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LaVela SL, Wu J, Harris AH, Frayne SM, Nevedal AL, Arnow KD, Barreto NB, Davis K, Eisenberg D. Physical and emotional consequences of excess weight as experienced by individuals with spinal cord injuries. J Spinal Cord Med 2024; 47:412-422. [PMID: 36448929 PMCID: PMC11044741 DOI: 10.1080/10790268.2022.2097994] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
CONTEXT/OBJECTIVE Excess weight has the potential to carry a substantial physical and emotional burden. A better understanding of perceived consequences of excess weight may facilitate the development of patient-centered programs and interventions to promote weight management efforts in persons with spinal cord injury (SCI). The study objective was to describe consequences of excess weight from the personal perspectives of individuals with SCI. DESIGN Descriptive qualitative design using in-depth semi-structured interviews and thematic analysis. SETTING Veterans Health Administration (VHA) SCI System of Care. PARTICIPANTS Individuals with SCI (n-33). OUTCOME MEASURES Key themes from thematic analysis. RESULTS Participants were male (61%), ranged from 29 to 84 years of age, and about half had tetraplegia (55%). Five themes were identified that demonstrate negative consequences of excess weight experienced by individuals with SCI, including: (1) physical health conditions (including chronic conditions and SCI secondary conditions), (2) physical symptoms (such as pain, discomfort, and fatigue), (3) movement challenges, (4) appearance-related concerns, and (5) emotional impacts. CONCLUSIONS Carrying excess weight is concerning to individuals with SCI and in terms of consequences such onset or exacerbation of chronic conditions, SCI secondary conditions, physical symptoms, e.g. pain, movement impairment (including hampered mobility, difficult transfers and self-care), image/appearance concerns (e.g. body image, clothing misfit), and negative emotions (e.g. unhappy, sad, depressed). Our findings may inform SCI healthcare providers about the consequences of excess weight as experienced by individuals with SCI, highlighting what matters most to persons with SCI and guiding a patient-centered approach to weight management in this population.
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Alex H.S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Susan M. Frayne
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andrea L. Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Katherine D. Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Nicolas B. Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
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Ghiassi S, Nimeri A, Aleassa EM, Grover BT, Eisenberg D, Carter J. American Society for Metabolic and Bariatric Surgery position statement on one-anastomosis gastric bypass. Surg Obes Relat Dis 2024; 20:319-335. [PMID: 38272786 DOI: 10.1016/j.soard.2023.11.003] [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: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/27/2024]
Abstract
The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the society by patients, physicians, society members, hospitals, health insurance payors, and others regarding one-anastomosis gastric bypass as a treatment for obesity and metabolic disease. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement may be revised in the future as more information becomes available.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Abdelrahman Nimeri
- Department of Surgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Essa M Aleassa
- Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Brandon T Grover
- Department of Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Dan Eisenberg
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
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LaVela SL, Wu J, Nevedal AL, Frayne SM, Harris AHS, Arnow KD, Davis K, Farkas GJ, Reyes L, Eisenberg D. Nutrition and eating beliefs and behaviors among individuals with spinal cord injuries and disorders: Healthy or misconceived? Rehabil Psychol 2024:2024-53542-001. [PMID: 38358714 DOI: 10.1037/rep0000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
PURPOSE/OBJECTIVE Nutrition knowledge, beliefs, and behaviors have important implications for managing and preventing chronic and injury-related secondary conditions in persons with spinal cord injuries and disorders (SCI/D). Yet, the unique dietary and nutritional needs and recommendations specific to individuals with SCI/D and their eating beliefs and behaviors have been understudied. Aim is to describe nutrition and eating beliefs and behaviors from the perspectives of individuals with SCI/D. RESEARCH METHOD/DESIGN Descriptive qualitative design using in-depth semistructured interviews with a national sample of veterans with SCI/D (n = 33). Audio-recorded and transcribed verbatim transcripts were coded and analyzed using thematic analysis. RESULTS Participants were male (61%), aged 29-84 years, and 55% had tetraplegia. Five key themes were identified: extreme fasting/caloric restriction, perceived healthy eating behaviors, perceived unhealthy eating behaviors, modified eating behaviors due to SCI/D-related symptoms, and food/preparation choices based on abilities/independence and access. CONCLUSIONS/IMPLICATIONS Nutrition among veterans with SCI/D may be impacted by many factors, such as nutrition knowledge and beliefs/behaviors about "healthy" and "unhealthy" nutrition, fasting, caloric restriction, imbalanced intake of macro- and micronutrients, overconsumption relative to energy needs, injury-related secondary complications, postinjury body composition and function changes, impairments related to satiety and hunger signals, and difficulty in obtaining and preparing food. Study findings provide many areas that would benefit from intervention. Findings can be used to inform ideal nutrition and healthy eating beliefs and behaviors which are important because nutritional inadequacies can lead to diet-related diseases, may exacerbate SCI secondary conditions, and lead to poor overall health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Sherri L LaVela
- Center of Innovation for Complex Chronic Care, Edward Hines Jr. VA Hospital
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System
| | - Andrea L Nevedal
- VA Center for Clinical Management Research,, VA Ann Arbor Healthcare System
| | - Susan M Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System
| | - Alex H S Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System
| | - Katherine D Arnow
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford University School of Medicine
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research and Education Center, Stanford University School of Medicine
| | - Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine
| | - Lorena Reyes
- Nutrition and Food Services, Edward Hines Jr. VA Hospital
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System
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Nevedal AL, Wu J, LaVela SL, Harris AHS, Frayne SM, Arnow KD, Barreto NB, Davis K, Eisenberg D. Why may patients with spinal cord injury be overlooked for obesity screening in the Veterans Health Administration? Qualitative research of the perspectives of patients and healthcare providers. Disabil Rehabil 2024; 46:270-281. [PMID: 36591701 DOI: 10.1080/09638288.2022.2159074] [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: 05/28/2022] [Accepted: 12/11/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE We sought to describe factors influencing reduced rates of obesity screening for patients with spinal cord injury (SCI) in the United States Veterans Health Administration (VA) and to foster potential solutions. MATERIALS AND METHODS Semi-structured interviews with healthcare providers and patients with SCI who were recruited nationally from diverse VAs. We performed rapid qualitative analysis using content analysis of interview data. RESULTS There were 36 providers and 37 patients. We identified provider, patient, and system level barriers to obesity screening for individuals with SCI. Overarching barriers involved provider and patient perceptions that obesity screening is a low priority compared to other health conditions, and body mass index is of low utility. Other obesity screening barriers were related to measuring weight (i.e., insufficient equipment, unknown wheelchair weight, staffing shortages, measurement errors, reduced access to annual screening, insufficient time, patient preference not to be weighed) and measuring height (i.e., insufficient guidance and equipment to this population, measurement errors). CONCLUSIONS Barriers to obesity screenings exist for patients with SCI receiving care in VA. Healthcare provider and patient interviews suggest possible solutions, including standardizing height and weight measurement processes, ensuring equipment availability in clinics, clarifying guidelines, and offering support to providers and patients.IMPLICATIONS FOR REHABILITATIONIndividuals with spinal cord injury (SCI) have higher rates of obesity, but are often overlooked for annual obesity screening, even in clinic settings designed to care for individuals with SCI.Results may help tailor guidelines/education for healthcare and rehabilitation providers offering them guidance for improving obesity screening for individuals with SCI by standardizing weight and height measurement and documentation. To facilitate this, findings highlight the need for resources, such as ensuring clinics have necessary equipment, and increasing patient access to support and equipment.Improving the provision of obesity screening for individuals with SCI is necessary to improve health outcomes and patient satisfaction with care.
