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Babarinsa IA, Bashir M, AbdelRahman Ahmed H, Ahmed B, Konje JC. Bariatric surgery and reproduction-implications for gynecology and obstetrics. Best Pract Res Clin Obstet Gynaecol 2023; 90:102382. [PMID: 37506498 DOI: 10.1016/j.bpobgyn.2023.102382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
As the rates of obesity continue to rise across the world, there has been an increasing resort to bariatric surgery amongst the options for treatment. Through the reproductive lifespan, between menarche and menopause, women might benefit from this surgical intervention, which may have a bearing on other aspects of their health. The consequences of bariatric surgery have been reported and evaluated from various perspectives in obstetrics and gynecology. Fertility and sexuality are enhanced, but not all gynecological diseases are ameliorated. There are also psychological and behavioral sequelae to be cognizant of. With multi-disciplinary and responsive care, most post-bariatric pregnancies have satisfactory outcomes. The effects of bariatric surgery on the babies conceived thereafter remains a subject of interest, whereas the possible effect on the climacteric is speculative.
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Affiliation(s)
- Isaac A Babarinsa
- Women's Wellness and Research Centre, Hamad Medical Corporation, Doha.
| | | | | | - Badreldeen Ahmed
- Feto Maternal Centre, Al Markhiya, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Qatar University, Qatar
| | - Justin C Konje
- Feto Maternal Centre, Al Markhiya, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Department of Health Sciences University of Leicester, UK
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Schiel WA, Peppe Neto ADP, Weiss AG, Cortiano LGG, Branco Filho AJ, Almeida FE, Rocco M. LAPAROSCOPIC AND LAPAROTOMY BARIATRIC SURGERY IN A PUBLIC HOSPITAL IN BRAZIL: ARE THERE DIFFERENCES IN COSTS AND COMPLICATIONS? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1739. [PMID: 37283394 PMCID: PMC10237274 DOI: 10.1590/0102-672020230021e1739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/18/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Despite its increasing popularity, laparoscopy is not the option for bariatric surgeries performed in the Brazilian public health system. AIMS To compare laparotomy and laparoscopic access in bariatric surgery, considering aspects such as morbidity, mortality, costs, and length of stay. METHODS The study included 80 patients who were randomly assigned to perform a Roux-en-Y gastric bypass. They were equally divided in two groups, laparoscopic and laparotomy. The results obtained in the postoperative period were evaluated and compared according to the Ministry of Health protocol, and later, in their outpatient returns. RESULTS The surgical time was similar in both groups (p=0.240). The costs of laparoscopic surgery proved to be higher, mainly due to staplers and staples. The patients included in the laparotomy group presented higher rates of severe complications, such as incisional hernia (p<0.001). Costs related to social security and management of postoperative complications were higher in the open surgery group (R$ 1,876.00 vs R$ 34,268.91). CONCLUSIONS The costs related to social security and treatment of complications were substantially lower in laparoscopic access when compared to laparotomy. However, considering the operative procedure itself, the laparotomy remained cheaper. Finally, the length of stay, the rate of complications, and return to labor had more favorable results in the laparoscopic route.
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Affiliation(s)
- Wagner Augusto Schiel
- Santa Casa de Misericórdia Hospital, Department of Bariatric and Metabolic Surgery - Curitiba (PR), Brazil
| | | | - André Gubert Weiss
- Santa Casa de Misericórdia Hospital, Department of Bariatric and Metabolic Surgery - Curitiba (PR), Brazil
| | | | - Alcides José Branco Filho
- Santa Casa de Misericórdia Hospital, Department of Bariatric and Metabolic Surgery - Curitiba (PR), Brazil
| | - Francisco Emanuel Almeida
- Santa Casa de Misericórdia Hospital, Department of Bariatric and Metabolic Surgery - Curitiba (PR), Brazil
| | - Mateus Rocco
- Santa Casa de Misericórdia Hospital, Department of Bariatric and Metabolic Surgery - Curitiba (PR), Brazil
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Kostic AM, Leifer VP, Gong Y, Robinson MK, Collins JE, Neogi T, Messier SP, Hunter DJ, Selzer F, Suter LG, Katz JN, Losina E. Cost-Effectiveness of Surgical Weight-Loss Interventions for Patients With Knee Osteoarthritis and Class III Obesity. Arthritis Care Res (Hoboken) 2023; 75:491-500. [PMID: 35657632 PMCID: PMC9827536 DOI: 10.1002/acr.24967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Class III obesity (body mass index [BMI] ≥40 kg/m2 ) is associated with worse knee pain and total knee replacement (TKR) outcomes. Because bariatric surgery yields sustainable weight loss for individuals with BMI ≥40 kg/m2 , our objective was to establish the value of Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) in conjunction with usual care for knee osteoarthritis (OA) patients with BMI ≥40 kg/m2 . METHODS We used the Osteoarthritis Policy model to assess long-term clinical benefits, costs, and cost-effectiveness of RYGB and LSG. We derived model inputs for efficacy, costs, and complications associated with these treatments from published data. Primary outcomes included quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3%/year. This analysis was conducted from a health care sector perspective. We performed sensitivity analyses to evaluate uncertainty in input parameters. RESULTS The usual care + RYGB strategy increased the quality-adjusted life expectancy by 1.35 years and lifetime costs by $7,209, compared to usual care alone (ICER = $5,300/QALY). The usual care + LSG strategy yielded less benefit than usual care + RYGB and was dominated. Relative to usual care alone, both usual care + RYGB and usual care + LSG reduced opioid use from 13% to 4%, and increased TKR usage from 30% to 50% and 41%, respectively. For cohorts with BMI between 38 and 41 kg/m2 , usual care + LSG dominated usual care + RYGB. In the probabilistic sensitivity analysis, at a willingness-to-pay threshold of $50,000/QALY, usual care + RYGB and usual care + LSG were cost-effective in 70% and 30% of iterations, respectively. CONCLUSION RYGB offers good value among knee OA patients with BMI ≥40 kg/m2 , while LSG may provide good value among those with BMI between 35 and 41 kg/m2 .
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Affiliation(s)
- Aleksandra M. Kostic
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Valia P. Leifer
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Yusi Gong
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Carle Illinois College of Medicine, Champaign, IL, USA
| | - Malcolm K. Robinson
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jamie E. Collins
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University of School of Medicine, Boston, MA, USA
| | - Stephen P. Messier
- Department of Health and Exercise Science, Wake Forest University, Salem, NC, USA
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, Australia
| | - Faith Selzer
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lisa G. Suter
- Section of Rheumatology, Yale School of Medicine, New Haven, CT, USA
- Section of Rheumatology, Veterans Affairs Medical Center, West Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, USA
| | - Jeffrey N. Katz
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA, USA
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elena Losina
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
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Cundy T, Gamble GD, Yi E, Evennett N, Beban G. Impact of Bariatric Surgery on Unplanned Hospital Admissions for Infection. Obes Surg 2022; 32:1896-1901. [PMID: 35377053 PMCID: PMC9072262 DOI: 10.1007/s11695-022-05975-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Abstract
Purpose
Both obesity and type 2 diabetes are associated with an increased risk of skin and soft tissue (SSTI), urinary tract, and lower respiratory tract infections but it is not clear whether the incidence of such infections is reduced after bariatric surgery. Materials and Methods In people accepted onto our publicly funded bariatric program, we recorded unplanned admissions to public hospitals over a median follow-up of 4.5 years in those successfully undergoing surgery and in those who withdrew from the program. Rates of admission for the composite outcome (SSTI, urinary tract, or lower respiratory infection) were compared. Results Of 774 people accepted onto the program, 49% underwent surgery. Infections accounted for 27% of unplanned admissions in those not completing surgery and 13% of those who underwent surgery (p < 0.001). The rate of admission was 60% lower in people who underwent surgery than those who did not: 4.3 vs 12.2 per 100 patient-years (P < 0.002), a difference maintained across 8 years’ follow-up. The impact of surgery was independent of enrolment age, BMI, or diabetes and smoking status. Of the three types of infection in the composite outcome, SSTI were the most prevalent and showed the greatest reduction (p < 0.0001). The median day stay for infection was 0.5 day less in those who underwent surgery (p < 0.01). Conclusions Hospitalization for these three infectious diseases in people undergoing bariatric surgery was lower than that in people enrolled in the bariatric program but not completing surgery. The effect was greatest for SSTI, and sustained to at least 8 years. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-022-05975-4.
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Affiliation(s)
- Tim Cundy
- Bariatric Surgical Service, Auckland City Hospital, Auckland, New Zealand.
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Greg D Gamble
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Elaine Yi
- Bariatric Surgical Service, Auckland City Hospital, Auckland, New Zealand
| | - Nicholas Evennett
- Bariatric Surgical Service, Auckland City Hospital, Auckland, New Zealand
| | - Grant Beban
- Bariatric Surgical Service, Auckland City Hospital, Auckland, New Zealand
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The SAGES MASTERS program presents the 10 seminal articles for Roux-en-Y gastric bypass. Surg Endosc 2021; 36:6-15. [PMID: 34855007 DOI: 10.1007/s00464-021-08861-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND One of the eight clinical pathways of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Masters Program is bariatric surgery which includes three anchoring procedures. For each anchoring procedure sentinel articles have been identified to enhance participant surgeon lifelong learning. Roux-en-Y gastric bypass (RYGB) is one of the 3 anchoring procedures for the Bariatric Pathway. In this article we present the top 10 seminal articles regarding the RYGB which surgeons should be familiar with. METHODS The literature was systematically searched to identify the most cited papers on RYGB. The SAGES Metabolic and Bariatric Surgery committee reviewed the most cited article list and using expert consensus selected the seminal articles that every bariatric surgeon should read. These articles were reviewed in detail by committee members and are presented here. RESULTS The top 10 most cited sentinel papers on RYGB focus on operative safety, outcomes, surgical technique, and physiologic changes after the procedure. A summary of each paper is presented here, including expert appraisal and commentary. CONCLUSION The seminal articles presented here have supported the widespread acceptance and use of the RYGB by bolstering the understanding of its mechanism of action and by demonstrating its safety and excellent patient outcomes. All bariatric surgeons should be familiar with these 10 landmark articles.
