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Lee S, Courtney M. The need for standardized perioperative care for patients undergoing bariatric and metabolic surgery in the United Kingdom. Clin Obes 2024; 14:e12650. [PMID: 38425267 DOI: 10.1111/cob.12650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/07/2023] [Accepted: 12/31/2023] [Indexed: 03/02/2024]
Abstract
Enhanced recovery after surgery (ERAS) protocols are shown to improve patient outcomes and reduce length of hospital stay. However, there is currently limited consensus on the perioperative management of patients undergoing bariatric and metabolic surgery (BMS) in the United Kingdom. This study aims to survey the level of consistency in patient care undergoing BMS. Bariatric nurse specialists from 30 bariatric units completed an anonymised, online survey from 21 December 2022 to 21 February 2023. Most units (77%) have implemented a premade postoperative care bundle protocol including predetermined timing of oral intake (77%) and postoperative day 1 bloods (60%). 63% of units have also established pre-set analgesia and anti-emetic bundles. Date of discharge is variable, ranging from 1 day after surgery (50%) to a 'two night stay' protocol (33%) to within 4 days after surgery (17%). Most follow-up clinics are either led by dietitians (33%) or both bariatric nurse specialists and dietitians collaboratively (57%). Patients are usually established on solid food 6 weeks after surgery in 53% (16/30) units. Chemical venous thromboembolism (VTE) prophylaxis was either given on day of surgery postoperatively (60%), day before (20%) or after (17%) surgery. Our study shows significant variability of care throughout the surgical pathway, in the study population. The results suggest a need for consensus guidelines outlining the best-practice approach to managing patients undergoing BMS; due to the heterogeneity of the patient group, these guidelines should contain overarching generalisable recommendations that can then be tailored to individual patients.
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Affiliation(s)
- Shiela Lee
- Bariatric Unit, Sunderland Royal Hospital, Sunderland, UK
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El Ansari W, El-Menyar A, El-Ansari K, Al-Ansari A, Lock M. Cumulative Incidence of Venous Thromboembolic Events In-Hospital, and at 1, 3, 6, and 12 Months After Metabolic and Bariatric Surgery: Systematic Review of 87 Studies and Meta-analysis of 2,731,797 Patients. Obes Surg 2024; 34:2154-2176. [PMID: 38602603 PMCID: PMC11127857 DOI: 10.1007/s11695-024-07184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
Systematic review/meta-analysis of cumulative incidences of venous thromboembolic events (VTE) after metabolic and bariatric surgery (MBS). Electronic databases were searched for original studies. Proportional meta-analysis assessed cumulative VTE incidences. (PROSPERO ID:CRD42020184529). A total of 3066 records, and 87 studies were included (N patients = 4,991,683). Pooled in-hospital VTE of mainly laparoscopic studies = 0.15% (95% CI = 0.13-0.18%); pooled cumulative incidence increased to 0.50% (95% CI = 0.33-0.70%); 0.51% (95% CI = 0.38-0.65%); 0.72% (95% CI = 0.13-1.52%); 0.78% (95% CI = 0-3.49%) at 30 days and 3, 6, and 12 months, respectively. Studies using predominantly open approach exhibited higher incidence than laparoscopic studies. Within the first month, 60% of VTE occurred after discharge. North American and earlier studies had higher incidence than non-North American and more recent studies. This study is the first to generate detailed estimates of the incidence and patterns of VTE after MBS over time. The incidence of VTE after MBS is low. Improved estimates and time variations of VTE require longer-term designs, non-aggregated reporting of characteristics, and must consider many factors and the use of data registries. Extended surveillance of VTE after MBS is required.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, 3050, Doha, Qatar.
- College of Medicine, Qatar University, Doha, Qatar.
- Department of Clinical Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar.
| | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Kareem El-Ansari
- Faculty of Medicine, St. George's University, Saint George's, Grenada
| | | | - Merilyn Lock
- Department of Exercise Science, Health and Epidemiology, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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Cataldo R, Bruni V, Migliorelli S, Gallo IF, Spagnolo G, Gibin G, Borgetti M, Strumia A, Ruggiero A, Pascarella G. Laparoscopic-Guided Transversus Abdominis Plane (TAP) Block Combined with Port-Site Infiltration (PSI) for Laparoscopic Sleeve Gastrectomy in an ERABS Pathway: A Randomized, Prospective, Double-Blind, Placebo-Controlled Trial. Obes Surg 2024:10.1007/s11695-024-07292-4. [PMID: 38764003 DOI: 10.1007/s11695-024-07292-4] [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: 03/02/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Abstract
PURPOSE Patients undergoing laparoscopic sleeve gastrectomy (LSG) commonly experience moderate to severe postoperative pain. We conducted a randomized, prospective double-blind placebo-controlled study to evaluate the analgesic effect of laparoscopic-guided TAP (LG-TAP) block after LSG in a high-volume bariatric center, applying an enhanced recovery after bariatric surgery (ERABS) pathway. MATERIAL AND METHODS One hundred ten patients were randomly allocated to receive LG-TAP block with local anesthetic (LA) or saline solution (placebo), both combined with port-site infiltration with LA (LA-PSI). Primary outcome was pain score measured in post-anesthesia care unit (PACU) and at 6, 12, and 24 h after surgery. Secondary outcomes included postoperative nausea and/or vomiting (PONV), analgesic requirement, time to walking, time to flatus, length of hospital stay (LOS), and surgical complications. RESULTS No significant differences were observed between LG-TAP and placebo groups in postoperative analgesia, with a median (IQR) NRS of 2 (4.75-0) vs. 2 (5.25-0) in PACU, 5.5 (7-3) vs. 6 (7-4) at 6 h, 2 (6-0) vs. 3 (5.25-1.75) at 12 h, and 2 (3.75-0) vs. 1 (2-0) at 24 h; all p > 0.05. A significant difference was found in PONV in PACU (LG-TAP, 46%; placebo, 25%, p-value, 0.019) and at 6 h postoperatively (LG-TAP, 69%, placebo, 41%, p-value, 0.003). No differences were observed as regards other secondary outcomes. CONCLUSION Our results suggest that LG-TAP block is not related to more effective postoperative analgesia compared to placebo when LA-PSI is performed.
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Affiliation(s)
- Rita Cataldo
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy
- Research Unit of Anesthesia and Intensive Care, Department of Medicine and Surgery, Università Campus Bio-Medico, 00128, Rome, Italy
| | - Vincenzo Bruni
- Unit of Bariatric Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy
| | - Sabrina Migliorelli
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy.
| | - Ida Francesca Gallo
- Unit of Bariatric Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy
| | - Giuseppe Spagnolo
- Unit of Bariatric Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy
| | - Giulia Gibin
- Unit of Bariatric Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy
| | - Miriam Borgetti
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy
| | - Alessandro Strumia
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy
| | - Alessandro Ruggiero
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy
| | - Giuseppe Pascarella
- Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128, Rome, Italy
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Yang N, Hua H, Liu S, Zhang S, Zhao X, Zhang P, Zhang P, Wang Y, Shen J, Lin S, Guan W, Liang H. The current status and challenges of perioperative management of patients with a BMI of greater than or equal to 50 kg/m 2 undergoing bariatric surgery in China: a multicenter cross-sectional study. Int J Surg 2024; 110:2577-2582. [PMID: 38265423 DOI: 10.1097/js9.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Performing bariatric surgery on patients with a BMI of over 50 kg/m 2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China. MATERIALS AND METHODS A prospective survey was designed to investigate the perioperative management of patients with a BMI of greater than or equal to 50 kg/m 2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anaesthesia, and postoperative management measures. A response from only one attending physician per bariatric centre was accepted. RESULTS Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centres had completed a total of 44 702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3280 patients had a BMI exceeding 50 kg/m 2 . The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centres, Roux-en-Y gastric bypass by 11 centres, sleeve gastrectomy plus jejunojejunal bypass by 19 centres, one anastomosis gastric bypass by 1 centre, and duodenal switch by 1 centre. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centres believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only three centres considered using intragastric balloon placement. Postoperative management measures varied greatly. CONCLUSION Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50 kg/m 2 . The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.
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Affiliation(s)
- Ningli Yang
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
| | - Hongxia Hua
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
| | - Shaozhuang Liu
- Department of General Surgery, Division of Bariatric and Metabolic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong
| | - Songhai Zhang
- Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, Zhenzhou, Henan
| | - Xiangwen Zhao
- Department of Metabolic and Bariatric Surgery, Xiaolan People's Hospital of Zhongshan, Zhongshan, Guangdong
| | - Peng Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University & National Clinical Research Center for Digestive Diseases, Beijing
| | - Pin Zhang
- Department of Bariatric and Metabolic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai
| | - Yong Wang
- Department of weight loss and metabolism, the Fourth Clinical College Affiliated to China Medical University, ShenYang, Dongbei, China
| | - Jiajia Shen
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
| | - Shibo Lin
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
| | - Wei Guan
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
| | - Hui Liang
- Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu
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Andugala S, McIntosh A, Orchard J, Rahiman S, Miedecke A, Keyser J, Betts K, Marathe S, Alphonso N, Venugopal P. Successful Implementation of Enhanced Recovery After Surgery (ERAS) in Paediatric Cardiac Surgery in Australia. Heart Lung Circ 2024:S1443-9506(24)00063-5. [PMID: 38594127 DOI: 10.1016/j.hlc.2024.01.029] [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: 12/08/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND & AIM Fast-track or enhanced recovery after surgery (ERAS) is a care pathway for surgical patients based on a multidisciplinary team approach aimed at optimising recovery without increasing risk with protocols based on scientific evidence, which is monitored continuously to ensure compliance and improvement. These protocols have been shown to reduce the duration of postoperative mechanical ventilation and intensive care unit (ICU) length of stay (LOS) following paediatric cardiac surgery. We present the first structured implementation of ERAS in paediatric cardiac surgery in Australia. METHODS All patients enrolled in the ERAS pathway between October 2019 and July 2023 were identified. Demographic and perioperative data were collected retrospectively from hospital records for patients operated before June 2021 and prospectively from June 2021. A control group (non-ERAS) was identified using propensity matching from patients who underwent similar procedures and were not enrolled in the ERAS pathway (prior to October 2019). Patients were matched for age, weight, and comprehensive Aristotle score. Outcomes of interest were duration of postoperative mechanical ventilation, ICU LOS, readmission to the ICU, hospital LOS, cardiac reintervention rate, postoperative complication rate, and number of 30-day readmissions. RESULTS Of 1,084 patients who underwent cardiac surgery during the study period (October 2019-July 2023), 121 patients (11.2%) followed the ERAS pathway. The median age at the time of surgery was 4.8 years (interquartile range [IQR] 2.8-8.8 years). The most common procedure was the closure of atrial septal defect (n=58, 47.9%). The median cardiopulmonary bypass and cross-clamp times were 40 min (IQR 28-53.5 minutes) and 24.5 min (IQR 13-34 minutes) respectively. The majority were extubated in the operating theatre (n=108, 89.3%). The median ICU and hospital LOS were 4.5 hrs (IQR 4.1-5.6 hours) and 4 days (IQR 4-5 days) respectively. None of the patients required readmission to the ICU within 24 hrs of discharge from the ICU. Three (3) patients (2.5%) required reintervention. When compared with the non-ERAS group, the duration of postoperative mechanical ventilation, ICU and hospital LOS were significantly lower in the ERAS group. There was no significant difference in the ICU readmission rate, reintervention rate, complication rate, and number of 30-day readmissions between both groups. CONCLUSIONS ERAS after paediatric cardiac surgery is feasible and safe in select patients with low preoperative risk. This pathway reduces the duration of postoperative mechanical ventilation, ICU and hospital LOS without increasing risks, enabling the optimisation of resources.
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Affiliation(s)
- Shalom Andugala
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Qld, Australia; Queensland Paediatric Cardiac Research, Centre for Children's Health Research, South Brisbane, Qld, Australia; School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Qld, Australia
| | - Amy McIntosh
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Jennifer Orchard
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Sarfaraz Rahiman
- Department of Paediatric Intensive Care Medicine, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Anna Miedecke
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Janelle Keyser
- Department of Anaesthesia and Pain Management, Queensland Children's Hospital, South Brisbane, Qld, Australia
| | - Kim Betts
- School of Population Health, Curtin University, Perth, WA, Australia
| | - Supreet Marathe
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Qld, Australia; Queensland Paediatric Cardiac Research, Centre for Children's Health Research, South Brisbane, Qld, Australia; School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Qld, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Qld, Australia; Queensland Paediatric Cardiac Research, Centre for Children's Health Research, South Brisbane, Qld, Australia; School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Qld, Australia
| | - Prem Venugopal
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, South Brisbane, Qld, Australia; Queensland Paediatric Cardiac Research, Centre for Children's Health Research, South Brisbane, Qld, Australia; School of Clinical Medicine, Children's Health Queensland Clinical Unit, University of Queensland, Brisbane, Qld, Australia.
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Duranti L, Tavecchio L. Surgery-related outcomes from a close-knit surgeons' team in thoracic oncology. Updates Surg 2024; 76:641-646. [PMID: 38007402 DOI: 10.1007/s13304-023-01700-7] [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: 09/11/2023] [Accepted: 11/07/2023] [Indexed: 11/27/2023]
Abstract
Reducing morbidity, length of hospital stay, and readmission rate are of paramount importance to improve patients' care. In the present paper, we aim to describe our experience in managing major oncologic thoracic surgery in clinical practice. This is a retrospective experience over the last 7 years. Data from 215 consecutive patients (performed by a single-team of two surgeon) undergoing thoracic surgery were reviewed and evaluated. The total hospital mean stay was 3,3 days. Complications were represented by 4 hemothorax, 1 pleural empyema without fistula, 3 arrhythmias (atrial fibrillation), 2 pnuemonias and 1 chylotorax. No 30-day severe surgery-related complication occurred, no mortality. In 169 Vats procedures, no convertion was necessary. We conclude that a united team work represented by two close-knit surgeons, with similar clinical background, propensity to share problems, no competitive behavior, allow to do faster surgery, to standardize the procedure improving the post-operative outcomes of cancer patients.