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Affiliation(s)
- Andrea L Nevedal
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor MI, USA
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare, VA Edward Hines Jr, Hines, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alex H S Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Susan M Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Katherine D Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Nicolas B Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, CA, USA
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Harris AHS, Finlay AK, Hagedorn HJ, Manfredi L, Jones G, Kamal RN, Sears ED, Hawn M, Eisenberg D, Pershing S, Mudumbai S. Identifying Strategies to Reduce Low-Value Preoperative Testing for Low-Risk Procedures: a Qualitative Study of Facilities with High or Recently Improved Levels of Testing. J Gen Intern Med 2023; 38:3209-3215. [PMID: 37407767 PMCID: PMC10651557 DOI: 10.1007/s11606-023-08287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/14/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Healthcare agencies and perioperative professional organizations recommend avoiding preoperative screening tests for low-risk surgical procedures. However, low-value preoperative tests are still commonly ordered even for generally healthy patients and active strategies to reduce this testing have not been adequately described. OBJECTIVE We sought to learn from hospitals with either high levels of testing or that had recently reduced use of low-value screening tests (aka "delta sites") about reasons for testing and active deimplementation strategies they used to effectively improve practice. DESIGN Qualitative study of semi-structured telephone interviews. PARTICIPANTS We identified facilities in the US Veterans Health Administration (VHA) with high or recently improved burden of potentially low-value preoperative testing for carpal tunnel release and cataract surgery. We recruited perioperative clinicians to participate. APPROACH Questions focused on reasons to order preoperative screening tests for patients undergoing low-risk surgery and, more importantly, what strategies had been successfully used to reduce testing. A framework method was used to identify common improvement strategies and specific care delivery innovations. KEY RESULTS Thirty-five perioperative clinicians (e.g., hand surgeons, ophthalmologists, anesthesiologists, primary care providers, directors of preoperative clinics, nurses) from 29 VHA facilities participated. Facilities that successfully reduced the burden of low-value testing shared many improvement strategies (e.g., building consensus among stakeholders; using evidence/norm-based education and persuasion; clarifying responsibility for ordering tests) to implement different care delivery innovations (e.g., pre-screening to decide if a preop clinic evaluation is necessary; establishing a dedicated preop clinic for low-risk procedures). CONCLUSIONS We identified a menu of common improvement strategies and specific care delivery innovations that might be helpful for institutions trying to design their own quality improvement programs to reduce low-value preoperative testing given their unique structure, resources, and constraints.
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Affiliation(s)
- Alex H S Harris
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA.
- Stanford -Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Andrea K Finlay
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
| | - Hildi J Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
- Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Luisa Manfredi
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
| | - Gabrielle Jones
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
| | - Robin N Kamal
- Department of Orthopedic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Erika D Sears
- Center for Clinical Management Research, VA Ann Arbor Health Care System , Ann Arbor, MI, USA
- University of Michigan Department of Surgery, Ann Arbor, MI, USA
| | - Mary Hawn
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Stanford -Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Stanford -Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Suzann Pershing
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Seshadri Mudumbai
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Eisenberg D, Shikora SA, Kothari SN. Reply to "New IFSO/ASMBS Indications for Metabolic and Bariatric Surgery? Yes, After Failure of Best Nonsurgical Therapy". Obes Surg 2023; 33:2594-2595. [PMID: 37308733 DOI: 10.1007/s11695-023-06667-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine and VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA.
| | - Scott A Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Shanu N Kothari
- Prisma Health, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
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Altieri MS, Carter J, Aminian A, Docimo S, Hinojosa MW, Cheguevara A, Campos GM, Eisenberg D. American Society for Metabolic and Bariatric Surgery literature review on prevention, diagnosis, and management of internal hernias after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2023; 19:763-771. [PMID: 37268518 DOI: 10.1016/j.soard.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Jonathan Carter
- Department of General Surgery, University of California, San Francisco, California
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Salvatore Docimo
- Department of Surgery, University of South Florida, Tampa, Florida
| | | | - Afaneh Cheguevara
- New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | | | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, Stanford, California
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Eisenberg D, Arnow KD, Barreto NB, Davis K, LaVela SL, Frayne SM, Nevedal AL, Wu J, Harris AHS. Interaction between increasing body mass index and spinal cord injury to the probability of developing a diagnosis of nonalcoholic fatty liver disease. Obes Sci Pract 2023; 9:253-260. [PMID: 37287523 PMCID: PMC10242254 DOI: 10.1002/osp4.643] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 06/09/2023] Open
Abstract
Background The prevalence of obesity and comorbidities is high in the population with spinal cord injury (SCI). We sought to determine the effect of SCI on the functional form of the relationship between body mass index (BMI) and risk of developing nonalcoholic fatty liver disease (NAFLD), and assess whether SCI-specific mapping of BMI to risk of developing NAFLD is needed. Methods Longitudinal cohort study comparing Veterans Health Administration patients with a diagnosis of SCI to a 1:2 matched control group without SCI. The relationship between BMI and development of NAFLD at any time was assessed with propensity score matched Cox regression models; NAFLD development at 10-year with a propensity score matched logistic model. The positive predictive value of developing NAFLD at 10 years was calculated for BMI 19-45 kg/m2. Results 14,890 individuals with SCI met study inclusion criteria, and 29,780 Non-SCI individuals in matched control group. Overall, 9.2% in SCI group and 7.3% in Non-SCI group developed NAFLD during the study period. A logistic model assessing the relationship between BMI and the probability of developing a diagnosis of NAFLD demonstrated that the probability of developing disease increased as BMI increased in both cohorts. The probability was significantly higher in the SCI cohort at each BMI threshold (p < 0.01), and increased at a higher rate compared with the Non-SCI cohort as BMI increased 19-45 kg/m2. Positive predictive value for developing a diagnosis of NAFLD was higher in the SCI group for any given BMI threshold from 19 kg/m2 to BMI 45 kg/m2. Conclusions The probability of developing NAFLD is greater in individuals with SCI than without SCI, at every BMI level 19 kg/m2 to 45 kg/m2. Individuals with SCI may warrant a higher level of suspicion and closer screening for NAFLD. The association of SCI and BMI is not linear.