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Effect of Bariatric Surgery on Survival and Hospitalizations in Patients with Severe Obesity. A Retrospective Cohort Study. Nutrients 2021; 13:nu13093150. [PMID: 34579025 PMCID: PMC8464847 DOI: 10.3390/nu13093150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/02/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
Bariatric surgery (BS) confers a survival benefit in specific subsets of patients with severe obesity; otherwise, effects on hospital admissions are still uncertain. We assessed the long-term effect on mortality and on hospitalization of BS in patients with severe obesity. This was a retrospective cohort study, including all patients residing in Piedmont (age 18-60 years, BMI ≥ 40 kg/m2) admitted during 2002-2018 to the Istituto Auxologico Italiano. Adjusted hazard ratios (HR) for BS were estimated for mortality and hospitalization, considering surgery as a time-varying variable. Out of 2285 patients, 331 (14.5%) underwent BS; 64.4% received sleeve gastrectomy (SG), 18.7% Roux-en-Y gastric bypass (RYGB), and 16.9% adjustable gastric banding (AGB). After 10-year follow-up, 10 (3%) and 233 (12%) patients from BS and non-BS groups died, respectively (HR = 0.52; 95% CI 0.27-0.98, by a multivariable Cox proportional-hazards regression model). In patients undergoing SG or RYGB, the hospitalization probability decreased significantly in the after-BS group (HR = 0.77; 0.68-0.88 and HR = 0.78; 0.63-0.98, respectively) compared to non-BS group. When comparing hospitalization risk in the BS group only, a marked reduction after surgery was found for all BS types. In conclusion, BS significantly reduced the risk of all-cause mortality and hospitalization after 10-year follow-up.
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Torquati M, Mendis M, Xu H, Myneni AA, Noyes K, Hoffman AB, Omotosho P, Becerra AZ. Using the Super Learner algorithm to predict risk of 30-day readmission after bariatric surgery in the United States. Surgery 2021; 171:621-627. [PMID: 34340821 DOI: 10.1016/j.surg.2021.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Risk prediction models that estimate patient probabilities of adverse events are commonly deployed in bariatric surgery. The objective was to validate a machine learning (Super Learner) prediction model of 30-day readmission after bariatric surgery in comparison with a traditional logistic regression. METHODS This prognostic study for validation of risk prediction models used data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Patients who underwent elective laparoscopic gastric bypass or laparoscopic sleeve gastrectomy between 2015 and 2018 were included. Models used 5-fold cross-validation and were evaluated using the area under the receiver operating characteristic curve, the net reclassification index, and the integrated discrimination improvement. RESULTS The 30-day readmission rate among 393,833 patients was 3.9%. Super Learner area under the receiver operating characteristic curve was 0.674 (95% confidence interval 0.670-0.679), compared to 0.650 (95% confidence interval 0.645-0.654) for logistic regression. The net reclassification index was 0.239 (95% confidence interval 0.223-0.254), and 0.252 (95% confidence interval 0.249-0.255) for those who were and were not readmitted within 30 days. The integrated discrimination improvement was 0.0032 (95% confidence interval 0.0030-0.0033). CONCLUSION The Super Learner outperformed traditional logistic regression in predicting risk of 30-day readmission after bariatric surgery. Machine learning models may help target high-risk patients more optimally and prevent unnecessary readmissions.
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Affiliation(s)
- Matteo Torquati
- Boston College, Morrissey College of Arts & Sciences, Boston, MA
| | | | - Huiwen Xu
- Department of Surgery, University of Rochester Medical Center, Rochester, NY. https://twitter.com/Dr_HuiwenXu
| | - Ajay A Myneni
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, NY
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, NY. https://twitter.com/KatiaPhd
| | - Aaron B Hoffman
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY
| | - Philip Omotosho
- Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Adan Z Becerra
- Department of Surgery, Rush University Medical Center, Chicago, IL.
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van Olst N, van Rijswijk AS, Mikdad S, Schoonmade LJ, van de Laar AW, Acherman YIZ, Bruin SC, van der Peet DL, de Brauw LM. Long-term Emergency Department Visits and Readmissions After Laparoscopic Roux-en-Y Gastric Bypass: a Systematic Review. Obes Surg 2021; 31:2380-2390. [PMID: 33813682 PMCID: PMC8113200 DOI: 10.1007/s11695-021-05286-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE There is considerable evidence on short-term outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB), but data on long-term outcome is scarce, especially on postoperative emergency department (ED) visits and readmissions. We aim to systematically review evidence on the incidence, indications, and risk factors of ED visits and readmissions beyond 30 days after LRYGB. MATERIALS AND METHODS A systematic search in PubMed, Scopus, Embase.com , Cochrane Library, and PsycINFO was performed. All studies reporting ED visits and readmissions > 30 days after LRYGB, with ≥ 50 patients, were included. PRISMA statement was used and the Newcastle-Ottawa Scale for quality assessment. RESULTS Twenty articles were included. Six studies reported on ED visits (n = 2818) and 19 on readmissions (n = 276,543). The rate of patients with an ED visit within 90 days after surgery ranged from 3.9 to 32.6%. ED visits at 1, 2, and 3 years occurred in 25.6%, 30.0%, and 31.1% of patients. Readmissions within 90 days and at 1-year follow-up ranged from 4.1 to 20.5% and 4.75 to 16.6%, respectively. Readmission was 29% at 2 years and 23.9% at 4.2 years of follow-up. The most common reason for ED visits and readmissions was abdominal pain. CONCLUSION Emergency department visits and readmissions have been reported in up to almost one in three patients on the long-term after LRYGB. Both are mainly indicated for abdominal pain. The report on indications and risk factors is very concise. A better understanding of ED visits and readmissions after LRYGB is warranted to improve long-term care, in particular for patients with abdominal pains.
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Affiliation(s)
- N van Olst
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.
| | - A S van Rijswijk
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - S Mikdad
- Department of Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - L J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, De Boelelaan 1117, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - A W van de Laar
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Y I Z Acherman
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - S C Bruin
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - D L van der Peet
- Department of Surgery, Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - L M de Brauw
- Department of Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
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Courcoulas A, Coley RY, Clark JM, McBride CL, Cirelli E, McTigue K, Arterburn D, Coleman KJ, Wellman R, Anau J, Toh S, Janning CD, Cook AJ, Williams N, Sturtevant JL, Horgan C, Tavakkoli A. Interventions and Operations 5 Years After Bariatric Surgery in a Cohort From the US National Patient-Centered Clinical Research Network Bariatric Study. JAMA Surg 2020; 155:194-204. [PMID: 31940024 DOI: 10.1001/jamasurg.2019.5470] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Additional data comparing longer-term problems associated with various bariatric surgical procedures are needed for shared decision-making. Objective To compare the risks of intervention, operation, endoscopy, hospitalization, and mortality up to 5 years after 2 bariatric surgical procedures. Design, Setting, and Participants Adults who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between January 1, 2005, and September 30, 2015, within the National Patient-Centered Clinical Research Network. Data from 33 560 adults at 10 centers within 4 clinical data research networks were included in this cohort study. Information was extracted from electronic health records using a common data model and linked to insurance claims and mortality indices. Analyses were conducted from January 2018 through October 2019. Exposures Bariatric surgical procedures. Main Outcomes and Measures The primary outcome was time until operation or intervention. Secondary outcomes included endoscopy, hospitalization, and mortality rates. Results Of 33 560 adults, 18 056 (54%) underwent RYGB, and 15 504 (46%) underwent SG. The median (interquartile range) follow-up for operation or intervention was 3.4 (1.6-5.0) years for RYGB and 2.2 (0.9-3.6) years for SG. The overall mean (SD) patient age was 45.0 (11.5) years, and the overall mean (SD) patient body mass index was 49.1 (7.9). The cohort was composed predominantly of women (80%) and white individuals (66%), with 26% of Hispanic ethnicity. Operation or intervention was less likely for SG than for RYGB (hazard ratio, 0.72; 95% CI, 0.65-0.79; P < .001). The estimated, adjusted cumulative incidence rates of operation or intervention at 5 years were 8.94% (95% CI, 8.23%-9.65%) for SG and 12.27% (95% CI, 11.49%-13.05%) for RYGB. Hospitalization was less likely for SG than for RYGB (hazard ratio, 0.82; 95% CI, 0.78-0.87; P < .001), and the 5-year adjusted cumulative incidence rates were 32.79% (95% CI, 31.62%-33.94%) for SG and 38.33% (95% CI, 37.17%-39.46%) for RYGB. Endoscopy was less likely for SG than for RYGB (hazard ratio, 0.47; 95% CI, 0.43-0.52; P < .001), and the adjusted cumulative incidence rates at 5 years were 7.80% (95% CI, 7.15%-8.43%) for SG and 15.83% (95% CI, 14.94%-16.71%) for RYGB. There were no differences in all-cause mortality between SG and RYGB. Conclusions and Relevance Interventions, operations, and hospitalizations were relatively common after bariatric surgical procedures and were more often associated with RYGB than SG. Trial Registration ClinicalTrials.gov identifier: NCT02741674.
