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Guggino J, Tamisier R, Betry C, Coumes S, Arvieux C, Wion N, Reche F, Pépin JL, Borel AL. Bariatric surgery short-term outcomes in patients with obstructive sleep apnoea: the Severe Obesity Outcome Network prospective cohort. Int J Obes (Lond) 2021; 45:2388-2395. [PMID: 34453099 DOI: 10.1038/s41366-021-00903-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/11/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND/OBJECTIVES Although the benefits of bariatric surgery have been clearly established, it is not known whether they are as important in patients with obstructive sleep apnoea (OSA). Primary aim: to evaluate whether patients with moderate-to-severe OSA (apnoea-hypopnea index (AHI) ≥ 15 events/h) treated by continuous positive airway pressure/non-invasive ventilation (median [IQR] adherence 6.5 h/night [5; 7.9] at baseline) lose the same amount of body weight 1 year after bariatric surgery as patients with no or mild OSA. Secondary objectives: to compare the evolution of type 2 diabetes and hypertension after bariatric surgery, and surgical complication rates between groups. METHODS/SUBJECTS Analyses were performed in 371 patients included in a prospective cohort of bariatric surgery, the Severe Obesity Outcome Network cohort. Subjects having moderate-to-severe OSA (n = 210) at baseline were compared with other subjects (n = 161). RESULTS Excess weight loss (%EWL) at 1 year was lower in patients with moderate-to-severe OSA than in patients without (64.9%EWL [46.9; 79.5] vs. 73.8%EWL [56.6; 89.3], p < 0.01). Multivariable analysis showed that age, initial body mass index and type of surgery, but not OSA status, were associated with 1-year %EWL. Diabetes remitted in 25 (41%) patients with moderate-to-severe OSA and 16 (48%) patients with no or mild OSA (p = 0.48). Hypertension remitted in 28 (32.9%) patients with moderate-to-severe OSA and 9 (40.9%) with no or mild (p = 0.48). Complication rates were 28 (13.3%) in patients with moderate-to-severe OSA and 12 (7.5%) in patients with no or mild OSA (p = 0.07). CONCLUSIONS Patients with OSA lose less body weight after bariatric surgery. This was related to older age and a higher baseline body mass index. However, the improvements of diabetes and hypertension were similar to that of patients without OSA, and the risk of surgical complications was not higher.
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Affiliation(s)
- Jessica Guggino
- Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France
| | - Renaud Tamisier
- Univ. Grenoble Alpes, Inserm, U1300, "Hypoxia-physiopathology" Laboratory, Grenoble Alpes University Hospital, "Pôle Thorax et Vaisseaux", Grenoble, France
| | - Cécile Betry
- Univ. Grenoble Alpes, "Translational Innovation in Medicine and Complexity" (TIMC) Laboratory, Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Grenoble, France
| | - Sandrine Coumes
- Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France
| | - Catherine Arvieux
- Univ. Grenoble Alpes, Department of Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Nelly Wion
- Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France
| | - Fabian Reche
- Univ. Grenoble Alpes, "Translational Innovation in Medicine and Complexity" (TIMC) Laboratory, Department of Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, Inserm, U1300, "Hypoxia-physiopathology" Laboratory, Grenoble Alpes University Hospital, "Pôle Thorax et Vaisseaux", Grenoble, France
| | - Anne-Laure Borel
- Univ. Grenoble Alpes, Inserm, U1300, "Hypoxia-physiopathology" Laboratory, Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France.
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van Veldhuisen SL, Kuppens K, de Raaff CAL, Wiezer MJ, de Castro SMM, van Veen RN, Swank DJ, Demirkiran A, Boerma EJG, Greve JWM, van Dielen FMH, Frederix GWJ, Hazebroek EJ. Protocol of a multicentre, prospective cohort study that evaluates cost-effectiveness of two perioperative care strategies for potential obstructive sleep apnoea in morbidly obese patients undergoing bariatric surgery. BMJ Open 2020; 10:e038830. [PMID: 33033026 PMCID: PMC7542938 DOI: 10.1136/bmjopen-2020-038830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Despite the high prevalence of obstructive sleep apnoea (OSA) in obese patients undergoing bariatric surgery, OSA is undiagnosed in the majority of patients and thus untreated. While untreated OSA is associated with an increased risk of preoperative and postoperative complications, no evidence-based guidelines on perioperative care for these patients are available. The aim of the POPCORN study (Post-Operative Pulse oximetry without OSA sCreening vs perioperative continuous positive airway pressure (CPAP) treatment following OSA scReeNing by polygraphy (PG)) is to evaluate which perioperative strategy is the most cost-effective for obese patients undergoing bariatric surgery without a history of OSA. METHODS AND ANALYSIS In this multicentre observational cohort study, data from 1380 patients who will undergo bariatric surgery will be collected. Patients will receive either postoperative care with pulse oximetry monitoring and supplemental oxygen during the first postoperative night, or care that includes preoperative PG and CPAP treatment in case of moderate or severe OSA. Local protocols for perioperative care in each participating hospital will determine into which cohort a patient is placed. The primary outcome is cost-effectiveness, which will be calculated by comparing all healthcare costs with the quality-adjusted life-years (QALYs, calculated using EQ-5D questionnaires). Secondary outcomes are mortality, complications within 30 days after surgery, readmissions, reoperations, length of stay, weight loss, generic quality of life (QOL), OSA-specific QOL, OSA symptoms and CPAP adherence. Patients will receive questionnaires before surgery and 1, 3, 6 and 12 months after surgery to report QALYs and other patient-reported outcomes. ETHICS AND DISSEMINATION Approval from the Medical Research Ethics Committees United was granted in accordance with the Dutch law for Medical Research Involving Human Subjects Act (WMO) (reference number W17.050). Results will be submitted for publication in peer-reviewed journals and presented at (inter)national conferences. TRIAL REGISTRATION NUMBER NTR6991.
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Affiliation(s)
| | - Kim Kuppens
- Department of Pulmonary Medicine, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | - Marinus J Wiezer
- Department of Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | - Ruben N van Veen
- Department of Surgery, OLVG, location West, Amsterdam, The Netherlands
| | - Dingeman J Swank
- Department of Surgery, Dutch Obesity Clinic (Nederlandse Obesitas Kliniek), The Hague, The Netherlands
| | - Ahmet Demirkiran
- Department of Surgery, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
| | - Evert-Jan G Boerma
- Department of Surgery, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - Jan-Willem M Greve
- Department of Surgery, Zuyderland Medisch Centrum, Heerlen, The Netherlands
- Department of Surger / Nutrim, Maastricht University, Maastricht, The Netherlands
| | | | - Geert W J Frederix
- Department of Public Health, Julius Center Research Program Methodology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Eric J Hazebroek
- Department of Surgery / Vitalys Clinic, Rijnstate Ziekenhuis, Arnhem, The Netherlands
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Gelderland, The Netherlands
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Sun Y, Liu B, Smith JK, Correia MLG, Jones DL, Zhu Z, Taiwo A, Morselli LL, Robinson K, Hart AA, Snetselaar LG, Bao W. Association of Preoperative Body Weight and Weight Loss With Risk of Death After Bariatric Surgery. JAMA Netw Open 2020; 3:e204803. [PMID: 32407504 PMCID: PMC7225906 DOI: 10.1001/jamanetworkopen.2020.4803] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Perception of weight loss requirements before bariatric surgery varies among patients, physicians, and health insurance payers. Current clinical guidelines do not require preoperative weight loss because of a lack of scientific support regarding its benefits. OBJECTIVE To examine the association of preoperative body mass index (BMI) and weight loss with 30-day mortality after bariatric surgery. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from 480 075 patients who underwent bariatric surgery from 2015 to 2017 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which covers more than 90% of all bariatric surgery programs in the United States and Canada. Clinical and demographic data were collected at all participating institutions using a standardized protocol. Data analysis was performed from December 2018 to November 2019. EXPOSURES Preoperative BMI and weight loss. MAIN OUTCOMES AND MEASURES 30-day mortality after bariatric surgery. RESULTS Of the 480 075 patients (mean [SD] age 45.1 [12.0] years; 383 265 [79.8%] women), 511 deaths (0.1%) occurred within 30 days of bariatric surgery. Compared with patients with a preoperative BMI of 35.0 to 39.9, the multivariable-adjusted odds ratios for 30-day mortality for patients with preoperative BMI of 40.0 to 44.9, 45.0 to 49.9, 50.0 to 54.9, and 55.0 and greater were 1.37 (95% CI, 1.02-1.83), 2.19 (95% CI, 1.64-2.92), 2.61 (95% CI, 1.90-3.58), and 5.03 (95% CI, 3.78-6.68), respectively (P for trend < .001). Moreover, compared with no preoperative weight loss, the multivariable-adjusted odds ratios for 30-day mortality for patients with weight loss of more than 0% to less than 5.0%, 5.0% to 9.9%, and 10.0% and greater were 0.76 (95% CI, 0.60-0.96), 0.69 (95% CI, 0.53-0.90), and 0.58 (95% CI, 0.41-0.82), respectively (P for trend = .003). CONCLUSIONS AND RELEVANCE In this study, even moderate weight loss (ie, >0% to <5%) before bariatric surgery was associated with a lower risk of 30-day mortality. These findings may help inform future updates of clinical guidelines regarding bariatric surgery.
