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Shen MR, Hammoud MM, Bonham AJ, Aaron B, Ghaferi AA, Varban OA, Carlin AM, Ehlers AP, Finks JF. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: impact on reflux and weight loss. Surg Obes Relat Dis 2024:S1550-7289(24)00131-X. [PMID: 38704333 DOI: 10.1016/j.soard.2024.04.001] [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: 12/18/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Sleeve gastrectomy (SG) is the most commonly performed weight loss operation, and its 2 most common complications are postoperative reflux and weight recurrence. There is limited evidence to guide decision-making in treating these conditions. OBJECTIVES To determine the efficacy of conversion of SG to Roux-en-Y gastric bypass (RYGB) for GERD management and weight loss. SETTING Forty-one hospitals in Michigan. METHODS We conducted a retrospective cohort study examining patients who underwent conversion of SG to RYGB from 2014 to 2022. The primary outcomes were changes in GERD-HRQL scores, anti-reflux medication use, and weight from baseline to 1 year after conversion. Secondary outcomes included 30-day postoperative complications and resource utilization. RESULTS Among 2133 patients undergoing conversion, 279 (13%) patients had baseline and 1-year GERD-HRQL survey data and anti-reflux medication data. GERD-HRQL scores decreased significantly from 24.6 to 6.6 (P < .01). Among these, 207 patients (74%) required anti-reflux medication at baseline, with only 76 patients (27%) requiring anti-reflux medication at 1 year postoperatively (P < .01). Of the 380 patients (18%) with weight loss data, mean weight decreased by 68.4lbs, with a 24.3% decline in total body weight and 51.5% decline in excess body weight. In terms of 30-day complications, 308 (14%) patients experienced any complication and 89 (4%) experienced a serious complication, but there were no leaks, perforations, or deaths. Three-hundred and fifty-five (17%) patients presented to the emergency department and 64 (3%) patients underwent reoperation. CONCLUSIONS This study represents the largest reported experience with conversion from SG to RYGB. We found that conversion to RYGB is associated with significant improvement in GERD symptoms, reduction in anti-reflux medication use, and significant weight loss and is therefore an effective treatment for GERD and weight regain after SG. However, the risks and benefits of conversion surgery should be carefully considered, especially in patients with significant comorbidity burden.
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Affiliation(s)
- Mary R Shen
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, Mass General Brigham, Boston, Massachusetts
| | - Maya M Hammoud
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Aaron J Bonham
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Bryan Aaron
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Department of Surgery, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Oliver A Varban
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Anne P Ehlers
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jonathan F Finks
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Ferber M, Hecht LM, Martens KM, Hamann A, Carlin AM, Miller-Matero LR. Examining differences in long-term weight loss outcomes after bariatric surgery: The role of romantic relationship status. Fam Syst Health 2024; 42:122-126. [PMID: 37616105 DOI: 10.1037/fsh0000832] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
INTRODUCTION This study tested for differences based on relationship status at the time of surgery in baseline body mass index (BMI), weight loss outcomes (change in BMI [ΔBMI], percent total weight loss [%TWL], percent excess weight loss [%EWL]), and rates of successful weight loss (defined as ≥ 50%EWL) up to 4-year postbariatric surgery. METHOD Data came from a secondary analysis of patients (N = 492) who were up to 4-year postsurgery and completed a presurgical psychological evaluation and postsurgical survey. RESULTS Sixty-nine percent of participants were patients in committed relationships and 31% were single/divorced/widowed patients. Single patients had higher presurgical BMIs than those who were partnered (t = 2.28, p = .02). There were no differences between those who were partnered and singles regarding ΔBMI and %TWL, although singles had smaller %EWL (t = -2.08, p = .04), which became nonsignificant after controlling for covariates. Most participants had successful weight loss (76.8%); however, this was not related to romantic relationship status. DISCUSSION The results suggest those who were partnered undergo surgery at better-starting weights than singles and maintain this advantage in the long term. Providers working with patients considering bariatric surgery could inquire about how their romantic and social relationships play a part in their decision-making process. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Megan Ferber
- Department of Family and Community Medicine, Medical Family Therapy Program, Saint Louis University
| | - Leah M Hecht
- Center for Health Policy & Health Services Research, Henry Ford Health System
| | | | - Aaron Hamann
- Department of Behavioral Health, Henry Ford Health System
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Miller-Matero LR, Haley EN, Loree AM, Braciszewski JM, Maye M, Sehgal M, Carlin AM. Post-surgical psychiatric symptoms, maladaptive eating patterns, and lifestyle behaviors associated with weight recurrence after bariatric surgery. Surg Obes Relat Dis 2024; 20:297-303. [PMID: 37923621 DOI: 10.1016/j.soard.2023.09.027] [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: 05/15/2023] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND A significant proportion of patients who undergo bariatric surgery experience weight recurrence; however, the most important areas to target to prevent weight recurrence remain unknown. OBJECTIVES The purpose was to examine whether psychiatric symptoms, maladaptive eating behaviors, and lifestyle factors were associated with weight recurrence. SETTING Single healthcare system. METHODS Individuals who underwent bariatric surgery were invited to complete a web-based survey in which they reported their current weight and completed measures of psychiatric symptoms, maladaptive eating behaviors, and lifestyle behaviors. Participants were included if they were at least 2 years postsurgery. Weight recurrence was measured from the 1-year follow-up to the survey date. RESULTS Participants (n = 169) were predominantly female and White or Black, with a mean age of 45 years. The rate of significant weight recurrence was 23.1%. Those who underwent sleeve gastrectomy were more likely to experience weight recurrence (odds ratio [OR] = 12.99; P = .01). In bivariate analyses, anxiety and depressive symptoms, emotional eating, loss of control eating, binge eating, and night eating were associated with weight recurrence (P < .05). Those who did not eat mindfully, take 20 minutes to eat, or get adequate sleep were also more likely to have weight recurrence (P < .05). In a multivariate model, only a lack of mindful eating (OR = 4.84; P = .03) and inadequate sleep (OR = 7.30; P = .02) remained statistically significant predictors. CONCLUSION Engaging in mindful eating and obtaining adequate sleep may protect against weight recurrence following bariatric surgery. Clinicians may want to screen and monitor these behaviors.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan.
| | - Erin N Haley
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Monica Sehgal
- Behavioral Health, Henry Ford Health, Detroit, Michigan
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Miller-Matero LR, Ross K, Arellano C, Zelenak L, DePascale E, Gavrilova L, Braciszewski JM, Hecht LM, Haley EN, Brescacin C, Carlin AM. Cannabis use following bariatric surgery is associated with anxiety and maladaptive eating. Surg Obes Relat Dis 2024; 20:91-97. [PMID: 37863791 DOI: 10.1016/j.soard.2023.09.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/30/2023] [Accepted: 09/04/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND There are limited data regarding the association of cannabis use with outcomes after bariatric surgery. As such, it is challenging to know how to counsel patients using cannabis. OBJECTIVES The purpose of this study was to examine whether postsurgical cannabis use was associated with psychiatric symptoms and maladaptive eating among individuals up to 4 years after bariatric surgery. SETTING Single health system. METHODS All patients who underwent bariatric surgery over a 4-year period were invited to participate. Participants (N = 765) completed questionnaires online regarding postsurgical cannabis use, psychiatric symptoms, and maladaptive eating. RESULTS Any cannabis use after bariatric surgery was associated with increased likelihood of having elevated symptoms of anxiety (odds ratio [OR] = 1.88, P = .003; 37.8% versus 24.4%), increased likelihood of grazing behaviors (OR = 1.77, P = .01; 71.2% versus 58.2%), and higher scores for eating in response to depression (P = .01; 12.13 versus 10.75). Weekly cannabis use was associated with loss of control eating (OR = 1.81, P = .04; 37.2% versus 24.7%), binge eating (OR = 2.16, P = .03; 20.0% versus 10.4%), and night eating behaviors (OR = 2.11, P = .01; 40.0% versus 24.0%). Cannabis use was not associated with depression (P > .05). CONCLUSIONS Cannabis use after bariatric surgery was associated with anxiety symptoms and engaging in maladaptive eating behaviors. Frequent cannabis use (i.e., ≥1 per week) was associated with additional types of maladaptive eating. Clinicians involved in presurgical and postsurgical care may want to counsel patients currently using cannabis, especially those who are engaging in frequent use.
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Affiliation(s)
- Lisa R Miller-Matero
- Henry Ford Health, Behavioral Health, Detroit, Michigan; Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan.
| | - Kaitlin Ross
- Wayne State University School of Medicine, Detroit, Michigan
| | - Camila Arellano
- Wayne State University School of Medicine, Detroit, Michigan
| | - Logan Zelenak
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan
| | - Eve DePascale
- Henry Ford Health, Behavioral Health, Detroit, Michigan
| | - Lyubov Gavrilova
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan
| | - Jordan M Braciszewski
- Henry Ford Health, Behavioral Health, Detroit, Michigan; Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan
| | - Leah M Hecht
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan
| | - Erin N Haley
- Henry Ford Health, Behavioral Health, Detroit, Michigan; Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, Michigan
| | - Carly Brescacin
- Henry Ford Health, Behavioral Health, Detroit, Michigan; Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Arthur M Carlin
- Wayne State University School of Medicine, Detroit, Michigan; Department of Surgery, Henry Ford Health, Detroit, Michigan
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Ramirez JL, Kim E, Fregenal AC, Vigran HJ, Hughes SE, Reynolds CW, Varban OA, Carlin AM, Ehlers AP, Bonham AJ, Finks JF. Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients. Surg Endosc 2023; 37:9582-9590. [PMID: 37735218 DOI: 10.1007/s00464-023-10353-x] [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: 05/01/2023] [Accepted: 07/30/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Depression is strongly associated with obesity and is common among patients undergoing bariatric surgery. Little is known about the impact of depression on early postoperative outcomes or its association with substance use. METHODS The Michigan Bariatric Surgery Collaborative is a statewide quality improvement program that maintains a large clinical registry. We evaluated patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 2017 and 2022. Patients self-reported symptoms of depression (PHQ-8) and use of alcohol (AUDIT-C), smoking, prescription opiates, and marijuana at baseline. Preoperative PHQ-8 scores stratified patients based on severity: no depression (0-4), mild (5-9), moderate (10-14), or severe (15-24). We compared 30-day outcomes and substance use between patients with and without depression. RESULTS Among 44,301 patients, 30.8% had some level of depression, with 19.8% mild, 7.5% moderate, and 3.5% severe. Patients with depression were more likely to have an extended length of stay (LOS) (> 3 days) than those without depression (no depression 2.1% vs. severe depression 3.0%, p = 0.0452). There were no significant differences between no depression and severe depression groups in rates of complications (5.7% vs. 5.2%, p = 0.1564), reoperations (0.9%, vs. 0.8%, p = 0.7394), ED visits (7.7% vs. 7.8%, p = 0.5353), or readmissions (3.2% vs. 3.9%, p = 0.3034). Patients with severe depression had significantly higher rates of smoking (9.7% vs. 12.5%, p < 0.0001), alcohol use disorder (8.6% vs. 14.0%, p < 0.0001), opiate use (14.5% vs. 22.4%, p < 0.0001) and marijuana use (8.4%, vs. 15.5%, p = 0.0008). CONCLUSIONS This study demonstrated that nearly one-third of patients undergoing bariatric surgery have depression, with over 10% in the moderate to severe range. There was a significant association between preoperative depressive symptoms and extended LOS after bariatric surgery, as well as higher rates of smoking and use of marijuana, prescription opiates and alcohol. There was no significant effect on adverse events or other measures of healthcare utilization.