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Affiliation(s)
- Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jeanne M Clark
- General Internal Medicine, Johns Hopkins University and Health Plan, Baltimore, Maryland
| | | | - Elizabeth Cirelli
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kathleen McTigue
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Sengwee Toh
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Cheri D Janning
- Duke Clinical Translational Science Institute, Duke University, Durham, North Carolina
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Jessica L Sturtevant
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Casie Horgan
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Stratification of Readmission after Bariatric Surgery by Day of Post-Discharge Presentation. Obes Surg 2020; 31:1496-1504. [PMID: 33206297 DOI: 10.1007/s11695-020-05130-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION/PURPOSE Reasons of postoperative readmissions may vary based on the timing of rehospitalization. This study characterizes predictors and causes for readmission after bariatric surgery on day-to-day basis after discharge. MATERIALS AND METHODS Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data, patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy were identified. Perioperative factors of early readmissions (post-discharge days 0-9) were compared to those of late readmissions (post-discharge days 10-30). Multivariable analysis was conducted to identify predictors of early versus late readmissions. Reasons for readmissions were characterized on day-to-day basis. RESULTS Of 509,631 operations, 19,061 (3.7%) cases were readmitted. Of these, 9666 (50.7%) were early, while 9395 (49.3%) were late readmissions. White race (OR = 1.2, CI = [1.1-1.3]), revisional surgery (OR = 1.2, CI = [1.1-1.4]), Roux-en-Y gastric bypass (OR = 1.2, CI = [1.1-1.3]), pulmonary complication (OR = 1.8, CI = [1.5-2.3]), bleeding (OR = 2, CI = [1.6-2.6]), and post-acute care (OR = 1.8, CI = [1.2-2.6]) were predictors of early readmission. Late readmission was associated with body mass index ≥ 40 (CI = 0.83, OR = [0.77-0.89]), renal/urological complication (OR = 0.6, CI = [0.5-0.8]), and deep vein thrombosis (OR = 0.5, CI = [0.4-0.6]). PO intolerance or dehydration/electrolyte imbalance was the most common readmission reason, peaking on post-discharge days 19-30. Pain, medical complications, obstruction, and bleeding were causes of early readmissions. However, venous thromboembolism readmissions peaked after post-discharge day 9. CONCLUSION Complex bariatric operations and patients who require post-discharge extended care are associated with early readmissions. Such readmissions are due to early post-discharge complications. However, late readmissions are driven by interrelated risk factors and complications. These findings suggest that targeting patients at risk for delayed rehospitalization is the most efficient approach to minimize readmissions after bariatric surgery.
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Rates and Predictors of 30-Day Readmissions in Patients Undergoing Bariatric Surgery in the US: a Nationwide Study. Obes Surg 2020; 31:62-69. [PMID: 32737691 DOI: 10.1007/s11695-020-04884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/18/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Among various therapeutic options for morbid obesity, bariatric surgery (BS) is now considered one of the most effective methods of weight loss. We decided to perform an analysis to look at 30-day all-cause readmission and independent predictors of readmission in patients undergoing BS. METHODS We queried the 2017 Nationwide Readmission Database (NRD) using ICD-10-CM diagnosis codes to identify all adult patients who underwent BS from January 1 to November 30, 2017. Outcomes assessed were 30-day readmission rates, mortality, length of stay (LOS) and hospitalization costs, and independent predictors of readmission. RESULTS A total of 182,848 adult patients underwent BS during hospitalization in 2017, with in-hospital mortality rate of 0.52% (951). Of the patients discharged, 4.99% (9088) patients were readmitted within 30 days. The most common primary diagnosis at readmission was "Other complications of other bariatric surgery". When compared with index admission, readmitted patients had higher in-hospital mortality (0.52% vs 2.06%, p < 0.01), increased mean LOS (2.94 days vs 5.94 days, p < 0.01) but lower mean hospitalization charges ($67,763 vs $66,065, p < 0.01). Increasing age (HR 1.01, 95% CI: 1.006-1.014, p < 0.01), longer LOS (HR 1.01, 95% CI: 1.008-1.014, p < 0.01), higher comorbidity score (HR 1.15, 95% CI: 1.12-1.18, p < 0.01), CHF (HR 1.19, 95% CI: 1.01-1.42, p < 0.05), and AKI (HR 1.64, 95% CI: 1.34-2.02, p < 0.01) were independently associated with increased likelihood of 30-day readmission. CONCLUSION This study shows that almost 5% patients undergoing bariatric surgery are readmitted within 30 days of discharge in the US. Further studies are needed to assess the high-risk populations to understand the reasons predisposing to early readmission.
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Dang JT, Tavakoli I, Switzer N, Mocanu V, Shi X, de Gara C, Birch DW, Karmali S. Factors that predict 30-day readmission after bariatric surgery: experience of a publicly funded Canadian centre. Can J Surg 2020; 63:E174-E180. [PMID: 32302084 DOI: 10.1503/cjs.014918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Hospital readmissions after bariatric surgery can significantly increase health care costs. Rates of readmission after bariatric surgery have ranged from 0.6% to 11.3%, but the rate of complications and the factors that predict readmission have not been well characterized in Canada. The objective of this study was to characterize readmission rates and the factors that predict 30-day readmission in a Canadian centre. Methods A retrospective study was performed on all patients who underwent bariatric surgery between 2010 and 2015 in a single Canadian centre. Procedures included laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB). Prospectively collected data were extracted from an administrative database. Multivariable logistic regression analysis was performed to determine which factors predict 30-day readmission. Results A total of 1468 patients had bariatric surgery (51.0% LRYGB, 40.5% LSG, 8.6% LAGB) during the 6-year study period, with an overall 30-day readmission rate of 7.5%. LRYGB was associated with a higher readmission rate (11.4%) than LSG (3.7%) or LAGB (1.6%). Common reasons for readmission were infection (24.8%), pain (17.4%) and nausea or vomiting (10.1%). Multivariable analysis identified 3 factors that independently predicted readmission: length of stay greater than 4 days (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.03-4.63, p = 0.042), LRYGB (OR 5.21, 95% CI 1.19-22.73, p = 0.028) and acute renal failure (OR 14.10, 95% CI 1.07-186.29, p = 0.045). Conclusion Readmissions after bariatric surgery were most commonly caused by potentially preventable factors, such as pain, nausea or vomiting. Strategies to identify and address factors associated with readmission may reduce readmissions and health care costs after bariatric surgery in a publicly funded health care system.
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Affiliation(s)
- Jerry T Dang
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Iran Tavakoli
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Noah Switzer
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Valentin Mocanu
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Xinzhe Shi
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Chris de Gara
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Daniel W Birch
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Shahzeer Karmali
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
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Spaniolas K, Goldberg I, Yang J, Zhu C, Docimo S, Talamini MA, Pryor AD. Hospital utilization 4 years after bariatric surgery: sleeve gastrectomy versus Roux-en-Y gastric bypass. Surg Obes Relat Dis 2019; 15:1465-1472. [PMID: 31358393 DOI: 10.1016/j.soard.2019.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND While sleeve gastrectomy (SG) has lower perioperative risk compared with Roux-en-Y gastric bypass (RYGB), long-term data about their differential impact on overall health are unclear. Hospital use after bariatric surgery is an important parameter for improving peri- and postoperative care. OBJECTIVE This present study was aimed to compare SG and RYGB in terms of their effect on long-term hospital-based healthcare utilization. SETTING Multicenter, statewide database. METHODS A retrospective cohort study of adult patients who underwent SG and RYGB between 2009 and 2011, with follow-up until 2015 and 2-year presurgery information. Propensity score-matched SG and RYGB groups were created using preoperative demographic characteristics, co-morbidities, and presurgery hospital use, measured by cumulative length of stay (LOS) and frequency of emergency department visits. Postsurgery yearly LOS, incidence of hospital visits, and the reason for the visit were compared. Primary outcomes included postoperative hospital visits during years 1 to 4 after bariatric surgery and cumulative LOS. Secondary outcomes included specific reasons for hospital use. RESULTS There were 3540 SG and 13,587 RYGB patients, whose mean (95% confidence interval [CI]) LOS was 1.3 (1.3-1.4), .9 (.8-1), 1 (.9-1.1), and 1.2 (1-1.3) days at years 1 through 4, respectively. Postoperative yearly LOS was similar between the 2 propensity-matched groups. The risk of hospitalizations (odd ratio .73, 95% CI .64-.84, P < .0001) and emergency department visits (odds ratio .84, 95% CI .75-.95, P = .005) was significantly lower for SG, during the first postoperative year. The reverse was seen at the fourth postoperative year, with higher risk of emergency department use after SG (odds ratio 1.16, 95% CI 1.01-1.33, P = .035). CONCLUSION Postoperative 4-year hospital utilization remains low for both SG and RYGB. The previously established lower early perioperative risk of SG was not appreciated for longer-term hospital use compared with RYGB.
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Affiliation(s)
- Konstantinos Spaniolas
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Iliya Goldberg
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York.