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Affiliation(s)
- Yangbo Sun
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Buyun Liu
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Jessica K. Smith
- Carver College of Medicine, Department of Surgery, University of Iowa, Iowa City
| | - Marcelo L. G. Correia
- Carver College of Medicine, Department of Internal Medicine, University of Iowa, Iowa City
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City
| | - Dana L. Jones
- Carver College of Medicine, Department of Surgery, University of Iowa, Iowa City
| | - Zhanyong Zhu
- Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Adeyinka Taiwo
- Carver College of Medicine, Department of Internal Medicine, University of Iowa, Iowa City
| | - Lisa L. Morselli
- Carver College of Medicine, Department of Internal Medicine, University of Iowa, Iowa City
| | - Katie Robinson
- Carver College of Medicine, Department of Internal Medicine, University of Iowa, Iowa City
- now with Scientific and Medical Affairs, Abbott Nutrition, Columbus, Ohio
| | - Alexander A. Hart
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Linda G. Snetselaar
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
| | - Wei Bao
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
- Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City
- Obesity Research and Education Initiative, University of Iowa, Iowa City
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Berends F, Aarts EO. Preoperative Screening and Treatment of OSA Is Like Using a Sledgehammer for Cracking Nuts. Obes Surg 2020; 30:1140-1142. [DOI: 10.1007/s11695-020-04388-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Prevalence of obstructive sleep apnea in an Asian bariatric population: an underdiagnosed dilemma. Surg Obes Relat Dis 2020; 16:778-783. [PMID: 32199766 DOI: 10.1016/j.soard.2020.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/18/2020] [Accepted: 02/04/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Obesity is a growing health problem that has become a global epidemic. Serial population studies have shown the same in Malaysia, where the prevalence of obesity increased rapidly in the last decade. Currently, bariatric surgery is the most effective treatment in patients with morbid obesity. Obstructive sleep apnea (OSA) is the most common type of sleep-related breathing disorder seen in obesity. OBJECTIVES We aim to ascertain the prevalence and severity of OSA in Asian patients who underwent bariatric surgery and were seen in our center. SETTING The study was conducted in our university hospital. METHODS Study approval was obtained from our institutional review board for a retrospective chart review. A total of 226 patients were included in this review. OSA was noted as absent or present and graded from mild to severe. The patient population was stratified by body mass index according to the World Health Organization guidelines for Asian population. RESULTS The overall sample prevalence of OSA was 80.5%. Of these, 24.3% had mild OSA, 23.9% had moderate OSA, and 32.3% had severe OSA. Only 17.3% have been diagnosed with OSA before bariatric workup. Among men, the prevalence of OSA was 93.7% and 75.5% among women. CONCLUSION Based on these findings, Asian patients undergoing bariatric workup should be considered for routine polysomnography to enable treatment of OSA.
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Quilliot D, Sirveaux MA, Nomine-Criqui C, Fouquet T, Reibel N, Brunaud L. Evaluation of risk factors for complications after bariatric surgery. J Visc Surg 2018; 155:201-210. [PMID: 29598850 DOI: 10.1016/j.jviscsurg.2018.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Preoperative Detection of Sarcopenic Obesity Helps to Predict the Occurrence of Gastric Leak After Sleeve Gastrectomy. Obes Surg 2018; 28:2379-2385. [DOI: 10.1007/s11695-018-3169-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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De Silva S. OSA and the bariatric patient. J Perioper Pract 2018; 27:167-168. [PMID: 29328763 DOI: 10.1177/1750458917027007-805] [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: 05/27/2016] [Accepted: 08/02/2016] [Indexed: 11/16/2022]
Abstract
Mrs NH is a 49-year-old lady who presented for assessment prior to weight reduction surgery.
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Risk Stratification Models: How Well do They Predict Adverse Outcomes in a Large Dutch Bariatric Cohort? Obes Surg 2016; 25:2290-301. [PMID: 25937046 DOI: 10.1007/s11695-015-1699-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Risk prediction models are useful tools for informing patients undergoing bariatric surgery about their risk for complications and correcting outcome reports. The aim of this study is to externally validate risk models assessing complications after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. METHODS All 740 patients who underwent a primary LRYGB between December 2007 and July 2012 were included in the validation cohort. PubMed was systematically searched for risk prediction models. Eight risk models were selected for validation. We classified our complications according to the Clavien-Dindo classification. Predefined criteria of a good model were a non-significant Hosmer and Lemeshow test, Nagelkerke R (2) ≥ 0.10, and c-statistic ≥0.7. RESULTS There were 85 (7.8 %) grade 1, 54 (7.3 %) grade 2, 5 (0.7 %) grade 3a, 14 (1.9 %) grade 3b, and 14 (1.9 %) grade 4a complications in our validation cohort. Only one model predicted adverse events satisfactorily. This model consisted of one patient-related factor (age) and four surgeon- or center related factors (conversion to open surgery, intraoperative events, the need for additional procedures during LRYGB and the learning curve of the center). CONCLUSIONS The overall majority of the included risk models are unsuitable for risk prediction. Only one model with an emphasis on surgeon- and center-related factors instead of patient-related factors predicted adverse outcome correctly in our external validation cohort. These findings support the establishment of specialty centers and warn benchmark data institutions not to correct bariatric outcome data by any other patient-related factor than age.