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Affiliation(s)
- Dan Eisenberg
- Center for Innovation to ImplementationVA Palo Alto Health Care SystemPalo AltoCaliforniaUSA
- Stanford‐Surgery Policy Improvement Research & Education CenterStanford School of MedicineStanfordCaliforniaUSA
| | - Katherine D. Arnow
- Stanford‐Surgery Policy Improvement Research & Education CenterStanford School of MedicineStanfordCaliforniaUSA
| | - Nicolas B. Barreto
- Stanford‐Surgery Policy Improvement Research & Education CenterStanford School of MedicineStanfordCaliforniaUSA
| | - Kristen Davis
- Stanford‐Surgery Policy Improvement Research & Education CenterStanford School of MedicineStanfordCaliforniaUSA
| | - Sherri L. LaVela
- Center of Innovation for Complex Chronic CareVA Edward Hines JrHinesIllinoisUSA
- Department of Physical Medicine and RehabilitationFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Susan M. Frayne
- Center for Innovation to ImplementationVA Palo Alto Health Care SystemPalo AltoCaliforniaUSA
- Department of MedicineStanford School of MedicineStanfordCaliforniaUSA
| | - Andrea L. Nevedal
- Center for Innovation to ImplementationVA Palo Alto Health Care SystemPalo AltoCaliforniaUSA
| | - Justina Wu
- Center for Innovation to ImplementationVA Palo Alto Health Care SystemPalo AltoCaliforniaUSA
| | - Alex H. S. Harris
- Center for Innovation to ImplementationVA Palo Alto Health Care SystemPalo AltoCaliforniaUSA
- Stanford‐Surgery Policy Improvement Research & Education CenterStanford School of MedicineStanfordCaliforniaUSA
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Mills J, Liebert C, Wren SM, Pratt JSA, Earley M, Eisenberg D. Robotic General Surgery Trends in the Veterans Health Administration, Community Practice, and Academic Centers From 2013 to 2021. JAMA Surg 2023; 158:552-554. [PMID: 36790771 PMCID: PMC9932937 DOI: 10.1001/jamasurg.2022.7728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/04/2022] [Indexed: 02/16/2023]
Abstract
This cross-sectional study compares trends in use of robotic surgery for general surgical procedures among the Veterans Health Administration (VHA), community practice, and academic health centers from 2013 to 2021.
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Affiliation(s)
- John Mills
- Surgical Service, VA Palo Alto Health Care System, Palo Alto, California
| | - Cara Liebert
- Surgical Service, VA Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | - Sherry M. Wren
- Surgical Service, VA Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | - Janey S. A. Pratt
- Surgical Service, VA Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | - Michelle Earley
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | - Dan Eisenberg
- Surgical Service, VA Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
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Eisenberg D, Shikora SA, Kothari SN. Reply to Letter to the Editor: Beyond the BMI: a Critical Analysis of the Edmonton Obesity Staging System and the New Guidelines for Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:1279-1280. [PMID: 36809589 DOI: 10.1007/s11695-023-06517-2] [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: 01/20/2023] [Revised: 01/20/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine and VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 112, USA.
| | - Scott A Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Shanu N Kothari
- Prisma Health, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
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Altieri MS, Rogers A, Afaneh C, Moustarah F, Grover BT, Khorgami Z, Eisenberg D. Bariatric Emergencies for the General Surgeon. Surg Obes Relat Dis 2023; 19:421-433. [PMID: 37024348 DOI: 10.1016/j.soard.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Ann Rogers
- Department of Surgery, Hershey School of Medicine, Penn State University, Hershey, Pennsylvania
| | | | - Fady Moustarah
- Department of Surgery, Beaumont Hospital, Bloomfield Hills, Michigan
| | - Brandon T Grover
- Department of Surgery, Gundersen Lutheran Medical Center, La Crosse, Wisconsin
| | - Zhamak Khorgami
- Department of Surgery, University of Oklahoma College of Community Medicine, Tulsa, Oklahoma; Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine and VA Palo Alto Health Care System, Palo Alto, California
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LaVela SL, Wu J, Nevedal AL, Harris AHS, Frayne SM, Arnow KD, Barreto NB, Davis K, Eisenberg D. The impact of the COVID-19 pandemic on individuals living with spinal cord injury: A qualitative study. Rehabil Psychol 2023; 68:12-24. [PMID: 36395055 PMCID: PMC10593179 DOI: 10.1037/rep0000469] [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: 11/19/2022]
Abstract
PURPOSE/OBJECTIVE To explore the impact of the COVID-19 pandemic as experienced and reported by individuals living with a spinal cord injury (SCI). RESEARCH METHOD/DESIGN Descriptive qualitative design using in-depth semistructured interviews with individuals with SCI (n = 33) followed by thematic analysis. RESULTS Three main themes described impacts of the COVID-19 pandemic. (a) Impact on health care use; subthemes elaborated that this was attributable to in-person health care facility restrictions or individual decisions to delay care. Individuals with SCI experienced lapses in primary and SCI-specialty care, rehabilitation/therapy services, and home care, but some made use of telehealth services. (b) Impact on weight and/or weight management lifestyle behaviors; subthemes discussed that engagement in physical activity declined because of fitness center closures, recreational activity cancellations, and safety precautions limiting community-based and outdoor activities. The pandemic disrupted participants' independence in purchasing and making preferred food selections which impacted healthy eating. Participants ate due to boredom, at nonmealtimes, and consumed unhealthy foods during the pandemic. (c) Impact on psychosocial factors; included subthemes noting reduced social interactions, social participation, and ability to pursue pastimes with family, friends, and groups they belonged to. The pandemic also triggered emotional reactions such as worry, fear, doubt, demotivation, and feelings of social isolation. CONCLUSIONS Our findings highlight the magnitude of consequences faced by individuals with SCI when restrictions to health care, healthy lifestyle endeavors, and social participation occurred during the COVID-19 pandemic. Findings may inform SCI health care providers on what is needed in response to future public health or natural disaster crises. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Healthcare, Department of Veterans Affairs, Edward Mines Jr. VA Hospital, Hines, Illinois, United Slates
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, United States
| | - Andrea L. Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, United States
| | - Alex H. S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, United States
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine
| | - Susan M. Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, United States
- Department of Medicine, Stanford University School of Medicine
| | - Katherine D. Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine
| | - Nicolas B. Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, United States
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine
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Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O’Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. Publisher Correction: 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:15-16. [PMID: 36445365 PMCID: PMC9834333 DOI: 10.1007/s11695-022-06369-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA 94304 USA
| | - Scott A. Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA USA
| | - Edo Aarts
- WeightWorks Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH USA
| | - Luigi Angrisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ricardo V. Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paolo, Brazil
| | | | - Silvia L. Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Center, Jordan Hospital, Amman, Jordan
| | | | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY USA
| | - Ken Loi
- St. George Hospital and Sutherland Hospital, Kogarah, NSW Australia
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, NC USA
| | - Mary O’Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pavlos K. Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT USA
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN USA
| | - Janey S. A. Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA 94304 USA ,Division of Pediatric Surgery, Lucille Packard Children’s Hospital, Palo Alto, CA USA
| | - Ann M. Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA USA
| | - Kimberley E. Steele
- NIDDK Metabolic and Obesity Research Unit, National Institutes of Health, Bethesda, MD USA
| | - Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland ,Department of Visceral Surgery, University Hospital, Lausanne, Switzerland
| | - Shanu N. Kothari
- Department of Surgery, Prisma Health, University of South Carolina School of Medicine, Greenville, SC USA
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Eisenberg D, Shikora SA, Aarts E, Aminian A, Angrisani L, Cohen RV, de Luca M, Faria SL, Goodpaster KPS, Haddad A, Himpens JM, Kow L, Kurian M, Loi K, Mahawar K, Nimeri A, O'Kane M, Papasavas PK, Ponce J, Pratt JSA, Rogers AM, Steele KE, Suter M, Kothari SN. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg 2023; 33:3-14. [PMID: 36336720 PMCID: PMC9834364 DOI: 10.1007/s11695-022-06332-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 92.0] [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] [Indexed: 11/09/2022]
Abstract
MAJOR UPDATES TO 1991 NATIONAL INSTITUTES OF HEALTH GUIDELINES FOR BARIATRIC SURGERY: Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI) >35 kg/m2, regardless of presence, absence, or severity of co-morbidities.MBS should be considered for individuals with metabolic disease and BMI of 30-34.9 kg/m2.BMI thresholds should be adjusted in the Asian population such that a BMI >25 kg/m2 suggests clinical obesity, and individuals with BMI >27.5 kg/m2 should be offered MBS.Long-term results of MBS consistently demonstrate safety and efficacy.Appropriately selected children and adolescents should be considered for MBS.(Surg Obes Relat Dis 2022; https://doi.org/10.1016/j.soard.2022.08.013 ) © 2022 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA.
