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Surve A, Cottam D, Pryor A, Cottam S, Michaelson R, Umbach T, Williams M, Bagshahi H, July L, Bueno R, Chock D, Apel M, Hart C, Johnson W, Curtis B, Rosenbluth A, Spaniolas K, Medlin W, Wright W, Lee C, Lee C, Trujeque R, Rinker D. A Prospective Multicenter Standard of Care Study of Outpatient Laparoscopic Sleeve Gastrectomy. Obes Surg 2024; 34:1122-1130. [PMID: 38366263 PMCID: PMC11026234 DOI: 10.1007/s11695-024-07094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
A global shift is occurring as hospital procedures move to ambulatory surgical settings. Surgeons have performed outpatient sleeve gastrectomy (SG) in bariatric surgery since 2010. However, prospective trials are needed to ensure its safety before widespread adoption. PURPOSE The study aimed to present a comprehensive report on the prospective data collection of 30-day outcomes of outpatient primary laparoscopic SG (LSG). This trial seeks to assess whether outpatient LSG is non-inferior to hospital-based surgery in selected patients who meet the outpatient surgery criteria set by the American Society for Metabolic and Bariatric Surgery. MATERIALS AND METHODS This study is funded by the Society of American Gastrointestinal and Endoscopic Surgeons and has been approved by the Advarra Institutional Review Board (Pro00055990). Cognizant of the necessity for a prospective approach, data collection commenced after patients underwent primary LSG procedures, spanning from August 2021 to September 2022, at six medical centers across the USA. Data centralization was facilitated through ArborMetrix. Each center has its own enhanced recovery protocols, and no attempt was made to standardize the protocols. RESULTS The analysis included 365 patients with a mean preoperative BMI of 43.7 ± 5.7 kg/m2. Rates for 30-day complications, reoperations, readmissions, emergency department visits, and urgent care visits were low: 1.6%, .5%, .2%, .2%, and 0%, respectively. Two patients (0.5%) experienced grade IIIb complications. There were no mortalities or leaks reported. CONCLUSION The prospective cohort study suggests that same-day discharge following LSG seems safe in highly selected patients at experienced US centers.
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Affiliation(s)
- Amit Surve
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Daniel Cottam
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA.
| | - Aurora Pryor
- Stony Brook University Hospital, 23 South Howell Ave, Centereach, NY, USA
| | - Samuel Cottam
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Robert Michaelson
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Thomas Umbach
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Michael Williams
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | | | - Laura July
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Racquel Bueno
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Devorah Chock
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Matthew Apel
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
| | - Christopher Hart
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - William Johnson
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Brendon Curtis
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Amy Rosenbluth
- Stony Brook University Hospital, 23 South Howell Ave, Centereach, NY, USA
| | | | - Walter Medlin
- Bariatric Medicine Institute, 1046 E 100 S, Salt Lake City, UT, USA
| | - Whitney Wright
- Northwest Weight & Wellness Center, 125 130Th St SE, Everett, WA, USA
| | - Ciara Lee
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | - Christy Lee
- Atlanta General and Bariatric Surgery Center, 6300 Hospital Parkway Ste. 150, Johns Creek, GA, USA
| | | | - Deborah Rinker
- Blossom Bariatrics, 7385 S Pecos Rd #101, Las Vegas, NV, USA
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Shinder E, Hanson P, Phillips H, Tuppo C, Spaniolas K, Pryor A, Powers K, Sanicola C, Hymowitz G. Preoperative medically supervised weight loss programs and weight loss outcomes following bariatric surgery - a prospective analysis. Surg Obes Relat Dis 2024; 20:165-172. [PMID: 37945471 DOI: 10.1016/j.soard.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/13/2023] [Accepted: 08/28/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Prior to undergoing bariatric surgery, many insurance companies require patients to attend medically supervised weight management visits for 3-6 months to be eligible for surgery. There have been few studies that have looked specifically at the relationship between medically supervised weight management visit attendance and postoperative outcomes, and the current literature reports discrepant findings. OBJECTIVES This project aimed to better characterize the relationship between preoperative medically supervised weight management visit attendance and postoperative weight loss outcomes by examining weight loss up to 5 years postbariatric surgery, and by stratifying findings according to the type of surgery undergone. SETTING University Hospital. METHODS Participants were recruited during presurgical bariatric surgery clinic visits at a bariatric and metabolic weight loss center. As part of standard of care all participants were required to participate in monthly medically supervised weight management visits before surgery. Participants who completed bariatric surgical procedures participated in postsurgical follow-up at 3 weeks, 3 months, 6 months, and then annually for 5 years. Weight outcomes measured were percentage of total weight lost. RESULTS The results do not indicate a significant association between number of group visits attended and percent total weight loss at 1 month, 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, or 5 years postbariatric surgery. CONCLUSIONS These data do not suggest a relationship between engagement in a medically supervised weight loss program prior to bariatric surgery and weight loss after surgery in either the short- or the long-term.
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Affiliation(s)
- Eliane Shinder
- Department of Psychiatry and Behavioral Health, Stony Brook School of Medicine, Stony Brook, New York.
| | - Paris Hanson
- Department of Psychiatry and Behavioral Health, Stony Brook School of Medicine, Stony Brook, New York
| | - Hannah Phillips
- Department of Psychiatry and Behavioral Health, Stony Brook School of Medicine, Stony Brook, New York
| | - Catherine Tuppo
- Department of Psychiatry and Behavioral Health, Stony Brook School of Medicine, Stony Brook, New York
| | - Konstantinos Spaniolas
- Department of Psychiatry and Behavioral Health, Stony Brook School of Medicine, Stony Brook, New York
| | - Aurora Pryor
- Department of Psychiatry and Behavioral Health, Stony Brook School of Medicine, Stony Brook, New York
| | - Kinga Powers
- Department of Psychiatry and Behavioral Health, Stony Brook School of Medicine, Stony Brook, New York
| | - Caroline Sanicola
- Department of Psychiatry and Behavioral Health, Stony Brook School of Medicine, Stony Brook, New York
| | - Genna Hymowitz
- Department of Psychiatry and Behavioral Health, Stony Brook School of Medicine, Stony Brook, New York
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Ceppa EP, Collings AT, Abdalla M, Onkendi E, Nelson DW, Ozair A, Miraflor E, Rahman F, Whiteside J, Shah MM, Ayloo S, Dirks R, Kumar SS, Ansari MT, Sucandy I, Ali K, Douglas S, Polanco PM, Vreeland TJ, Buell J, Abou-Setta AM, Awad Z, Kwon CH, Martinie JB, Sbrana F, Pryor A, Slater BJ, Richardson W, Jeyarajah R, Alseidi A. SAGES/AHPBA guidelines for the use of microwave and radiofrequency liver ablation for the surgical treatment of hepatocellular carcinoma or colorectal liver metastases less than 5 cm. Surg Endosc 2023; 37:8991-9000. [PMID: 37957297 DOI: 10.1007/s00464-023-10468-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the liver's two most common malignant neoplasms. Liver-directed therapies such as ablation have become part of multidisciplinary therapies despite a paucity of data. Therefore, an expert panel was convened to develop evidence-based recommendations regarding the use of microwave ablation (MWA) and radiofrequency ablation (RFA) for HCC or CRLM less than 5 cm in diameter in patients ineligible for other therapies. METHODS A systematic review was conducted for six key questions (KQ) regarding MWA or RFA for solitary liver tumors in patients deemed poor candidates for first-line therapy. Subject experts used the GRADE methodology to formulate evidence-based recommendations and future research recommendations. RESULTS The panel addressed six KQs pertaining to MWA vs. RFA outcomes and laparoscopic vs. percutaneous MWA. The available evidence was poor quality and individual studies included both HCC and CRLM. Therefore, the six KQs were condensed into two, recognizing that these were two disparate tumor groups and this grouping was somewhat arbitrary. With this significant limitation, the panel suggested that in appropriately selected patients, either MWA or RFA can be safe and feasible. However, this recommendation must be implemented cautiously when simultaneously considering patients with two disparate tumor biologies. The limited data suggested that laparoscopic MWA of anatomically more difficult tumors has a compensatory higher morbidity profile compared to percutaneous MWA, while achieving similar overall 1-year survival. Thus, either approach can be appropriate depending on patient-specific factors (very low certainty of evidence). CONCLUSION Given the weak evidence, these guidelines provide modest guidance regarding liver ablative therapies for HCC and CRLM. Liver ablation is just one component of a multimodal approach and its use is currently limited to a highly selected population. The quality of the existing data is very low and therefore limits the strength of the guidelines.
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Affiliation(s)
- Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA.
| | - Amelia T Collings
- Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Moustafa Abdalla
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Edwin Onkendi
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Daniel W Nelson
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Ahmad Ozair
- King George's Medical University, Lucknow, India
| | - Emily Miraflor
- UCSF East Bay Department of Surgery, UCSF, Oakland, CA, USA
| | - Faique Rahman
- Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Jake Whiteside
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Mihir M Shah
- Division of Surgical Oncology, Department of Surgery, Emory University Winship Cancer Institute, Atlanta, GA, USA
| | | | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Kchaou Ali
- Department of Surgery A, Sfax Medical School, Sfax, Tunisia
| | - Sam Douglas
- Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Patricio M Polanco
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Joseph Buell
- Department of Surgery, Mission Health Care System, Asheville, NC, USA
| | | | - Ziad Awad
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - Choon Hyuck Kwon
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Fabio Sbrana
- Department of Surgery, Chicago Medical School, Rosalind Franklin University, Chicago, IL, USA
| | - Aurora Pryor
- Department of Surgery, Long Island Jewish Medical Center, Northwell Health, Great Neck, NY, USA
| | | | | | | | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, CA, USA
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Sethi I, Aicher A, Cheema F, Powers K, Rosenbluth A, Pryor A, Spaniolas K. Postoperative outcomes for sleeve gastrectomy patients with positive pH-defined GERD. Surg Endosc 2023; 37:6861-6866. [PMID: 37311887 DOI: 10.1007/s00464-023-10149-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/20/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a possible side effect of sleeve gastrectomy (SG). However, procedure selection for patients with GERD and risk factors for morbidity after bypass surgeries is complex. For patients with a preoperative GERD diagnosis, literature related to worsening postoperative symptoms is discordant. OBJECTIVE This study evaluated the effects of SG on patients with pre-operative GERD confirmed through pH testing. SETTING University Hospital, United States. METHODS This was a single-center case-series. SG patients with preoperative pH testing were compared based on DeMeester scoring. Preoperative demographics, endoscopy results, need for conversion surgery, and changes in gastrointestinal quality of life (GIQLI) scores were compared. Two-sample independent t-tests assuming unequal variances were used for statistical analysis. RESULTS Twenty SG patients had preoperative pH testing. Nine patients were GERD positive; median DeMeester score 26.7 (22.1-31.15). Eleven patients were GERD negative, with a median DeMeester score of 9.0 (4.5-13.1). The two groups had similar median BMI, preoperative endoscopic findings and use of GERD medications. Concurrent hiatal hernia repair was performed in 22% of GERD positive vs. 36% of GERD negative patients, (p = 0.512). Two patients in the GERD positive cohort required conversion to gastric bypass (22%), while none in the GERD negative cohort did. No significant postoperative differences were noted in GIQLI, heartburn, or regurgitation symptoms. CONCLUSION Objective pH testing may allow the differentiation of patients who would be higher risk for need for conversion to gastric bypass. For patients with mild symptoms, but negative pH testing, SG may represent a durable option.