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Passeri LA, Choi JG, Kaban LB, Lahey ET. Morbidity and Mortality Rates After Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea. J Oral Maxillofac Surg 2016; 74:2033-43. [PMID: 27181624 DOI: 10.1016/j.joms.2016.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/25/2016] [Accepted: 04/05/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare morbidity and mortality rates in obstructive sleep apnea (OSA) versus dentofacial deformity (DFD) patients undergoing equivalent maxillofacial surgical procedures. PATIENTS AND METHODS Patients with OSA who underwent maxillomandibular advancement with genial tubercle advancement in the Massachusetts General Hospital Department of Oral and Maxillofacial Surgery from December 2002 to June 2011 were matched to patients with DFD undergoing similar maxillofacial procedures during the same period. They were compared regarding demographic variables, medical comorbidities, perioperative management, intraoperative complications, early and late postoperative complications, and mortality rate. RESULTS A study group of 28 patients with OSA and a control group of 26 patients with DFD were compared. The patients with OSA were older (41.9 ± 12.5 years vs 21.7 ± 8.6 years), had a higher American Society of Anesthesiologists classification (2.0 ± 0.5 vs 1.3 ± 0.6), and had a higher body mass index (29.6 ± 4.7 kg/m(2) vs 23.0 ± 3.1 kg/m(2)). They also had a greater number of medical comorbidities (2.4 ± 2.3 vs 0.7 ± 1.0). More OSA patients than DFD patients had complications (28 [100%] vs 19 [73%], P = .003), and the total number of complications in the OSA group was higher (108 vs 33, P < .001). Of the complications, 13.9% in the OSA group and 3.0% in the DFD group were classified as major. The absolute risk of a complication was 3.9 for the OSA group versus 1.3 for the DFD group. The relative risk of complications in OSA patients compared with DFD patients was 3.0. No difference in mortality rate was found. CONCLUSIONS The patients in the OSA group were older, had more comorbidities, and ultimately had a greater number of early, late, minor, and major complications than those in the DFD group. The incidence of death in both groups was zero. Maxillomandibular advancement appears to be a safe procedure regarding mortality rate, but OSA patients should be counseled preoperatively regarding the relative increased risk of complications.
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Affiliation(s)
- Luis A Passeri
- Research Fellow and Visiting Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA; and Professor of Oral and Maxillofacial Surgery, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - James G Choi
- Resident, Department of Oral and Maxillofacial Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Leonard B Kaban
- Walter C. Guralnick Professor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA
| | - Edward T Lahey
- Assistant in Oral and Maxillofacial Surgery and Instructor, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA.
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de Oliveira LF, Tisott CG, Silvano DM, Campos CMM, do Nascimento RR. GLYCEMIC BEHAVIOR IN 48 HOURS POSTOPERATIVE PERIOD OF PATIENTS WITH TYPE 2 DIABETES MELLITUS AND NON DIABETIC SUBMITTED TO BARIATRIC SURGERY. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2015; 28 Suppl 1:26-30. [PMID: 26537269 PMCID: PMC4795302 DOI: 10.1590/s0102-6720201500s100009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 06/29/2015] [Indexed: 01/06/2023]
Abstract
UNLABELLED Although there is no indication for surgery taking only into account the glycemic condition, results have shown that benefits can be obtained in glycemic control with bariatric surgery. AIM To compare the glycemic behavior among type 2 diabetic and non-diabetic patients within 48 h after bariatric surgery, and clarify whether there is a reduction in blood glucose level in obese patients with diabetes before the loss of weight excess. METHODS Descriptive epidemiological study with prospective cohort design with 31 obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy. The patients were controlled with hemoglucotests in different periods of time: preoperative, postoperative and each 6 h after surgery for 48 h. RESULTS Average ambulatory blood glucose in diabetics was 120.7±2.9 mg/dl vs 91.8±13.9 mg/dl in the nondiabetic. After 48 h there was decrease in diabetics to 100.0±17.0 mg/dl (p=0.003), while the non-diabetic group did not change significantly (102.7±25.4 mg/dl; p=0.097). There were no differences between the surgical techniques. There were no death. CONCLUSIONS Diabetic patients significantly reduced blood glucose after surgery regardless of the use of exogenous insulin or oral hypoglycemic agents.
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Villamere J, Gebhart A, Vu S, Nguyen NT. Body Mass Index is Predictive of Higher In-hospital Mortality in Patients Undergoing Laparoscopic Gastric Bypass but Not Laparoscopic Sleeve Gastrectomy or Gastric Banding. Am Surg 2014. [DOI: 10.1177/000313481408001028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
High body mass index (BMI) has been shown to be a factor predictive of increased morbidity and mortality in several single-institution studies. Using the University HealthSystem Consortium clinical database, we examined the impact of BMI on in-hospital mortality for patients who underwent laparoscopic gastric bypass, sleeve gastrectomy, and gastric banding between October 2011 and February 2014. Outcomes were examined within each procedure according to BMI groups of 35 to 49.9, 50.0 to 59.9, and 60.0 kg/m2 or greater. Outcome measures included in-hospital mortality, major complications, length of hospital stay, 30-day readmission, and cost. A total of 40,102 bariatric procedures were performed during this time period. For gastric bypass, there was an increase of in-hospital mortality (0.01 and 0.02 vs 0.34%; P < 0.01) and major complications (0.93 and 0.99 vs 2.62%; P < 0.01) in the BMI 60 kg/m2 or greater group. In contrast, sleeve gastrectomy and gastric banding had no association between BMI and rates of mortality and major complications. Cost increased with increasing BMI groups for all procedures. A strong association was found between BMI 60 kg/m2 or greater and higher in-hospital mortality and major complication rates for patients who underwent laparoscopic gastric bypass but not in patients who underwent sleeve gastrectomy or gastric banding.
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Affiliation(s)
- James Villamere
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Alana Gebhart
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Stephen Vu
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
| | - Ninh T. Nguyen
- Department of Surgery, University of California, Irvine Medical Center, Orange, California
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Haito-Chavez Y, Law JK, Kratt T, Arezzo A, Verra M, Morino M, Sharaiha RZ, Poley JW, Kahaleh M, Thompson CC, Ryan MB, Choksi N, Elmunzer BJ, Gosain S, Goldberg EM, Modayil RJ, Stavropoulos SN, Schembre DB, DiMaio CJ, Chandrasekhara V, Hasan MK, Varadarajulu S, Hawes R, Gomez V, Woodward TA, Rubel-Cohen S, Fluxa F, Vleggaar FP, Akshintala VS, Raju GS, Khashab MA. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects (with video). Gastrointest Endosc 2014; 80:610-622. [PMID: 24908191 DOI: 10.1016/j.gie.2014.03.049] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/27/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The over-the-scope clip (OTSC) provides more durable and full-thickness closure as compared with standard clips. Only case reports and small case series have reported on outcomes of OTSC closure of GI defects. OBJECTIVE To describe a large, multicenter experience with OTSCs for the management of GI defects. Secondary goals were to determine success rate by type of defect and type of therapy and to determine predictors of treatment outcomes. DESIGN Multicenter, retrospective study. SETTING Multiple, international, academic centers. PATIENTS Consecutive patients who underwent attempted OTSC placement for GI defects, either as a primary or as a rescue therapy. INTERVENTIONS OTSC placement to attempt closure of GI defects. MAIN OUTCOME MEASUREMENTS Long-term success of the procedure. RESULTS A total of 188 patients (108 fistulae, 48 perforations, 32 leaks) were included. Long-term success was achieved in 60.2% of patients during a median follow-up of 146 days. Rate of successful closure of perforations (90%) and leaks (73.3%) was significantly higher than that of fistulae (42.9%) (P < .05). Long-term success was significantly higher when OTSCs were applied as primary therapy (primary 69.1% vs rescue 46.9%; P = .004). On multivariate analysis, patients who had OTSC placement for perforations and leaks had significantly higher long-term success compared with those who had fistulae (OR 51.4 and 8.36, respectively). LIMITATIONS Retrospective design and multiple operators with variable expertise with the OTSC device. CONCLUSION OTSC is safe and effective therapy for closure of GI defects. Clinical success is best achieved in patients undergoing closure of perforations or leaks when OTSC is used for primary or rescue therapy. Type of defect is the best predictor of successful long-term closure.
