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Rashdan M, Al-Sabe L, Salameh M, Halaseh S, Al-Mikhi B, Sha’bin S, Alqirem L, Alsaadi T, Ahmad J, Sabbagh A, Haddad F, Algharrawi Y, Alghazawi L, Nofal MN. Predictive factors for readmission after bariatric surgery: Experience of an obesity center. Medicine (Baltimore) 2024; 103:e39242. [PMID: 39121271 PMCID: PMC11315472 DOI: 10.1097/md.0000000000039242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/19/2024] [Indexed: 08/11/2024] Open
Abstract
Avoidable readmissions after bariatric surgery are a major burden on the healthcare systems. Rates of readmission after bariatric surgery have ranged from 1% up to 20%, but the factors that predict readmission have not been well studied. The objective of this study was to determine readmission rates following bariatric surgery and identify factors that contribute to early (within 90 days of surgery) and late readmission. A retrospective cohort study of 736 patients undergoing either Laparoscopic Sleeve Gastrectomy or Laparoscopic Roux-en-Y Gastric Bypass in Jordan University Hospital from 2016 to 2019. Demographic characteristics, co-morbidities, and readmissions were extracted from their medical records and analyzed. Multivariable logistic regression analysis was performed to determine which factors predict readmission. A total of 736 patients had bariatric surgery (Laparoscopic Sleeve Gastrectomy 89% vs Laparoscopic Roux-en-Y Gastric Bypass 11%) during the study period. Thirty-day readmission rate was 6.62% and an overall readmission rate of 23.23%. Common reasons for early readmission (within 90 days of surgery) were nausea, vomiting, and dehydration. Late readmissions were mainly caused by gallbladder stones. Three risk factors were identified that independently predicted readmission: the type of procedure being performed (P-value = .003, odds ratio [OR] 2.14, 95% confidence interval [CI] 1.32-3.49), depression (P-value = .028, OR 6.49, 95% CI 1.18-52.9) and preoperative body mass index (P-value = .011, OR 1.03, 95% CI 1.01-1.05). Several factors were identified that cause patients to represent and subsequently admitted into hospitals. Early readmission was usually due to nausea, vomiting, and dehydration, whereas late admissions were mostly due to biliary complications. Preoperative body mass index and depression were independent risk factors for readmission.
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Affiliation(s)
- Mohammad Rashdan
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Lana Al-Sabe
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Salameh
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Shahed Halaseh
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Bana Al-Mikhi
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Shereen Sha’bin
- Department of General Surgery, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Lina Alqirem
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Tabarak Alsaadi
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Jood Ahmad
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Aseel Sabbagh
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Faris Haddad
- Faculty of Medicine, The University of Jordan, Amman, Jordan
| | | | - Laith Alghazawi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Mohammad N. Nofal
- Department of General Surgery, Faculty of Medicine, Mutah University, Al Karak, Jordan
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Alrayes MS, Altawili MA, Alsuabie SM, Sindi AW, Alharbi KM, Alsalhi KM, Al Alawi RM, Ali ID, Nasser AN, Alabdulrahim JM, Alkhaldi MH, Alhudhaif HM, Alotaibi SA. Surgical Interventions for the Management of Obesity-Related Joint Pain: A Narrative Review. Cureus 2024; 16:e59082. [PMID: 38800150 PMCID: PMC11128294 DOI: 10.7759/cureus.59082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Obesity-related joint pain is a common and debilitating condition that significantly impacts the quality of life, primarily due to the excess weight straining the joints. This results in inflammation and degeneration, which can cause pain, stiffness, and difficulty moving. We aimed to comprehensively review the literature discussing surgical interventions for obesity-related joint pain. We searched across databases (PubMed, Scopus, and Cochrane Library) to identify studies published between 2000 and 2023 that assessed surgical interventions for obesity-related joint pain. This review highlights the complex interplay of mechanical, inflammatory, and metabolic factors contributing to joint pain in obese individuals, highlighting both surgical and non-surgical interventions. Non-surgical interventions include weight loss, exercise, physical therapy, and medications. Surgical interventions include bariatric surgery and joint replacement surgery. Bariatric surgery significantly reduces body weight and improves the quality of life outcomes; however, multiple studies have found no improvement or worsening of joint pain post-surgery. Total joint arthroplasty has demonstrated good improvement in pain and function outcomes based on recent meta-analyses, although risks of complications are higher in obese patients. The treatment choice for obesity-related joint pain depends on the individual patient's circumstances. Non-surgical interventions are usually the first line of treatment. However, if these interventions are not effective, surgical interventions may be an option.
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Affiliation(s)
| | | | | | - Ahmad W Sindi
- General Practice, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Kawkab M Alharbi
- Surgery, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
| | | | | | | | - Alrashed N Nasser
- General Practice, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | | | - Hamad M Alhudhaif
- General Practice, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Azran C, Dahan AE, Shimoni O, Dicker D, Hammerman A, Dahan A. Can Consultation by a Clinical Pharmacist Prevent Morbidity and Mortality in Patients Undergoing Bariatric Surgery? J Clin Med 2024; 13:310. [PMID: 38256443 PMCID: PMC10816230 DOI: 10.3390/jcm13020310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
The purpose of this work was to investigate the effect of clinical pharmacist consultation on the long-term morbidity and mortality outcomes among patients undergoing bariatric surgery. In this retrospective cohort study, 165 bariatric patients at Herzliya Medical Center who were identified as complex cases and were consulted by a clinical pharmacist (2013-2019) were compared with a wider group of bariatric patients with chronic diseases who were recorded in the Israeli General Bariatric Registry during the same years. The primary outcomes were rates of surgical complications, re-hospitalizations, and death up to one year after surgery. The secondary outcome was the rate of re-hospitalizations in different time periods. The twelve (12)-month rate of re-hospitalization in the intervention group was 10.9% vs. 19.5% in the comparison group (p = 0.005); the rate of documented postoperative complications was 2.7% vs. 3.9% (p = 0.462), and mortality was null vs. 0.16%, respectively. As for the secondary outcomes, the rates of re-hospitalizations in the periods of 0-30, 31-90, 91-180, and 181-365 days after surgery were 1.8% vs. 5.3% (p = 0.046), 2.4% vs. 4.1% (p = 0.278), 3.6% vs. 4.8% (p = 0.476), and 7.3% vs. 9.9% (p = 0.256) in the intervention vs. comparison cohorts, respectively. In conclusion, this study demonstrates the importance and benefit of referring to a specialized clinical pharmacist around bariatric surgery for improving patient safety, especially in complex patients. This is the first study to look at the long-term effects of clinical pharmacist consultation on re-hospitalization and mortality among bariatric patients, and our encouraging outcomes should hopefully stimulate more studies to show the invaluable role of specialized clinical pharmacists.