| | - Scott A Shikora
- Department of Surgery, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Edo Aarts
- WeightWorks Clinics and Allurion Clinics, Amersfoort, The Netherlands
| | - Ali Aminian
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Luigi Angrisani
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paolo, Brazil
| | | | - Silvia L Faria
- Gastrocirurgia de Brasilia, University of Brasilia, Brasilia, Brazil
| | | | - Ashraf Haddad
- Gastrointestinal Bariatric and Metabolic Center, Jordan Hospital, Amman, Jordan
| | | | - Lilian Kow
- Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Ken Loi
- St. George Hospital and Sutherland Hospital, Kogarah, New South Wales, Australia
| | - Kamal Mahawar
- Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Abdelrahman Nimeri
- Department of Surgery, Carolinas Medical Center, University of North Carolina, Charlotte, NC, USA
| | - Mary O'Kane
- Department of Nutrition and Dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pavlos K Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, CT, USA
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, TN, USA
| | - Janey S A Pratt
- Department of Surgery, Stanford School of Medicine, VA Palo Alto Health Care System, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA
- Division of Pediatric Surgery, Lucille Packard Children's Hospital, Palo Alto, CA, USA
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kimberley E Steele
- NIDDK Metabolic and Obesity Research Unit, National Institutes of Health, Bethesda, MD, USA
| | - Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, Rennaz, Switzerland
- Department of Visceral Surgery, University Hospital, Lausanne, Switzerland
| | - Shanu N Kothari
- Prisma Health, Department of Surgery, University of South Carolina School of Medicine, Greenville, SC, USA
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15
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Stoltz DJ, Liebert CA, Seib CD, Bruun A, Arnow KD, Barreto NB, Pratt JS, Eisenberg D. Preventive Health Screening in Veterans Undergoing Bariatric Surgery. Am J Prev Med 2022; 63:979-986. [PMID: 36100538 DOI: 10.1016/j.amepre.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/02/2022] [Accepted: 06/23/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Individuals with obesity are vulnerable to low rates of preventive health screening. Veterans with obesity seeking bariatric surgery are also hypothesized to have gaps in preventive health screening. Evaluation in a multidisciplinary bariatric surgery clinic is a point of interaction with the healthcare system that could facilitate improvements in screening. METHODS This is a retrospective cohort study of 381 consecutive patients undergoing bariatric surgery at a Veterans Affairs Hospital from January 2010 to October 2021. Age- and sex-appropriate health screening rates were determined at initial referral to a multidisciplinary bariatric surgery clinic and at the time of surgery. Rates of guideline concordance at both time points were compared using McNemar's test. Univariate and multivariate analyses were performed to identify the risk factors for nonconcordance. RESULTS Concordance with all recommended screening was low at initial referral and significantly improved by time of surgery (39.1%‒63.8%; p<0.001). Screening rates significantly improved for HIV (p<0.001), cervical cancer (p=0.03), and colon cancer (p<0.001). Increases in BMI (p=0.005) and the number of indicated screening tests (p=0.029) were associated with reduced odds of concordance at initial referral. Smoking history (p=0.012) and increasing distance to the nearest Veterans Affairs Medical Center (p=0.039) were associated with reduced odds of change from nonconcordance at initial referral to concordance at the time of surgery. CONCLUSIONS Rates of preventive health screening in Veterans with obesity are low. A multidisciplinary bariatric surgery clinic is an opportunity to improve preventive health screening in Veterans referred for bariatric surgery.
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Affiliation(s)
- Daniel J Stoltz
- Department of Surgery, Stanford University School of Medicine, Stanford, California.
| | - Cara A Liebert
- Department of Surgery, Stanford University School of Medicine, Stanford, California; Surgical Services, VA Palo Alto Health Care System, Palo Alto, California
| | - Carolyn D Seib
- Department of Surgery, Stanford University School of Medicine, Stanford, California; Surgical Services, VA Palo Alto Health Care System, Palo Alto, California; Stanford-Surgery Policy Improvement Research Education (S-SPIRE) Center, Stanford, California
| | - Aida Bruun
- Surgical Services, VA Palo Alto Health Care System, Palo Alto, California
| | - Katherine D Arnow
- Stanford-Surgery Policy Improvement Research Education (S-SPIRE) Center, Stanford, California
| | - Nicolas B Barreto
- Stanford-Surgery Policy Improvement Research Education (S-SPIRE) Center, Stanford, California
| | - Janey S Pratt
- Department of Surgery, Stanford University School of Medicine, Stanford, California; Surgical Services, VA Palo Alto Health Care System, Palo Alto, California
| | - Dan Eisenberg
- Department of Surgery, Stanford University School of Medicine, Stanford, California; Surgical Services, VA Palo Alto Health Care System, Palo Alto, California; Stanford-Surgery Policy Improvement Research Education (S-SPIRE) Center, Stanford, California
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16
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Harris AHS, Bowe T, Kamal RN, Sears ED, Hawn M, Eisenberg D, Finlay AK, Hagedorn HJ, Mudumbai S. Frequency and costs of low-value preoperative tests for patients undergoing low-risk procedures in the veterans health administration. Perioper Med (Lond) 2022; 11:33. [PMID: 36096937 PMCID: PMC9469517 DOI: 10.1186/s13741-022-00265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines discourage routine preoperative screening tests for patients undergoing low-risk procedures. This study sought to determine the frequency and costs of potentially low-value preoperative screening tests in Veterans Health Administration (VA) patients undergoing low-risk procedures. METHODS Using the VA Corporate Data Warehouse, we identified Operative Stress Score class 1 procedures ("very minor") performed without general anesthesia in VA during fiscal year 2019 and calculated the overall national and facility-level rates and costs of nine common tests received in the 30 preoperative days. Patient factors associated with receiving at least one screening test, and the number of tests received, were examined. RESULTS Eighty-six thousand three hundred twenty-seven of 178,775 low-risk procedures (49.3%) were preceded by 321,917 potentially low-value screening tests representing $11,505,170 using Medicare average costs. Complete blood count was the most common (33.2% of procedures), followed by basic metabolic profile (32.0%), urinalysis (26.3%), electrocardiography (18.9%), and pulmonary function test (12.4%). Older age, female sex, Black race, and having more comorbidities were associated with higher odds of low-value testing. Transthoracic echocardiogram occurred prior to only 4.5% of the procedures but accounted for 47.8% of the total costs ($5,499,860). In 129 VA facilities, the facility-level proportion of procedures preceded by at least one test ranged from 0 to 81.2% and facility-level costs ranged from $0 to $388,476. CONCLUSIONS Routine preoperative screening tests for very low-risk procedures are common and costly in some VA facilities. These results highlight a potential target to improve quality and value by reducing unnecessary care. Measures of low-value perioperative care could be integrated into VA's extensive quality monitoring and improvement infrastructure.