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Affiliation(s)
| | - Erin Kim
- University of Michigan Medical School, Ann Arbor, MI, USA.
| | | | | | - Sarah E Hughes
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Oliver A Varban
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Anne P Ehlers
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan F Finks
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
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Somerset AE, Wood MH, Bonham AJ, Carlin AM, Finks J, Ghaferi AA, Varban OA. Association of program-specific variation in bariatric surgery volume for Medicaid patients and access to care: a tale of inequality? Surg Endosc 2023; 37:8570-8576. [PMID: 37872428 DOI: 10.1007/s00464-023-10411-4] [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: 09/18/2021] [Accepted: 07/30/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Although patients with lower socioeconomic status are at higher risk of obesity, bariatric surgery utilization among patients with Medicaid is low and may be due to program-specific variation in access. Our goal was to compare bariatric surgery programs by percentage of Medicaid cases and to determine if variation in distribution of patients with Medicaid could be linked to adverse outcomes. METHODS Using a state-wide bariatric-specific data registry that included 43 programs performing 97,207 cases between 2006 and 2020, we identified all patients with Medicaid insurance (n = 4780, 4.9%). Bariatric surgery programs were stratified into quartiles according to the percentage of Medicaid cases performed and we compared program-specific characteristics as well as baseline patient characteristics, risk-adjusted complication rates and wait times between top and bottom quartiles. RESULTS Program-specific distribution of Medicaid cases varied between 0.69 and 22.4%. Programs in the top quartile (n = 11) performed 18,885 cases in total, with a mean of 13% for Medicaid patients, while programs in the bottom quartile (n = 11) performed 32,447 cases in total, with a mean of 1%. Patients undergoing surgery at programs in the top quartile were more likely to be Black (20.2% vs 13.5%, p < 0.0001), have diabetes (35.1% vs 29.5%, p < 0.0001), hypertension (55.1% vs 49.6%, p < 0.0001) and hyperlipidemia (47.6% vs 45.2%, p < 0.0001). Top quartile programs also had higher complication rates (8.4% vs 6.6%, p < 0.0001), extended length of stay (5.6% vs 4.0%, p < 0.0001), Emergency Department visits (8.1% vs 6.5%, p < 0.0001) and readmissions (4.7% vs 3.9%, p < 0.0001). Median time from initial evaluation to surgery date was also significantly longer among top quartile programs (200 vs 122 days, p < 0.0001). CONCLUSIONS Bariatric surgery programs that perform a higher proportion of Medicaid cases tend to care for patients with greater disease severity who experience delays in care and also require more resource utilization. Improving bariatric surgery utilization among patients with lower socioeconomic status may benefit from insurance standardization and program-centered incentives to improve access and equitable distribution of care.
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Affiliation(s)
- Amy E Somerset
- Department of Surgery, Detroit Medical Center, Wayne State University, 3990 John R, Detroit, MI, 48201, USA.
| | - Michael H Wood
- Department of Surgery, Detroit Medical Center, Wayne State University, 3990 John R, Detroit, MI, 48201, USA
| | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Jonathan Finks
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
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Hider AM, Johanson H, Bonham AJ, Ghaferi AA, Finks J, Ehlers AP, Carlin AM, Varban OA. Evaluating outcomes among surgeons who changed their technique for gastric bypass: a state-wide analysis from 2011 to 2021. Surg Endosc 2023; 37:8464-8472. [PMID: 37740112 DOI: 10.1007/s00464-023-10434-x] [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: 07/02/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Technical variation exists when performing the gastrojejunostomy during Roux-en-Y gastric bypass (RYGB). However, it is unclear whether changing technique results in improved outcomes or patient harm. METHODS Surgeons participating in a state-wide bariatric surgery quality collaborative who completed a survey on how they perform a typical RYGB in 2011 and again in 2021 were included in the analysis (n = 31). Risk-adjusted 30-day complication rates and case characteristics for cases in 2011 were compared to those in 2021 among surgeons who changed their gastrojejunostomy technique from end-to-end anastomosis (EEA) to either a linear staple or handsewn anastomosis (LSA/HSA). In addition, case characteristics and outcomes among surgeons who maintained an EEA technique throughout the study period were assessed. RESULTS A total of 15 surgeons (48.3%) changed their technique from EEA to LSA/HSA while 7 surgeons (22.3%) did not. Nine surgeons did LSA or HSA the entire period and therefore were not included. Surgeons who changed their technique had significantly lower rates of surgical complications in 2021 when compared to 2011 (1.9% vs 5.1%, p = 0.0015), including lower rates of wound complications (0.5% vs 2.1%, p = 0.0030) and stricture (0.1% vs 0.5%, p = 0.0533). Likewise, surgeons who did not change their EEA technique, also experienced a decrease in surgical complications (1.8% vs 5.8%, p < 0.0001), wound complications (0.7% vs 2.1%, p < 0.0001) and strictures (0.2% vs 1.2%, p = 0.0006). Surgeons who changed their technique had a significantly higher mean annual robotic bariatric volume in 2021 (30.0 cases vs 4.9 cases, p < 0.0001) when compared to those who did not. CONCLUSIONS Surgeons who changed their gastrojejunostomy technique from circular stapled to handsewn demonstrated greater utilization of the robotic platform than those who did not and experienced a similar decrease in adverse events during the study period, despite altering their technique. Surgeons who chose to modify their operative technique may be more likely to adopt newer technologies.
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Affiliation(s)
- Ahmad M Hider
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA.
| | | | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jonathan Finks
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
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Braciszewski JM, Hecht LM, Barnett NP, Moore RS, Carlin AM, Haley EN, Miller-Matero LR. Preventing alcohol use post-bariatric surgery: patient perspectives on a technology-based approach. Surg Endosc 2023; 37:8263-8268. [PMID: 37670188 DOI: 10.1007/s00464-023-10407-0] [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: 04/13/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Nearly two-thirds of patients engage in alcohol use after bariatric surgery, while a substantial number meet criteria for alcohol use disorder after their procedure. Given that pre-surgical education may not be sufficient, alternative methods of preventing post-surgical drinking are needed. We sought feedback on a proposed technology-based intervention to reduce alcohol use for individuals who have undergone bariatric surgery. METHODS Twenty patients who consumed alcohol post-surgery completed qualitative interviews where they provided opinions on sample intervention content, delivery method, timing, and other aspects of a two-session web-based intervention followed by tailored text messaging for 6 months. Interviews were recorded, transcribed, and coded using thematic analysis principles. RESULTS Participants strongly endorsed using technology to deliver an alcohol intervention, citing the interactivity and personal tailoring available in the proposed software. Education about the effects of post-surgical drinking and learning new coping strategies for social situations were the two most salient themes to emerge from questions about intervention content. Throughout the interviews, participants strongly highlighted the importance of measuring patient readiness to change alcohol use and matching intervention content to such motivation levels. Respondents felt that text messages could extend what they had learned, but also requested additional non-alcohol content (e.g., recipes, exercise tips). Most participants agreed that an online forum consisting of peers and professionals with whom they could ask questions and interact would be useful. CONCLUSION Web- and text message-based interventions may be an acceptable approach to prevent alcohol use post-bariatric surgery.
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Affiliation(s)
- Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health, One Ford Place, Suite 5E, Detroit, MI, 48202, USA.
| | - Leah M Hecht
- Center for Health Policy and Health Services Research, Henry Ford Health, One Ford Place, Suite 5E, Detroit, MI, 48202, USA
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, USA
| | - Roland S Moore
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, USA
| | | | - Erin N Haley
- Center for Health Policy and Health Services Research, Henry Ford Health, One Ford Place, Suite 5E, Detroit, MI, 48202, USA
- Behavioral Health, Henry Ford Health, Detroit, USA
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research, Henry Ford Health, One Ford Place, Suite 5E, Detroit, MI, 48202, USA
- Behavioral Health, Henry Ford Health, Detroit, USA
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Haley EN, Loree AM, Maye M, Coleman KJ, Braciszewski JM, Snodgrass M, Harry ML, Carlin AM, Miller-Matero LR. Racial Differences in Psychiatric Symptoms, Maladaptive Eating, and Lifestyle Behaviors After Bariatric Surgery. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01835-8. [PMID: 37874488 DOI: 10.1007/s40615-023-01835-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
There are several psychological and behavioral factors associated with poorer outcomes following bariatric surgery, yet it is unknown whether and how these factors may differ by race. In this cross-sectional study, individuals who underwent bariatric surgery from 2018 to 2021 and up to 4 years post-surgery were invited to complete an online survey. Psychiatric symptoms, maladaptive eating patterns, self-monitoring behaviors, and exercise frequency were examined. Participants (N = 733) were 87% women, 63% White, with a mean age of 44 years. Analyses of covariance demonstrated that White individuals endorsed greater anxiety symptoms (p =.01) and emotional eating due to depression (p = .01), whereas Black individuals endorsed greater depression severity (p = .02). Logistic regression analyses demonstrated that White individuals were more likely to experience loss of control eating (OR= 1.7, p = .002), grazing (OR= 2.53, p <.001), and regular self-weighing (OR= 1.41, p <.001) than Black individuals, and were less likely to skip meals (OR= .61, p = .04), or partake in nighttime eating (OR= .40, p <.001). There were no racial differences in binge eating, emotional eating due to anxiety or frustration, use of a food diary, or exercise. Thus, depressive symptoms, skipping meals, and nighttime eating may be important, modifiable intervention targets to optimize the benefits of bariatric surgery and promote equitable outcomes.
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Affiliation(s)
- Erin N Haley
- Behavioral Health, Henry Ford Health, Detroit, USA.
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA.
| | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | | | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health, Detroit, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | | | - Melissa L Harry
- Essentia Institute of Rural Health, Essentia Health, Duluth, USA
| | | | - Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
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Janes LA, Hammond JW, Bonham AJ, Carlin AM, Ghaferi AA, Varban OA, Ehlers AP, Finks JF. The effect of marijuana use on short-term outcomes with bariatric surgery. Surg Obes Relat Dis 2023; 19:964-970. [PMID: 37142472 DOI: 10.1016/j.soard.2023.02.025] [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: 08/06/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Despite increasing marijuana use nationwide, there are limited data on implications of marijuana use on bariatric surgery outcomes. OBJECTIVE We investigated associations between marijuana use and bariatric surgery outcomes. SETTING Multicenter statewide study utilizing data from the Michigan Bariatric Surgery Collaborative, a payor-funded consortium including over 40 hospitals and 80 surgeons performing bariatric surgery statewide. METHODS We analyzed data from the Michigan Bariatric Surgery Collaborative clinical registry on patients who underwent a laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass between June 2019 and June 2020. Patients were surveyed at baseline and annually on medication use, depression symptoms, and substance use. Regression analysis was performed to compare 30-day and 1-year outcomes between marijuana users and nonusers. RESULTS Of 6879 patients, 574 reported baseline marijuana use and 139 reported use at baseline and 1 year. Marijuana users were more likely to be current smokers (14% versus 8%, P < .0001), screen positive for alcohol use disorder (20.0% versus 8.4%, P < .0001), and score higher on the Patient Health Questionnaire-8 (6.1 versus 3.0, P < .0001). There were no statistically significant differences in 30-day outcomes or co-morbidity remission at 1 year. Marijuana users had higher adjusted total mean weight loss (47.6 versus 38.1 kg, P < .0001) and body mass index reduction (17 versus 14 kg/m2, P < .0001). CONCLUSIONS Marijuana use is not associated with worse 30-day outcomes or 1-year weight loss outcomes and should not be a barrier to bariatric surgery. However, marijuana use is associated with higher rates of smoking, substance use, and depression. These patients may benefit from additional mental health and substance abuse counseling.