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Affiliation(s)
- Leonardo Duranti
- Thoracic Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Via G Venezian 1, 20133, Milan, Italy.
| | - Luca Tavecchio
- Thoracic Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Via G Venezian 1, 20133, Milan, Italy
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Dong J, Lei Y, Wan Y, Dong P, Wang Y, Liu K, Zhang X. Enhanced recovery after surgery from 1997 to 2022: a bibliometric and visual analysis. Updates Surg 2024:10.1007/s13304-024-01764-z. [PMID: 38446378 DOI: 10.1007/s13304-024-01764-z] [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: 10/04/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024]
Abstract
Enhanced recovery after surgery (ERAS) is a multimodal perioperative management concept, but there is no article to comprehensively review the collaboration and impact of countries, institutions, authors, journals, references, and keywords on ERAS from a bibliometric perspective. This study assessed the evolution of clustering of knowledge structures and identified hot trends and emerging topics. Articles and reviews related to ERAS were retrieved through subject search from the Web of Science Core Collection. We used the following strategy: "TS = Enhanced recovery after surgery" OR "Enhanced Postsurgical Recovery" OR "Postsurgical Recoveries, Enhanced" OR "Postsurgical Recovery, Enhanced" OR "Recovery, Enhanced Postsurgical" OR "Fast track surgery" OR "improve surgical outcome". Bibliometric analyses were conducted on Excel 365, CiteSpace, VOSviewer, and Bibliometrics (R-Tool of R-Studio). Totally 3242 articles and reviews from 1997 to 2022 were included. These publications were mainly from 684 journals in 78 countries, led by the United States and China. Kehlet H published the most papers and had the largest number of co-citations. Analysis of the journals with the most outputs showed that most journals mainly cover Surgery and Oncology. The hottest keyword is "enhanced recovery after surgery". Later appearing topics and keywords indicate that the hotspots and future research trends include ERAS protocols for other types of surgery and improving perioperative status, including "bariatric surgery", "thoracic surgery", and "prehabilitation". This study reviewed the research on ERAS using bibliometric and visualization methods, which can help scholars better understand the dynamic evolution of ERAS and provide directions for future research.
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Affiliation(s)
- Jingyu Dong
- Department of Anesthesiology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, Gansu, China
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangdong Provincial Key Laboratory of Precision Anaesthesia and Perioperative Organ Protection, 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, China
| | - Yuqiong Lei
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangdong Provincial Key Laboratory of Precision Anaesthesia and Perioperative Organ Protection, 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, China
| | - Yantong Wan
- Guangdong Provincial Key Laboratory of Proteomics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Peng Dong
- College of Anesthesiology, Southern Medical University, Guangzhou, China
| | - Yingbin Wang
- Department of Anesthesiology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, Gansu, China
| | - Kexuan Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangdong Provincial Key Laboratory of Precision Anaesthesia and Perioperative Organ Protection, 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, China.
| | - Xiyang Zhang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangdong Provincial Key Laboratory of Precision Anaesthesia and Perioperative Organ Protection, 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, China.
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Wysocki M, Mizera M, Karpińska I, Ptaszkiewicz K, Małczak P, Pisarska-Adamczyk M, Kania M, Major P. Analysis of Changes in Glucose and Lipid Metabolism in Patients with Clinically Severe Obesity and Type 2 Diabetes Mellitus Undergoing Laparoscopic Sleeve Gastrectomy-Prospective Observational Study. Obes Surg 2024; 34:467-478. [PMID: 38105282 PMCID: PMC10811010 DOI: 10.1007/s11695-023-06991-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION We still lack studies providing analysis of changes in glucose and lipid metabolism after laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes mellitus (DM2). We aimed to investigate postoperative changes in glucose and lipid metabolism after LSG in patients with DM2. MATERIAL AND METHODS Prospective, observational study included patients with BMI ≥ 35 kg/m2 and ≤ 50 kg/m2, DM2 < 10 years of duration, who were qualified for LSG. Perioperative 14-day continuous glucose monitoring (CGM) began after preoperative clinical assessment and OGTT, then reassessment 1 and 12 months after LSG. Thirty-three patients in mean age of 45 ± 10 years were included in study (23 females). RESULTS EBMIL before LSG was 17 ± 11.7%, after 1 month-36.3 ± 12.8%, while after 12 months-66.1 ± 21.7%. Fifty-two percent of the patients had DM2 remission after 12 months. None required then insulin therapy. 16/33 patients initially on oral antidiabetics still required them after 12 months. Significant decrease in HbA1C was observed: 5.96 ± 0.73%; 5.71 ± 0.80; 5.54 ± 0.52%. Same with HOMA-IR: 5.34 ± 2.84; 4.62 ± 3.78; 3.20 ± 1.99. In OGTT, lower increase in blood glucose with lesser insulin concentrations needed to recover glucose homeostasis was observed during follow-ups. Overtime perioperative average glucose concentration in CGM of 5.03 ± 1.09 mmol/L significantly differed after 12 months, 4.60 ± 0.53 (p = 0.042). Significantly higher percentage of glucose concentrations above targeted compartment (3.9-6.7 mmol/L) was observed in perioperative period (7% ± 4%), than in follow-up (4 ± 6% and 2 ± 1%). HDL significantly rose, while triglyceride levels significantly decreased. CONCLUSIONS Significant improvement in glucose and lipid metabolism was observed 12 months after LSG and changes began 1 month after procedure.
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Affiliation(s)
- Michał Wysocki
- Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital in Cracow, Os. Zlotej Jesieni 1, 31-826, Cracow, Poland.
| | - Magdalena Mizera
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Izabela Karpińska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Kuba Ptaszkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | | | - Michał Kania
- Department of Metabolic Diseases and Diabetology, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
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Satapathy T, Singh G, Pandey RK, Shukla SS, Bhardwaj SK, Gidwani B. Novel Targets and Drug Delivery System in the Treatment of Postoperative Pain: Recent Studies and Clinical Advancement. Curr Drug Targets 2024; 25:25-45. [PMID: 38037995 DOI: 10.2174/0113894501271207231127063431] [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: 07/08/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023]
Abstract
Pain is generated by a small number of peripheral targets. These can be made more sensitive by inflammatory mediators. The number of opioids prescribed to the patients can be reduced dramatically with better pain management. Any therapy that safely and reliably provides extended analgesia and is flexible enough to facilitate a diverse array of release profiles would be useful for improving patient comfort, quality of care, and compliance after surgical procedures. Comparisons are made between new and traditional methods, and the current state of development has been discussed; taking into account the availability of molecular and cellular level data, preclinical and clinical data, and early post-market data. There are a number of benefits associated with the use of nanotechnology in the delivery of analgesics to specific areas of the body. Nanoparticles are able to transport drugs to inaccessible bodily areas because of their small molecular size. This review focuses on targets that act specifically or primarily on sensory neurons, as well as inflammatory mediators that have been shown to have an analgesic effect as a side effect of their anti- inflammatory properties. New, regulated post-operative pain management devices that use existing polymeric systems were presented in this article, along with the areas for potential development. Analgesic treatments, both pharmacological and non-pharmacological, have also been discussed.
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Affiliation(s)
- Trilochan Satapathy
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh-493111, India
| | - Gulab Singh
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh-493111, India
| | - Ravindra Kumar Pandey
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh-493111, India
| | - Shiv Shankar Shukla
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh-493111, India
| | - Shiv Kumar Bhardwaj
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh-493111, India
| | - Beena Gidwani
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh-493111, India
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Anika NN, Mohammed M, Shehryar A, Rehman A, Oliveira Souza Lima SR, Hamid YH, Mimms CS, Abdallah S, Kumar YS, Ibrahim M. Transforming Bariatric Surgery Outcomes: The Pivotal Role of Enhanced Recovery After Surgery (ERAS) Protocols in Patient-Centered Care. Cureus 2024; 16:e52648. [PMID: 38380206 PMCID: PMC10877221 DOI: 10.7759/cureus.52648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/22/2024] Open
Abstract
Bariatric surgery is a critical strategy in managing morbid obesity. Enhanced recovery after surgery (ERAS) protocols have revolutionized perioperative care in this field. This systematic review aims to synthesize current evidence on the impact of ERAS protocols on patient-centered outcomes in bariatric surgery. A comprehensive search across multiple databases was conducted, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies involving adult patients undergoing bariatric surgery and focusing on the implementation and outcomes of ERAS protocols were included. Data extraction and analysis emphasized patient recovery, well-being, and satisfaction. Eleven studies met the inclusion criteria. The review revealed that ERAS protocols are associated with reduced postoperative recovery times, decreased hospital stays, and enhanced patient satisfaction. Notably, ERAS protocols effectively reduced complications and optimized resource utilization in bariatric surgery. Comparative insights from non-bariatric surgeries highlighted the versatility and adaptability of ERAS protocols across different surgical disciplines. ERAS protocols significantly improve patient-centered outcomes in bariatric surgery. Their adoption facilitates a patient-focused approach, accelerating recovery and enhancing overall patient well-being. The findings advocate for the broader implementation of ERAS protocols in surgical care, emphasizing the need for continuous refinement to meet evolving healthcare demands. This review supports the paradigm shift toward integrating ERAS protocols in bariatric surgery and potentially other surgical fields.
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Affiliation(s)
- Nabila N Anika
- Medicine and Surgery, Holy Family Red Crescent Medical College and Hospital, Dhaka, BGD
| | | | | | | | | | - Yusra H Hamid
- Community Medicine, University of Khartoum, Khartoum, SDN
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Jani A, Chaudhry K, Kaur A, Bhatia PK, Kumar P, Gigi PG, Batra T, Chugh A. Efficacy of Enhanced Recovery after Surgery (ERAS) protocol in maxillofacial trauma: A randomized controlled trial. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101576. [PMID: 37544506 DOI: 10.1016/j.jormas.2023.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/06/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Enhanced Recovery after surgery (ERAS) guidelines have been formulated in the literature for various different specialties but none is present for maxillofacial trauma patients. Hence, we have formulated ERAS protocol for maxillofacial trauma (ERAS-MT) patients and compared with the patients receiving the standard traditional care for post trauma outcomes. METHODOLOGY A randomized controlled trial included 74 patients divided into two groups: Group 1 (ERAS group:37 patients) and Group II (Control group:37 patients). ERAS group were intervened according to the formulated ERAS protocol based on the previous literature and the control group received the standard of care. The both groups were compared for various post trauma outcomes. RESULTS Baseline demographic data was non-significant between both the groups. There was significant decrease in pre-operative IV fluid use and total number of IV analgesics used till 72 h as well as in the immediate post operative period in the ERAS group(p = 0.001). ERAS group started oral feeds within 6 h and they were significantly compliant for oral carbohydrates in the pre-operative phase(p = 0.001). PONV episodes, swelling and infections were insignificantly less in the ERAS group(p > 0.05), however a significant difference was seen throat pain and decreased anxiety as well as Oral Hygiene Index(p = 0.001). At two weeks, a significant difference was seen in overall patient's satisfaction and cost analysis in the ERAS group (p = 0.001). CONCLUSION Our study suggested that ERAS protocol was associated with shorter hospital stay, early recovery with better overall satisfaction of the patients, lesser post-operative complications and significantly decreased cost analysis.
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Affiliation(s)
- Astha Jani
- All India Institute of Medical Sciences, Jodhpur, India
| | | | - Amanjot Kaur
- All India Institute of Medical Sciences, Vijaypur, Jammu, India
| | | | - Pravin Kumar
- All India Institute of Medical Sciences, Jodhpur, India
| | - P G Gigi
- All India Institute of Medical Sciences, Jodhpur, India
| | - Tanya Batra
- All India Institute of Medical Sciences, Jodhpur, India
| | - Ankita Chugh
- All India Institute of Medical Sciences, Jodhpur, India.
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12
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Weinberg L, Scurrah N, Neal-Williams T, Zhang W, Chen S, Slifirski H, Liu DS, Armellini A, Aly A, Clough A, Lee DK. The transit of oral premedication beyond the stomach in patients undergoing laparoscopic sleeve gastrectomy: a retrospective observational multicentre study. BMC Surg 2023; 23:335. [PMID: 37924061 PMCID: PMC10625241 DOI: 10.1186/s12893-023-02246-6] [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: 07/14/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Antiemetic and analgesic oral premedications are frequently prescribed preoperatively to enhance recovery after laparoscopic sleeve gastrectomy. However, it is unknown whether these medications transit beyond the stomach or if they remain in the sleeve resection specimen, thereby negating their pharmacological effects. METHODS A retrospective cohort study was performed on patients undergoing laparoscopic sleeve gastrectomy and receiving oral premedication (slow-release tapentadol and netupitant/palonosetron) as part of enhanced recovery after bariatric surgery program. Patients were stratified into the Transit group (premedication absent in the resection specimen) and Failure-to-Transit group (premedication present in the resection specimen). Age, sex, body mass index, and presence of diabetes were compared amongst the groups. The premedication lead time (time between premedications' administration and gastric specimen resection), and the premedication presence or absence in the specimen was evaluated. RESULTS One hundred consecutive patients were included in the analysis. Ninety-nine patients (99%) were morbidly obese, and 17 patients (17%) had Type 2 diabetes mellitus. One hundred patients (100%) received tapentadol and 89 patients (89%) received netupitant/palonosetron. One or more tablets were discovered in the resected specimens of 38 patients (38%). No statistically significant differences were observed between the groups regarding age, sex, diabetes, or body mass index. The median (Q1‒Q3) premedication lead time was 80 min (57.8‒140.0) in the Failure-to-Transit group and 119.5 min (85.0‒171.3) in the Transit group; P = 0.006. The lead time required to expect complete absorption in 80% of patients was 232 min (95%CI:180‒310). CONCLUSIONS Preoperative oral analgesia and antiemetics did not transit beyond the stomach in 38% of patients undergoing laparoscopic sleeve gastrectomy. When given orally in combination, tapentadol and netupitant/palonosetron should be administered at least 4 h before surgery to ensure transition beyond the stomach. Future enhanced recovery after bariatric surgery guidelines may benefit from the standardization of premedication lead times to facilitate increased absorption. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry; number ACTRN12623000187640; retrospective registered on 22/02/2023.
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Affiliation(s)
- Laurence Weinberg
- Department of Anesthesia, Austin Health, Heidelberg, Australia.
- Department of Critical Care, The University of Melbourne, Austin Health, Heidelberg, Australia.
| | - Nick Scurrah
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | | | - Wendell Zhang
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - Sharon Chen
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - Hugh Slifirski
- Department of Anesthesia, Austin Health, Heidelberg, Australia
| | - David S Liu
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Australia
- General and Gastrointestinal Surgery Research Group, The University of Melbourne, Austin Precinct, Heidelberg, Australia
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Australia
| | | | - Ahmad Aly
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Australia
| | - Anthony Clough
- Department of Surgery, Box Hill Hospital, Box Hill, Australia
- Melbourne Centre for Bariatric Surgery, Melbourne, Australia
| | - Dong-Kyu Lee
- Department of Anesthesiology and Pain Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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Dupont L, Alves A, Bui E, Lee Bion A, Meunier H, Briant A, Parienti JJ, Menahem B. Long-term weight loss outcomes after bariatric surgery: a propensity score study among patients with psychiatric disorders. Surg Endosc 2023; 37:8362-8372. [PMID: 37700014 DOI: 10.1007/s00464-023-10343-z] [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: 05/05/2023] [Accepted: 07/30/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION To analyze the safety and long-term result of bariatric surgery in patients with psychiatric disorders. MATERIAL AND METHODS From January 2009 to December 2018, n = 961 patients underwent bariatric surgery in a tertiary center. Among them, two groups of patients were created: a group of patients with psychiatric disorders (PG) and a group without psychiatric disorders (CG), using a propensity score matched (PSM). Primary endpoint was long-term outcomes and secondary endpoints were the postoperative morbidity 90 days after surgery, late morbidity, occurrence of psychiatric adverse events, and resolution of obesity-related comorbidities. RESULTS Analysis with PSM permitted to compare 136 patients in each group, with a ratio 1:1. TWL% at 2 years in the PG was 32.7% versus 36.6% in the CG (p = 0.002). Overall surgical morbidity was higher in the PG than the CG (28% vs 17%, p = 0.01). Severe surgical complications were not statistically significant (4% vs 3%, p = 0.44). Psychiatric adverse events were significantly more frequent in the PG than in the CG. The resolution of obesity comorbidities was equivalent for both groups at 2 years. CONCLUSION Substantial weigh loss was reported among patients with psychiatric disorders receiving bariatric surgery at the cost of more non-severe surgical complications. Further, a psychiatric postoperative follow-up visit may be warranted for patients with preoperative psychiatric disorders, given the incidence of psychiatric adverse events.
