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Bluml BM, Hamstra SA, Tonrey LL, Little JB, Bonham AJ, Grabenstein JD. Pharmacist Assessments and Care to Improve Adult Vaccination Rates: A Report from Project IMPACT Vaccine Confidence. J Am Pharm Assoc (2003) 2024:102061. [PMID: 38432481 DOI: 10.1016/j.japh.2024.102061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Neglect of vaccination needs among adults results in a needless burden of hospitalization, suffering, and death. America's community pharmacists deliver a substantial portion of adult vaccinations, yet many Americans still have unmet vaccination needs. OBJECTIVES This study evaluated rates of vaccine contraindications, acceptance, and willingness to be vaccinated among ambulatory adults. METHODS This was a prospective, multisite, multistate, observational study conducted in three waves between October 2021 and August 2023. Pharmacists conducted comprehensive vaccination need assessments. The primary outcomes were numbers of vaccination needs per participant and vaccinations administered, scheduled, or declined. RESULTS Pharmacists identified a mean of 1.8 to 2.2 unmet vaccination needs per adult assessed, more than in pilot studies. Participants had already received 61% to 74% of vaccinations recommended for them, hence 26% to 39% of needs were unmet at baseline. The leading vaccination needs were COVID-19, influenza, zoster, tetanus-containing, and pneumococcal vaccines. From a baseline mean of 59.1% for these five vaccinations, pharmacists increased the mean percentage vaccinated to 73.2%. When an option for scheduling future vaccination was added to the process, declinations dropped from 46% to 18%. DISCUSSION This study provides insight into adult vaccine acceptance, willingness, and declination behaviors not described elsewhere. Offering options for future vaccination reduced declination rates. CONCLUSION Pharmacists resolved substantial proportions of adult vaccination needs. The signal that apportioning adult vaccines needed, but not received on day of assessment, across several months could help resolve unmet vaccination needs warrants additional research, especially with the rising number of vaccines recommended for adults.
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Ramirez JL, Kim E, Fregenal AC, Vigran HJ, Hughes SE, Reynolds CW, Varban OA, Carlin AM, Ehlers AP, Bonham AJ, Finks JF. Depression as a risk factor for adverse outcomes and increased healthcare utilization in bariatric surgery patients. Surg Endosc 2023; 37:9582-9590. [PMID: 37735218 DOI: 10.1007/s00464-023-10353-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/30/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Depression is strongly associated with obesity and is common among patients undergoing bariatric surgery. Little is known about the impact of depression on early postoperative outcomes or its association with substance use. METHODS The Michigan Bariatric Surgery Collaborative is a statewide quality improvement program that maintains a large clinical registry. We evaluated patients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 2017 and 2022. Patients self-reported symptoms of depression (PHQ-8) and use of alcohol (AUDIT-C), smoking, prescription opiates, and marijuana at baseline. Preoperative PHQ-8 scores stratified patients based on severity: no depression (0-4), mild (5-9), moderate (10-14), or severe (15-24). We compared 30-day outcomes and substance use between patients with and without depression. RESULTS Among 44,301 patients, 30.8% had some level of depression, with 19.8% mild, 7.5% moderate, and 3.5% severe. Patients with depression were more likely to have an extended length of stay (LOS) (> 3 days) than those without depression (no depression 2.1% vs. severe depression 3.0%, p = 0.0452). There were no significant differences between no depression and severe depression groups in rates of complications (5.7% vs. 5.2%, p = 0.1564), reoperations (0.9%, vs. 0.8%, p = 0.7394), ED visits (7.7% vs. 7.8%, p = 0.5353), or readmissions (3.2% vs. 3.9%, p = 0.3034). Patients with severe depression had significantly higher rates of smoking (9.7% vs. 12.5%, p < 0.0001), alcohol use disorder (8.6% vs. 14.0%, p < 0.0001), opiate use (14.5% vs. 22.4%, p < 0.0001) and marijuana use (8.4%, vs. 15.5%, p = 0.0008). CONCLUSIONS This study demonstrated that nearly one-third of patients undergoing bariatric surgery have depression, with over 10% in the moderate to severe range. There was a significant association between preoperative depressive symptoms and extended LOS after bariatric surgery, as well as higher rates of smoking and use of marijuana, prescription opiates and alcohol. There was no significant effect on adverse events or other measures of healthcare utilization.
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Affiliation(s)
| | - Erin Kim
- University of Michigan Medical School, Ann Arbor, MI, USA.
| | | | | | - Sarah E Hughes
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Oliver A Varban
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Anne P Ehlers
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan F Finks
- Department of Surgery, University of Michigan Health Systems, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
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Somerset AE, Wood MH, Bonham AJ, Carlin AM, Finks J, Ghaferi AA, Varban OA. Association of program-specific variation in bariatric surgery volume for Medicaid patients and access to care: a tale of inequality? Surg Endosc 2023; 37:8570-8576. [PMID: 37872428 DOI: 10.1007/s00464-023-10411-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 07/30/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Although patients with lower socioeconomic status are at higher risk of obesity, bariatric surgery utilization among patients with Medicaid is low and may be due to program-specific variation in access. Our goal was to compare bariatric surgery programs by percentage of Medicaid cases and to determine if variation in distribution of patients with Medicaid could be linked to adverse outcomes. METHODS Using a state-wide bariatric-specific data registry that included 43 programs performing 97,207 cases between 2006 and 2020, we identified all patients with Medicaid insurance (n = 4780, 4.9%). Bariatric surgery programs were stratified into quartiles according to the percentage of Medicaid cases performed and we compared program-specific characteristics as well as baseline patient characteristics, risk-adjusted complication rates and wait times between top and bottom quartiles. RESULTS Program-specific distribution of Medicaid cases varied between 0.69 and 22.4%. Programs in the top quartile (n = 11) performed 18,885 cases in total, with a mean of 13% for Medicaid patients, while programs in the bottom quartile (n = 11) performed 32,447 cases in total, with a mean of 1%. Patients undergoing surgery at programs in the top quartile were more likely to be Black (20.2% vs 13.5%, p < 0.0001), have diabetes (35.1% vs 29.5%, p < 0.0001), hypertension (55.1% vs 49.6%, p < 0.0001) and hyperlipidemia (47.6% vs 45.2%, p < 0.0001). Top quartile programs also had higher complication rates (8.4% vs 6.6%, p < 0.0001), extended length of stay (5.6% vs 4.0%, p < 0.0001), Emergency Department visits (8.1% vs 6.5%, p < 0.0001) and readmissions (4.7% vs 3.9%, p < 0.0001). Median time from initial evaluation to surgery date was also significantly longer among top quartile programs (200 vs 122 days, p < 0.0001). CONCLUSIONS Bariatric surgery programs that perform a higher proportion of Medicaid cases tend to care for patients with greater disease severity who experience delays in care and also require more resource utilization. Improving bariatric surgery utilization among patients with lower socioeconomic status may benefit from insurance standardization and program-centered incentives to improve access and equitable distribution of care.
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Affiliation(s)
- Amy E Somerset
- Department of Surgery, Detroit Medical Center, Wayne State University, 3990 John R, Detroit, MI, 48201, USA.
| | - Michael H Wood
- Department of Surgery, Detroit Medical Center, Wayne State University, 3990 John R, Detroit, MI, 48201, USA
| | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Jonathan Finks
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
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Hider AM, Johanson H, Bonham AJ, Ghaferi AA, Finks J, Ehlers AP, Carlin AM, Varban OA. Evaluating outcomes among surgeons who changed their technique for gastric bypass: a state-wide analysis from 2011 to 2021. Surg Endosc 2023; 37:8464-8472. [PMID: 37740112 DOI: 10.1007/s00464-023-10434-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Technical variation exists when performing the gastrojejunostomy during Roux-en-Y gastric bypass (RYGB). However, it is unclear whether changing technique results in improved outcomes or patient harm. METHODS Surgeons participating in a state-wide bariatric surgery quality collaborative who completed a survey on how they perform a typical RYGB in 2011 and again in 2021 were included in the analysis (n = 31). Risk-adjusted 30-day complication rates and case characteristics for cases in 2011 were compared to those in 2021 among surgeons who changed their gastrojejunostomy technique from end-to-end anastomosis (EEA) to either a linear staple or handsewn anastomosis (LSA/HSA). In addition, case characteristics and outcomes among surgeons who maintained an EEA technique throughout the study period were assessed. RESULTS A total of 15 surgeons (48.3%) changed their technique from EEA to LSA/HSA while 7 surgeons (22.3%) did not. Nine surgeons did LSA or HSA the entire period and therefore were not included. Surgeons who changed their technique had significantly lower rates of surgical complications in 2021 when compared to 2011 (1.9% vs 5.1%, p = 0.0015), including lower rates of wound complications (0.5% vs 2.1%, p = 0.0030) and stricture (0.1% vs 0.5%, p = 0.0533). Likewise, surgeons who did not change their EEA technique, also experienced a decrease in surgical complications (1.8% vs 5.8%, p < 0.0001), wound complications (0.7% vs 2.1%, p < 0.0001) and strictures (0.2% vs 1.2%, p = 0.0006). Surgeons who changed their technique had a significantly higher mean annual robotic bariatric volume in 2021 (30.0 cases vs 4.9 cases, p < 0.0001) when compared to those who did not. CONCLUSIONS Surgeons who changed their gastrojejunostomy technique from circular stapled to handsewn demonstrated greater utilization of the robotic platform than those who did not and experienced a similar decrease in adverse events during the study period, despite altering their technique. Surgeons who chose to modify their operative technique may be more likely to adopt newer technologies.