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Affiliation(s)
- Ila Sethi
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA.
| | - Aidan Aicher
- Division of General Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, USA
| | - Fareed Cheema
- Department of Surgery, NYU Langone Hospital-Brooklyn, Brooklyn, NY, USA
| | - Kinga Powers
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA
| | - Amy Rosenbluth
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA
| | - Aurora Pryor
- Department of Surgery, Long Island Jewish Medical Center, Queens, NY, USA
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut, and Advanced GI Surgery, Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11790, USA
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Anderson B, Robins B, Fraser JA, Swaszek L, Sanicola C, King N, Pryor A, Spaniolas K, Tholey R, Tannouri S, Palazzo F, Beekley A, Tatarian T. Weight loss and clinical outcomes following primary versus secondary Roux-en-Y gastric bypass: a multi-institutional experience. Surg Endosc 2023:10.1007/s00464-023-10133-7. [PMID: 37217683 DOI: 10.1007/s00464-023-10133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Revisional bariatric surgeries are increasing for weight recurrence and return of co-morbidities. Herein, we compare weight loss and clinical outcomes following primary Roux-en-Y Gastric Bypass (P-RYGB), adjustable gastric banding to RYGB (B-RYGB), and sleeve gastrectomy to RYGB (S-RYGB) to determine if primary versus secondary RYGB offer comparable benefits. METHODS Participating institutions' EMRs and MBSAQIP databases were used to identify adult patients who underwent P-/B-/S-RYGB from 2013 to 2019 with a minimum one-year follow-up. Weight loss and clinical outcomes were assessed at 30 days, 1 year, and 5 years. Our multivariable model controlled for year, institution, patient and procedure characteristics, and excess body weight (EBW). RESULTS 768 patients underwent RYGB: P-RYGB n = 581 [75.7%]; B-RYGB n = 106 [13.7%]; S-RYGB n = 81 [10.5%]. The number of secondary RYGB procedures increased in recent years. The most common indications for B-RYGB and S-RYGB were weight recurrence/nonresponse (59.8%) and GERD (65.4%), respectively. Mean time from index operation to B-RYGB or S-RYGB was 8.9 and 3.9 years, respectively. After adjusting for EBW, 1 year %TWL (total weight loss) and %EWL (excess weight loss) were greater after P-RYGB (30.4%, 56.7%) versus B-RYGB (26.2%, 49.4%) or S-RYGB (15.6%, 37%). Overall comorbidity resolution was comparable. Secondary RYGB patients had a longer adjusted mean length of stay (OR 1.17, p = 0.071) and a higher risk of pre-discharge complications or 30-day reoperation. CONCLUSION Primary RYGB offers superior short-term weight loss outcomes compared to secondary RYGB, with decreased risk of 30-day reoperation.
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Affiliation(s)
- Brigitte Anderson
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Bryan Robins
- Department of Surgery, Stony Brook University Hospital, Stony Brook, New York, USA
| | - James A Fraser
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Luke Swaszek
- Department of Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Caroline Sanicola
- Department of Surgery, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Neil King
- Department of Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Aurora Pryor
- Department of Surgery, Northwell Health Long Island Jewish Hospital, New Hyde Park, NY, USA
| | | | - Renee Tholey
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Sami Tannouri
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Alec Beekley
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA
| | - Talar Tatarian
- Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA.
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Weis JJ, Pryor A, Alseidi A, Tellez J, Goldblatt MI, Mattar S, Murayama K, Awad M, Scott DJ. Defining benchmarks for fellowship training in foregut surgery: a 10-year review of fellowship council index cases. Surg Endosc 2022; 36:8856-8862. [PMID: 35641699 DOI: 10.1007/s00464-022-09317-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/27/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Surgical treatment of foregut disease is a complex field that demands advanced expertise to ensure favorable outcomes for patients. To address the growing need for foregut surgeons, leaders within several national societies have become interested in developing a foregut fellowship. The aim of this study was to develop data-driven benchmarks that will aid in defining appropriate accreditation criteria for these fellowships. METHODS We obtained case log data for Fellowship Council fellows trained from 2009-2019. We identified 78 complex foregut (non-bariatric) case codes and divided them into 5 index case categories including (1) hiatal/paraoesophageal hernia repair, (2) fundoplication, (3) esophageal myotomy, (4) major organ resection, and (5) minor organ resection. Median volumes in each index category were compared over time using Kruskall-Wallis tests. The share of cases done using open, laparoscopic, or robotic approaches were analyzed using linear regression analysis. RESULTS For the 10 years analyzed, 1362 fellows logged 82,889 operations and 111,799 endoscopies. Median foregut cases per fellow grew significantly from 42 (IQR = 24-74) cases in 2010 to 69 (IQR = 33-106) cases in 2019. Median endoscopy volumes also grew significantly from 42 (IQR = 7-88) in 2010 to 69 (IQR 32-123) in 2019.The volume of hiatal/paraoesophageal hernia repairs increased significantly over time while volumes in the remaining 4 index categories remained stable. The share of robotic cases exhibited near perfect linear growth from 2.2% of all foregut cases in 2010 to 14.4% in 2019 (R = 0.99, p < 0.0001). Open cases exhibited linear decay from 7.2% of cases in 2010 to 4.7% of cases in 2019 (R = 0.92, p = 0.0001). Laparoscopic/thoracoscopic cases also exhibited linear decay from 90.6% of cases in 2010 to 80.9% of cases in 2019 (R = 0.98, p < 0.00001). CONCLUSIONS FC fellows are exposed to robust volumes of foregut cases. This rich data set provides an evidence-based guide for establishing criteria for potential foregut fellowships.
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Affiliation(s)
- Joshua J Weis
- University of Texas Health Science Center at Houston, Houston, USA.
| | | | | | - Juan Tellez
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | - Michael Awad
- Washington University in St. Louis, St. Louis, USA
| | - Daniel J Scott
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Devas N, Guenthart A, Nie L, Joshi I, Yang J, Morris-Stiff G, Pryor A. Timing is everything: outcomes of 30,259 delayed cholecystectomies in New York State. Surg Endosc 2022; 36:9390-9397. [PMID: 35768738 DOI: 10.1007/s00464-022-09251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/07/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The timing of cholecystectomy in relation to outcomes has been debated. To our knowledge, there are no large population-based studies looking at outcomes and complications of delayed cholecystectomy [DC] (> 72 h after presentation). This study utilizes a statewide database to determine whether there are differences in patient outcomes for DC performed at 3-4 days, 5-6 days, and ≥ 7 days after presentation. METHODS The New York SPARCS database was used to identify adult patients presenting with a diagnosis of acute cholecystitis from 2005 to 2017. Patients aged < 18, those with missing identifier or procedure-date information, those who underwent early cholecystectomy < 72 h or upon readmission, were excluded. Patients undergoing DC at 3-4 days, 5-6 days, and ≥ 7 days were compared in terms of overall complications, hospital length of stay (LOS), 30-day readmissions/emergency department (ED) visits, and 30-day mortality. RESULTS 30,259 patients were identified. DCs were performed within 3-4 days (n = 19,845, 65.6%), 5-6 days (n = 6432, 21.3%), and ≥ 7 days (n = 3982, 13.2%). There was a stepwise deterioration in outcomes with increased delay to surgery (Fig. 1). When comparing 3-4 and ≥ 7 days, overall complications (OR = 0.418, 95% CI: 0.387-0.452), 30-day readmissions (OR = 0.609, 95% CI: 0.549-0.674), 30-day ED visits (OR = 0.697, 95% CI: 0.637-0.763), 30-day mortality (OR = 0.601, 95% CI: 0.400-0.904), and LOS (OR = 0.729, 95% CI: 0.710-0.748) were lower in the 3-4 day cohort. CONCLUSIONS DC within 3-4 days is associated with fewer complications, readmissions and ED visits, and reduced LOS compared to DC at 5-6 or ≥ 7 days after presentation. In addition, 30-day mortality was also significantly different comparing 3-4 with ≥ 7-day cohorts. These data are important for guiding patients in the consent process and may point to choosing an earlier interval cholecystectomy for high-risk patients.