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Affiliation(s)
- Alex H S Harris
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA.
- Stanford -Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, USA.
| | - Thomas Bowe
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA
| | - Robin N Kamal
- Department of Orthopedic Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Erika D Sears
- Center for Clinical Management Research, VA Ann Arbor Health Care System, Michigan Medicine Department of Surgery, Ann Arbor, USA
| | - Mary Hawn
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA
- Stanford -Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA
- Stanford -Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, USA
| | - Andrea K Finlay
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA
| | - Hildi J Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis Veterans Affairs Medical Center, Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, USA
| | - Seshadri Mudumbai
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, USA
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Eisenberg D, LaVela SL, Frayne SM, Chen R, Barreto NB, Wu J, Nevedal AL, Davis K, Arnow KD, Harris AH. Rates, Variability, and Predictors of Screening for Obesity: Are Individuals with Spinal Cord Injury Being Overlooked? Obes Facts 2022; 15:451-457. [PMID: 35263742 PMCID: PMC9209967 DOI: 10.1159/000523917] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Individuals with spinal cord injury (SCI) are vulnerable to obesity. Annual obesity screening using body mass index (BMI) is the standard of care mandated by US Veterans Health Administration (VHA) guidelines. Our objective was to determine the rates, variability, and predictors of guideline-concordant annual screening for obesity, given potential challenges of height and weight measurements in individuals with SCI. METHODS This is a cross-sectional retrospective study using US national VA databases. We identified all VHA patients with chronic SCI in the fiscal year (FY) 2019, their treating facility and frequency of recorded height and weight. We applied mixed-effects logistic regression models to assess associations between annual BMI screening and patient- and facility-level characteristics. RESULTS Of 20,978 individuals with chronic SCI in VHA in FY19, guideline-concordant annual BMI screening was lacking in 37.9%. Accounting for facility-level factors (geographic region, SCI facility type, volume of patients with SCI treated at the facility), a mixed-effects logistic regression model demonstrated that lack of annual obesity screening was significantly associated with older patient age (p < 0.001) and fewer outpatient encounters (p < 0.001) but not other patient-level factors such as sex, race, level of injury, or rurality. The rate of obesity screening among different facilities within VHA varied widely from 11.1% to 75.7%. CONCLUSION A large proportion of persons with SCI receiving care in VHA do not receive guideline-concordant annual obesity screening, an especially acute problem in some facilities. Older patients with fewer outpatient encounters are more likely to be missed. To inform the design of interventions to improve identification and documentation of obesity, further study is needed to assess potential barriers to obesity screening in the population with SCI.
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Affiliation(s)
- Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
- *Dan Eisenberg,
| | - Sherri L. LaVela
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Susan M. Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Medicine, Stanford School of Medicine, Stanford, California, USA
| | - Rui Chen
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Nicolas B. Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Andrea L. Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Katherine D. Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
| | - Alex H.S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford School of Medicine, Stanford, California, USA
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Mazzini GS, Augustin T, Noria S, Romero-Marrero C, Li N, Hameed B, Eisenberg D, Azagury DE, Ikramuddin S. ASMBS Position Statement on the Impact of Metabolic and Bariatric Surgery on Nonalcoholic Steatohepatitis. Surg Obes Relat Dis 2021; 18:314-325. [PMID: 34953742 DOI: 10.1016/j.soard.2021.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/07/2021] [Indexed: 10/25/2022]
Affiliation(s)
- Guilherme S Mazzini
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Toms Augustin
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sabrena Noria
- Department of Surgery, Division of General and Gastrointestinal Surgery, The Ohio state University, Wexner Medical Center, Columbus, Ohio
| | - Carlos Romero-Marrero
- South Florida Transplant Center, Broward Health Medical Center, Fort Lauderdale, Florida
| | - Na Li
- Division of Gastroenterology, Hepatology, & Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bilal Hameed
- Department of Medicine, University of California, San Francisco, California
| | - Dan Eisenberg
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Dan E Azagury
- Section of Minimally Invasive & Bariatric Surgery, Stanford University School of Medicine, Stanford, California
| | - Sayeed Ikramuddin
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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Carter J, Chang J, Birriel TJ, Moustarah F, Sogg S, Goodpaster K, Benson-Davies S, Chapmon K, Eisenberg D. ASMBS position statement on preoperative patient optimization before metabolic and bariatric surgery. Surg Obes Relat Dis 2021; 17:1956-1976. [PMID: 34629296 DOI: 10.1016/j.soard.2021.08.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/11/2021] [Accepted: 08/27/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jonathan Carter
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California.
| | - Julietta Chang
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - T Javier Birriel
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Fady Moustarah
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Stephanie Sogg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Kasey Goodpaster
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Sue Benson-Davies
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Katie Chapmon
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
| | - Dan Eisenberg
- Clinical Issues Committee, American Society of Metabolic and Bariatric Surgeons; Department of Clinical Surgery, University of California-San Francisco, San Francisco, California
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20
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Papasavas P, Docimo S, Oviedo RJ, Eisenberg D. Biliopancreatic access following anatomy-altering bariatric surgery: a literature review. Surg Obes Relat Dis 2021; 18:21-34. [PMID: 34688572 DOI: 10.1016/j.soard.2021.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/19/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Pavlos Papasavas
- Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut.
| | - Salvatore Docimo
- Division of Bariatric, Foregut, and Advanced GI Surgery, Stony Brook Medicine, Stony Brook, New York
| | | | - Dan Eisenberg
- Department of Surgery, Stanford University and Palo Alto VA Health Care Center, Palo Alto, California
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21
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Mudumbai SC, Pershing S, Bowe T, Kamal RN, Sears ED, Hawn MT, Eisenberg D, Finlay AK, Hagedorn H, Harris AHS. Variability and Costs of Low-Value Preoperative Testing for Cataract Surgery Within the Veterans Health Administration. JAMA Netw Open 2021; 4:e217470. [PMID: 33956131 PMCID: PMC8103225 DOI: 10.1001/jamanetworkopen.2021.7470] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE The Choosing Wisely guidelines indicate that preoperative testing is often unnecessary and wasteful for patients undergoing cataract operations. However, little is known about the impact of these widely disseminated guidelines within the US Veterans Health Administration (VHA) system. OBJECTIVE To examine the extent, variability, associated factors, and costs of low-value tests (LVTs) prior to cataract operations in the VHA. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined records of all patients receiving cataract operations within the VHA in fiscal year 2017 (October 1, 2016, to September 31, 2017). Records from 135 facilities nationwide supporting both ambulatory and inpatient surgery were included. EXPOSURES A laboratory test occurring within 30 days prior to cataract surgery and within 30 days after clinic evaluation. MAIN OUTCOMES AND MEASURES Overall national and facility-level rates and associated costs of receiving any of 8 common LVTs in the 30 days prior to cataract surgery. The patient characteristics, procedure type, and facility-level factors associated with receiving at least 1 test, the number of tests received, and receipt of a bundle of 4 tests (complete blood count, basic metabolic profile, chest radiograph, and electrocardiogram). RESULTS A total of 69 070 cataract procedures were identified among 50 106 patients (66 282 [96.0%] men; mean [SD] age, 71.7 [8.1] years; 53 837 [77.9%] White, 10 292 [14.9%] Black). Most of the patient population had either overweight (23 292 [33.7%] patients) or obesity (27 799 [40.2%] patients). Approximately 49% of surgical procedures (33 424 procedures) were preceded by 1 or more LVT with an overall LVT cost of $2 597 623. Among patients receiving LVTs, electrocardiography (7434 patients [29.9%]) was the most common, with some patients also receiving more costly tests, including chest radiographs (489 patients [8.2%]) and pulmonary function tests (127 patients [3.4%]). For receipt of any LVT, the intraclass correlation coefficient was 0.61 (P < .001) at the facility level and 0.06 (P < .001) at the surgeon level, indicating the substantial contribution of the facility to amount of tests given. CONCLUSIONS AND RELEVANCE Despite existing guidelines, use of LVTs prior to cataract surgery is both common and costly within a large, national integrated health care system. Our results suggest that publishing evidence-based guidelines alone-such as the Choosing Wisely campaign-may not sufficiently influence individual physician behavior, and that system-level efforts to directly deimplement LVTs may therefore necessary to effect sustained change.