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Affiliation(s)
- Ahmad M Hider
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA.
| | | | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jonathan Finks
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of Surgery, Henry Ford Health, Detroit, MI, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
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Little J, Bonham AJ, Bluml BM. Solutions for Atrial Fibrillation Edvocacy (SAFE): Improving Awareness And Access To Afib Screening For Detection And Referral For Treatment. Innov Pharm 2023; 14:10.24926/iip.v14i2.5477. [PMID: 38025178 PMCID: PMC10653716 DOI: 10.24926/iip.v14i2.5477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Background: Atrial Fibrillation (Afib) can lead to stroke and heart failure, and early detection of Afib is an effective method of preventing these life-threatening conditions. An estimated 2.7 million Americans are living with Afib1, a number that is expected to rise dramatically in the coming years. Methods: The aim of this demonstration project was to create an additional access point in the community at local pharmacies for Afib screening, detection, and referral to physicians for follow-up and initiation of evidence-based therapy when appropriate. This prospective research study was conducted with 14 community pharmacies across the US, in which a total of 650 patients were screened for Afib. Pharmacists conducted SAFEty Risk Assessments that consisted of completion of a Stroke Risk Scorecard and EKG determination utilizing AliveCor's KardiaMobile® 6L device. Results: In 552 (82.5%) of 669 total EKG readings, a "normal" rhythm was detected, and in 117 (17.5%) EKG readings an abnormal detection occurred. A total of 12 out of 650 patients (1.8%) received EKG readings of Afib, which is greater than double the expected prevalence of Afib in the US (0.81%), a statistically significant finding (p < 0.0001). Other notable findings included 42 (6.3%) EKG readings of Wide QRS, and 26 (3.9%) EKG readings of tachycardia. A total of 44 patients were referred to physicians for follow-up on their risk for Afib. Conclusions: Community pharmacies offer a unique, valuable access point for patients to receive Afib screenings. Pharmacists are well positioned to make a significant contribution in the cardiovascular health of their patients and increase the value of team-based health care.
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Janes LA, Hammond JW, Bonham AJ, Carlin AM, Ghaferi AA, Varban OA, Ehlers AP, Finks JF. The effect of marijuana use on short-term outcomes with bariatric surgery. Surg Obes Relat Dis 2023; 19:964-970. [PMID: 37142472 DOI: 10.1016/j.soard.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Despite increasing marijuana use nationwide, there are limited data on implications of marijuana use on bariatric surgery outcomes. OBJECTIVE We investigated associations between marijuana use and bariatric surgery outcomes. SETTING Multicenter statewide study utilizing data from the Michigan Bariatric Surgery Collaborative, a payor-funded consortium including over 40 hospitals and 80 surgeons performing bariatric surgery statewide. METHODS We analyzed data from the Michigan Bariatric Surgery Collaborative clinical registry on patients who underwent a laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass between June 2019 and June 2020. Patients were surveyed at baseline and annually on medication use, depression symptoms, and substance use. Regression analysis was performed to compare 30-day and 1-year outcomes between marijuana users and nonusers. RESULTS Of 6879 patients, 574 reported baseline marijuana use and 139 reported use at baseline and 1 year. Marijuana users were more likely to be current smokers (14% versus 8%, P < .0001), screen positive for alcohol use disorder (20.0% versus 8.4%, P < .0001), and score higher on the Patient Health Questionnaire-8 (6.1 versus 3.0, P < .0001). There were no statistically significant differences in 30-day outcomes or co-morbidity remission at 1 year. Marijuana users had higher adjusted total mean weight loss (47.6 versus 38.1 kg, P < .0001) and body mass index reduction (17 versus 14 kg/m2, P < .0001). CONCLUSIONS Marijuana use is not associated with worse 30-day outcomes or 1-year weight loss outcomes and should not be a barrier to bariatric surgery. However, marijuana use is associated with higher rates of smoking, substance use, and depression. These patients may benefit from additional mental health and substance abuse counseling.
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Affiliation(s)
| | - John W Hammond
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Aaron J Bonham
- University of Michigan, Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Arthur M Carlin
- Henry Ford Health, Michigan Bariatric Surgery Collaborative, Detroit, Michigan
| | - Amir A Ghaferi
- University of Michigan, Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Oliver A Varban
- University of Michigan, Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Anne P Ehlers
- University of Michigan, Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Jonathan F Finks
- University of Michigan, Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan.
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Dennis A, Deng C, Yang P, Bonham AJ, Carlin AM, Varban OA. Evaluating the impact of metabolic surgery on patients with prior opioid use. Surg Obes Relat Dis 2023; 19:889-896. [PMID: 36872158 DOI: 10.1016/j.soard.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/14/2023] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Metabolic surgery is the most effective treatment for obesity and may improve obesity-related pain syndromes. However, the effect of surgery on the persistent use of opioids in patients with a history of prior opioid use remains unclear. OBJECTIVE To determine the effect of metabolic surgery on opioid use behaviors in patients with prior opioid use. SETTING A consortium of public and private hospitals in Michigan. METHODS Using a statewide metabolic-specific data registry, we identified 16,820 patients who self-reported opioid use before undergoing metabolic surgery between 2006 and 2020 and analyzed the 8506 (50.6%) patients who responded to 1-year follow-up. We compared patient characteristics, risk-adjusted 30-day postoperative outcomes, and weight loss between patients who self-reported discontinuing opioid use 1 year after surgery and those who did not. RESULTS Among patients who self-reported using opioids before metabolic surgery, 3864 (45.4%) discontinued use 1 year after surgery. Predictors of persistent opioid use included an annual income of <$10,000 (odds ratio [OR] = 1.24; 95% confidence interval [CI], 1.06-1.44; P = .006), Medicare insurance (OR = 1.48; 95% CI, 1.32-1.66; P < .0001), and preoperative tobacco use (OR = 1.36; 95% CI, 1.16-1.59; P = .0001). Patients with persistent use were more likely to have a surgical complication (9.6% versus 7.5%, P = .0328) and less percent excess weight loss (61.6% versus 64.4%, P < .0001) than patients who discontinued opioids after surgery. There were no differences in the morphine milligram equivalents prescribed within the first 30 days following surgery between groups (122.3 versus 126.5, P = .3181). CONCLUSIONS Nearly half of patients who reported taking opioids before metabolic surgery discontinued use at 1 year. Targeted interventions aimed at high-risk patients may increase the number of patients who discontinue opioid use after metabolic surgery.
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Affiliation(s)
| | - Callie Deng
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Phillip Yang
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Aaron J Bonham
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | | | - Oliver A Varban
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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Akpinar EO, Ghaferi AA, Liem RSL, Bonham AJ, Nienhuijs SW, Greve JWM, Marang-van de Mheen PJ. Predicting serious complication risks after bariatric surgery: external validation of the Michigan Bariatric Surgery Collaborative risk prediction model using the Dutch Audit for Treatment of Obesity. Surg Obes Relat Dis 2023; 19:212-221. [PMID: 36274015 DOI: 10.1016/j.soard.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/14/2022] [Accepted: 09/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Risk-prediction tools can support doctor-patient (shared) decision making in clinical practice by providing information on complication risks for different types of bariatric surgery. However, external validation is imperative to ensure the generalizability of predictions in a new patient population. OBJECTIVE To perform an external validation of the risk-prediction model for serious complications from the Michigan Bariatric Surgery Collaborative (MBSC) for Dutch bariatric patients using the nationwide Dutch Audit for Treatment of Obesity (DATO). SETTING Population-based study, including all 18 hospitals performing bariatric surgery in the Netherlands. METHODS All patients registered in the DATO undergoing bariatric surgery between 2015 and 2020 were included as the validation cohort. Serious complications included, among others, abdominal abscess, bowel obstruction, leak, and bleeding. Three risk-prediction models were validated: (1) the original MBSC model from 2011, (2) the original MBSC model including the same variables but updated to more recent patients (2015-2020), and (3) the current MBSC model. The following predictors from the MBSC model were available in the DATO: age, sex, procedure type, cardiovascular disease, and pulmonary disease. Model performance was determined using the area under the curve (AUC) to assess discrimination (i.e., the ability to distinguish patients with events from those without events) and a graphical plot to assess calibration (i.e., whether the predicted absolute risk for patients was similar to the observed prevalence of the outcome). RESULTS The DATO validation cohort included 51,291 patients. Overall, 986 patients (1.92%) experienced serious complications. The original MBSC model, which was extended with the predictors "GERD (yes/no)," "OSAS (yes/no)," "hypertension (yes/no)," and "renal disease (yes/no)," showed the best validation results. This model had a good calibration and an AUC of .602 compared with an AUC of .65 and moderate to good calibration in the Michigan model. CONCLUSION The DATO prediction model has good calibration but moderate discrimination. To be used in clinical practice, good calibration is essential to accurately predict individual risks in a real-world setting. Therefore, this model could provide valuable information for bariatric surgeons as part of shared decision making in daily practice.
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Affiliation(s)
- Erman O Akpinar
- Department of Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands; Dutch Obesity Clinic, The Hague & Gouda, The Netherlands
| | - Aaron J Bonham
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Jan Willem M Greve
- Department of Surgery, Maastricht University Medical Center, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands; Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands; Dutch Obesity Clinic South, Heerlen, The Netherlands
| | - Perla J Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
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Shen MR, Jiang S, Millis MA, Bonner SN, Bonham AJ, Finks JF, Ghaferi A, Carlin A, Varban OA. Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery. Surg Endosc 2023; 37:564-570. [PMID: 35508664 PMCID: PMC9633573 DOI: 10.1007/s00464-022-09292-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/18/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although bariatric surgery is the most effective treatment for obesity and weight-related comorbid diseases, utilization rates are disproportionately low among non-white patients. We sought to understand if variation in baseline characteristics or access to care exists between white and non-white patients. METHODS Using a statewide bariatric-specific data registry, we evaluated all patients who underwent bariatric surgery between 2006 and 2020 and completed a preoperative baseline questionnaire, which included a question about self-identification of race. Patient characteristics, co-morbidities, and time from initial preoperative clinic evaluation to date of surgery were compared among racial groups. RESULTS A total of 73,141 patients met inclusion criteria with 18,741 (25.5%) self-identified as non-white. These included Black/African American (n = 11,904), Hispanic (n = 3448), Asian (n = 121), Native Hawaiian/Pacific Islander (n = 41), Middle Eastern (n = 164), Multiple (n = 2047) and other (n = 608). Non-white males were the least represented group, accounting for only 4% of all bariatric cases performed. Non-white patients were more likely to be younger (43.0 years vs. 46.6 years, p < 0.0001), disabled (16% vs. 11.4%, p < 0.0001) and have Medicaid (8.4% vs. 3.8%, p < 0.0001) when compared to white patients, despite having higher rates of college education (78.0% vs. 76.6, p < 0.0001). In addition, median time from initial evaluation to surgery was also longer among non-white patients (157 days vs. 127 days, p < 0.0001), despite having higher rates of patients with a body mass index above 50 kg/m2 (39.0% vs. 33.2%, p < 0.0001). CONCLUSIONS Non-white patients undergoing bariatric surgery represent an extremely diverse group of patients with more socioeconomic disadvantages and longer wait times when compared to white patients despite presenting with higher rates of severe obesity. Current guidelines and referral patterns for bariatric surgery may not be equitable and need further examination when considering the management of obesity within diverse populations to reduce disparities in care-of which non-white males are particularly at risk.