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Affiliation(s)
- Nina Devas
- Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Andrew Guenthart
- Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA.
| | - Lizhou Nie
- Department of Biostatistics, Stony Brook School of Medicine, Stony Brook, USA
| | - Isha Joshi
- Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Jie Yang
- Department of Biostatistics, Stony Brook School of Medicine, Stony Brook, USA
| | | | - Aurora Pryor
- Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA
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Altieri MS, Pryor A, Torres MB, Miller ME, Möller MG, Diego EJ, Reyna C. Support of pregnancy and parental leave for trainees and practicing surgeons. Am J Surg 2022; 224:1501-1503. [PMID: 35987658 DOI: 10.1016/j.amjsurg.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Aurora Pryor
- Department of General Surgery, SUNY Stony Brook, Stony Brook, NY, USA
| | - Madeline B Torres
- Department of General Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Megan E Miller
- Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reverse University School of Medicine, Cleveland, OH, USA
| | - Mecker G Möller
- Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Emilia J Diego
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Chantal Reyna
- Department of Surgery Crozer Health System, Drexel Hill, PA, USA
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9
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Ozair A, Collings A, Adams AM, Dirks R, Kushner BS, Sucandy I, Morrell D, Abou-Setta AM, Vreeland T, Whiteside J, Cloyd JM, Ansari MT, Cleary SP, Ceppa E, Richardson W, Alseidi A, Awad Z, Ayloo S, Buell JF, Orthopoulos G, Sbayi S, Wakabayashi G, Slater BJ, Pryor A, Jeyarajah DR. Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis. Surg Endosc 2022; 36:7915-7937. [PMID: 36138246 DOI: 10.1007/s00464-022-09612-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/05/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND While surgical resection has a demonstrated utility for patients with colorectal liver metastases (CRLM), it is unclear whether minimally invasive surgery (MIS) or an open approach should be used. This review sought to assess the efficacy and safety of MIS versus open hepatectomy for isolated, resectable CRLM when performed separately from (Key Question (KQ) 1) or simultaneously with (KQ2) the resection of the primary tumor. METHODS PubMed, Embase, Google Scholar, Cochrane CENTRAL, International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov databases were searched to identify both randomized controlled trials (RCTs) and non-randomized comparative studies published during January 2000-September 2020. Two independent reviewers screened literature for eligibility, extracted data from included studies, and assessed internal validity using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed using risk ratios (RR) and mean differences (MD). RESULTS From 2304 publications, 35 studies were included for meta-analysis. For staged resections, three RCTs and 20 observational studies were included. Data from RCTs indicated MIS having similar disease-free survival (DFS) at 1-year (RR 1.03, 95%CI 0.70-1.50), overall survival (OS) at 5-years (RR 1.04, 95%CI 0.84-1.28), fewer complications of Clavien-Dindo Grade III (RR 0.62, 95%CI 0.38-1.00), and shorter hospital length of stay (LOS) (MD -6.6 days, 95%CI -10.2, -3.0). For simultaneous resections, 12 observational studies were included. There was no evidence of a difference between MIS and the open group for DFS-1-year, OS-5-year, complications, R0 resections, blood transfusions, along with lower blood loss (MD -177.35 mL, 95%CI -273.17, -81.53) and shorter LOS (MD -3.0 days, 95%CI -3.82, -2.17). CONCLUSIONS Current evidence regarding the optimal approach for CRLM resection demonstrates similar oncologic outcomes between MIS and open techniques, however MIS hepatectomy had a shorter LOS, lower blood loss and complication rate, for both staged and simultaneous resections.
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Affiliation(s)
- Ahmad Ozair
- Faculty of Medicine, King George's Medical University, Uttar Pradesh, Lucknow, India
| | - Amelia Collings
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Bradley S Kushner
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA
| | - David Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Timothy Vreeland
- Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA
| | - Jake Whiteside
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eugene Ceppa
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | | | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Subhashini Ayloo
- Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Joseph F Buell
- Division of Surgery, Mission Healthcare System, HCA Healthcare, Asheville, NC, USA
| | - Georgios Orthopoulos
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Samer Sbayi
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, New York, NY, USA
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Department of Surgery, Ageo Central General Hospital, Ageo City, Japan
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - D Rohan Jeyarajah
- Department of Surgery, TCU School of Medicine, and Methodist Richardson Medical Center, 2805 East President George Bush Highway, Fort Worth, TX, USA.
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10
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Drakos P, Volteas P, Seeras K, Humayon S, Flink B, Yang J, Zhu C, Spaniolas K, Talamini M, Pryor A. S157-a structured early intervention program in patients with predicted poor long-term outcome following bariatric surgery: a prospective randomized study. Surg Endosc 2022; 36:6903-6914. [PMID: 35075525 DOI: 10.1007/s00464-022-09029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early postoperative weight loss can be predictive of one-year outcomes. It is unclear if poor performers identified in the first post-operative month can have improvement in outcomes with additional support and education. PURPOSE To evaluate the impact of a structured targeted support program for patients with lower-than-average early post-operative weight loss on 1-year outcomes. METHODS This was a prospective randomized study of bariatric surgery patients who experienced less than 50th percentile excess body weight loss (%EWL) at 3 weeks. Subjects with EWL < 18% were randomized into two groups: an intervention (IV) arm or a control (NI, no intervention) arm. The IV arm was offered a program with 7-weekly behavioral support sessions, while the NI patients received routine post-operative care. RESULTS A total of 128 patients were randomized: 65 NI and 63 IV. In the IV group, 20 attended all sessions, 7 attended < 4, and 36 did not participate. There was no difference in baseline demographics, procedure type, or BMI. At 1 year, there was no difference in %EWL (ratio 0.993, 95% CI 0.873, 1.131), %EBMIL (ratio 0.997, 95% CI 0.875, 1.137), and %TWL (ratio 1.016, 95% CI 0.901, 1.146) between groups. A subgroup analysis including only the subjects who participated in all seven sessions showed similar results. CONCLUSION Patients who present with suboptimal weight loss early after bariatric surgery do not experience a significant weight loss improvement with a structured behavioral support program. Importantly, despite being alerted to their poor early weight loss, patients demonstrated poor adherence to the proposed interventions.
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Affiliation(s)
- Panagiotis Drakos
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA.
| | - Panagiotis Volteas
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
| | - Kevin Seeras
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Shabana Humayon
- Department of Biostatistics, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Benjamin Flink
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Jie Yang
- Division of Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Chencan Zhu
- Department of Biostatistics, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Konstantinos Spaniolas
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Mark Talamini
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
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11
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Campbell J, Pryor A, Docimo S. Transcystic Choledochoscopy Utilizing a Disposable Choledochoscope: How We Do It. Surg Laparosc Endosc Percutan Tech 2022; 32:616-620. [PMID: 35960694 DOI: 10.1097/sle.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Biliary disease is common occurrence and can make up a large portion of the practice of a general surgeon. Choledocholithasis is a common entity amongst those with biliary disease. Although modern trends favor endoscopic retrograde cholangiopancreatography (ERCP) and other imaging modalities for the diagnosis and management of choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is likely underutilized. METHODS A literature summary utilizing a PUBMED search was performed to provide an up-to-date account regarding the latest data on LCBDE. A video identifying and explaining the critical components of a LBCDE procedure is provided. RESULTS LCBDE is an underutilized procedure which offers equivalent clinical outcomes compared with ERCP along with a shorter length of stay and reduced costs. LCBDE is also noted to be an effective option for common bile duct stones in the setting of altered anatomy, such as a Roux-en-Y gastric bypass. CONCLUSION Although modern trends favor ERCP and other imaging modalities for the diagnosis and management of choledocholithiasis, LCBDE is likely underutilized by surgeons. LCBDE can provide many benefits to patients including avoidance of additional procedures, shorter length of stay, higher success rates, and less costs. Out video should act is a guide for those surgeons interested in implementation LCBDE in their practice.
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Affiliation(s)
- John Campbell
- General Surgery Resident, Stony Brook Medicine, Stony Brook, NY
| | - Aurora Pryor
- Surgery, Chief Bariatric, Foregut and Advanced GI Surgery, Vice Chair for Clinical Affairs, Stony Brook University
| | - Salvatore Docimo
- Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL
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12
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Docimo S, Seeras K, Acho R, Pryor A, Spaniolas K. Academic and community hernia center websites in the United States fail to meet healthcare literacy standards of readability. Hernia 2022; 26:779-786. [PMID: 35344107 DOI: 10.1007/s10029-022-02584-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health literacy is considered the single best predictor of health status. Organizations including the American Medical Association (AMA) and the National Institutes of Health (NIH) have recommended that the readability of patient education materials not exceed the sixth-grade level. Our study focuses on the readability of self-designated hernia centers websites at both academic and community organizations across the United States to determine their ability to dispense patient information at an appropriate reading level. METHODS A search was conducted utilizing the Google search engine. The key words "Hernia Center" and "University Hernia Center" were used to identify links to surgical programs within the United States. The following readability tests were conducted via the program: Flesch-Kincaid Grade Level (FKGL), Gunning Fox Index (GFI), Coleman-Liau Index (CLI), Simple Measure of Gobbledygook (SMOG), and Flesch Reading Ease (FRE) score. RESULTS Of 96 websites, zero (0%) had fulfilled the recommended reading level in all four tests. The mean test scores for all non-academic centers (n = 50) were as follows: FKGL (11.14 ± 2.68), GFI (14.39 ± 3.07), CLI (9.29 ± 2.48) and SMOG (13.38 ± 2.03). The mean test scores [SK1] for all academic programs (n = 46) were as follows: FKGL (11.7 ± 2.66), GFI (15.01 ± 2.99), CLI (9.34 ± 1.91) and SMOG (13.71 ± 2.02). A one-sample t test was performed to compare the FKGL, GFI, CLI, and SMOG scores for each hernia center to a value of 6.9 (6.9 or less is considered an acceptable reading level) and a p value of 0.001 for all four tests were noted demonstrating statistical significance. The Academic and Community readability scores for both groups were compared to each other with a two-sample t test with a p value of > 0.05 for all four tests and there were no statistically significant differences. CONCLUSION Neither Academic nor Community hernia centers met the appropriate reading level of sixth-grade or less. Steps moving forward to improve patient comprehension and/or involving with their care should include appropriate reading level material, identification of a patient with a low literacy level with intervention or additional counseling when appropriate, and the addition of adjunct learning materials such as videos.
