1
|
Aceto P, De Cicco R, Calabrese C, Marusco I, Del Tedesco F, Luca E, Modesti C, Sacco T, Sollazzi L, Ciccoritti L, Greco F, Giustacchini P, Pennestrì F, Gallucci P, Raffaelli M. Obesity Surgery Mortality Risk Score as a Predictor for Intensive Care Unit Admission in Patients Undergoing Laparoscopic Bariatric Surgery. J Clin Med 2024; 13:2252. [PMID: 38673525 PMCID: PMC11050932 DOI: 10.3390/jcm13082252] [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: 03/06/2024] [Revised: 04/03/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Laparoscopic bariatric surgery provides many benefits including lower postoperative pain scores, reduced opioid consumption, shorter hospital stays, and improved quality of recovery. However, the anaesthetic management of obese patients requires caution in determining postoperative risk and in planning adequate postoperative pathways. Currently, there are no specific indications for intensive care unit (ICU) admission in this surgical population and most decisions are made on a case-by-case basis. The aim of this study is to investigate whether Obesity Surgery Mortality Risk Score (OS-MRS) is able to predict ICU admission in patients undergoing laparoscopic bariatric surgery (LBS). Methods: We retrospectively reviewed data of patients who underwent LBS during a 2-year period (2017-2019). The collected data included demographics, comorbidities and surgery-related variables. Postoperative ICU admission was decided via bariatric anaesthesiologists' evaluations, based on the high risk of postoperative cardiac or respiratory complications. Anaesthesia protocol was standardized. Logistic regression was used for statistical analysis. Results: ICU admission was required in 2% (n = 15) of the 763 patients. The intermediate risk group of the OS-MRS was detected in 84% of patients, while the American Society of Anaesthesiologists class III was reported in 80% of patients. A greater OS-MRS (p = 0.01), advanced age (p = 0.04), male gender (p = 0.001), longer duration of surgery (p = 0.0001), increased number of patient comorbidities (p = 0.002), and previous abdominal surgeries (p = 0.003) were predictive factors for ICU admission. Conclusions: ICU admission in obese patients undergoing LBS is predicted by OS-MRS together with age, male gender, number of comorbidities, previous abdominal surgeries, and duration of surgery.
Collapse
Affiliation(s)
- Paola Aceto
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
- Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberto De Cicco
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Claudia Calabrese
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Irene Marusco
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Filippo Del Tedesco
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Ersilia Luca
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Cristina Modesti
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
- Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Teresa Sacco
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
| | - Liliana Sollazzi
- Department of Emergency, Anesthesiologic and Reanimation Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (R.D.C.); (C.C.); (I.M.); (F.D.T.); (C.M.); (T.S.); (L.S.)
- Department of Basic Biotechnological Science, Intensive and Peri-Operative Clinics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luigi Ciccoritti
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
| | - Francesco Greco
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
| | - Piero Giustacchini
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
| | - Francesco Pennestrì
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Pierpaolo Gallucci
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
| | - Marco Raffaelli
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (L.C.); (F.G.); (P.G.); (F.P.); (P.G.); (M.R.)
- Centro di Ricerca di Chirurgia delle Ghiandole Endocrine e dell’Obesità, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
2
|
Alanzi A, Alamannaei F, Abduljawad S, Ghuloom A, Alahmed FA, Alzaidani AE, Almusaifer MF, Alanezi MA, Adeel S. Patient Outcomes and Rate of Intensive Care Unit Admissions Following Bariatric Surgery: A Retrospective Cohort Study of 775 Patients. Cureus 2023; 15:e49667. [PMID: 38161944 PMCID: PMC10756585 DOI: 10.7759/cureus.49667] [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: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Background The last two decades have seen a significant rise in obesity and its adverse consequences across the globe. Bariatric surgery has emerged as a widely employed therapeutic approach for weight reduction and alleviating the risk of obesity-related chronic diseases such as diabetes, cardiovascular diseases, and cancer. As bariatric procedures are gaining popularity, the complications associated with these procedures can not be ignored. This retrospective study aimed to investigate the incidence of intensive care unit (ICU) admissions following bariatric surgery and ICU-related mortality. Methodology This retrospective study conducted at King Hamad University Hospital, Bahrain evaluated the patient outcomes and the rate of ICU admissions following bariatric surgery between 2018 and 2022. Demographic data of the patients were extracted from electronic health records. The primary endpoint was ICU admission incidence and mortality, while secondary outcomes included risk factors, duration of ICU stay, and complications leading to ICU admission. Results Of the 775 patients included, 66.3% were female. The mean age of the patients was 35.92 ± 21.12 years. Over 91% of the patients had a body mass index above 30 kg/m2. The most common primary procedure was laparoscopic sleeve gastrectomy (75%), followed by gastric bypass (22.6%). In revision bariatric surgery, the majority (91.3%) had a conversion from sleeve gastrectomy to gastric bypass. Overall, 0.77% of patients were admitted to the ICU, with the majority being unplanned ICU admissions (0.52%). The average ICU stay was 21 days (1 to 54 days). The most common reason for ICU admission was sepsis, septic shock, and gastric leakage. Conclusions The results of this study show a relatively lower number of ICU admissions after bariatric surgery compared to previous studies.
