total hip arthroplasty or total knee arthroplasty and subsequently canceled were identified. The etiology of cancelation and time to rescheduling were recorded. Results: Of the 505 (4.3%) canceled patients, 209 (42%) were due to medical reasons. Three hundred ninety-one patients (77%) eventually underwent their procedure at a mean delay of 165 days (19-1908). Only 53 (25%) patients canceled for a medical reason underwent further diagnostic or therapeutic intervention for their medical condition. When compared to patient-driven cancelations, those canceled for medical reasons had a higher mean Charlson Comorbidity Index (0.82 vs 0.39, P <.001), were canceled closer to the scheduled surgery date (8.55 vs 18.1 days, P <.001), and were more likely to eventually undergo surgery (86% vs 73%, P = .004). Conclusion: Canceled elective TJA surgeries are most often due to a medical concern, however only a minority of these patients undergo intervention for that medical condition. To minimize the risk of cancelation, healthcare providers may consider early referral of medically complex patients to the patient's primary care physician. After cancelation, patients should have a clearly defined path to return to the operative schedule to prevent further delays. (C) 2020 Elsevier Inc. All rights reserved.