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Affiliation(s)
- Ludovic Dupont
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- UMR INSERM 1086 "Cancers et preventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen Cedex, France
| | - Eric Bui
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- Department of Psychiatry, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
- UNICAEN, INSERM, U1237, PhIND «Physiopathology and Imaging of Neurological Disorders», NEUROPRESAGE Team, Institut Blood and Brain @ Caen-Normandie, Caen University Hospital and Normandie University, Cyceron, 14000, Caen, France
| | - Adrien Lee Bion
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Hugo Meunier
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Anaïs Briant
- Department of Biostatistics, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Jean-Jacques Parienti
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France
- Department of Biostatistics, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen Cedex, France.
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen Cedex, France.
- UMR INSERM 1086 "Cancers et preventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen Cedex, France.
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la cote de Nacre, 14032, Caen Cedex, France.
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Lapointe-Gagner M, Jain S, Alali N, Elhaj H, Poirier AS, Kaneva P, Alhashemi M, Lee L, Agnihotram RV, Feldman LS, Gagner M, Andalib A, Fiore JF. Predictors of post-discharge pain and satisfaction with pain management after laparoscopic bariatric surgery: a prospective cohort study. Surg Endosc 2023; 37:8611-8622. [PMID: 37491658 DOI: 10.1007/s00464-023-10307-3] [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: 05/07/2023] [Accepted: 07/12/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Pain management after bariatric surgery remains challenging given the risk for analgesia-related adverse events (e.g., opioid use disorder, marginal ulcers). Identifying modifiable factors associated with patient-reported pain outcomes may improve quality of care. We evaluated the extent to which patient and procedural factors predict 7-day post-discharge pain intensity, pain interference, and satisfaction with pain management after bariatric surgery. METHODS This prospective cohort study included adults undergoing laparoscopic bariatric surgery at two university-affiliated hospitals and one private clinic. Preoperative assessments included demographics, Pain Catastrophizing Scale (score range 0-52), Patient Activation Measure (low [< 55.1] vs. high [≥ 55.1]), pain expectation (0-10), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) anxiety and depression scales. At 7 days post-discharge, assessments included PROMIS-29 pain intensity (0-10) and pain interference scales (41.6-75.6), and satisfaction with pain management (high [10-9] vs. lower [8-0]). Linear and logistic regression were used to assess the association of pain outcomes with potential predictors. RESULTS Three hundred and fifty-one patients were included (mean age = 44 ± 11 years, BMI = 45 ± 8 kg/m2, 77% female, 71% sleeve gastrectomy). At 7 days post-discharge, median (IQR) patient-reported pain intensity was 2.5 (1-5), pain interference was 55.6 (52.0-61.2), and 76% of patients reported high satisfaction with pain management. Pain intensity was predicted by preoperative anxiety (β + 0.04 [95% CI + 0.01 to + 0.07]) and pain expectation (+ 0.15 [+ 0.05 to + 0.25]). Pain interference was predicted by preoperative anxiety (+ 0.22 [+ 0.11 to + 0.33]), pain expectation (+ 0.47 [+ 0.10 to + 0.84]), and age (- 0.09 [- 0.174 to - 0.003]). Lower satisfaction was predicted by low patient activation (OR 1.94 [1.05-3.58]), higher pain catastrophizing (1.03 [1.003-1.05]), 30-day complications (3.27 [1.14-9.38]), and age (0.97 [0.948-0.998]). CONCLUSION Patient-related factors are important predictors of post-discharge pain outcomes after bariatric surgery. Our findings highlight the value of addressing educational, psychological, and coping strategies to improve postoperative pain outcomes.
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Affiliation(s)
- Maxime Lapointe-Gagner
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Shrieda Jain
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Naser Alali
- Division of Experimental Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Hiba Elhaj
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Anne-Sophie Poirier
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Pepa Kaneva
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Mohsen Alhashemi
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Ramanakumar V Agnihotram
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Michel Gagner
- Clinique Michel Gagner MD Inc., Montreal, QC, Canada
| | - Amin Andalib
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
- Department of Surgery, Center for Bariatric Surgery, McGill University, Montreal, QC, Canada
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
- Division of Experimental Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Montreal General Hospital, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada.
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Lo HC, Hsu SC. Suggested Flowchart Through Integrated C-Reactive Protein and White Blood Cell Count Analysis for Screening for Early Complications After Gastric Bypass: a Single-Center Retrospective Study. Obes Surg 2023; 33:3517-3526. [PMID: 37801238 DOI: 10.1007/s11695-023-06864-0] [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: 07/18/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Early leakage detection following bariatric procedures is crucial, but a standardized evaluation method is lacking. The aim was to validate the potential benefits of postoperative day 1 (POD1) C-reactive protein (CRP) levels and white blood cell (WBC) counts in distinguishing at-risk patients following Roux-en-Y gastric bypass (RYGB) while considering the impact of obesity-related chronic inflammation. METHODS Retrospective analysis of 261 consecutive patients aged 18-65 years with a body mass index (BMI) of 32.5-50 kg/m2 who underwent primary RYGB between 2017 and 2022. Sequential changes in CRP levels and WBC counts measured 48 h preoperatively and on POD1 morning were collected and compared between patients with/without complications and in patients without complications stratified by preoperative CRP levels. RESULTS Female patients and those with a higher BMI tended to have higher baseline CRP levels, which were positively related to postoperative CRP. Patients experiencing complications had higher WBC counts and a higher prevalence of WBC counts >14,000/μl (77.8% vs. 25.4%; p<0.001) than those without complications. Baseline CRP ≥ 0.3 mg/dl, a longer operative time, and blood loss >10 ml were significantly more common with WBC counts above 14,000/μl; a reasonable range of change in WBC count (∆WBC) derived from its positive correlation to postoperative WBC count (r=0.6695) may serve as a useful complementary indicator. CONCLUSION An individualized CRP threshold setting and integrated interpretation of the WBC count can be more appropriate than using static criteria for differentiating at-risk patients after RYGB. Further studies are needed to validate these findings and determine their generalizability.
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Affiliation(s)
- Hung-Chieh Lo
- Division of Trauma and Emergency Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei, Taiwan.
- TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Shih-Chang Hsu
- Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Flore G, Deledda A, Fosci M, Lombardo M, Moroni E, Pintus S, Velluzzi F, Fantola G. Perioperative Nutritional Management in Enhanced Recovery after Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6899. [PMID: 37835169 PMCID: PMC10573058 DOI: 10.3390/ijerph20196899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
Obesity is a crucial health problem because it leads to several chronic diseases with an increased risk of mortality and it is very hard to reverse with conventional treatment including changes in lifestyle and pharmacotherapy. Bariatric surgery (BS), comprising a range of various surgical procedures that modify the digestive tract favouring weight loss, is considered the most effective medical intervention to counteract severe obesity, especially in the presence of metabolic comorbidities. The Enhanced Recovery After Bariatric Surgery (ERABS) protocols include a set of recommendations that can be applied before and after BS. The primary aim of ERABS protocols is to facilitate and expedite the recovery process while enhancing the overall effectiveness of bariatric procedures. ERABS protocols include indications about preoperative fasting as well as on how to feed the patient on the day of the intervention, and how to nourish and hydrate in the days after BS. This narrative review examines the application, the feasibility and the efficacy of ERABS protocols applied to the field of nutrition. We found that ERABS protocols, in particular not fasting the patient before the surgery, are often not correctly applied for reasons that are not evidence-based. Furthermore, we identified some gaps in the research about some practises that could be implemented in the presence of additional evidence.
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Affiliation(s)
- Giovanna Flore
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Andrea Deledda
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Michele Fosci
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Via di Val Cannuta, 247, 00166 Rome, Italy;
| | - Enrico Moroni
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
| | - Stefano Pintus
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
| | - Fernanda Velluzzi
- Obesity Unit, Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy; (G.F.); (A.D.); (M.F.)
| | - Giovanni Fantola
- Obesity Surgery Unit, Department of Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione G. Brotzu, 09134 Cagliari, Italy; (E.M.); (S.P.); (G.F.)
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Hart JWH', Takken R, Hogewoning CRC, Biter LU, Apers JA, Zengerink H, Dunkelgrün M, Verhoef C. Markers for Major Complications at Day-One Postoperative in Fast-Track Metabolic Surgery: Updated Metabolic Checklist. Obes Surg 2023; 33:3008-3016. [PMID: 37610699 PMCID: PMC10514089 DOI: 10.1007/s11695-023-06782-1] [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: 04/24/2023] [Revised: 07/31/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION In fast-track metabolic surgery, the window to identify complications is narrow. Postoperative checklists can be useful tools in the decision-making of safe early discharge. The aim of this study was to evaluate the predictive value of a checklist used in metabolic surgery. METHODS Retrospective data from June 2018 to January 2021 was collected on all patients that underwent metabolic surgery in a high-volume bariatric hospital in the Netherlands. Patients without an available checklist were excluded. The primary outcome was major complications and the secondary outcomes were minor complications, readmission, and unplanned hospital visits within 30 days postoperatively. RESULTS Major complications within 30 days postoperatively occurred in 62/1589 (3.9%) of the total included patients. An advise against early discharge was significantly more seen in patients with major complications compared to those without major complications (90.3% versus 48.1%, P < 0.001, respectively), and a negative checklist (advice for discharge) had a negative predictive value of 99.2%. The area under the curve for the total checklist was 0.80 (P < 0.001). Using a cut-off value of ≥3 positive points, the sensitivity and specificity were 65% and 82%, respectively. Individual parameters from the checklist: oral intake, mobilization, calf pain, willingness for discharge, heart rate, drain (>30 ml/24 h), hemoglobin, and leukocytes count were also significantly different between groups. CONCLUSION This checklist is a valuable tool to decide whether patients can be safely discharged early. Heart rate appeared to be the most predictive parameter for the development of major complications. Future studies should conduct prediction models to identify patients at risk for major complications.
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Affiliation(s)
- J W H 't Hart
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands.
| | - R Takken
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - C R C Hogewoning
- Department of Surgery, St. Antonius Hospital, Utrecht, The Netherlands
| | - L U Biter
- Department of Surgery, Tulp Medisch Centrum, Zwijndrecht, The Netherlands
| | - J A Apers
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - H Zengerink
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - M Dunkelgrün
- Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045, PM, Rotterdam, The Netherlands
| | - C Verhoef
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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Jain S, Lapointe-Gagner M, Alali N, Elhaj H, Poirier AS, Kaneva P, Alhashemi M, Lee L, Agnihotram RV, Feldman LS, Gagner M, Andalib A, Fiore JF. Prescription and consumption of opioids after bariatric surgery: a multicenter prospective cohort study. Surg Endosc 2023; 37:8006-8018. [PMID: 37460817 DOI: 10.1007/s00464-023-10265-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/27/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION In the current opioid crisis, bariatric surgical patients are at increased risk of harms related to postoperative opioid overprescribing. This study aimed to assess the extent to which opioids prescribed at discharge after bariatric surgery are consumed by patients. METHODS This multicenter prospective cohort study included adult patients (≥ 18yo) undergoing laparoscopic bariatric surgery. Preoperative assessments included demographics and patient-reported measures. Information regarding surgical and perioperative care interventions (including discharge prescriptions) was obtained from medical records. Self-reported opioid consumption was assessed weekly up to 30 days post-discharge. Number of opioid pills prescribed and consumed was compared using Wilcoxon signed-rank test. Zero-inflated negative binomial regression was used to identify predictors of post-discharge opioid consumption. RESULTS We analyzed 351 patients (mean age 44 ± 11 years, BMI 45 ± 8.0 kg/m2, 77% female, 71% sleeve gastrectomy, length of stay 1.6 ± 0.6 days). The quantity of opioids prescribed at discharge (median 15 pills [IQR 15-16], 112.5 morphine milligram equivalents (MMEs) [IQR 80-112.5]) was significantly higher than patient-reported consumption (median 1 pill [IQR 0-5], 7.5 MMEs [IQR 0-37.5]) (p < 0.001). Overall, 37% of patients did not take any opioids post-discharge and 78.5% of the opioid pills prescribed were unused. Increased post-discharge opioid consumption was associated with male sex (IRR 1.54 [95%CI 1.14 to 2.07]), higher BMI (1.03 [95%CI 1.01 to 1.05]), preoperative opioid use (1.48 [95%CI 1.04 to 2.10]), current smoking (2.32 [95%CI 1.44 to 3.72]), higher PROMIS-29 depression score (1.03 [95% CI 1.01 to 1.04]), anastomotic procedures (1.33 [95%CI 1.01 to 1.75]), and number of pills prescribed (1.04 [95%CI 1.01 to 1.06]). CONCLUSION This study supports that most opioid pills prescribed to bariatric surgery patients at discharge are not consumed. Patient and procedure-related factors may predict opioid consumption. Individualized post-discharge analgesia strategies with minimal or no opioids may be feasible and should be further investigated in future research.
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Affiliation(s)
- Shrieda Jain
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Maxime Lapointe-Gagner
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Naser Alali
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Hiba Elhaj
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
| | - Anne-Sophie Poirier
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Pepa Kaneva
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Mohsen Alhashemi
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Ramanakumar V Agnihotram
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Michel Gagner
- Clinique Michel Gagner (Westmount Square Surgical Center), Westmount, QC, Canada
| | - Amin Andalib
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
- Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.
- Division of Experimental Surgery, McGill University, Montreal, QC, Canada.
- Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada.
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
- Montreal General Hospital, 1650 Cedar Ave, R2-104, Montreal, QC, H3G 1A4, Canada.