Collapse
Affiliation(s)
- Ahmed Alanzi
- Anesthesia and Critical Care, King Hamad University Hospital, Muharraq, BHR
| | | | | | - Ameera Ghuloom
- General Practice, Ministry of Health - Bahrain, Manama, BHR
| | - Fatema A Alahmed
- Internal Medicine, King Hamad University Hospital, Muharraq, BHR
| | | | | | | | - Shahid Adeel
- Anesthesia and Critical Care, King Hamad University Hospital, Muharraq, BHR
| |
Collapse
|
3
|
Comparison of robot-assisted sleeve gastrectomy outcomes in multiple staple line treatment modalities from 2015 to 2019: a 5-year propensity score-adjusted MBSAQIP® analysis. Surg Endosc 2023; 37:1401-1411. [PMID: 35701675 DOI: 10.1007/s00464-022-09366-9] [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: 03/28/2022] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Robot-assisted sleeve gastrectomy (RSG) is an increasingly common approach to sleeve gastrectomy (SG). Staple line reinforcement (SLR) is well-discussed in laparoscopic SG literature, but not RSG- likely due to the absence of dedicated robotic SLR devices. However, most RSG cases report SLR. This retrospective analysis compares outcomes in RSG cases reporting (1) any staple line treatment (SLT) vs none and (2) SLR vs oversewing. METHODS MBSAQIP was queried for adults who underwent RSG from 2015 to 2019. Open procedures, Natural Orifice Transluminal Endoscopic Surgery, hand-assisted, single-incision, concurrent procedures, and illogical BMIs were excluded (n = 3444). Final sample included 52,354 patients. Two comparisons were made: SLT (n = 34,886) vs none (n = 17,468) and SLR (n = 22,217) vs oversew (n = 5620). We fitted multivariable regression models to estimate risk ratios (RR) and 95% confidence intervals (CI) and performed propensity score analysis with inverse probability of treatment weight based on patient factors. RESULTS Most RSG cases utilized SLT (66.6%). Cases with SLT had a reduced risk of organ space SSI (RR 0.68 [0.49, 0.94]), 30-day reoperation (RR 0.77 [0.64, 0.93]), 30-day re-intervention (RR 0.80 [0.67, 0.96]), sepsis (RR 0.58 [0.35, 0.96]), unplanned intubation (RR 0.59 [0.37, 0.93]), extended ventilator use (RR 0.46 [0.23, 0.91]), and renal failure (RR 0.40 [0.19, 0.82]) compared to no-treatment cases. In single-treatment cases (n = 27,837), most utilized SLR (79.8%). Cases with oversew had a higher risk of any SSI (RR 1.70 [1.19, 2.42]), superficial incisional SSI (RR 1.71 [1.06, 2.76]), septic shock (RR 6.47 [2.11, 19.87]), unplanned intubation (RR 2.18 [1.06, 4.47]), and extended ventilator use (> 48 h) (RR 4.55 [1.63, 12.71]) than SLR. CONCLUSIONS Our data suggest SLT in RSG is associated with reduced risk of some adverse outcomes vs no-treatment. Among SLT, SLR demonstrated lower risk than oversewing. However, risk of all-cause mortality, cardiac arrest, and unplanned ICU admission were not significant.
