Exploring Outcomes Related to Residential Determinants in Acute Mesenteric Ischemia Patients.

INTRODUCTION: To access the relationship between residential status and outcomes in surgical acute mesenteric ischemia (AMI) patients. METHODS: Retrospective chart review of 153 AMI patients admitted to our institution between 2007 and 2021. Residential median income and Rural-Urban Commuting Area (RUCA) code were used as residential proxies. RESULTS: Being of the female sex (odds ratio [OR] = 3.116 [1.276-7.609] P = 0.013) and having a vascular intervention performed (OR = 2.927 [1.087-7.883] P = 0.034) were both associated with a threefold increase in the risk of mortality. Increased age (OR = 1.037 [1.002-1.073] P = 0.039), elevated blood urea nitrogen (OR = 1.032 [1.012-1.051] P = 0.001), and living in higher residential income area (OR = 1.049 [1.009-1.091] P = 0.017) had a small, but statistically significant, increased risk of mortality. Patients in higher median income areas were less likely to undergo colonic resection (OR = 0.953 [0.911-0.997] P = 0.038) and tended to have a lower likelihood of receiving an ostomy (OR = 0.963 [0.927-1] P = 0.051). Being from urban or rural areas was not associated with mortality (OR = 1.565 [0.647-3.790] P = 0.321, although rural patients were more likely to undergo colon resection (OR = 2.183 [0.938-5.079] P = 0.070). Furthermore, rural patients were much more likely to be readmitted than urban dwellers (OR = 4.700 [1.022-21.618] P = 0.047). CONCLUSIONS: AMI patients living in rural or small-town areas were more likely to be readmitted and tended to undergo colonic resection. Patients residing in higher income areas had a slightly higher risk of mortality but tended to be less likely to require ostomy or colonic resection. These findings suggest a potential need for postoperative care initiatives focused on AMI patients living in rural and lower income areas.

Physician-patient communication in vascular surgery: Analysis of encounters in academic practice.

Objective: To assess physician-patient communication in vascular consults with the aim of identifying areas for improvement. Introduction: Shared decision-making in clinical consults can enhance patient outcomes. Its potential benefits are significant in vascular surgery, where decisions are dependent on the patient's definition of quality of life and outcomes are influenced by significant lifestyle changes. Methods: In this qualitative cross-sectional study, encounters between five vascular surgeons and their patients with two asymptomatic vascular diseases were audio recorded, transcribed, and analyzed for validated sociolinguistic statistics. The nine-item shared decision-making questionnaire was used to gauge subjective patient perspective. Results: Physicians spent an average of 19 min and 28 s (±8:55) per consult and an average of 12 min and 7 s talking to the patient (±6:33). Physicians used formalized language about 10.3 times an encounter (±8.39), checked for understanding 6.4 times (±4.84), and asked more close-ended than open-ended questions (10.5 ± 6.15 versus 4.6 ± 2.37). Physicians accounted for 46.34% of utterances (±6%) and averaged 5.8 interruptions per encounter (±4). Patients and company accounted for 53.66% of total utterances (±6%) and averaged 10.1 clarification questions (±9.78). The average nine-item shared decision-making questionnaire Likert-type score per patient was 2.82 on a range of -3 to +3 (±0.33), with positive numbers indicating agreement. On average, patients strongly (+2) or completely (+3) agreed that physicians covered the nine criteria. Conclusion: The 9-item shared decision-making questionnaire data showed that patients mostly felt their physician was adequate in exhibiting shared decision-making behaviors. However, physicians asked closed-ended questions that elicited "yes/no" or brief responses, continuously interrupted patient narratives, and rarely checked for understanding from their patients. These subliminal behaviors restrict patient participation in shared decision-making and may be corrected via longitudinal intervention.