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Deshmukh A, Desai PM, Ma C, Kushnir V, Eckhouse S, Dimou FM, McCarty TR, Bazarbashi AN. Endoscopic Management of Gastric Band Erosion: a Systematic Review and Meta-Analysis. Obes Surg 2024; 34:494-502. [PMID: 38158502 DOI: 10.1007/s11695-023-06995-4] [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: 08/30/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Gastric band erosion may be seen in up to 3% of patients. Endoscopic intervention has become increasingly utilized due to its minimally invasive nature. The purpose of this study was to perform a systematic review and meta-analysis to examine the role of endoscopic removal for eroded gastric bands. METHODS Individualized search strategies were developed for PubMed, EMBASE, Web of Science, and Cochrane Library databases in accordance with PRISMA and MOOSE guidelines. Outcomes included technical success, clinical success, procedure duration, adverse events, and surgical conversion. Pooled proportions were analyzed using random effects models. Heterogeneity and publication bias was assessed with I2 statistics and funnel plot asymmetry using Egger and Begg tests. Meta-regression was also performed comparing outcomes by endoscopic tools. RESULTS Ten studies (n=282 patients) were included in this meta-analysis. Mean age was 40.68±7.25 years with average duration of band placement of 38.49±19.88 months. Pre-operative BMI was 42.76±1.06 kg/m2 with BMI of 33.06±3.81 kg/m2 at time of band erosion treatment. Endoscopic removal was attempted in 240/282 (85.11%) of cases. Pooled technical and clinical success of the endoscopic therapy was 86.08% (95% CI: 79.42-90.83; I2=28.62%) and 85.34% (95% CI: 88.70-90.62; I2=38.56%), respectively. Mean procedure time for endoscopic removal was 46.47±11.52 min with an intra-operative adverse event rate of 4.15% (95% CI: 1.98-8.51; I2=0.00%). Post-procedure-associated adverse events occurred in 7.24% (CI: 4.46-11.55; I2=0.00%) of patients. Conversion to laparotomy/laparoscopy occurred in 10.54% (95% CI: 6.12-17.54) of cases. CONCLUSION Endoscopic intervention is a highly effective and safe modality for the treatment of gastric band erosion.
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Affiliation(s)
- Ameya Deshmukh
- Department of Internal Medicine, School of Medicine, Saint Louis University, St. Louis, MO, 63104, USA
| | - Parth M Desai
- Division of Gastroenterology and Hepatology, Tower Health, Reading Hospital, Reading, PA, 19611, USA
| | - Christine Ma
- Department of Internal Medicine, School of Medicine, Washington University, St. Louis, MO, 63110, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, Hepatology and Endoscopy, School of Medicine, Washington University, 660 S Euclid Ave, St. Louis, MO, 63110, USA
| | - Shaina Eckhouse
- Department of Surgery, School of Medicine, Washington University, St. Louis, MO, 63110, USA
| | - Francesca M Dimou
- Department of Surgery, School of Medicine, Washington University, St. Louis, MO, 63110, USA
| | - Thomas R McCarty
- Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, School of Medicine, Washington University, 660 S Euclid Ave, St. Louis, MO, 63110, USA.