Collapse
|
4
|
Geerts A, Lefere S. Bariatric surgery for non-alcoholic fatty liver disease: Indications and post-operative management. Clin Mol Hepatol 2023; 29:S276-S285. [PMID: 36545709 PMCID: PMC10029945 DOI: 10.3350/cmh.2022.0373] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
The prevalence of obesity and metabolic consequences such as nonalcoholic fatty liver diseases (NAFLD) has become a crucial health problem. Lifestyle modifications, especially weight loss, effectively reduces liver injury in NAFLD patients. However, adherence to lifestyle changes is very low in the clinical setting. Bariatric surgery can improve metabolic components and cause long-term weight loss. Therefore, bariatric surgery could serve as an attractive treatment option for NAFLD patients. This review integrates data about the benefits of bariatric surgery on NAFLD but also describes the potential pitfalls.
Collapse
Affiliation(s)
- Anja Geerts
- Liver Research Center Ghent, Ghent University, Ghent, Belgium
- Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Sander Lefere
- Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| |
Collapse
|
5
|
Tian C, Hawryluck L, Tomlinson G, Chung F, Beattie S, Miller M, Hassan N, Wong DT, Wong J, Hudson J, Jackson T, Singh M. Impact of a continuous enhanced cardio-respiratory monitoring pathway on cardio-respiratory complications after bariatric surgery: A retrospective cohort study. J Clin Anesth 2021; 77:110639. [PMID: 34953279 DOI: 10.1016/j.jclinane.2021.110639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To determine the impact of an enhanced monitoring pathway consisting of continuous postoperative cardio-respiratory monitoring on adverse outcomes after bariatric. DESIGN Single-center, retrospective cohort study. PATIENTS Adult patients who underwent bariatric surgeries between 2009 and 2016. INTERVENTIONS We evaluated the use of an enhanced monitoring pathway consisting of a distant, continuous, non-invasive respiratory monitoring system on postoperative cardio-respiratory complications in patients undergoing bariatric surgery. Treating physicians had the option to assign patients to enhanced monitoring (intervention group) in the postoperative period for suspected or diagnosed OSA or other clinical concerns. The control group had intermittent vital sign checks as per institutional standards. MEASUREMENTS The primary outcome was a composite of cardio-respiratory complications (rapid response team activation, intensive care admission, respiratory complications), major adverse cardiac events, and all-cause mortality. The secondary outcome was length of stay (LOS). MAIN RESULTS Of 1450 patients, 752 patients received enhanced monitoring (intervention) and 698 patients received standard monitoring (control). Univariate analysis showed that, compared to control, enhanced monitoring was associated with lower odds of composite cardio-respiratory complications (OR: 0.41, 95%CI: 0.32-0.53, p < 0.001) and lower odds of prolonged LOS > 2 days (OR: 0.37, 95% CI: 0.28-0.49, p < 0.001. After adjusting for potential confounders, enhanced monitoring remained associated with a reduction in composite cardio-respiratory complications (OR: 0.64, 95% CI: 0.46-0.88, p = 0.005). CONCLUSIONS Our study demonstrates that postoperative enhanced monitoring pathway was associated with a lower incidence of cardio-respiratory composite events, compared to a standard of care, in patients undergoing bariatric surgery. As our results show association rather than causation, future prospective randomized trials are needed to confirm the benefit of enhanced monitoring. Findings of our study add to the existing literature involved in clinical management pathways to reduce the incidence of adverse postoperative outcomes in high-risk patients undergoing inpatient surgeries.
Collapse
Affiliation(s)
- Chenchen Tian
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Laura Hawryluck
- University of Toronto, Toronto, Ontario, Canada; Department of Intensive Care Medicine, Toronto Western Hospital, University Health Network, Canada
| | - George Tomlinson
- University of Toronto, Toronto, Ontario, Canada; Biostatistics Research Unit, Department of Medicine, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Frances Chung
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Scott Beattie
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Matthew Miller
- Department of Anaesthesia, St George Hospital, Sydney, Australia; University of New South Wales Australia, St George and Sutherland Clinical Schools, Australia
| | - Najia Hassan
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - David T Wong
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Jean Wong
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Julie Hudson
- Biostatistics Research Unit, Department of Medicine, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Timothy Jackson
- University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Toronto Western Hospital, University Health Network, Canada
| | - Mandeep Singh
- Department of Anesthesiology, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Department of Anesthesiology, Women's College Hospital, Toronto, Ontario, Canada.