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Affiliation(s)
- Carmil Azran
- Department of Medical Technologies, Maccabi Healthcare Services, Tel-Aviv 6772168, Israel
- School of Pharmacy, Faculty of Medicine, The Hebrew University, Jerusalem 9112102, Israel
| | - Almog Eliyahu Dahan
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel; (A.E.D.); (O.S.)
| | - Orly Shimoni
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel; (A.E.D.); (O.S.)
| | - Dror Dicker
- Internal Medicine Department, Hasharon Hospital-Rabin Medical Center, Petah Tikva 4937211, Israel;
- Faculty of Medicine, Tel Aviv University, Tel-Aviv 6997801, Israel
| | | | - Arik Dahan
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel; (A.E.D.); (O.S.)
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Dubchuk C, Afifi AM, Chawla K, Nasif A, Ren G, Osman MF, Sferra J, Pannell S, Nazzal M. Gender, BMI, Patient Comorbidities, and Hospital Characteristics Influence 30-Day Readmission Following Vertical Sleeve Gastrectomy. Obes Surg 2023; 33:3786-3796. [PMID: 37821710 DOI: 10.1007/s11695-023-06855-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Obesity impacts 300 million people worldwide and the number continues to increase. Laparoscopic sleeve gastrectomy (LSG) is one of several bariatric procedures offered to help these individuals achieve a healthier life. Here, we report 30-day readmission rates and risk factors for readmission after gastrectomy. MATERIALS AND METHODS We used the US Healthcare Utilization Project's Nationwide Readmission Database (NRD) from 2016 to 2019 for patients who underwent laparoscopic gastrectomy and evaluated 30-day readmission rates, comparing readmitted patients to non-readmitted patients. Confounder adjusted and unadjusted analysis were proceeded to the potential factors. RESULTS The study population consisted of 235,563 patients, with a 3.0% readmission rate. Factors associated with a higher readmission rate included older age, male gender, higher BMI, Medicare as the primary payer, longer length of stay, higher total charge, higher Charlson Comorbidity Index, higher Elixhauser-Comorbidity Index, lower household income, non-elective admission type, and non-routine disposition. Additionally, larger hospital bed size, and private, invest-own hospital ownership were associated with higher readmission rates. After adjusting for confounders, several comorbidities and complications were found to be significantly associated with readmission, including ileus, abnormal weight loss, postprocedural complications of digestive system, acute posthemorrhagic anemia, and history of pulmonary embolism (all p < 0.001). CONCLUSIONS Patient characteristics including age, BMI, and payment source, as well as hospital characteristics, can impact the 30-day readmission after LSG. Such factors should be considered by CMS when deciding on penalties related to readmission.
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Affiliation(s)
- Christina Dubchuk
- Department of Surgery, Division of Vascular Surgery and Endovascular Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Ahmed M Afifi
- Department of Surgery, Division of Vascular Surgery and Endovascular Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Karan Chawla
- Department of Surgery, Division of Vascular Surgery and Endovascular Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Abdullah Nasif
- Department of Surgery, Division of Vascular Surgery and Endovascular Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Gang Ren
- Department of Surgery, Division of Vascular Surgery and Endovascular Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Mohamed F Osman
- Department of Surgery, Division of Vascular Surgery and Endovascular Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Joseph Sferra
- Department of Surgery, Division of Vascular Surgery and Endovascular Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Stephanie Pannell
- Department of Surgery, Division of Vascular Surgery and Endovascular Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Munier Nazzal
- Department of Surgery, Division of Vascular Surgery and Endovascular Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
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Sakran N, Sherf-Dagan S, Hod K, Kaplan U, Azaria B, Raziel A. One Anastomosis Gastric Bypass in 6722 Patients: Early Outcomes from a Private Hospital Registry. J Clin Med 2023; 12:6872. [PMID: 37959337 PMCID: PMC10648472 DOI: 10.3390/jcm12216872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) is an emerging metabolic bariatric surgery (MBS) type used in both primary OAGB (pOAGB) and revisional OAGB (rOAGB). We studied ≤30-day outcomes of pOAGB and rOAGB and identified predictors of early complications. METHODS Electronic medical records of all OAGBs performed between January 2017 and December 2021 at a high-volume bariatric clinic in Israel comprising four hospital centers were scanned retrospectively using specialized data software (MDClone software, version 6.1). Data gathered were patients' characteristics, surgical procedure, and ≤30-day complications with Clavien-Dindo Classification (CDC). Multivariate logistic regression analyses were used to identify factors related to early complications of pOAGB and rOAGB. RESULTS A total of 6722 patients underwent a pOAGB (n = 5088, 75.7%) or rOAGB (n = 1634, 24.3%) procedure at our institution. Preoperative mean age and body mass index (BMI) were 40.6 ± 11.5 years and 41.2 ± 4.6 kg/m2, respectively. Early complications occurred in 258 (3.8%) patients (176 pOAGB and 82 rOAGB) and included mainly bleeding (n = 133, 2.0%), leaks (n = 31, 0.5%), and obstruction/strictures (n = 19, 0.3%). CDC complications for grades 1-2 and grades 3a--5 were 1.5% and 1.6%, respectively. The overall mortality rate was 0.03% (n = 2). Age, operative time ≥3 h, and any additional concomitant procedure were independent predictors of early complications following pOAGB, while a diagnosis of diabetes mellitus and operative time ≥3 h were independent predictors of early complications following rOAGB. CONCLUSIONS OAGB was found to be a safe primary and revisional MBS procedure in the ≤30-postoperative day term. The most common complications were gastrointestinal bleeding, leaks, and obstruction/stricture.