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19
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Destan C, Baratte C, Torcivia A, Brevart C, Malgras B, Clément K, Poitou C, Oppert JM, Aron-Wisnewsky J, Genser L. Revisional Roux-en-Y Gastric Bypass After Sleeve Gastrectomy for Gastro-esophageal Reflux Disease and or Insufficient Weight-Loss: a Comparative Study. Obes Surg 2023; 33:3077-3089. [PMID: 37594673 DOI: 10.1007/s11695-023-06784-z] [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: 05/18/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is a popular surgical weight-loss procedure, but there are increasing reports of revisional Roux-Y-gastric-bypass (R-RYGB) to manage weight-loss failure (WLF) or proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) after SG, with little data available in these settings. METHODS This retrospective study included all consecutive patients undergoing R-RYGB for WLF or RGERD after SG in two bariatric care centers from 2012 to 2018. RESULTS Of 720 patients, 46 (3.6%) underwent R-RYGB (RGERD, n = 25; 54.4%; WLF, n = 21; 45.6%) within 44.8 ± 27.5 months post-SG. SG had enabled 27% ± 11.6 total weight loss (TWL) in the RGERD group vs. 7.2% ± 12.5% TWL in the WLF group (p < 0.001). At R-RYGB, WLF-group patients had a higher BMI (47.8 ± 8.4 vs. 34.7 ± 6.1 kg/m2; p < 0.001) and a higher number of comorbidities (2.4 ± 1.5 vs 1.5 ± 1.2; p < 0.02) compared to RGERD-group patients, while severe morbidity (Clavien-Dindo ≥ IIIb) was not significantly different between groups (6.5% vs 2.1%, p = 0.6). %TWL was still higher in the RGERD group at 12 months post-R-RYGB (35.6% ± 10.4 vs. 23.8% ± 9.2; p < 0.01) but not after 24 months post-R-RYGB. R-RYGB corrected reflux symptoms in 32 (94%) patients and reduced PPI use in 29 (97%) patients (p < 0.001), with no significant between-group difference. A history of adjustable gastric banding (AGB) (N = 8;17.4%) prior to SG was associated with a similar prevalence of GERD at R-RYGB and a lower %TWL (AGB:13.1 ± 10.2 vs. No AGB:31.6 ± 8.5; p < 0.05) at 3 years post-R-RYGB. CONCLUSION R-RYGB following SG provides remission of reflux symptoms in 94% of patients and extra weight loss in patients with WLF, except in patients with a history of AGB prior to SG.
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Affiliation(s)
- Clément Destan
- Sorbonne Université, Assistance Publique- Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- Department of Digestive Surgery, Begin Military Teaching Hospital, 69 Avenue de Paris, 94160, Saint Mandé, France
- Val de Grace Academy, 1 Place Alphonse Laveran, 75005, Paris, France
| | - Clément Baratte
- Sorbonne Université, Assistance Publique- Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Adriana Torcivia
- Sorbonne Université, Assistance Publique- Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Christophe Brevart
- Department of Digestive Surgery, Begin Military Teaching Hospital, 69 Avenue de Paris, 94160, Saint Mandé, France
- Val de Grace Academy, 1 Place Alphonse Laveran, 75005, Paris, France
| | - Brice Malgras
- Department of Digestive Surgery, Begin Military Teaching Hospital, 69 Avenue de Paris, 94160, Saint Mandé, France
- Val de Grace Academy, 1 Place Alphonse Laveran, 75005, Paris, France
| | - Karine Clément
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Department of Nutrition, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- INSERM, Nutrition and ObesitiesSystemic Approaches, NutriOmicsResearch Unit, Sorbonne Université, 91 Boulevard de L'hôpital, Paris, France
| | - Christine Poitou
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Department of Nutrition, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- INSERM, Nutrition and ObesitiesSystemic Approaches, NutriOmicsResearch Unit, Sorbonne Université, 91 Boulevard de L'hôpital, Paris, France
| | - Jean-Michel Oppert
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Department of Nutrition, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
| | - Judith Aron-Wisnewsky
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, AP-HP, Department of Nutrition, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France
- INSERM, Nutrition and ObesitiesSystemic Approaches, NutriOmicsResearch Unit, Sorbonne Université, 91 Boulevard de L'hôpital, Paris, France
| | - Laurent Genser
- Sorbonne Université, Assistance Publique- Hôpitaux de Paris, AP-HP, Department of Hepato-Biliary and Pancreatic Surgery, liver transplantation, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de L'Hôpital, 75013, Paris, France.
- INSERM, Nutrition and ObesitiesSystemic Approaches, NutriOmicsResearch Unit, Sorbonne Université, 91 Boulevard de L'hôpital, Paris, France.
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20
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Aguas-Ayesa M, Yárnoz-Esquíroz P, Olazarán L, Gómez-Ambrosi J, Frühbeck G. Precision nutrition in the context of bariatric surgery. Rev Endocr Metab Disord 2023; 24:979-991. [PMID: 36928810 PMCID: PMC10020075 DOI: 10.1007/s11154-023-09794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
Bariatric surgery (BS) is the most effective long-term treatment for severe obesity. This review summarizes the main nutritional deficiencies before and after BS, as well as current dietary and supplementation recommendations to avoid them. Likewise, we have reviewed all those aspects that in recent years have been shown to be related to postoperative weight loss (WL) and its subsequent maintenance, such as hormonal changes, dietary patterns, changes in food preference, adherence to recommendations and follow-up, genetic factors and microbiota, among others. Despite all the knowledge, nutritional deficiencies and weight regain after BS are frequent. It is essential to continue studying in this field in order to establish more precise recommendations according to the individual characteristics of patients. It is also a major objective to understand more deeply the role of the factors involved in WL and its maintenance. This will allow the development of precision treatments and nutrition for patients with obesity, optimizing their benefit after BS.
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Affiliation(s)
- Maite Aguas-Ayesa
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 31008, Pamplona, Spain.
| | - Patricia Yárnoz-Esquíroz
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain
| | - Laura Olazarán
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain
| | - Javier Gómez-Ambrosi
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 31008, Pamplona, Spain
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008, Pamplona, Spain
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
- Navarra Institute for Health Research, 31008, IdiSNA, Pamplona, Spain.
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 31008, Pamplona, Spain.
- Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008, Pamplona, Spain.
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21
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Greco C, Passerini F, Coluccia S, Teglio M, Bondi M, Mecheri F, Trapani V, Volpe A, Toschi P, Madeo B, Simoni M, Rochira V, Santi D. Long-term trajectories of bone metabolism parameters and bone mineral density (BMD) in obese patients treated with metabolic surgery: a real-world, retrospective study. J Endocrinol Invest 2023; 46:2133-2146. [PMID: 36971952 DOI: 10.1007/s40618-023-02066-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Potential negative effects of metabolic surgery on skeletal integrity remain a concern, since long-term data of different surgical approaches are poor. This study aimed to describe changes in bone metabolism in subjects with obesity undergoing both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). METHODS A single center, retrospective, observational clinical study on real-world data was performed enrolling subjects undergoing metabolic surgery. RESULTS 123 subjects were enrolled (males 31: females 92; ages 48.2 ± 7.9 years). All patients were evaluated until 16.9 ± 8.1 months after surgery, while a small group was evaluated up to 4.5 years. All patients were treated after surgery with calcium and vitamin D integration. Both calcium and phosphate serum levels significantly increased after metabolic surgery and remained stable during follow-up. These trends did not differ between RYGB and SG (p = 0.245). Ca/P ratio decreased after surgery compared to baseline (p < 0.001) and this decrease remained among follow-up visits. While 24-h urinary calcium remained stable across all visits, 24-h urinary phosphate showed lower levels after surgery (p = 0.014), also according to surgery technique. Parathyroid hormone decreased (p < 0.001) and both vitamin D (p < 0.001) and C-terminal telopeptide of type I collagen (p = 0.001) increased after surgery. CONCLUSION We demonstrated that calcium and phosphorous metabolism shows slight modification even after several years since metabolic surgery, irrespective of calcium and vitamin D supplementation. This different set point is characterized by a phosphate serum levels increase, together with a persistent bone loss, suggesting that supplementation alone may not ensure the maintenance of bone health in these patients.
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Affiliation(s)
- C Greco
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - F Passerini
- Division of Internal Medicine and Metabolism, Department of Internal Medicine, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
- Unit of Internal and Metabolic Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - S Coluccia
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - M Teglio
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
| | - M Bondi
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - F Mecheri
- Division of General, Emergency Surgery and New Technologies, Ospedale Civile di Baggiovara, Modena, Italy
| | - V Trapani
- Division of General, Emergency Surgery and New Technologies, Ospedale Civile di Baggiovara, Modena, Italy
| | - A Volpe
- Division of General, Emergency Surgery and New Technologies, Ospedale Civile di Baggiovara, Modena, Italy
| | - P Toschi
- Department of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy
| | - B Madeo
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - M Simoni
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - V Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy.
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
| | - D Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
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22
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Signorini FJ, Soria MB, Huais F, Andrada M, Priotto A, Obeide LR, Moser F. Development and Implementation of an Enhanced Recovery Protocol for Bariatric Patients in a Third World Environment. J Laparoendosc Adv Surg Tech A 2023; 33:980-987. [PMID: 37590535 DOI: 10.1089/lap.2023.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Introduction: An applicable and reproducible enhanced recovery protocol was developed and implemented to improve our outcomes in a third-world environment. Methods: We compared the results obtained prospectively. The group treated before the application of the enhanced recovery protocol was called usual care (UC) and included all bariatric surgeries operated on between 2014 and 2017. The new protocol was applied between 2017 and 2019 including all operated patients, and this group was called Fast Track (FT). The variables analyzed were the length of stay, readmissions, and complications recorded during the first 30 days. We also analyzed the milligrams of morphine used by each patient, and a cost analysis was performed. Results: During the study period, 816 patients were studied. Of these, 385 (47.2%) belonged to the UC group and 431 (52.8%) to the FT group. The mean hospital stay was 58.5 hours (UC) versus 40.3 hours (FT) (P = .0001). When comparing the global morbidity of both groups, we did not find significant differences (P = .47). There was also no statistically significant difference when comparing major complications (P = .79). No mortality was recorded. Morphine indication reported a statistically significant difference that favored FT. Costs were significantly higher in UC than in FT (P < .0001). Conclusions: We believe that the implementation of an enhanced recovery protocol in bariatric surgery is a reliable measure and can be implemented even in an underdevelopment environment enlarging the benefit for patients.
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Affiliation(s)
- Franco José Signorini
- General Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - M Belén Soria
- General Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Florencia Huais
- General Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Martín Andrada
- General Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Analía Priotto
- General Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Lucio Ricardo Obeide
- General Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Federico Moser
- General Surgery Department, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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23
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Ng AP, Bakhtiyar SS, Verma A, Richardson S, Kronen E, Darbinian K, Mabeza R, Yetasook A, Benharash P. Cost Variation in Bariatric Surgery Across the United States. Am Surg 2023; 89:4061-4065. [PMID: 37203440 DOI: 10.1177/00031348231177937] [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] [Indexed: 05/20/2023]
Abstract
BACKGROUND High costs have been cited as a barrier to utilization of bariatric surgery despite the increasing prevalence of obesity in the United States. The present work characterizes the center-level variation and risk factors for increased hospitalization costs following bariatric operations. STUDY DESIGN The 2016-2019 Nationwide Readmissions Database was queried to identify all adults undergoing elective laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). Random effects were estimated using Bayesian methodology and used to rank hospitals by increasing risk-adjusted center-level costs. RESULTS Of an estimated 687,866 patients at an annual 2435 hospitals, 69.9% underwent SG and 30.1% RYGB, with median costs of $10,900 (interquartile range: 8600-14,000) and $13,600 (10,300-18,000), respectively. Hospitals in the highest tertile of annual SG and RYGB volume were associated with a $1500 (95% CI - 2,100, -800) and $3400 reduction in costs (95% CI -4,200, -2600). Approximately 37.2% (95% CI 35.8-38.6) of variation in hospitalization costs was attributable to the hospital. Hospitals in the top decile of center-level costs were associated with increased odds of developing complications (AOR 1.22, 95% CI 1.05-1.40) but not mortality. CONCLUSION The present work identified significant interhospital variation in the costs of bariatric operations. Further efforts to standardize costs may enhance the value of bariatric surgical care in the US.
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Affiliation(s)
- Ayesha P Ng
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Shannon Richardson
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elsa Kronen
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Khajack Darbinian
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Russyan Mabeza
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amy Yetasook
- Department of General and Bariatric Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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24
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Vitiello A, Iacovazzo C, Berardi G, Vargas M, Marra A, Buonanno P, Velotti N, Musella M. Propensity score matched analysis of postoperative nausea and pain after one anastomosis gastric bypass (MGB/OAGB) versus sleeve gastrectomy (SG). Updates Surg 2023; 75:1881-1886. [PMID: 37193850 PMCID: PMC10543143 DOI: 10.1007/s13304-023-01536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
The aim of our study was to assess and compare postoperative nausea and pain after one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (LSG). Patients undergoing OAGB and LSG at our institution between November 2018 and November 2021 have been prospectively asked to report postoperative nausea and pain on a numeric analogic scale. Medical records were retrospectively reviewed to collect scores of these symptoms at the 6th and 12th postoperative hour. One-way analysis of variance (ANOVA) was used to evaluate effect of type of surgery on postoperative nausea and pain scores. To adjust for baseline differences between cohorts, a propensity score algorithm was used to match LSG patients to MGB/OAGB patients in a 1:1 ratio with a 0.1 tolerance. A total number of 228 (119 SGs and 109 OAGBs) subjects were included in our study. Nausea after OAGB was significantly less severe than after LSG both at the 6th and 12th hour assessment; pain was less strong after OAGB at the 6th hour but not after 12 h. Fifty-three individuals had a rescue administration of metoclopramide after LSG and 34 after OAGB (44.5% vs 31.2%, p = 0.04); additional painkillers were required by 41 patients after LSG and 23 after OAGB (34.5% vs 21.1%, p = 0.04). Early postoperative nausea was significantly less severe after OAGB, while pain was comparable especially at the 12th hour.
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Carmine Iacovazzo
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Maria Vargas
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Annachiara Marra
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Pasquale Buonanno
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
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Biancucci A, Fassari A, Lucchese S, Santoro E, Lirici MM. Use of quantitative indocyanine green near-infrared fluorescence imaging in bariatric surgery: early results. MINIM INVASIV THER 2023; 32:249-255. [PMID: 37039717 DOI: 10.1080/13645706.2023.2197049] [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: 09/22/2022] [Accepted: 03/22/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Indocyanine green fluorescence angiography (ICG-FA) is commonly used in general surgery, but its use in bariatric surgery is still marginal. Moreover, post-operative leaks remain a dramatic complication after this surgery and the leak tests available have poor performance preventing them. The aim of the present paper is to assess the use and utility of a new innovative technology based on quantitative measures of fluorescence signal intensity. MATERIAL AND METHODS From January 2022 to June 2022, 40 consecutive patients with a median age of 51 years and a preoperative median body mass index of 45.2 kg/m2 underwent bariatric surgery with quantitative ICG fluorescence angiography in our center. Two different types of surgery, based on the multidisciplinary evaluation, were performed: laparoscopic sleeve gastrectomy (LSG) and one anastomosis gastric bypass (OAGB). For ICG visualization, quantitative laparoscopic ICG platform was used to identify the vascular supply. RESULTS Thirteen patients underwent LSG and 27 patients underwent OAGB. ICG was performed in all patients with no adverse events. An adequate and satisfactory blood supply was assessed in each case. No case of post-operative leak was detected. CONCLUSIONS The quantitative ICG-FA seems to be a useful and promising tool for the prevention of complications in bariatric surgery but further studies are mandatory.