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Hider AM, Bonham AJ, Carlin AM, Finks JF, Ghaferi AA, Varban OA, Ehlers AP. Impact of concurrent hiatal hernia repair during laparoscopic sleeve gastrectomy on patient-reported gastroesophageal reflux symptoms: a state-wide analysis. Surg Obes Relat Dis 2022; 19:619-625. [PMID: 36586763 DOI: 10.1016/j.soard.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/21/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Concurrent hiatal hernia repair (HHR) during laparoscopic sleeve gastrectomy (LSG) may improve gastroesophageal reflux disease (GERD) symptoms. However, patient-reported outcomes are limited, and the influence of surgeon technique remains unclear. OBJECTIVES To assess patient-reported GERD severity before and after LSG with and without concomitant HHR. SETTING Teaching and non-teaching hospitals participating in a state-wide quality improvement collaborative. METHODS Using a state-wide bariatric-specific data registry, all patients who underwent a primary LSG between 2015 and 2019 who completed a baseline and 1 year validated GERD health related quality of life (GERD-HRQL) survey were identified (n = 11,742). GERD severity at 1 year as well as 30-day risk-adjusted adverse events was compared between patients who underwent LSG with or without HHR. Results were also stratified by anterior versus posterior HHR. RESULTS A total of 4015 patients underwent a LSG-HHR (34%). Compared to patients who underwent LSG without HHR, LSG-HHR patients were older (47.8 yr versus 44.6 yr; P < .0001), had a lower preoperative body mass index (BMI) (45.8 kg/m2 versus 48 kg/m2; P < .0001) and more likely to be female (85.2% versus 77.6%, P < .0001). Patients who underwent a posterior HHR (n = 3205) experienced higher rates of symptom improvement (69.5% versus 64.0%, P = .0014) and lower rates of new onset symptoms at 1 year (28.2% versus 30.2%, P = .0500). Patients who underwent an anterior HHR (n = 496) experienced higher rates of hemorrhage and readmissions with no significant difference in symptom improvement. CONCLUSIONS Concurrent posterior hiatal HHR at the time of sleeve gastrectomy can improve reflux symptoms. Patients undergoing anterior repair derive no benefit and should be avoided.
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Affiliation(s)
- Ahmad M Hider
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
| | - Aaron J Bonham
- Center for Healthcare Outcomes & Policy, Ann Arbor, Michigan
| | | | - Jonathan F Finks
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes & Policy, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Oliver A Varban
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes & Policy, Ann Arbor, Michigan
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11
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Yang P, Bonham AJ, Carlin AM, Finks JF, Ghaferi AA, Varban OA. Patient characteristics and outcomes among bariatric surgery patients with high narcotic overdose scores. Surg Endosc 2022; 36:9313-9320. [PMID: 35411461 DOI: 10.1007/s00464-022-09205-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/21/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Obesity-related chronic pain can increase the risk of narcotic abuse in bariatric surgery patients. However, assessment of overdose risk has not been evaluated to date. METHODS A NARxCHECK® overdose score ("Narx score") was obtained preoperatively on all patients undergoing bariatric surgery (n = 306) between 2018 and 2020 at a single-center academic bariatric surgery program. The 3-digit score ranges from 000 to 999 and is based on patient risk factors found within the Prescription Drug Monitoring Program. A Narx score ≥ 200 indicates tenfold increased risk of narcotic overdose. Patient characteristics, comorbidities, and emergency room (ER) visits were compared between patients in the upper (≥ 200) and lower (000) terciles of Narx scores. Morphine milligram equivalent (MME) prescribed at discharge and refills was also evaluated. RESULTS Patients in the upper tercile represented 32% (n = 99) of the study population, and compared to the lower tercile (n = 101, 33%), were more likely to have depression (63.6% vs 38.6%, p = 0.0004), anxiety (47.5% vs 30.7%, p = 0.0150), and bipolar disorder (6.1% vs 0.0%, p = 0.0120). Median MME prescribed at discharge was the same between both groups (75); however, high-risk patients were more likely to be prescribed more than 10 tablets of a secondary opioid (83.3% vs 0.0%, p = 0.0111), which was prescribed by another provider in 67% of cases. ER visits among patients who did not have a complication or require a readmission was also higher among high-risk patients (7.8% vs 0.0%, p = 0.0043). There were no deaths or incidents of mental health-related ER visits in either group. CONCLUSION Patients with a Narx score ≥ 200 were more likely to have mental health disorders and have potentially avoidable ER visits in the setting of standardized opioid prescribing practices. Narx scores can help reduce ER visits by identifying at-risk patients who may benefit from additional clinic or telehealth follow-up.
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Affiliation(s)
- Phillip Yang
- 2926 Taubman Center, University of Michigan Medical School, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA.
| | - Aaron J Bonham
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | | | - Amir A Ghaferi
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Oliver A Varban
- Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA
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12
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Carlin AM, Varban OA, Ehlers AP, Bonham AJ, Ghaferi AA, Finks JF. Independent predictors and timing of portomesenteric vein thrombosis after bariatric surgery. Surg Obes Relat Dis 2022; 18:1385-1391. [PMID: 36198496 DOI: 10.1016/j.soard.2022.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/09/2022] [Accepted: 07/22/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Portomesenteric vein thrombosis (PVT) is a rare complication following bariatric surgery but can result in severe morbidity as well as death. OBJECTIVE Identification of risk factors for PVT to facilitate targeted management strategies to reduce incidence. SETTING Prospective, statewide bariatric-specific clinical registry. METHODS We identified all patients who underwent primary bariatric surgery between June 2006 and November 2021 (n = 102,869). Patient characteristics, procedure type, operative details, and 30-day postoperative complications were analyzed with multivariable logistic regression to evaluate for independent predictors of PVT. RESULTS A total of 117 patients (.11%) developed a postoperative PVT, with 6 (5.1%) associated deaths. The majority of PVTs occurred in patients who underwent sleeve gastrectomy (109 patients; 93.2%), and the PVT occurred most commonly during the second (37%), third (31%), and fourth weeks (23%) after surgery. Independent risk factors for PVT included a prior history of venous thromboembolism (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 1.64-5.98; P = .0005), liver disorder (OR = 2.3; 95% CI: 1.36-4.00; P = .0021), undergoing sleeve gastrectomy (OR = 12.4; 95% CI: 4.98-30.69; P < .0001), and postoperative complications including obstruction (OR = 12.5; 95% CI: 4.65-33.77; P < .0001), leak (OR = 7.9; 95% CI: 2.76-22.64; P = .0001), and hemorrhage (OR = 7.6; 95% CI: 3.57-16.06; P < .0001). CONCLUSIONS Independent predictors of PVT include a prior history of venous thromboembolism, liver disease, undergoing sleeve gastrectomy, and experiencing a serious postoperative complication. Given that the incidence of PVT is most common within the first month after surgery, extending postdischarge chemoprophylaxis during this time frame is advised for patients with increased risk.
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Affiliation(s)
- Arthur M Carlin
- Department of Surgery, Henry Ford Health, Detroit, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan.
| | - Oliver A Varban
- Department of Surgery, Henry Ford Health, Detroit, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Anne P Ehlers
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Aaron J Bonham
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan
| | - Jonathan F Finks
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan; Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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13
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Abram AM, Szewczyk MM, Park SG, Sam SS, Eldana HB, Koria FJ, Ferracciolo JM, Young LA, Qadir H, Bonham AJ, Yang F, Zora JS, Abdulelah SA, Patel NA, Koleilat A, Saleh MA, Alhabeil JA, Khan S, Tripathi A, Palanci JG, Krukonis ES. A Co-Association of Streptococcus mutans and Veillonella parvula/dispar in Root Caries Patients and In Vitro Biofilms. Infect Immun 2022; 90:e0035522. [PMID: 36129298 PMCID: PMC9584289 DOI: 10.1128/iai.00355-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Root caries in geriatric patients is a growing problem as more people are maintaining their natural teeth into advanced age. We determined the levels of various bacterial species previously implicated in root caries disease or health using quantitative real-time PCR in a pilot study of 7 patients with 1 to 4 root caries lesions per person. Levels of 12 different species on diseased roots compared to healthy (contralateral control) roots were measured. Four species were found at significantly higher levels on diseased roots (Streptococcus mutans, Veillonella parvula/dispar, Actinomyces naeslundii/viscosus, and Capnocytophaga granulosa) compared across all plaque samples. The level of colonization by these species varied dramatically (up to 1,000-fold) between patients, indicating different patients have different bacteria contributing to root caries disease. Neither of the two species previously reported to correlate with healthy roots (C. granulosa and Delftia acidovorans) showed statistically significant protective roles in our population, although D. acidovorans showed a trend toward higher levels on healthy teeth (P = 0.08). There was a significant positive correlation between higher levels of S. mutans and V. parvula/dispar on the same diseased teeth. In vitro mixed biofilm studies demonstrated that co-culturing S. mutans and V. parvula leads to a 50 to 150% increase in sucrose-dependent biofilm mass compared to S. mutans alone, depending on the growth conditions, while V. parvula alone did not form in vitro biofilms. The presence of V. parvula also decreased the acidification of S. mutans biofilms when grown in artificial saliva and enhanced the health of mixed biofilms.