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Affiliation(s)
| | - John W Hammond
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Aaron J Bonham
- University of Michigan, Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Arthur M Carlin
- Henry Ford Health, Michigan Bariatric Surgery Collaborative, Detroit, Michigan
| | - Amir A Ghaferi
- University of Michigan, Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Oliver A Varban
- University of Michigan, Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Anne P Ehlers
- University of Michigan, Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Jonathan F Finks
- University of Michigan, Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan.
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11
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Dennis A, Deng C, Yang P, Bonham AJ, Carlin AM, Varban OA. Evaluating the impact of metabolic surgery on patients with prior opioid use. Surg Obes Relat Dis 2023; 19:889-896. [PMID: 36872158 DOI: 10.1016/j.soard.2023.01.030] [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: 10/22/2022] [Revised: 01/14/2023] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Metabolic surgery is the most effective treatment for obesity and may improve obesity-related pain syndromes. However, the effect of surgery on the persistent use of opioids in patients with a history of prior opioid use remains unclear. OBJECTIVE To determine the effect of metabolic surgery on opioid use behaviors in patients with prior opioid use. SETTING A consortium of public and private hospitals in Michigan. METHODS Using a statewide metabolic-specific data registry, we identified 16,820 patients who self-reported opioid use before undergoing metabolic surgery between 2006 and 2020 and analyzed the 8506 (50.6%) patients who responded to 1-year follow-up. We compared patient characteristics, risk-adjusted 30-day postoperative outcomes, and weight loss between patients who self-reported discontinuing opioid use 1 year after surgery and those who did not. RESULTS Among patients who self-reported using opioids before metabolic surgery, 3864 (45.4%) discontinued use 1 year after surgery. Predictors of persistent opioid use included an annual income of <$10,000 (odds ratio [OR] = 1.24; 95% confidence interval [CI], 1.06-1.44; P = .006), Medicare insurance (OR = 1.48; 95% CI, 1.32-1.66; P < .0001), and preoperative tobacco use (OR = 1.36; 95% CI, 1.16-1.59; P = .0001). Patients with persistent use were more likely to have a surgical complication (9.6% versus 7.5%, P = .0328) and less percent excess weight loss (61.6% versus 64.4%, P < .0001) than patients who discontinued opioids after surgery. There were no differences in the morphine milligram equivalents prescribed within the first 30 days following surgery between groups (122.3 versus 126.5, P = .3181). CONCLUSIONS Nearly half of patients who reported taking opioids before metabolic surgery discontinued use at 1 year. Targeted interventions aimed at high-risk patients may increase the number of patients who discontinue opioid use after metabolic surgery.
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Affiliation(s)
| | - Callie Deng
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Phillip Yang
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Aaron J Bonham
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | | | - Oliver A Varban
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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12
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Miller-Matero LR, Ross K, DePascale E, Arellano C, Zelenak L, Braciszewski JM, Hecht LM, Haley EN, Loree AM, Carlin AM. Post-surgical cannabis use is associated with weight loss among individuals up to 4 years after bariatric surgery. Surg Endosc 2023:10.1007/s00464-023-10126-6. [PMID: 37202524 DOI: 10.1007/s00464-023-10126-6] [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: 03/07/2023] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Although cannabis is known to stimulate appetite, it is not clear whether cannabis use may impact weight loss outcomes following bariatric surgery. Although some work has suggested that pre-surgical cannabis use is not associated with post-surgical weight loss, the role of post-surgical cannabis use has not yet been examined. The purpose of this study was to measure pre- and post-surgical cannabis use and determine whether cannabis use was associated with weight loss outcomes following bariatric surgery. METHODS Patients who underwent bariatric surgery over a 4-year period at a single health care system were invited to complete a survey regarding pre- and post-surgical cannabis use and report their current weight. Pre-surgical weight and BMI were extracted from medical records to calculate change in BMI (ΔBMI), percent total weight loss (%TWL), percent excess weight loss (%EWL), whether participants experienced a successful weight loss outcome, and whether participants had weight recurrence. RESULTS Among all participants (N = 759), 10.7% and 14.5% engaged in pre- and post-surgical cannabis use, respectively. Pre-surgical cannabis use was not associated with any weight loss outcomes (p > 0.05). Any post-surgical cannabis use was associated with lower %EWL (p = 0.04) and greater likelihood of weight recurrence (p = 0.04). Weekly cannabis use was associated with lower %EWL (p = 0.003), lower %TWL (p = 0.04), and a lower likelihood of having a successful weight loss outcome (p = 0.02). CONCLUSIONS Although pre-surgical cannabis use may not predict weight loss outcomes, post-surgical cannabis was associated with poorer weight loss outcomes. Frequent use (i.e., weekly) may be especially problematic. Providers should consider screening patients for cannabis use and educate them about the potential impact of postoperative cannabis use on weight loss following bariatric surgery.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA.
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA.
| | - Kaitlin Ross
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Eve DePascale
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
| | | | - Logan Zelenak
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Leah M Hecht
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Erin N Haley
- Behavioral Health, Henry Ford Health, 1 Ford Place, Detroit, MI, 48202, USA
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Amy M Loree
- Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, 5E, Detroit, MI, 48202, USA
| | - Arthur M Carlin
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
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13
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Miller-Matero LR, Hecht LM, Barnett NP, Moore RS, Jackson KM, McCarthy D, Martens KM, Hamann A, Felton JW, Carlin AM, Braciszewski JM. Patient perceptions regarding alcohol use after bariatric surgery. Surg Endosc 2023; 37:3669-3675. [PMID: 36639579 PMCID: PMC10251245 DOI: 10.1007/s00464-023-09868-0] [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: 08/19/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Patients who have undergone bariatric surgery are at increased risk of an alcohol use disorder. Though patients understand this risk, the majority engage in post-surgical alcohol use. This suggests that education alone is not sufficient to reduce post-surgical drinking. To prevent development of post-surgical alcohol use disorders, we need better understanding of the reasons patients use alcohol following surgery. The purpose of this study was to identify factors associated with post-surgical alcohol use. METHOD Patients (N = 20) who were 1-3 years post-bariatric surgery and were consuming alcohol at least twice monthly participated in a 60-min interview. Participants responded about their knowledge regarding risk of post-surgical alcohol use and reasons why patients may start drinking. Deductive and inductive coding were completed by two independent raters. RESULTS Although nearly all participants were aware of the risks associated with post-surgical alcohol use, most believed that lifelong abstinence from alcohol was unrealistic. Common reasons identified for using alcohol after bariatric surgery included social gatherings, resuming pre-surgical use, and addiction transfer. Inductive coding identified three themes: participants consumed alcohol in different ways compared to prior to surgery; the effect of alcohol was substantially stronger than pre-surgery; and beliefs about why patients develop problematic alcohol use following surgery. CONCLUSION Patients consume alcohol after bariatric surgery for a variety of reasons and they do not believe recommending abstinence is useful. Understanding patient perceptions can inform interventions to minimize alcohol use after bariatric surgery. Modifications to traditional alcohol relapse prevention strategies may provide a more robust solution to decreasing negative outcomes experienced by individuals undergoing bariatric surgery.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, 1 Ford Place, 3A, Detroit, MI, 48202, USA.
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA.
| | - Leah M Hecht
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Nancy P Barnett
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Roland S Moore
- Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | - Kristina M Jackson
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | | | - Kellie M Martens
- Behavioral Health, Henry Ford Health, 1 Ford Place, 3A, Detroit, MI, 48202, USA
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health, 1 Ford Place, 3A, Detroit, MI, 48202, USA
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
| | - Julia W Felton
- Behavioral Health, Henry Ford Health, 1 Ford Place, 3A, Detroit, MI, 48202, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | | | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health, 1 Ford Place, 3A, Detroit, MI, 48202, USA
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
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14
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Varban OA, Hassett KP, Yost M, Carlin AM, Ghaferi AA, Finks JF, Ehlers AP. Financial Impact of Metabolic Surgery on Prescription Diabetes Medications in Michigan. JAMA Surg 2023; 158:554-556. [PMID: 36857073 PMCID: PMC9979000 DOI: 10.1001/jamasurg.2022.7749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/29/2022] [Indexed: 03/02/2023]
Abstract
This study compares expenditures for diabetes medications before and after metabolic surgery among patients with diabetes in Michigan.
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Affiliation(s)
| | | | | | | | - Amir A. Ghaferi
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Jonathan F. Finks
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
| | - Anne P. Ehlers
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
- Department of Surgery, University of Michigan, Ann Arbor
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15
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Miller-Matero LR, Adkins E, Zohr SJ, Martens KM, Hamann A, Snodgrass M, Maye M, Braciszewski JM, Szymanski W, Green S, Genaw J, Carlin AM. Utility of phosphatidylethanol testing as an objective measure of alcohol use during the preoperative evaluation for bariatric surgery. Surg Obes Relat Dis 2023; 19:158-164. [PMID: 36443213 DOI: 10.1016/j.soard.2022.10.025] [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: 08/15/2022] [Revised: 10/11/2022] [Accepted: 10/21/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The risk of alcohol use disorder increases after bariatric surgery. Preoperative alcohol use is a risk factor, and this is evaluated during the routine preoperative psychosocial evaluation. However, it is not clear whether patients accurately report their alcohol use. OBJECTIVE To determine whether an objective measure of alcohol use, phosphatidylethanol (PEth) testing, offers utility beyond self-reported alcohol use during the preoperative evaluation for bariatric surgery. SETTING Single healthcare system. METHODS PEth testing was included as part of the routine laboratory work for 139 patients undergoing evaluation for bariatric surgery. PEth testing results were compared with self-reported alcohol use and scores on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) questionnaire obtained during the preoperative psychosocial evaluation. PEth testing results were categorized into abstinent, light use, moderate use, or heavy use. There were 85 patients who completed both PEth testing and a preoperative psychosocial evaluation. RESULTS There were 25 participants (29.4%) who had a positive PEth test; about half had moderate or heavy use values (15.3% of the total sample). The majority of participants with a positive PEth test (82.6%) denied recent alcohol use. Of those with PEth values indicating moderate or heavy use, 61.5% did not have an elevated AUDIT-C score. CONCLUSIONS Patients appeared to underreport their alcohol use during the preoperative psychosocial evaluation. There appears to be utility for routine PEth testing as part of the evaluation process to identify those with risky drinking patterns. Patients with preoperative risky drinking could be educated about their risk and/or referred to programs to mitigate the development of preoperative alcohol misuse.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan.
| | - Elise Adkins
- Behavioral Health, Henry Ford Health, Detroit, Michigan
| | | | - Kellie M Martens
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Maunda Snodgrass
- Behavioral Health, Henry Ford Health, Detroit, Michigan; Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Melissa Maye
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | - Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, Michigan
| | | | - Sally Green
- Department of Surgery, Henry Ford Health, Detroit, Michigan
| | - Jeffrey Genaw
- Department of Surgery, Henry Ford Health, Detroit, Michigan
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16
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Vitous CA, Carlin AM, Waljee J, Stricklen A, Ross R, Ghaferi A, Ehlers AP. Factors that influence discharge opioid prescribing among bariatric surgeons across Michigan. Am J Surg 2023; 225:184-190. [PMID: 35933183 DOI: 10.1016/j.amjsurg.2022.07.023] [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: 06/29/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Opioid prescribing following bariatric surgery has been a focus due to its association with new persistent opioid use (NPOU) and worse outcomes. Guidelines have led to a reduction in opioids prescribed, but there remains variation in prescribing practices. METHODS We conducted interviews with 20 bariatric surgeons across Michigan. Transcripts were analyzed using descriptive content analysis. RESULTS At the patient level, surgeons described the role of surgical history and pain tolerance. At the provider level, surgeons discussed patient dissatisfaction, reputation, and workload. At the institution level, surgeons discussed colleagues, resources, and administration. At a collaborative level, surgeons described the role of evidence and performance measures. There was lack of consensus on whether NPOU is a problem facing patients undergoing bariatric surgery. CONCLUSION Despite efforts aimed at addressing opioid prescribing, variability exists in prescribing practices. Understanding determinants that impact stakeholder alignment is critical to increasing adherence to guideline-concordant care.