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Affiliation(s)
- Andrea Biancucci
- Department of Surgical Oncology, San Giovanni Addolorata Hospital Complex, Rome, Italy
| | - Alessia Fassari
- Department of Surgical Oncology, San Giovanni Addolorata Hospital Complex, Rome, Italy
| | - Sara Lucchese
- Department of Surgical Oncology, San Giovanni Addolorata Hospital Complex, Rome, Italy
| | - Emanuele Santoro
- Department of Surgical Oncology, San Giovanni Addolorata Hospital Complex, Rome, Italy
| | - Marco Maria Lirici
- Center for Advanced Laparoscopic Surgery and Multidisciplinary Obesity Unit, Nuova Clinica Annunziatella, Rome, Italy
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Silverstein J, Sohail AH, Silva-Pacheco TB, Khayat A, Amodu L, Cherasard P, Levine J, Goparaju A, Kella V, Shahidul I, Petrone P, Brathwaite CEM. Impact of Enhanced Recovery After Surgery (ERAS) Combined with Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) Protocol on Patient Outcomes, Length of Stay and Opioid Prescription After Bariatric Surgery. Obes Surg 2023; 33:3206-3211. [PMID: 37653212 DOI: 10.1007/s11695-023-06794-x] [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: 10/11/2022] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Evidence shows that 14.2% of opioid-naive patients have long-term opioid dependence after bariatric surgery. Enhanced recovery after surgery (ERAS) protocols are widely used in bariatric surgery, while bariatric surgery targeting opioid prescriptions (BSTOP) protocols were recently introduced. We will investigate the combined impact of ERAS and BSTOP protocols after bariatric surgery. METHODS We conducted a retrospective review for patients who underwent either a sleeve gastrectomy or Roux-en-Y gastric bypass at a tertiary care center. Pre-intervention and post-intervention data were compared. Primary outcomes were length of stay (LOS), 30-day readmission, 30-day complications, and discharge on opioids. Multivariate Poisson regression with robust standard error was used to analyze LOS. RESULTS There was no significant difference in 30-day emergency room visits (3.3% vs. 4.0%; p value = 0.631), 30-day readmission (4.4% vs. 5.4%; p value = 0.577) or 30-day complication rate (4.2% vs. 6.4%; p value = 0.199). LOS was significantly lower in the post-intervention group; mean (interquartile range) 2 (1-2) days vs. 1 (1-2) day, p value < 0.001. On multivariate analysis, the post-intervention group had 0.74 (95% confidence interval 0.65-0.85; p value < 0.001) times lower LOS as compared to pre-intervention group. Patients with DM had a significantly longer LOS (relative risk: 1.22; p = 0.018). No other covariates were associated with LOS (p value < 0.05 for all). BSTOP analysis found a significant difference between the two groups. Discharge on opioids decreased from 40.6% pre-intervention to 7.1% post-intervention. CONCLUSION ERAS and BSTOP protocols reduced length of stay and opioid need at discharge without an increase in complication or readmission rates.
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Affiliation(s)
- Jeffrey Silverstein
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Amir H Sohail
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Tulio B Silva-Pacheco
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Adam Khayat
- Department of Radiology, Rush University, Chicago, IL, USA
| | - Leo Amodu
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Patricia Cherasard
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Jun Levine
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Anirudha Goparaju
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Venkata Kella
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Islam Shahidul
- Department of Foundations of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY, USA
| | - Patrizio Petrone
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Collin E M Brathwaite
- Department of Surgery, NYU Grossman Long Island School of Medicine, NYU Langone Hospital-Long Island, Mineola, NY, USA.
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Ho C, Samwil SNM, Kahairudin Z, Jamhuri N, Abd Aziz A. Exercise and pre-habilitation with high whey-protein-based meal replacement therapy promote weight loss and preserve muscle mass before bariatric surgery. Asian J Surg 2023; 46:3716-3721. [PMID: 36931924 DOI: 10.1016/j.asjsur.2023.03.026] [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: 10/14/2022] [Revised: 02/01/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Bariatric surgery is considered as an effective therapy for those with morbid obesity. Preoperative weight loss with a very low-calorie diet is commonly used to ease the bariatric surgery. Pre-habilitation increases functional and physiological capacity. The study demonstrated the changes of body composition and functional status following short term pre-habilitation before bariatric surgery. METHOD This prospective study targeted those admitted for bariatric surgery. Participants underwent the biweekly pre-habilitation program included an individualized high whey-based protein very low-calorie (VLCHP) enteral regime (600-900 kcal/day) and moderate intensive exercise before bariatric surgery. Body composition and waist circumference were assessed after fortnight. Participants were segregated into morbid obese (MOG) (BMI <49 kg/m2) and super morbid obese group (SMOG) (BMI ≥50 kg/m2) for analysis. RESULT Majority of participants were female (71%) with median age 36.0 years old (MOG) and 34.3 years old (SMOG) respectively. SMOG achieved significant greater loss in weight (-7.4 kg vs -4.0 kg), fat percentage (-4.4% vs -1.7%) and fat mass (-9.9 kg vs -3.8 kg); but MOG had a significant increment in muscle mass (3.2 kg vs 2.8 kg) as compared to SOG (p < 0.001). DISCUSSION Body composition measurement and changes remain critical in nutritional assessment to achieve successful surgery and minimize nutritional complication. Whey-based VLCHP attenuates muscle loss and preserves myofibrillar protein synthesis; promotes a better muscle strength and mass growth during periods of negative energy balance combined with moderately intense aerobic activity. CONCLUSION Individualized whey-based VLCHP enteral regime and moderate intensive exercise encourage weight loss; increases muscle mass and strength; improve function status prior to bariatric surgery.
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Affiliation(s)
- ChiouYi Ho
- Department of Dietetics and Food Services, Institut Kanser Negara, Ministry of Health, 4, Jalan P7, Presint 7, 62250, Putrajaya, Malaysia.
| | - Siti Nuraini Mohd Samwil
- Department of Dietetics and Food Services, Institut Kanser Negara, Ministry of Health, 4, Jalan P7, Presint 7, 62250, Putrajaya, Malaysia
| | - Zuliehaiza Kahairudin
- Department of Dietetics and Food Services, Institut Kanser Negara, Ministry of Health, 4, Jalan P7, Presint 7, 62250, Putrajaya, Malaysia
| | - Norshariza Jamhuri
- Department of Dietetics and Food Services, Institut Kanser Negara, Ministry of Health, 4, Jalan P7, Presint 7, 62250, Putrajaya, Malaysia
| | - Adibah Abd Aziz
- Unit of Physiotherapy, Institut Kanser Negara, Ministry of Health, 4, Jalan P7, Presint 7, 62250, Putrajaya, Malaysia
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Abhinav K, Jadhav D, Andar UB, Karmarkar V, Agrawal R, Agrawal A. Management of Post-craniotomy Pain in Elective Cases: A Randomized Controlled Trial. Cureus 2023; 15:e46189. [PMID: 37905293 PMCID: PMC10613341 DOI: 10.7759/cureus.46189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Craniotomy is associated with significant postoperative discomfort. Standardized pain management and enhanced recovery after surgery (ERAS) protocol could improve patient-reported outcomes and lower medical expenses. AIM The aim of this study is to prospectively assess the effectiveness of an ERAS protocol for neurosurgery in the treatment of postoperative pain following elective craniotomies. METHODS AND MATERIALS A total of 128 patients were assigned to the ERAS group and received care in accordance with the neurosurgical ERAS regulations, while 130 other participants were assigned to the control group and received traditional postoperative assistance. The participants' postoperative pain ratings using the numerical rating scale (NRS) were this study's main outcome of interest. The verbal NRS uses the numbers 0 to 10, with 0 indicating no sensation of pain and 10 indicating the most severe pain. On postoperative day (POD) 1, the patients' postoperative pain level at the surgical site was evaluated using the NRS. This was repeated every day until the patient either reported feeling no sensation of pain or was discharged home. RESULTS The mean value of pain on the day of surgery was 4.43 ± 0.43 and 4.72 ± 0.68 for patients in the ERAS and control groups, respectively. The pain values were higher in the control group compared to the ERAS group. However, the difference was not statistically significant (p = 0.478). The mean value of pain on POD1 was 3.13 ± 0.21 and 4.45 ± 0.95 for patients in the ERAS and control groups, respectively. These pain values were higher in the control group compared to the ERAS group, and the difference was statistically significant (p = 0.011). The mean value of pain on POD2 was 2.86 ± 0.3 and 4.33 ± 0.37 for patients in the ERAS and control groups, respectively. The values of pain were higher in the control group compared to the ERAS group, and the difference was statistically significant (p = 0.003). The mean value of pain on POD3 was 2.33 ± 0.52 and 4.04 ± 0.15 for patients in the ERAS and control groups, respectively. The pain values were higher in the control group compared to the ERAS group. The difference was meaningful statistically (p < 0.001). The mean value of pain on POD4 was 2.26 ± 0.9 and 2.84 ± 0.13 for the ERAS and control groups, respectively. However, the difference was not statistically significant (p = 0.274). The ERAS group had a significantly higher proportion of participants rating their pain between 1 and 3 (68.9%) and a lower proportion rating their pain between 4 and 7 (28.2%), compared to the control group (p < 0.001). Differences in the highest pain ratings (8-10) between the groups were not statistically significant. The duration of hospital stay, beginning from surgery to discharge, was lesser among study participants in the ERAS group, and this finding was statistically significant (p < 0.001). CONCLUSION The findings of this study imply that the ERAS protocol may aid pain management following elective craniotomies. Additionally, the ERAS protocol decreased the overall expense of medical care and the cumulative/postoperative length of hospital stay.
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Affiliation(s)
- Kumar Abhinav
- Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, IND
| | - Dikpal Jadhav
- Department of Neurosurgery, King Edward Memorial (KEM) Hospital, Mumbai, IND
| | - Uday B Andar
- Department of Neurosurgery, Bai Jerbai Wadia Hospital for Children, Mumbai, IND
| | - Vikram Karmarkar
- Department of Neurosurgery, Bombay Hospital and Medical Research Centre, Mumbai, IND
| | - Rama Agrawal
- Department of Physiology, Patna Medical College and Hospital, Patna, IND
| | - Ankita Agrawal
- Department of Conservative and Endodontics, Buddha Institute of Dental Sciences & Hospital, Patna, IND
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Crespo-Yanguas M, Lumpuy-Castillo J, Espadas C, Aragón-Valera C, Vázquez C, Lorenzo Ó. A Program of Life-Style Modification Improved the Body Weight and Micronutrient Status in Obese Patients after Bariatric Surgery. Nutrients 2023; 15:3807. [PMID: 37686839 PMCID: PMC10490431 DOI: 10.3390/nu15173807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Bariatric surgery is an efficient approach to rapidly reduce morbid obesity and associated comorbidities. However, approximately one-fourth of patients experience weight and comorbidity recurrence, and both obesity and bariatric surgery can lead to micronutrient deficiencies. Implementing a structured program of lifestyle modification (PLM) might enhance weight loss and improve micronutrient status. METHODOLOGY A total of 121 severely obese patients underwent Roux-en-Y gastric bypass (RYGB). Among them, 71 adhered to a PLM involving dietary changes (low- and very-low-calorie Mediterranean diets) and physical exercises (aerobic and resistance training) both before and after surgery, while 50 patients followed a conventional protocol. Anthropometric measurements and serological parameter quantifications were conducted throughout the procedures. RESULTS The obese study population, primarily female (76.9%), with an average age of 47.11 ± 9.68, and a body mass index (BMI) of 44.68 ± 5.08 kg/m2, underwent either RYGB with a PLM or a conventional procedure. Before surgery, the PLM group exhibited significant reductions in body weight (6.3%) and phosphoremia compared to the conventional protocol (0.78%). Post-RYGB, the PLM group demonstrated shortened in-hospital stays and further BMI reductions (-16.12 kg/m2) that persisted for up to 2 years. Furthermore, the PLM group experienced increased plasma vitamin D levels (14.79 ng/mL vs. 1.2 ng/mL) for up to 2 years, as well as elevated folic acid (1.52 vs. -0.29 ng/mL) and phosphorus (0.48 vs. 0.06 mg/dL) levels at 1 month and 1 year after intervention, respectively. Notably, these effects were independent of weight loss. CONCLUSIONS Initiating a structured PLM from the early stages of patients' preparation for RYGB could enhance and extend the benefits of weight loss and positively impact micronutrient (vitamin D, phosphorus, and folic acid) status in obese patients.
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Affiliation(s)
- Marta Crespo-Yanguas
- Division of Endocrinology, Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain; (M.C.-Y.); (C.A.-V.); (C.V.)
| | - Jairo Lumpuy-Castillo
- Laboratory of Diabetes and Vascular Pathology, IIS-Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain; (J.L.-C.); (C.E.)
- Biomedical Research Network on Diabetes and Associated Metabolic Disorders (CIBERDEM), Carlos III National Health Institute, 28029 Madrid, Spain
| | - Cristina Espadas
- Laboratory of Diabetes and Vascular Pathology, IIS-Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain; (J.L.-C.); (C.E.)
- Biomedical Research Network on Diabetes and Associated Metabolic Disorders (CIBERDEM), Carlos III National Health Institute, 28029 Madrid, Spain
| | - Carmen Aragón-Valera
- Division of Endocrinology, Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain; (M.C.-Y.); (C.A.-V.); (C.V.)
| | - Clotilde Vázquez
- Division of Endocrinology, Hospital Fundación Jiménez Díaz, 28040 Madrid, Spain; (M.C.-Y.); (C.A.-V.); (C.V.)
| | - Óscar Lorenzo
- Laboratory of Diabetes and Vascular Pathology, IIS-Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain; (J.L.-C.); (C.E.)
- Biomedical Research Network on Diabetes and Associated Metabolic Disorders (CIBERDEM), Carlos III National Health Institute, 28029 Madrid, Spain
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Stryhn K, Alstrup L, Riber C, Ørting M, Hadad R, Hvistendahl J, Tollund C, Boye N, Haugaard SB, Funch-Jensen P. Complications in Patients Undergoing Laparoscopic Bariatric Surgery in an ERABS-optimized, High-Volume, Single Center During 2020 and 2021. Obes Surg 2023; 33:2064-2071. [PMID: 37199830 PMCID: PMC10289944 DOI: 10.1007/s11695-023-06596-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Complication rates after fast-track optimization in bariatric surgery are varying. The aim of this study was to identify short-term complications in patients undergoing laparoscopic sleeve gastrectomy (SG) in an ERABS (enhanced recovery after bariatric surgery) optimized setup. MATERIALS AND METHODS This study is an observational analysis of a consecutive cohort of 1600 patients undergoing SG at an ERABS-optimized, private hospital during 2020 and 2021. Primary outcomes were length of stay, mortality, readmissions, reoperations, and complications according to the Clavien-Dindo classification (CDC) within postoperative day (POD) 30 and 90. Secondary outcomes were weight loss and quality of life (QoL) according to Moorehead-Ardelt questionnaires during the first postoperative year. RESULTS Primary outcomes: 99.1% of patients were discharged within POD 1. The 90-day mortality rate was zero. There were 1% readmissions and 1.2% reoperations within POD 30. Total 30-day complication rate was 4.6%, where 3.4% accounted for CDC grades ≤ II, and 1.3% accounted for CDC grade III. There were zero grade IV-V complications. SECONDARY OUTCOMES One year after surgery, weight loss was substantial (p < 0.001), with an excess weight loss of 71.9%, and QoL had significantly increased (p < 0.001). CONCLUSION This study demonstrates that the use of an ERABS protocol in bariatric surgery does not compromise neither safety nor efficacy. Complication rates were low, and weight loss was significant. This study thus provides strong arguments that ERABS programs are beneficial in bariatric surgery.