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Clanahan JM, Awad MM, Dimou FM. Use of targeted educational resources to improve robotic bariatric surgery training. Surg Endosc 2024; 38:894-901. [PMID: 37823946 DOI: 10.1007/s00464-023-10436-9] [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: 03/31/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Evidence for how to best train surgical residents for robotic bariatric procedures is lacking. We developed targeted educational resources to promote progression on the robotic bariatric learning curve. This study aimed to characterize the effect of resources on resident participation in robotic bariatric procedures. METHODS Performance metrics from the da Vinci Surgical System were retrospectively reviewed for sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) cases involving general surgery trainees with a single robotic bariatric surgeon. Pictorial case guides and narrated operative videos were developed for these procedures and disseminated to trainees. Percent active control time (%ACT)-amount of trainee console time spent in active instrument manipulations over total active time from both consoles-was the primary outcome measure following dissemination. One-way ANOVA, Student's t-tests, and Pearson correlations were applied. RESULTS From September 2020 to July 2021, 50 cases (54% SG, 46% RYGB) involving 14 unique trainees (PGY1-PGY5) were included. From November 2021 to May 2022 following dissemination, 29 cases (34% SG, 66% RYGB) involving 8 unique trainees were included. Mean %ACT significantly increased across most trainee groups following resource distribution: 21% versus 38% for PGY3s (p = 0.087), 32% versus 45% for PGY4s (p = 0.0009), and 38% versus 57% for PGY5s (p = 0.0015) and remained significant when stratified by case type. Progressive trainee %ACT was not associated with total active time for SG cases before or after intervention (pre r = - 0.0019, p = 0.9; post r = - 0.039, p = 0.9). It was moderately positively associated with total active time for RYGB cases before dissemination (r = 0.46, p = 0.027) but lost this association following intervention (r = 0.16, p = 0.5). CONCLUSION Use of targeted educational resources promoted increases in trainee participation in robotic bariatric procedures with more time spent actively operating at the console. As educators continue to develop robotic training curricula, efforts should include high-quality resource development for other sub-specialty procedures. Future work will examine the impact of increased trainee participation on clinical and patient outcomes.
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Affiliation(s)
- Julie M Clanahan
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
- Department of Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Mailstop 8109-22-9905, St. Louis, MO, 63110-1093, USA.
| | - Michael M Awad
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca M Dimou
- Section of Minimally Invasive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Han J, Gallerand A, Erlich EC, Helmink BA, Mair I, Li X, Eckhouse SR, Dimou FM, Shakhsheer BA, Phelps HM, Chan MM, Mintz RL, Lee DD, Schilling JD, Finlay CM, Allen JE, Jakubzick CV, Else KJ, Onufer EJ, Zhang N, Randolph GJ. Human serous cavity macrophages and dendritic cells possess counterparts in the mouse with a distinct distribution between species. Nat Immunol 2024; 25:155-165. [PMID: 38102487 PMCID: PMC10990619 DOI: 10.1038/s41590-023-01688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/20/2023] [Indexed: 12/17/2023]
Abstract
In mouse peritoneal and other serous cavities, the transcription factor GATA6 drives the identity of the major cavity resident population of macrophages, with a smaller subset of cavity-resident macrophages dependent on the transcription factor IRF4. Here we showed that GATA6+ macrophages in the human peritoneum were rare, regardless of age. Instead, more human peritoneal macrophages aligned with mouse CD206+ LYVE1+ cavity macrophages that represent a differentiation stage just preceding expression of GATA6. A low abundance of CD206+ macrophages was retained in C57BL/6J mice fed a high-fat diet and in wild-captured mice, suggesting that differences between serous cavity-resident macrophages in humans and mice were not environmental. IRF4-dependent mouse serous cavity macrophages aligned closely with human CD1c+CD14+CD64+ peritoneal cells, which, in turn, resembled human peritoneal CD1c+CD14-CD64- cDC2. Thus, major populations of serous cavity-resident mononuclear phagocytes in humans and mice shared common features, but the proportions of different macrophage differentiation stages greatly differ between the two species, and dendritic cell (DC2)-like cells were especially prominent in humans.
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Affiliation(s)
- Jichang Han
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Alexandre Gallerand
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Emma C Erlich
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Beth A Helmink
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Iris Mair
- Lydia Becker Institute of Immunology and Inflammation, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Xin Li
- Departments of Microbiology and Immunology, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Shaina R Eckhouse
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca M Dimou
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Baddr A Shakhsheer
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Hannah M Phelps
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Mandy M Chan
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Rachel L Mintz
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel D Lee
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joel D Schilling
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Conor M Finlay
- Lydia Becker Institute of Immunology and Inflammation, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Judith E Allen
- Lydia Becker Institute of Immunology and Inflammation, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Wellcome Trust Centre for Cell Matrix Research, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Claudia V Jakubzick
- Departments of Microbiology and Immunology, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Kathryn J Else
- Lydia Becker Institute of Immunology and Inflammation, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Emily J Onufer
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Nan Zhang
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
- Ellen and Ronald Caplan Cancer Center at the Wistar Institute in Philadelphia, Philadelphia, PA, USA
| | - Gwendalyn J Randolph
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.