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Affiliation(s)
- Amber M. Abram
- Department of Biology, University of Detroit Mercy, Detroit, Michigan, USA
| | | | - Seon G. Park
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Sumita S. Sam
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Haya B. Eldana
- Department of Biology, University of Detroit Mercy, Detroit, Michigan, USA
| | - Fadi J. Koria
- Department of Biology, University of Detroit Mercy, Detroit, Michigan, USA
| | | | - Laura A. Young
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Hina Qadir
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Aaron J. Bonham
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Fei Yang
- Natural Products Discovery Core, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan S. Zora
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Sara A. Abdulelah
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Neil A. Patel
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Ayah Koleilat
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Malaka A. Saleh
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Jamal A. Alhabeil
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Shameel Khan
- University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Ashootosh Tripathi
- Natural Products Discovery Core, University of Michigan, Ann Arbor, Michigan, USA
| | - John G. Palanci
- Division of Restorative Dentistry, University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
| | - Eric S. Krukonis
- Division of Integrated Biomedical Sciences, University of Detroit Mercy School of Dentistry, Detroit, Michigan, USA
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14
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Ehlers AP, Bonham AJ, Ghaferi AA, Finks JF, Carlin AM, Varban OA. Impact of hiatal hernia repair technique on patient-reported gastroesophageal reflux symptoms following laparoscopic sleeve gastrectomy. Surg Endosc 2022; 36:6815-6821. [PMID: 35854122 DOI: 10.1007/s00464-021-08970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Repairing a hiatal hernia at the time of laparoscopic sleeve gastrectomy (SG) can reduce or even prevent gastroesophageal reflux disease (GERD) symptoms in the post-operative period. Several different hiatal hernia repair techniques have been described but their impact on GERD symptoms after SG is unclear. METHODS Surgeons (n = 74) participating in a statewide quality collaborative were surveyed on their typical technique for repair of hiatal hernias during SG. Options included posterior repair with mesh (PRM), posterior repair (PR), and anterior repair (AR). Patients who underwent SG with concurrent hiatal hernia repair (n = 7883) were compared according to their surgeon's reported technique. Patient characteristics, baseline and 1-year GERD health-related quality of life surveys, weight loss and 30-day risk-adjusted complications were analyzed. RESULTS The most common technique reported by surgeons for hiatal hernia repair was PR (n = 64, 85.3%), followed by PRM (n = 7, 9.3%) and AR (n = 4, 5.3%). Patients who underwent SG by surgeons who perform AR had lower rates of baseline GERD diagnosis (AR 55.3%, PR 59.5%, PRM 64.8%, p < 0.01), but were more likely to experience worsening GERD symptoms at 1 year (AR 29.8%, PR 28.7%, PRM 28.2%, p < 0.0001), despite similar weight loss (AR 29.8%, PR 28.7%, PRM 28.2%, p = 0.08). Satisfaction with GERD symptoms at 1 year was high (AR 73.2%, PR 76.3%, PRM 75.7%, p = 0.43), and risk-adjusted 30-day outcomes were similar among all groups. CONCLUSIONS Patients undergoing SG with concurrent hiatal hernia repair by surgeons who typically perform an AR were more likely to report worsening GERD at 1 year despite excellent weight loss. Surgeons who typically performed an AR had nearly one-half of their patients report increased GERD severity after surgery despite similar weight loss. While GERD symptom control may be multifactorial, technical approach to hiatal hernia repair at the time of SG may play a role and a posterior repair is recommended.
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Affiliation(s)
- Anne P Ehlers
- Department of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA.
- Center for Healthcare Outcomes & Policy, Ann Arbor, MI, USA.
| | - Aaron J Bonham
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Department of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes & Policy, Ann Arbor, MI, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Jonathan F Finks
- Department of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Oliver A Varban
- Department of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5343, 2210 Taubman Center, Ann Arbor, MI, 48109, USA
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
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15
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Varban OA, Bonham AJ, Carlin AM, Finks JF, Ghaferi AA, Ehlers AP. Independent Predictors of Discontinuation of Diabetic Medications after Sleeve Gastrectomy and Gastric Bypass: Does Procedure Type Matter? J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Chao GF, Bonham AJ, Stricklen AJ, Ross R, Ghaferi AA. Association Between Validated Psychometric Scales and Follow-up Rates After Bariatric Surgery. Obes Surg 2021; 31:5092-5095. [PMID: 34494231 DOI: 10.1007/s11695-021-05705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Grace F Chao
- National Clinician Scholars Program, University of Michigan, 2800 Plymouth Road, Building 14, Room G100, Ann Arbor, MI, 48109, USA. .,Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA. .,Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Aaron J Bonham
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Rachel Ross
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA
| | - Amir A Ghaferi
- Michigan Bariatric Surgery Collaborative, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
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17
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Varban OA, Bonham AJ, Stricklen AL, Ross R, Carlin AM, Finks JF, Ghaferi AA. Am I on Track? Evaluating Patient-Specific Weight Loss After Bariatric Surgery Using an Outcomes Calculator. Obes Surg 2021; 31:3210-3217. [PMID: 33825152 DOI: 10.1007/s11695-021-05397-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Individual weight loss outcomes after bariatric surgery can vary considerably. As a result, identifying and assisting patients who are not on track to reach their weight loss goals can be challenging. MATERIALS AND METHODS Using a bariatric surgery outcomes calculator, which was formulated using a state-wide bariatric-specific data registry, predicted weight loss at 1 year after surgery was calculated on 658 patients who underwent bariatric surgery at 35 different bariatric surgery programs between 2015 and 2017. Patient characteristics, postoperative complications, and weight loss trajectories were compared between patients who met or exceeded their predicted weight loss calculation to those who did not based on observed to expected weight loss ratio (O:E) at 1 year after surgery. RESULTS Patients who did not meet their predicted weight loss at 1 year (n = 237, 36%) had a mean O:E of 0.71, while patients who met or exceeded their prediction (n = 421, 63%) had a mean O:E = 1.14. At 6 months, there was a significant difference in the percent of the total amount of predicted weight loss between the groups (88% of total predicted weight loss for those that met their 1-year prediction vs 66% for those who did not, p < 0.0001). Age, gender, procedure type, and risk-adjusted complication rates were similar between groups. CONCLUSION Using a bariatric outcomes calculator can help set appropriate weight-loss expectations after surgery and also identify patients who may benefit from additional therapy prior to reaching their weight loss nadir.
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Affiliation(s)
- Oliver A Varban
- Department of Surgery, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA.
| | - Aaron J Bonham
- Center for Healthcare Outcomes and Policy, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA
| | - Amanda L Stricklen
- Center for Healthcare Outcomes and Policy, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA
| | - Rachel Ross
- Center for Healthcare Outcomes and Policy, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Jonathan F Finks
- Department of Surgery, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA.,Center for Healthcare Outcomes and Policy, University of Michigan, 2926 Taubman Center, 1500 E Medical Center Drive, SPC 5343, Ann Arbor, MI, 48109-5343, USA
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18
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Alvarez R, Stricklen A, Buda CM, Ross R, Bonham AJ, Carlin AM, Varban OA, Ghaferi AA, Finks JF. Factors associated with completion of patient surveys 1 year after bariatric surgery. Surg Obes Relat Dis 2020; 17:538-547. [PMID: 33334677 DOI: 10.1016/j.soard.2020.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/05/2020] [Accepted: 10/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patient-reported outcomes (PRO) obtained from follow-up survey data are essential to understanding the longitudinal effects of bariatric surgery. However, capturing data among patients who are well beyond the recovery period of surgery remains a challenge, and little is known about what factors may influence follow-up rates for PRO. OBJECTIVES To assess the effect of hospital practices and surgical outcomes on patient survey completion rates at 1 year after bariatric surgery. SETTING Prospective, statewide, bariatric-specific clinical registry. METHODS Patients at hospitals participating in the Michigan Bariatric Surgery Collaborative are surveyed annually to obtain information on weight loss, medication use, satisfaction, body image, and quality of life following bariatric surgery. Hospital program coordinators were surveyed in June 2017 about their practices for ensuring survey completion among their patients. Hospitals were ranked based on 1-year patient survey completion rates between 2011 and 2015. Multivariable regression analyses were used to identify associations between hospital practices, as well as 30-day outcomes, on hospital survey completion rankings. RESULTS Overall, patient survey completion rates at 1 year improved from 2011 (33.9% ± 14.5%) to 2015 (51.0% ± 13.0%), although there was wide variability between hospitals (21.1% versus 77.3% in 2015). Hospitals in the bottom quartile for survey completion rates had higher adjusted rates of 30-day severe complications (2.6% versus 1.7%, respectively; P = .0481), readmissions (5.0% versus 3.9%, respectively; P = .0157), and reoperations (1.5% versus .7%, respectively; P = .0216) than those in the top quartile. While most hospital practices did not significantly impact survey completion at 1 year, physically handing out surveys during clinic visits was independently associated with higher completion rates (odds ratio, 13.60; 95% confidence interval, 1.99-93.03; P =.0078). CONCLUSIONS Hospitals vary considerably in completion rates of patient surveys at 1 year after bariatric surgery, and lower rates were associated with hospitals that had higher complication rates. Hospitals with the highest completion rates were more likely to physically hand surveys to patients during clinic visits. Given the value of PRO on longitudinal outcomes of bariatric surgery, improving data collection across multiple hospital systems is imperative.
