Surgical endoscopy · 2025
Hospital-at-home for acute complicated diverticulitis: a single-arm feasibility study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Boukhili Neyla, Paradis Tiffany, Faris-Sabboobeh Sarah, Demian Marie, Morin Nancy, Vasilevsky Carol-Ann, Ghitulescu Gabriela, Faria Julio, Pang Allison, Boutros Marylise
Аннотация
INTRODUCTION: Non-operative management (NOM) of acute complicated diverticulitis (ACD) has become the preferred approach. A Hospital-at-Home (HaH) program at our institution launched to provide NOM for ACD. This study evaluated the HaH program feasibility for well-selected patients.
METHODS: Prospective single-arm single-institution non-randomized feasibility study conducted from 10/2022 to 10/2023. Patients in the Emergency Department (ED) with ACD who met inclusion criteria (> 18 years, hemodynamically stable, caregiver at home, technology proficiency, within 10 km of service center within health network) were admitted to HaH instead of hospitalization. Participants wore devices measuring vitals, were contacted by a nurse TID, and had a virtual physician visit ≥ qd. At-home phlebotomy, IV fluids/antibiotics , priority outpatient imaging, percutaneous drainage, and PICC were available. The program ended once patients met discharge criteria or were transferred to the ward for planned surgery. Primary outcome was feasibility defined as 60% of participants not requiring unplanned healthcare visits 30 days post-discharge. Secondary outcomes included descriptive data, hospital bed-days saved, and unplanned healthcare visits at 60 days.
RESULTS: Of 22 patients who met inclusion criteria, 10 were enrolled. Participants were 80% male, with mean age of 56 ± 9.3 years, and mean Charlson Comorbidity Index of 1.6 ± 1.4. CT revealed abscess (3.14 ± 1.7 cm) and extraluminal gas in 90 and 40% of participants, respectively. 70% received IV antibiotics alone, 10% required percutaneous drainage, and 20% required surgery. Of the 10, 6 had resolution without further care, 2 progressed to semi-elective surgery, and 2 failed the program for ED presentation within 7 days of discharge. The HaH program had an 80% success rate. Median length of stay was 9.5 (IQR 6.3-13) days, resulting in 98 saved hospital bed-days.
CONCLUSION: Our novel HaH program for patients with ACD demonstrated feasibility with 80% of patients successfully completing it, suggesting that HaH is a viable alternative to inpatient care for ACD in well-selected patients.
METHODS: Prospective single-arm single-institution non-randomized feasibility study conducted from 10/2022 to 10/2023. Patients in the Emergency Department (ED) with ACD who met inclusion criteria (> 18 years, hemodynamically stable, caregiver at home, technology proficiency, within 10 km of service center within health network) were admitted to HaH instead of hospitalization. Participants wore devices measuring vitals, were contacted by a nurse TID, and had a virtual physician visit ≥ qd. At-home phlebotomy, IV fluids/antibiotics , priority outpatient imaging, percutaneous drainage, and PICC were available. The program ended once patients met discharge criteria or were transferred to the ward for planned surgery. Primary outcome was feasibility defined as 60% of participants not requiring unplanned healthcare visits 30 days post-discharge. Secondary outcomes included descriptive data, hospital bed-days saved, and unplanned healthcare visits at 60 days.
RESULTS: Of 22 patients who met inclusion criteria, 10 were enrolled. Participants were 80% male, with mean age of 56 ± 9.3 years, and mean Charlson Comorbidity Index of 1.6 ± 1.4. CT revealed abscess (3.14 ± 1.7 cm) and extraluminal gas in 90 and 40% of participants, respectively. 70% received IV antibiotics alone, 10% required percutaneous drainage, and 20% required surgery. Of the 10, 6 had resolution without further care, 2 progressed to semi-elective surgery, and 2 failed the program for ED presentation within 7 days of discharge. The HaH program had an 80% success rate. Median length of stay was 9.5 (IQR 6.3-13) days, resulting in 98 saved hospital bed-days.
CONCLUSION: Our novel HaH program for patients with ACD demonstrated feasibility with 80% of patients successfully completing it, suggesting that HaH is a viable alternative to inpatient care for ACD in well-selected patients.