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Abebe TB, Doyle MB, Khan A, Eagon JC, Dimou FM, Eckhouse SR, Shakhsheer BA. Should Bariatric Surgery Play a Larger Role in the Management of Pediatric Patients with Severe Obesity and End-Stage Organ Disease? Obes Surg 2023; 33:2585-2587. [PMID: 37273156 DOI: 10.1007/s11695-023-06661-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Tsehay B Abebe
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Majella B Doyle
- Department of Surgery, Section of Abdominal Transplant Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Adeel Khan
- Department of Surgery, Section of Abdominal Transplant Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J Christopher Eagon
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca M Dimou
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Shaina R Eckhouse
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Baddr A Shakhsheer
- Department of Surgery, Division of Pediatric Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Dimou FM, Lidor A, Velanovich V. Commentary on the Multi-society Consensus Conference and Guideline on the Treatment of Gastroesophageal Reflux Disease (GERD). J Gastrointest Surg 2023; 27:650-652. [PMID: 36720755 DOI: 10.1007/s11605-023-05613-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/08/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Francesca M Dimou
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 S. Euclid Ave Campus Box 8109, Saint Louis, MO, 63108, USA.
| | - Anne Lidor
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Vic Velanovich
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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6
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Steinberger AE, Nickel KB, Keller M, Wallendorf M, Sprague J, Nicol GE, Dimou FM, Eagon JC, Eckhouse SR, Shakhsheer BA. National Trends in Pediatric Metabolic and Bariatric Surgery: 2010-2017. Pediatrics 2022; 150:189942. [PMID: 36373280 DOI: 10.1542/peds.2022-057316] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The childhood obesity epidemic has grown exponentially and is known to disproportionately affect minority groups. Successful treatment of this complex health issue requires a multidisciplinary approach including metabolic and bariatric surgery (MBS) for qualifying pediatric patients. This study examines current national trends in pediatric bariatric surgery from 2010 to 2017 using the National Inpatient Sample. METHODS This study analyzed MBS among pediatric patients <19 years old using weighted discharge data from 2010 to 2017. The primary outcome was national procedure rates. Secondary analyses included procedure type, demographics, BMI, comorbidities, length of stay, and complication rates. RESULTS From 2010 to 2017, annual bariatric procedure rates increased from 2.29 to 4.62 per 100 000 (P < .001). Laparoscopic sleeve gastrectomy outpaced Roux-en-Y gastric bypass and laparoscopic adjustable gastric band over time (0.31-3.99 per 100 000, P < .0001). The mean age was stable over time 18.10-17.96 (P = .78). The cohort was primarily female (76.5% to 75.4%), white (54.0% to 45.0%), and privately-insured (59.9% to 53.4%). Preoperative BMI increased from 2010 to 2017 (P < .001), whereas number of obesity-related comorbidities was stable (P > .05). Length of stay was <2 days (2.02-1.75, P = .04) and in-hospital complication rates were low (7.2% to 6.45%, P = .88). CONCLUSIONS Pediatric MBS is underutilized nationally with disproportionately lower rates among minority groups. Despite incremental progress, further investigation into the racial and social determinants that limit access to pediatric weight loss surgery is critical.