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Affiliation(s)
- C Ann Vitous
- Michigan Bariatric Surgical Collaborative, United States; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, United States.
| | - Arthur M Carlin
- Michigan Bariatric Surgical Collaborative, United States; Henry Ford Health System, Detroit, United States
| | - Jennifer Waljee
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, United States; Department of Surgery, University of Michigan, Ann Arbor, United States
| | | | - Rachel Ross
- Michigan Bariatric Surgical Collaborative, United States
| | - Amir Ghaferi
- Michigan Bariatric Surgical Collaborative, United States; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, United States; Department of Surgery, University of Michigan, Ann Arbor, United States
| | - Anne P Ehlers
- Michigan Bariatric Surgical Collaborative, United States; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, United States; Department of Surgery, University of Michigan, Ann Arbor, United States
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17
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Hider AM, Bonham AJ, Carlin AM, Finks JF, Ghaferi AA, Varban OA, Ehlers AP. Impact of concurrent hiatal hernia repair during laparoscopic sleeve gastrectomy on patient-reported gastroesophageal reflux symptoms: a state-wide analysis. Surg Obes Relat Dis 2022; 19:619-625. [PMID: 36586763 DOI: 10.1016/j.soard.2022.12.021] [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: 07/28/2022] [Revised: 10/21/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Concurrent hiatal hernia repair (HHR) during laparoscopic sleeve gastrectomy (LSG) may improve gastroesophageal reflux disease (GERD) symptoms. However, patient-reported outcomes are limited, and the influence of surgeon technique remains unclear. OBJECTIVES To assess patient-reported GERD severity before and after LSG with and without concomitant HHR. SETTING Teaching and non-teaching hospitals participating in a state-wide quality improvement collaborative. METHODS Using a state-wide bariatric-specific data registry, all patients who underwent a primary LSG between 2015 and 2019 who completed a baseline and 1 year validated GERD health related quality of life (GERD-HRQL) survey were identified (n = 11,742). GERD severity at 1 year as well as 30-day risk-adjusted adverse events was compared between patients who underwent LSG with or without HHR. Results were also stratified by anterior versus posterior HHR. RESULTS A total of 4015 patients underwent a LSG-HHR (34%). Compared to patients who underwent LSG without HHR, LSG-HHR patients were older (47.8 yr versus 44.6 yr; P < .0001), had a lower preoperative body mass index (BMI) (45.8 kg/m2 versus 48 kg/m2; P < .0001) and more likely to be female (85.2% versus 77.6%, P < .0001). Patients who underwent a posterior HHR (n = 3205) experienced higher rates of symptom improvement (69.5% versus 64.0%, P = .0014) and lower rates of new onset symptoms at 1 year (28.2% versus 30.2%, P = .0500). Patients who underwent an anterior HHR (n = 496) experienced higher rates of hemorrhage and readmissions with no significant difference in symptom improvement. CONCLUSIONS Concurrent posterior hiatal HHR at the time of sleeve gastrectomy can improve reflux symptoms. Patients undergoing anterior repair derive no benefit and should be avoided.
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Affiliation(s)
- Ahmad M Hider
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
| | - Aaron J Bonham
- Center for Healthcare Outcomes & Policy, Ann Arbor, Michigan
| | | | - Jonathan F Finks
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes & Policy, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Oliver A Varban
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes & Policy, Ann Arbor, Michigan
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18
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Yang P, Bonham AJ, Carlin AM, Finks JF, Ghaferi AA, Varban OA. Patient characteristics and outcomes among bariatric surgery patients with high narcotic overdose scores. Surg Endosc 2022; 36:9313-9320. [PMID: 35411461 DOI: 10.1007/s00464-022-09205-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/21/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity-related chronic pain can increase the risk of narcotic abuse in bariatric surgery patients. However, assessment of overdose risk has not been evaluated to date. METHODS A NARxCHECK® overdose score ("Narx score") was obtained preoperatively on all patients undergoing bariatric surgery (n = 306) between 2018 and 2020 at a single-center academic bariatric surgery program. The 3-digit score ranges from 000 to 999 and is based on patient risk factors found within the Prescription Drug Monitoring Program. A Narx score ≥ 200 indicates tenfold increased risk of narcotic overdose. Patient characteristics, comorbidities, and emergency room (ER) visits were compared between patients in the upper (≥ 200) and lower (000) terciles of Narx scores. Morphine milligram equivalent (MME) prescribed at discharge and refills was also evaluated. RESULTS Patients in the upper tercile represented 32% (n = 99) of the study population, and compared to the lower tercile (n = 101, 33%), were more likely to have depression (63.6% vs 38.6%, p = 0.0004), anxiety (47.5% vs 30.7%, p = 0.0150), and bipolar disorder (6.1% vs 0.0%, p = 0.0120). Median MME prescribed at discharge was the same between both groups (75); however, high-risk patients were more likely to be prescribed more than 10 tablets of a secondary opioid (83.3% vs 0.0%, p = 0.0111), which was prescribed by another provider in 67% of cases. ER visits among patients who did not have a complication or require a readmission was also higher among high-risk patients (7.8% vs 0.0%, p = 0.0043). There were no deaths or incidents of mental health-related ER visits in either group. CONCLUSION Patients with a Narx score ≥ 200 were more likely to have mental health disorders and have potentially avoidable ER visits in the setting of standardized opioid prescribing practices. Narx scores can help reduce ER visits by identifying at-risk patients who may benefit from additional clinic or telehealth follow-up.
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Affiliation(s)
- Phillip Yang
- 2926 Taubman Center, University of Michigan Medical School, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA.
| | - Aaron J Bonham
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | | | - Amir A Ghaferi
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
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19
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Carlin AM, Varban OA, Ehlers AP, Bonham AJ, Ghaferi AA, Finks JF. Independent predictors and timing of portomesenteric vein thrombosis after bariatric surgery. Surg Obes Relat Dis 2022; 18:1385-1391. [PMID: 36198496 DOI: 10.1016/j.soard.2022.07.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/09/2022] [Accepted: 07/22/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Portomesenteric vein thrombosis (PVT) is a rare complication following bariatric surgery but can result in severe morbidity as well as death. OBJECTIVE Identification of risk factors for PVT to facilitate targeted management strategies to reduce incidence. SETTING Prospective, statewide bariatric-specific clinical registry. METHODS We identified all patients who underwent primary bariatric surgery between June 2006 and November 2021 (n = 102,869). Patient characteristics, procedure type, operative details, and 30-day postoperative complications were analyzed with multivariable logistic regression to evaluate for independent predictors of PVT. RESULTS A total of 117 patients (.11%) developed a postoperative PVT, with 6 (5.1%) associated deaths. The majority of PVTs occurred in patients who underwent sleeve gastrectomy (109 patients; 93.2%), and the PVT occurred most commonly during the second (37%), third (31%), and fourth weeks (23%) after surgery. Independent risk factors for PVT included a prior history of venous thromboembolism (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 1.64-5.98; P = .0005), liver disorder (OR = 2.3; 95% CI: 1.36-4.00; P = .0021), undergoing sleeve gastrectomy (OR = 12.4; 95% CI: 4.98-30.69; P < .0001), and postoperative complications including obstruction (OR = 12.5; 95% CI: 4.65-33.77; P < .0001), leak (OR = 7.9; 95% CI: 2.76-22.64; P = .0001), and hemorrhage (OR = 7.6; 95% CI: 3.57-16.06; P < .0001). CONCLUSIONS Independent predictors of PVT include a prior history of venous thromboembolism, liver disease, undergoing sleeve gastrectomy, and experiencing a serious postoperative complication. Given that the incidence of PVT is most common within the first month after surgery, extending postdischarge chemoprophylaxis during this time frame is advised for patients with increased risk.
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Affiliation(s)
- Arthur M Carlin
- Department of Surgery, Henry Ford Health, Detroit, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan.
| | - Oliver A Varban
- Department of Surgery, Henry Ford Health, Detroit, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Aaron J Bonham
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Jonathan F Finks
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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20
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Vitous CA, Stricklen AL, Ross RA, Ghaferi AA, Carlin AM, Ehlers AE. Factors That Influence Discharge Opioid Prescribing among Bariatric Surgeons across Michigan. J Am Coll Surg 2022. [DOI: 10.1097/01.xcs.0000895608.54025.53] [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: 11/25/2022]
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21
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Ehlers AP, Bonham AJ, Ghaferi AA, Finks JF, Carlin AM, Varban OA. Impact of hiatal hernia repair technique on patient-reported gastroesophageal reflux symptoms following laparoscopic sleeve gastrectomy. Surg Endosc 2022; 36:6815-6821. [PMID: 35854122 DOI: 10.1007/s00464-021-08970-5] [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: 09/01/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Repairing a hiatal hernia at the time of laparoscopic sleeve gastrectomy (SG) can reduce or even prevent gastroesophageal reflux disease (GERD) symptoms in the post-operative period. Several different hiatal hernia repair techniques have been described but their impact on GERD symptoms after SG is unclear. METHODS Surgeons (n = 74) participating in a statewide quality collaborative were surveyed on their typical technique for repair of hiatal hernias during SG. Options included posterior repair with mesh (PRM), posterior repair (PR), and anterior repair (AR). Patients who underwent SG with concurrent hiatal hernia repair (n = 7883) were compared according to their surgeon's reported technique. Patient characteristics, baseline and 1-year GERD health-related quality of life surveys, weight loss and 30-day risk-adjusted complications were analyzed. RESULTS The most common technique reported by surgeons for hiatal hernia repair was PR (n = 64, 85.3%), followed by PRM (n = 7, 9.3%) and AR (n = 4, 5.3%). Patients who underwent SG by surgeons who perform AR had lower rates of baseline GERD diagnosis (AR 55.3%, PR 59.5%, PRM 64.8%, p < 0.01), but were more likely to experience worsening GERD symptoms at 1 year (AR 29.8%, PR 28.7%, PRM 28.2%, p < 0.0001), despite similar weight loss (AR 29.8%, PR 28.7%, PRM 28.2%, p = 0.08). Satisfaction with GERD symptoms at 1 year was high (AR 73.2%, PR 76.3%, PRM 75.7%, p = 0.43), and risk-adjusted 30-day outcomes were similar among all groups. CONCLUSIONS Patients undergoing SG with concurrent hiatal hernia repair by surgeons who typically perform an AR were more likely to report worsening GERD at 1 year despite excellent weight loss. Surgeons who typically performed an AR had nearly one-half of their patients report increased GERD severity after surgery despite similar weight loss. While GERD symptom control may be multifactorial, technical approach to hiatal hernia repair at the time of SG may play a role and a posterior repair is recommended.
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Affiliation(s)
- Anne P Ehlers
- Department of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA.