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Affiliation(s)
- Katrine Stryhn
- Department of Surgery, Aleris Hospitals, Copenhagen Department, Gyngemose Parkvej 66, 2860 Søborg, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Lærke Alstrup
- Department of Surgery, Aleris Hospitals, Copenhagen Department, Gyngemose Parkvej 66, 2860 Søborg, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Claus Riber
- Department of Surgery, Aleris Hospitals, Copenhagen Department, Gyngemose Parkvej 66, 2860 Søborg, Denmark
| | - Michael Ørting
- Department of Surgery, Aleris Hospitals, Aarhus Department, Brendstrupgårdsvej 21, 8200 Aarhus, Denmark
- Department of Surgery, Aleris Hospitals, Esbjerg Department, Bavnehøjvej 2, 6700 Esbjerg, Denmark
| | - Rakin Hadad
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Jan Hvistendahl
- Department of Anesthesiology, Aleris Hospitals, Aarhus Department, Brendstrupgårdsvej 21, 8200 Aarhus, Denmark
- Department of Anesthesiology, Aleris Hospitals, Esbjerg Department, Bavnehøjvej 2, 6700 Esbjerg, Denmark
| | - Carsten Tollund
- Department of Anesthesiology, Aleris Hospitals, Copenhagen Department, Gyngemose Parkvej 66, 2860 Søborg, Denmark
| | - Niels Boye
- Department of Endocrinology, Aleris Hospitals, Copenhagen Department, Gyngemose Parkvej 66, 2860 Søborg, Denmark
- Department of Endocrinology, Aleris Hospitals, Aarhus Department, Brendstrupgårdsvej 21, 8200 Aarhus, Denmark
- Department of Endocrinology, Aleris Hospitals, Esbjerg Department, Bavnehøjvej 2, 6700 Esbjerg, Denmark
| | - Steen B. Haugaard
- Institute of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
- Department of Endocrinology, Aleris Hospitals, Copenhagen Department, Gyngemose Parkvej 66, 2860 Søborg, Denmark
- Department of Endocrinology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Peter Funch-Jensen
- Department of Surgery, Aleris Hospitals, Copenhagen Department, Gyngemose Parkvej 66, 2860 Søborg, Denmark
- Department of Surgery, Aleris Hospitals, Aarhus Department, Brendstrupgårdsvej 21, 8200 Aarhus, Denmark
- Department of Surgery, Aleris Hospitals, Esbjerg Department, Bavnehøjvej 2, 6700 Esbjerg, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
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Marshall C, Estes SJ. Reproductive Surgery in Females with Obesity: Reproductive Consequences of Obesity and Applications for Surgical Care. Semin Reprod Med 2023; 41:97-107. [PMID: 37967852 DOI: 10.1055/s-0043-1776915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Obesity is the most common medical problem in women of reproductive age. The surgical applications for this population, many of who are interested in current or future fertility, are critical to safe and effective evaluation and management of issues that impact the reproductive system. As rates of obesity continue to rise worldwide, it is projected that one in two individuals will have obesity by 2030 leading to increasing numbers of individuals affected by a disease process that has implications for their gynecologic surgical care, fertility-related assessment, and infertility treatment. Offering patients with obesity access to safe reproductive surgery is a cornerstone of reproductive autonomy. This review will summarize current recommendations regarding surgical concepts for the operating room, office hysteroscopy, oocyte retrieval, and embryo transfer in female patients with obesity.
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Affiliation(s)
- Ciara Marshall
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Stephanie J Estes
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Division of Reproductive Endocrinology and Infertility, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Gupta S, Tao X, Matur AV, Wu A, Chilakapati SS, Palmisciano P, Conteh FS, Duah HO, Shukla G, Vorster P, Garcia-Vargas J, Kwan D, Adogwa O. Bariatric Surgery Before Spine Surgery is Associated With Fewer Postsurgical Complications: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2023; 48:944-949. [PMID: 37075380 DOI: 10.1097/brs.0000000000004682] [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: 02/07/2023] [Accepted: 03/29/2023] [Indexed: 04/21/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To perform a systematic review and meta-analysis investigating the rate of adverse events after spine surgery in patients who underwent bariatric surgery (BS). SUMMARY OF BACKGROUND DATA Obesity is an established risk factor for postoperative complications after spine surgery. BS has been associated with improvements in health in patients with severe obesity. However, it is not known whether undergoing BS before spine surgery is associated with reduced adverse outcomes. MATERIALS AND METHODS PubMed, EMBASE, Scopus, and Web-of-Science were systematically searched according to "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The search included indexed terms and text words from database inception to the date of the search (May 27, 2022). Data and estimates were pooled using the Mantel-Haenszel method for random-effects meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute risk of bias tool. The primary outcome was an all-cause complication rate after surgery. Relative risks for surgical and medical complications were assessed. RESULTS A total of 4 studies comprising 177,273 patients were included. The pooled analysis demonstrated that the all-cause medical complication rate after spine surgery was lower in patients undergoing BS (relative risk: 0.54, 95% CI: 0.39, 0.74, P < 0.01). There was no difference in rates of surgical complications and 30-day hospital readmission rates between the cohort undergoing BS before spine surgery and the cohort that did not. CONCLUSION These analyses suggest that obese patients undergoing BS before spine surgery have significantly lower adverse event rates. Future prospective studies are needed to corroborate these findings. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Sahil Gupta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Andrew Wu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Fatu S Conteh
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Henry O Duah
- Institute of Nursing Research, University of Cincinnati College of Nursing, Cincinnati, OH
| | - Geet Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Julia Garcia-Vargas
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - David Kwan
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Meißner C, Meyer F, Ridwelski K. Prehabilitation in elective surgical interventions - what must the general and abdominal surgeon know. Innov Surg Sci 2023; 8:93-101. [PMID: 38058772 PMCID: PMC10696941 DOI: 10.1515/iss-2023-0006] [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: 02/01/2023] [Accepted: 06/02/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives For years, many efforts have been invested to prepare patients, in particular, those with reduced physical and psychic status, much better to provide and finally achieve better outocme if there is time available to provide several beneficial measures. Methods Therefore, the objective was to illustrate the concept and various single elements of a complex prehabilitation concept based on (i) selective references from the medical literature and (ii) own clinical experiences from clinical practice in general and abdominal surgery. Results Prehabiliation can be considered the solution of the efforts to improve preoperative status for patients in a disadvantageous status for almost all types of surgery and all other operative and/or interventional procedures. It is the targeted process to improve individual functionality and organ function before a planned (elective) surgical intervention; P. comprises basically nutritional, physical and psychological measures; P. focusses especially onto the elderly, frail and malnourished patients before a planned surgical intervention; the overall aim is to significantly improve final outcome characterized by shorter length of stay, lower complication rate and mortality as well as cost efficiency; P. is especially important in cancer surgery, in which the beneficial effects can be particularly implemented; P. programs and/or "Standard Operating Protocols" (SOP) may help to establish and materialize its single aspects and enhanced recovery after surgery (ERAS). There is still further potential to reliably establish and to utilize the options of prehabilitation measures as listed above. Conclusions Prehabiliation is an indispensable aspect in today's preparation for elective surgery, which needs to become obligatory part of the preparation measures to planned surgical interventions, which can further contribute to a better final outcome and ERAS as well as, in addtion, needs to be further developed and accomplished.
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Affiliation(s)
- Carl Meißner
- MVZ “Im Altstadtquartier”, General Surgery, Magdeburg, Germany
- Otto-von-Guericke University at Magdeburg, Institute for Quality Assurance in Operative Medicine, Magdeburg, Germany
| | - Frank Meyer
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University at Magdeburg with University Hospital, Magdeburg, Germany
| | - Karsten Ridwelski
- Department of General and Abdominal Surgery, Municipal Hospital (“Klinikum Magdeburg gGmbH”), Magdeburg, Germany
- Otto-von-Guericke University at Magdeburg, Institute for Quality Assurance in Operative Medicine, Magdeburg, Germany
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Aghazarian GS, Lind R, Motola D, Perry M, Singletary N, Lastrapes L, Ghanem M, Jawad MA, Teixeira AF. Impact of Emend on Perioperative Bariatric Surgery Antiemetic Utilization, Patient Satisfaction, and Costs. Surg Laparosc Endosc Percutan Tech 2023; 33:265-269. [PMID: 36821697 DOI: 10.1097/sle.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/25/2022] [Indexed: 02/25/2023]
Abstract
PURPOSE Postoperative nausea and vomiting (PONV) is one of the most common adverse effects of anesthesia and surgery, resulting in patient discomfort and dissatisfaction. Latest research has demonstrated the efficacy of NK-1 receptor antagonists in PONV management and its use in chemotherapy nausea prophylaxis. The authors of this article would like to provide evidence to support the use fosaprepitant, as monotherapy, in postoperative care, replacing a polypharmacological standard of care regimen. METHODS This was a retrospective chart review of 400 patients who received standard of care antiemetic regimen or received fosaprepitant (No-Fosaprepitant vs. Fosaprepitant groups, respectively). The primary outcome of this study is to evaluate the impact of fosaprepitant (administered intravenously) on perioperative antiemetic use, treatment cost, and patient satisfaction. RESULTS Total PONV medication cost decreased with the replacement of standard of care regimen for fosaprepitant, from 46.47±20.54 United States Dollars in the no-Fosaprepitant group to 25.69±14.84 United States Dollars in the Fosaprepitant group. There was a significant reduction in antiemetic doses between groups; 0.37±0.745 versus 7.61±5.202 for ondansetron ( P =0.001), 92±1.279 versus 2.21±2.399 for promethazine ( P =0.001), 0.25±0.685 versus 1.41±0.577 for scopolamine patch ( P =0.001), and 0.05±0.218 versus 1.14±0.398 for dexamethasone ( P =0.001). Patient satisfaction, measured by a questionnaire, was a 11.6% higher in the Fosaprepitant group. CONCLUSION Fosaprepitant is a relevant alternative in preventing and treating PONV in patients who underwent bariatric/metabolic surgical procedures.
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Affiliation(s)
| | - Romulo Lind
- Department of Bariatric Surgery, 89 W Copeland Dr, 1st Floor
| | - David Motola
- Department of Bariatric Surgery, 89 W Copeland Dr, 1st Floor
| | - Melanie Perry
- Department of Pharmacy, Orlando Regional Medical Center, Orlando Health, 1414 Kuhl Ave., Orlando, FL
| | - Norman Singletary
- Department of Pharmacy, Orlando Regional Medical Center, Orlando Health, 1414 Kuhl Ave., Orlando, FL
| | - Linda Lastrapes
- Department of Bariatric Surgery, 89 W Copeland Dr, 1st Floor
| | - Muhammad Ghanem
- Department of Bariatric Surgery, 89 W Copeland Dr, 1st Floor
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Lacroix C, Zamparini M, Meunier H, Fiant AL, Le Roux Y, Bion AL, Savey V, Alves A, Menahem B. Mid-term Results of an ERAS Program of Bariatric Surgery in a Tertiary Referral Center. World J Surg 2023; 47:1597-1606. [PMID: 37188970 DOI: 10.1007/s00268-023-07023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND To identify preoperative risk factors for discharge failure beyond postoperative day two (POD-2) in bariatric surgery ERAS program in a tertiary referral center. METHODS all consecutive patients who underwent laparoscopic bariatric treated in accordance with ERAS protocol between January 2017 and December 2019 were included. Two groups were identified, failure of early discharge (> POD-2) (ERAS-F) and success of early discharge (≤ POD-2) (ERAS-S). Overall postoperative morbidity, unplanned readmission rates were analyzed at POD-30 and POD-90, respectively. Multivariate logistic regression was performed to determine the independent risk factors for LOS > 2 days (ERAS-F). RESULTS A total of 697 consecutive patients were included, 148 (21.2%) in ERAS-F group and 549 (78.8%) in ERAS-S group. All postoperative complications at POD 90, whether medical or surgical were significantly more frequent in ERAS-F group than in ERAS-S group. Neither readmission nor unplanned consultations rates at POD 90 were significantly different between both groups. History of psychiatric disorder (p = 0.01), insulin-dependent diabetes (p < 0.0001), use of anticoagulants medicine (p < 0.00001), distance to the referral center > 100 km (p = 0.006), gallbladder lithiasis (p = 0.02), and planned additional procedures (p = 0.01) were independent risk factors for delayed discharge beyond POD-2. CONCLUSIONS One in five patients with bariatric surgery failed to discharge earlier despite the ERAS program. Knowledge of these preoperative risk factors would allow us to identify patients who need more recovery time and a tailored approach to the ERAS protocol.
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Affiliation(s)
- Coralie Lacroix
- Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France
| | - Marion Zamparini
- Department of Anesthesia, University Hospital of Caen, Caen, France
| | - Hugo Meunier
- Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France
| | - Anne-Lise Fiant
- Department of Anesthesia, University Hospital of Caen, Caen, France
| | - Yannick Le Roux
- Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France
| | - Adrien Lee Bion
- Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France
| | - Véronique Savey
- Department of Nutrition, University Hospital of Caen, Caen, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France
- UNICAEN, INSERM, ANTICIPE, Normandie Univ, 14000, Caen, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, Avenue de La Côte de Nacre, 14033, Caen Cedex, France.
- UNICAEN, INSERM, ANTICIPE, Normandie Univ, 14000, Caen, France.
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Reijnders-Boerboom GT, Albers KI, Jacobs LM, van Helden E, Rosman C, Díaz-Cambronero O, Mazzinari G, Scheffer GJ, Keijzer C, Warlé MC. Low intra-abdominal pressure in laparoscopic surgery: a systematic review and meta-analysis. Int J Surg 2023; 109:1400-1411. [PMID: 37026807 PMCID: PMC10389627 DOI: 10.1097/js9.0000000000000289] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/03/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Guidelines do not provide clear recommendations with regard to the use of low intra-abdominal pressure (IAP) during laparoscopic surgery. The aim of this meta-analysis is to assess the influence of low versus standard IAP during laparoscopic surgery on the key-outcomes in perioperative medicine as defined by the StEP-COMPAC consensus group. MATERIALS AND METHODS We searched the Cochrane Library, PubMed, and EMBASE for randomized controlled trials comparing low IAP (<10 mmHg) with standard IAP (10 mmHg or higher) during laparoscopic surgery without time, language, or blinding restrictions. According to the PRISMA guidelines, two review authors independently identified trials and extracted data. Risk ratio (RR), and mean difference (MD), with 95% CIs were calculated using random-effects models with RevMan5. Main outcomes were based on StEP-COMPAC recommendations, and included postoperative complications, postoperative pain, postoperative nausea and vomiting (PONV) scores, and length of hospital stay. RESULTS Eighty-five studies in a wide range of laparoscopic procedures (7349 patients) were included in this meta-analysis. The available evidence indicates that the use of low IAP (<10 mmHg) leads to a lower incidence of mild (Clavien-Dindo grade 1-2) postoperative complications (RR=0.68, 95% CI: 0.53-0.86), lower pain scores (MD=-0.68, 95% CI: -0.82 to 0.54) and PONV incidence (RR=0.67, 95% CI: 0.51-0.88), and a reduced length of hospital stay (MD=-0.29, 95% CI: -0.46 to 0.11). Low IAP did not increase the risk of intraoperative complications (RR=1.15, 95% CI: 0.77-1.73). CONCLUSIONS Given the established safety and the reduced incidence of mild postoperative complications, lower pain scores, reduced incidence of PONV, and shorter length of stay, the available evidence supports a moderate to strong recommendation (1a level of evidence) in favor of low IAP during laparoscopic surgery.