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Affiliation(s)
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
| | - Matthew Keller
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, Missouri
| | | | | | - Ginger E Nicol
- Child and Adolescent Psychiatry, Department of Psychiatry
| | | | | | | | - Baddr A Shakhsheer
- Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO
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Zarate Rodriguez JG, Caldwell KE, Frances AS, Han BJ, Dimou FM, Awad MM, Sacks BC. An Analysis of Diversity Statements and Support of Special Interest Societies by General Surgery Residency Programs. J Surg Educ 2022; 79:e116-e123. [PMID: 36068160 DOI: 10.1016/j.jsurg.2022.08.009] [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] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/11/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The purpose of this study was to characterize the nondiscrimination and diversity, equity, and inclusion (DEI) statements found on the websites of general surgery residency programs, as well as to measure programmatic commitment to diversity through their involvement with special interest surgical societies (SISS). DESIGN The authors evaluated the relationship between DEI statements and SISS participation, and performed a natural language processing analysis of general surgery residency DEI statements. SETTING The residency program websites from 319 non-military general surgery residency programs within the United States were analyzed. PARTICIPANTS This study evaluated the DEI statement and SISS participation in general surgery residency programs. RESULTS Of the 319 general surgery residency websites reviewed, 127 (39.8%) featured an identifiable statement of nondiscrimination or commitment to diversity. Compared to programs without diversity statements, programs with statements were more likely to be involved with special interest surgical societies (53.5% vs 30.7%, p < 0.001). Natural language processing analysis revealed that the diversity statements of programs with SISS involvement had higher word counts (p = 0.001), higher clout scores (measure of confidence conveyed, p = 0.001), and higher positive tone scores (p = 0.006) compared with the statements of those without special interest society involvement. CONCLUSIONS In the era of virtual interviewing, applicants are forced to rely heavily on surgery residency websites as their main source of information. Less than 40% of programs participating in the Match in 2022 feature diversity statements on their websites. Programs with some degree of involvement with special interest societies were more likely to have statements that score higher in confidence and positivity in natural language processing analysis, which may potentially reflect a more earnest commitment to diversity, equity, and inclusion. Residency programs should continue to improve the visibility of their DEI efforts to recruit a diverse resident class.
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Affiliation(s)
| | - Katharine E Caldwell
- Department of Surgery, Washington University, St Louis School of Medicine, St Louis, Missouri
| | - Avila Soto Frances
- Department of Surgery, Washington University, St Louis School of Medicine, St Louis, Missouri
| | - Britta J Han
- Department of Surgery, Washington University, St Louis School of Medicine, St Louis, Missouri
| | - Francesca M Dimou
- Department of Surgery, Washington University, St Louis School of Medicine, St Louis, Missouri
| | - Michael M Awad
- Department of Surgery, Washington University, St Louis School of Medicine, St Louis, Missouri
| | - Bethany C Sacks
- Department of Surgery, Washington University, St Louis School of Medicine, St Louis, Missouri
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Dimou FM, Ackermann N, Chang SH, Freeman D, Eagon JC, Eckhouse SR. Understanding the Current Role of Robotic-Assisted Bariatric Surgery. Obes Surg 2021; 31:3130-3137. [PMID: 33783678 DOI: 10.1007/s11695-021-05375-0] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/13/2021] [Accepted: 03/22/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The role of robotic surgery in bariatrics remains controversial. Patient selection for robotic surgery is not well-studied. The objective of this study was to identify factors associated with robotic surgery and its temporal trends. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database from 2015 to 2018 was used. Adult patients undergoing primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the laparoscopic or robotic approach were identified. Revisional, hybrid, or those with concomitant procedures were excluded. Logistic regression was conducted to identify factors associated with undergoing robotic-assisted surgery. RESULTS Among 211,568 patients who underwent SG, 9.1% underwent a robotic SG; among 76,805 patients who underwent RYGB, 7.9% of patients underwent a robotic RYGB. During 2015-2018, robotics increased from 7.1 to 11.3% for SG and 7.4 to 8.6% for RYGB. After controlling for patient characteristics, there was still an increasing trend in the use of robotic surgery: SG (multivariable-adjusted odds ratio, aOR, 1.18; 95% confidence interval, CI, 1.17-1.20) and RYGB (aOR, 1.05; 95% CI, 1.03-1.08). For both robotic SG and RYGB, functional status and African American race were associated with undergoing robotic surgery, while races other than White or African American and Hispanic ethnicity were not. Pre-operative IVC filter was associated with robotic SG, while the presence of GERD, diabetes, and COPD were associated with robotic RYGB. CONCLUSIONS Robotic bariatric surgery has increased over time. Our findings identified factors associated with the receipt of robotic surgery. Reasons for these factors require further investigation to better delineate indications for this technology.