| |
Collapse
|
6
|
A Comparative Analysis of Fleur-de-Lis and Traditional Panniculectomy after Bariatric Surgery. Aesthetic Plast Surg 2021; 45:2208-2219. [PMID: 33544187 DOI: 10.1007/s00266-021-02149-y] [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: 11/20/2020] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The Fleur-de-Lis panniculectomy (FdL) adds a vertical component to correct complex contour deformities after massive weight loss by addressing supra-umbilical horizontal skin excess which is not addressed with infra-umbilical transverse panniculectomy (TP). We aim to perform a head-to-head comparison of clinical outcomes and patient reported outcomes (PROs) between FdL and TP. METHODS A retrospective review of patients ≥18 with a history of bariatric surgery undergoing FdL or TP by a single plastic surgeon between 07/01/2015 and 05/31/2020 was conducted. Surgical site occurrences (SSOs) including surgical site infection (SSI), delayed healing, cellulitis, seroma, hematoma, surgical site occurrences requiring procedural intervention (SSOpi), and a composite of other postoperative outcomes were assessed. In addition, patient satisfaction was analyzed using the Body-Q questionnaire across 12 domains. RESULTS The analysis included 56 patients; 26 and 30 patients who were treated with FdL and TP, respectively. Cohorts were statistically similar in terms of age, gender, BMI, and co-morbid conditions. The overall complication rate was 50% (FdL n = 14 (53.9%), TP n = 14 (46.7%); p = 0.592). On multivariate analysis, pannus weight was associated with the development of SSO (p = 0.04). FdL incision, however, was not an independent risk factor for adverse outcomes. Absolute improvement in PROs was similar in both cohorts across multiple domains. CONCLUSION FdL showed a comparable safety and efficacy profile to TP when performed in post-bariatric surgery patients, with equivalent improvement in PROs across multiple domains. Preoperative weight loss should be encouraged in this population as pannus weight is an independent risk factor for complications. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
7
|
Meunier H, Menahem B, Le Roux Y, Bion AL, Marion Y, Vallois A, Contival N, Gautier T, Lubrano J, Briant A, Parienti JJ, Alves A. Development of the "OS-SEV90 Score" to Predict Severe Postoperative Complications at 90 Days Following Bariatric Surgery. Obes Surg 2021; 31:3053-3064. [PMID: 33907969 DOI: 10.1007/s11695-021-05367-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bariatric surgery may be associated with severe postoperative complications (SPC). Factors associated with the risk of SPC have not been fully investigated. OBJECTIVES This study aimed to identify preoperative risk factors of SPC within 90 days and to develop a risk prediction model based on these factors. METHODS We conducted a retrospective single-center cohort study based on a prospectively maintained database of obese patients undergoing laparoscopic bariatric surgery from October 2005 to May 2019. All SPC occurring up to the 90th postoperative day were recorded according to the Dindo-Clavien classification. Associations between potential risk factors and SPC were analyzed using a logistic regression model, and the risk prediction ("OS-SEV90 score") was computed. Based on the OS-SEV90 score, the patients were grouped into 3 categories of risk: low, intermediate, and high. RESULTS Among 1963 consecutive patients, no patient died and 82 (4.2%) experienced SPC within 90 days. History of gastric or esophageal surgery (adjusted odds ratio (aOR) 3.040, 95% confidence interval; CI 1.78-5.20, p< 0.0001), past of thromboembolic event aOR 2.26, 95%; CI 1.12-4.55, p = 0.0225), and surgery performed by a junior surgeon (aOR 1.99, 95%; CI 1.26-3.13, p = 0.003) were all independently associated with risk for SPC, adjusting for ASA physical status system (ASA) score ≥ 3, severe OSA, psychiatric disease, asthma, a history of abdominal surgery, alcohol, cardiac disease, and dyslipidemia. "the OS-SEV90 score" based on these factors was constructed to classify patients into 3 risk groups: low (≤2), intermediate (3-4), and high (≥5). According to "the OS-SEV90 score," SPC increased significantly from 2.9% in the low-risk group, 7.7% in the intermediate-risk group, and 23.3% in the high-risk group. CONCLUSIONS A predictive model of SPC within 90 days "the OS-SEV90 score" has been developed using 9 baseline risk factors. The use of the OS-SEV90 score may help the multidisciplinary team to identify the specific risk of each patient and inform them about and optimize the comorbidities before the surgery. Further studies are warranted to validate this score in a new independent cohort before using it in clinical practice.