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Affiliation(s)
- Nasser Sakran
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
- Department of General Surgery, Holy Family Hospital, Nazareth 1601001, Israel
- The Azrieli Faculty of Medicine Safed, Bar-Ilan University, Ramat Gan 5290002, Israel
| | - Shiri Sherf-Dagan
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel 4077625, Israel
| | - Keren Hod
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
| | - Uri Kaplan
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
- Department of Surgery, Emek Medical Center, Afula 1812601, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3200003, Israel
| | - Bella Azaria
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
| | - Asnat Raziel
- Assuta Medical Center, Tel Aviv 6971028, Israel; (S.S.-D.); (K.H.); (U.K.); (B.A.); (A.R.)
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Walton GF, Broussard TD. Evaluation of Alternate Laparoscopic Stapling Device for Bariatric Surgery. Surg Laparosc Endosc Percutan Tech 2023; 33:505-510. [PMID: 37523506 DOI: 10.1097/sle.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/20/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND As laparoscopic bariatric surgical techniques have matured, the incidence of complications has decreased over time. Surgical stapling devices are commonly used for resection and anastomosis of gastric tissue during bariatric surgery. The purpose of this study is to assess and compare complication rates and clinical outcomes between patient cohorts using 2 different approved stapling devices. MATERIALS AND METHODS Clinical outcomes were retrospectively compared for patients undergoing bariatric surgery between April 2019 and December 2020 using laparoscopic surgical stapling device A (LSSD-A) against outcomes between January 2017 and September 2018 using laparoscopic surgical stapling device B (LSSD-B). Tradenames for LSSD-A and LSSD-B were AEON Endostapler and Endo GIA with Tri-Staple Technology, respectively. RESULTS In all, 814 patients underwent laparoscopic bariatric operation using LSSD-A and 1034 using LSSD-B. Laparoscopic surgery included sleeve gastrectomy (n=1359, 73.5%), Roux-en-Y gastric bypass (RYGB) (n=425, 23.0%), and single anastomosis duodenoileostomy with gastric sleeve (n=64, 3.5%). Stapler-related complications were evenly distributed over the 20.9-month LSSD-B study period. No stapler-related complications were seen in the last 13 months of the LSSD-A study period, during which time 428 (52.5%) laparoscopic bariatric operations were performed. One staple line leak was observed, occurring in the LSSD-B group. Patients undergoing laparoscopic RYGB with LSSD-A had fewer overall complications, fewer transfusions, and fewer reoperations for staple line bleeding. CONCLUSIONS Both LSSD-A and LSSD-B were safe and effective in the performance of laparoscopic bariatric operations with low complication rates and comparable clinical performance in sleeve gastrectomy and single anastomosis duodenoileostomy with gastric sleeve. Statistically significant differences in complication rates were observed in RYGB favoring LSSD-A.
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Vierra BM, Edgerton CA, Shikora SA. The impact of procedure type on 30-day readmissions following metabolic and bariatric surgery: postoperative complications of bariatric surgery. Surg Endosc 2023; 37:2127-2132. [PMID: 36316585 DOI: 10.1007/s00464-022-09720-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hospital readmission (HR) rates following metabolic/bariatric surgery (MBS) are used as a surrogate for quality outcomes and are increasingly tied to reimbursement rates. There are limited data concerning predictors of HR rates with regard to type of bariatric procedure. METHODS This study is a retrospective review of prospectively collected data from patients who underwent MBS from January 2014 to December 2019 at Brigham and Women's Hospital in Boston, Massachusetts. The causes of all HRs and reoperations within 30 days of the original discharge were analyzed. Statistical significance was determined using Chi Squared test and T test. RESULTS 2815 patients underwent MBS. 2373 patients (84.3%) had primary procedures, while 442 patients (15.7%) had secondary or revisional procedures. The overall 30-day readmission rate was 5.7%, with no significant difference for patients who underwent primary vs. secondary MBS. Among primary procedures, the readmission rate was higher for Roux-en-Y Gastric Bypass (RYGB) than laparoscopic sleeve gastrectomy (SG) (10.32% vs. 4.77%). Readmissions were most often due to nontechnical causes. The overall reoperation rate was 1.14% and was higher for patients undergoing secondary vs. primary procedures (2.94% vs 0.80%). CONCLUSIONS Readmission rate was similar to that in existing literature. Revisional/secondary surgery did not lead to increased readmissions, although was associated with a higher reoperation rate. Most HRs were due to nontechnical causes. Optimization of postoperative care, such as fluid status, may reduce the incidence of postoperative complications.