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Affiliation(s)
- Rafael Alvarez
- Department of Surgery, University of Michigan, Ann Arbor, Michigan.
| | | | - Colleen M Buda
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Rachel Ross
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Aaron J Bonham
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Arthur M Carlin
- Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan; Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Oliver A Varban
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
| | - Jonathan F Finks
- Department of Surgery, University of Michigan, Ann Arbor, Michigan; Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan
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19
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Martens K, Hamann A, Miller-Matero LR, Miller C, Bonham AJ, Ghaferi AA, Carlin AM. Relationship between depression, weight, and patient satisfaction 2 years after bariatric surgery. Surg Obes Relat Dis 2020; 17:366-371. [PMID: 33127323 DOI: 10.1016/j.soard.2020.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/16/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Findings regarding longer term symptoms of depression and the impact of depression on outcomes such as weight loss and patient satisfaction, are mixed or lacking. OBJECTIVES This study sought to understand the relationship between depression, weight loss, and patient satisfaction in the two years after bariatric surgery. SETTING This study used data from a multi-institutional, statewide quality improvement collaborative of 45 different bariatric surgery sites. METHODS Participants included patients (N = 1991) who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2015-2018. Participants self-reported symptoms of depression (Patient Health Questionnaire-8 [PHQ-8]), satisfaction with surgery, and weight presurgery and 1 year and 2 years postsurgery. RESULTS Compared to presurgery, fewer patients' PHQ-8 scores indicated clinically significant depression (PHQ-8≥10) at 1 year (P < .001; 14.3% versus 5.1%) and 2 years postsurgery (P < .0001; 8.7%). There was a significant increase in the prevalence of clinical depression from the first to second year postsurgery (P < .0001; 5.1% versus 8.7%). Higher PHQ-8 at baseline was related to less weight loss (%Total Weight Loss [%TWL] and %Excess Weight Loss [%EWL]) at 1 year postsurgery (P < .001), with a trend toward statistical significance at 2 years (P = .06). Postoperative depression was related to lower %TWL and %EWL, and less reduction in body mass index (BMI) at 1 year (P < .001) and 2 years (P < .0001). Baseline and postoperative depression were associated with lower patient satisfaction at both postoperative time points. CONCLUSIONS This study suggests improvements in depression up to 2 years postbariatric surgery, although it appears that the prevalence of depression increases after the first year. Depression, both pre- and postbariatric surgery, may impact weight loss and patient satisfaction.
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Affiliation(s)
- Kellie Martens
- Department of Surgery, Henry Ford Health System, Detroit, Michigan; Behavioral Health, Henry Ford Health System, Detroit, Michigan.
| | - Aaron Hamann
- Department of Surgery, Henry Ford Health System, Detroit, Michigan; Behavioral Health, Henry Ford Health System, Detroit, Michigan
| | - Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Chazlyn Miller
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Aaron J Bonham
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
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Yang P, Bonham AJ, Ghaferi AA, Varban OA. Weight-Independent Benefits of Sleeve Gastrectomy on Patient Comorbidities. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Smith ME, Bacal D, Bonham AJ, Varban OA, Carlin AM, Ghaferi AA, Finks JF. Perioperative and 1-year outcomes of bariatric surgery in septuagenarians: implications for patient selection. Surg Obes Relat Dis 2019; 15:1805-1811. [PMID: 31530451 DOI: 10.1016/j.soard.2019.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/12/2019] [Accepted: 08/03/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although bariatric surgery is an effective treatment for obesity, utilization of bariatric procedures in older adults remains low. Previous work reported higher morbidity in older patients undergoing bariatric surgery. However, the generalizability of these data to contemporary septuagenarians is unclear. OBJECTIVES We sought to evaluate differences in 30-day outcomes, 1-year weight loss, and co-morbidity remission after bariatric surgery among 3 age groups as follows: <45 years, 45-69 years, and ≥70 years. SETTING Statewide quality improvement collaborative. METHODS Using a large quality improvement collaborative, we identified patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) between 2006 and 2018. We used multivariable logistic regression models to evaluate the association between age cohorts and 30-day outcomes, 1-year weight loss, and co-morbidity remission. RESULTS We identified 641 septuagenarians who underwent SG (68.5%) or RYGB (31.5%). Compared with 45-69 year olds, septuagenarians had higher rates of hemorrhage (5.1% versus 3.1%; P = .045) after RYGB and higher rates of leak/perforation (.9% versus .3%; P = .044) after SG. Compared with younger patients, septuagenarians lost less of their excess weight, losing 64.8% after RYGB and 53.8% after SG. Remission rates for diabetes and obstructive sleep were similar for patients aged ≥70 years and 45-69 years. CONCLUSIONS Bariatric surgery in septuagenarians results in substantial weight loss and co-morbidity remission with an acceptable safety profile. Surgeons with self-imposed age limits should consider broadening their selection criteria to include patients ≥70 years old.
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Affiliation(s)
- Margaret E Smith
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Daniel Bacal
- Department of Surgery, Beaumont Hospital Dearborn, Dearborn, Michigan
| | - Aaron J Bonham
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
| | - Oliver A Varban
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Amir A Ghaferi
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jonathan F Finks
- Department of General Surgery, University of Michigan, Ann Arbor, Michigan
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Abstract
Importance The outcomes of bariatric surgery vary considerably across patients, but the association of race with these measures remains unclear. Objective To examine the association of race on perioperative and 1-year outcomes of bariatric surgery. Design, Setting, and Participants Propensity score matching was used to assemble cohorts of black and white patients from the Michigan Bariatric Surgery Collaborative who underwent a primary bariatric operation (Roux-en-Y gastric bypass, sleeve gastrectomy, or adjustable gastric banding) between June 2006 and January 2017. Cohorts were balanced on baseline characteristics and procedure. Conditional fixed-effects models were used to evaluate the association of race on outcomes within hospitals and surgeons. Data analysis occurred from June 2006 through August 2018. Main Outcomes and Measures Thirty-day complications and health care resource utilization measures, as well as 1-year weight loss, comorbidity remission, quality of life, and satisfaction. Results In each group, 7105 patients were included. Black patients had a higher rate of any complication (628 [8.8%] vs 481 [6.8%]; adjusted odds ratio, 1.33 [95% CI, 1.17-1.51]; P = .02), but there were no significant differences in the rates of serious complications (178 [2.5%] vs 135 [1.9%]; adjusted odds ratio, 1.32 [95% CI, 1.05-1.66]; P = .29) or mortality (5 [0.10%] vs 7 [0.10%]; adjusted odds ratio, 0.73 [95% CI, 0.23-2.31]; P = .54). Black patients had a greater length of stay (mean [SD], 2.2 [3.0] days vs 1.9 [1.7] days; adjusted odds ratio, 0.30 [95% CI, 0.20-0.40]; P < .001), as well as a higher rate of emergency department visits (541 [11.6%] vs 826 [7.6%]; adjusted odds ratio, 1.60 [95% CI, 1.43-1.79]; P < .001) and readmissions (414 [5.8%] vs 245 [3.5%]; adjusted odds ratio, 1.73 [95% CI, 1.47-2.03]; P < .001). At 1 year, black patients had lower mean total body weight loss and as a percentage of weight (32.0 kg [26%]; vs 38.3 kg [29%]; P < .001) and this held true across procedures. Remission of hypertension was lower for black patients (564 [40.0%] vs 1096 [56.0%]; P < .001), but the rate of sleep apnea remission (467 [62.6%] vs 615 [56.1%]; P = .005) and gastroesophageal reflux disease (309 [78.6%] vs 453 [75.4%]; P = .049) were higher. There were no significant differences in remission of diabetes with insulin dependence, diabetes without insulin dependence,or hyperlipidemia hyperlipidemia. Fewer black patients than white patients reported a good or very good quality of life (1379 [87.2%] vs 2133 [90.4%]; P = .002) and being very satisfied with surgery (1908 [78.4%] vs 2895 [84.2%]; P < .001) at 1 year. Conclusions and Relevance Black patients undergoing bariatric surgery in Michigan had significantly higher rates of 30-day complications and resource utilization and experienced lower weight loss at 1 year than a matched cohort of white patients. While sleep apnea and gastroesophageal reflux disease remission were higher and hypertension remission lower in black patients, comorbidity remission was otherwise similar between matched cohorts. Racial and cultural differences among patients should be considered when designing strategies to optimize outcomes with bariatric surgery.
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Affiliation(s)
- Michael H Wood
- Department of Surgery, Harper University Hospital and Wayne State University, Detroit, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan.,Department of Surgery, Wayne State University, Detroit, Michigan
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan Health Systems, Ann Arbor
| | - Oliver A Varban
- Department of Surgery, St John Providence Health System and Wayne State University, Detroit, Michigan
| | - Abdelkader Hawasli
- Department of Surgery, St John Providence Health System and Wayne State University, Detroit, Michigan
| | - Aaron J Bonham
- Department of Surgery, University of Michigan Health Systems, Ann Arbor
| | - Nancy J Birkmeyer
- Department of Surgery, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Jonathan F Finks
- Department of Surgery, University of Michigan Health Systems, Ann Arbor
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Martens KM, Hamann A, Miller-Matero LR, Miller C, Bonham AJ, Carlin AM. Relationship between depression, weight, and patient satisfaction two years after bariatric surgery. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Carlin AM, Varban OA, Finks JF, Weiner MJ, Bonham AJ, Ghaferi AA. Postoperative complications increase the risk of venous thromboembolism following sleeve gastrectomy and gastric bypass. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2018.09.476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Alvarez R, Cassidy RB, Bonham AJ, Buda CM, Varban OA. Access to Bariatric Surgery: A Statewide Report on Wait Times for the Surgical Treatment of Morbid Obesity. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Howard M, Bonham AJ, Heyland DK, Sudore R, Fassbender K, Robinson CA, McKenzie M, Elston D, You JJ. Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study. BMJ Open 2016; 6:e010375. [PMID: 27338877 PMCID: PMC4932285 DOI: 10.1136/bmjopen-2015-010375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess the feasibility, acceptability and clinical sensibility of a novel survey, the advance care planning (ACP) Engagement Survey, in various healthcare settings. SETTING A target sample of 50 patients from each of primary care, hospital, cancer care and dialysis care settings. PARTICIPANTS A convenience sample of patients without cognitive impairment who could speak and read English was recruited. Patients 50 and older were eligible in primary care; patients 80 and older or 55 and older with clinical markers of advanced chronic disease were recruited in hospital; patients aged 19 and older were recruited in cancer and renal dialysis centres. OUTCOMES We assessed feasibility, acceptability and clinical sensibility of the ACP Engagement Survey using a 6-point scale. The ACP Engagement Survey measures ACP processes (knowledge, contemplation, self-efficacy and readiness) on 5-point Likert scales and actions (yes/no). RESULTS 196 patients (38-96 years old, 50.5% women) participated. Mean (±SD) time to administer was 48.8±19.6 min. Mean acceptability scores ranged from 3.2±1.3 in hospital to 4.7±0.9 in primary care, and mean relevance ranged from 3.5±1.0 in hospital to 4.9±0.9 in dialysis centres (p<0.001 for both). The mean process score was 3.1±0.6 and the mean action score was 11.2±5.6 (of a possible 25). CONCLUSIONS The ACP Engagement Survey demonstrated feasibility and acceptability in outpatient settings but was less feasible and acceptable among hospitalised patients due to length. A shorter version may improve feasibility. Engagement in ACP was low to moderate.