- Center for Healthcare Outcomes & Policy, Ann Arbor, MI, USA.
| | - Aaron J Bonham
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Department of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes & Policy, Ann Arbor, MI, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Jonathan F Finks
- Department of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Oliver A Varban
- Department of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
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22
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Lehman HS, Diaz S, Dandalides A, Carlin AM. Feasibility of an Opioid Sparing Discharge Protocol Following Laparoscopic Bariatric Surgery. Obes Surg 2022; 32:1-6. [PMID: 35507273 DOI: 10.1007/s11695-022-06094-w] [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: 02/17/2022] [Revised: 04/16/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Opioids are commonly prescribed after laparoscopic bariatric surgery but have untoward effects including dependence and diversion. Prior investigation revealed that over three-fourths of discharge opioids prescribed to our patients went unused. OBJECTIVES To determine the feasibility of an opioid sparing discharge protocol following laparoscopic bariatric surgery. METHODS A total of 212 opioid-naïve patients undergoing laparoscopic bariatric surgery were examined and divided into two groups; 106 prior to (Cohort A) and 106 after implementation of an opioid sparing discharge protocol (Cohort B). Opioids were converted to morphine milligram equivalents (MME) and post-operative consumption was examined. Data was described as mean ± standard deviation. RESULTS No patients in Cohort B and 54.7% (58) in Cohort A received an opioid discharge prescription (37.5 MME). Of the 154 patients that remained, only 1.3% (2) received one after discharge. Cohort A took greater amounts of opioids than Cohort B after discharge (4.74 ± 11 vs. 0.21 ± 2 MME; p < 0.001). During hospitalization, Cohort A took greater amounts of opioids (6.92 ± 11 vs. 2.74 ± 5 MME; p < 0.001) but lower amounts of methocarbamol (759 ± 590 vs. 966 ± 585 mg; p = 0.011). No patient requested an opioid prescription refill or presented to the emergency room secondary to pain. CONCLUSION Following laparoscopic bariatric surgery, an opioid sparing discharge protocol is feasible with < 2% of patients receiving opioids after discharge and no increase in emergency room visits. Education regarding these protocols may impact the amount of opioids taken during hospitalization.
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Affiliation(s)
- Haley S Lehman
- Department of Surgery, Henry Ford Macomb Hospital, 15855 19 Mile Road, Clinton Township, MI, 48038, USA.
| | - Sarah Diaz
- Department of Surgery, St. Joseph Mercy Ann Arbor, Ypsilanti, MI, 48917, USA
| | - Alissa Dandalides
- Department of Surgery, Henry Ford Macomb Hospital, 15855 19 Mile Road, Clinton Township, MI, 48038, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health, Detroit, MI, 48202, USA
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23
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Varban OA, Cain-Nielsen AH, Wood MH, Carlin AM, Ghaferi AA, Telem DA. Adopt or Abandon? Surgeon-Specific Trends in Robotic Bariatric Surgery Utilization Between 2010 and 2019. J Laparoendosc Adv Surg Tech A 2022; 32:768-774. [PMID: 35041519 DOI: 10.1089/lap.2021.0150] [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] [Indexed: 11/13/2022] Open
Abstract
Background: It is unknown if surgeons are more likely to adopt or abandon robotic techniques given that bariatric procedures are already performed by surgeons with advanced laparoscopic skills. Methods: We used a statewide bariatric-specific data registry to evaluate surgeon-specific volumes of robotic bariatric cases between 2010 and 2019. Operative volume, procedure type, and patient characteristics were compared between the highest utilizers of robotic bariatric procedures (adopters) and surgeons who stopped performing robotic cases, despite demonstrating prior use (abandoners). Results: A total of 44 surgeons performed 3149 robotic bariatric procedures in Michigan between 2010 and 2019. Robotic utilization peaked in 2019, representing 7.24% of all bariatric cases. We identified 7 surgeons (16%) who performed 95% of the total number of robotic cases (adopters) and 12 surgeons (27%) who stopped performing bariatric cases during the study period (abandoners). Adopters performed a higher proportion of gastric bypass both robotically (22.9% versus 3.1%, P < .001) and laparoscopically (27.5% versus 15.1%, P < .001), when compared with abandoners. Surgeon experience (no. of years in practice), type of practice (teaching versus nonteaching hospital), and patient populations were similar between groups. Conclusions: Robotic bariatric utilization increased during the study period. The majority of robotic cases were performed by a small number of surgeons who were more likely to perform more complex cases such as gastric bypass in their own practice. Robotic adoption may be influenced by surgeon-specific preferences based upon procedure-specific volumes and may play a greater role in performing more complex surgical procedures in the future.
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Affiliation(s)
- Oliver A Varban
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne H Cain-Nielsen
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael H Wood
- Department of Surgery, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Dana A Telem
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.,Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
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24
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Varban OA, Bonham AJ, Carlin AM, Finks JF, Ghaferi AA, Ehlers AP. Independent Predictors of Discontinuation of Diabetic Medications after Sleeve Gastrectomy and Gastric Bypass: Does Procedure Type Matter? J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.020] [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: 11/25/2022]
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25
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Martens K, Pester BD, Hecht LM, Herb Neff KM, Clark-Sienkiewicz SM, Hamann A, Carlin AM, Miller-Matero LR. Adherence to Post-operative Appointments Is Associated with Weight Loss Following Bariatric Surgery. Obes Surg 2021; 31:5494-5496. [PMID: 34651288 DOI: 10.1007/s11695-021-05717-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Kellie Martens
- Department of Surgery, Henry Ford Health System, Detroit, MI, 48202, USA.
- Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA.
| | - Bethany D Pester
- Department of Surgery, Henry Ford Health System, Detroit, MI, 48202, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Leah M Hecht
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Kirstie M Herb Neff
- Department of Surgery, Henry Ford Health System, Detroit, MI, 48202, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Shannon M Clark-Sienkiewicz
- Department of Surgery, Henry Ford Health System, Detroit, MI, 48202, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Aaron Hamann
- Department of Surgery, Henry Ford Health System, Detroit, MI, 48202, USA
- Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, 48202, USA
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26
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Miller-Matero LR, Orlovskaia J, Hecht LM, Braciszeweski JM, Martens KM, Hamann A, Carlin AM. Hazardous Alcohol Use in the Four Years Following Bariatric Surgery. PSYCHOL HEALTH MED 2021; 27:1884-1890. [PMID: 34096405 DOI: 10.1080/13548506.2021.1930075] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to estimate the prevalence of hazardous drinking in the four years after bariatric surgery and investigate whether there are differences between those undergoing Roux-en-Y gastric bypass and sleeve gastrectomy. Participants (N = 564) who underwent bariatric surgery between 2014 and 2017 completed a survey regarding post-surgical alcohol use. The rate of alcohol use following bariatric surgery was significantly higher among those between 1- and 4-years post-surgery compared to those less than 1-year post-surgery. Of those who were consuming alcohol at the time of participation, 16.1% had scores indicative of hazardous drinking. The rate of hazardous drinking among those 3-4 years post-surgery was greater than those less than 1-year post-surgery with 33.3% of patients engaging in hazardous drinking at 3-4 years post-surgery. Patients undergoing sleeve gastrectomy had similar rates of hazardous drinking as RYGB (16.3% vs. 15.7%). Thus, findings showed that rates of hazardous drinking were higher among those further removed from bariatric surgery and patients undergoing sleeve gastrectomy appeared to have similar rates of hazardous drinking as those who underwent RYGB. Results suggest a need for monitoring of alcohol use for all patients pursuing bariatric surgery, regardless of surgery type.
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Affiliation(s)
- Lisa R Miller-Matero
- Henry Ford Health System, Behavioral Health, Detroit, MI USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | | | - Leah M Hecht
- Henry Ford Health System, Behavioral Health, Detroit, MI USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Jordan M Braciszeweski
- Henry Ford Health System, Behavioral Health, Detroit, MI USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Kellie M Martens
- Henry Ford Health System, Behavioral Health, Detroit, MI USA.,Department of General Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Aaron Hamann
- Henry Ford Health System, Behavioral Health, Detroit, MI USA.,Department of General Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Arthur M Carlin
- Department of General Surgery, Henry Ford Health System, Detroit, MI, USA
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27
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Nasser H, Ivanics T, Varban OA, Finks JF, Bonham A, Ghaferi AA, Carlin AM. Comparison of early outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy among patients with body mass index ≥ 60 kg/m 2. Surg Endosc 2021; 35:3115-3121. [PMID: 32572625 DOI: 10.1007/s00464-020-07750-x] [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: 04/03/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is no consensus on the ideal bariatric operation to choose for patients with extremely high body mass index (BMI). The aim of this study was to compare the perioperative complications, weight loss, and comorbidity remission between laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) among patients with BMI ≥ 60 kg/m2. METHODS Data from a statewide bariatric surgery registry were used to identify all patients with BMI ≥ 60 kg/m2 undergoing LRYGB or LSG between January 2006 and June 2019. Risk and reliability adjustment were used to compare outcomes between the two groups. RESULTS A total of 6015 patients were identified and 2505 (41.6%) underwent LRYGB and 3510 (58.4%) underwent LSG. The overall mean age was 43.1 ± 11.2 years with a mean preoperative BMI of 66.7 ± 6.4 kg/m2. Females accounted for 69.3% and the majority were either white (68.5%) or black (21.2%). LRYGB was associated with a higher rate of adjusted 30-day postoperative serious complications (4.0% vs 2.2%; p < 0.01) including anastomotic leak, obstruction, and bleeding. Resource utilization was also higher with LRYGB (23.7% vs 14.8%; p < 0.01) and included more emergency department visits, readmissions, reoperations, and length of stay ≥ 4 days. The overall 1-year follow-up rate was 38.8%. The adjusted percent total weight loss at 1 year was significantly higher following LRYGB compared to LSG (36.6 ± 9.3 vs 31.3 ± 9.3%; p < 0.01). LRYGB was associated with a higher rate of treatment discontinuation for diabetes mellitus, hyperlipidemia, and obstructive sleep apnea. CONCLUSIONS In patients with BMI ≥ 60 kg/m2, LRYGB was associated with better weight loss and medication discontinuation 1 year following surgery at the expense of an increase in perioperative complications and resource utilization compared to LSG.
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Affiliation(s)
- Hassan Nasser
- Department of Surgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
| | - Tommy Ivanics
- Department of Surgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
| | - Oliver A Varban
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan F Finks
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Aaron Bonham
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202, USA
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28
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Varban OA, Bonham AJ, Stricklen AL, Ross R, Carlin AM, Finks JF, Ghaferi AA. Am I on Track? Evaluating Patient-Specific Weight Loss After Bariatric Surgery Using an Outcomes Calculator. Obes Surg 2021; 31:3210-3217. [PMID: 33825152 DOI: 10.1007/s11695-021-05397-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/21/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Individual weight loss outcomes after bariatric surgery can vary considerably. As a result, identifying and assisting patients who are not on track to reach their weight loss goals can be challenging. MATERIALS AND METHODS Using a bariatric surgery outcomes calculator, which was formulated using a state-wide bariatric-specific data registry, predicted weight loss at 1 year after surgery was calculated on 658 patients who underwent bariatric surgery at 35 different bariatric surgery programs between 2015 and 2017. Patient characteristics, postoperative complications, and weight loss trajectories were compared between patients who met or exceeded their predicted weight loss calculation to those who did not based on observed to expected weight loss ratio (O:E) at 1 year after surgery. RESULTS Patients who did not meet their predicted weight loss at 1 year (n = 237, 36%) had a mean O:E of 0.71, while patients who met or exceeded their prediction (n = 421, 63%) had a mean O:E = 1.14. At 6 months, there was a significant difference in the percent of the total amount of predicted weight loss between the groups (88% of total predicted weight loss for those that met their 1-year prediction vs 66% for those who did not, p < 0.0001). Age, gender, procedure type, and risk-adjusted complication rates were similar between groups. CONCLUSION Using a bariatric outcomes calculator can help set appropriate weight-loss expectations after surgery and also identify patients who may benefit from additional therapy prior to reaching their weight loss nadir.