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Affiliation(s)
- Yamile Haito-Chavez
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Joanna K Law
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Thomas Kratt
- Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Tübingen, Germany
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Mauro Verra
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Reem Z Sharaiha
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Michel Kahaleh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York, USA
| | | | - Michele B Ryan
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Neel Choksi
- Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - B Joseph Elmunzer
- Division of Gastroenterology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Sonia Gosain
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eric M Goldberg
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rani J Modayil
- Division of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, New York, USA
| | - Stavros N Stavropoulos
- Division of Gastroenterology, Hepatology and Nutrition, Winthrop University Hospital, Mineola, New York, USA
| | - Drew B Schembre
- Swedish Gastroenterology, Swedish Medical Center, Seattle, Washington, USA
| | - Christopher J DiMaio
- Division of Gastroenterology, The Mount Sinai Medical Center, New York, New York, USA
| | - Vinay Chandrasekhara
- Gastroenterology Division, Department of Internal Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Muhammad K Hasan
- Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
| | - Shyam Varadarajulu
- Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
| | - Robert Hawes
- Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA
| | - Victoria Gomez
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Timothy A Woodward
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Sergio Rubel-Cohen
- Department of Gastroenterology, Clinica Las Condes, Universidad de Chile, Santiago, Chile
| | - Fernando Fluxa
- Department of Gastroenterology, Clinica Las Condes, Universidad de Chile, Santiago, Chile
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mouen A Khashab
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Quilliot D. Faut-il faire maigrir un patient obèse avant un acte de chirurgie lourde ? NUTR CLIN METAB 2014. [DOI: 10.1016/j.nupar.2014.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lorente L, Ramón JM, Vidal P, Goday A, Parri A, Lanzarini E, Pera M, Grande L. Obesity Surgery Mortality Risk Score for the Prediction of Complications After Laparoscopic Bariatric Surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.cireng.2013.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Utilidad de la escala Obesity surgery mortality risk score en la predicción de complicaciones tras cirugía bariátrica por vía laparoscópica. Cir Esp 2014; 92:316-23. [DOI: 10.1016/j.ciresp.2013.09.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 09/17/2013] [Accepted: 09/24/2013] [Indexed: 11/19/2022]
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Obesity and surgical wound healing: a current review. ISRN OBESITY 2014; 2014:638936. [PMID: 24701367 PMCID: PMC3950544 DOI: 10.1155/2014/638936] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 11/17/2013] [Indexed: 12/15/2022]
Abstract
Objective. The correlation between obesity and deficient wound healing has long been established. This review examines the current literature on the mechanisms involved in obesity-related perioperative morbidity. Methods. A literature search was performed using Medline, PubMed, Cochrane Library, and Internet searches. Keywords used include obesity, wound healing, adipose healing, and bariatric and surgical complications. Results. Substantial evidence exists demonstrating that obesity is associated with a number of postoperative complications. Specifically in relation to wound healing, explanations include inherent anatomic features of adipose tissue, vascular insufficiencies, cellular and composition modifications, oxidative stress, alterations in immune mediators, and nutritional deficiencies. Most recently, advances made in the field of gene array have allowed researchers to determine a few plausible alterations and deficiencies in obese individuals that contribute to their increased risk of morbidity and mortality, especially wound complications. Conclusion. While the literature discusses how obesity may negatively affect health on various of medical fronts, there is yet to be a comprehensive study detailing all the mechanisms involved in obesity-related morbidities in their entirety. Improved knowledge and understanding of obesity-induced physiological, cellular, molecular, and chemical changes will facilitate better assessments of surgical risks and outcomes and create efficient treatment protocols for improved patient care of the obese patient population.
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Trimer R, Cabiddu R, Mendes RG, Costa FSM, Oliveira AD, Borghi-Silva A, Bianchi AM. Heart Rate Variability and Cardio-respiratory Coupling During Sleep in Patients Prior to Bariatric Surgery. Obes Surg 2014; 24:471-7. [DOI: 10.1007/s11695-013-1171-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pathophysiologic Considerations of Perioperative Respiratory Managements of Obese Patients with Obstructive Sleep Apnea. Sleep Med Clin 2013. [DOI: 10.1016/j.jsmc.2012.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Proposal for a bariatric mortality risk classification system for patients undergoing bariatric surgery. Surg Obes Relat Dis 2013; 9:239-46. [DOI: 10.1016/j.soard.2011.12.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 11/10/2011] [Accepted: 12/13/2011] [Indexed: 01/06/2023]
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Abstract
OBJECTIVE To systematically examine the association between annual hospital and surgeon case volume and patient outcomes in bariatric surgery. BACKGROUND Bariatric surgery remains a technically demanding field with significant risk for morbidity and mortality. To mitigate this risk, minimum annual hospital and surgeon case volume requirements are being set and certain hospitals are being designated as "Bariatric Surgery Centers of Excellence." The effects of these interventions on patient outcomes remain unclear. METHODS A comprehensive systematic review on volume-outcome association in bariatric surgery was conducted by searching MEDLINE, Cochrane Database of Systematic Reviews, and Evidence Based Medicine Reviews databases. Abstracts of identified articles were reviewed and pertinent full-text versions were retrieved. Manual search of bibliographies was performed and relevant studies were retrieved. Methodological quality assessment and data extraction were completed in a systematic fashion. Pooling of results was not feasible due to the heterogeneity of the studies. A qualitative summary of results is presented. RESULTS From a total of 2928 unique citations, 24 studies involving a total of 458,032 patients were selected for review. Two studies were prospective cohorts (level of evidence [LOE] 1), 3 were retrospective cohorts (LOE 3), 2 were retrospective case controls (LOE 3), and 17 were retrospective case series (LOE 4). The overall methodological quality of the reviewed studies was fair. A positive association between annual surgeon volume and patient outcomes was reported in 11 of 13 studies. A positive association between annual hospital volume and patient outcomes was reported in 14 of 17 studies. CONCLUSIONS There is strong evidence of improved patient outcomes in the hands of high-volume surgeons and high-volume centers. This study supports the concept of "Bariatric Surgery Center of Excellence" accreditation; however, future research into the quality of care characteristics of successful bariatric programs is recommended. Understanding the characteristics of high-volume surgeons, which lead to improved patient outcomes, also requires further investigation.
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Effect of elevated hemoglobin A1c in diabetic patients on complication rates after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2012; 9:749-52. [PMID: 22884300 DOI: 10.1016/j.soard.2012.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 06/12/2012] [Accepted: 06/30/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Little is known regarding the effect of chronic hyperglycemia, expressed by glycated hemoglobin, on the healing-related complication rates in Roux-en-Y gastric bypass (RYGB). METHODS We retrospectively examined the rate of complications in patients with type 2 diabetes mellitus undergoing RYGB according to the preoperative glycated hemoglobin (HbA1c) level, focusing specifically on the complications related to wound healing (i.e., anastomotic leak, stomal stenosis, and wound infection). Two groups were formed separating those with HbA1c values >7 and <7 g/dL. All patients were taking oral antiglycemic medications or insulin to control their blood glucose levels. RESULTS A total of 342 patients with type 2 diabetes mellitus underwent laparoscopic RYGB during a 3-year period (2008-2011). Of the 342 patients, 170 had elevated HbA1c values >7 g/dL (average 9.0) preoperatively, of which there were 4 superficial surgical site infections and 1 stomal stenosis, but no anastomotic leaks. Of the remaining 172 diabetic patients whose HbA1c level was <7 g/dL preoperatively (average 6.0 g/dL), 2 superficial surgical site infections, 2 stomal stenoses, and, again, no anastomotic leaks. No difference was seen in the combined complication rates between the 2 groups (2.9% versus 2.3%, P = .50). CONCLUSION In the present study, an elevated HbA1c >7 g/dL in patients with type 2 diabetes mellitus did not convey increased complication rates after RYGB.