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Affiliation(s)
- Seshadri C. Mudumbai
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California
| | - Suzann Pershing
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
- Department of Ophthalmology, Byers Eye Institute at Stanford, Stanford University School of Medicine, Stanford, California
| | - Tom Bowe
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
| | - Robin N. Kamal
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Erika D. Sears
- Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan
- Department of Surgery, Michigan Medicine, Ann Arbor
| | - Mary T. Hawn
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
- Stanford–Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
- Stanford–Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Andrea K. Finlay
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
| | - Hildi Hagedorn
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Alex H. S. Harris
- Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
- Stanford–Surgical Policy Improvement Research and Education Center, Department of Surgery, Stanford University School of Medicine, Stanford, California
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Harris AHS, Meerwijk EL, Kamal RN, Sears ED, Hawn M, Eisenberg D, Finlay AK, Hagedorn H, Marshall N, Mudumbai SC. Variation in Surgeons' Requests for General Anesthesia When Scheduling Carpal Tunnel Release. Hand (N Y) 2020; 15:608-614. [PMID: 30789047 PMCID: PMC6703973 DOI: 10.1177/1558944719828006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Carpal tunnel release (CTR) can be performed with a variety of anesthesia techniques. General anesthesia is associated with higher risk profile and increased resource utilization, suggesting it should not be routinely used for CTR. The purpose of this study was to examine the patient factors associated with surgeons' requests for general anesthesia for CTR and the frequency of routine use of general anesthesia by Veterans Health Administration (VHA) surgeons and facilities. Methods: National VHA data for fiscal years 2015 and 2017 were used to identify patients receiving CTR. Mixed-effects logistic regression was used to evaluate patient, procedure, and surgeon factors associated with requests by the surgeon for general anesthesia versus other anesthesia techniques. Results: In all, 18 145 patients underwent CTR performed by 780 surgeons in 113 VHA facilities. Overall, there were 2218 (12.2%) requests for general anesthesia. Although some patient (eg, older age, obesity), procedure (eg, open vs endoscopic), and surgeon (eg, higher volume) factors were associated with lower odds of requests for general anesthesia, there was substantial facility- and surgeon-level variability. The percentage of patients with general anesthesia requested ranged from 0% to 100% across surgeons. Three facilities and 28 surgeons who performed at least 5 CTRs requested general anesthesia for more than 75% of patients. Conclusions: Where CTR is performed and by whom appear to influence requests for general anesthesia more than patient factors in this study. Avoidance of routine use of general anesthesia for CTR should be considered in future clinical practice guidelines and quality measures.
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Affiliation(s)
- Alex H. S. Harris
- VA Palo Alto Health Care System, Menlo Park, CA, USA,Stanford University School of Medicine, CA, USA,Alex H. S. Harris, Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA.
| | | | | | | | - Mary Hawn
- VA Palo Alto Health Care System, Menlo Park, CA, USA,Stanford University School of Medicine, CA, USA
| | - Dan Eisenberg
- VA Palo Alto Health Care System, Menlo Park, CA, USA,Stanford University School of Medicine, CA, USA
| | | | - Hildi Hagedorn
- Minneapolis Veterans Affairs Medical Center, MN, USA,University of Minnesota School of Medicine, Minneapolis, USA
| | - Nell Marshall
- VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - Seshadri C. Mudumbai
- VA Palo Alto Health Care System, Menlo Park, CA, USA,Stanford University School of Medicine, CA, USA
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Arnedt J, Conroy D, Mooney A, DuBuc K, Balstad S, Pace D, Yang A, Furgal A, Sen A, Eisenberg D. 0532 Cognitive Behavioral Therapy Delivered Via Telemedicine vs. Face-to-Face: Results from a Randomized Controlled Non-Inferiority Trial. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Telemedicine is increasingly an option for delivery of healthcare services, but its efficacy and acceptability for delivering CBT for insomnia has not been adequately tested. In a randomized controlled non-inferiority trial, we compared face-to-face and telemedicine delivery (via the AASM SleepTM platform) of CBT for insomnia for improving sleep and daytime functioning at post-treatment and 12-week follow-up.
Methods
Sixty-five adults with chronic insomnia (46 women, mean age 47.2 ± 16.3 years) were recruited primarily from insomnia clinics and screened for disqualifying sleep, medical, and mental health disorders. Eligible participants were randomized to 6 sessions of CBT for insomnia delivered face-to-face (n=32) or via AASM SleepTM (n=33). Participants completed self-report measures of insomnia (Insomnia Severity Index, ISI) and daytime functioning (fatigue, depression, anxiety, and overall functioning) at pre-treatment, post-treatment, and 12-week follow-up. The ISI was the primary non-inferiority outcome.
Results
Telemedicine was non-inferior to face-to-face delivery of CBT for insomnia, based on a non-inferiority margin of 4 points on the ISI (β = -0.07, 95% CI -2.28 to 2.14). Compared to pre-treatment, ISI scores improved significantly at post-treatment (β = -9.02, 95% CI -10.56 to -7.47) and at 12-week follow-up (β = -9.34, 95% CI -10.89 to -7.79). Similarly, daytime functioning measures improved from pre- to post-treatment, with sustained improvements at 12-week follow-up. Scores on the fatigue scale were lower in the telemedicine group at both post-treatment (F=4.64, df=1,119, p<.03) and follow-up (F=5.79, df=1,119, p<.02).
Conclusion
Insomnia and daytime functioning improve similarly whether CBT for insomnia is delivered via telemedicine or face-to-face. Telemedicine delivery of CBT for insomnia should be implemented more systematically to improve access to this evidence-based treatment.