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Affiliation(s)
- S Docimo
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Renaissance School, Medicine at Stony Brook University, Stony Brook, NY, USA.
| | - K Seeras
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Renaissance School, Medicine at Stony Brook University, Stony Brook, NY, USA
| | - R Acho
- Henry Ford Macomb, Detroit, MI, USA
| | - A Pryor
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Renaissance School, Medicine at Stony Brook University, Stony Brook, NY, USA
| | - K Spaniolas
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Renaissance School, Medicine at Stony Brook University, Stony Brook, NY, USA
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13
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Park J, Pryor A. Adolescent metabolic and bariatric surgery: what does the data show? Ann Laparosc Endosc Surg 2022. [DOI: 10.21037/ales-22-55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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14
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Drakos P, Volteas P, Cleri NA, Alkadaa LN, Asencio AA, Oganov A, Pryor A, Talamini M, Rubano J, Bannazadeh M, Mikell CB, Spaniolas K, Mofakham S. Acute Gastrointestinal Injury and Feeding Intolerance as Prognostic Factors in Critically Ill COVID-19 Patients. J Gastrointest Surg 2022; 26:181-190. [PMID: 33905039 PMCID: PMC8077860 DOI: 10.1007/s11605-021-05015-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/12/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although acute gastrointestinal injury (AGI) and feeding intolerance (FI) are known independent determinants of worse outcomes and high mortality in intensive care unit (ICU) patients, the incidence of AGI and FI in critically ill COVID-19 patients and their prognostic importance have not been thoroughly studied. METHODS We reviewed 218 intubated patients at Stony Brook University Hospital and stratified them into three groups based on AGI severity, according to data collected in the first 10 days of ICU course. We used chi-square test to compare categorical variables such as age and sex and two-sample t-test or Mann-Whitney U-tests for continuous variables, including important laboratory values. Cox proportional hazards regression models were utilized to determine whether AGI score was an independent predictor of survival, and multivariable analysis was performed to compare risk factors that were deemed significant in the univariable analysis. We performed Kaplan-Meier survival analysis based on the AGI score and the presence of FI. RESULTS The overall incidence of AGI was 95% (45% AGI I/II, 50% AGI III/IV), and FI incidence was 63%. Patients with AGI III/IV were more likely to have prolonged mechanical ventilation (22 days vs 16 days, P-value <0.002) and higher mortality rate (58% vs 28%, P-value <0.001) compared to patients with AGI 0/I/II. This was confirmed with multivariable analysis which showed that AGI score III/IV was an independent predictor of higher mortality (AGI III/IV vs AGI 0/I/II hazard ratio (HR), 2.68; 95% confidence interval (CI), 1.69-4.25; P-value <0.0001). Kaplan-Meier survival analysis showed that both AGI III/IV and FI (P-value <0.001) were associated with worse outcomes. Patients with AGI III/IV had higher daily and mean D-dimer and CRP levels compared to AGI 0/I/II (P-value <0.0001). CONCLUSIONS The prevalence of AGI and FI among critically ill COVID-19 patients was high. AGI grades III/IV were associated with higher risk for prolonged mechanical ventilation and mortality compared to AGI 0/I/II, while it also correlated with higher D-dimer and C-reactive protein (CRP) levels. FI was independently associated with higher mortality. The development of high-grade AGI and FI during the first days of ICU stay can serve as prognostic tools to predict outcomes in critically ill COVID-19 patients.
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Affiliation(s)
- Panagiotis Drakos
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
| | - Panagiotis Volteas
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
| | - Nathaniel A Cleri
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Leor N Alkadaa
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Anthony A Asencio
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Anthony Oganov
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Aurora Pryor
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Mark Talamini
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
| | - Jerry Rubano
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
| | - Mohsen Bannazadeh
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA
- Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Charles B Mikell
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Konstantinos Spaniolas
- Department of Surgery, Renaissance School of Medicine, HSC T-12, Room 064, Stony Brook, NY, 11794, USA.
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA.
| | - Sima Mofakham
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA.
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15
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Drakos P, Volteas P, Naeem Z, Asencio AA, Cleri NA, Alkadaa LN, Oganov A, Gammel T, Saadon JR, Bannazadeh M, Tassiopoulos AK, Mikell CB, Rubano J, Pryor A, Spaniolas K, Mofakham S. Aggressive Anticoagulation May Decrease Mortality in Obese Critically Ill COVID-19 Patients. Obes Surg 2021; 32:391-397. [PMID: 34816357 PMCID: PMC8610786 DOI: 10.1007/s11695-021-05799-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 01/02/2023]
Abstract
Background Obesity is a widely accepted risk factor for the development of severe COVID-19. We sought to determine the survival benefit of early initiation of aggressive anticoagulation in obese critically ill COVID-19 patients. Methods We retrospectively reviewed 237 intubated patients at a single academic accredited bariatric center and stratified them based on their BMI into 2 groups, obese (BMI > 30) and non-obese (BMI ≤ 30). We used chi-square tests to compare categorical variables such as age and sex, and two-sample t-tests or Mann Whitney U-tests for continuous variables, including important laboratory values. Cox proportional-hazards regression models were utilized to determine whether obesity was an independent predictor of survival and multivariable analysis was performed to compare risk factors that were deemed significant in the univariable analysis. Survival with respect to BMI and its association with level of anticoagulation in the obese cohort was evaluated using Kaplan–Meier models. Results The overall mortality in the obese and non-obese groups was similar at 47% and 44%, respectively (p = 0.65). Further analysis based on the level of AC showed that obese patients placed on early aggressive AC protocol had improved survival compared to obese patients who did not receive protocol based aggressive AC (ON-aggressive AC protocol 26% versus OFF-aggressive AC protocol 61%, p = 0.0004). Conclusions The implementation of early aggressive anticoagulation may balance the negative effects of obesity on the overall mortality in critically ill COVID-19 patients. Graphical abstract ![]()
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Affiliation(s)
- Panagiotis Drakos
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Panagiotis Volteas
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Zaina Naeem
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Anthony A Asencio
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Nathaniel A Cleri
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Leor N Alkadaa
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Anthony Oganov
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Theresa Gammel
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Jordan R Saadon
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Mohsen Bannazadeh
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA.,Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Apostolos K Tassiopoulos
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA.,Division of Vascular Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Charles B Mikell
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Jerry Rubano
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Aurora Pryor
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA.,Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Konstantinos Spaniolas
- Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA. .,Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA. .,Department of Neurosurgery and Department of Surgery, Health Sciences Center T12-064, Stony Brook, NY, 11794, USA.
| | - Sima Mofakham
- Department of Neurosurgery, Renaissance School of Medicine, Stony Brook, NY, USA. .,Department of Neurosurgery and Department of Surgery, Health Sciences Center T12-064, Stony Brook, NY, 11794, USA.
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16
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Wolbrom DH, Brunt LM, Lidor A, Jeyarajah DR, Mattar SG, Pryor A. Gender disparities in gastrointestinal surgery fellowship programs. Surg Endosc 2021; 36:3805-3810. [PMID: 34459975 DOI: 10.1007/s00464-021-08697-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gender disparities in surgical leadership have come under increased scrutiny, and in order to better understand why these disparities exist, it is important to study the disparities across surgical fellowship programs. METHODS Data derived from the Fellowship Council (FC) database for fellows completing training from academic years 2015-2019 were analyzed. Available information included institution, fellowship type, program director (PD), associate program director (APD), faculty, and fellow names for all FC Fellowships. Faculty and fellow gender were determined from personal knowledge or publicly available online biographical information. RESULTS A total of 1023 fellows and 221 programs were analyzed. The advanced gastrointestinal (GI)/minimally invasive surgery (MIS) fellowship programs included 321 fellows, with a small increase in the percentage of female fellows from 28 to 31% over 5 years. Advanced GI/MIS/bariatric fellowship programs had a total of 262 fellows, also with a small increase in the percent of female fellows, from 29 to 38% in the study period. The gender of program directors, assistant program directors, and faculty for the fellowship programs studied were analyzed as well. Of the 221 programs in the Fellowship Council data, 13.6% of program directors, 18.3% of associate program directors, and 19.9% of faculty were female. Advanced GI/MIS fellowship programs had the lowest percentage of female PDs, with only 9.3% of the program directors being female. Colorectal surgery fellowships had the highest percentage of female PDs, with 33% being female. CONCLUSIONS In conclusion, women are underrepresented in gastrointestinal surgery fellowships among both trainees and educators. It is likely that a significant contributing factor to this underrepresentation of female fellows is the underrepresentation of female program directors and faculty; although neither our study nor any previously published study has proven that statistically.
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Affiliation(s)
- Daniel H Wolbrom
- Department of Surgery, Stony Brook University School of Medicine, 101 Nicolls Road, Stony Brook, NY, 11794, USA.
| | - L Michael Brunt
- Washington University School of Medicine, St. Louis, MO, USA
| | - Anne Lidor
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Samer G Mattar
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook University School of Medicine, 101 Nicolls Road, Stony Brook, NY, 11794, USA
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17
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Rogers AT, Dirks R, Burt HA, Haggerty S, Kohn GP, Slater BJ, Walsh D, Stefanidis D, Pryor A. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines development: standard operating procedure. Surg Endosc 2021; 35:2417-2427. [PMID: 33871718 DOI: 10.1007/s00464-021-08469-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/25/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The mission of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is to innovate, educate, and collaborate to improve patient care. A critical element in meeting this mission is the publishing of trustworthy and current guidelines for the practicing surgeon. METHODS In this manuscript, we outline the steps of developing high quality practice guidelines using a completely volunteer-based professional organization. RESULTS SAGES has developed a standardized approach to train volunteer surgeons and trainees alike to develop clinically pertinent guidelines in a timely manner, without sacrificing quality. CONCLUSIONS This methodology can be used more widely by volunteer organizations to efficiently develop effective tools for practicing physicians.
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Affiliation(s)
- Amelia T Rogers
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
- , 1319 Rufer Ave, Louisville, KY, 40204, USA.
| | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Holly Ann Burt
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Los Angeles, USA
| | | | - Geoffrey P Kohn
- Department of Surgery, Monash University, Eastern Health Clinical School, Melbourne, VIC, Australia
- Melbourne Upper GI Surgical Group, Melbourne, VIC, Australia
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, USA
| | - Danielle Walsh
- Department of Surgery, East Carolina University, Greenville, USA
| | | | - Aurora Pryor
- Department of Surgery, Stony Brook University, Stony Brook, USA
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McKinley SK, Dirks RC, Walsh D, Hollands C, Arthur LE, Rodriguez N, Jhang J, Abou-Setta A, Pryor A, Stefanidis D, Slater BJ. Surgical treatment of GERD: systematic review and meta-analysis. Surg Endosc 2021; 35:4095-4123. [PMID: 33651167 DOI: 10.1007/s00464-021-08358-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) has a high worldwide prevalence in adults and children. There is uncertainty regarding medical versus surgical therapy and different surgical techniques. This review assessed outcomes of antireflux surgery versus medical management of GERD in adults and children, robotic versus laparoscopic fundoplication, complete versus partial fundoplication, and minimal versus maximal dissection in pediatric patients. METHODS PubMed, Embase, and Cochrane databases were searched (2004-2019) to identify randomized control and non-randomized comparative studies. Two independent reviewers screened for eligibility. Random effects meta-analysis was performed on comparative data. Study quality was assessed using the Cochrane Risk of Bias and Newcastle Ottawa Scale. RESULTS From 1473 records, 105 studies were included. Most had high or uncertain risk of bias. Analysis demonstrated that anti-reflux surgery was associated with superior short-term quality of life compared to PPI (Std mean difference = - 0.51, 95%CI - 0.63, - 0.40, I2 = 0%) however short-term symptom control was not significantly superior (RR = 0.75, 95%CI 0.47, 1.21, I2 = 82%). A proportion of patients undergoing operative treatment continue PPI treatment (28%). Robotic and laparoscopic fundoplication outcomes were similar. Compared to total fundoplication, partial fundoplication was associated with higher rates of prolonged PPI usage (RR = 2.06, 95%CI 1.08, 3.94, I2 = 45%). There was no statistically significant difference for long-term symptom control (RR = 0.94, 95%CI 0.85, 1.04, I2 = 53%) or long-term dysphagia (RR = 0.73, 95%CI 0.52, 1.02, I2 = 0%). Ien, minimal dissection during fundoplication was associated with lower reoperation rates than maximal dissection (RR = 0.21, 95%CI 0.06, 0.67). CONCLUSIONS The available evidence regarding the optimal treatment of GERD often suffers from high risk of bias. Additional high-quality randomized control trials may further inform surgical decision making in the treatment of GERD.