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Obstructive sleep apnea is underrecognized and underdiagnosed in patients undergoing bariatric surgery. Eur Arch Otorhinolaryngol 2012; 269:1865-71. [PMID: 22310840 PMCID: PMC3365234 DOI: 10.1007/s00405-012-1948-0] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 01/16/2012] [Indexed: 11/07/2022]
Abstract
The aim of this study was to evaluate prevalence of obstructive sleep apnea among patients undergoing bariatric surgery and the predictive value of various clinical parameters: body mass index (BMI), neck circumference (NC) and the Epworth Sleepiness Scale (ESS). We performed a prospective, multidisciplinary, single-center observational study including all patients on the waiting list for bariatric surgery between June 2009 and June 2010, irrespective of history or clinical findings. Patients visited our ENT outpatient clinic for patient history, ENT and general examination and underwent a full night polysomnography, unless performed previously. As much as 69.9% of the patients fulfilled the criteria for OSA (mean BMI 44.2 ± SD 6.4 kg/m2); 40.4% of the patients met the criteria for severe OSA. The regression models found BMI to be the best clinical predictor, while the ROC curve found the NC to be the most accurate predictor of the presence of OSA. The discrepancy of the results and the poor statistical power suggest that all three clinical parameters are inadequate predictors of OSA. In conclusion, in this large patient series, 69.9% of patients undergoing BS meet the criteria for OSA. More than 40% of these patients have severe OSA. A mere 13.3% of the patients were diagnosed with OSA before being placed on the waiting list for BS. On statistical analysis, increased neck circumference, BMI and the ESS were found to be insufficient predictors of the presence of OSA. Polysomnography is an essential component of the preoperative workup of patients undergoing BS. When OSA is found, specific perioperative measures are indicated.
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Strain GW, Gagner M, Pomp A, Dakin G, Inabnet WB, Saif T. Comparison of fat-free mass in super obesity (BMI ≥ 50 kg/m2) and morbid obesity (BMI <50 kg/m2) in response to different weight loss surgeries. Surg Obes Relat Dis 2011; 8:255-9. [PMID: 22118843 DOI: 10.1016/j.soard.2011.09.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 09/15/2011] [Accepted: 09/29/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Differences in excess weight loss, body mass index (BMI) change, and body composition have been related to different types of bariatric procedures. Our objective was to explore these alterations related to body mass in superobese (SO) and morbidly obese (MO) patients in a university hospital setting. METHODS Patients provided written informed consent and had their body composition measured before and after surgery using bioimpedance (Tanita 310). The t test was used to compare MO and SO. Pearson's correlations were used to examine the BMI, excessive BMI loss, percentage of body fat (BF) change, and fat-free mass. RESULTS A total of 133 MO patients had a BMI of 43.3 kg/m(2) and 88 SO patients had a BMI of 59.4 kg/m(2). The percentage of BF was 46.7% and 51.9% (P < .0001). The differences in the follow-up period after surgery (21.5 and 20.6 months; P = .62) and patient age (43.4 and 42.5 yr) were not significant, but the gender distribution was significant (P = .003). After surgery, the MO patients had a BMI of 30.9 ± 5.7 kg/m(2) and the SO patients had a BMI of 37.3 ± 9.0 kg/m(2). The percentage of BF was not different between the 2 groups (MO, 33.1% ± 9.6% and SO, 35.0% ± 12.4%; P = .21). Gender differences in the percentage of BF were present before surgery; however, after surgery, these were absent for the men in the 2 groups (24.8% and 26.6%; P = .51). The change in the BMI and the change in the BF had a stronger correlation for the MO patients (r = .83 versus r = .53) than for the SO patients. The fat-free mass loss correlated with the change in BMI without regard to procedure. The percentage of excessive BMI loss was 65.1% for the MO and 63.4% for the SO patients (P = .64). CONCLUSIONS The SO patients achieved excessive BMI loss similar to that of the MO patients, with more SO men choosing biliopancreatic diversion/duodenal switch. At a BMI of 37.3 kg/m(2), the SO patients had a percentage of BF that was not different from that of the MO patients at 30.9 kg/m(2). The fat-free mass losses correlated with the change in BMI.
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Affiliation(s)
- Gladys W Strain
- Weill Cornell College of Medicine, New York, New York 10065, USA.
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Nguyen NT, Masoomi H, Laugenour K, Sanaiha Y, Reavis KM, Mills SD, Stamos MJ. Predictive factors of mortality in bariatric surgery: data from the Nationwide Inpatient Sample. Surgery 2011; 150:347-51. [PMID: 21801970 DOI: 10.1016/j.surg.2011.05.020] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 05/16/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND Understanding predictors of mortality in bariatric surgery enables surgeons to use these factors for analysis of risk-adjusted mortality and aids in the surgical decision making and informed consent process. OBJECTIVES To evaluate the effect of patient characteristics (age, gender, race, and payer type), preoperative comorbidities, and operative technique (laparoscopic versus open, gastric bypass versus gastric band) on mortality in patients who underwent bariatric operations. METHODS Using the National Inpatient Sample database, clinical data of patients with morbid obesity who underwent bariatric surgery from 2006 to 2008 were examined. Multivariate logistic regression analyses were performed to identify independent predictors of in-hospital mortality. RESULTS A total 304,515 patients underwent bariatric surgery over the 3-year period. The majority of patients were female (80%) and Caucasian (74%). Their mean age was 44 years and 31.6% were >50 years old. The most common payer type was private (73.5%). Laparoscopic approach was utilized in 86.2% of cases. The overall in-hospital mortality was 0.12%. Using multivariate regression analysis, male gender (adjusted odds ratio [AOR], 1.7), age >50 years (AOR, 3.8), congestive heart failure (AOR, 9.5), peripheral vascular disease (AOR, 7.4), chronic renal failure (AOR, 2.7), open procedure (AOR, 5.5), and gastric bypass operation (AOR, 1.6) were factors associated with greater mortality. Ethnicity, hypertension, diabetes, liver disease, chronic lung disease, sleep apnea, alcohol abuse, and payer type had no association with mortality in this study. CONCLUSION Modifiable risk factors predictive of mortality include open surgery and gastric bypass procedure; nonmodifiable risk factors include older age, male gender, and a history of congestive heart failure, peripheral vascular disease, and chronic renal failure. Surgeons should consider these factors in selection of patients to undergo bariatric operations, providing informed consent, and selection of the procedural type.
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Affiliation(s)
- Ninh T Nguyen
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA.
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Abstract
BACKGROUND This is the largest single-centre series of single-stage laparoscopic sleeve gastrectomy (LSG) reporting on perioperative outcomes, weight loss, comorbidity resolution including urological outcomes and results in the super obese. Review of prospectively collected data for patients who underwent LSG from March 2007-August 2009. METHODS There were 253 patients with a mean age of 44 years (SD, 9) and a mean preoperative body mass index (BMI) of 50 kg/m(2) (SD, 7). There were 17 (7%) major complications and no deaths. The mean follow-up was 9 months. One hundred and seventy-one patients with a mean follow-up of 12 months had a mean postoperative weight loss of 41 kg (SD, 16) and mean excess BMI (meBMI) loss of 59% (SD, 22). RESULTS One hundred fourteen patients were super obese (BMI, >50 kg/m(2)). The mean weight loss was 45 kg (SD, 18), and the meBMI lost was 49% (SD, 21). Super-obese patients experienced more complications (p = 0.02) and lost less eBMI (49% vs. 61%; p < 0.01). Fifty-three patients (46%) remained morbidly obese (BMI, >40 kg/m(2)) postoperatively. Hypertension and diabetes improved or resolved in 73 (79%) and 73 (90%) patients, respectively. Stress urinary incontinence was reported preoperatively in 60 (32%) females, and complete resolution or improvement was reported in 54 (90%) patients. CONCLUSIONS LSG provides satisfactory weight loss and resolution of comorbidities in the short- and medium-term with inferior, though acceptable, results in the super obese.