Support
American Sleep Medicine Foundation Grant # 168-SR-17 (JT Arnedt, PhD)
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Affiliation(s)
- J Arnedt
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - D Conroy
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - A Mooney
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - K DuBuc
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - S Balstad
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - D Pace
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - A Yang
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - A Furgal
- Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - A Sen
- Michigan Medicine, University of Michigan, Ann Arbor, MI
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24
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Kitamura R, Chen R, Trickey A, Eisenberg D. Positive and Negative Independent Predictive Factors of Weight Loss After Bariatric Surgery in a Veteran Population. Obes Surg 2020; 30:2124-2130. [DOI: 10.1007/s11695-020-04428-0] [Citation(s) in RCA: 9] [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: 12/14/2022]
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25
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Mudumbai SC, Pershing S, Bowe T, Kamal RN, Sears ED, Finlay AK, Eisenberg D, Hawn MT, Weng Y, Trickey AW, Mariano ER, Harris AHS. Development and validation of a predictive model for American Society of Anesthesiologists Physical Status. BMC Health Serv Res 2019; 19:859. [PMID: 31752856 PMCID: PMC6868867 DOI: 10.1186/s12913-019-4640-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Received: 08/28/2019] [Accepted: 10/15/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The American Society of Anesthesiologists Physical Status (ASA-PS) classification system was developed to categorize the fitness of patients before surgery. Increasingly, the ASA-PS has been applied to other uses including justification of inpatient admission. Our objectives were to develop and cross-validate a statistical model for predicting ASA-PS; and 2) assess the concurrent and predictive validity of the model by assessing associations between model-derived ASA-PS, observed ASA-PS, and a diverse set of 30-day outcomes. METHODS Using the 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data File, we developed and internally cross-validated multinomial regression models to predict ASA-PS using preoperative NSQIP data. Accuracy was assessed with C-Statistics and calibration plots. We assessed both concurrent and predictive validity of model-derived ASA-PS relative to observed ASA-PS and 30-day outcomes. To aid further research and use of the ASA-PS model, we implemented it into an online calculator. RESULTS Of the 566,797 elective procedures in the final analytic dataset, 8.9% were ASA-PS 1, 48.9% were ASA-PS 2, 39.1% were ASA-PS 3, and 3.2% were ASA-PS 4. The accuracy of the 21-variable model to predict ASA-PS was C = 0.77 +/- 0.0025. The model-derived ASA-PS had stronger association with key indicators of preoperative status including comorbidities and higher BMI (concurrent validity) compared to observed ASA-PS, but less strong associations with postoperative complications (predictive validity). The online ASA-PS calculator may be accessed at https://s-spire-clintools.shinyapps.io/ASA_PS_Estimator/ CONCLUSIONS: Model-derived ASA-PS better tracked key indicators of preoperative status compared to observed ASA-PS. The ability to have an electronically derived measure of ASA-PS can potentially be useful in research, quality measurement, and clinical applications.
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Affiliation(s)
- Seshadri C Mudumbai
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94402, USA. .,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA. .,Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, California, 94025, USA.
| | - Suzann Pershing
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, California, 94025, USA.,Department of Ophthalmology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Thomas Bowe
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, California, 94025, USA
| | - Robin N Kamal
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, California, 94025, USA.,Department of Orthopaedic Surgery, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Erika D Sears
- Department of Surgery, Section of Plastic Surgery at the University of Michigan, 2101 Taubman Center 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.,Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI, 48105, USA
| | - Andrea K Finlay
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, California, 94025, USA
| | - Dan Eisenberg
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, California, 94025, USA.,Department of Surgery Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Mary T Hawn
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, California, 94025, USA.,Department of Surgery Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Yingjie Weng
- Department of Surgery Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Amber W Trickey
- Department of Surgery Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94402, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Alex H S Harris
- Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, California, 94025, USA.,Department of Surgery Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
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26
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Affiliation(s)
- Gao Linda Chen
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Eric Kubat
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Surgical Service, Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, California
| | - Dan Eisenberg
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.,Surgical Service, Department of Surgery, Stanford School of Medicine, Stanford University, Stanford, California
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27
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Harris AHS, Meerwijk EL, Kamal RN, Sears ED, Hawn M, Eisenberg D, Finlay AK, Hagedorn H, Mudumbai S. Variability and Costs of Low-Value Preoperative Testing for Carpal Tunnel Release Surgery. Anesth Analg 2019; 129:804-811. [PMID: 31425223 PMCID: PMC6760302 DOI: 10.1213/ane.0000000000004291] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The American Society of Anesthesiologists (ASA) Choosing Wisely Top-5 list of activities to avoid includes "Don't obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery - specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal." Accordingly, we define low-value preoperative tests (LVTs) as those performed before minor surgery in patients without significant systemic disease. The objective of the current study was to examine the extent, variability, drivers, and costs of LVTs before carpal tunnel release (CTR) surgeries in the US Veterans Health Administration (VHA). METHODS Using fiscal year (FY) 2015-2017 data derived from the VHA Corporate Data Warehouse (CDW), we determined the overall national and facility-level rates and associated costs of receiving any of 8 common LVTs in the 30 days before CTR in ASA physical status (PS) I-II patients. We also examined the patient, procedure, and facility factors associated with receiving ≥1 LVT with mixed-effects logistic regression and the number of tests received with mixed-effects negative binomial regression. RESULTS From FY15-17, 10,000 ASA class I-II patients received a CTR by 699 surgeons in 125 VHA facilities. Overall, 47.0% of patients had a CTR that was preceded by ≥1 LVT, with substantial variability between facilities (range = 0%-100%; interquartile range = 36.3%), representing $339,717 in costs. Older age and female sex were associated with higher odds of receiving ≥1 LVT. Local versus other modes of anesthesia were associated with lower odds of receiving ≥1 LVT. Several facilities experienced large (>25%) increases or decreases from FY15 to FY17 in the proportion of patients receiving ≥1 LVT. CONCLUSIONS Counter to guidance from the ASA, we found that almost half of CTRs performed on ASA class I-II VHA patients were preceded by ≥1 LVT. Although the total cost of these tests is relatively modest, CTR is just one of many low-risk procedures (eg, trigger finger release, cataract surgery) that may involve similar preoperative testing practices. These results will inform site selection for qualitative investigation of the drivers of low-value testing and the development of interventions to improve preoperative testing practice, especially in locations where rates of LVT are high.