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Affiliation(s)
- Benjamin M Vierra
- Brigham and Women's Hospital, Center for Weight Management and Wellness, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Colston A Edgerton
- Department of Surgery, Novant Health New Hanover Regional Medical Center, Wilmington, NC, USA
| | - Scott A Shikora
- Brigham and Women's Hospital, Center for Weight Management and Wellness, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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Quadri P, Sanchez-Johnsen L, Aguiluz-Cornejo G, Masrur M, Sigmon D, Danielson KK, Gangemi A, Hassan C. Bariatric Surgery Hospital Readmissions in an Urban Academic Medical Center. Bariatr Surg Pract Patient Care 2022. [DOI: 10.1089/bari.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Pablo Quadri
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lisa Sanchez-Johnsen
- Department of Psychiatry Surgery, Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | | | - Mario Masrur
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - David Sigmon
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kirstie K. Danielson
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Antonio Gangemi
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Chandra Hassan
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Elnahas AI, Reid JN, Lam M, Doumouras AG, Anvari M, Schlachta CM, Alkhamesi NA, Hawel JD, Urbach DR. Bariatric Center Designation and Outcomes Following Repeat Abdominal Surgery in Bariatric Patients. J Surg Res 2022; 280:421-428. [PMID: 36041342 DOI: 10.1016/j.jss.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Repeat abdominal surgery in the bariatric surgery patient population may be challenging for non-bariatric-accredited institutions. The impact of regionalized bariatric care on clinical outcomes for bariatric surgery patients requiring repeat abdominal surgery is currently unknown. This study aims to investigate the association between bariatric center designation and clinical outcomes following hepatobiliary, hernia, and upper and lower gastrointestinal operations among patients with prior bariatric surgery. METHODS This is a cohort study of a large sample of Ontario residents who underwent primary bariatric surgery between 2010 and 2017. A comprehensive list of eligible abdominal operations was captured using administrative data. The primary outcome was 30-d complications. Secondary outcomes included 30-d mortality, readmission, and length of stay. RESULTS Among the 3301 study patients, 1305 (40%) received their first abdominal reoperation following bariatric surgery at a designated bariatric center. Nonbariatric center designation was not associated with significantly higher rates of 30-d complications (5.73% versus 5.72%), mortality (0.80% versus 0.77%), readmissions (1.11% versus 1.85%), or median postoperative length of stay (4 versus 4 d). After grouping the category of reoperations, upper gastrointestinal (odds ratio [OR] 0.66, confidence interval [CI] 0.39-1.11) and abdominal wall hernia surgery (OR 0.52, CI 0.27-0.99) showed a lower adjusted OR for complications among bariatric centers. CONCLUSIONS Our study demonstrates that after adjustment for case-mix and patient characteristics, bariatric surgery patients undergoing repeat abdominal surgery at nonbariatric centers is not associated with higher proportion of complications or mortality. Complex hernia surgery may be considered the most appropriate for referral.
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Affiliation(s)
- Ahmad I Elnahas
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ICES, London, Ontario, Canada.
| | | | | | - Aristithes G Doumouras
- ICES, London, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mehran Anvari
- ICES, London, Ontario, Canada; Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Christopher M Schlachta
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Nawar A Alkhamesi
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jeffrey D Hawel
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David R Urbach
- ICES, London, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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10
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Zhou B, Ji H, Liu Y, Chen Z, Zhang N, Cao X, Meng H. ERAS reduces postoperative hospital stay and complications after bariatric surgery: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e27831. [PMID: 34964750 PMCID: PMC8615334 DOI: 10.1097/md.0000000000027831] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Abstract
Enhanced recovery after surgery (ERAS) is a multimodal, multidisciplinary approach for caring surgical patients. The present study aimed to compare the perioperative outcomes of laparoscopic bariatric surgery between patients with ERAS and those with conventional care.The clinical data of all patients undergoing primary laparoscopic bariatric surgery between January 2014 and June 2017 were retrospectively collected and reviewed. Patients were managed with conventional care during 2014 to 2015 (conventional care group) and with ERAS protocols during 2016 to 2017 (ERAS group). The 2 groups were compared in terms of postoperative length of hospital stay (LOS) and postoperative day 1 discharge rate.A total of 435 consecutive patients were included with 198 patients in the conventional care group and 237 patients in the ERAS group. The ERAS group had significantly shorter LOS (2.2 ± 0.9 vs 4.0 ± 2.6 days, P < .01) and significantly higher day 1 discharge rate (15.2% vs 1%, P < .01) compared with the conventional care group. During postoperative 30 days, the ERAS group had significantly less complications (2.1% vs 8.6%, P < .01) and readmissions (1.3% vs 4.5%, P = .02) compared with the conventional care group.Compared with conventional care, ERAS significantly reduces postoperative LOS, complications, and readmissions in patients undergoing laparoscopic bariatric surgery.
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Affiliation(s)
- Biao Zhou
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Haoyang Ji
- Second Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yumeng Liu
- Department of General Surgery, Beijing Huaxin Hospital (First Hospital of Tsinghua University), Beijing, China
| | - Zhe Chen
- Department of General Surgery, Capital Medical University Beijing Friendship Hospital, Beijing, China
| | - Nianrong Zhang
- Department of Nephrology, China-Japan Friendship Hospital, Beijing, China
| | - Xinyu Cao
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
| | - Hua Meng
- Department of General Surgery & Obesity and Metabolic Disease Center, China-Japan Friendship Hospital, Beijing, China
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Analysis of Emergency Department Visits and Unplanned Readmission After Bariatric Surgery: An Experience From a Tertiary Referral Center. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:107-113. [PMID: 34653112 DOI: 10.1097/sle.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective treatment of morbid obesity. As the number of bariatric procedures performed has increased, visits to the emergency department (ED) and readmissions have subsequently increased. The present study aimed to assess the rates and indications for of ED visits and readmission after bariatric surgery and to identify the predictors of hospital readmission. PATIENTS AND METHODS This was a retrospective cohort study on patients who underwent bariatric surgery from January 2018 to April 2020. The percentage of ED visits and unplanned readmission was estimated and the indications and management of each were analyzed. The association of age, sex, body mass index, and type of procedure with readmission was assessed. RESULTS Of 582 patients who underwent bariatric surgery in the study period, 204 (35%) required ED visits, and 42 (7.2%) required readmission. The mean age of patients was 33 years, and the mean body mass index was 43 kg/m2. The most common indication for ED visits was abdominal pain (41.2%). In all, 64.8% of ED visits and 43% of readmissions were unrelated to bariatric surgery complications. A total of 94.1% of patients who required ED visits and 71.4% of readmitted patients were managed conservatively. The most common procedure followed by readmission was laparoscopic sleeve gastrectomy (50%) then one-anastomosis gastric bypass (21.4%). Age, sex, body mass index, and procedure type were not significantly associated with higher readmission. CONCLUSIONS The rates of ED visits and readmission in our cohort were 35% and 7.2%, respectively. Most cases of ED visits were not related to adverse effects of bariatric surgery and the majority of which were managed conservatively.