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Comparison of Early and Late Complications after Various Bariatric Procedures: Incidence and Treatment During 15 Years at a Single Institution. World J Surg 2010; 35:93-101. [DOI: 10.1007/s00268-010-0816-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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McAlpine DE, Frisch MJ, Rome ES, Clark MM, Signore C, Lindroos AK, Allison KC. Bariatric surgery: a primer for eating disorder professionals. EUROPEAN EATING DISORDERS REVIEW 2010; 18:304-17. [PMID: 20589766 DOI: 10.1002/erv.1012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Obesity is a public health epidemic with medical, psychological and economic consequences. It continues to increase globally in prevalence and severity. Despite numerous behaviourally, medically or pharmacologically guided treatments, an effective non-surgical long-term treatment approach has not been identified. Bariatric surgery has surfaced as a viable option for a subset of individuals with medically complicated obesity who have failed non-surgical approaches. Pre-operative evaluation followed by post-operative, longitudinal follow-up by a multidisciplinary team specializing in surgery, medicine, psychiatry/psychology, exercise science and nutrition constitutes recognized and necessary standard of care for these complex patients. More information is needed regarding factors that interfere with successful outcomes and mechanisms of optimal follow-up for bariatric surgery patients to prevent and detect post-operative medical, psychological and social difficulties. We will review these issues with a focus on issues relevant to eating disorders professionals.
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Affiliation(s)
- Donald E McAlpine
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, MN 55905, USA.
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Callery CD, Filiciotto S, Neil KL. Collagen matrix staple line reinforcement in gastric bypass. Surg Obes Relat Dis 2010; 8:185-9. [PMID: 21130045 DOI: 10.1016/j.soard.2010.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 07/21/2010] [Accepted: 09/08/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Staple line leaks and bleeding, anastomotic strictures, and marginal ulcers are significant complications of Roux-en-Y gastric bypass (RYGB) for morbid obesity. Reinforcing the staple lines with bovine collagen matrix reinforcement (CMR) might safely decrease the incidence of leaks and bleeding without causing other complications. Our objective was to determine the effect in RYGB of reinforcing the linear and circular gastric staple lines with CMR on the outcomes including abdominal septic events, blood transfusions, and the incidence of stricture and marginal ulceration of the gastrojejunostomy in a private bariatric surgery practice at 2 Surgical Review Committee Center of Excellence community hospitals. METHODS We performed a retrospective review of prospectively collected data comparing consecutive outcomes of 505 patients undergoing RYGB without CMR from 2005 to 2006 to 568 patients with CMR of the linear and circular gastric staple lines from 2007 to 2009. RESULTS The application of CMR was associated with a significant reduction from 4% to 1% in the incidence of abdominal septic events, including frank staple line leakage, purulent drainage, and abscess. The number of patients needing transfusion showed a trend downward. The frequency of stricture (1%) and marginal ulceration (2%) was unchanged. No gastrogastric fistulas were identified in either group. No evidence of migration of collagen matrix material appeared after CMR. The 90-day mortality rate for each group was .2% and was unrelated to staple line complications. CONCLUSION The use of CMR was associated with a significant reduction in the incidence of abdominal septic complications and a trend toward fewer patients needing transfusion. The frequency of stricture and marginal ulceration was unchanged by the use of CMR.
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Slotman GJ. Non-transectional open gastric bypass as the definitive bariatric procedure for 61 patients with BMI of 70 and higher. Obes Surg 2009; 20:7-12. [PMID: 19826887 DOI: 10.1007/s11695-009-9991-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 09/22/2009] [Indexed: 01/07/2023]
Abstract
BACKGROUND Technical difficulties in laparoscopic gastric bypass for severely obese patients have led to sleeve gastrectomy first and then laparoscopic gastric bypass as a second stage after significant weight loss. Rather than commit these fragile patients to two operations, we have done open gastric bypass as a definitive surgical treatment for extreme obesity. METHODS Office records of 61 patients with body mass index (BMI) of 70 and higher were reviewed. All underwent non-transectional open gastric bypass with a 150 cm Roux limb. Data included age, sex, weight, BMI, co-morbidities, operative information, length of stay (LOS), surgical morbidity, and percent excess weight loss (%XSWL). Data are in median (range). RESULTS There were 21 (34%) men and 40 (66%) women: age, 37 years (19-53); pre-operative weight, 468 lb (300-650); and pre-operative BMI, 77 (70-95). Co-morbidities were diabetes mellitus, 26 (46%); hypertension, 26 (43%); sleep apnea, 61 (100%); gastroesophageal reflux disease, 20 (33%); and hypothyroid nine (15%). Incision length was 15 cm (12-20), abdominal wall fat thickness was 8 cm (5-13), operative time was 150 min (100-210), and estimated blood loss was 100 ml (25-750); post-op intensive care unit: yes 16 (26%) and no 44 (74%). LOS was 3 days for 44 patients (74%), 4 days for 11 (18%), 5 days for five (8%), and 7 days for one (1.6%). Post-operative morbidity was as follows: zero mortality, splenectomy, stoma leak, deep venous thrombosis, pulmonary embolus, GI bleeding, stomal ulcer, intestinal obstruction, fascial dehiscence, or 30-day readmission; wound infections in one (1.6%); skin wound separation in six (10%); pneumonia in one (1.6%); anemia in nine (14.8%); vitamin B(12) deficiency in six (10%); incisional hernia in 17 (28%); and gastric staple line disruption in two (3.3%). %XSWL were 51% in 1 year (28-84) and 60% in 2 years (27-97). CONCLUSIONS Non-transectional open gastric bypass for patients with BMI of 70 and higher is safe and effective as a one-stage operation for severe obesity.
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Laparoscopic bariatric surgery for morbid obesity: the first hundred cases in an Irish centre. Ir J Med Sci 2009; 179:17-22. [PMID: 19714393 DOI: 10.1007/s11845-009-0413-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 07/25/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION This study evaluated outcomes for the first 100 bariatric surgical procedures in a single, publicly funded Irish centre. METHODS This was a retrospective, chart-based study. Demographics and comorbidities of patients, peri- and post-operative outcomes and health benefits obtained by surgery were assessed. RESULTS In total, 87 patients underwent Roux-en-Y gastric bypass procedures, 11 underwent sleeve gastrectomies and 2 underwent duodenal switch. The first 13 operations were done as open procedures. Of the remaining 87 cases, 85 were started laparoscopically. Postoperatively, 2 laparotomies were performed for bleeding and 2 patients developed incarcerated incisional hernias that required repair. The 30-day readmission rate was 6% of which 2 patients required emergency surgery. There was one postoperative mortality from cardio-respiratory failure. CONCLUSIONS This series audits the introduction of a publicly funded bariatric service in Ireland and reports a high percentage of procedures completed laparoscopically with an acceptable morbidity and mortality.
