"But His Yelp Reviews Are Awful!": Analysis of General Surgeons' Yelp Reviews.

BACKGROUND: Patients use Web-based platforms to review general surgeons. However, little is known about the free-form text and structured content of the reviews or how they relate to the physicians' characteristics or their practices. OBJECTIVE: This observational study aimed to analyze the Web-based reviews of general surgeons on the west side of Los Angeles. METHODS: Demographics, practice characteristics, and Web-based presence were recorded. We evaluated frequency and types of Yelp reviews and assigned negative remarks to 5 categories. Tabulated results were evaluated using independent t test, one-way analysis of variance, and Pearson correlation analysis to determine associations between the number of total and negative reviews with respect to practice structure and physician characteristics. RESULTS: Of the 146 general surgeons, 51 (35%) had at least 1 review and 29 (20%) had at least 1 negative review. There were 806 total reviews, 679 (84.2%) positive reviews and 127 (15.8%) negative reviews. The negative reviews contained a total of 376 negative remarks, categorized into physician demeanor (124/376, 32.9%), clinical outcomes (81/376, 22%), office or staff (83/376, 22%), scheduling (44/376, 12%), and billing (44/376, 12%). Surgeons with a professional website had significantly more reviews than those without (P=.003). Surgeons in private practice had significantly more reviews (P=.002) and more negative reviews (P=.03) than surgeons who were institution employed. A strong and direct correlation was found between a surgeon's number of reviews and number of negative reviews (P<.001). CONCLUSIONS: As the most common category of complaints was about physician demeanor, surgeons may optimize their Web-based reputation by improving their bedside manner. A surgeon's Web presence, private practice, and the total number of reviews are significantly associated with both positive and negative reviews.

Presentation and outcomes among inflammatory bowel disease patients with concurrent pneumatosis intestinalis: a case series and systematic review.

BACKGROUND/AIMS: Inflammatory bowel disease (IBD) involves chronic inflammation of the colon with ulcerative colitis (UC), and the colon and/or small intestine with Crohn's disease (CD). Pneumatosis intestinalis (PI), characterized by compromise of the intestinal wall with gas-filled cysts, has rarely been reported with IBD. The presentation, best management and outcomes of PI with IBD are poorly defined. METHODS: We conducted a search for PI in all abdominal computed tomography (CT) reports at 2 large tertiary care hospitals from January 1, 2010 to December 31, 2017, cross referenced to ICD codes for IBD. CT and chart review was performed to confirm PI and IBD respectively. A systematic review excluding case reports was performed for PI with IBD for comparison. RESULTS: Of 5,990 patients with a CT abdomen report mentioning PI, we identified 11 cases of PI with IBD, 4 UC, 6 CD, and 1 indeterminate colitis. PI was limited to the small bowel in 5 patients, the right colon in 5, and small bowel and colonic in 1. All 3 mortalities had CD, small intestinal PI and portal/mesenteric venous gas. The systematic literature search identified 9 articles describing 58 patients with IBD and PI. These cases were mostly included in larger cohorts of PI patients without extractable data on presentation or outcomes in the IBD subpopulation. CONCLUSIONS: Ours appears to be the first reporting of presentations and outcomes, outside of case reports, for those with PI and IBD. The high mortality for those with CD and PI of the small bowel appears to define a group requiring more than supportive medical care.