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Affiliation(s)
- Oliver A Varban
- Department of Surgery, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA.
| | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA
| | - Amanda L Stricklen
- Center for Healthcare Outcomes and Policy, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA
| | - Rachel Ross
- Center for Healthcare Outcomes and Policy, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Jonathan F Finks
- Department of Surgery, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA.,Center for Healthcare Outcomes and Policy, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA
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29
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Hecht LM, Hadwiger A, Martens K, Hamann A, Carlin AM, Miller-Matero LR. The association between number of children and weight loss outcomes among individuals undergoing bariatric surgery. Surg Obes Relat Dis 2021; 17:1127-1131. [PMID: 33814316 DOI: 10.1016/j.soard.2021.02.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Existing research demonstrates that parity is associated with risk for obesity. The majority of those who undergo bariatric surgery are women, yet little is known about whether having children before bariatric surgery is associated with pre- and postsurgical weight outcomes. OBJECTIVES We aim to evaluate presurgical body mass index (BMI) and postsurgical weight loss among a racially diverse sample of women with and without children. SETTING Metropolitan hospital system. METHODS Women (n = 246) who underwent bariatric surgery were included in this study. Participants self-reported their number of children. Presurgical BMI and postsurgical weight outcomes at 1 year, including change in BMI (ΔBMI), percentage excess weight loss (%EWL), and percentage total weight loss (%TWL) were calculated from measured height and weight. RESULTS Those with children had a lower presurgical BMI (P = .01) and had a smaller ΔBMI (P = .01) at 1 year after surgery than those without children, although %EWL and %TWL at 1 year did not differ by child status or number of children. After controlling for age, race, and surgery type, the number of children a woman had was related to smaller ΔBMI at 1 year post surgery (P = .01). CONCLUSIONS Although women with children had lower reductions in BMI than those without children, both women with and without children achieved successful postsurgical weight loss. Providers should assess for number of children and be cautious not to deter women with children from having bariatric surgery.
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Affiliation(s)
- Leah M Hecht
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
| | - Ashley Hadwiger
- Behavioral Health Department, Henry Ford Health System, Detroit, Michigan
| | - Kellie Martens
- Behavioral Health Department, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Aaron Hamann
- Behavioral Health Department, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Lisa R Miller-Matero
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan; Behavioral Health Department, Henry Ford Health System, Detroit, Michigan
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30
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Miller-Matero LR, Hamann A, LaLonde L, Martens KM, Son J, Clark-Sienkiewicz S, Sata M, Coleman JP, Hecht LM, Braciszewski JM, Carlin AM. Predictors of Alcohol Use after Bariatric Surgery. J Clin Psychol Med Settings 2020; 28:596-602. [PMID: 33205321 DOI: 10.1007/s10880-020-09751-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 12/25/2022]
Abstract
Patients undergoing bariatric surgery are at risk for devloping an alcohol use disorder (AUD). The purpose of this study was to investigate pre-surgical psychosocial risk factors for post-surgical alcohol consumption and hazardous drinking. Participants (N = 567) who underwent bariatric surgery between 2014 and 2017 reported their post-surgical alcohol use. Information was collected from the pre-surgical evaluation including history of alcohol use, psychiatric symptoms, and maladaptive eating behaviors (i.e., binge eating, purging, and emotional eating). Younger age and pre-surgical alcohol use predicted post-surgical alcohol use and hazardous drinking. In addition, higher levels of depressive symptoms and maladaptive eating patterns predicted post-surgical binge drinking. Clinicians conducting pre-surgical psychosocial evaluations should be aware of the multiple risk factors related to post-surgical problematic alcohol use. Future research should evaluate whether preventive interventions for high-risk patients decrease risk for post-surgical alcohol misuse.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA. .,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA.
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA.,Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Leah LaLonde
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA
| | - Kellie M Martens
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA.,Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - John Son
- Wayne State University School of Medicine, Henry Ford Health System, Detroit, MI, USA
| | | | - Monika Sata
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA
| | - Joseph P Coleman
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Leah M Hecht
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Jordan M Braciszewski
- Behavioral Health, Henry Ford Health System, 1 Ford Place, 3A, Detroit, MI, 48202, USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA.,Wayne State University School of Medicine, Henry Ford Health System, Detroit, MI, USA
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31
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Alvarez R, Stricklen A, Buda CM, Ross R, Bonham AJ, Carlin AM, Varban OA, Ghaferi AA, Finks JF. Factors associated with completion of patient surveys 1 year after bariatric surgery. Surg Obes Relat Dis 2020; 17:538-547. [PMID: 33334677 DOI: 10.1016/j.soard.2020.10.028] [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: 04/15/2020] [Revised: 08/05/2020] [Accepted: 10/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patient-reported outcomes (PRO) obtained from follow-up survey data are essential to understanding the longitudinal effects of bariatric surgery. However, capturing data among patients who are well beyond the recovery period of surgery remains a challenge, and little is known about what factors may influence follow-up rates for PRO. OBJECTIVES To assess the effect of hospital practices and surgical outcomes on patient survey completion rates at 1 year after bariatric surgery. SETTING Prospective, statewide, bariatric-specific clinical registry. METHODS Patients at hospitals participating in the Michigan Bariatric Surgery Collaborative are surveyed annually to obtain information on weight loss, medication use, satisfaction, body image, and quality of life following bariatric surgery. Hospital program coordinators were surveyed in June 2017 about their practices for ensuring survey completion among their patients. Hospitals were ranked based on 1-year patient survey completion rates between 2011 and 2015. Multivariable regression analyses were used to identify associations between hospital practices, as well as 30-day outcomes, on hospital survey completion rankings. RESULTS Overall, patient survey completion rates at 1 year improved from 2011 (33.9% ± 14.5%) to 2015 (51.0% ± 13.0%), although there was wide variability between hospitals (21.1% versus 77.3% in 2015). Hospitals in the bottom quartile for survey completion rates had higher adjusted rates of 30-day severe complications (2.6% versus 1.7%, respectively; P = .0481), readmissions (5.0% versus 3.9%, respectively; P = .0157), and reoperations (1.5% versus .7%, respectively; P = .0216) than those in the top quartile. While most hospital practices did not significantly impact survey completion at 1 year, physically handing out surveys during clinic visits was independently associated with higher completion rates (odds ratio, 13.60; 95% confidence interval, 1.99-93.03; P =.0078). CONCLUSIONS Hospitals vary considerably in completion rates of patient surveys at 1 year after bariatric surgery, and lower rates were associated with hospitals that had higher complication rates. Hospitals with the highest completion rates were more likely to physically hand surveys to patients during clinic visits. Given the value of PRO on longitudinal outcomes of bariatric surgery, improving data collection across multiple hospital systems is imperative.
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Affiliation(s)
- Rafael Alvarez
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | | | - Colleen M Buda
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Rachel Ross
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Aaron J Bonham
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Arthur M Carlin
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Oliver A Varban
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Jonathan F Finks
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
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Martens K, Hamann A, Miller-Matero LR, Miller C, Bonham AJ, Ghaferi AA, Carlin AM. Relationship between depression, weight, and patient satisfaction 2 years after bariatric surgery. Surg Obes Relat Dis 2020; 17:366-371. [PMID: 33127323 DOI: 10.1016/j.soard.2020.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 04/21/2020] [Revised: 08/16/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Findings regarding longer term symptoms of depression and the impact of depression on outcomes such as weight loss and patient satisfaction, are mixed or lacking. OBJECTIVES This study sought to understand the relationship between depression, weight loss, and patient satisfaction in the two years after bariatric surgery. SETTING This study used data from a multi-institutional, statewide quality improvement collaborative of 45 different bariatric surgery sites. METHODS Participants included patients (N = 1991) who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2015-2018. Participants self-reported symptoms of depression (Patient Health Questionnaire-8 [PHQ-8]), satisfaction with surgery, and weight presurgery and 1 year and 2 years postsurgery. RESULTS Compared to presurgery, fewer patients' PHQ-8 scores indicated clinically significant depression (PHQ-8≥10) at 1 year (P < .001; 14.3% versus 5.1%) and 2 years postsurgery (P < .0001; 8.7%). There was a significant increase in the prevalence of clinical depression from the first to second year postsurgery (P < .0001; 5.1% versus 8.7%). Higher PHQ-8 at baseline was related to less weight loss (%Total Weight Loss [%TWL] and %Excess Weight Loss [%EWL]) at 1 year postsurgery (P < .001), with a trend toward statistical significance at 2 years (P = .06). Postoperative depression was related to lower %TWL and %EWL, and less reduction in body mass index (BMI) at 1 year (P < .001) and 2 years (P < .0001). Baseline and postoperative depression were associated with lower patient satisfaction at both postoperative time points. CONCLUSIONS This study suggests improvements in depression up to 2 years postbariatric surgery, although it appears that the prevalence of depression increases after the first year. Depression, both pre- and postbariatric surgery, may impact weight loss and patient satisfaction.
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Affiliation(s)
- Kellie Martens
- Department of Surgery, Henry Ford Health System, Detroit, Michigan; Behavioral Health, Henry Ford Health System, Detroit, Michigan.
| | - Aaron Hamann
- Department of Surgery, Henry Ford Health System, Detroit, Michigan; Behavioral Health, Henry Ford Health System, Detroit, Michigan
| | - Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Chazlyn Miller
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Aaron J Bonham
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
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Miller-Matero LR, Hecht L, Patel S, Martens KM, Hamann A, Carlin AM. The Influence of Health Literacy and Health Numeracy on Weight Loss Outcomes Following Bariatric Surgery. Surg Obes Relat Dis 2020; 17:384-389. [PMID: 33082073 DOI: 10.1016/j.soard.2020.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 07/08/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although cognitive functioning and health literacy are related to weight loss 1year following bariatric surgery, the influence of health numeracy (i.e., health-related mathematical abilities) is unknown. In addition, further research is needed to examine the impact of all these factors on longer-term weight loss outcomes to determine if they influence the ability to maintain weight loss. SETTING Single bariatric center. METHODS Patients (N = 567) who underwent bariatric surgery from 2014-2017 completed a brief survey including current weight. Retrospective chart reviews were conducted to gather information from the presurgical evaluation including weight, body mass index (BMI), health literacy, health numeracy and score on a cognitive screener. RESULTS Among participants in the weight loss period (< 2 years postsurgery), health literacy, health numeracy and cognitive functioning were not related to change in BMI (ΔBMI), percent total weight loss (%TWL) or percent excess weight loss (%EWL). However, for participants in the weight maintenance period (2-4 years postsurgery), higher health literacy scores were related to greater change in ΔBMI, and higher health numeracy scores were related to greater ΔBMI, %TWL, and %EWL. DISCUSSION Although health literacy and health numeracy did not predict weight loss outcomes for those in the initial weight loss period, they were related to weight outcomes for participants in the weight maintenance period. This suggests that health literacy and health numeracy may play a role in facilitating longer-term weight maintenance among patients who undergo bariatric surgery. Clinicians conducting presurgical psychosocial evaluations should consider routinely screening for health literacy and health numeracy.