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Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, Pories W, Courcoulas A, McCloskey C, Mitchell J, Patterson E, Pomp A, Staten MA, Yanovski SZ, Thirlby R, Wolfe B. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 2009; 361:445-54. [PMID: 19641201 PMCID: PMC2854565 DOI: 10.1056/nejmoa0901836] [Citation(s) in RCA: 922] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization. METHODS We performed a prospective, multicenter, observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007. A composite end point of 30-day major adverse outcomes (including death; venous thromboembolism; percutaneous, endoscopic, or operative reintervention; and failure to be discharged from the hospital) was evaluated among patients undergoing first-time bariatric surgery. RESULTS There were 4776 patients who had a first-time bariatric procedure (mean age, 44.5 years; 21.1% men; 10.9% nonwhite; median body-mass index [the weight in kilograms divided by the square of the height in meters], 46.5). More than half had at least two coexisting conditions. A Roux-en-Y gastric bypass was performed in 3412 patients (with 87.2% of the procedures performed laparoscopically), and laparoscopic adjustable gastric banding was performed in 1198 patients; 166 patients underwent other procedures and were not included in the analysis. The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding was 0.3%; a total of 4.3% of patients had at least one major adverse outcome. A history of deep-vein thrombosis or pulmonary embolus, a diagnosis of obstructive sleep apnea, and impaired functional status were each independently associated with an increased risk of the composite end point. Extreme values of body-mass index were significantly associated with an increased risk of the composite end point, whereas age, sex, race, ethnic group, and other coexisting conditions were not. CONCLUSIONS The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics. In helping patients make appropriate choices, short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese. (ClinicalTrials.gov number, NCT00433810.)
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Short- and mid-term outcomes of sleeve gastrectomy for morbid obesity: the experience of the Spanish National Registry. Obes Surg 2009; 19:1203-10. [PMID: 19572113 DOI: 10.1007/s11695-009-9892-9] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 06/01/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Reports on laparoscopic sleeve gastrectomy (LSG) communicate very good short-term results on very high-risk morbid obese patients. However, mid- and long-term results are still unknown. A National Registry has been created in Spain to achieve information on the outcomes of this bariatric procedure. METHODS Data were obtained from 17 centers and collected in a database. Technical issues, preoperative comorbid conditions, hospital stay, early and late complications, and short- and mid-term weight loss were analyzed. RESULTS Five hundred forty patients were included; 76% were women. Mean BMI was 48.1 +/- 10. Mean age was 44.1 +/- 11.8. Morbidity rate was 5.2% and mortality rate 0.36%. Complications presented more frequently in superobese patients (OR, 2.8 (1.18-6.65)), male (OR, 2.98 (1.26-7.0)), and patients >55 years old (OR, 2.8 (1.14-6.8)). Staple-line reinforcement was related to a lower complication rate (3.7 vs 8.8%; p = 0.039). Mean hospital stay was 4.8 +/- 8.2 days. Mean follow-up was 16.5 +/- 10.6 months (1-73). Mean percent excess BMI loss (EBL) at 3 months was 38.8 +/- 22, 55.6 +/- 8 at 6 months, 68.1 +/- 28 at 12 months, and 72.4 +/- 31 at 24 months. %EBL was superior in patients with lower initial BMI and lower age. Bougie caliber was an inverse predictive factor of %EBL at 12 and 24 months (RR, 23.3 (11.4-35.2)). DM is remitted in 81% of the patients and HTA improved in 63.2% of them. A second-stage surgery was performed in 18 patients (3.2%). CONCLUSIONS LSG provides good short- and mid-term results with a low morbid-mortality rate. Better results are obtained in younger patients with lowest BMI. Staple-line reinforcement and a thinner bougie are recommended to improve outcome.
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Kelles SMB, Barreto SM, Guerra HL. Mortality and hospital stay after bariatric surgery in 2,167 patients: influence of the surgeon expertise. Obes Surg 2009; 19:1228-35. [PMID: 19562422 DOI: 10.1007/s11695-009-9894-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 06/01/2009] [Indexed: 01/14/2023]
Abstract
BACKGROUND Postoperative mortality is a rare event after bariatric surgery. The main goal of this study was to calculate the 30-day mortality rate postbariatric "open" surgery and the length of hospital stay of patients assisted by a health maintenance organization in Brazil. We also investigate their association with sex, age, BMI, preexisting comorbidities, and volume of procedures performed by surgeons. METHODS A total of 2,167 patients who underwent RYGB between 01/2004 and 12/2007 were analyzed. The deaths and hospital stay were identified in the healthcare transactional database and the morbidity data in the preoperative medical audit records. Factors contributing to adverse outcomes were determined by multiple logistic regression analysis. RESULTS The overall mortality rate was 0.64%, with a decreasing trend over the years. The median hospital stay was 3.1 days. In the multivariate analysis, both mortality and longer hospital stay were positively and significantly associated with age > 50 years, BMI > 50 kg/m(2), and surgeon volume of less than 20 bariatric surgeries/year. Presence of hypertension also increased the risk of longer hospital stay. Multivariate analysis showed that the 30-day mortality was six times higher in patients operated by professionals who performed less surgeries/year and longer hospital stay, four times more frequent. CONCLUSIONS The 30-day mortality post-RYGB is similar to the rates found in developed countries and much lower than the rates found for patients assisted by the public health system in Brazil. In addition to age and clinical factors, the results suggest that mortality and longer hospital stay are strong and inversely related to surgeon's experience.
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Affiliation(s)
- Silvana Márcia Bruschi Kelles
- Program of Post-graduation on Adults Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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Effect of circular staple line buttressing material on gastrojejunostomy failure in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2009; 6:64-7. [PMID: 19640800 DOI: 10.1016/j.soard.2009.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 04/10/2009] [Accepted: 05/13/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND To determine the effect of bovine pericardium strip (BPS) reinforcement of the circular stapler on the gastrojejunostomy leak rates and staple line failure after laparoscopic Roux-en-Y gastric bypass (LRYGB) at a university hospital in the United States. Gastrojejunostomy leak after LRYGB is a devastating complication. Various techniques, including buttressing the gastrojejunostomy staple line with biomaterial, have been used in an effort to minimize leaks. METHODS A total of 350 consecutive patients underwent LRYGB without staple line buttressing. After this initial experience, BPS reinforcement of the gastrojejunostomy was conducted in 81 consecutive patients. BPS reinforcement was not used for the final 69 consecutive patients in this 500 patient series. Circular staple line failures (intraoperative immediate and complete failure of the anastomosis) and leaks were evaluated retrospectively. RESULTS Three leaks (and no intraoperative staple line failures) occurred in 419 patients without BPS buttressing, all in the first 100 cases of our experience, and 3 leaks and an anastomotic staple line failure occurred in the 81 patients with BPS buttressing (.7% versus 4.9%, P = .02). The body mass index and other potential leak risk factors did not differ between the 2 groups. CONCLUSION In our experience, buttressing of the circular staple line with BPS during LRYGB was associated with an increased staple line adverse event rate. BPS buttressing of the gastrointestinal circular staple lines should be used with caution.