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Chencan Zhu
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York
| | - Salvatore Docimo
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Mark A Talamini
- Office of the Chairman, Department of Surgery, Health Sciences Center T19-010, Stony Brook Medicine, Stony Brook, New York
| | - Aurora D Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
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Furbetta N, Gragnani F, Flauti G, Guidi F, Furbetta F. Laparoscopic adjustable gastric banding on 3566 patients up to 20-year follow-up: Long-term results of a standardized technique. Surg Obes Relat Dis 2018; 15:409-416. [PMID: 30704912 DOI: 10.1016/j.soard.2018.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/17/2018] [Accepted: 12/06/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND As obesity is a chronic disease, any bariatric procedure should be validated by long-term results. OBJECTIVE To present our long-term results after laparoscopic adjustable gastric banding over a period of >20 years and to investigate the outcomes in terms of efficacy, complications, and reoperations. SETTING Private practice, Italy. METHODS From October 1995 to February 2018, 3566 laparoscopic adjustable gastric banding were performed by a single surgeon. Data were retrieved from a prospectively collected computer database and retrospectively analyzed. Furthermore, patients were stratified according to body mass index and age and results are evaluated for each subgroup. RESULTS All the operations were performed laparoscopically without any mortality and/or major specific complications. Nine hundred twenty-six patients (71.6%) completed at least 10-years follow-up and 180 (58.4%) reached 15-years follow-up. There was a mean of 49%, 52.6%, and 59.2% of excess weight loss at 10, 15, and 20 years, respectively. Major late complications were pouch herniation-dilation (5.8%) and erosion (2.5%), both solved by a replicable, less invasive operation. Total reoperation rate was 24.1%. CONCLUSION Our experience suggested that the combination of a standardized surgical technique and close patient follow-up, performed in collaboration with an interdisciplinary team, may make the laparoscopic adjustable gastric banding system a powerful long-term surgical tool in the treatment of morbid obesity. The best results were obtained in young patients with high body mass index but results were also satisfactory in elderly patients and in those with low body mass index.
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Affiliation(s)
- Niccolò Furbetta
- General Surgery, Department of Surgery, University of Pisa, Pisa, Italy.
| | - Francesca Gragnani
- General and laparoscopic Surgery, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
| | - Giuseppe Flauti
- General and laparoscopic Surgery, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
| | - Francesco Guidi
- Anesthesiologist, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
| | - Francesco Furbetta
- General and laparoscopic Surgery, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
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Main WP, Murphy AE, Hussain LR, Meister KM, Tymitz KM. Thirty-Day Readmission Rate Using an Outpatient Infusion Pathway after Laparoscopic Roux-en-Y Gastric Bypass. Am Surg 2018. [DOI: 10.1177/000313481808400944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The objective of this study was to determine whether implementing an outpatient infusion pathway (OIP) resulted in a decreased 30-day readmission rate after laparoscopic Roux-en-Y gastric bypass (LRYGB). Data were retrospectively gathered on all patients who underwent LRYGB at our institution between April 1, 2015, and March 31, 2016, after instituting an OIP (postinfusion group). Thirty-day readmission rate, length of stay, and 30-day mortality rate were compared with patients who underwent LRYGB between January 1, 2014, and December 31, 2014, before implementing the OIP (preinfusion group). Patients not able to take 40 ounces of fluid orally at discharge after surgery were enrolled in the OIP. One OIP session would include an antiemetic, 1 liter bolus of 0.9 per cent saline, and intravenous multivitamin, thiamine, and folic acid. A total of 174 patients were included for analysis. Seventy-nine patients were in the pre-infusion group and 95 patients in the postinfusion group. Of the 95 patients in the postinfusion group, 18 patients (18.9%) met inclusion criteria for the OIP. There was a 45 per cent decrease in 30-day readmission rate after the institution of the OIP for patients who underwent LRYGB, however this was not statistically significant (11.39% vs 6.31%; OR 1.907; 95% confidence interval: 0.648–5.613, P = 0.235). There was no difference in postoperative length of hospital stay (1.65 vs 1.41 days, P = 0.114) or mortality (0.7% vs 0%, P = 0.454), in the pre- and postinfusion groups, respectively. Implementation of an OIP decreased 30-day readmission rate after LRYGB by 45 per cent; however, this was not statistically significant.
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Affiliation(s)
| | | | - Lala R. Hussain
- TriHealth Hatton Research Institute, TriHealth, Cincinnati, Ohio
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Lee SA, Park EC, Shin J, Ju YJ, Choi Y, Lee HY. Patient and hospital factors associated with 30-day unplanned readmission in patients with stroke. J Investig Med 2018; 67:52-58. [DOI: 10.1136/jim-2018-000748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/23/2018] [Accepted: 06/23/2018] [Indexed: 11/03/2022]
Abstract
Stroke is frequently associated with readmission; moreover, readmission is regarded as an important indicator of the quality of stroke care. Thus, we investigated factors associated with 30-day readmission in patients with stroke in South Korea. We used claims data from 2013 for stroke (I60–I62) patients (n=44 729) in 94 hospitals and classified unplanned readmission according to the Centers for Medicare and Medicaid guidelines. We used multilevel models to investigate patient (age, gender, type of insurance, admission via emergency room, length of stay, type of stroke, Elixhauser Index Score) and hospital (stroke care quality grade, location of hospital, type of hospital, number of doctors and nurses per 100 beds) factors associated with readmission within 30 days of discharge. Among the 44 729 patients admitted due to stroke, 9.2% (n=4124) were readmitted to hospital and 7.6% (n=3379) had unplanned readmissions. Regarding patient characteristics, medical aid and longer hospital stay were associated with 30-day readmission rate. Among hospital factors, patients admitted to a low-grade hospital or a non-capital area hospital were more likely to be readmitted within 30 days of discharge. We identified patient and hospital factors associated with 30-day readmission among stroke patients. In particular, patients admitted to hospitals with higher quality stroke care showed lower readmission rates.
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Affiliation(s)
- Tyler S Wahl
- Department of Surgery, University of Alabama at Birmingham, 1722 7th Avenue South, Kracke Building 217, Birmingham, AL 35249, USA
| | - Mary T Hawn
- Surgery, Stanford University, Alway Building M121, 300 Pasteur Drive, MC 5115, Stanford, CA 94305, USA.
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Takemoto E, Andrea SB, Wolfe BM, Nagel CL, Boone-Heinonen J. Weighing in on Bariatric Surgery: Effectiveness Among Medicaid Beneficiaries-Limited Evidence and Future Research Needs. Obesity (Silver Spring) 2018; 26:463-473. [PMID: 29464910 DOI: 10.1002/oby.22059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/09/2017] [Accepted: 09/12/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION In the general population, bariatric surgery is well documented as the most effective obesity treatment for sustained weight loss and remission of comorbidities. Characterization of the patient populations most likely to benefit from surgical intervention is needed, but the heterogeneity of treatment effects across payer groups has not been reviewed. METHODS A systematic review of published studies focusing on bariatric surgery outcomes among Medicaid beneficiaries was conducted. By using PubMed and Scopus, this study searched for studies that quantitatively compared clinical or social bariatric surgery outcomes for United States adult Medicaid recipients and commercially insured patients. RESULTS Of the 568 titles reviewed, 21 met inclusion criteria. Weight loss and the remission of comorbidities at 1 or 2 years postoperatively were similar between groups despite differences in baseline health status. Short-term health care utilization and mortality outcomes were worse in Medicaid recipients; for instance, Medicaid patients had an average length of stay that was 2 days longer and experienced three more deaths in the first postoperative year. CONCLUSIONS The critical research gaps in the evidence base needed to improve treatment guidelines for Medicaid patients undergoing bariatric surgery include an understanding of the causes of the baseline health differences and how these differences contribute to postoperative outcomes.
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Affiliation(s)
- Erin Takemoto
- OHSU-PSU School of Public Health, Portland, Oregon, USA
| | | | - Bruce M Wolfe
- Department of Surgery, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Corey L Nagel
- OHSU-PSU School of Public Health, Portland, Oregon, USA
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Larsen AT, Højgaard B, Ibsen R, Kjellberg J. The Socio-economic Impact of Bariatric Surgery. Obes Surg 2017; 28:338-348. [DOI: 10.1007/s11695-017-2834-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Affiliation(s)
- Tyler S Wahl
- Department of Surgery, University of Alabama at Birmingham, 1922 7th Avenue South, Kracke Building 417, Birmingham, AL 35249, USA
| | - Mary T Hawn
- Department of Surgery, Stanford University, Alway Building M121, 300 Pasteur Drive, MC 5115, Stanford, CA 94305-2200, USA.