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Charles-Nelson A, Lazzati A, Katsahian S. Analysis of Trajectories of Care After Bariatric Surgery Using Data Mining Method and Health Administrative Information Systems. Obes Surg 2021; 30:2206-2216. [PMID: 32030617 DOI: 10.1007/s11695-020-04430-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT The 30-day readmission rate after bariatric surgery is considered an important metric of the quality of hospital care. However, readmission rate beyond 30 days is rarely reported and does not provide any information about trajectories of care which would be of great interest for healthcare planning. The aim of this study was to analyze trajectories of care during the first year after bariatric surgery on a nationwide basis using data mining methods. METHOD This was a retrospective descriptive study on the trajectories of care within the first year after bariatric surgery. Data were extracted from a national administrative claims database (the PMSI database) and trajectories were defined as principal diagnosis of successive readmissions. Formal Concept Analysis was performed to find common concepts of trajectories of care. RESULTS We included for analysis 198,389 bariatric procedures performed on 196,323 patients. Twelve main concepts were selected. About one third of patients (32.4%) were readmitted in the first year after surgery. Most common trajectories were as follows: regular follow-up (14.9%), cholelithiasis (2.2%), abdominal pain (1.9%), and abdominal sepsis (1.3%). Important differences were found in trajectories among different bariatric procedures: 1.8% of gastric banding patients had pregnancy-related events (delivery or medical abortion), while we observed a readmission rate for abdominal sepsis in 2.7% and 5.1% of patients operated of gastric bypass and sleeve gastrectomy respectively. CONCLUSION Administrative claim data can be analyzed through Formal Concept Analysis in order to classify trajectories of care. This approach permits to quantify expected postoperative complications and to identify unexpected events.
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Affiliation(s)
- Anaïs Charles-Nelson
- Sorbonne Universités, UPMC Univ Paris 06, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France. .,INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France. .,Université Paris Descartes, Sorbonne Paris Cité, UMRS 1138, Centre de Recherche des Cordeliers, F75006, Paris, France. .,Assistance Publique Hôpitaux de Paris, Hôpital européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, INSERM, Centre d'Investigation Clinique1418, module Épidémiologie Clinique, HEGP, Paris, France.
| | - Andrea Lazzati
- Université Paris Descartes, Sorbonne Paris Cité, UMRS 1138, Centre de Recherche des Cordeliers, F75006, Paris, France.,Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, 40 avenue de Verdun, 94000, Créteil, France
| | - Sandrine Katsahian
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, UMRS 1138, Centre de Recherche des Cordeliers, F75006, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, INSERM, Centre d'Investigation Clinique1418, module Épidémiologie Clinique, HEGP, Paris, France
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13
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Doumouras AG, Lee Y, Paterson JM, Gerstein HC, Shah BR, Sivapathasundaram B, Tarride JE, Anvari M, Hong D. Association Between Bariatric Surgery and Major Adverse Diabetes Outcomes in Patients With Diabetes and Obesity. JAMA Netw Open 2021; 4:e216820. [PMID: 33900401 PMCID: PMC8076963 DOI: 10.1001/jamanetworkopen.2021.6820] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE There are high-quality randomized clinical trial data demonstrating the effect of bariatric surgery on type 2 diabetes remission, but these studies are not powered to study mortality in this patient group. Large observational studies are warranted to study the association of bariatric surgery with mortality in patients with type 2 diabetes. OBJECTIVE To determine the association between bariatric surgery and all-cause mortality among patients with type 2 diabetes and severe obesity. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based matched cohort study included patients with type 2 diabetes and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) 35 or greater who underwent bariatric surgery from January 2010 to December 2016 in Ontario, Canada. Multiple linked administrative databases were used to define confounders, including age, baseline BMI, sex, comorbidities, duration of diabetes diagnosis, health care utilization, socioeconomic status, smoking status, substance abuse, cancer screening, and psychiatric history. Potential controls were identified from a primary care electronic medical record database. Data were analyzed in 2020. EXPOSURE Bariatric surgery (gastric bypass and sleeve gastrectomy) and nonsurgical management of obesity provided by the primary care physician. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality. Secondary outcomes were cause-specific mortality and nonfatal morbidities. Groups were compared through a multivariable Cox proportional Hazards model. RESULTS A total of 6910 patients (mean [SD] age at baseline, 52.04 [9.45] years; 4950 [71.6%] women) were included, with 3455 patients who underwent bariatric surgery and 3455 match controls and a median (interquartile range) follow-up time of 4.6 (3.22-6.35) years. In the surgery group, 83 patients (2.4%) died, compared with 178 individuals (5.2%) in the control group (hazard ratio [HR] 0.53 [95% CI, 0.41-0.69]; P < .001). Bariatric surgery was associated with a 68% lower cardiovascular mortality (HR, 0.32 [95% CI, 0.15-0.66]; P = .002) and a 34% lower rate of composite cardiac events (HR, 0.68 [95% CI, 0.55-0.85]; P < .001). Risk of nonfatal renal events was also 42% lower in the surgical group compared with the control group (HR, 0.58 [95% CI, 0.35-0.95], P = .03). Of the groups that had the highest absolute benefit associated with bariatric surgery, men had an absolute risk reduction (ARR) of 3.7% (95% CI, 1.7%-5.7%), individuals with more than 15 years of diabetes had an ARR of 4.3% (95% CI, 0.8%-7.8%), and individuals aged 55 years or older had an ARR of 4.7% (95% CI, 3.0%-6.4%). CONCLUSIONS AND RELEVANCE These findings suggest that bariatric surgery was associated with reduced all-cause mortality and diabetes-specific cardiac and renal outcomes in patients with type 2 diabetes and severe obesity.