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Affiliation(s)
- Francesca M Dimou
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA.
| | - Nicole Ackermann
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Dawn Freeman
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA
| | - J Christopher Eagon
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA
| | - Shaina R Eckhouse
- Department of Surgery, Washington University in Saint Louis School of Medicine, 660 South Euclid Ave Campus Box 6109, Saint Louis, MO, 63110, USA
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Affiliation(s)
- Francesca M Dimou
- Department of Surgery, University of South Florida, 13220 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Taylor S Riall
- Department of Surgery, University of Arizona, 1501 North Campbell Avenue, Room 4237, PO Box 245131, Tucson, AZ 85724-5131, USA.
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Dimou FM, Mehta HB, Adhikari D, Harland RC, Riall TS, Kuo YF. The role of extended criteria donors in liver transplantation for nonalcoholic steatohepatitis. Surgery 2016; 160:1533-1543. [PMID: 27554622 DOI: 10.1016/j.surg.2016.06.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nonalcoholic steatohepatitis is expected to become the leading indication for liver transplantation. Use of extended criteria donors (ECD) may help with donor allocation in these patients. The objective of this study was to determine the use of ECDs in patients with nonalcoholic steatohepatitis undergoing liver transplantation to stimulate a liver-specific predictive model for ECD use. METHODS The United Network for Organ Sharing database was used to identify patients undergoing liver transplantation for nonalcoholic steatohepatitis (2002-2014). Cox hazards models were created using (1) United Network for Organ Sharing ECD criteria (based on kidney allocation), (2) individual donor characteristics (age, sex, race, cause of death, body mass index, cold ischemic time), and (3) the Kidney Donor Profile Index (KDPI) to examine the effect of ECDs on mortality and graft failure. RESULTS A total of 4,387 patients underwent liver transplantation for nonalcoholic steatohepatitis; 1,359 (30.9%) patients received an ECD. Transplantation with ECD livers had comparable patient survival (hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.91-1.23) between donor types but an increased risk of graft failure (HR 1.18, 95% CI 1.03-1.36) compared to standard donors. Individual characteristics did not affect patient survival or graft failure. A 10% increase in KDPI was associated with a 28% increase in patient mortality (HR 1.28, 95% CI 1.02-1.60) and 45% increase in graft failure (HR 1.45, 95% CI 1.18-1.80). CONCLUSION Based on the current United Network for Organ Sharing definition, ECDs in nonalcoholic steatohepatitis were associated with similar overall survival but increased risk of graft failure. Given the shortage of organs, creation of an easily calculated, liver-specific model similar to the KDPI may help risk stratify patients and improve organ allocation.
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Affiliation(s)
- Francesca M Dimou
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX; Department of Surgery, University of South Florida, Tampa, FL.