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Affiliation(s)
- Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
| | - Leah Hecht
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Shivali Patel
- Behavioral Health, Henry Ford Health System, Detroit, Michigan
| | - Kellie M Martens
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Aaron Hamann
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
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Varban OA, Thumma JR, Carlin AM, Finks JF, Ghaferi AA, Dimick JB. Peer Assessment of Operative Videos with Sleeve Gastrectomy to Determine Optimal Operative Technique. J Am Coll Surg 2020; 231:470-477. [DOI: 10.1016/j.jamcollsurg.2020.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/12/2022]
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Clark-Sienkiewicz SM, Hecht LM, Pester B, Martens K, Hamann A, Carlin AM, Miller-Matero LR. Racial Differences in Psychological Symptoms and Eating Behaviors Among Bariatric Surgery Candidates. J Racial Ethn Health Disparities 2020; 8:94-98. [DOI: 10.1007/s40615-020-00761-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/29/2020] [Accepted: 04/13/2020] [Indexed: 12/26/2022]
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de Meireles A, Carlin AM, Cain-Nielsen A, Stricklen A, Ross R, Finks JF, Varban OA, Ghaferi AA. Association Between Surgeon Practice Knowledge and Venous Thromboembolism. Obes Surg 2020; 30:2274-2279. [PMID: 32062847 DOI: 10.1007/s11695-020-04468-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The most common cause of mortality following bariatric surgery is venous thromboembolism. Our study aimed to (1) determine the practice patterns of venous thromboembolism (VTE) chemoprophylaxis among bariatric surgeons participating in a large statewide quality collaborative and (2) compare the results of surgeon self-reported chemoprophylaxis practices to actual practices from abstracted chart data. METHODS We administered a 13-question survey to 66 surgeons across a statewide collaborative aimed at revealing VTE practice patterns such as medication type, dosage, timing, duration, and level of trainee involvement (response rate 93%). We conducted on-site data audits to examine the charts of all patients that had developed VTE during the study period and 15 other randomly selected patient charts per site. We then evaluated both the ordered perioperative chemoprophylaxis and the actual administered chemoprophylaxis from nursing and electronic records. RESULTS There was 31% overall discordance between self-reported and abstracted chart data for pre-operative VTE dosing regimens. Among patients who had a VTE, 39% of administered chemoprophylaxis did not match surgeon responses. Conversely, among patients who did not have a VTE, only 29% were discordant (p = 0.03). In contrast, for post-operative VTE dosing, there was no significant difference in the rate of discordance in patients with and without a VTE (47% discordance vs 38%, p = 0.0552, respectively). CONCLUSIONS Greater discordance between surgeon self-reported and actual perioperative VTE chemoprophylaxis is associated with significantly increased risk of VTE. Further understanding of the system characteristics associated with these practices may yield insights into how best to improve appropriate VTE chemoprophylaxis.
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Affiliation(s)
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | | | | | - Rachel Ross
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Jonathan F Finks
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA. .,Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA. .,Institute for Healthcare Policy & Innovation, University of Michigan, 2800 Plymouth Avenue Building 16, Rm 140-E, Ann Arbor, MI, 48109-2800, USA.
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Smith ME, Bacal D, Bonham AJ, Varban OA, Carlin AM, Ghaferi AA, Finks JF. Perioperative and 1-year outcomes of bariatric surgery in septuagenarians: implications for patient selection. Surg Obes Relat Dis 2019; 15:1805-1811. [PMID: 31530451 DOI: 10.1016/j.soard.2019.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 06/04/2019] [Revised: 07/12/2019] [Accepted: 08/03/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although bariatric surgery is an effective treatment for obesity, utilization of bariatric procedures in older adults remains low. Previous work reported higher morbidity in older patients undergoing bariatric surgery. However, the generalizability of these data to contemporary septuagenarians is unclear. OBJECTIVES We sought to evaluate differences in 30-day outcomes, 1-year weight loss, and co-morbidity remission after bariatric surgery among 3 age groups as follows: <45 years, 45-69 years, and ≥70 years. SETTING Statewide quality improvement collaborative. METHODS Using a large quality improvement collaborative, we identified patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 2006 and 2018. We used multivariable logistic regression models to evaluate the association between age cohorts and 30-day outcomes, 1-year weight loss, and co-morbidity remission. RESULTS We identified 641 septuagenarians who underwent SG (68.5%) or RYGB (31.5%). Compared with 45-69 year olds, septuagenarians had higher rates of hemorrhage (5.1% versus 3.1%; P = .045) after RYGB and higher rates of leak/perforation (.9% versus .3%; P = .044) after SG. Compared with younger patients, septuagenarians lost less of their excess weight, losing 64.8% after RYGB and 53.8% after SG. Remission rates for diabetes and obstructive sleep were similar for patients aged ≥70 years and 45-69 years. CONCLUSIONS Bariatric surgery in septuagenarians results in substantial weight loss and co-morbidity remission with an acceptable safety profile. Surgeons with self-imposed age limits should consider broadening their selection criteria to include patients ≥70 years old.
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Affiliation(s)
- Margaret E Smith
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Daniel Bacal
- Department of Surgery, Beaumont Hospital Dearborn, Dearborn, Michigan
| | - Aaron J Bonham
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
| | - Oliver A Varban
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Amir A Ghaferi
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jonathan F Finks
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
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Miller-Matero LR, Coleman JP, LaLonde L, Martens KM, Hamann A, Carlin AM. Patient Recall of Education about the Risks of Alcohol Use Following Bariatric Surgery. Obes Surg 2019; 29:2707-2710. [DOI: 10.1007/s11695-019-03940-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
Importance The outcomes of bariatric surgery vary considerably across patients, but the association of race with these measures remains unclear. Objective To examine the association of race on perioperative and 1-year outcomes of bariatric surgery. Design, Setting, and Participants Propensity score matching was used to assemble cohorts of black and white patients from the Michigan Bariatric Surgery Collaborative who underwent a primary bariatric operation (Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding) between June 2006 and January 2017. Cohorts were balanced on baseline characteristics and procedure. Conditional fixed-effects models were used to evaluate the association of race on outcomes within hospitals and surgeons. Data analysis occurred from June 2006 through August 2018. Main Outcomes and Measures Thirty-day complications and health care resource utilization measures, as well as 1-year weight loss, comorbidity remission, quality of life, and satisfaction. Results In each group, 7105 patients were included. Black patients had a higher rate of any complication (628 [8.8%] vs 481 [6.8%]; adjusted odds ratio, 1.33 [95% CI, 1.17-1.51]; P = .02), but there were no significant differences in the rates of serious complications (178 [2.5%] vs 135 [1.9%]; adjusted odds ratio, 1.32 [95% CI, 1.05-1.66]; P = .29) or mortality (5 [0.10%] vs 7 [0.10%]; adjusted odds ratio, 0.73 [95% CI, 0.23-2.31]; P = .54). Black patients had a greater length of stay (mean [SD], 2.2 [3.0] days vs 1.9 [1.7] days; adjusted odds ratio, 0.30 [95% CI, 0.20-0.40]; P < .001), as well as a higher rate of emergency department visits (541 [11.6%] vs 826 [7.6%]; adjusted odds ratio, 1.60 [95% CI, 1.43-1.79]; P < .001) and readmissions (414 [5.8%] vs 245 [3.5%]; adjusted odds ratio, 1.73 [95% CI, 1.47-2.03]; P < .001). At 1 year, black patients had lower mean total body weight loss and as a percentage of weight (32.0 kg [26%]; vs 38.3 kg [29%]; P < .001) and this held true across procedures. Remission of hypertension was lower for black patients (564 [40.0%] vs 1096 [56.0%]; P < .001), but the rate of sleep apnea remission (467 [62.6%] vs 615 [56.1%]; P = .005) and gastroesophageal reflux disease (309 [78.6%] vs 453 [75.4%]; P = .049) were higher. There were no significant differences in remission of diabetes with insulin dependence, diabetes without insulin dependence,or hyperlipidemia hyperlipidemia. Fewer black patients than white patients reported a good or very good quality of life (1379 [87.2%] vs 2133 [90.4%]; P = .002) and being very satisfied with surgery (1908 [78.4%] vs 2895 [84.2%]; P < .001) at 1 year. Conclusions and Relevance Black patients undergoing bariatric surgery in Michigan had significantly higher rates of 30-day complications and resource utilization and experienced lower weight loss at 1 year than a matched cohort of white patients. While sleep apnea and gastroesophageal reflux disease remission were higher and hypertension remission lower in black patients, comorbidity remission was otherwise similar between matched cohorts. Racial and cultural differences among patients should be considered when designing strategies to optimize outcomes with bariatric surgery.
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Affiliation(s)
- Michael H Wood
- Department of Surgery, Harper University Hospital and Wayne State University, Detroit, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan.,Department of Surgery, Wayne State University, Detroit, Michigan
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan Health Systems, Ann Arbor
| | - Oliver A Varban
- Department of Surgery, St John Providence Health System and Wayne State University, Detroit, Michigan
| | - Abdelkader Hawasli
- Department of Surgery, St John Providence Health System and Wayne State University, Detroit, Michigan
| | - Aaron J Bonham
- Department of Surgery, University of Michigan Health Systems, Ann Arbor
| | - Nancy J Birkmeyer
- Department of Surgery, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Jonathan F Finks
- Department of Surgery, University of Michigan Health Systems, Ann Arbor
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Martens KM, Hamann A, Miller-Matero LR, Miller C, Bonham AJ, Carlin AM. Relationship between depression, weight, and patient satisfaction two years after bariatric surgery. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.168] [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: 10/27/2022]
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Varban OA, Thumma J, Carlin AM, Finks JF, Ghaferi AA, Dimick JB. Analysis of Self vs Peer Ratings of Surgical Skill with Bariatric Surgery. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.113] [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: 11/24/2022]
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Miller-Matero LR, Coleman JP, LaLonde L, Martens KM, Hamann A, Carlin AM. The BARS Study: Patient Understanding and Use of Alcohol after Bariatric Surgery. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.170] [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: 11/29/2022]
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Carlin AM, Varban OA, Finks JF, Weiner MJ, Bonham AJ, Ghaferi AA. Postoperative complications increase the risk of venous thromboembolism following sleeve gastrectomy and gastric bypass. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Smith ME, Lee JS, Bonham A, Varban OA, Finks JF, Carlin AM, Ghaferi AA. Effect of new persistent opioid use on physiologic and psychologic outcomes following bariatric surgery. Surg Endosc 2018; 33:2649-2656. [PMID: 30353238 DOI: 10.1007/s00464-018-6542-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 04/14/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION New persistent opioid use following surgery is a common iatrogenic complication, developing in roughly 6% of patients after elective surgery. Despite increased awareness of misuse and associated morbidity, opioids remain the cornerstone of pain management in bariatric surgery. The potential impact of new persistent opioid use on long-term postoperative outcomes is unknown. We sought to determine the relationship between new persistent opioid use and 1-year postoperative outcomes for patients undergoing bariatric surgery. METHODS Using data from the MBSC registry, we identified patients undergoing primary bariatric surgery between 2006 and 2016. Using previously validated patient-reported survey methodology, we evaluated patient opioid use preoperatively and at 1 year following surgery. New persistent use was defined as a previously opioid-naïve patient who self-reported opioid use 1 year after surgery. We used multivariable logistic regression models to evaluate the association between new persistent opioid use, risk-adjusted weight loss, and psychologic outcomes (psychological wellbeing, body image, and depression). RESULTS 27,799 patients underwent primary bariatric surgery between 2006 and 2016. Among opioid-naïve patients, the rate of new persistent opioid use was 6.3%. At 1-year after surgery, patients with new persistent opioid user lost significantly less excess body weight compared to those without new persistent use (57.6% vs. 60.3%; p < 0.0001). Patients with new persistent opioid use had significantly worse psychological wellbeing (35.0 vs. 33.1; p < 0.0001), body image (19.9 vs. 18.0; p < 0.0001), and depression scores (2.4 vs. 5.0; p < 0.0001). New persistent opioid users also reported less overall satisfaction with their bariatric surgery (75.1% vs. 85.7%; p < 0.0001). CONCLUSIONS New persistent opioid use is common following bariatric surgery and associated with significantly worse physiologic and psychologic outcomes. More effective screening and postoperative surveillance tools are needed to identify these patients, who likely require more aggressive counseling and treatment to maximize the benefits of bariatric surgery.