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Affiliation(s)
| | - Yung Lee
- Division of General Surgery, McMaster University, Hamilton, Canada
| | - J. Michael Paterson
- ICES, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Hertzel C. Gerstein
- Population Health Research Institute, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Baiju R. Shah
- ICES, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Sunnybrook Research Institute, Toronto, Canada
| | | | - Jean-Eric Tarride
- Programs for Assessment of Technology in Health Research Institute, St Joseph’s Healthcare, McMaster University, Hamilton, Canada
- Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mehran Anvari
- Division of General Surgery, McMaster University, Hamilton, Canada
- ICES, Toronto, Canada
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, Canada
- ICES, Toronto, Canada
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Stratification of Readmission after Bariatric Surgery by Day of Post-Discharge Presentation. Obes Surg 2020; 31:1496-1504. [PMID: 33206297 DOI: 10.1007/s11695-020-05130-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION/PURPOSE Reasons of postoperative readmissions may vary based on the timing of rehospitalization. This study characterizes predictors and causes for readmission after bariatric surgery on day-to-day basis after discharge. MATERIALS AND METHODS Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data, patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy were identified. Perioperative factors of early readmissions (post-discharge days 0-9) were compared to those of late readmissions (post-discharge days 10-30). Multivariable analysis was conducted to identify predictors of early versus late readmissions. Reasons for readmissions were characterized on day-to-day basis. RESULTS Of 509,631 operations, 19,061 (3.7%) cases were readmitted. Of these, 9666 (50.7%) were early, while 9395 (49.3%) were late readmissions. White race (OR = 1.2, CI = [1.1-1.3]), revisional surgery (OR = 1.2, CI = [1.1-1.4]), Roux-en-Y gastric bypass (OR = 1.2, CI = [1.1-1.3]), pulmonary complication (OR = 1.8, CI = [1.5-2.3]), bleeding (OR = 2, CI = [1.6-2.6]), and post-acute care (OR = 1.8, CI = [1.2-2.6]) were predictors of early readmission. Late readmission was associated with body mass index ≥ 40 (CI = 0.83, OR = [0.77-0.89]), renal/urological complication (OR = 0.6, CI = [0.5-0.8]), and deep vein thrombosis (OR = 0.5, CI = [0.4-0.6]). PO intolerance or dehydration/electrolyte imbalance was the most common readmission reason, peaking on post-discharge days 19-30. Pain, medical complications, obstruction, and bleeding were causes of early readmissions. However, venous thromboembolism readmissions peaked after post-discharge day 9. CONCLUSION Complex bariatric operations and patients who require post-discharge extended care are associated with early readmissions. Such readmissions are due to early post-discharge complications. However, late readmissions are driven by interrelated risk factors and complications. These findings suggest that targeting patients at risk for delayed rehospitalization is the most efficient approach to minimize readmissions after bariatric surgery.
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Endoscopic management of early GI tract bleeding in a group of bariatric patients undergoing a fast track protocol. Wideochir Inne Tech Maloinwazyjne 2020; 16:139-144. [PMID: 33786127 PMCID: PMC7991939 DOI: 10.5114/wiitm.2020.99146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Enhanced recovery after bariatric surgery (ERABS) and other fast track protocols are currently being implemented in bariatric surgery. This approach has several benefits. However, early complications may occur and require urgent re-hospitalization and management. Gastrointestinal (GI) bleeding following bariatric surgery remains one of the most serious complications requiring endoscopic treatment. Aim To evaluate the potential influence of early endoscopic intervention on bariatric patients’ management. Material and methods A clinical database was searched for patients undergoing endoscopic treatment because of GI tract bleeding following bariatric surgery under the ERABS protocol. 14 out of 1431 patients operated on were identified and their data were extracted for the purposes of this study. Patients readmitted to the hospital due to developing GI tract bleeding (group 2) were compared with patients undergoing endoscopic intervention during the initial stay (group 1), for the same purpose. Results We found no statistically significant differences in hemoglobin level or length of hospital stay before endoscopy between groups. Based on the analyzed data, the percentage of GI bleeding in patients operated on under the ERABS protocol in our center is 0.97% (n = 14). The rate of early (up to 30 days) readmissions due to GI tract bleeding is 0.4% (n = 5) with an overall early readmission rate of 0.91% (n = 13) in the study period since the ERABS protocol was implemented. Conclusions Long-term effects (% total weight loss, %TWL) of bariatric surgery do not depend on the need of early endoscopic intervention and rehospitalization. Endoscopic intervention is a safe treatment modality, not associated with risk of reoperation or complications.
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16
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Dang JT, Tavakoli I, Switzer N, Mocanu V, Shi X, de Gara C, Birch DW, Karmali S. Factors that predict 30-day readmission after bariatric surgery: experience of a publicly funded Canadian centre. Can J Surg 2020; 63:E174-E180. [PMID: 32302084 DOI: 10.1503/cjs.014918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Hospital readmissions after bariatric surgery can significantly increase health care costs. Rates of readmission after bariatric surgery have ranged from 0.6% to 11.3%, but the rate of complications and the factors that predict readmission have not been well characterized in Canada. The objective of this study was to characterize readmission rates and the factors that predict 30-day readmission in a Canadian centre. Methods A retrospective study was performed on all patients who underwent bariatric surgery between 2010 and 2015 in a single Canadian centre. Procedures included laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB). Prospectively collected data were extracted from an administrative database. Multivariable logistic regression analysis was performed to determine which factors predict 30-day readmission. Results A total of 1468 patients had bariatric surgery (51.0% LRYGB, 40.5% LSG, 8.6% LAGB) during the 6-year study period, with an overall 30-day readmission rate of 7.5%. LRYGB was associated with a higher readmission rate (11.4%) than LSG (3.7%) or LAGB (1.6%). Common reasons for readmission were infection (24.8%), pain (17.4%) and nausea or vomiting (10.1%). Multivariable analysis identified 3 factors that independently predicted readmission: length of stay greater than 4 days (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.03-4.63, p = 0.042), LRYGB (OR 5.21, 95% CI 1.19-22.73, p = 0.028) and acute renal failure (OR 14.10, 95% CI 1.07-186.29, p = 0.045). Conclusion Readmissions after bariatric surgery were most commonly caused by potentially preventable factors, such as pain, nausea or vomiting. Strategies to identify and address factors associated with readmission may reduce readmissions and health care costs after bariatric surgery in a publicly funded health care system.