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Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J, Guven S. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring) 2009; 17 Suppl 1:S1-70, v. [PMID: 19319140 DOI: 10.1038/oby.2009.28] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist health-care professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
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Fares LG, Reeder RC, Bock J, Batezel V. 23-Hour Stay Outcomes for Laparoscopic Roux-en-Y Gastric Bypass in a Small, Teaching Community Hospital. Am Surg 2008. [DOI: 10.1177/000313480807401216] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The goal of every surgery is a successful outcome with the shortest hospital stay. Morbidly obese patients with their myriad of comorbidities have confounded surgeons over the years, usually leading to an increased length of hospital stays after complicated surgeries. Laparoscopic Roux-en-Y gastric bypass (LRYGB) has proven to be an effective treatment for the morbidly obese with a usual length of stay of 3 days. The purpose of this article is to review our experience with 23-hour stays for LRYGB over a 13-month period and to apply a recently published risk score to these patients. A single surgeon performed 173 bariatric surgeries of which 96 were LRYGB, the study group. The demographics of this group found the overwhelming majority were female, white, slightly older than the men but with a somewhat smaller body mass index (BMI). The ethnic breakdown was 67.7 per cent white, 22.9 per cent black, and 9.4 per cent Hispanic. The average for all patients was 41.7 years and the BMI was 49.25 kg/m2. Using the Obesity Surgery Mortality Risk Score, 62.5 per cent of our patients were low risk or Class A, 37.5 per cent intermediate risk or Class B, and none of our patients qualified as high risk or Class C. Our average patient score was 1.3. In terms of length of stay, 91 of the 96 patients (94.8%) were discharged within 23 hours of surgery without mortality or 30-day readmission. The remaining five patients (5.2%) had unexplained, sustained tachycardia and were re-explored on the first postoperative day laparoscopically. Three of these patients had negative explorations. One had a jejunojejunostomy revision and the other was found to have a small bowel injury, which was laparoscopically repaired. All five patients were discharged within the next 23 hours. All patients were discharged on a clear liquid diet and advanced to a regular diet over the next month. No diet intolerance was noted nor were any patients converted to an open operation. In conclusion, we have demonstrated that a comprehensive bariatric program in a small teaching community hospital can successfully perform LRYGB and discharge a high percentage of patients within 23 hours with a very low complication rate. We also believe the Obesity Surgery Mortality Risk Score will help bariatric programs to risk-stratify their patients preoperatively. This will contribute to decision-making and further inform patients of their risk as part of their education preoperatively.
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Affiliation(s)
- Louis G. Fares
- Department of Surgery, St. Francis Medical Center, Seton Hall University School of Graduate Medical Education, Trenton, New Jersey; and the
- Center for Advanced Weight Loss, Hamilton, New Jersey
| | - Rachel C. Reeder
- Department of Surgery, St. Francis Medical Center, Seton Hall University School of Graduate Medical Education, Trenton, New Jersey; and the
| | - John Bock
- Center for Advanced Weight Loss, Hamilton, New Jersey
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Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocr Pract 2008; 14 Suppl 1:1-83. [PMID: 18723418 DOI: 10.4158/ep.14.s1.1] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, Apovian CM, Livingston EH, Brolin R, Sarwer DB, Anderson WA, Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg Obes Relat Dis 2008; 4:S109-84. [PMID: 18848315 DOI: 10.1016/j.soard.2008.08.009] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. The American Society for Parenteral & Enteral Nutrition fully endorses sections of these guidelines that address the metabolic and nutritional management of the bariatric surgical patient.
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Søvik TT, Aasheim ET, Kristinsson J, Schou CF, Diep LM, Nesbakken A, Mala T. Establishing laparoscopic Roux-en-Y gastric bypass: perioperative outcome and characteristics of the learning curve. Obes Surg 2008; 19:158-165. [PMID: 18566869 DOI: 10.1007/s11695-008-9584-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 05/23/2008] [Indexed: 01/14/2023]
Abstract
BACKGROUND Bariatric surgery was established at several Norwegian hospitals in 2004. This study evaluates the perioperative outcome and the learning curves for two surgeons while introducing laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS Morbidly obese patients undergoing primary LRYGB were included. Lengths of surgery and postoperative hospital stay, and 30-day rates of morbidity, reoperations, and readmissions were set as indicators of the learning curve. Learning effects were evaluated by graphical analyses and comparing the first and last 40 procedures for both surgeons. RESULTS The 292 included patients had a mean age of 40.0 +/- 9.5 years and a mean body mass index (BMI) of 46.7 +/- 5.3 kg/m(2). The mean length of surgery was 101 +/- 55 min. Complications occurred in 43 patients (14.7%), with no conversions to open surgery in the primary procedure and no mortality. Reoperations were performed in 14 patients (4.8%), of which five patients required open surgery. The median length of stay was 3 days (range 1-77), and 19 patients (6.5%) were readmitted. High patient age, but not high BMI, was associated with an increased risk of complication. For both surgeons, lengths of surgery and hospital stay were significantly reduced (p < 0.001), leveling out after 100 procedures. Reductions in the rates of morbidity, reoperations and readmissions were not found. CONCLUSION LRYGB was introduced with an acceptable morbidity rate and no mortality. Only the length of surgery and postoperative hospital stay were suitable indicators of a learning curve, which comprised about 100 cases.
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Affiliation(s)
| | - Erlend T Aasheim
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
| | - Jon Kristinsson
- Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
| | - Carl Fredrik Schou
- Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
| | - Lien My Diep
- Aker University Hospital Research Center, Trondheimsveien 235, 0514, Oslo, Norway
| | | | - Tom Mala
- Department of Gastrointestinal Surgery, Aker University Hospital, Trondheimsveien 235, 0514, Oslo, Norway
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Belle SH, Chapman W, Courcoulas AP, Flum DR, Gagner M, Inabnet WB, King WC, Mitchell JE, Patterson EJ, Thirlby R, Wolfe BM, Yanovski SZ. Relationship of body mass index with demographic and clinical characteristics in the Longitudinal Assessment of Bariatric Surgery (LABS). Surg Obes Relat Dis 2008; 4:474-80. [PMID: 18514583 DOI: 10.1016/j.soard.2007.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 12/05/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND The relationship between body mass index (BMI) and demographic/clinical characteristics of patients undergoing bariatric surgery is poorly characterized. BMI is often used to characterize patient risk in bariatric surgery. However, its relationship with other risk factors has not been well characterized. METHODS The Longitudinal Assessment of Bariatric Surgery-1 was a study of the 30-day outcomes in patients undergoing bariatric procedures at 10 clinical centers in the United States. The sample for this study included participants with a BMI > or =40 kg/m(2) and no history of undergoing a bariatric procedure from March 1, 2005 to March 26, 2007. This analysis examined the relationships between BMI strata and several demographic/clinical characteristics. RESULTS Of 2559 patients (23% male, 10% black, 9% age > or =60 yr) with a BMI of > or =40 kg/m(2), 29% had a BMI of 50 to <60 kg/m(2) and 12% a BMI of > or =60 kg/m(2). The percentage of men and blacks increased with greater BMI category and the percentage of older patients (age > or =60 yr) decreased. Patients with a greater BMI were more likely to have a history of several co-morbid conditions (hypertension, diabetes, congestive heart failure, asthma, poor functional status, sleep apnea, pulmonary hypertension, venous thromboembolism, or venous edema with ulcerations) than were patients with a BMI of 40-50 kg/m(2) after adjusting for age, race, sex, and ethnicity. CONCLUSION A greater BMI was associated with several patient characteristics that have been linked to less weight loss, more adverse outcomes, and increased healthcare use in previous studies. Outcomes analyses should consider the potential for the confounding of BMI with demographic and clinical characteristics.
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2008; 15:193-207. [PMID: 18316957 DOI: 10.1097/med.0b013e3282fba8b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Affiliation(s)
- Deron J Tessier
- Staff Surgeon, Kaiser Permanente Medical Center, Fontana, California, USA
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Al-Sabah S, Ladouceur M, Christou N. Anastomotic leaks after bariatric surgery: it is the host response that matters. Surg Obes Relat Dis 2008; 4:152-7; discussion 157-8. [DOI: 10.1016/j.soard.2007.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 12/06/2007] [Accepted: 12/27/2007] [Indexed: 10/22/2022]
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Klonoff DC. Bariatric surgery for obese adolescents. J Diabetes Sci Technol 2007; 1:451-3. [PMID: 19885106 PMCID: PMC2769630 DOI: 10.1177/193229680700100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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