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Kumpf VJ, Slocum K, Binkley J, Jensen G. Complications After Bariatric Surgery: Survey Evaluating Impact on the Practice of Specialized Nutrition Support. Nutr Clin Pract 2017; 22:673-8. [DOI: 10.1177/0115426507022006673] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Vanessa J. Kumpf
- Vanderbilt University Medical Center, Nashville,
Tennessee; University of Alabama, Birmingham,
Alabama; Maury Regional Hospital, Columbia,
Tennessee; Penn State University, University
Park, Pennsylvania
| | - Kelsey Slocum
- Vanderbilt University Medical Center, Nashville,
Tennessee; University of Alabama, Birmingham,
Alabama; Maury Regional Hospital, Columbia,
Tennessee; Penn State University, University
Park, Pennsylvania
| | - Jeff Binkley
- Vanderbilt University Medical Center, Nashville,
Tennessee; University of Alabama, Birmingham,
Alabama; Maury Regional Hospital, Columbia,
Tennessee; Penn State University, University
Park, Pennsylvania
| | - Gordon Jensen
- Vanderbilt University Medical Center, Nashville,
Tennessee; University of Alabama, Birmingham,
Alabama; Maury Regional Hospital, Columbia,
Tennessee; Penn State University, University
Park, Pennsylvania
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Ahmed A, AlBuraikan D, ALMuqbil B, AlJohi W, Alanazi W, AlRasheed B. Readmissions and Emergency Department Visits after Bariatric Surgery at Saudi Arabian Hospital: The Rates, Reasons, and Risk Factors. Obes Facts 2017; 10:432-443. [PMID: 28988235 PMCID: PMC5741164 DOI: 10.1159/000456667] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/11/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Saudi Arabian hospital readmissions and emergency department (ED) visits following bariatric surgery and discharge have never been investigated. This study aimed to evaluate the rates and reasons of hospital readmissions and ED visits related to surgical weight loss interventions at the King Abdulaziz Medical City - Riyadh. METHODS We conducted a retrospective cohort study on 301 patients who underwent bariatric surgery between January 2011 and July 2016. We reviewed patient medical records progressively to assess hospital readmission, ED visits, and complications. RESULTS Of the 301 patients analyzed, 67.1% were female and 93% had class II obesity. The readmission rate, ED visit rate after discharge and the rate of either of the two was 8%, 14%,and 18.3%, respectively. The most common causes of readmission were abdominal pain (37.5%), nausea/vomiting (29.2%), and site leak (25%), while the most common causes of ED visits were abdominal pain (59.5%) and nausea/vomiting (16.9%). Readmission rates tended to be higher in older patients (age of patients readmitted 42 ± 12.1 years vs. age of patients not readmitted 34.3 ± 11.8 years; p = 0.002). The rate of readmission tends to increase in patients with overweight or class I obesity (odds ratio (OR) = 20.15), diabetes (OR = 14.82), and obstructive sleep apnea (OR = 14.29). Dyslipidemia was positively associated with ED visits (p = 0.027, OR = 2.87). The rate of readmission or ED visits increased with age, while there were decreases in readmission and ED visits for those who had received gastric sleeve surgery. CONCLUSIONS The study reported high rates of readmission and ED visits, thus the effectiveness of different types of weight loss surgeries should be further evaluated, particularly in individuals with complicated medical issues such as diabetes, dyslipidemia, and obstructive sleep apnea.
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Affiliation(s)
- Anwar Ahmed
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- *Anwar Ahmed, Ph.D., College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, MC 2350, P.O. Box 22490, 11426 Riyadh, Saudi Arabia,
| | - Doaa AlBuraikan
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Bashayr ALMuqbil
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Wijdan AlJohi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Wala Alanazi
- Al-Maarefa College for Science and Technology, Riyadh, Saudi Arabia
| | - Budor AlRasheed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Factors associated with bariatric postoperative emergency department visits. Surg Obes Relat Dis 2016; 12:1826-1831. [DOI: 10.1016/j.soard.2016.02.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 11/19/2022]
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Garg T, Rosas U, Rogan D, Hines H, Rivas H, Morton JM, Azagury D. Characterizing Readmissions After Bariatric Surgery. J Gastrointest Surg 2016; 20:1797-1801. [PMID: 27613733 DOI: 10.1007/s11605-016-3247-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/10/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Readmissions are an important quality metric for surgery. Here, we compare characteristics of readmissions across laparoscopic Roux-en-Y gastric bypass (LRYGB), sleeve gastrectomy (LSG), and adjustable gastric band (LAGB). METHODS Demographic, intraoperative, anthropometric, and laboratory data were prospectively obtained for 1775 patients at a single academic institution. All instances of readmissions within 1 year were recorded. Data were analyzed using STATA, release 12. RESULTS For the 1775 patients, 113 (6.37 %) were readmitted. Mean time to readmission was 52.1 days. Of all the readmissions, 64.6 % were within 30 days, 22.1 % from 30 to 90 days, 1.77 % from 90 to 180 days, and 11.5 % from 180 to 365 days. Incidence of 30-day readmissions varied across surgeries (LRYGB: 7.17 %; LAGB: 3.05 %; LSG: 4.25 %, p = 0.04). Time to readmission varied as well, with 90.0 % of LSG and 80.0 % of LABG patients within the first 30 days, versus 60.8 % of LRYGB (p = 0.02). The most common causes of readmissions were gastrointestinal issues related to index procedure (34.5 %) and did not vary across surgeries. In multivariable logistic regression, index hospital length of stay (LOS) was associated with readmission (OR = 1.07, 95 % CI 1.02-1.13, p = 0.01). CONCLUSIONS Readmissions after bariatric surgery are associated with high index hospital LOS, and a measureable proportion of procedure-related readmissions can occur up to 1 year, especially for LRYGB.
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Affiliation(s)
- Trit Garg
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
| | - Ulysses Rosas
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
| | - Daniel Rogan
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
| | - Harrison Hines
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
| | - Homero Rivas
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
| | - John M Morton
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA.
- , 300 Pasteur Drive, H3680, Stanford, CA, 94305, USA.
| | - Dan Azagury
- Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, Stanford, USA
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Doumouras AG, Saleh F, Tarride JE, Hong D. A population-based analysis of the drivers of short-term costs after bariatric surgery within a publicly funded regionalized center of excellence system. Surg Obes Relat Dis 2016; 12:1023-1031. [DOI: 10.1016/j.soard.2016.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
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Bhatti JA, Nathens AB, Thiruchelvam D, Redelmeier DA. Weight loss surgery and subsequent emergency care use: a population-based cohort study. Am J Emerg Med 2016; 34:861-5. [DOI: 10.1016/j.ajem.2016.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 12/15/2015] [Accepted: 02/02/2016] [Indexed: 01/01/2023] Open
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Garg T, Rosas U, Rivas H, Azagury D, Morton JM. National prevalence, causes, and risk factors for bariatric surgery readmissions. Am J Surg 2016; 212:76-80. [PMID: 27133197 DOI: 10.1016/j.amjsurg.2016.01.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 01/03/2016] [Accepted: 01/05/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Readmissions are often used as a quality metric particularly in bariatric surgery. METHODS Laparoscopic Roux en Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy were identified using Current Procedure Terminology codes in the 2012 National Surgical Quality Improvement Program public use file. RESULTS A total of 18,296 patients were included, 10,080 (55.1%) were laparoscopic Roux en Y gastric bypass, 1,829 (10.0%) were laparoscopic adjustable gastric banding, and 6,387 (34.9%) were laparoscopic sleeve gastrectomy. Among all patients, 955 (5.22%) were readmitted. Patients with readmissions had a higher proportion of body mass index greater than 50 (30.2% vs 24.6%, P < .001), higher index operative time (132 minutes vs 115, P < .001) and greater proportion with length of stay greater than 4 days (9.57% vs 3.36%, P < .001). Readmitted patients were more likely to have diabetes (31.1% vs 27.7%, P = .02), chronic obstructive pulmonary disease (2.63% vs 1.72%, P = .04), and hypertension (54.5% vs 50.8%, P = .03). Overall, 40.6% of readmitted patients had a complication. Common readmissions were gastrointestinal-related (45.0%), dietary (33.5%), and bleeding (6.57%). Readmission was independently associated with African-American race (odds ratio [OR] = 1.53, P = .02), complication (OR = 11.3, 95%, P < .001), and resident involvement (OR = .53, P = .04). CONCLUSIONS A 30-day readmission after bariatric surgery is prevalent and closely associated with complications.
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Affiliation(s)
- Trit Garg
- Department of Surgery, Section of Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305, USA
| | - Ulysses Rosas
- Department of Surgery, Section of Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305, USA
| | - Homero Rivas
- Department of Surgery, Section of Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305, USA
| | - Dan Azagury
- Department of Surgery, Section of Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305, USA
| | - John M Morton
- Department of Surgery, Section of Bariatric and Minimally Invasive Surgery, Stanford School of Medicine, 300 Pasteur Drive, H3680, Stanford, CA 94305, USA.
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BEFORE-AND-AFTER STUDY: DOES BARIATRIC SURGERY REDUCE HEALTHCARE UTILIZATION AND RELATED COSTS AMONG OPERATED PATIENTS? Int J Technol Assess Health Care 2016; 31:407-13. [DOI: 10.1017/s0266462315000653] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Healthcare use and costs are about 81% higher for morbidly obese individuals compared to non-obese persons, and 47% higher compared to the non-morbidly obese population. The benefits of bariatric surgery for health are well established, but its mid-term impact on healthcare use and costs remains controversial.Methods: This study examines the trends in healthcare use and costs in a Brazilian cohort during a 4-year period before and after surgery. Healthcare use and direct costs related to inpatients and outpatients were retrieved from a healthcare insurance company database from which all cohort members were selected.Results: Between 2004 and 2010, 4,006 individuals underwent bariatric surgery. Most patients were female (80%) with a mean age of 36.2 years and a mean body mass index of 42.8 kg/m2. Elevated blood pressure was present in 38% of cases and diabetes was found in 12.5% of subjects. Hospital admissions increased consistently after surgery, even after excluding hospitalizations for esthetic surgery and pregnancy-related care. The most prevalent conditions in this group were gastrointestinal diseases. Emergency department visits increased after bariatric procedures, in particular for genitourinary and hematologic problems. Adjusted costs were higher after surgery as assessed during a 4-year follow-up period.Conclusion: Results indicate that costs and hospital admissions after bariatric surgery increase following this procedure, even when elective interventions are excluded. Healthcare providers and policy makers need to be aware that a decrease in obesity-related diseases following bariatric surgery does not reduce healthcare use and costs.