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Affiliation(s)
| | - Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Danielle Walsh
- Walsh - Department of Surgery, East Carolina University, Greenville, USA
| | - Celeste Hollands
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Lauren E Arthur
- Walsh - Department of Surgery, East Carolina University, Greenville, USA
| | - Noe Rodriguez
- Department of Surgery, Florida Atlantic University, Boca Raton, USA
| | - Joyce Jhang
- University of Nebraska Medical Center, Omaha, USA
| | - Ahmed Abou-Setta
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Aurora Pryor
- Department of Surgery, Stony Brook University, Stony Brook, USA
| | | | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, 5841 S. Maryland Avenue, MC 4062, Chicago, IL, 606037, USA.
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Dirks RC, Kohn GP, Slater B, Whiteside J, Rodriguez NA, Docimo S, Pryor A, Stefanidis D. Is peroral endoscopic myotomy (POEM) more effective than pneumatic dilation and Heller myotomy? A systematic review and meta-analysis. Surg Endosc 2021; 35:1949-1962. [PMID: 33655443 DOI: 10.1007/s00464-021-08353-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Achalasia is a rare, chronic, and morbid condition with evolving treatment. Peroral endoscopic myotomy (POEM) has gained considerable popularity, but its comparative effectiveness is uncertain. We aim to evaluate the literature comparing POEM to Heller myotomy (HM) and pneumatic dilation (PD) for the treatment of achalasia. METHODS We conducted a systematic review of comparative studies between POEM and HM or PD. A priori outcomes pertained to efficacy, perioperative metrics, and safety. Internal validity of observational studies and randomized trials (RCTs) was judged using the Newcastle Ottawa Scale and the Cochrane Risk of Bias 2.0 tool, respectively. RESULTS From 1379 unique literature citations, we included 28 studies comparing POEM and HM (n = 21) or PD (n = 8), with only 1 RCT addressing each. Aside from two 4-year observational studies, POEM follow-up averaged ≤ 2 years. While POEM had similar efficacy to HM, POEM treated dysphagia better than PD both in an RCT (treatment "success" RR 1.71, 95% CI 1.34-2.17; 126 patients) and in observational studies (Eckardt score MD - 0.43, 95% CI - 0.71 to - 0.16; 5 studies; I2 21%; 405 patients). POEM needed reintervention less than PD in an RCT (RR 0.19, 95% CI 0.08-0.47; 126 patients) and HM in an observational study (RR 0.33, 95% CI 0.16, 0.68; 98 patients). Though 6-12 months patient-reported reflux was worse than PD in 3 observational studies (RR 2.67, 95% CI 1.02-7.00; I2 0%; 164 patients), post-intervention reflux was inconsistently measured and not statistically different in measures ≥ 1 year. POEM had similar safety outcomes to both HM and PD, including treatment-related serious adverse events. CONCLUSIONS POEM has similar outcomes to HM and greater efficacy than PD. Reflux remains a critical outcome with unknown long-term clinical significance due to insufficient data and inconsistent reporting.
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Affiliation(s)
- Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 125, Indianapolis, IN, 46202, USA.
| | - Geoffrey P Kohn
- Department of Surgery, Monash University Eastern Health Clinical School, Melbourne, VIC, Australia
| | - Bethany Slater
- Division of Pediatric Surgery, University of Chicago, Chicago, IL, USA
| | - Jake Whiteside
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 125, Indianapolis, IN, 46202, USA
| | - Noe A Rodriguez
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Salvatore Docimo
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 125, Indianapolis, IN, 46202, USA
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Docimo S, Yang J, Zhang X, Pryor A, Spaniolas K. One anastomosis gastric bypass versus Roux-en-Y gastric bypass: a 30-day follow-up review. Surg Endosc 2021; 36:498-503. [PMID: 33591446 DOI: 10.1007/s00464-021-08309-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/09/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) type procedures have been widely adopted outside the United States. International experience of OAGB commonly suggests improved early postoperative safety with OAGB over Roux-en-Y gastric bypass (RYGB). This study aims to report on the early experience with OAGB in Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) accredited centers, and compare with RYGB in terms of complication rates. METHODS The MBSAQIP public use files from 2015 to 2018 were used to identify adult patients who underwent primary OAGB and RYGB. Propensity score analysis was used to estimate the marginal population-average differences between OAGB and RYGB patients. Based on the matched samples, McNemar's tests and Wilcoxon signed rank test were carried out for binary and continuous outcomes. P-value < 0.05 was considered statistically significant. RESULTS Propensity score matching analysis resulted in 279 matched pairs for OAGB and RYGB. Twelve OAGB patients (4.3%) experienced a complication; 3 of them (1.1%) were diagnosed with anastomotic leaks. Compared to 14 (5%) of RYGB patients experiencing a complication; 5 (1.8%) were diagnosed with anastomotic leaks. Reintervention, reoperation and readmission rates for OAGB were 2.5%, 3.2% and 5%, compared to 1.8%, 1.8%, and 3.2% for RYGB. DISCUSSION Our study supports previous data that suggests OAGB has a similar early safety profile compared to RYGB and perioperative risks of OAGB should not be of a concern regarding its adoption. Conversely, OAGB does not seem to be associated with an improved safety profile over RYGB.
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Affiliation(s)
- Salvatore Docimo
- Department of Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
| | - Jie Yang
- Department of Family, Population & Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Xiaoyue Zhang
- Department of Family, Population & Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Aurora Pryor
- Department of Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Konstantinos Spaniolas
- Department of Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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Dirks RC, Walsh D, Haggerty S, Kohn GP, Pryor A, Stefanidis D. SAGES guidelines: an appraisal of their quality and value by SAGES members. Surg Endosc 2021; 35:1493-1499. [PMID: 33528662 DOI: 10.1007/s00464-021-08323-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/11/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines Committee develops evidence-based guidelines for practicing surgeons using standard methodology. Our objective was to survey the SAGES membership regarding guidelines' quality, use, and value and identify topics of interest for new guideline development. METHODS An anonymous online survey was emailed in October 2019 to SAGES members. Respondents were asked 18 questions on their use and evaluation of SAGES guidelines and SAGES reviews and to provide suggestions for new guideline topics and areas of improvement. The survey was open for 6 weeks with a 3-week reminder. RESULTS Of 548 responders, most were minimally invasive (41%) or general surgeons (33%). There was an even distribution between academic (46%) and non-academic practice (24% private practice, 23% hospital employed). Most used SAGES guidelines frequently (22%) or occasionally (68%) and found them to be of value (83%), above average quality (86%), and easy to use (74%). While most stated it was important (35%) or very important (58%) that SAGES continues to follow "rigorous guidelines development processes," common suggestions were for more timely updates and improved web access. Of 442 overlapping topic suggestions, 60% fell into overarching categories of hernia, bariatric, robotic, HPB, and colorectal surgery. CONCLUSIONS The SAGES guidelines are used frequently and valued by its users for their quality and content. Topics proposed by SAGES members and valuable insight from this survey can guide creation of new guidelines and refinement of established guidelines and processes.
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Affiliation(s)
- Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Danielle Walsh
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, NC, USA
| | - Stephen Haggerty
- Division of Gastrointestinal and General Surgery, NorthShore University Healthsystem, Evanston, IL, USA
| | - Geoffrey P Kohn
- Department of Surgery, Monash University, Melbourne, VIC, Australia
| | - Aurora Pryor
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA. .,, 11725 North Illinois Street, Suite 350, Carmel, IN, 46032, USA.
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22
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Altieri MS, Yang J, Zhang X, Zhu C, Madani A, Castillo J, Talamini M, Pryor A. Evaluating readmissions following laparoscopic cholecystectomy in the state of New York. Surg Endosc 2020; 35:4667-4672. [PMID: 32875412 DOI: 10.1007/s00464-020-07906-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Hospital readmissions constitute an important component of associated costs of a disease and can contribute a significant burden to healthcare. The majority of studies evaluating readmissions following laparoscopic cholecystectomy (LC) comprise of single center studies and thus can underestimate the actual incidence of readmission. We sought to examine the rate and causes of readmissions following LC using a large longitudinal database. METHODS The New York SPARCS database was used to identify all adult patients undergoing laparoscopic cholecystectomy for benign biliary disease between 2000 and 2016. Due to the presence of a unique identifier, patients with readmission to any New York hospital were evaluated. Planned versus unplanned readmission rates were compared. Following univariate analysis, multivariable logistic regression model was used to identify risk factors for unplanned readmissions after accounting for baseline characteristics, comorbidities and complications. RESULTS There were 591,627 patients who underwent LC during the studied time period. Overall 30-day readmission rate was 4.94% (n = 29,245) and unplanned 30-days readmission rate was 4.58% (n = 27,084). Female patients were less likely to have 30-day unplanned readmissions. Patients with age older than 65 or younger than 29 were more likely to have 30-day unplanned readmissions compared to patients with age 30-44 or 45-64. Insurance status was also significant, as patients with Medicaid/Medicare were more likely to have unplanned readmissions compared to commercial insurance. In addition, variables such as Black race, presence of any comorbidity, postoperative complication, and prolonged initial hospital length of stay were associated with subsequent readmission. CONCLUSION This data show that readmissions rates following LC are relatively low; however, majority of readmissions are unplanned. Most common reason for unplanned readmissions was associated with complications of the procedure or medical care. By identifying certain risk groups, unplanned readmissions may be prevented.
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Affiliation(s)
- Maria S Altieri
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA.