Collapse
Affiliation(s)
- Hugo Meunier
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France.
- UMR INSERM 1086 "Cancers et préventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen cedex, France.
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen cedex, France.
| | - Yannick Le Roux
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Adrien Lee Bion
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Yoann Marion
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Antoine Vallois
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Nicolas Contival
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Thomas Gautier
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
| | - Jean Lubrano
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen cedex, France
| | - Anaïs Briant
- Department of Biostatistics, University Hospital of Caen, Caen, France
| | - Jean-Jacques Parienti
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen cedex, France
- Department of Biostatistics, University Hospital of Caen, Caen, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la côte de Nacre, 14033, Caen cedex, France
- UMR INSERM 1086 "Cancers et préventions", Centre François Baclesse, 3 avenue du Général Harris, 14045, Caen cedex, France
- UFR de Médecine, 2 avenue des Rochambelles, CS 60001, 14033, Caen cedex, France
| |
Collapse
|
8
|
Bruceta M, De Souza L, Carr ZJ, Bonavia A, Kunselman AR, Karamchandani K. Post-operative intensive care unit admission after elective non-cardiac surgery: A single-center analysis of the NSQIP database. Acta Anaesthesiol Scand 2020; 64:319-328. [PMID: 31710692 DOI: 10.1111/aas.13504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/15/2019] [Accepted: 10/30/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Admission to the intensive care unit (ICU) after surgery can be associated with significant morbidity and mortality. This observational cohort study aims to identify perioperative factors associated with post-operative ICU admission in patients undergoing elective non-cardiac surgery. METHODS Data from the ACS NSQIP® database at a tertiary care academic medical center were analyzed from January 2011 to September 2016. Univariable and multivariable logistic regression of patient and surgery-specific characteristics was performed to assess association with post-operative ICU admission. The Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9) billing codes, as well as associated outcomes, were reviewed. RESULTS Of 5254 database patient records, 1150 met our inclusion criteria. Elevated body mass index (BMI), longer procedure duration and a diagnosis of disseminated cancer were associated with post-operative ICU admission. Prostatectomy and morbid obesity were the most common CPT and ICD-9 codes identified. Patients who were admitted to the ICU after surgery had a longer hospital length of stay (LOS), had a higher frequency of readmission, re-operation, and in-hospital mortality. CONCLUSION Admission to the ICU after elective non-cardiac surgery is common. Our analysis of the ACS NSQIP® database identified elevated BMI, longer duration of surgery and disseminated cancer as predictors of post-operative ICU admissions in patients undergoing elective non-cardiac surgery.
Collapse
Affiliation(s)
- Melanio Bruceta
- Department of Anesthesiology and Perioperative Medicine Penn State Health Milton S. Hershey Medical Center Hershey PA USA
| | - Luisa De Souza
- Department of Anesthesiology and Perioperative Medicine Penn State Health Milton S. Hershey Medical Center Hershey PA USA
| | - Zyad J. Carr
- Department of Anesthesiology and Perioperative Medicine Penn State Health Milton S. Hershey Medical Center Hershey PA USA
| | - Anthony Bonavia
- Department of Anesthesiology and Perioperative Medicine Penn State Health Milton S. Hershey Medical Center Hershey PA USA
| | - Allen R. Kunselman
- Division of Biostatistics and Bioinformatics Department of Public Health Sciences Penn State College of Medicine Hershey PA USA
| | - Kunal Karamchandani
- Department of Anesthesiology and Perioperative Medicine Penn State Health Milton S. Hershey Medical Center Hershey PA USA
| |
Collapse
|
9
|
Safety of Continuous Postoperative Pulse Oximetry Monitoring Without Obstructive Sleep Apnea Screening in > 5000 Patients Undergoing Bariatric Surgery. Obes Surg 2019; 30:1079-1085. [DOI: 10.1007/s11695-019-04297-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
|
11
|
Cosse C, Rebibo L, Brazier F, Hakim S, Delcenserie R, Regimbeau JM. Cost-effectiveness analysis of stent type in endoscopic treatment of gastric leak after laparoscopic sleeve gastrectomy. Br J Surg 2018; 105:570-577. [DOI: 10.1002/bjs.10732] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/12/2017] [Accepted: 09/20/2017] [Indexed: 01/30/2023]
Abstract
Abstract
Background
Gastric leak is the most feared surgical postoperative complication after sleeve gastrectomy. An endoscopic procedure is usually required to treat the leak. No data are available on the cost-effectiveness of different stent types in this procedure.