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Lewis KH, Zhang F, Arterburn DE, Ross-Degnan D, Gillman MW, Wharam JF. Comparing Medical Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass. JAMA Surg 2015; 150:787-94. [PMID: 26039097 DOI: 10.1001/jamasurg.2015.1081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE There is conflicting evidence about how different bariatric procedures impact health care use. OBJECTIVE To compare the impact of laparoscopic adjustable gastric banding (AGB) and laparoscopic Roux-en-Y gastric bypass (RYGB) on health care use and costs. DESIGN, SETTING, AND PARTICIPANTS Retrospective interrupted time series with comparison series study using a national claims data set. The data analysis was initiated in September 2011 and completed in January 2015. We identified bariatric surgery patients aged 18 to 64 years who underwent a first AGB or RYGB between 2005 and 2011. We propensity score matched 4935 AGB to 4935 RYGB patients according to baseline age group, sex, race/ethnicity, socioeconomic variables, comorbidities, year of procedure and baseline costs, emergency department (ED) visits, and hospital days. Median postoperative follow-up time was 2.5 years. MAIN OUTCOMES AND MEASURES Quarterly and yearly total health care costs, ED visits, hospital days, and prescription drug costs. We used segmented regression to compare pre-to-post changes in level and trend of these measures in the AGB vs the RYGB groups and difference-in-differences analysis to estimate the magnitude of difference by year. RESULTS Both AGB and RYGB were associated with downward trends in costs; however, by year 3, AGB patients had total annual costs that were 16% higher than RYGB patients (P < .001; absolute change: $818; 95% CI, $278 to $1357). In postoperative years 1 and 2, AGB was associated with 27% to 29% fewer ED visits than RYGB (P < .001; absolute changes: -0.6; 95% CI, -0.9 to -0.4 and -0.4; 95% CI, -0.6 to -0.1 visits/person, respectively); however, by year 3, there were no detectable differences. Postoperative annual hospital days were not significantly different between the groups. Although both procedures lowered prescription costs, annual postoperative prescription costs were 17% to 32% higher for AGB patients than RYGB patients (P < .001). CONCLUSIONS AND RELEVANCE Both laparoscopic AGB and RYGB were associated with flattened total health care cost trajectories but RYGB patients experienced lower total and prescription costs by 3 years postsurgery. On the other hand, RYGB was associated with increased ED visits in the 2 years after surgery. Clinicians and policymakers should weigh such differences in use and costs when making recommendations or shaping regulatory guidance about these procedures.
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Affiliation(s)
- Kristina H Lewis
- Kaiser Permanente Georgia, Center for Clinical and Outcomes Research, Atlanta2Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Fang Zhang
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Matthew W Gillman
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - J Frank Wharam
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Doumouras AG, Saleh F, Hong D. 30-Day readmission after bariatric surgery in a publicly funded regionalized center of excellence system. Surg Endosc 2015; 30:2066-72. [PMID: 26275546 DOI: 10.1007/s00464-015-4455-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/12/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Avoidable readmission after surgery is a major burden on healthcare resources and is common after major surgery. Bariatric surgery is one of the most common surgical procedures in North America, and there is a paucity of strategies to prevent readmission. Strategies for prevention must first identify actual risk factors before interventions can be designed. METHODS Our objective was to evaluate the readmission rate, characteristics of readmitted patients, and factors associated with readmission. We performed a population-based cohort study that included all patients who received a Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) procedure in Ontario from April 2009 until March 2012 for the purposes of weight loss. Data were derived from the Canadian Institute for Health Information Discharge Abstract Database and Hospital Morbidity Database. RESULTS Over 3 years, 5007 procedures (91.7 % RYGB, 8.1 % SG) were performed with an overall 30-day readmission rate of 6.1 %. Readmission stays of 72 h or less accounted for 83 % of the cohort. The most common reasons for readmission were: infectious complications (24.6 %), pain (16.4 %) nausea/vomiting (11.5 %), bleeding complications (11.5 %), obstruction (5.6 %). A complication during initial admission OR 2.07 (95 % CI 1.44-2.97; P value < 0.001) and a length of stay greater than 2 days OR 1.40 (95 % CI 1.07-1.84; P value = 0.013) were independent predictors of readmission within 30 days. CONCLUSION The readmission rate after bariatric surgery in Ontario is similar to other major population-based bariatric surgery programs. Complications on initial admission and prolonged length of stay were independent predictors of readmission. Considering a large proportion of the readmissions were short term, future research into potential measures to prevent these readmissions is essential.
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Affiliation(s)
- Aristithes G Doumouras
- Department of Surgery, McMaster University, Hamilton, ON, Canada. .,Division of General Surgery, St. Joseph's Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| | - Fady Saleh
- Division of General Surgery, St. Joseph's Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Dennis Hong
- Department of Surgery, McMaster University, Hamilton, ON, Canada.,Division of General Surgery, St. Joseph's Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
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Edye M, Talbot ML. Inequalities of access to bariatric surgery in Australia. Med J Aust 2014; 201:502-3. [PMID: 25358562 DOI: 10.5694/mja14.01169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 10/08/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Michael Edye
- Blacktown/Mt Druitt Clinical School, University of Western Sydney, Sydney, NSW, Australia.
| | - Michael L Talbot
- Department of Surgery, St George Hospital, Sydney, NSW, Australia
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Predicting potentially preventable hospital readmissions following bariatric surgery. Surg Obes Relat Dis 2014; 11:866-72. [PMID: 25868837 DOI: 10.1016/j.soard.2014.12.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/20/2014] [Accepted: 12/17/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Using hospital readmissions as a quality of care measure predicates that some readmissions were preventable. OBJECTIVES This study identifies predictors of potentially preventable readmissions (PPR) within 30 days of bariatric surgery discharge. SETTING New York State acute care hospitals. METHODS Adult inpatient surgical discharges, during 2012, with a principal diagnosis of overweight or obesity and a principal procedure for bariatric surgery were identified. Logistic regression was used to evaluate surgical approach, sex, age, race/ethnicity, payor, body mass index, complications and co-morbidities recorded during the surgical admission. RESULTS There were 10,448 surgeries studied for readmission of which 552 were followed by a PPR, for a statewide rate of 5.3 per 100 surgeries. Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) was the most common surgical approach (46.0%), then Sleeve Gastrectomy (SG) (41.3%), Laparoscopic Adjustable Gastric Band (LAGB) (8.1%), and Open Roux-en-Y Gastric Bypass (RYGB) (4.6%). RYGB had the highest PPR rate (8.8), followed by LRYGB (6.1), SG (4.3) and LAGB (3.3). Compared to LAGB, the odds of a PPR in patients with RYGB, LRYGB, and SG increased by 2.4 fold, 1.8 fold and 1.2 fold respectively. Black, non-Hispanic patients were at a greater risk of PPR (odds-ratio 2.0, P<.0001) compared to White, non-Hispanic patients while the risk of a PPR increased by 2-fold in patients with a surgical complication. CONCLUSIONS Taking all patient risk factors into account, the most significant predictors of a PPR were surgical approach, race and the presence of a surgical complication.
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Talbot ML. Revision LAGB to RYGBP in patients with BMI<35: not yet ready for prime time. Surg Obes Relat Dis 2014; 10:1109. [PMID: 25393048 DOI: 10.1016/j.soard.2014.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
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Telem DA, Talamini M, Gesten F, Patterson W, Peoples B, Gracia G, Yang J, Zhang Q, Altieri M, Pryor AD. Hospital admissions greater than 30 days following bariatric surgery: patient and procedure matter. Surg Endosc 2014; 29:1310-5. [PMID: 25294523 DOI: 10.1007/s00464-014-3834-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 08/15/2014] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Assessment of hospital admission in the 30-day period following bariatric surgery likely underestimates true hospital utilization. The purpose of this study is to assess hospital admissions for 2 years following bariatric surgery to identify potential differences by patient and procedure. METHODS New York State Planning and Research Cooperative System (SPARCS) longitudinal administrative data were used to identify 22,139 adult patients who underwent a primary bariatric surgery from 2006 to 2008. Bariatric operations included laparoscopic gastric banding (LGB), laparoscopic Roux-en-y gastric bypass (RYGB), and laparoscopic sleeve gastrectomy (LSG). Patients were followed for 2 years after surgery to identify all-cause hospital admissions. Statistical correlation between postoperative hospital admission and patient demographics, comorbid conditions, and bariatric procedure was performed. RESULTS Of the 22,139 patients, 5,718 (26 %) patients were admitted within 2 years of surgery for a total of 9,502 admissions. Thirty-day admission rate was 5 %. The number of admissions per patient ranged from 1 to 22. Assessing the number of admissions per patient demonstrated that 3,741 (17 %) patients had one, 1,575 (7 %) had 2-3, and 402 (2 %) patients had greater than 4 admissions. LSG had both the highest admission rate and percentage of patients with >4 admissions, followed by RYGB and then LGB (p < 0.001). Risk factors for admission included black race, female gender, age > 50, Medicaid/Medicare as payer, congestive heart failure, pulmonary disease, diabetes, rheumatoid arthritis, history of substance abuse, and psychoses/depression. CONCLUSION One out of four bariatric patients will be admitted to the hospital within 2 years of surgery. While most patients are admitted only once, a subset of patients requiring numerous hospital admissions was identified. LSG is associated with both the highest rate as well as highest frequency of hospital admissions. Several patient factors were also identified that significantly increased admission risk. Consideration and attention to these factors are necessary for operative planning, preoperative patient education, and postoperative monitoring.