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Xiaoyue Zhang
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Chencan Zhu
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Amin Madani
- Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Jed Castillo
- Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Mark Talamini
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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Altieri MS, Thompson H, Pryor A, Yang J, Zhu C, Talamini M, Genua J. Incidence of colon resections is increasing in the younger populations: should an early initiation of colon cancer screening be implemented? Surg Endosc 2020; 35:3636-3641. [DOI: 10.1007/s00464-020-07842-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/24/2020] [Indexed: 12/18/2022]
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Goldberg I, Nie L, Yang J, Docimo S, Obici S, Talamini M, Pryor A, Spaniolas K. Impact of bariatric surgery on the development of diabetic microvascular and macrovascular complications. Surg Endosc 2020; 35:3923-3931. [DOI: 10.1007/s00464-020-07848-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/24/2020] [Indexed: 11/28/2022]
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Wady H, Restle D, Park J, Pryor A, Talamini M, Abdel-Misih S. The role of surgeons during the COVID-19 pandemic: impact on training and lessons learned from a surgical resident's perspective. Surg Endosc 2020; 35:3430-3436. [PMID: 32666253 PMCID: PMC7359425 DOI: 10.1007/s00464-020-07790-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/04/2020] [Indexed: 01/28/2023]
Abstract
Background Surgeons are trained as “internists that also operate,” bringing an important skillset to patient management during the current COVID-19 pandemic. A review was performed to illustrate the response of surgical staff during the pandemic with regard to patient care and residency training. Methods The evaluation and assessment of the changes enacted at Stony Brook Medicine’s Department of Surgery is illustrated through the unique perspective of surgical residents. No IRB approval or written consent was obtained nor it was necessary for the purposes of this paper. Results Hospital policy was enacted to hinder transmission of COVID-19 and included limited gatherings of people, restricted travel, quarantined symptomatic staff, and careful surveillance for disease incidence. Surgical residency transformed as residents were diverted from traditional surgical services to staff new COVID-19 ICUs. Education transitioned to an online-based platform for lectures and reviews. New skills sets were acquired such as PICC line placement and complex ventilator management. Conclusions The viral surge impacted surgical training while also providing unique lessons regarding preparedness and strategic planning for future pandemic and disaster management.
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Affiliation(s)
- Heitham Wady
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
| | - David Restle
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Juyeon Park
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Aurora Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Mark Talamini
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Sherif Abdel-Misih
- Division of Surgical Oncology, Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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Altieri MS, Carmichael H, Jones E, Robinson T, Pryor A, Madani A. Educational value of telementoring for a simulation-based fundamental use of surgical energy™ (FUSE) curriculum: a randomized controlled trial in surgical trainees. Surg Endosc 2020; 34:3650-3655. [DOI: 10.1007/s00464-020-07609-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
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Docimo S, Bates A, Alteri M, Talamini M, Pryor A, Spaniolas K. Evaluation of the use of component separation in elderly patients: results of a large cohort study with 30-day follow-up. Hernia 2020; 24:503-507. [PMID: 31894430 DOI: 10.1007/s10029-019-02069-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 10/11/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND The incidence of massive ventral hernias among the elderly will increase as the population ages. Advanced age is often viewed as a contraindication to elective hernia repair. A relationship between age and complications of component separation procedures for ventral hernias is not well established. This study evaluated the effect of age on the peri-operative safety of AWR. METHODS The 2005-2013 ACS-NSQIP participant use data were reviewed to compare surgical site infection (SSI), overall morbidity, and serious morbidity in non-emergent component separation procedures among all age groups. All patients were stratified into four age quartiles and evaluated. Baseline characteristics included age, body mass index (BMI) and ASA 3 or 4 criteria. Statistical analysis was performed using SPSS. Odds ratios (OR) and 95% confidence intervals were reported as appropriate. RESULTS 4485 patients were identified. Majority of the cases were clean (76.8%). Patients were divided into the following quartiles based on age. The older quartile had a mean age of 72.7 ± 4.87 years. There were baseline differences in BMI and chronic comorbidity severity (measured by incidence of ASA score of 3 or 4) between the age groups, with the oldest group having lower BMI but higher rate of ASA 3 or 4 (p < 0.0001 for both). The rate of postoperative SSI was significantly different between age quartile groups (ranging from 16.3% from the youngest group to 9.4% for the oldest group, p < 0.0001). After adjusting for other baseline differences, advanced age was independently associated with lower SSI rate (OR 0.55, 95% CI 0.41-0.73). There was no significant difference in overall morbidity (p = 0.277) and serious morbidity (p = 0.131) between groups. CONCLUSION AWR is being performed with safety across all age groups. In selected patients of advanced age, AWR can be performed with similar safety profile and low SSI rate.
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Affiliation(s)
- S Docimo
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA.
| | - A Bates
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA
| | - M Alteri
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA
| | - M Talamini
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA
| | - A Pryor
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA
| | - K Spaniolas
- Department of Surgery, Division of Bariatric, Foregut, and Advanced GI surgery, Stony Brook Medicine, HST T19 R053, Stony Brook, NY, 11794-8191, USA
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Hong J, Lu D, Humayon S, Heslin KP, Murphy PF, Lind MA, Docimo S, Sbayi S, Spaniolas K, Pryor A. Home Health and Discharge Planning Survey in Elective Surgery Patients. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Grocott M, Gan TJ, Shaw AD, Thacker JKM, Miller TE, Hedrick TL, McEvoy MD, Mythen MG, Bergamaschi R, Gupta R, Holubar SD, Senagore AJ, Abola RE, Bennett-Guerrero E, Kent ML, Feldman LS, Fiore JF. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway. Anesth Analg 2019; 126:1883-1895. [PMID: 29369092 DOI: 10.1213/ane.0000000000002743] [Citation(s) in RCA: 209] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.
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Affiliation(s)
- Paul E Wischmeyer
- From the Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | | | - David C Evans
- Department of Surgery, Division of Trauma, Critical Care, and Burn, Ohio State University, Columbus, Ohio
| | | | - Rosemary Kozar
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Aurora Pryor
- Department of Surgery, Stony Brook Medicine, Stony Brook, New York
| | - Robert H Thiele
- Departments of Anesthesiology and Biomedical Engineering, Divisions of Cardiac, Thoracic, and Critical Care Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sotiria Everett
- Nutrition Division, Department of Family, Population, Preventive Medicine, Stony Brook Medicine, Stony Brook, New York
| | - Mike Grocott
- Respiratory and Critical Care Research Area, National Institute of Health Research Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdom.,Southampton National Health Service Foundation Trust, Integrative Physiology and Critical Illness Group, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Morpheus Collaboration, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University School of Medicine, Stony Brook, New York
| | - Andrew D Shaw
- Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie K M Thacker
- Department of Surgery, Division of Advanced Oncologic and Gastrointestinal Surgery
| | - Timothy E Miller
- Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Durham, North Carolina
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Abola RE, Bennett-Guerrero E, Kent ML, Feldman LS, Fiore JF, Shaw AD, Thacker JKM, Gan TJ, Miller TE, Hedrick TL, McEvoy MD, Mythen MG, Bergamaschi R, Gupta R, Holubar SD, Senagore AJ, Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Grocott M. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway. Anesth Analg 2019; 126:1874-1882. [PMID: 29293180 DOI: 10.1213/ane.0000000000002758] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2-3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using the Quality of Recovery-15 score. After discharge at 30 and 90 days, we recommend the use of the World Health Organization Disability Assessment Scale 2.0, or a tailored use of the Patient-Reported Outcomes Measurement Information System. (4) Future study that consistently applies PROMs in an ERP will define the role these measures will have evaluating quality and guiding clinical care. Consensus guidelines regarding the incorporation of PRO measures in an ERP were created by the POQI workgroup. The inclusion of PROMs with traditional measures of health care quality after surgery provides an opportunity to improve clinical care.
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Affiliation(s)
- Ramon E Abola
- From the Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York
| | | | - Michael L Kent
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
| | - Liane S Feldman
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Julio F Fiore
- Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada
| | - Andrew D Shaw
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie K M Thacker
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Tong J Gan
- From the Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York
| | - Timothy E Miller
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina
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Pyke O, Yang J, Cohn T, Yin D, Docimo S, Talamini MA, Bates AT, Pryor A, Spaniolas K. Marginal ulcer continues to be a major source of morbidity over time following gastric bypass. Surg Endosc 2018; 33:3451-3456. [DOI: 10.1007/s00464-018-06618-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 12/04/2018] [Indexed: 11/30/2022]
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Altieri MS, Bevilacqua L, Yang J, Yin D, Docimo S, Spaniolas K, Talamini M, Pryor A. Cholecystectomy following percutaneous cholecystostomy tube placement leads to higher rate of CBD injuries. Surg Endosc 2018; 33:2686-2690. [PMID: 30478694 DOI: 10.1007/s00464-018-6559-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/19/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Percutaneous cholecystostomy tube (PCT) placement is often the management of severe acute cholecystitis in the unstable patient. PCT can be later reversed and cholecystectomy performed. The purpose of this study is to investigate the incidence of subsequent cholecystectomy and clinical factors associated with subsequent procedure. METHODS The SPARCS, an administrative database, was used to search all patients undergoing PCT placement between 2000 and 2012 in the state of New York. Using a unique identifier, all patients were followed for subsequent cholecystectomy procedures for at least 2 years. Patients were also followed up to 2014 for potential CBD injury during subsequent laparoscopic (LC) or open cholecystectomy (OC). Univariate and multivariable regression analysis were performed when appropriate. RESULTS There were 9738 patients identified who underwent PCT placements. The incidence of patients who had a PCT in 2000-2012, which subsequently underwent cholecystectomy increased from 25.0% in 2000 to 31.7% in 2012. In addition, patients undergoing subsequent LC increased from 11.8% in 2000 to 22.2% in 2012, while the incidence of OC decreased from 13.2% in 2000 to 9.5% in 2012. After accounting for other confounding factors, younger male patients, race as white compared to black, who didn't have any complications during PCT placement were more likely to undergo subsequent cholecystectomy (p < 0.05). Average time to LC was 122.0 days versus 159.6 days for OC (p < 0.0001). From the patients who underwent cholecystectomy following PCT, 47 patients experienced CBD injury (1.6%). CONCLUSIONS Incidence of cholecystectomy following PCT increased during the study period. Surgeons seem to be more comfortable performing LC as rate of LC increased from 11.8 to 22.2%. However, rate of CBD injury is higher during subsequent cholecystectomy compared to that of the general population. Caution should be used when performing subsequent cholecystectomy following PCT, as these procedures may be more technically challenging.