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Affiliation(s)
- Margaret E Smith
- Department of General Surgery, University of Michigan, Ann Arbor, MI, USA. .,University of Michigan Health System, 1500 E. Medical Center Drive, TC 2110, Ann Arbor, MI, 48109-5346, USA.
| | - Jay S Lee
- Department of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Aaron Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan F Finks
- Department of General Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Amir A Ghaferi
- Department of General Surgery, University of Michigan, Ann Arbor, MI, USA
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Varban OA, Thumma JR, Finks JF, Carlin AM, Ghaferi AA, Dimick JB. Evaluating the Effect of Surgical Skill on Outcomes for Laparoscopic Sleeve Gastrectomy: A Video-Based Study. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.007] [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: 11/29/2022]
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Varban OA, Thumma JR, Finks JF, Carlin AM, Kemmeter PR, Ghaferi AA, Dimick JB. Assessing variation in technique for sleeve gastrectomy based on outcomes of surgeons ranked by safety and efficacy: a video-based study. Surg Endosc 2018; 33:895-903. [DOI: 10.1007/s00464-018-6382-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 08/10/2018] [Indexed: 12/11/2022]
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Shaikh SH, Stenz JJ, McVinnie DW, Morrison JJ, Getzen T, Carlin AM, Mir FR. Percutaneous gastric remnant gastrostomy following Roux-en-Y gastric bypass surgery: a single tertiary center's 13-year experience. Abdom Radiol (NY) 2018; 43:1464-1471. [PMID: 28929218 DOI: 10.1007/s00261-017-1313-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of the study is to evaluate the indications, techniques, and outcomes for percutaneous gastrostomy placement in the gastric remnant following Roux-en-Y gastric bypass (RYGB) in bariatric patients. MATERIALS AND METHODS Retrospective chart review and summary statistical analysis was performed on all RYGB patients that underwent attempted percutaneous remnant gastrostomy placement at our institution between April 2003 and November 2016. RESULTS A total of 38 patients post-RYGB who underwent gastric remnant gastrostomy placement were identified, 32 women and 6 men, in which a total of 41 procedures were attempted. Technical success was achieved in 39 of the 41 cases (95%). Indications for the procedure were delayed gastric remnant emptying/biliopancreatic limb obstruction (n = 8), malnutrition related to RYGB (n = 17), nutritional support for conditions unrelated to RYGB (n = 15), and access for endoscopic retrograde cholangiopancreatography (ERCP, n = 1). Insufflation of the gastric remnant was performed via a clear window (n = 35), transhepatic (n = 5), and transjejunal (n = 1) routes. Five complications were encountered. The four major complications (9.8%) included early tube dislodgement with peritonitis, early tube dislodgement requiring repeat intervention, intractable pain, and upper gastrointestinal bleeding. A single minor complication occurred (2.4%), cellulitis. CONCLUSION Patients with a history of RYGB present a technical challenge for excluded gastric remnant gastrostomy placement. As the RYGB population increases and ages, obtaining and maintaining access to the gastric remnant is likely to become an important part of interventional radiology's role in the management of the bariatric patient.
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Varban OA, Cassidy RB, Bonham A, Carlin AM, Ghaferi A, Finks JF. Factors Associated With Achieving a Body Mass Index of Less Than 30 After Bariatric Surgery. JAMA Surg 2017; 152:1058-1064. [PMID: 28746723 DOI: 10.1001/jamasurg.2017.2348] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Importance Achieving a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of less than 30 is an important goal of bariatric surgery, given the increased risk for weight-related morbidity and mortality with a BMI above this threshold. Objective To identify predictors for achieving a BMI of less than 30 after bariatric surgery. Design, Setting, and Participants This retrospective study used data from the Michigan Bariatric Surgery Collaborative, a statewide quality improvement collaborative that uses a prospectively gathered clinical data registry. A total of 27 320 adults undergoing primary bariatric surgery between June 2006 and May 2015 at teaching and nonteaching hospitals in Michigan were included. Exposure Bariatric surgery. Main Outcomes and Measures Logistic regression was used to identify predictors for achieving a BMI of less than 30 at 1 year after surgery. Secondary outcome measures included 30-day postoperative complications and 1-year self-reported comorbidity remission. Results A total of 9713 patients (36%; mean [SD] age, 46.9 [11.3] years; 16.6% male) achieved a BMI of less than 30 at 1 year after bariatric surgery. A significant predictor for achieving this goal was a preoperative BMI of less than 40 (odds ratio [OR], 12.88; 95% CI, 11.71-14.16; P < .001). Patients who had a sleeve gastrectomy, gastric bypass, or duodenal switch were more likely to achieve a BMI of less than 30 compared with those who underwent adjustable gastric banding (OR, 8.37 [95% CI, 7.44-9.43]; OR, 21.43 [95% CI, 18.98-24.19]; and OR, 82.93 [95% CI, 59.78-115.03], respectively; P < .001). Only 8.5% of patients with a BMI greater than 50 achieved a BMI of less than 30 after bariatric surgery. Patients who achieved a BMI of less than 30 had significantly higher reported rates of medication discontinuation for hyperlipidemia (60.7% vs 43.2%, P < .001), diabetes (insulin: 67.7% vs 50.0%, P < .001; oral medications: 78.5% vs 64.3%, P < .001), and hypertension (54.7% vs 34.6%, P < .001), as well as a significantly higher rate of sleep apnea remission (72.5% vs 49.3%, P < .001) and higher satisfaction rate (92.8% vs 78.0%, P < .001) compared with patients who did not. Conclusions and Relevance Patients with a preoperative BMI of less than 40 are more likely to achieve a BMI of less than 30 after bariatric surgery and are more likely to experience comorbidity remission. Policies and practice patterns that delay bariatric surgery until the BMI is 50 or greater can result in significantly inferior outcomes.
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Affiliation(s)
- Oliver A Varban
- Department of Surgery, University of Michigan Health Systems, Ann Arbor
| | - Ruth B Cassidy
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Aaron Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Arthur M Carlin
- Wayne State University, Detroit, Michigan.,Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Amir Ghaferi
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Jonathan F Finks
- Department of Surgery, University of Michigan Health Systems, Ann Arbor.,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
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Varban OA, Sheetz KH, Cassidy RB, Stricklen A, Carlin AM, Dimick JB, Finks JF. Evaluating the effect of operative technique on leaks after laparoscopic sleeve gastrectomy: a case-control study. Surg Obes Relat Dis 2016; 13:560-567. [PMID: 28089439 DOI: 10.1016/j.soard.2016.11.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 07/08/2016] [Revised: 09/10/2016] [Accepted: 11/29/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To assess the effect of operative technique on staple line leaks after laparoscopic sleeve gastrectomy (LSG). BACKGROUND Staple-line leaks after LSG are a major source of morbidity and mortality. Variations in operative technique exist; however, their effect on leaks is poorly understood. METHODS We analyzed data from the Michigan Bariatric Surgery Collaborative (MBSC) to perform a case-control study comparing patients who had a clinically significant leak after undergoing a primary LSG to those who did not. A total of 45 patients with leaks were identified between January 2007 and December 2013. The leak group was matched 1:2 to a control group based on procedure type, age, body mass index, sex, and year the procedure was performed. Technique-specific factors were assessed by reviewing operative notes from all primary bariatric procedures in our study population. Conditional logistic regression was used to identify techniques associated with leaks. To increase the power of our analysis, we used a significance level of .10. RESULTS Leak rates with LSG have decreased over the past 5 years (1.18% to .36%) as annual case volume has increased (846 cases/yr to 4435 cases/yr). Surgeons who performed 43 or more cases per year had a leak rate<1%. Leaks were more common among cases requiring a blood transfusion (26.2% versus 1.08%, P = .0031) and when cases were converted to open surgery (7.14% versus 0%, P = .0741). However, there was no significant difference in operative time between cases involving a leak and their matched controls (95.4 min versus 87.1 min, P = .1197). Oversewing of the staple line was the only technique associated with less leaks after controlling for confounding factors (OR .397 CI .174, .909, P = .0665). Notably, surgeons who oversewed routinely were also found to have higher case volume (307 versus 140, P = .0216) and less overall complication rates (4.81% versus 7.95%, P = .0027). Furthermore, oversewing technique varied widely as only 22.6% of cases involved oversewing of the entire staple line. CONCLUSION Despite considerable variation in operative technique, leak rates with laparoscopic sleeve gastrectomy have decreased over time as operative volume has increased. Oversewing of the staple line was associated with fewer leaks, but specific suturing technique was not uniform and oversewing was performed routinely by more experienced surgeons with higher case volumes and less complication rates overall. Before standardizing surgical technique one must take into account variations in surgeon skill and experience.
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Affiliation(s)
- Oliver A Varban
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan.
| | - Kyle H Sheetz
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Ruth B Cassidy
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Amanda Stricklen
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Arthur M Carlin
- Wayne State University, Detroit, Michigan; Department of Surgery, Henry Ford Health System, Dearborn, Michigan
| | - Justin B Dimick
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Jonathan F Finks
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, Michigan
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Varban OA, Greenberg CC, Schram J, Ghaferi AA, Thumma JR, Carlin AM, Dimick JB. Surgical skill in bariatric surgery: Does skill in one procedure predict outcomes for another? Surgery 2016; 160:1172-1181. [PMID: 27324569 DOI: 10.1016/j.surg.2016.04.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 02/20/2016] [Revised: 04/03/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent data establish a strong link between peer video ratings of surgical skill and clinical outcomes with laparoscopic gastric bypass. Whether skill for one bariatric procedure can predict outcomes for another related procedure is unknown. METHODS Twenty surgeons voluntarily submitted videos of a standard laparoscopic gastric bypass procedure, which was blindly rated by 10 or more peers using a modified version of the Objective Structured Assessment of Technical Skills. Surgeons were divided into quartiles for skill in performing gastric bypass, and within 30 days of sleeve gastrectomy, their outcomes were compared. Multivariate logistic regression analysis was utilized to adjust for patient risk factors. RESULTS Surgeons with skill ratings in the top (n = 5), middle (n = 10, middle 2 combined), and bottom (n = 5) quartiles for laparoscopic gastric bypass saw similar rates of surgical and medical complications after laparoscopic sleeve gastrectomy (top 5.7%, middle 6.4%, bottom 5.5%, P = .13). Furthermore, surgeons' skill ratings did not correlate with rates of reoperation, readmission, and emergency department visits. Top-rated surgeons had significantly faster operating room times for sleeve gastrectomy (top 76 minutes, middle 90 minutes, bottom 88 minutes; P < .001) and a higher annual volume of bariatric cases per year (top 240, middle 147, bottom 105; P = .001). CONCLUSION Video ratings of surgical skill with laparoscopic gastric bypass do not predict outcomes of laparoscopic sleeve gastrectomy. Evaluation of surgical skill with one procedure may not apply to other related procedures and may require independent assessment of surgical technical proficiency.
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Affiliation(s)
- Oliver A Varban
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI.
| | - Caprice C Greenberg
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jon Schram
- Department of Surgery, Spectrum Health Medical Group, MI
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI; Ann Arbor VA Healthcare System, Ann Arbor, MI
| | - Joythi R Thumma
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Arthur M Carlin
- Wayne State University and Department of Surgery, Henry Ford Health System, Detroit, MI
| | - Justin B Dimick
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
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