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Affiliation(s)
- Dana A Telem
- Division of Bariatric and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA,
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Tayne S, Merrill CA, Shah SN, Kim J, Mackey WC. Risk factors for 30-day readmissions and modifying postoperative care after gastric bypass surgery. J Am Coll Surg 2014; 219:489-95. [PMID: 25151343 DOI: 10.1016/j.jamcollsurg.2014.03.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/08/2014] [Accepted: 03/10/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although hospital 30-day readmissions policies currently focus on medical conditions, readmission penalties will be expanding to encompass surgical procedures, logically beginning with common and standardized procedures, such as gastric bypass. Therefore, understanding predictors of readmission is essential in lowering readmission rate for these procedures. STUDY DESIGN This is a retrospective case-control study of patients undergoing laparoscopic gastric bypass at Tufts Medical Center from 2007 to 2012. Variables analyzed included demographics, comorbidities, intraoperative events, postoperative complications, discharge disposition, and readmission diagnoses. Univariate analysis was used to identify factors associated with readmission, which were then subjected to multivariable logistic regression analysis. RESULTS We reviewed 358 patients undergoing laparoscopic gastric bypass, 119 readmits, and 239 controls. By univariate analysis, public insurance, body mass index >60 kg/m(2), duration of procedure, high American Society of Anesthesiologists (ASA) class, and discharge with visiting nurse services (VNA) were significantly associated with 30-day readmissions. In the regression model, duration of procedure, high ASA class, and discharge with visiting nurse services (VNA) remained significantly associated with readmission when controlling for other factors (odds ratio [OR] 1.523, 95% CI 1.314 to 1.766; OR 2.447, 95% CI 1.305 to 4.487; and OR 0.053 with 95% CI 0.011 to 0.266, respectively). The majority of readmissions occurred within the first week after discharge. Gastrointestinal-related issues were the most common diagnoses on readmission, and included anastomotic leaks, postoperative ileus, and bowel obstruction. The next 2 most common reasons for readmission were wound infection and fluid depletion. CONCLUSIONS Using readmission risk, we can stratify patients into tiered clinical pathways. Because most readmissions occur within the first postdischarge week and are most commonly associated with dehydration, pain, or wound issues, focusing our postoperative protocols and patient education should further lower the incidence of readmission.
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Affiliation(s)
| | | | - Sajani N Shah
- Department of Surgery, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - Julie Kim
- Department of Surgery, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | - William C Mackey
- Department of Surgery, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
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Vauthier V, Swartz TD, Chen P, Roujeau C, Pagnon M, Mallet J, Sarkis C, Jockers R, Dam J. Endospanin 1 silencing in the hypothalamic arcuate nucleus contributes to sustained weight loss of high fat diet obese mice. Gene Ther 2014; 21:638-44. [PMID: 24784449 DOI: 10.1038/gt.2014.36] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 02/19/2014] [Accepted: 03/21/2014] [Indexed: 12/21/2022]
Abstract
Leptin targets specific receptors (OB-R) expressed in the hypothalamus to regulate energy balance. Leptin decreases food intake in normal weight individuals, but this effect is blunted in obese subjects who are characterized by a state of leptin resistance. The prevention of leptin resistance is one of the major goals of obesity research. Recently, we identified endospanin 1 as a negative regulator of OB-R, which by interacting with OB-R retains the receptor inside the cell. We show here that in obese mice endospanin 1 is upregulated in the hypothalamic arcuate nucleus (ARC), the major brain structure involved in body weight regulation, suggesting that endospanin 1 is implicated in obesity development and/or the installation of leptin resistance. In contrast, silencing of endospanin 1 with lentiviral vectors in the ARC of obese mice fully restores leptin responsiveness when combined with a switch to ad libitum fed chow diet. The recovery of central leptin sensitivity is accompanied by sustained body weight loss and amelioration of blood lipid parameters and steatosis. Collectively, our results define endospanin 1 as a novel therapeutic target against obesity.
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Affiliation(s)
- V Vauthier
- 1] Inserm, U1016, Institut Cochin, Paris, France [2] CNRS UMR 8104, Paris, France [3] University Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - T D Swartz
- 1] Inserm, U1016, Institut Cochin, Paris, France [2] CNRS UMR 8104, Paris, France [3] University Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - P Chen
- 1] Inserm, U1016, Institut Cochin, Paris, France [2] CNRS UMR 8104, Paris, France [3] University Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - C Roujeau
- 1] Inserm, U1016, Institut Cochin, Paris, France [2] CNRS UMR 8104, Paris, France [3] University Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - M Pagnon
- 1] Inserm, U1016, Institut Cochin, Paris, France [2] CNRS UMR 8104, Paris, France [3] University Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - J Mallet
- UMR 7091, University Paris Pierre et Marie Curie (UPMC), CNRS, NewVectys, Paris, France
| | - C Sarkis
- UMR 7091, University Paris Pierre et Marie Curie (UPMC), CNRS, NewVectys, Paris, France
| | - R Jockers
- 1] Inserm, U1016, Institut Cochin, Paris, France [2] CNRS UMR 8104, Paris, France [3] University Paris Descartes, Sorbonne Paris Cite, Paris, France
| | - J Dam
- 1] Inserm, U1016, Institut Cochin, Paris, France [2] CNRS UMR 8104, Paris, France [3] University Paris Descartes, Sorbonne Paris Cite, Paris, France
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Risk factors for 30-day readmission in patients undergoing ventral hernia repair. Surgery 2014; 155:702-10. [DOI: 10.1016/j.surg.2013.12.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/18/2013] [Indexed: 11/24/2022]
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Abstract
Obesity is an epidemic in the United States and Western World with an associated increasing impact on radiology departments. The increased prevalence of obesity in conjunction with the growing use and success of bariatric surgery results in an influx of obese patients into the health system in need of hospital services and care. Imaging services in particular are in demand in this patient population. Obese patients place special needs upon facilities and imaging equipment and also create technical challenges. This manuscript will address problems and potential solutions for imaging obese patients, specifically with regards to the modalities of radiography, fluoroscopy, computed tomography, and magnetic resonance imaging.
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Affiliation(s)
- Laura R Carucci
- Department of Radiology, Magnetic Resonance Imaging, Computed Tomography, Virginia Commonwealth University Health System, 1250 East Marshall Street, Richmond, VA 23298, USA.
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Nguyen GC, Patel AM. Racial Disparities in Mortality in Patients Undergoing Bariatric Surgery in the USA. Obes Surg 2013; 23:1508-14. [DOI: 10.1007/s11695-013-0957-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Harris TJ, Murphy TP, Jay BS, Hampson CO, Zafar AM. Visceral blood flow modulation: potential therapy for morbid obesity. Cardiovasc Intervent Radiol 2013; 36:803-8. [PMID: 23381772 DOI: 10.1007/s00270-013-0560-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 12/26/2012] [Indexed: 11/25/2022]
Abstract
We present this preliminary investigation into the safety and feasibility of endovascular therapy for morbid obesity in a swine model. A flow-limiting, balloon-expandable covered stent was placed in the superior mesenteric artery of three Yorkshire swine after femoral arterial cutdown. The pigs were monitored for between 15 and 51 days after the procedure and then killed, with weights obtained at 2-week increments. In the two pigs in which the stent was flow limiting, a reduced rate of weight gain (0.42 and 0.53 kg/day) was observed relative to the third pig (0.69 kg/day), associated with temporary food aversion and signs of mesenteric ischemia in one pig.
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Affiliation(s)
- Tyler J Harris
- Department of Vascular and Interventional Radiology, University of California, Los Angeles, 757 Westwood Blvd., Suite 1638, Los Angeles, CA 90095-7437, USA.
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Abstract
OBJECTIVE To determine the change in total medical expenditures, total pharmacy expenditures, and subcategories of medical and pharmacy expenditures in obese individuals following weight loss surgery (WLS), and to compare these costs with expenditures in obese individuals not receiving WLS. METHODS Louisiana Office of Group Benefits (OGB), the state-managed health insurer, invited members to be evaluated for insurance-covered WLS. Of 951 obese members who provided written consent to begin the WLS screening process, 40 were selected for surgery. Medical and pharmaceutical claims cost data of the 911 patients who did not have surgery and the 39 individuals who completed surgery were compared over a 2-year presurgical and 6-year postsurgical period. RESULTS Total nonpharmacy medical costs were lower for WLS patients compared with non-WLS patients beginning 4 years postsurgery and lasting through 6 years postsurgery. No differences were found between WLS and non-WLS patients in expenditures for most medical subcategories examined, including emergency department, physical and occupational therapy, office visits, and laboratory/pathology; whereas sleep facility and all remaining medical expenditures not represented by a subcategory were lower for WLS patients during some postsurgery years. Total pharmacy costs were lower for WLS participants at 2 and 3 years postsurgery, but these lower costs were not maintained; however, costs remained lower for antidiabetic agents, antihypertensive agents, and dyslipidemic agents through all 6 postsurgery years under study. CONCLUSIONS The cost of WLS may begin to be recouped within the first 4 years postsurgery with continued effects 6 years postsurgery.