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Affiliation(s)
- Jerry T Dang
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Iran Tavakoli
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Noah Switzer
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Valentin Mocanu
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Xinzhe Shi
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Chris de Gara
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Daniel W Birch
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
| | - Shahzeer Karmali
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali)
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Lazzati A, Chatellier G, Katsahian S. Readmissions After Bariatric Surgery in France, 2013–2016: a Nationwide Study on Administrative Data. Obes Surg 2019; 29:3680-3689. [DOI: 10.1007/s11695-019-04053-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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18
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Hariri K, Dong M, Edwards ED, Kini SU, Inabnet WB, Herron DM, Fernandez-Ranvier G. Why Are Patients Readmitted? An Analysis of Adverse Events Leading to Readmission, Reintervention, or Reoperation After Bariatric Surgery. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2018.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kamyar Hariri
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Matthew Dong
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Eric D. Edwards
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Subhash U. Kini
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - William B. Inabnet
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Daniel M. Herron
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Gustavo Fernandez-Ranvier
- The Garlock Division of General Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, New York
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Major P, Wysocki M, Torbicz G, Gajewska N, Dudek A, Małczak P, Pędziwiatr M, Pisarska M, Radkowiak D, Budzyński A. Risk Factors for Prolonged Length of Hospital Stay and Readmissions After Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2018; 28:323-332. [PMID: 28762024 PMCID: PMC5778173 DOI: 10.1007/s11695-017-2844-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB) are most commonly performed bariatric procedures. Laparoscopic approach and enhanced recovery after surgery (ERAS) protocols managed to decrease length of hospital and morbidity. However, there are patients in whom, despite adherence to the protocol, the length of stay (LOS) remains longer than targeted. This study aimed to assess potential risk factors for prolonged LOS and readmissions. Methods The study was a prospective observation with a post-hoc analysis of bariatric patients in a tertiary referral university teaching hospital. Inclusion criteria were undergoing laparoscopic bariatric surgery. Exclusion criteria were occurrence of perioperative complications, prior bariatric procedures, and lack of necessary data. The primary endpoints were the evaluations of risk factors for prolonged LOS and readmissions. Results Median LOS was 3 (2–4) days. LOS > 3 days occurred in 145 (29.47%) patients, 79 after LSG (25.82%) and 66 after LRYGB (35.48%; p = 0.008). Factors significantly prolonging LOS were low oral fluid intake, high intravenous volume of fluids administered on POD0, and every additional 50 km distance from habitual residence to bariatric center. The risk of hospital readmission rises with occurrence of intraoperative adverse events and low oral fluid intake on the day of surgery on. Conclusions Risk factors for prolonged LOS are low oral fluid intake, high intravenous volume of fluids administered on POD0, and every additional 50 km distance from habitual residence. Risk factors for hospital readmission are intraoperative adverse events and low oral fluid intake on the day of surgery.
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Affiliation(s)
- Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Grzegorz Torbicz
- Students' Scientific Group at 2nd Department of Surgery, JUMC, Krakow, Poland
| | - Natalia Gajewska
- Students' Scientific Group at 2nd Department of Surgery, JUMC, Krakow, Poland
| | - Alicja Dudek
- Students' Scientific Group at 2nd Department of Surgery, JUMC, Krakow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland. .,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland. .,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Dorota Radkowiak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 St., 31-501, Krakow, Poland.,Department of Endoscopic, Metabolic and Soft Tissue Tumors Surgery, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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Lim R, Beekley A, Johnson DC, Davis KA. Early and late complications of bariatric operation. Trauma Surg Acute Care Open 2018; 3:e000219. [PMID: 30402562 PMCID: PMC6203132 DOI: 10.1136/tsaco-2018-000219] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/14/2018] [Accepted: 08/17/2018] [Indexed: 01/02/2023] Open
Abstract
Weight loss surgery is one of the fastest growing segments of the surgical discipline. As with all medical procedures, postoperative complications will occur. Acute care surgeons need to be familiar with the common problems and their management. Although general surgical principles generally apply, diagnoses specific to the various bariatric operations must be considered. There are anatomic considerations which alter management priorities and options for these patients in many instances. These problems present both early or late in the postoperative course. Bariatric operations, in many instances, result in permanent alteration of a patient’s anatomy, which can lead to complications at any time during the course of a patient’s life. Acute care surgeons diagnosing surgical emergencies in postbariatric operation patients must be familiar with the type of surgery performed, as well as the common postbariatric surgical emergencies. In addition, surgeons must not overlook the common causes of an acute surgical abdomen—acute appendicitis, acute diverticulitis, acute pancreatitis, and gallstone disease—for these are still among the most common etiologies of abdominal pathology in these patients.
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Affiliation(s)
- Robert Lim
- Department of Surgery, Tripler Army Medical Center, Tripler, Honolulu, Hawaii, USA
| | - Alec Beekley
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dirk C Johnson
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kimberly A Davis
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Jalilvand A, Dewire J, Detty A, Needleman B, Noria S. Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery. Surg Endosc 2018; 33:1661-1666. [PMID: 30255332 DOI: 10.1007/s00464-018-6459-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/18/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND The impact of well-controlled or historical psychiatric diagnoses in patients seeking bariatric surgery (BS) on perioperative outcomes is unclear. The primary objective of this study was to determine the impact of psychiatric diagnoses on hospital length of stay (LOS), 30-day readmission rates after BS, and post-operative weight loss outcomes. METHODS Patients who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (LRNYGB) from 2014 to 2016 at a single academic institution were retrospectively reviewed. Baseline demographic data and psychiatric history including depression, anxiety, and/or bipolar disorder (DAB) were obtained from the electronic medical record. Hospital LOS, 30-day readmissions, and % excess body weight loss (%EBWL) were obtained on all patients and compared between DAB patients and those without any psychiatric history. RESULTS During the study period, 354 patients were reviewed, of which 78% were female; 60% underwent LSG. The mean preoperative BMI was 48.9 ± 8.4 m/kg2. Major depression was the leading diagnosis (42%), and 13% had both depression and anxiety. The 30-day readmission rate was significantly higher than the control (10.5% vs. 3.7%, p = 0.02). Mean hospital LOS and the incidence of long hospital LOS (≥ 4 days) was not different between the groups, although within LSG patients, the incidence of long hospital LOS trended towards being higher for DAB patients (9.2% vs. 4%, p = 0.10). Patients with depression and anxiety had a higher incidence of long LOS (23.4% vs. 9.2%, p < 0.005). While 6-month %EBWL was significantly lower for DAB patients (41% vs. 46%, p = 0.004), 1-year weight loss outcomes were not different, even when adjusting for surgical procedure. CONCLUSION Patients with baseline or historical DAB had significantly higher early readmission rates, and those with multiple diagnoses were associated with a hospital LOS ≥ 4 days. Future studies should focus on elucidating the impact of psychiatric diagnoses on these quality metrics.
