Complications Rate Variability after Bariatric Surgery and the Importance of Standardization of a Reporting System

Pre- and Postoperative Care for Bariatric Surgery Patients: The Impact of a Designed Reference Guide on Nurses' Awareness and Patient Satisfaction

BACKGROUND/OBJECTIVES

Bariatric surgery is a crucial intervention for the treatment of morbid obesity, necessitating that nursing staff possess a thorough understanding of expected outcomes to ensure successful patient care and promote healthier lifestyles. Recognizing this need, the present study aimed to develop and implement a reference guide tailored to nursing staff providing bariatric surgery care.

METHODS

A quasi-experimental design was employed, utilizing a convenience sample of 78 nurses and 156 patients-comprising 78 participants before the administration of the reference guide and another 78 participants after its provision-from the general surgery units at Mansoura University Hospital. Four tools were employed for data collection: a sociodemographic datasheet, a knowledge questionnaire assessing nurses' understanding of care for bariatric surgery patients, a self-reported practice questionnaire, and a patients' satisfaction measurement tool. A reference guide for bariatric surgery care was constructed. Descriptive and inferential statistics were conducted with adherence to all ethical considerations.

RESULTS

After implementing the reference guide, the percentage of nurses who exhibited good knowledge of bariatric surgery increased from 10.3% to 80.8%. Additionally, the proportion of nurses reporting poor self-reported practices related to necessary procedures decreased from 80.8% to 5.1%. Surprisingly, the improvement in knowledge and self-reported practices was sustained for a long time, though reduced. Furthermore, patient satisfaction levels showed a marked improvement following the intervention.

CONCLUSION

Implementing a reference guide significantly improved nurses' knowledge, self-reported practices, and patient satisfaction. To sustain these improvements, it is recommended that the reference guide be made available and educational programs be provided to nursing staff.

New world of big data-new challenges for evidence synthesis: impact of data duplication on estimates generated by meta-analyses and the development of a framework for its identification and management

OBJECTIVES

The aim of this study was to highlight the effects of entering duplicated or overlapping data from published studies using the same data registries into a meta-analysis, including its identification and management using a novel structured framework.

STUDY DESIGN AND SETTING

Secondary analysis of data from a proportional meta-analysis of 30-day cumulative incidence of venous thromboembolic events (VTE) after metabolic and bariatric surgery was performed. Sensitivity analysis was conducted a) including all studies regardless of duplication (uncorrected sample) and b) comparing it to a corrected sample of studies. We developed a decision tree framework to identify duplicated data from prospective studies and data registries.

RESULTS

We demonstrated that biasing from duplicated data, primarily from data registries, underestimated the incidence of VTE in the literature by 0.15% of the patient population (an erroneous difference equivalent to 22.06% of total VTE). This error persisted at 8.16% of total VTE when limiting to studies using a primarily laparoscopic approach. The decision tree framework used a comparison of the data source (country and hospital or registry), sampling time frame (dates/years of included data) and inclusion characteristics (included procedures/diagnoses or inclusion criteria) to identify potentially duplicated data. Inter-rater reliability was excellent (κ = 1.00, P < .001), although only 17.86% of studies coded as containing data duplication were verified by the authors while the remaining studies could not be verified. Lastly, we identified a strong lack of diversity in the geographical origins of the data from the included studies.

CONCLUSION

We demonstrated that inadvertently including duplicated data in a meta-analysis can result in substantially inaccurate pooled estimates. We outlined a comprehensive decision tree framework that future researchers can apply to assist with decision making when identifying and managing duplicated data, including that from prospective trials and data registries or other publicly accessible datasets.

PLAIN LANGUAGE SUMMARY

We explored the effects of entering duplicated or overlapping data from published studies using the same data registries into a meta-analysis; and developed a decision tree framework to identify such duplicated data from prospective studies and data registries. We analyzed data of 30-day incidence of venous thromboembolic events after metabolic and bariatric surgery. We demonstrated that including duplicated data, mainly from data registries, in a meta-analysis can result in substantially inaccurate pooled estimates, underestimating the incidence of total venous thromboembolic events by 22.06%. We also found a lack of diversity in the geographical origins of the data. The decision tree compared data source (country and hospital/registry), sampling time frame (dates/years of included data) and inclusion characteristics (inclusion criteria/procedures/diagnoses) to identify potentially duplicated data. Future researchers can apply the framework to make decisions when identifying and managing duplicated data from data registries or other publicly accessible datasets.

RESULTS OF MECHANIC VERSUS MOTORIZED STAPLER USED IN GASTRIC SURGERY: PROSPECTIVE STUDY

BACKGROUND

Mechanic sutures represent an enormous benefit for digestive surgery in decreasing postoperative complications. Currently, the advantages of motorized stapler are under evaluation.

AIMS

To compare the efficacy of mechanic versus motorized stapler in gastric surgery, analyzing rate of leaks, bleeding, time of stapling, and postoperative complications.

METHODS

Ninety-eight patients were submitted to gastric surgery, divided into three groups: laparoscopic sleeve gastrectomy (LSG) (n=47), Roux-en-Y gastric bypass (LRYGB) (n=30), and laparoscopic distal gastrectomy (LDG) (n=21). Motorized staplers were employed in 61 patients. The number of firings, number of clips, time of total firings, total time to complete the surgery, and postoperative outcome were recorded in a specific protocol.

RESULTS

Patients submitted to LSG, LRYGB, and LDG recorded a shorter time to complete the procedure and a smaller number of firings were observed using motorized stapler (p<0.0001). No differences were identified regarding the number of clips used in patients submitted to LSG. In the group that used mechanic stapler to complete gastrojejunostomy, jejuno-jejuno-anastomosis, and jejunal transection, it was observed more prolonged time of firing and total time for finishing the procedure (p=0.0001). No intraoperative complications were found comparing the two devices used. Very similar findings were noted in the group of patients undergoing LDG.

CONCLUSIONS

The motorized stapler offers safety and efficacy as demonstrated in prior reports and is relevant since less total time of surgical procedure without intraoperative or postoperative complications were confirmed.

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

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.

Sleeve gastrectomy is feasible in obese patients with phenylketonuria: A case report and literature review

INTRODUCTION AND IMPORTANCE

Patients with phenylketonuria (PKU) exhibit a high incidence of obesity. Currently, bariatric surgery remains the most effective long-term treatment for obese patients. However, limited data regarding the applicability of bariatric surgery to obese patients with PKU have been reported in the literature.

CASE PRESENTATION

A case involving a young woman, in whom sleeve gastrectomy was performed to manage obesity that was resistant to conservative therapy, is presented herein.

CLINICAL DISCUSSION

The present report is the first to describe sleeve gastrectomy in an obese patient with PKU. The surgery proceeded without complications. Furthermore, the patient's phenylalanine levels remained under control for the first 3 months after surgery, with no major neurological complications. The diet prescribed in the first few months after surgery is complex; nevertheless, it is feasible to follow if supervised by a dietary team specialised in rare metabolic diseases.

CONCLUSION

Bariatric surgery in this patient with PKU did not result in any major complications. Surgery is feasible but it is important for the dietetic team involved to have expertise in PKU management.