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Kim JH, Wolfe B. Bariatric/Metabolic Surgery: Short- and Long-Term Safety. Curr Atheroscler Rep 2012; 14:597-605. [DOI: 10.1007/s11883-012-0287-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ramanan B, Gupta PK, Gupta H, Fang X, Forse RA. Development and Validation of a Bariatric Surgery Mortality Risk Calculator. J Am Coll Surg 2012; 214:892-900. [DOI: 10.1016/j.jamcollsurg.2012.02.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 02/14/2012] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
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Bolen SD, Chang HY, Weiner JP, Richards TM, Shore AD, Goodwin SM, Johns RA, Magnuson TH, Clark JM. Clinical outcomes after bariatric surgery: a five-year matched cohort analysis in seven US states. Obes Surg 2012; 22:749-63. [PMID: 22271357 PMCID: PMC4040221 DOI: 10.1007/s11695-012-0595-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective weight loss treatment, yet few studies have reported on short- and long-term outcomes postsurgery. METHODS Using claims data from seven Blue Cross/Blue Shield health plans serving seven states, we conducted a non-concurrent, matched cohort study. We followed 22,693 persons who underwent bariatric surgery during 2003-2007 and were enrolled at least 6 months before and after surgery. Using logistic regression, we compared serious and less serious adverse clinical outcomes, hospitalizations, planned procedures, and obesity-related co-morbidities between groups for up to 5 years. RESULTS Relative to controls, surgery patients were more likely to experience a serious [odds ratio (OR) 1.9; 95% confidence interval (CI) 1.8-2.0] or less serious (OR 2.5, CI 2.4-2.7) adverse clinical outcome or hospitalization (OR 1.3, CI 1.3-1.4) at 1 year postsurgery. The risk remained elevated until 4 years postsurgery for serious events and 5 years for less serious outcomes and hospitalizations. Some complication rates were lower for patients undergoing laparoscopic surgery. Planned procedures, such as skin reduction, peaked in postsurgery year 2 but remained elevated through year 5. Surgery patients had a 55% decreased risk of obesity-related co-morbidities, such as type 2 diabetes, in the first year postsurgery, which remained low throughout the study (year 5: OR 0.4, CI 0.4-0.5). CONCLUSIONS While bariatric surgery is associated with a higher risk of adverse clinical outcomes compared to controls, it also substantially decreased obesity-related co-morbidities during the 5-year follow-up.
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Affiliation(s)
- Shari Danielle Bolen
- Center for Health Care Research and Policy, Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, 2500 MetroHealth Drive, Rammelkamp building R234A, Cleveland, OH 44109, USA.
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Vanella S, Brisinda G, Marniga G, Crocco A, Bianco G, Maria G. Botulinum toxin for chronic anal fissure after biliopancreatic diversion for morbid obesity. World J Gastroenterol 2012; 18:1021-7. [PMID: 22416176 PMCID: PMC3296975 DOI: 10.3748/wjg.v18.i10.1021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 05/05/2011] [Accepted: 01/22/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To study the effect of botulinum toxin in patients with chronic anal fissure after biliopancreatic diversion (BPD) for severe obesity. METHODS Fifty-nine symptomatic adults with chronic anal fissure developed after BPD were enrolled in an open label study. The outcome was evaluated clinically and by comparing the pressure of the anal sphincters before and after treatment. All data were analyzed in univariate and multivariate analysis. RESULTS Two months after treatment, 65.4% of the patients had a healing scar. Only one patient had mild incontinence to flatus that lasted 3 wk after treatment, but this disappeared spontaneously. In the multivariate analysis of the data, two registered months after the treatment, sex (P = 0.01), baseline resting anal pressure (P = 0.02) and resting anal pressure 2 mo after treatment (P < 0.0001) were significantly related to healing rate. CONCLUSION Botulinum toxin, despite worse results than in non-obese individuals, appears the best alternative to surgery for this group of patients with a high risk of incontinence.
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Affiliation(s)
- Serafino Vanella
- Department of Surgery, Catholic School of Medicine, University Hospital Agostino Gemelli, 00168 Rome, Italy
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Dorman RB, Miller CJ, Leslie DB, Serrot FJ, Slusarek B, Buchwald H, Connett JE, Ikramuddin S. Risk for hospital readmission following bariatric surgery. PLoS One 2012; 7:e32506. [PMID: 22412881 PMCID: PMC3296721 DOI: 10.1371/journal.pone.0032506] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/31/2012] [Indexed: 01/06/2023] Open
Abstract
Background and Objectives Complications resulting in hospital readmission are important concerns for those considering bariatric surgery, yet present understanding of the risk for these events is limited to a small number of patient factors. We sought to identify demographic characteristics, concomitant morbidities, and perioperative factors associated with hospital readmission following bariatric surgery. Methods We report on a prospective observational study of 24,662 patients undergoing primary RYGB and 26,002 patients undergoing primary AGB at 249 and 317 Bariatric Surgery Centers of Excellence (BSCOE), respectively, in the United States from January 2007 to August 2009. Data were collected using standardized assessments of demographic factors and comorbidities, as well as longitudinal records of hospital readmissions, complications, and mortality. Results The readmission rate was 5.8% for RYGB and 1.2% for AGB patients 30 days after discharge. The greatest predictors for readmission following RYGB were prolonged length of stay (adjusted odds ratio [OR], 2.3; 95% confidence interval [CI], 2.0–2.7), open surgery (OR, 1.8; CI, 1.4–2.2), and pseudotumor cerebri (OR, 1.6; CI, 1.1–2.4). Prolonged length of stay (OR, 2.3; CI, 1.6–3.3), history of deep venous thrombosis or pulmonary embolism (OR, 2.1; CI, 1.3–3.3), asthma (OR, 1.5; CI, 1.1–2.1), and obstructive sleep apnea (OR, 1.5; CI, 1.1–1.9) were associated with the greatest increases in readmission risk for AGB. The 30-day mortality rate was 0.14% for RYGB and 0.02% for AGB. Conclusion Readmission rates are low and mortality is very rare following bariatric surgery, but risk for both is significantly higher after RYGB. Predictors of readmission were disparate for the two procedures. Results do not support excluding patients with certain comorbidities since any reductions in overall readmission rates would be very small on the absolute risk scale. Future research should evaluate the efficacy of post-surgical managed care plans for patients at higher risk for readmission and adverse events.
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Affiliation(s)
- Robert B. Dorman
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Christopher J. Miller
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Daniel B. Leslie
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Federico J. Serrot
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Bridget Slusarek
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Henry Buchwald
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - John E. Connett
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sayeed Ikramuddin
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
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Abstract
BACKGROUND The effect of bariatric surgery on health care utilization and costs among individuals with type 2 diabetes remains unclear. OBJECTIVE To examine health care utilization and costs in an insured cohort of individuals with type 2 diabetes after bariatric surgery. RESEARCH DESIGN Cohort study derived from administrative data from 2002 to 2008 from 7 Blue Cross Blue Shield Plans. PARTICIPANTS Seven thousand eight hundred six individuals with type 2 diabetes who had bariatric surgery. MEASURES Cost (inpatient, outpatient, pharmacy, and others) and utilization (number of inpatient days, outpatient visits, specialist visits). RESULTS Compared with presurgical costs, the ratio of hospital costs (excluding the initial surgery), among beneficiaries who had any hospital costs, was higher in years 2 through 6 of the postsurgery period and increased over time [post 1: odds ratio (OR)=0.58; 95% confidence interval (CI), 0.50-0.67; post 6: OR=3.43; 95% CI, 2.60-4.53]. In comparison with the presurgical period, the odds of having any health care costs was lower in the postsurgery period and remained relatively flat over time. Among those with hospitalizations, the adjusted ratio of inpatient days was higher after surgery (post 1: OR=1.05; 95% CI, 0.94-1.16; post 6: OR=2.77; 95% CI, 1.57-4.90). Among those with primary care visits, the adjusted OR was lower after surgery (post 1: OR=0.80; 95% CI, 0.78-0.82; post 6: OR=0.66; 95% CI, 0.57-0.76). CONCLUSIONS : In the 6 years after surgery, individuals with type 2 diabetes did not have lower health care costs than before surgery.
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“But Then I Learned…”: Weight loss surgery patients negotiate surgery discourses. Soc Sci Med 2011; 73:1230-7. [DOI: 10.1016/j.socscimed.2011.07.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 07/25/2011] [Accepted: 07/26/2011] [Indexed: 11/24/2022]
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Abstract
BACKGROUND To minimize morbidity and mortality associated with surgery risks in the obese patient, algorithms offer planning operative strategy. Because these algorithms often classify patients based on inadequate category granularity, outcomes may not be predicted accurately. We reviewed patient factors and patient outcomes for those who had undergone bariatric surgical procedures to determine relationships and developed a nomogram to calculate individualized patient risk. METHODS From the American College of Surgeons National Security Quality Improvement Program database, we identified 32,426 bariatric surgery patients meeting NIH criteria and treated between 2005 and 2008. We defined a composite binary outcome of 30-day postoperative morbidity and mortality. A predictive model based on preoperative variables was developed using multivariable logistic regression; a multiple imputation procedure allowed inclusions of observations with missing data. Model performance was assessed using the C-statistic. A calibration plot graphically assessed the agreement between predicted and observed probabilities in regard to 30-day morbidity/mortality. RESULTS The nomogram model was constructed for maximal predictive accuracy. The estimated C-statistic [95% confidence interval] for the predictive nomogram was 0.629 [0.614, 0.645], indicative of slight to moderate discriminative ability beyond that of chance alone, and the greatest impacts on the estimated probability of morbidity/mortality were determined to be age, body mass index, serum albumin, and functional status. CONCLUSIONS By accurately predicting 30-day morbidity and mortality, this nomogram may prove useful in patient preoperative counseling on postoperative complication risk. Our results additionally indicate that neither age nor presence of obesity-related comorbidities should exclude patients from bariatric surgery consideration.
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