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Affiliation(s)
- Maria S Altieri
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA.
| | - Lisa Bevilacqua
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Donglei Yin
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Salvatore Docimo
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA
| | - Mark Talamini
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA
| | - Aurora Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA
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Bevilacqua LA, Obeid NR, Spaniolas K, Bates A, Docimo S, Pryor A. Early postoperative diet after bariatric surgery: impact on length of stay and 30-day events. Surg Endosc 2018; 33:2475-2478. [PMID: 30374793 DOI: 10.1007/s00464-018-6533-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 10/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pathways for enhanced recovery after surgery (ERAS) have been shown to improve length-of-stay (LOS) and post-operative complications across various surgical fields, however there is a lack of evidence-based studies in bariatric surgery. Specifically, the value of early feeding within an ERAS program in bariatric surgery is unclear. The objective of the current study was to determine the effect of early feeding on LOS for patients who underwent primary or revisional laparoscopic sleeve gastrectomy (LSG) and Roux-en-y gastric bypass (RYGB). METHODS Retrospective single institution study of implementation of a new diet protocol in which initiation of oral intake changed from post-operative day 1 to day 0. LOS and 30-day events were compared. Patients were excluded if they were planned for 23-h stay, had significant intra-operative complications, or required reoperation within the same admission. Mann-Whitney U tests were done to compare LOS and chi-squared tests to compare 30-day events pre- and post-intervention. RESULTS A total of 244 patients were included; 84.4% were primary cases. 50.8% of cases occurred prior to early feeding implementation. Median age was 43.5 years (IQR 33-53) and majority of patients were female (78.7%). Median LOS was 32.6 (IQR 30.0-50.6). Median LOS across the whole sample was shorter in the early feeding group (36.2 vs. 31.0 h; p < 0.001). This difference remained statistically significant for primary, but not revisional cases. Post-operative events at 30 days were similar between pre- and post-intervention groups. CONCLUSIONS Early feeding the day of surgery is associated with significantly shorter LOS for patients who undergo bariatric surgery with no difference in 30-day readmissions.
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Affiliation(s)
- Lisa A Bevilacqua
- Department of Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Nabeel R Obeid
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Andrew Bates
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Salvatore Docimo
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA.
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Sullivan S, Swain J, Woodman G, Edmundowicz S, Hassanein T, Shayani V, Fang JC, Noar M, Eid G, English WJ, Tariq N, Larsen M, Jonnalagadda SS, Riff DS, Ponce J, Early D, Volckmann E, Ibele AR, Spann MD, Krishnan K, Bucobo JC, Pryor A. Randomized sham-controlled trial of the 6-month swallowable gas-filled intragastric balloon system for weight loss. Surg Obes Relat Dis 2018; 14:1876-1889. [PMID: 30545596 DOI: 10.1016/j.soard.2018.09.486] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/14/2018] [Accepted: 09/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Obesity is a significant health problem and additional therapies are needed to improve obesity treatment. OBJECTIVE Determine the efficacy and safety of a 6-month swallowable gas-filled intragastric balloon system for weight loss. SETTING Fifteen academic and private practice centers in the United States. METHODS This was a double-blind, randomized sham-controlled trial of the swallowable gas-filled intragastric balloon system plus lifestyle therapy compared with lifestyle therapy alone for weight loss at 6 months in participants aged 22 to 60 years with body mass index 30 to 40 kg/m2, across 15 sites in the United States. The following endpoints were included: difference in percent total weight loss in treatment group versus control group was >2.1%, and a responder rate of >35% in the treatment group. RESULTS Three hundred eighty-seven patients swallowed at least 1 capsule. Of participants, 93.3% completed all 24 weeks of blinded study testing. Nonserious adverse events occurred in 91.1% of patients, but only .4% were severe. One bleeding ulcer and 1 balloon deflation occurred. In analysis of patients who completed treatment, the treatment and control groups achieved 7.1 ± 5.0% and 3.6 ± 5.1% total weight loss, respectively, and a mean difference of 3.5% (P = .0085). Total weight loss in treatment and control groups were 7.1 ± 5.3 and 3.6 ± 5.1 kg (P < .0001), and body mass index change in the treatment and control groups were 2.5 ± 1.8 and 1.3 ± 1.8 kg/m2 (P < .0001), respectively. The responder rate in the treatment group was 66.7% (P < .0001). Weight loss maintenance in the treatment group was 88.5% at 48 weeks. CONCLUSIONS Treatment with lifestyle therapy and the 6-month swallowable gas-filled intragastric balloon system was safe and resulted in twice as much weight loss compared with a sham control, with high weight loss maintenance at 48 weeks.
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Affiliation(s)
- Shelby Sullivan
- Washington University School of Medicine, St. Louis, Missouri; University of Colorado School of Medicine, Aurora, Colorado.
| | - James Swain
- HonorHealth Research Institute, Scottsdale, Arizona
| | | | - Steven Edmundowicz
- Washington University School of Medicine, St. Louis, Missouri; University of Colorado School of Medicine, Aurora, Colorado
| | | | - Vafa Shayani
- Bariatric Institute of Greater Chicago, Bolingbrook, Illinois
| | - John C Fang
- University of Utah Hospital, Salt Lake City, Utah
| | - Mark Noar
- Endoscopy Microsurgery Associates, Townson, Maryland
| | - George Eid
- Alleghany Singer Research at West Penn, Pittsburgh, Pennsylvania
| | | | - Nabil Tariq
- Houston Methodist Research Institute, Houston, Texas
| | | | | | | | - Jaime Ponce
- Chattanooga Bariatrics, Chattanooga, Tennessee
| | - Dayna Early
- Washington University School of Medicine, St. Louis, Missouri
| | | | - Anna R Ibele
- University of Utah Hospital, Salt Lake City, Utah
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Cairo SB, Majumdar I, Pryor A, Posner A, Harmon CM, Rothstein DH. Response to Letter to the Editor; Comments on "Challenges in Transition of Care for Pediatric Patients after Weight-Reduction Surgery: a Systematic Review and Recommendations for Comprehensive Care". Obes Surg 2018; 28:2914-2915. [PMID: 29909516 DOI: 10.1007/s11695-018-3329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.
| | - Indrajit Majumdar
- Division of Endocrinology/Diabetes, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.,Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA
| | - Aurora Pryor
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Alan Posner
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Division of Surgery, State University of New York, New York, NY, USA
| | - Carroll M Harmon
- Department of Pediatric Surgery, John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Division of Surgery, State University of New York, New York, NY, USA
| | - David H Rothstein
- Department of Pediatric Surgery, John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Division of Surgery, State University of New York, New York, NY, USA
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Altieri MS, Yang J, Xu J, Talamini M, Pryor A, Telem DA. Outcomes after Robotic Ventral Hernia Repair: A Study of 21,565 Patients in the State of New York. Am Surg 2018. [DOI: 10.1177/000313481808400639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The purpose of our study is to assess outcomes following robotic ventral hernia (RVH) repair. The New York Statewide Planning and Research Cooperative System administrative database was used to identify all patients undergoing laparoscopic ventral hernia (LVH) and RVH between 2010 and 2013. Outcome measures including complications, hospital length of stay (HLOS), 30-day readmissions, and 30-day emergency department (ED) visits were compared. Propensity score (PS) analysis was used to estimate the adjusted marginal differences between patients who underwent robotic-assisted and laparoscopic procedures. There were 20,896 LVH and 679 (3.2%) RVH repairs. Initial univariate analysis demonstrated that patients undergoing RVH had worse outcomes in terms of complications (20.18% vs 10.56%, P < 0.0001), longer HLOS (4.32 vs 2.19 days, P = 0.0023), higher rates in 30-day readmissions (9.28% vs 5.06%, P < 0.0001), and 30-day ED visits (14.43% vs 10.46%, P < 0.0001). Following PS analysis, which accounts for all patient associated variables, there was no difference found in 30-day readmission or 30-day ED visits between RVH and LVH (P = 0.2760 and 0.2043, respectively). Patients undergoing RVH had a significantly shorter HLOS (P < 0.0001) and lower rate of complications (P = 0.0134). Following PS analysis, this study demonstrates that RVH may be associated with shorter HLOS and lower complication rate. Further studies are necessary to compare laparoscopic and robotic approaches for ventral hernia.
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Affiliation(s)
- Maria S. Altieri
- Department of Surgery, Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Jie Yang
- Department of Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Jianjin Xu
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York
| | - Mark Talamini
- Department of Surgery, Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Aurora Pryor
- Department of Surgery, Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Dana A. Telem
- Department of Surgery, Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University Medical Center, Stony Brook, New York
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Altieri MS, Yang J, Xu J, Talamini M, Pryor A, Telem DA. Outcomes after Robotic Ventral Hernia Repair: A Study of 21,565 Patients in the State of New York. Am Surg 2018; 84:902-908. [PMID: 29981622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of our study is to assess outcomes following robotic ventral hernia (RVH) repair. The New York Statewide Planning and Research Cooperative System administrative database was used to identify all patients undergoing laparoscopic ventral hernia (LVH) and RVH between 2010 and 2013. Outcome measures including complications, hospital length of stay (HLOS), 30-day readmissions, and 30-day emergency department (ED) visits were compared. Propensity score (PS) analysis was used to estimate the adjusted marginal differences between patients who underwent robotic-assisted and laparoscopic procedures. There were 20,896 LVH and 679 (3.2%) RVH repairs. Initial univariate analysis demonstrated that patients undergoing RVH had worse outcomes in terms of complications (20.18% vs 10.56%, P < 0.0001), longer HLOS (4.32 vs 2.19 days, P = 0.0023), higher rates in 30-day readmissions (9.28% vs 5.06%, P < 0.0001), and 30-day ED visits (14.43% vs 10.46%, P < 0.0001). Following PS analysis, which accounts for all patient associated variables, there was no difference found in 30-day readmission or 30-day ED visits between RVH and LVH (P = 0.2760 and 0.2043, respectively). Patients undergoing RVH had a significantly shorter HLOS (P < 0.0001) and lower rate of complications (P = 0.0134). Following PS analysis, this study demonstrates that RVH may be associated with shorter HLOS and lower complication rate. Further studies are necessary to compare laparoscopic and robotic approaches for ventral hernia.