Methods
Between April 2005 and July 2016, patients with a confirmed gastric leak undergoing endoscopic treatment using a covered stent (CS) or double-pigtail stent (DPS) were included. The primary objective of the study was to assess overall costs of the stent types after primary sleeve gastrectomy. Secondary objectives were the cost-effectiveness of each stent type expressed as an incremental cost-effectiveness ratio (ICER); the incremental net benefit; the probability of efficiency, defined as the probability of being cost-effective at a threshold of €30 000, and identification of the key drivers of ICER derived from a multivariable analysis.
Results
One hundred and twelve patients were enrolled. The overall mean costs of gastric leak were €22 470; the mean(s.d.) cost was €24 916(12 212) in the CS arm and €20 024(3352) in the DPS arm (P = 0·018). DPS was more cost-effective than CS (ICER €4743 per endoscopic procedure avoided), with an incremental net benefit of €25 257 and a 27 per cent probability of efficiency. Key drivers of the ICER were the inpatient ward after diagnosis of gastric leak (surgery versus internal medicine), type of institution (private versus public) and duration of hospital stay per endoscopic procedure.
Conclusion
DPS for the treatment of gastric leak is more cost-effective than CS and should be proposed as the standard regimen whenever possible.
Collapse
Affiliation(s)
- C Cosse
- Department of Digestive Surgery, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
- Institut National de la Santé et de la Recherche Médicale U1088, Jules Verne University of Picardie, Amiens, France
| | - L Rebibo
- Department of Digestive Surgery, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - F Brazier
- Department of Gastroenterology, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - S Hakim
- Department of Gastroenterology, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - R Delcenserie
- Department of Gastroenterology, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
| | - J M Regimbeau
- Department of Digestive Surgery, Amiens South Hospital, Jules Verne University of Picardie, Amiens, France
- EA4294, Jules Verne University of Picardie, Amiens, France
| |
Collapse
|
12
|
Gero D, Gutschow CA, Bueter M. Does Gastric Surgery (Such as Bariatric Surgery) Impact the Risk of Intestinal Inflammation? Inflamm Intest Dis 2016; 1:129-134. [PMID: 29922668 DOI: 10.1159/000449267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/21/2016] [Indexed: 12/13/2022] Open
Abstract
Background The prevalence of morbid obesity and inflammatory bowel disease (IBD) is on the rise in association with a Western lifestyle. Both conditions are characterized by chronic inflammation. Bariatric surgery (BS) is a recommended and widely used approach to address severe obesity and its related comorbidities. Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG) are the most frequently performed procedures worldwide. Evidence is scarce on outcomes of BS in IBD patients. Summary Systemic and adipose-tissue inflammation seems to decrease following BS. Different studies observed decreased serum levels of inflammatory markers (CRP, IL-6, MCP-1, and TNF-α) along with a reduction of insulin resistance both after RYGBP and SG. Several authors documented postbariatric improvement of concomitant chronic inflammatory diseases (rheumatoid arthritis, systemic lupus erythematosus, gout, and psoriasis). There are only few retrospective case series on outcomes of BS in IBD patients. These studies reported safety and feasibility of BS and improvement in IBD status, manifested by prolonged disease remission and decreased use of pharmacotherapy. Weight loss outcomes were excellent and similar to those of non-IBD patients. The preferred surgical approach for morbidly obese IBD patients is SG in order to avoid potential drawbacks of RYGBP, such as malabsorption, intestinal manipulation, and augmentation of technical difficulties for future IBD surgery. Seven cases of newly diagnosed IBD after BS have been reported, which are more likely to result from postoperative intestinal microbial dysbiosis than from directly induced inflammation. Key Messages This review summarizes the outcomes of BS in IBD patients. SG is the preferable technique for morbidly obese IBD patients, who have potentially a double benefit from BS: weight loss and IBD remission. Further research is necessary to clarify the common pathophysiology of chronic inflammation in morbid obesity and in IBD. Postbariatric changes in gut microbiota should also be assessed to understand whether they promote IBD development or not.
Collapse
Affiliation(s)
- Daniel Gero
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Christian A Gutschow
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bueter
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|