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Affiliation(s)
| | - Kim I. Albers
- Departments of Anesthesiology
- Surgery, Radboudumc, Nijmegen, The Netherlands
| | | | | | | | - Oscar Díaz-Cambronero
- Department of Anesthesiology, La Fé University and Polytechnic Hospital, Valencia, Spain
| | - Guido Mazzinari
- Department of Anesthesiology, La Fé University and Polytechnic Hospital, Valencia, Spain
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Mahmoudieh M, Kalidari B, Sayadi Shahraki M, Mellali H, Mirzaie H, Salamati M. Comparison of the Effects of Special Care Enhanced Recovery and Conventional Recovery Methods after Mini Omega Gastric Bypass. Adv Biomed Res 2023; 12:99. [PMID: 37288032 PMCID: PMC10241633 DOI: 10.4103/abr.abr_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 06/09/2023] Open
Abstract
Background Bariatric surgery is a surgical procedure for patients with extreme obesity. Enhanced Recovery after Surgery (ERAS) is a method that provides special peri- and post-operation care. Here, we aimed to compare the effects of ERAS and standard recovery cares. Materials and Methods This is a randomized clinical trial that was performed in 2020-2021 in Isfahan on 108 candidates for mini gastric bypass. Patients were then randomly divided into two equal groups receiving ERAS and standard recovery protocols. Patients were examined and visited after one month regarding the average number of hospitalization days, the average days required to return to normal activity or work, occurrence of pulmonary thromboemboli (PTE) and the rate of readmission. Results Patients that received ERAS had significantly lower frequencies of nausea and vomiting (P = 0.032). Patients that received ERAS had significantly lower hospitalization duration (P < 0.001) compared to controls. No other significant differences were observed between two groups regarding surgery complication, re-admission rate and occurrence of PTE (P > 0.99 for all). Conclusion Patients that received ERAS protocol after gastric bypass had significantly lower hospitalization duration and lower incidence of nausea and vomiting. They also had similar post-operative outcomes compared to the standard protocol.
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Affiliation(s)
- Mohsen Mahmoudieh
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Kalidari
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Sayadi Shahraki
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Mellali
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Mirzaie
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Salamati
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Pereira SE, Rossoni C, Cambi MPC, Faria SL, Mattos FCC, De Campos TBF, Petry TBZ, Da Silva SA, Pereira AZ, Umeda LM, Nogueira C, De Araújo Burgos MGP, Magro DO. Brazilian guide to nutrition in bariatric and metabolic surgery. Langenbecks Arch Surg 2023; 408:143. [PMID: 37039877 DOI: 10.1007/s00423-023-02868-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. MATERIALS AND METHODS A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). RESULTS The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. CONCLUSION We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.
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Affiliation(s)
- Silvia Elaine Pereira
- Postgraduate Program in Nutritional Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Carina Rossoni
- Faculty of Medicine (ISAMB), Instituto of Environmental Health, Universidade de Lisboa, Lisbon, Portugal.
| | | | - Silvia Leite Faria
- Postgraduate Program in Human Nutrition, University of Brasilia, Brasilia, Brazil
| | | | | | | | - Silvia Alves Da Silva
- Postgraduate Program in Nutritional in Bariatric Surgery, Federal University of Pernambuco, Recife, Brazil
| | | | - Luciana Mela Umeda
- Medical Residency Program in Endrocrinology and Metabology, Ipiranga Hospital, São Paulo, Brazil
| | - Carla Nogueira
- Postgraduate Program in Human Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Motola D, Lind R, Geisel L, Aghazarian G, Ghanem M, Teixeira AF, Jawad MA. Implementing novel modalities into an institutional enhanced recovery after bariatric surgery (ERABS) protocol. Surg Endosc 2023:10.1007/s00464-023-10027-8. [PMID: 37017770 DOI: 10.1007/s00464-023-10027-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/12/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION Enhanced recovery after bariatric surgery pathways are associated with improved postoperative outcomes. This study aims to assess efficacy and safety of three novel protocol contributions (transversus abdominis plane blocks, ketamine and fosaprepitant), as well as their impact on length of stay (LOS) and on postoperative complications. METHODS Effectiveness and safety were retrospectively investigated in patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) over a 6-year period in a single institution. Group 1 patients were not exposed to any of our suggested interventions, whereas Group 2 were exposed to all of three. RESULTS Between January 2015 and August 2021, 1480 patients underwent primary SG (77.6%) or RYGB (22.4%); of those, 1132 (76.5%) and 348 (23.5%) were in Groups 1 and 2, respectively. Mean BMI and age were 45.87 versus 43.65 kg/m2 and 45.53 versus 44.99 years in groups 1 and 2, respectively. Suggested interventions were associated with lower operative times (84.79 ± 24.21 vs. 80.78 ± 32.8 min, p = 0.025). In Group 2, the mean LOS decreased in 0.18 day (1.79 ± 1.04 vs. 1.60 ± 0.90; p = 0.004). Overall complication rates were 8% and 8.6% for groups 1 and 2, respectively; readmission rates were 5.7% (64 pts) vs. 7.2% (25 pts), p > 0.05. Reoperations were less prevalent in Group 2 (1.5% vs. 1.1%; p = 0.79). CONCLUSION Focus on optimized pain management, allied to a superior PONV control, may be relevant contributors for a lower LOS without negative impacts in complications rates.
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Affiliation(s)
- David Motola
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Romulo Lind
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA.
| | - Lauren Geisel
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Gary Aghazarian
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Muhammad Ghanem
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Andre F Teixeira
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
| | - Muhammad A Jawad
- Department of Bariatric Surgery, Orlando Regional Medical Center, Orlando Health, 89 W Copeland Dr, 1st Floor, Orlando, FL, USA
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Svetanoff WJ, Diefenbach K, Hall B, Craver A, Rutledge S, McManaway C, Eneli I, Tobias J, Michalsky MP. Utilization of an Enhanced Recovery After Surgery (ERAS) protocol for pediatric metabolic and bariatric surgery. J Pediatr Surg 2023; 58:695-701. [PMID: 36641311 DOI: 10.1016/j.jpedsurg.2022.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) protocols for pediatric metabolic and bariatric surgery are limited. In 2018, an ERAS protocol for patients undergoing robotically assisted vertical sleeve gastrectomy (r-VSG) was instituted. This study's aim was to compare outcomes before and after ERAS initiation. METHODS A single institution retrospective review of patients undergoing r-VSG from July 2015 to July 2021 was performed. The multimodal ERAS protocol focused on limiting post-operative nausea and narcotic utilization. Subjects were categorized into non-ERAS (July 2015-July 2018) and ERAS (August 2018-July 2021) groups. In-hospital and 30-day outcomes were compared. RESULTS 110 subjects (94 females) with a median age of 17.6 years (range 12.5-22.0 years) were included (60 non-ERAS, 50 ERAS). Demographics were similar except for a higher proportion of females in the non-ERAS group (97% vs 72%, p < 0.001). A significant decrease in narcotic use (p < 0.001) and higher utilization of acetaminophen (p < 0.001) and ketorolac (p < 0.001) was observed in the ERAS group. Additionally, median time to oral intake, a proxy for postoperative nausea and vomiting [2:00 h (1:15, 2:30) vs. 3:22 h (2:03, 6:15), p < 0.001] and hospital length of stay (LOS) [1.25 days (1.14, 1.34) vs. 2.16 days (1.48, 2.42), p < 0.001] were shorter in the ERAS group. Eleven subjects (10%; ERAS = 5, non-ERAS = 6) experienced post-discharge dehydration, prompting readmission 8 times for 7 (6%) individuals. CONCLUSION Utilization of ERAS led to a significant decrease narcotic utilization, time to first oral intake, and hospital LOS with no change in adverse events following pediatric metabolic and bariatric surgery. Larger studies, including comparative analysis of health care utilization, should be carried out. LEVEL OF EVIDENCE III. TYPE OF STUDY Treatment Study.
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Affiliation(s)
- Wendy Jo Svetanoff
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Karen Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Brian Hall
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Amber Craver
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Sarah Rutledge
- Department of Anesthesia and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Cindy McManaway
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Ihuoma Eneli
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Joseph Tobias
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
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Gao B, Chen J, Liu Y, Hu S, Wang R, Peng F, Fang C, Gan Y, Su S, Han Y, Yang X, Li B. Efficacy and safety of enhanced recovery after surgery protocol on minimally invasive bariatric surgery: a meta-analysis. Int J Surg 2023; 109:1015-1028. [PMID: 36999781 PMCID: PMC10389529 DOI: 10.1097/js9.0000000000000372] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/16/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS), a multidisciplinary and multimodal perioperative care protocol, has been widely used in several surgical fields. However, the effect of this care protocol on patients receiving minimally invasive bariatric surgery remains unclear. This meta-analysis compared the clinical outcomes of the ERAS protocol and standard care (SC) in patients who underwent minimally invasive bariatric surgery. MATERIAL AND METHODS PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched to identify literature reporting the effects of the ERAS protocol on clinical outcomes in patients undergoing minimally invasive bariatric surgery. All the articles published until 01 October 2022, were searched, followed by data extraction of the included literature and independent quality assessment. Then, pooled mean difference (MD) and odds ratio with a 95% CI were calculated by either a random-effects or fixed-effects model. RESULTS Overall, 21 studies involving 10 764 patients were included in the final analysis. With the ERAS protocol, the length of hospitalization (MD: -1.02, 95% CI: -1.41 to -0.64, P <0.00001), hospitalization costs (MD: -678.50, 95% CI: -1196.39 to -160.60, P =0.01), and the incidence of 30-day readmission (odds ratio =0.78, 95% CI: 0.63-0.97, P =0.02) were significantly reduced. The incidences of overall complications, major complications (Clavien-Dindo grade ≥3), postoperative nausea and vomiting, intra-abdominal bleeding, anastomotic leak, incisional infection, reoperation, and mortality did not differ significantly between the ERAS and SC groups. CONCLUSIONS The current meta-analysis indicated that the ERAS protocol could be safely and feasibly implemented in the perioperative management of patients receiving minimally invasive bariatric surgery. Compared with SC, this protocol leads to significantly shorter hospitalization lengths, lower 30-day readmission rate, and hospitalization costs. However, no differences were observed in postoperative complications and mortality.
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Affiliation(s)
- Benjian Gao
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Jianfei Chen
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Yongfa Liu
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Shuai Hu
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Rui Wang
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Fangyi Peng
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Chen Fang
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Yu Gan
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Song Su
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Yunwei Han
- Department of Oncology, The Affiliated Hospital of Southwest Medical University
| | - Xiaoli Yang
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Bo Li
- Department of General Surgery (Hepatopancreatobiliary Surgery
- Academician (Expert) Workstation of Sichuan Province, Metabolic Hepatobiliary and Pancreatic Diseases Key Laboratory of Luzhou City, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
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42
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Yu X, Huang YH, Feng YZ, Cheng ZY, Wang CC, Cai XR. Association of body composition with postoperative complications after laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Eur J Radiol 2023; 162:110768. [PMID: 36913816 DOI: 10.1016/j.ejrad.2023.110768] [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: 08/01/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To evaluate predictive values of body composition parameters measured from preoperative CT/MRIs for postoperative complications after laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) in patients with obesity. METHODS In this retrospective case-control study, patients performing abdominal CT/MRIs within one month before and developing 30-day complications after bariatric procedures were matched for age, sex, and type of surgery with patients without complications (1/3 ratio, respectively). Complications were determined by documentation in the medical record. Two readers blindly segmented the total abdominal muscle area (TAMA) and visceral fat area (VFA) using predetermined thresholds for the Hounsfield unit (HU) on unenhanced CT and the signal intensity (SI) on T1-weighted MRI at the L3 vertebral level. Visceral obesity (VO) was defined as VFA > 136 cm2 in males and > 95 cm2 in females. These measures, along with perioperative variables, were compared. Multivariate logistic regression analyses were performed. RESULTS Of 145 included patients, 36 had postoperative complications. No significant differences between LSG and LRYGB were present regarding complications and VO. Hypertension (p = 0.022), impaired lung function (p = 0.018), American Society of Anesthesiologists (ASA) grade (p = 0.046), VO (p = 0.021), and VFA/TAMA ratio (p < 0.0001) were associated with postoperative complications in the univariate logistic analysis; the VFA/TAMA ratio was the only independent predictor in multivariate analyses (OR 2.01, 95% CI 1.37-2.93, p < 0.001). CONCLUSION The VFA/TAMA ratio provides important perioperative information in predicting patients who are likely to develop postoperative complications undergoing bariatric surgery.
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Affiliation(s)
- Xin Yu
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yan-Hao Huang
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - You-Zhen Feng
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Zhong-Yuan Cheng
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Cun-Chuan Wang
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Xiang-Ran Cai
- Medical Imaging Centre, First Affiliated Hospital of Jinan University, Guangzhou, China.
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Fair LC, Leeds SG, Whitfield EP, Bokhari SH, Rasmussen ML, Hasan SS, Davis DG, Arnold DT, Ogola GO, Ward MA. Enhanced Recovery After Surgery Protocol in Bariatric Surgery Leads to Decreased Complications and Shorter Length of Stay. Obes Surg 2023; 33:743-749. [PMID: 36701011 DOI: 10.1007/s11695-023-06474-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE Enhanced recovery after surgery (ERAS) programs have been shown in some specialties to improve short-term outcomes following surgical procedures. There is no consensus regarding the optimal perioperative care for bariatric surgical patients. The purpose of this study was to develop a bariatric ERAS protocol and determine whether it improved outcomes following surgery. MATERIALS AND METHODS An IRB-approved prospectively maintained database was retrospectively reviewed for all patients undergoing bariatric surgery from October 2018 to January 2020. Propensity matching was used to compare post-ERAS implementation patients to pre-ERAS implementation. RESULTS There were 319 patients (87 ERAS, 232 pre-ERAS) who underwent bariatric operations between October 2018 and January 2020. Seventy-nine patients were kept on the ERAS protocol whereas 8 deviated. Patients who deviated from the ERAS protocol had a longer length of stay when compared to patients who completed the protocol. The use of any ERAS protocol (completed or deviated) reduced the odds of complications by 54% and decreased length of stay by 15%. Furthermore, patients who completed the ERAS protocol had an 83% reduction in odds of complications and 31% decrease in length of stay. Similar trends were observed in the matched cohort with 74% reduction in odds of complications and 26% reduction in length of stay when ERAS was used. CONCLUSIONS ERAS protocol decreases complications and reduces length of stay in bariatric patients.