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Hedrick TL, McEvoy MD, Mythen M(MG, Bergamaschi R, Gupta R, Holubar SD, Senagore AJ, Gan TJ, Shaw AD, Thacker JKM, Miller TE, Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Grocott M, Abola RE, Bennett-Guerrero E, Kent ML, Feldman LS, Fiore JF. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery. Anesth Analg 2018; 126:1896-1907. [DOI: 10.1213/ane.0000000000002742] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Cohn T, Pryor A, Spaniolas K. Surgical Procedures for Patients With Severe Obesity. JAMA 2018; 319:2136-2137. [PMID: 29800169 DOI: 10.1001/jama.2018.4112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Tyler Cohn
- Stony Brook University, Stony Brook, New York
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Altieri MS, Pryor A, Bates A, Docimo S, Talamini M, Spaniolas K. Bariatric procedures in adolescents are safe in accredited centers. Surg Obes Relat Dis 2018; 14:1368-1372. [PMID: 29980465 DOI: 10.1016/j.soard.2018.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/15/2018] [Accepted: 04/10/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND With the rise of obesity in adolescents, there is an exponential increase in bariatric procedures in this patient population. OBJECTIVES The purpose of our study was to examine perioperative outcomes after bariatric surgery in this cohort. SETTING University hospital, involving a large database in New York State. METHODS The Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program public use file was queried to identify all adolescent patients (age <19 years) undergoing primary laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in 2015. We assessed 30-day postoperative complications. RESULTS We identified 1072 patients who underwent Roux-en-Y gastric bypass (n = 279) or SG (n = 793). The majority were Caucasian (n = 790) and female (n = 857) with mean body mass index and age of 47.9 ± 8.1 kg/m2 and 18.2 ± 1 years, respectively, preoperative hypertension, type 2 diabetes, and obstructive sleep apnea were present in 90 (8.4%), 139 (13%), and 165 (15.4%) of patients, respectively. There was significant difference in preoperative gastroesophageal reflux disease (18.6% versus 13.4%, P = .033), obstructive sleep apnea (19.7% versus 13.9%, P = .02), and body mass index (48.6 ± 7.9 versus 47.6 ± 8.2 kg/m2, P = .03) between patients undergoing Roux-en-Y gastric bypass and SG, respectively. Thirty-day reoperation, readmission, and reintervention were reported in 1.5%, 3.3%, and 1.6% of the adolescent cohort, respectively. Four patients (.4%) developed a staple line/anastomotic leak, and 1 patient (.09%) died within 30 days; 93.9% of all adolescent patients experienced an uneventful 30-day recovery. Uneventful recovery was significantly more likely for patients undergoing SG (95.3% versus 90%, P = .001; adjusted odds ratio 2.2, 95% confidence interval 1.31-3.69). CONCLUSION Perioperative safety of bariatric surgery in adolescents in accredited centers is safer than previously reported with low rate of 30-day events. SG is a safer procedure in this patient population.
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Affiliation(s)
- Maria S Altieri
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York.
| | - Aurora Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Andrew Bates
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Salvatore Docimo
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Mark Talamini
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
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Cairo SB, Majumdar I, Pryor A, Posner A, Harmon CM, Rothstein DH. Challenges in Transition of Care for Pediatric Patients after Weight-Reduction Surgery: a Systematic Review and Recommendations for Comprehensive Care. Obes Surg 2018; 28:1149-1174. [DOI: 10.1007/s11695-018-3138-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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Weis JJ, Goldblatt M, Pryor A, Dunkin BJ, Brunt LM, Jones DB, Scott DJ. SAGES's advanced GI/MIS fellowship curriculum pilot project. Surg Endosc 2018; 32:2613-2619. [PMID: 29344791 DOI: 10.1007/s00464-018-6020-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/03/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The American health care system faces deficits in quality and quantity of surgeons. SAGES is a major stakeholder in surgical fellowship training and is responsible for defining the curriculum for the Advanced GI/MIS fellowship. SAGES leadership is actively adapting this curriculum. METHODS The process of reform began in 2014 through a series of iterative meetings and discussions. A working group within the Resident and Fellow Training Committee reviewed case log data from 2012 to 2015. These data were used to propose new criteria designed to provide adequate exposure to core content. The working group also proposed using video assessment of an MIS case to provide objective assessment of competency. RESULTS Case log data were available for 326 fellows with a total of 85,154 cases logged (median 227 per fellow). The working group proposed new criteria starting with minimum case volumes for five defined categories including foregut (20), bariatrics (25), inguinal hernia (10), ventral hernia (10), and solid organ/colon/thoracic (10). Fellows are expected to perform an additional 75 complex MIS cases of any category for a total of 150 required cases overall. The proposal also included a minimum volume of flexible endoscopy (50) and submission of an MIS foregut case for video assessment. The new criteria more clearly defined which surgeon roles count for major credit within individual categories. Fourteen fellowships volunteered to pilot these new criteria for the 2017-2018 academic year. CONCLUSIONS The new SAGES Advanced GI/MIS fellowship has been crafted to better define the core content that should be contained in these fellowships, while still allowing sufficient heterogeneity so that individual learners can tailor their training to specific areas of interest. The criteria also introduce innovative, evidence-based methods for assessing competency. Pending the results of the pilot program, SAGES will consider broad implementation of the new fellowship criteria.
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Affiliation(s)
- Joshua J Weis
- University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX, 75390-9092, USA
| | | | - Aurora Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | | | - L Michael Brunt
- Washington University School of Medicine, St. Louis, MO, USA
| | | | - Daniel J Scott
- University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX, 75390-9092, USA.
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Altieri MS, Yang J, Nie L, Blackstone R, Spaniolas K, Pryor A. Rate of revisions or conversion after bariatric surgery over 10 years in the state of New York. Surg Obes Relat Dis 2017; 14:500-507. [PMID: 29496440 DOI: 10.1016/j.soard.2017.12.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND A primary measure of the success of a procedure is the whether or not additional surgery may be necessary. Multi-institutional studies regarding the need for reoperation after bariatric surgery are scarce. OBJECTIVES The purpose of this study is to evaluate the rate of revisions/conversions (RC) after 3 common bariatric procedures over 10 years in the state of New York. SETTING University Hospital, involving a large database in New York State. METHODS The Statewide Planning and Research Cooperative System database was used to identify all patients undergoing laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) between 2004 and 2010. Patients were followed for RC to other bariatric procedures for at least 4 years (up to 2014). Multivariable cox proportional hazard regression analysis was performed to identify risk factors for additional surgery after each common bariatric procedure. Multivariable logistic regression was used to check the factors associated with having ≥2 follow-up procedures. RESULTS There were 40,994 bariatric procedures with 16,444 LAGB, 22,769 RYGB, and 1781 SG. Rate of RC was 26.0% for LAGB, 9.8% for SG, and 4.9% for RYGB. Multiple RC ( = />2) were more common for LAGB (5.7% for LAGB, .5% for RYGB, and .2% for LSG). Band revision/replacements required further procedures compared with patients who underwent conversion to RYGB/SG (939 compared with 48 procedures). Majority of RC were not performed at initial institution (68.2% of LAGB patients, 75.9% for RYGB, 63.7% of SG). Risk factors for multiple procedures included surgery type, as LAGB was more likely to have multiple RC. CONCLUSIONS Reoperation was common for LAGB, but less common for RYGB (4.9%) and SG (9.8%). RC rate are almost twice after SG than after RYGB. LAGB had the highest rate (5.7%) of multiple reoperations. Conversion was the procedure of choice after a failed LAGB.
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Affiliation(s)
- Maria S Altieri
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York.
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Lizhou Nie
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York
| | - Robin Blackstone
- Department of Surgery, Banner-University Medical Center, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Aurora Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
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Altieri MS, Yang J, Groves D, Yin D, Cagino K, Talamini M, Pryor A. Academic status does not affect outcome following complex hepato-pancreato-biliary procedures. Surg Endosc 2017; 32:2355-2364. [DOI: 10.1007/s00464-017-5931-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 10/08/2017] [Indexed: 02/07/2023]
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Altieri MS, Yang J, Zhu C, Sbayi S, Spaniolas K, Talamini M, Pryor A. What happens to biliary colic patients in New York State? 10-year follow-up from emergency department visits. Surg Endosc 2017; 32:2058-2066. [PMID: 29063306 DOI: 10.1007/s00464-017-5902-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/17/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Biliary colic is a common diagnosis for patients presenting to the emergency department (ED). The purpose of this study is to examine the outcomes of patients coming to the ED with biliary colic. METHODS The NYS longitudinal SPARCS database was used to identify patients presenting to the ED with biliary colic from 2005 to 2014. Through the use of a unique identifier, patients were followed in NYS across multiple institutions. Patients who were lost to follow-up, with duplicated records, and those that underwent percutaneous cholecystectomy tubes were excluded from the analysis. RESULTS Between 2005 and 2014, there were 72,376 patients who presented to an ED with biliary colic. The admission rate was 20.7-26.02%. Overall, most patients who presented to the ED did not undergo surgery (39,567, 54.7%), of which 35,204 (89%) had only one ED visit, while 4,363(11%) returned to the ED (≥ 2 visits). Only 3.23-5.51% of patients underwent cholecystectomy at the time of initial presentation. Most subsequent cholecystectomies were performed electively (27.38-52.51%) (See Table 1 in this article). Average time to surgery among patients with elective cholecystectomy was 178.4 days. From the patients who underwent cholecystectomy, 10.35% had cholecystectomy at their first ED visit, 77.7% had cholecystectomy following the first ED visit, and 12% had multiple ED visits prior to surgery. Among patients who were discharged from the ED, 32% had their surgery at a different hospital than index presentation. CONCLUSION A significant portion of patients (48.6%) who present to the ED with biliary colic will not return or have surgery within 5 years. A third of patients who eventually undergo cholecystectomy will go to another hospital for their surgery.
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Affiliation(s)
- Maria S Altieri
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery. Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA. .,Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T19, Stony Brook, NY, 11794, USA.
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Chencan Zhu
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA
| | - Samer Sbayi
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery. Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Konstantinos Spaniolas
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery. Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Mark Talamini
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery. Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
| | - Aurora Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery. Department of Surgery, Stony Brook University Medical Center, Stony Brook, NY, USA
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Hymowitz G, Tuppo C, Spaniolas K, Pryor A. Prospective evaluation of pre-operative participation in a medically supervised weight loss program and post-operative weight loss outcomes: Do number of sessions attended make a difference? Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Humayon S, Altieri M, Yang J, Price K, Spaniolas K, Pryor A. Adolescent bariatric surgery is on the Rise: An analysis of utilization and procedure trends in New York State. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Docimo S, Pryor A, Bates A, Obeid N, Talamini M, Spaniolas D. Bariatric Surgery is Safe in Patients on Immunosuppressive Agents. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Spaniolas K, Docimo S, Obeid N, Talamini M, Pryor A, Bates A. Routine contrast studies after bariatric surgery prolong hospital length of stay. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hymowitz G, Tuppo C, Salwen-Deremer J, Spaniolas K, Pryor A. Influence of Pre-operative Self-Monitoring of Physical Activity on Pre-operative Physical Activity, and Post-operative Weight Loss Outcomes. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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