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Affiliation(s)
- Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aaron J Bonham
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Public Health, Queen's University, Kingston, Ontario, Canada
| | - Rebecca Sudore
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Medicine, Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | | | - Carole A Robinson
- School of Nursing, University of British Columbia, Kelowna, British Columbia, Canada
| | - Michael McKenzie
- Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Cancer Centre, Vancouver, Canada
| | - Dawn Elston
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - John J You
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Paynter CA, Van Treeck BJ, Verdenius I, Lau AW, Dhawan T, Lash KA, Bergamini EA, Ekekezie CN, Hilal AM, James KN, Alongi S, Harper SM, Bonham AJ, Baumgartner KB, Baumgartner RN, Harper DM. Adherence to cervical cancer screening varies by human papillomavirus vaccination status in a high-risk population. Prev Med Rep 2015; 2:711-6. [PMID: 26844141 PMCID: PMC4721469 DOI: 10.1016/j.pmedr.2015.07.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Cervical cancer screening has reduced the incidence of cervical cancer over the past 75 years. The primary aim of this study was to determine if women receiving Gardasil™ (HPV4 vaccine) participated in future cervical cancer screening at the same rate as that observed for unvaccinated women matched on birth year and health care campus. This is a retrospective cohort study of subjects selected from 27,786 females born from 1980 to 1992 who received health care in the Truman Medical Center safety net health system in Kansas City Missouri, USA. 1154 women 14-26 years old who received at least one dose of HPV4 vaccine between 2006 and 2009 were chosen at random from the vaccine records. 1154 randomly chosen unvaccinated women were age and health campus matched to the vaccinated women and all were followed until July 1, 2013. Women who were screened after 21 years and received three vaccine doses before 21 years, had the lowest screening rate of 24%. Their only predictive factor for screening, compared to the unvaccinated, was being closer to 21 years than 14 years at vaccination (aOR = 1.71 95% CI: 1.45, 2.00). Women vaccinated with three doses and screened at or after 21 years had the highest screening rate of 84% predicting a six-fold increase in screening participation over no vaccine received (aOR = 5.94 95% CI: 3.77, 9.35). Our results suggest that women who receive HPV4 vaccination closer to 21 years, not 14, are more likely to participate in cervical cancer screening in an underserved US population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sadie Alongi
- University of Missouri—Kansas City School of Medicine, Kansas City, MO, USA
| | - Sean M. Harper
- University of Louisville, Department of Mathematics, Louisville, KY, USA
| | | | - Kathy B. Baumgartner
- University of Louisville, School of Public Health and Information Sciences, Department of Epidemiology and Population Health, Louisville, KY, USA
| | - Richard N. Baumgartner
- University of Louisville, School of Public Health and Information Sciences, Department of Epidemiology and Population Health, Louisville, KY, USA
| | - Diane M. Harper
- University of Louisville, School of Public Health and Information Sciences, Department of Epidemiology and Population Health, Louisville, KY, USA
- University of Louisville, School of Medicine, Department of Family and Geriatric Medicine, Louisville, KY, USA
- University of Louisville, School of Medicine, Department of Obstetrics and Gynecology, Louisville, KY, USA
- University of Louisville, School of Public Health and Information Sciences, Department of Health Promotion and Behavioral Health Sciences, Louisville, KY, USA
- University of Louisville, Speed School of Engineering, Department of Bioengineering, Louisville, KY, USA
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Harper DM, Else BM, Bartley MJ, Arey AM, Barnett AL, Rosemergey BE, Paynter CA, Verdenius I, Harper SM, Harris GD, Groner JA, Malnar GJ, Wall J, Bonham AJ. In a safety net population HPV4 vaccine adherence worsens as BMI increases. PLoS One 2014; 9:e103172. [PMID: 25076128 PMCID: PMC4116139 DOI: 10.1371/journal.pone.0103172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 06/26/2014] [Indexed: 12/19/2022] Open
Abstract
Objectives Obesity adversely inhibits antibody response to vaccination. Three doses of HPV4 may or may not provide adequate long term protection against HPV 16/18 in obese females. The aim of this study was to determine whether adherence to HPV4 vaccination in a safety net population was reduced with increasing body mass index (BMI). Methods We designed a historical prospective study evaluating the number and dates of HPV4 dosing that occurred from July 1, 2006 through October 1, 2009 by the demographic characteristics of the 10–26 year old recipient females. The defined dosing intervals were adapted from the literature and obesity categories were defined by the WHO. Results 1240 females with BMI measurements received at least one dose of HPV4; 38% were obese (class I, II and III) and 25% were overweight. Females with normal BMI received on-time triplet dosing significantly more often than did the obese class II and III females (30% vs. 18%, p<0.001). Obese class II/III females have a significant 45% less chance of completing the on-time triplet HPV4 series than normal women (OR = 0.55, 95% CI: 0.37, 0.83). Pregnancy history has a significant influence on BMI and HPV4 dosing compliance in this safety net population where 71% had been gravid. Hispanic females were less likely to complete HPV4 dosing regardless of BMI (aOR = 0.39, 95% CI: 0.16, 0.95). Conclusions Obesity, as well as gravidity and Hispanic race, are risk factors for lack of HPV4 vaccine adherence among young females in a safety net population.
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Affiliation(s)
- Diane M. Harper
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
- * E-mail:
| | - Britney M. Else
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Mitchell J. Bartley
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Anne M. Arey
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Angela L. Barnett
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Beth E. Rosemergey
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Christopher A. Paynter
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Inge Verdenius
- Department of Obstetrics and Gynecology, Radboud University, Nijmegen, the Netherlands
| | - Sean M. Harper
- Hampshire College, Amherst, Massachusetts, United States of America
| | - George D. Harris
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Jennifer A. Groner
- Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Gerard J. Malnar
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Jeffrey Wall
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Aaron J. Bonham
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, United States of America
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Sandri KJ, Verdenius I, Bartley MJ, Else BM, Paynter CA, Rosemergey BE, Harris GD, Malnar GJ, Harper SM, Griffith RS, Bonham AJ, Harper DM. Urban and rural safety net health care system clinics: no disparity in HPV4 vaccine completion rates. PLoS One 2014; 9:e96277. [PMID: 24816199 PMCID: PMC4015932 DOI: 10.1371/journal.pone.0096277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/05/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Safety net health care centers in the US serve vulnerable and underinsured females. The primary aim of this work was to determine if HPV4 dosing compliance differs between females who receive doses at rural vs. urban core safety net health care locations. METHODS Females exclusively receiving health care in the Truman Medical Center (TMC) safety net system at the urban core and rural locations were identified by their HPV4 vaccine records. Dates and number of HPV4 doses as well as age, gravidity, parity and race/ethnicity were recorded from the electronic medical record (EMR). Appropriate HPV4 dosing intervals were referenced from the literature. RESULTS 1259 females, 10-26 years of age, received HPV4 vaccination at either the rural (23%) or urban core location (77%). At the rural location, 23% received three doses on time, equal to the 24% at the urban core. Females seen in the urban core were more likely to receive on-time doublet dosing than on-time triplet dosing (82% vs. 67%, p<0.001). Mistimed doses occurred equally often among females receiving only two doses, as well as those receiving three doses. CONCLUSIONS Compliance with on-time HPV4 triplet dose completion was low at rural and urban core safety net health clinics, but did not differ by location.
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Affiliation(s)
- Kelly Jo Sandri
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Inge Verdenius
- Radboud University, Department of Obstetrics and Gynecology, Nijmegen, the Netherlands
| | - Mitchell J. Bartley
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Britney M. Else
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Christopher A. Paynter
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Beth E. Rosemergey
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - George D. Harris
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Gerard J. Malnar
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Sean M. Harper
- Hampshire College, Amherst, Massachusetts, United States of America
| | - R. Stephen Griffith
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Aaron J. Bonham
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
| | - Diane M. Harper
- Department of Community and Family Medicine, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Obstetrics and Gynecology, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
- Department of Biomedical and Health Informatics, University of Missouri, Kansas City School of Medicine, Kansas City, Missouri, United States of America
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Rebenitsch RL, Brown EN, Binder NR, Jani A, Bonham AJ, Krishna R, Pikey K. Effect of topical loteprednol on intraocular pressure after selective laser trabeculoplasty for open-angle glaucoma. Ophthalmol Ther 2013; 2:113-20. [PMID: 25135811 PMCID: PMC4108146 DOI: 10.1007/s40123-013-0018-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Indexed: 11/13/2022] Open
Abstract
Introduction To determine whether there is a statistically significant difference in the decrease in intraocular pressure (IOP) after selective laser trabeculoplasty (SLT) between patients receiving a 5–7 days co-administration of loteprednol versus no loteprednol over the course of 1 year. Methods We conducted a retrospective chart review to evaluate use of loteprednol in patients aged 30–85 years undergoing SLT for open-angle glaucoma at our center over a 3-year period. Results Three hundred and eighteen eyes from 313 patients who underwent a 360° SLT treatment between January 2008 and August 2011 were included in the analysis. Patients who received loteprednol showed a mean reduction of 2.5 (±SE 0.3) mmHg or 11.8% (±1.5%) in IOP versus a mean reduction of 3.2 (±0.6) mmHg or 14.9% (±2.5%) in those not treated with loteprednol. This difference showed a trend toward lower IOP without loteprednol, but this was not statistically significant (p = 0.29). Conclusion Postoperative use of loteprednol does not appear to significantly affect IOP in patients undergoing SLT. A randomized double-blinded study in a larger group of patients would be required to clarify this issue. Until such information is available, we recommend that individual clinical judgment be used regarding whether to use topical steroids in patients undergoing SLT.