| | - Hemalkumar B Mehta
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Deepak Adhikari
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
| | | | - Taylor S Riall
- Department of Surgery, University of Arizona, Tucson, AZ
| | - Yong-Fang Kuo
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
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Dimou FM, Eckelbarger D, Riall TS. Surgeon Burnout: A Systematic Review. J Am Coll Surg 2016; 222:1230-1239. [PMID: 27106639 DOI: 10.1016/j.jamcollsurg.2016.03.022] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/04/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Francesca M Dimou
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX.,Department of Surgery, University of South Florida, Tampa, FL
| | - David Eckelbarger
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Taylor S Riall
- Department of Surgery, University of Arizona, Banner-University Medical Center, Tucson, AZ
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Dimou FM, Adhikari D, Mehta HB, Riall TS. Trends in Follow-Up of Patients Presenting to the Emergency Department with Symptomatic Cholelithiasis. J Am Coll Surg 2015; 222:377-84. [PMID: 26837281 DOI: 10.1016/j.jamcollsurg.2015.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fewer than 25% of Medicare beneficiaries presenting with symptomatic cholelithiasis undergo elective cholecystectomy. To better understand underuse of cholecystectomy, we examined physician follow-up patterns after emergency department (ED) visits for symptomatic gallstones. STUDY DESIGN We used 100% Texas Medicare claims (2001 to 2010) to identify patients 66 years of age and older who presented to the ED with symptomatic cholelithiasis and were discharged home without cholecystectomy. Timing of outpatient physician visits after ED discharge and rates of emergent cholecystectomy based on physician follow-up patterns were compared. RESULTS In total, 11,126 patients presented to the ED with symptomatic cholelithiasis and were discharged without cholecystectomy. After discharge, 5,327 patients (47.9%) had an outpatient surgeon visit, 29.0% saw another physician and never saw a surgeon, and 23.1% never saw a physician; 68.2% of patients who saw a surgeon underwent elective cholecystectomy; and 8.3% of patients who saw a surgeon, 14.6% of patients who saw other physicians and no surgeon, and 77.6% of patients who never saw any physician, required emergent hospitalization (p < 0.0001). For people who did not see a physician, mean time to emergent hospitalization was 7.5 days (median 2 days); 95.9% presented within 2 weeks after their initial presentation. CONCLUSIONS Fewer than half of patients were evaluated by a surgeon after an initial ED visit for symptomatic gallstones. Patients who did not have physician follow-up were most likely to require emergent cholecystectomy, suggesting inappropriate ED discharge and highlighting the need for timely follow-up. Early outpatient surgical consultation is critical in determining appropriateness for cholecystectomy and avoiding emergent cholecystectomy in older patients with symptomatic gallstones.
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Affiliation(s)
- Francesca M Dimou
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Department of Surgery, University of South Florida, Tampa, FL
| | - Deepak Adhikari
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Hemalkumar B Mehta
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | - Taylor S Riall
- Department of Surgery, University of Texas Medical Branch, Galveston, TX; Department of Surgery, University of Arizona, Tucson, AZ.
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Williams TP, Dimou FM, Adhikari D, Kimbrough TD, Riall TS. Hospital readmission after emergency room visit for cholelithiasis. J Surg Res 2015; 197:318-23. [PMID: 25959838 DOI: 10.1016/j.jss.2015.04.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 01/13/2015] [Revised: 02/19/2015] [Accepted: 04/09/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND For patients presenting with symptomatic cholelithiasis, cholecystectomy is the definitive treatment modality. Our goal was to evaluate the surgical follow-up and outcomes in patients seen in the emergency department (ED) for an episode of symptomatic cholelithiasis and discharged home for elective follow-up. METHODS We performed a retrospective review of consecutive patients seen in the ED for cholelithiasis and discharged without hospital admission between August 2009 and May 2014. All patients were followed for 2 y from the date of the initial ED visit. We evaluated outpatient surgeon visits, elective and emergent cholecystectomy rates, and additional ED visits. Cumulative incidence and Kaplan-Meier curves were used to examine the time from the initial ED visit to outpatient surgeon evaluation and the time from the initial ED visit to ED readmission. RESULTS Seventy-one patients were discharged from the ED with a diagnosis of symptomatic gallstones. Patients who had an elective cholecystectomy in the 2 y after the initial visit were 12.6%. In this group, the mean time from the initial ED visit to outpatient surgeon follow-up was 7.7 d, and all elective cholecystectomies occurred within 1 mo of the initial visit. Of the 62 patients who did not have an elective cholecystectomy, only 14.5% of patients in this group had outpatient surgeon follow-up at mean time of 137 d from the initial ED visit for symptomatic gallstones. In addition, 37.1% of patients in this group had additional ED visits for gallstone-related symptoms, with 17.7% of patients having two or more additional ED visits, and 12.9% required emergent and/or urgent cholecystectomy. Additional ED visits (43.5%) occurred within 1 mo and 60.9% within 3 mo of their initial ED visit. In patients with additional ED visits for symptomatic cholelithiasis, 60.9% had more than one abdominal ultrasound or computed tomography scan during the course of multiple visits. CONCLUSIONS Failure to achieve a timely surgical follow-up leads to multiple ED readmissions and emergent gallstone-related hospitalizations, including emergency cholecystectomy. System-level interventions to ensure outpatient surgical follow-up within 1-2 wk of the initial ED visit has the potential to improve outcomes for patients with symptomatic biliary colic.