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Affiliation(s)
- Anahita Jalilvand
- Department of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Jane Dewire
- Department of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Andrew Detty
- Department of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Bradley Needleman
- Department of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Sabrena Noria
- Department of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
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Doumouras AG, Saleh F, Gmora S, Anvari M, Hong D. The value of surgical experience: excess costs associated with the Roux-en-Y gastric bypass learning curve. Surg Endosc 2018; 33:1944-1951. [DOI: 10.1007/s00464-018-6472-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
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Emergency department visits and readmissions within 1 year of bariatric surgery: A statewide analysis using hospital discharge records. Surgery 2017; 162:1155-1162. [DOI: 10.1016/j.surg.2017.06.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/04/2017] [Accepted: 06/14/2017] [Indexed: 01/01/2023]
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Doumouras AG, Saleh F, Anvari S, Gmora S, Anvari M, Hong D. A Longitudinal Analysis of Short-Term Costs and Outcomes in a Regionalized Center of Excellence Bariatric Care System. Obes Surg 2017; 27:2811-2817. [DOI: 10.1007/s11695-017-2707-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ahmed A, AlBuraikan D, ALMuqbil B, AlJohi W, Alanazi W, AlRasheed B. Readmissions and Emergency Department Visits after Bariatric Surgery at Saudi Arabian Hospital: The Rates, Reasons, and Risk Factors. Obes Facts 2017; 10:432-443. [PMID: 28988235 PMCID: PMC5741164 DOI: 10.1159/000456667] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/11/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Saudi Arabian hospital readmissions and emergency department (ED) visits following bariatric surgery and discharge have never been investigated. This study aimed to evaluate the rates and reasons of hospital readmissions and ED visits related to surgical weight loss interventions at the King Abdulaziz Medical City - Riyadh. METHODS We conducted a retrospective cohort study on 301 patients who underwent bariatric surgery between January 2011 and July 2016. We reviewed patient medical records progressively to assess hospital readmission, ED visits, and complications. RESULTS Of the 301 patients analyzed, 67.1% were female and 93% had class II obesity. The readmission rate, ED visit rate after discharge and the rate of either of the two was 8%, 14%,and 18.3%, respectively. The most common causes of readmission were abdominal pain (37.5%), nausea/vomiting (29.2%), and site leak (25%), while the most common causes of ED visits were abdominal pain (59.5%) and nausea/vomiting (16.9%). Readmission rates tended to be higher in older patients (age of patients readmitted 42 ± 12.1 years vs. age of patients not readmitted 34.3 ± 11.8 years; p = 0.002). The rate of readmission tends to increase in patients with overweight or class I obesity (odds ratio (OR) = 20.15), diabetes (OR = 14.82), and obstructive sleep apnea (OR = 14.29). Dyslipidemia was positively associated with ED visits (p = 0.027, OR = 2.87). The rate of readmission or ED visits increased with age, while there were decreases in readmission and ED visits for those who had received gastric sleeve surgery. CONCLUSIONS The study reported high rates of readmission and ED visits, thus the effectiveness of different types of weight loss surgeries should be further evaluated, particularly in individuals with complicated medical issues such as diabetes, dyslipidemia, and obstructive sleep apnea.
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Affiliation(s)
- Anwar Ahmed
- King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- *Anwar Ahmed, Ph.D., College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, MC 2350, P.O. Box 22490, 11426 Riyadh, Saudi Arabia,
| | - Doaa AlBuraikan
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Bashayr ALMuqbil
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Wijdan AlJohi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Wala Alanazi
- Al-Maarefa College for Science and Technology, Riyadh, Saudi Arabia
| | - Budor AlRasheed
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Is bariatric surgery safe in the elderly population? Surg Endosc 2016; 31:1538-1543. [PMID: 28039650 DOI: 10.1007/s00464-016-5050-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 06/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bariatric surgery has proven to be the most effective treatment for morbid obesity in all age groups and is considered superior to medical treatment. The aim of our study was to report the outcomes of bariatric surgery in patients over 65 years of age at our institution. METHODS A retrospective review of a prospectively collected database was conducted of all patients > 65 years who underwent a bariatric procedure between 2005 and 2015 at our institution. We compared this group to a control group of patients < 65 years of age who were operated on during the last 5 years, from 2011 to 2015. Data analyzed included age, preoperative BMI, postoperative complications, and comorbidities. RESULTS Of 1613 patients studied, 1220 patients were under 65 years of age, and in Group B, 393 were >65 years of age at time of surgery. There was a significant difference in proportion of male patients among groups; 42 % in Group B were male compared to 30 % in Group A (p < 0.001). Caucasians represented the majority in both groups. Both groups had comparable preoperative BMI 42.27 kg/m2 for the younger Group A population versus 41.64 kg/m2 for Group B (p = 0.074). Group B had more comorbidities than Group A: hypertension (p < 0.001), sleep apnea (p < 0.001), and hypercholesterolemia (p < 0.001). No difference was found between groups in history of depression (p = 0.409) or type II diabetes (p = 0.961). Distribution of procedures was significantly different between groups, with more LSG in Group A (p < 0.001). Elderly patients had longer length of stay (LOS) by one day on average (LOS = 3 days, p < 0.001), but a lower readmission rate (10 % vs. 7 %) (p = 0.023). Complication rates were comparable in both groups, except for incidence of de novo GERD, which was higher in Group B (5 % vs. 8 %) (p = 0.005). CONCLUSIONS Elderly patients are usually sicker in terms of comorbidities than the younger population. However, age does not seem to represent a risk of surgical complications after bariatric surgery.
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Doumouras AG, Saleh F, Tarride JE, Hong D. A population-based analysis of the drivers of short-term costs after bariatric surgery within a publicly funded regionalized center of excellence system. Surg Obes Relat Dis 2016; 12:1023-1031. [DOI: 10.1016/j.soard.2016.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 10/22/2022]
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