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Affiliation(s)
- Ronald L Rebenitsch
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA,
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Rao KC, Enriquez M, Gantt TC, Gerkovich MM, Bonham AJ, Griffin RG, Bamberger DM. Nonengagement in HIV care: a descriptive and qualitative study in hospitalized patients and community-based analysis. J Int Assoc Provid AIDS Care 2013; 12:178-84. [PMID: 23442561 DOI: 10.1177/2325957412472058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nonengagement in HIV care is a major clinical and public health challenge. To identify the risk factors and reasons, we performed (1) a retrospective study of patients admitted to the hospital with advanced HIV disease, (2) a prospective qualitative study, and (3) a population-based area-wide telephone interview. In the retrospective study, clinic care engagement was associated with age (43.9 ± 9.1 years vs 37.9 ± 7.2 years, P = .005) and improved from 23% to 44% (P = .03) after hospitalization. Survival was higher (93% vs 73%, P = .03) among those who engaged in care. Twelve inpatients were interviewed in the qualitative study. Themes identified for nonengagement were social stigma, indifference, or lack of understanding of care needs/denial and life care issues. In the population-based study, 145 patients were interviewed. In all, 49 denied the need for HIV care and 28 denied their HIV status. Stigma, denial, and indifference or lack of understanding of need are significant barriers to care engagement.
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Affiliation(s)
- Kavitha C Rao
- Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Jacobsen RC, Toy S, Bonham AJ, Salomone J, Ruthstrom J, Gratton M. Anaphylaxis Knowledge Among Paramedics: Results of a National Survey. PREHOSP EMERG CARE 2012; 16:527-34. [DOI: 10.3109/10903127.2012.689931] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Singh D, Laya AS, Vaidya OU, Ahmed SA, Bonham AJ, Clarkston WK. Risk of bleeding after percutaneous endoscopic gastrostomy (PEG). Dig Dis Sci 2012; 57:973-80. [PMID: 22138961 DOI: 10.1007/s10620-011-1965-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 10/29/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients who undergo percutaneous endoscopic gastrostomy (PEG) placement are often on anticoagulation and/or antiplatelet therapy with a potential thromboembolic risk if these medications are discontinued. Data on the safety of peri-procedural use of these drugs is limited. AIMS To assess the risk and to identify any predictive factors for post-PEG bleeding, and to determine if clopidogrel increases the risk of bleeding following PEG. METHODS A retrospective chart audit was conducted from January 1, 2002 to June 30, 2011. RESULTS A total of 1,541 patients underwent PEG placement during this period. Gastrointestinal bleeding after PEG placement occurred in 51 cases (3.3%) and bleeding directly attributed to PEG was noted in six patients (0.4%). Multivariate logistic regression analysis of variables (age, gender, length of hospitalization, indication for PEG, antiplatelet or anticoagulant medications) showed that heparin infusion (P = 0.018) and length of hospitalization (P = 0.029) were statistically significant predictors of bleeding. The mean period for cessation and resumption of clopidogrel with PEG placement were 2.2 and 1.3 days, respectively. CONCLUSION Although PEG is classified as a high-risk endoscopic procedure, bleeding with PEG placement was rare, even with use of anticoagulation and antiplatelet medications. In selected patients on heparin infusion undergoing PEG, delaying the procedure, alternative use of low-molecular-weight heparin or close monitoring and frequent assessments should be considered. Clopidogrel did not contribute to an increase in bleeding risk, despite being held for a much shorter peri-procedural period as recommended by expert consensus.
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Affiliation(s)
- Dushyant Singh
- Section of Gastroenterology, University of Missouri Kansas City, Kansas City, MO, USA.
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Roberts SR, Crigler J, Lafferty WE, Bonham AJ, Hunter JL, Smith AJ, Banderas JW, Early GL, King RK. Addressing Social Determinants to Improve HealthCare Quality and Reduce Cost. J Healthc Qual 2012; 34:12-20. [DOI: 10.1111/j.1945-1474.2011.00179.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Muffly TM, Couri B, Edwards A, Kow N, Bonham AJ, Paraíso MFR. Effect of petroleum gauze packing on the mechanical properties of suture materials. J Surg Educ 2012; 69:37-40. [PMID: 22208830 DOI: 10.1016/j.jsurg.2011.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 05/29/2011] [Accepted: 06/27/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To test the tensile properties of knotted suture made of 4 different suture materials and exposed to petroleum gauze. STUDY DESIGN We tested the tensile strength of United States Pharmacopeia size 0-0 gauge polydioxanone, polyglyconate, glycolide/lactide copolymer, and silk when exposed to petroleum packing or saline. Suture materials were randomized, and knots were tied and then evaluated via tensiometer to the point of knot failure. RESULTS A total of 285 knots were tied in 8 groups based on material and exposure to saline or petroleum gauze. We found that petroleum exposure knots failed at a mean of 116.7 N (SD = 31.5) and that saline soaked knots failed at 123.8 N (SD = 32.0). We conducted a 4 × 2 factorial analysis of variance, finding knots exposed to petroleum failed at a statistically significantly lower tensile strengths than saline soaked knots (p = 0.002). CONCLUSION Petroleum-exposed sutures fail at lower tensions than saline-exposed sutures.
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Affiliation(s)
- Tyler M Muffly
- Section of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Foundation, Cleveland 44195 Ohio, USA
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Early GL, Roberts SR, Bonham AJ. When core measures fail: how often has the patient received the prescribed care? Mo Med 2011; 108:179-181. [PMID: 21736077 PMCID: PMC6188307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Core measures were developed to assess the gap between recommended best medical practice and actual applied care using publicly-reported hospital results We found that 29+/-6% (p>0.001), of failed core measure cases actually received best medical practice care but failed documentation requirements.
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Affiliation(s)
- Gerald L Early
- Department of Surgery, University of Missouri-Kansas City School of Medicine, Truman Medical Center, Kansas City, MO, USA.
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Abstract
OBJECTIVE To test the integrity of knots tied with expired suture and non-expired suture, using 5 different suture materials. STUDY DESIGN Knots were tied using expired and non-expired chromic catgut, polyglactin 910, polydioxanone, silk, or coated polyester. Expired sutures were a mean of 10.5 years past the date of expiration stamped on the packaging. Suture packaging was inspected for any flaws or humidity. There were 116 knots with expired suture and 109 non-expired knots. All knots were tied by hand. Suture was soaked in 0.9% sodium chloride for 60 seconds and subsequently transferred to a tensiometer where the tails of the knots were cut to 3 mm length. We compared the tensile strength of knots using a tensiometer to pull the knots until the suture broke or untied. A minimum of 30 knots were needed in order to detect a statistically significant main effect for expired and non-expired sutures with 80% power and a 5% chance of type I error. RESULTS A total of 225 knots were tied. Overall, we found no difference in mean tension between expired suture (77.5 ± 31.7 N) and non-expired suture at failure (81.9 ± 30.2 N). All the sutures broke at the knot and none untied. Expired chromic and polydioxanone were significantly weaker than the non-expired suture of the same material (p = 0.002 and p = 0.001, respectively). There was no statistically significant difference in tensile strength between expired absorbable or permanent suture materials. Based on a univariate analysis of variance ([SCAP]ANOVA)[R] there was no difference in the tension at failure between expired and non-expired sutures with suture packet as a covariate. No suture untied when knotted with expired suture. CONCLUSIONS Under laboratory conditions, expired chromic and polydioxanone sutures broke at lower tensile strength than non-expired sutures of the same material.
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Affiliation(s)
- Tyler M Muffly
- Center of Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Muffly TM, Boyce J, Kieweg SL, Bonham AJ. Tensile strength of a surgeon's or a square knot. J Surg Educ 2010; 67:222-6. [PMID: 20816357 PMCID: PMC4167833 DOI: 10.1016/j.jsurg.2010.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 06/07/2010] [Accepted: 06/15/2010] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To test the integrity of surgeon's knots and flat square knots using 4 different suture materials. STUDY DESIGN Chromic catgut, polyglactin 910, silk, and polydioxanone sutures were tied in the 2 types of knot configurations. For all sutures, a 0-gauge United States Pharmacopeia suture was used. Knots were tied by a single investigator (J.B.). The suture was soaked in 0.9% sodium chloride for 60 s and subsequently transferred to a tensiometer where the tails were cut to 3-mm length. We compared the knots, measuring knot strength with a tensiometer until the sutures broke or untied. RESULTS A total of 119 throws were tied. We found no difference in mean tension at failure between a surgeon's knot (79.7 N) and a flat square knot (82.9 N). Using a chi(2) test, we did not find a statistically significant difference in the likelihood of knots coming untied between surgeon's knots (29%) and flat square knots (38%). CONCLUSIONS Under laboratory conditions, surgeon's knots and flat square knots did not differ in tension at failure or in likelihood of untying.
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Affiliation(s)
- Tyler M Muffly
- Center of Urogynecology and Pelvic Floor Disorders, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Galliher JM, Post DM, Weiss BD, Dickinson LM, Manning BK, Staton EW, Brown JB, Hickner JM, Bonham AJ, Ryan BL, Pace WD. Patients' question-asking behavior during primary care visits: a report from the AAFP National Research Network. Ann Fam Med 2010; 8:151-9. [PMID: 20212302 PMCID: PMC2834722 DOI: 10.1370/afm.1055] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The Ask Me 3 (AM3) health communication program encourages patients to ask specific questions during office visits with the intention of improving understanding of their health conditions and adherence to treatment recommendations. This study evaluated whether implementing AM3 improves patients' question-asking behavior and increases adherence to prescription medications and lifestyle recommendations. METHODS This randomized trial involved 20 practices from the American Academy of Family Physicians National Research Network that were assigned to an AM3 intervention group or a control group. Forty-one physicians in the practices were each asked to enroll at least 20 patients. The patients' visits were audio recorded, and recordings were reviewed to determine whether patients asked questions and which questions they asked. Patients were interviewed 1 to 3 weeks after the visit to assess their recall of physicians' recommendations, rates of prescription filling and taking, and attempts at complying with lifestyle recommendations. RESULTS The study enrolled 834 eligible patients in 20 practices. There were no significant difference between the AM3 and control patients in the rate of asking questions, but this rate was high (92%) in both groups. There also were no differences in rates of either filling or taking prescriptions, although rates of these outcomes were fairly high, too. Control patients were more likely to recall that their physician recommended a lifestyle change, however (68% vs 59%, P = .04). CONCLUSIONS In a patient population in which asking questions already occurs at a high rate and levels of adherence are fairly high, we found no evidence that the AM3 intervention results in patients asking specific questions or more questions in general, or in better adherence to prescription medications or lifestyle recommendations.