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Affiliation(s)
- Taylor P Williams
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - Francesca M Dimou
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas; Department of Surgery, University of South Florida, Tampa, Florida
| | - Deepak Adhikari
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - Thomas D Kimbrough
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas
| | - Taylor S Riall
- Department of Surgery, The University of Texas Medical Branch, Galveston, Texas.
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14
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Dimou FM, Riall TS. Pancreatic Resection Results in a Statewide Surgical Collaborative. Ann Surg Oncol 2015; 22:2462-3. [PMID: 25814366 DOI: 10.1245/s10434-015-4536-x] [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] [Received: 03/14/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Francesca M Dimou
- Department of Surgery, John Sealy Distinguished Chair in Clinical Research, The University of Texas Medical Branch, Galveston, TX, USA
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Riall TS, Adhikari D, Parmar AD, Linder SK, Dimou FM, Crowell W, Tamirisa NP, Townsend CM, Goodwin JS. The risk paradox: use of elective cholecystectomy in older patients is independent of their risk of developing complications. J Am Coll Surg 2014; 220:682-90. [PMID: 25660731 DOI: 10.1016/j.jamcollsurg.2014.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 12/09/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND We recently developed and validated a prognostic model that accurately predicts the 2-year risk of emergent gallstone-related hospitalization in older patients presenting with symptomatic gallstones. STUDY DESIGN We used 100% Texas Medicare data (2000 to 2011) to identify patients aged 66 years and older with an initial episode of symptomatic gallstones not requiring emergency hospitalization. At presentation, we calculated each patient's risk of 2-year gallstone-related emergent hospitalization using the previously validated model. Patients were placed into the following risk groups based on model estimates: <30%, 30% to <60%, and ≥ 60%. Within each risk group, we calculated the percent of elective cholecystectomies (≤ 2.5 months from initial episode) performed. RESULTS In all, 161,568 patients had an episode of symptomatic gallstones. Mean age was 76.5 ± 7.3 years and 59.9% were female. The 2-year risk of gallstone-related hospitalizations increased from 15.9% to 41.5% to 65.2% across risk groups. For the overall cohort, 22.3% in the low-risk group, 20.9% in the moderate-risk group, and 23.2% in the high-risk group underwent elective cholecystectomy in the 2.5 months after the initial symptomatic episode. In patients with no comorbidities, elective cholecystectomy rates decreased from 34.2% in the low-risk group to 26.7% in the high-risk group. Of patients who did not undergo cholecystectomy, only 9.5% were seen by a surgeon in the 2.5 months after the initial episode. CONCLUSIONS The risk of recurrent acute biliary symptoms requiring hospitalization has no influence, or even a paradoxical negative influence, on the decision to perform elective cholecystectomy after an initial symptomatic episode. Translation of the risk prediction model into clinical practice can better align treatment with risk and improve outcomes in older patients with symptomatic gallstones.
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Affiliation(s)
- Taylor S Riall
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX.
| | - Deepak Adhikari
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Abhishek D Parmar
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX; Department of Surgery, The University of California, San Francisco-East Bay, Oakland, CA
| | - Suzanne K Linder
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Francesca M Dimou
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX; Department of Surgery, The University of South Florida, Tampa, FL
| | - Winston Crowell
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Nina P Tamirisa
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX; Department of Surgery, The University of California, San Francisco-East Bay, Oakland, CA
| | - Courtney M Townsend
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
| | - James S Goodwin
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX
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