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Affiliation(s)
- Lucas C Fair
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX, 75246, USA.,Center for Advanced Surgery, Baylor Scott and White Health, 3417 Gaston Ave Suite 965, Dallas, TX, 75246, USA.,Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA
| | - Steven G Leeds
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX, 75246, USA.,Center for Advanced Surgery, Baylor Scott and White Health, 3417 Gaston Ave Suite 965, Dallas, TX, 75246, USA.,Texas A&M College of Medicine, Bryan, TX, 77807, USA
| | | | - Syed Harris Bokhari
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA
| | - Madeline L Rasmussen
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX, 75246, USA.,Center for Advanced Surgery, Baylor Scott and White Health, 3417 Gaston Ave Suite 965, Dallas, TX, 75246, USA
| | | | - Daniel G Davis
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX, 75246, USA.,Texas A&M College of Medicine, Bryan, TX, 77807, USA.,Center for Medical and Surgical Weight Loss Management, Baylor University Medical Center, Dallas, TX, 75246, USA
| | - David T Arnold
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX, 75246, USA.,Texas A&M College of Medicine, Bryan, TX, 77807, USA
| | - Gerald O Ogola
- Research Institute, Baylor Scott and White Health, 3535 Worth St., Suite C3.510, Dallas, TX, 75246, USA
| | - Marc A Ward
- Department of Minimally Invasive Surgery, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX, 75246, USA. .,Center for Advanced Surgery, Baylor Scott and White Health, 3417 Gaston Ave Suite 965, Dallas, TX, 75246, USA. .,Texas A&M College of Medicine, Bryan, TX, 77807, USA.
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Ebrahimian M, Mirhashemi SH, Oshidari B, Zamani A, Shadidi-Asil R, Kialashaki M, Ghayebi N. Effects of ondansetron, metoclopramide and granisetron on perioperative nausea and vomiting in patients undergone bariatric surgery: a randomized clinical trial. Surg Endosc 2023:10.1007/s00464-023-09939-2. [PMID: 36809588 PMCID: PMC9942645 DOI: 10.1007/s00464-023-09939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/05/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Post-operative nausea and vomiting (PONV) is a common problem after sleeve gastrectomy. In recent years, following the increase in the number of such operations, special attention has been paid to preventing PONV. Additionally, several prophylaxis methods have been developed, including enhanced recovery after surgery (ERAS) and preventive antiemetics. Nevertheless, PONV has not been completely eliminated, and the clinicians are trying to reduce the incidence of PONV yet. METHODS After successful ERAS implementation, patients were divided into five groups, including control and experimental groups. Metoclopramide (MA), ondansetron (OA), granisetron (GA), and a combination of metoclopramide and ondansetron (MO) were used as antiemetics for each group. The frequency of PONV during the first and second days of admission was recorded using a subjective PONV scale. RESULTS A total of 130 patients were enrolled in this study. The MO group showed a lower incidence of PONV (46.1%) compared to the control group (53.8%) and other groups. Furthermore, the MO group did not require rescue antiemetics, however, one-third of control cases used rescue antiemetics (0 vs. 34%). CONCLUSION Using the combination of metoclopramide and ondansetron is recommended as the antiemetic regimen for the reduction of PONV after sleeve gastrectomy. This combination is more helpful when implemented alongside ERAS protocols.
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Affiliation(s)
- Manoochehr Ebrahimian
- Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Seyed-Hadi Mirhashemi
- grid.411600.2Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahador Oshidari
- grid.411600.2Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Zamani
- grid.411600.2Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roozbeh Shadidi-Asil
- grid.411600.2Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrnoosh Kialashaki
- grid.411600.2Department of General Surgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Negin Ghayebi
- grid.411600.2School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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45
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Puccetti F, Elmore U, Rosati R. Application of ERAS protocols in esophagogastric emergency surgery: is it feasible and does it make sense? Updates Surg 2023; 75:383-387. [PMID: 36044180 DOI: 10.1007/s13304-022-01362-x] [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: 03/24/2022] [Accepted: 08/13/2022] [Indexed: 01/24/2023]
Abstract
Management and treatment of esophagogastric diseases have been evolving in terms of multimodal approach and quality of care. The recent introduction of standardized perioperative protocols has represented the opportunity to homogenize the multiple factors enhancing patients' recovery after surgery worldwide. A further optimization would lead to the extension of the ERAS program to upper GI emergencies. This review provides a comprehensive collection of scientific basis, current supporting evidence, and potential applicative limitations.
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Affiliation(s)
- Francesco Puccetti
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan (MI), Italy
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan (MI), Italy.
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Research Hospital, Via Olgettina 60, 20132, Milan (MI), Italy
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Impact of Perioperative Ketamine on Postoperative Bariatric Surgery Opioid Use and Length of Stay. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2023; 33:50-54. [PMID: 36729562 DOI: 10.1097/sle.0000000000001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/24/2022] [Indexed: 02/03/2023]
Abstract
SETTINGS Postoperative pain management is an ever-growing challenge with the rise of the opioid crisis. Ketamine is an NMDA channel blocker, considered an alternative to perioperative opioid use; small concentrations are safe. Objective: The primary objective of this study was to evaluate the impact of perioperative ketamine administration on postoperative opioid use and the length of hospital stay in bariatric patients. METHODS Four hundred (366) charts were retrospectively reviewed; of those, 187 received ketamine and were placed in the Ketamine group, 179 received standard-of-care pain management and were part of the No-Ketamine group. Data was collected using medical databases from July 2020 to January 2021. RESULTS A greater length of stay was recorded in the No-Ketamine group (45.67±20.6 hours) when compared with the Ketamine group (40.6±14.3 hours); P <0.05. The Ketamine group had a mean MME of 17.5±16.5 whereas the No-Ketamine had a mean MME of 22.3±17.7, P <0.05. CONCLUSIONS Ketamine may be a feasible alternative to reduce opioid use and hospital length of stay. We believe that ketamine can be an important contribution to ERABS pathways, being responsible for improved outcomes after bariatric/metabolic surgical procedures.
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47
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Nottelmann K, Menzen A, Röding T, Grünewald M, Kehl F. [Anesthesia in obesity surgery : Recommendations from the practice for the practice]. DIE ANAESTHESIOLOGIE 2023; 72:89-96. [PMID: 36622398 DOI: 10.1007/s00101-022-01240-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/24/2022] [Accepted: 11/15/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Due to unsuccessful conservative treatment concepts and the steady increase in the prevalence of obesity, obesity surgery has gained importance worldwide. In Germany alone, around 20,000 surgical operations for obesity are performed each year. In addition to patient history and physical examination a close interdisciplinary cooperation taking into account the currently applicable standards and guidelines of the professional societies are prerequisites for best patient care and to evaluate and mitigate patient risks. AIM The aim of this work was to compile and consent experiences of experts in the implementation of applicable standards and guidelines for anesthesia in obesity surgery for daily clinical practice. METHOD Anesthesiologists from five bariatric centers, comprising about 10% of the obesity surgery caseload of Germany per year, have collated their clinical experiences to agree on a consensus for procedures. The procedures for preoperative patient evaluation, drug premedication and PONV prophylaxis, induction of anesthesia and drug dosage recommendations for anesthetics were consented based on the authors' practice. RESULTS AND CONCLUSION The procedures described herein were developed as part of a joint work process. The authors describe a practically applicable approach to the anesthesiological care of obesity surgery patients and recommend using a pragmatic formula for dosing the medication calculated on the basis of total body weight (TBW).
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Affiliation(s)
- Klaus Nottelmann
- Anästhesiologie, Intensiv- und Schmerzmedizin, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland.
| | - Angelika Menzen
- Anästhesiologie und Intensivmedizin, St. Marien-Hospital Friesoythe, Friesoythe, Deutschland
| | - Thomas Röding
- Adipositaszentrum der Klinik Ernst von Bergmann, Bad Belzig und Adipositaszentrum im Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - Matthias Grünewald
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Franz Kehl
- Klinik für Anästhesie und Intensivmedizin, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
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Papasavas P, Seip RL, McLaughlin T, Staff I, Thompson S, Mogor I, Sweeney J, Gannon R, Waberski W, Tishler D. A randomized controlled trial of an enhanced recovery after surgery protocol in patients undergoing laparoscopic sleeve gastrectomy. Surg Endosc 2023; 37:921-931. [PMID: 36050610 DOI: 10.1007/s00464-022-09512-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/26/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of an enhanced recovery after surgery (ERAS) protocol on opioid and anti-emetic use, length of stay and safety after laparoscopic sleeve gastrectomy (LSG). METHODS Patients who underwent LSG between March 2018 and January 2019 at our accredited, high-volume bariatric surgery center were randomized to either standard of care (SOC) or ERAS. ERAS included a pre- and post-surgical medication regimen designed to reduce postoperative nausea, vomiting and pain. Outcomes included post-operative symptom scores, opioid use, anti-emetic use, time to achieve readiness for discharge (RFD) and inpatient and 30-day adverse events, readmissions and emergency department visits. RESULTS The final analysis included 130 patients, (SOC 65; ERAS 65). Groups did not differ on demographics or comorbidities. Relative to SOC, fewer ERAS patients utilized opioids in the hospital ward (72.3% vs. 95.4%; p < .001), peak pain scores were significantly lower, and median time to achieve RFD was shorter (28.0 h vs. 44.4 h; p = 0.001). More ERAS patients were discharged on post-operative day 1 (38.5% vs. 15.4%; p < .05). The overall use of rescue anti-emetic medications was not different between groups. Rates of postoperative 30-day events, readmissions, and emergency department visits did not differ between groups. CONCLUSION Relative to SOC, ERAS was associated with earlier discharge, lower pain scores, less frequent use of opioids and use in lower amounts after LSG with no differences in 30 day safety outcomes.
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Affiliation(s)
- Pavlos Papasavas
- Hartford Healthcare Surgical Weight Loss Center, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06106, USA.
| | - Richard L Seip
- Hartford Healthcare Surgical Weight Loss Center, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06106, USA
| | - Tara McLaughlin
- Department of Surgery, Hartford Hospital, Hartford, CT, 06102, USA
| | - Ilene Staff
- Hartford Healthcare Research Program, Hartford, CT, 06102, USA
| | | | - Ifeoma Mogor
- Hartford Healthcare Surgical Weight Loss Center, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06106, USA
| | - Jane Sweeney
- Hartford Healthcare Surgical Weight Loss Center, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06106, USA
| | - Richard Gannon
- Pharmacy Department, Hartford Hospital, Hartford, CT, 06102, USA
| | - Witold Waberski
- Department of Anesthesia, Hartford Hospital, Hartford, CT, 06102, USA
| | - Darren Tishler
- Hartford Healthcare Surgical Weight Loss Center, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06106, USA
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Furini C, Spaggiari G, Simoni M, Greco C, Santi D. Ketogenic state improves testosterone serum levels-results from a systematic review and meta-analysis. Endocrine 2023; 79:273-282. [PMID: 36149528 DOI: 10.1007/s12020-022-03195-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND It is widely demonstrated that obesity and hypogonadism are bi-directionally correlated, since the hypogonadism prevalence is higher in obese population, while weight loss increases testosterone serum levels. Several approaches are available to contrast weight excess, from simple dietary regimens to more complex surgical procedures. Ketogenic diets (KD) fit in this context and their application is growing year after year, aiming to improve the metabolic and weight patterns in obese patients. However, KD influence on testosterone levels is still poorly investigated. OBJECTIVES To systematically evaluate the potential effect of KD on testosterone levels. METHODS A systematic literature search was performed until April 2022 including studies investigating testosterone levels before and after KD. Secondary endpoints were body weight, estradiol and sex-hormone binding globulin serum levels. Any kind of KD was considered eligible, and no specific criteria for study populations were provided. RESULTS Seven studies (including eight trials) were included in the analysis for a total of 230 patients, five using normocaloric KD and three very low calories KD (VLCKD). Only three studies enrolled overweight/obese men. A significant total testosterone increase was recorded after any kind of KD considering 111 patients (2.86 [0.95, 4.77], p = 0.003). This increase was more evident considering VLCKD compared to normocaloric KD (6.75 [3.31, 10.20], p < 0.001, versus 0.98 [0.08, 1.88], p = 0.030). Meta-regression analyses highlighted significant correlations between the post-KD testosterone raise with patients' age (R-squared 36.4, p < 0.001) and weight loss (R-squared 73.6, p < 0.001). CONCLUSIONS Comprehensively, KD improved testosterone levels depending on both patients' age and KD-induced weight loss. However, the lack of information in included studies on hormones of the hypothalamic-pituitary-gonadal axis prevents an exhaustive comprehension about mechanisms connecting ketosis and testosterone homeostasis.
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Affiliation(s)
- Chiara Furini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Giorgia Spaggiari
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Manuela Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - Carla Greco
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
| | - Daniele Santi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
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Becker E, Hernandez A, Greene H, Gadbois K, Gallus D, Wisbach G. Does Liposomal Bupivacaine Decrease Postoperative Opioid Use in Conjunction with an Enhanced Recovery After Bariatric Surgery Pathway? A Prospective, Double-blind, Randomized Controlled Trial. Obes Surg 2023; 33:555-561. [PMID: 36564620 DOI: 10.1007/s11695-022-06417-x] [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: 07/05/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Minimization of opiate use is an important focus in the setting of the severe national opioid crisis. This study evaluated the role of liposomal bupivacaine (LB) in decreasing postoperative opioid use before and after implementation of a bariatric enhanced recovery after surgery (ERAS) program. METHODS We performed an IRB-approved, prospective, double-blind, randomized controlled trial of LB versus plain bupivacaine (PB) in patients undergoing elective, minimally invasive, weight loss surgery at a comprehensive metabolic and bariatric surgery program from November 2017 to December 2019. Primary outcomes were postoperative morphine milligram equivalents per day (MME/day) and average subjective inpatient pain level. Secondary outcomes were length of hospital stay (LOS) and adverse events (AEs). RESULTS Of the 100 patients enrolled, 78 were randomly assigned to LB (42) or PB (36). Thirty-four received the ERAS protocol, and 44 did not. The mean MME/day use did not differ significantly by the bupivacaine group [median, IQR PB: 20.3 (40.95); LB: 33.0 (42.9); p = .314], but it did differ by the ERAS group [median, IQR no ERAS 33.2 (47.1), ERAS 24.0 (34.0); p = .049]. Length of stay, inpatient pain score, and AEs did not differ significantly by either the bupivacaine or the ERAS group. CONCLUSIONS In our study, liposomal bupivacaine did not significantly decrease postoperative opioid use either before implementation of ERAS or as part of an enhanced recovery after surgery program for minimally invasive bariatric surgery procedures.
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Affiliation(s)
- Elise Becker
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - Amy Hernandez
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - Howard Greene
- Clinical Investigation Department, Navy Medicine Readiness & Training Command, San Diego, CA, 92134, USA
| | - Kyle Gadbois
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - David Gallus
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA
| | - Gordon Wisbach
- General Surgery Department, Navy Medicine Readiness & Training Command, 34800 Bob Wilson Drive, San Diego, CA, 92134, USA.
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