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Affiliation(s)
- James M Galliher
- American Academy of Family Physicians National Research Network, Leawood, Kansas 66208, USA.
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Zhang L, Bonham AJ, Li J, Pei YF, Chen J, Papasian CJ, Deng HW. Family-based bivariate association tests for quantitative traits. PLoS One 2009; 4:e8133. [PMID: 19956578 PMCID: PMC2779861 DOI: 10.1371/journal.pone.0008133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Accepted: 10/06/2009] [Indexed: 01/20/2023] Open
Abstract
The availability of a large number of dense SNPs, high-throughput genotyping and computation methods promotes the application of family-based association tests. While most of the current family-based analyses focus only on individual traits, joint analyses of correlated traits can extract more information and potentially improve the statistical power. However, current TDT-based methods are low-powered. Here, we develop a method for tests of association for bivariate quantitative traits in families. In particular, we correct for population stratification by the use of an integration of principal component analysis and TDT. A score test statistic in the variance-components model is proposed. Extensive simulation studies indicate that the proposed method not only outperforms approaches limited to individual traits when pleiotropic effect is present, but also surpasses the power of two popular bivariate association tests termed FBAT-GEE and FBAT-PC, respectively, while correcting for population stratification. When applied to the GAW16 datasets, the proposed method successfully identifies at the genome-wide level the two SNPs that present pleiotropic effects to HDL and TG traits.
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Affiliation(s)
- Lei Zhang
- Key Laboratory of Biomedical Information Engineering, Ministry of Education and Institute of Molecular Genetics, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Aaron J. Bonham
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Jian Li
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Yu-Fang Pei
- Key Laboratory of Biomedical Information Engineering, Ministry of Education and Institute of Molecular Genetics, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Jie Chen
- Department of Mathematics and Statistics, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Christopher J. Papasian
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Hong-Wen Deng
- Key Laboratory of Biomedical Information Engineering, Ministry of Education and Institute of Molecular Genetics, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
- Center of System Biomedical Sciences, Shanghai University of Science and Technology, Shanghai, People's Republic of China
- College of Life Sciences and Engineering, Beijing Jiao Tong University, Beijing, People's Republic of China
- * E-mail:
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Galliher JM, Bonham AJ, Dickinson LM, Staton EW, Pace WD. Representativeness of PBRN physician practice patterns and related beliefs: the case of the AAFP National Research Network. Ann Fam Med 2009; 7:547-54. [PMID: 19901315 PMCID: PMC2775620 DOI: 10.1370/afm.1015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We wanted to compare survey responses from members of a national practice-based research network (PBRN) with those of a larger sample of family physicians to assess the generalizability of findings from the PBRN to the larger physician population. METHODS The American Academy of Family Physicians National Research Network (AAFP NRN) conducted 3 separate national surveys among random samples of AAFP active members and physician members of the AAFP NRN. The surveys assessed self-reported clinical behaviors and beliefs related to hepatitis C, hyperlipidemia, and pharyngitis. Bivariate comparisons were conducted to detect statistical differences between the AAFP and AAFP NRN respondents on both demographic and clinically relevant survey items. Multivariate analyses of outcomes were found to be statistically significant at the bivariate level. RESULTS Response rates to the surveys ranged from 53% to 59% for AAFP members and 60% to 72% for AAFP NRN members. The most consistent differences (P <.05) in demographic comparisons were for percentage of time spent in patient care, practice location, practice type, and census region. Bivariate comparisons found the groups differed on 8 (12%) of 66 clinically relevant survey items, with the Bonferroni correction for multiple comparisons reducing these items to 4 (6%). These comparisons were followed by multivariate analyses of outcomes that were found statistically significant at bivariate level. CONCLUSIONS The AAFP NRN and AAFP membership differed on several demographic characteristics, but network members were overall more representative than not of the AAFP active membership in their self-reported clinical behaviors and related beliefs.
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Affiliation(s)
- James M Galliher
- AAFP National Research Network, 11400 Tomahawk Creek Pkwy, Leawood, KS 66211, USA.
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Muffly TM, Cook C, Distasio J, Bonham AJ, Blandon RE. Suture end length as a function of knot integrity. J Surg Educ 2009; 66:276-280. [PMID: 20005500 DOI: 10.1016/j.jsurg.2009.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2009] [Revised: 09/16/2009] [Accepted: 10/10/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate tension at the failure of 3 commonly used sutures when suture ends were cut to 3 lengths. STUDY DESIGN Knots were tied using U.S. Pharmacopeia Size 0-0 polyglactin 910, silk, or polydioxanone sutures. The knots were tied randomly on a jig by the same surgeon. End lengths were then cut to random lengths of 0, 3, and 10 mm. We compared the individual knot strength when subjected to tensile forces via tensiometer with the point of knot failure, which was defined as untying and/or breaking of the knot. RESULTS Three types of suture were divided into 3 groups based on end lengths for a total of 178 knots. A logistic regression analysis showed the odds of knots coming untied were highest for polyglactin 910 (odds ratio [OR] = 33.7; 95% confidence interval [CI] = 4.1-277.1). End length also had a significant effect on knots untying, with the 0-mm knots being more likely to come untied (OR, 21.2; 95% CI, 2.9-153.0). Post hoc tests for a 3 x 3 analysis of variance found that silk knots failed at significantly lower tension than polydioxanone (p < 0.001) and polyglactin 910 (p < 0.001) knots. CONCLUSIONS The knots with an end length of 0 mm were significantly more likely to come untied than either 3- or 10-mm knots. Among all the materials, polyglactin 910 was the most prone to untying; however, it resulted in untying at a mean tension greater than the breaking point of silk.
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Affiliation(s)
- Tyler M Muffly
- Department of Obstetrics and Gynecology, Cleveland Clinic Foundation, 9500 Euclid Avenue,Cleveland, OH 44195, USA.
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Arkes HR, González-Vallejo C, Bonham AJ, Kung YH, Bailey N. Assessing the merits and faults of holistic and disaggregated judgments. J Behav Decis Making 2009. [DOI: 10.1002/bdm.655] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bonham AJ, González-Vallejo C. Assessment of calibration for reconstructed eye-witness memories. Acta Psychol (Amst) 2009; 131:34-52. [PMID: 19362279 DOI: 10.1016/j.actpsy.2009.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 02/06/2009] [Accepted: 02/13/2009] [Indexed: 11/30/2022] Open
Abstract
Two experiments examined confidence judgments associated with eyewitness memory for events to misinformation [Loftus, E. F. (1975). Leading questions and the eyewitness report. Cognitive Psychology, 7, 560-572]. Participants in each experiment watched videos depicting crimes and either responded to questionnaires (Experiment 1) or read narratives (Experiment 2) containing veridical or non-veridical information. Upon testing for memory performance 24h later, participants exposed to misinformation accepted the misinformation as part of their memory of the events in the videos. In both experiments, confidence judgments of participants subjected to misinformation were high and comparable to those of participants not subjected to misinformation. The relationship between accurate responding and confidence was assessed via calibration analysis [Yates, J. F. (1990). Judgments and decision making. Englewood Cliffs, NJ: Prentice Hall]. Performance on various measures of calibration was generally better for participants who were not exposed to misinformation. We conclude that confidence judgments can depend on factors other than those that improve the accuracy of memory, such as the retrieval fluency of one's memories.
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Affiliation(s)
- Aaron J Bonham
- Department of Informatic Medicine and Personalized Health, University of Missouri-Kansas City, School of Medicine, 2411 Holmes St., Kansas City, MO 64108, USA.
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Howell G, Gary S, Singh R, Bonham AJ. CHANGING FROM AN OPEN TO A CLOSED INTENSIVE CARE UNIT MODEL IMPROVES SATISFACTION OF NON-PHYSICIAN MEMBERS OF THE HEALTH CARE TEAM. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p111001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Howell GH, Clark N, Salzman G, Bonham AJ. EFFECTS OF A CLOSED INTENSIVE CARE UNIT MODEL ON PATIENT CARE OUTCOMES. Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.p109003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Eaton CB, Galliher JM, McBride PE, Bonham AJ, Kappus JA, Hickner J. Family physician's knowledge, beliefs, and self-reported practice patterns regarding hyperlipidemia: a National Research Network (NRN) survey. J Am Board Fam Med 2006; 19:46-53. [PMID: 16492005 DOI: 10.3122/jabfm.19.1.46] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Family physicians have the potential to make a major impact on reducing the burden of cardiovascular disease through the optimal assessment and management of hyperlipidemia. We were interested in assessing the knowledge, beliefs, and self-reported practice patterns of a representative sample of family physicians regarding the assessment and management of hyperlipidemia 2 years after the release of the evidence-based National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines. METHODS A 33-item survey was mailed to a random sample (N = 1200) of members of the American Academy of Family Physicians in April of 2004, with 2 follow-up mailings to nonresponders. Physicians were queried about sociodemographic characteristics, their knowledge, attitudes, and self-reported practice patterns regarding the assessment and management of hyperlipidemia. Four case scenarios also were presented. RESULTS Response rate was 58%. Over 90% of surveyed family physicians screened adults for hyperlipidemia as part of a cardiovascular disease prevention strategy. Most (89%) did this screening by themselves without the support of office staff, and 36% reported routine use of a flow sheet. Most had heard of the ATP III guidelines (85%), but only 13% had read them carefully. Only 17% of respondents used a coronary heart disease (CHD) risk calculator usually or always. Over 90% of those responding reported using low-density lipoprotein (LDL) as the treatment goal but only 76% reported using non-high-density lipoprotein (HDL) cholesterol as a secondary goal of therapy. CONCLUSION We found a large variability in knowledge, beliefs, and practice patterns among practicing family physicians. We found general agreement on universal screening of adults for hyperlipidemia as part of cardiovascular disease prevention strategy and use of LDL cholesterol as a treatment goal. Many other aspects of the NCEP ATP III guidelines, such as use of a systematic, multidisciplinary approach, using non-HDL cholesterol as a secondary goal, routinely using a CHD risk calculator for risk assessment to guide cholesterol management, have not yet penetrated into self-reported clinical practice.
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Affiliation(s)
- Charles B Eaton
- Brown University Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI, USA
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