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Affiliation(s)
- Alex H S Harris
- From the Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
- Department of Surgery, Stanford-Surgical Policy Improvement Research and Education Center, Stanford University School of Medicine, Stanford, California
| | - Esther L Meerwijk
- From the Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Robin N Kamal
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Erika D Sears
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan
- Department of Surgery, Michigan Medicine
| | - Mary Hawn
- From the Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
- Department of Surgery, Stanford-Surgical Policy Improvement Research and Education Center, Stanford University School of Medicine, Stanford, California
| | - Dan Eisenberg
- From the Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
- Department of Surgery, Stanford-Surgical Policy Improvement Research and Education Center, Stanford University School of Medicine, Stanford, California
| | - Andrea K Finlay
- From the Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Hildi Hagedorn
- Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Seshadri Mudumbai
- From the Center for Innovation to Implementation, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
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28
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Eisenberg D. A New Standard for 24-Hour Intraocular Pressure Studies. Ophthalmology 2019; 126:1105-1106. [DOI: 10.1016/j.ophtha.2019.01.022] [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] [Received: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 11/25/2022] Open
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Eisenberg D, Noria S, Grover B, Goodpaster K, Rogers AM. ASMBS position statement on weight bias and stigma. Surg Obes Relat Dis 2019; 15:814-821. [DOI: 10.1016/j.soard.2019.04.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/27/2019] [Indexed: 12/14/2022]
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Horvath K, Eisenberg D, Stone R, Anderson J, Kark J, Aviv A. Paternal Age and Transgenerational Telomere Length Maintenance: A Simulation Model. Sci Rep 2019; 9:20. [PMID: 30631124 PMCID: PMC6328556 DOI: 10.1038/s41598-018-36923-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/30/2018] [Accepted: 11/23/2018] [Indexed: 02/07/2023] Open
Abstract
Telomere length (TL) in offspring is positively correlated with paternal age at the time of the offspring conception. The paternal-age-at-conception (PAC) effect on TL is puzzling, and its biological implication at the population level is unknown. Using a probabilistic model of transgenerational TL and population dynamics, we simulated the effect of PAC on TL in individuals over the course of 1,000 years. Findings suggest a key role for an isometric PAC midpoint (PACmp) in modulating TL across generations, such that offspring conceived by males younger than the isometric PACmp have comparatively short telomeres, while offspring conceived by males older than the isometric PACmp have comparatively long telomeres. We further show that when cancer incidence escalates, the average PAC drops below the isometric PACmp and transgenerational adaptation to cancer ensues through TL shortening. We propose that PAC serves to maintain an optimal TL across generations.
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Affiliation(s)
- K Horvath
- Center of Human Development and Aging, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey, United States of America
| | - D Eisenberg
- Department of Anthropology, and Center for Studies in Demography and Ecology, University of Washington, Seattle, Washington, United States of America
| | - R Stone
- Center of Human Development and Aging, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey, United States of America
| | - J Anderson
- University of Washington, School of Aquatic and Fishery Sciences, Seattle, Washington, United States of America
| | - J Kark
- Hebrew University-Hadassah School of Public Health and Community Medicine, Jerusalem, Israel
| | - A Aviv
- Center of Human Development and Aging, Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey, United States of America.
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31
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Sox-Harris A, Meerwijk EL, Kamal RN, Sears E, Finlay AK, Hawn MT, Eisenberg D, Mudumbai S. Low Value Preoperative Testing for Carpal Tunnel Release in the Veterans Health Administration. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.084] [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: 11/26/2022]
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Carden A, Blum K, Arbaugh CJ, Trickey A, Eisenberg D. Low socioeconomic status is associated with lower weight-loss outcomes 10-years after Roux-en-Y gastric bypass. Surg Endosc 2018; 33:454-459. [PMID: 29987570 DOI: 10.1007/s00464-018-6318-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 03/30/2018] [Accepted: 06/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) is the criterion standard operation for weight loss. Low socioeconomic status (SES) is common in the Veteran population undergoing bariatric surgery, but the impact of SES on long-term weight-loss outcomes is not known. We hypothesize that low socioeconomic status is associated with less weight loss after gastric bypass in long-term follow-up. METHODS We performed a retrospective review of patients undergoing RYGB at a single Veterans Affairs (VA) hospital. Patients with at least 10 years of follow-up data in the electronic health record were included in the analysis. Weight loss was measured as percent excess body mass index loss (%EBMIL). The primary predictor variable, median household income, was determined using zip codes of patient residences matched to publicly available 2010 U.S. census data. Univariate relationships between income, weight loss, and other patient characteristics were evaluated. We calculated a multivariate generalized linear model of %EBMIL to estimate independent relationships with median household income quartile while controlling for patients' age, race, sex, and VA distance. RESULTS Complete 10-year follow-up data were available for 83 of 92 patients (90.2%) who underwent RYGB between 2001 and 2007 and survived at least 10 years. The majority of patients were male (79.5%) and white (73.5%). The mean 10-year %EBMIL was 57.8% (SD: 29.5%, range - 36.0% - 132.8%). In univariate analysis, income was significantly associated with race (p < 0.001) and median distance to the VA bariatric center (p = 0.034), but income did not differ by gender (p = 0.73) or age (p = 0.45). Multivariate analysis revealed significantly lower 10-year %EBMIL for patients with the lowest income compared to patients with low-mid income (p = 0.03) and mid-high income (p = 0.01), after controlling for gender, race, age, and VA distance. CONCLUSIONS Low socioeconomic status is associated with lower weight-loss outcomes, 10 years after RYGB. Durable weight loss is observed in all income groups.
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Affiliation(s)
- Anthony Carden
- Surgical Services, Palo Alto VA Health Care System, 3801 Miranda Avenue, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA
| | - Kelly Blum
- Department of Surgery and Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Carlie J Arbaugh
- Stanford School of Medicine, 291 Campus Drive, Stanford, CA, USA
| | - Amber Trickey
- Department of Surgery and Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Dan Eisenberg
- Surgical Services, Palo Alto VA Health Care System, 3801 Miranda Avenue, 3801 Miranda Avenue, GS 112, Palo Alto, CA, 94304, USA. .,Department of Surgery and Stanford-Surgery Policy Improvement Research and Education (S-SPIRE) Center, Stanford University School of Medicine, Stanford, CA, USA.
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Parikh M, Eisenberg D, Johnson J, El-Chaar M. American Society for Metabolic and Bariatric Surgery review of the literature on one-anastomosis gastric bypass. Surg Obes Relat Dis 2018; 14:1088-1092. [PMID: 29907540 DOI: 10.1016/j.soard.2018.04.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 04/25/2018] [Accepted: 04/27/2018] [Indexed: 12/31/2022]
Abstract
The following review is being published by the American Society for Metabolic and Bariatric Surgery in response to numerous inquiries made to the Society by patients, physicians, society members, hospitals, and others regarding one-anastomosis gastric bypass as a primary treatment for obesity or metabolic disease. The review is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The review is not intended as, and should not be construed as, stating or establishing a local, regional, or national standard of care.
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Affiliation(s)
- Manish Parikh
- Department of Surgery NYU Langone Medical Center/Bellevue Hospital Center, New York, New York.
| | - Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, Stanford, California; Department of Surgery, Palo Alto VA Healthcare System, Palo Alto, California
| | - Jason Johnson
- Department of General Surgery, Spartanburg Regional Healthcare System, Spartanburg, South Carolina
| | - Maher El-Chaar
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Medical School of Temple University/St. Luke's University Health Network, Allentown, Pennsylvania
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Grace N, Kubat E, Eisenberg D. An Integrated, Collaborative Multidisciplinary Clinic Improves 12-Month Follow-Up After Bariatric Surgery at a Single Veterans Affairs Medical Center. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2017.0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Nalani Grace
- Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Eric Kubat
- Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
| | - Dan Eisenberg
- Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Department of Surgery, Stanford School of Medicine, Stanford, California
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Funk LM, Gunnar W, Dominitz JA, Eisenberg D, Frayne S, Maggard-Gibbons M, Kalarchian MA, Livingston E, Sanchez V, Smith BR, Weidenbacher H, Maciejewski ML. A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration. J Gen Intern Med 2017; 32:65-69. [PMID: 28271434 PMCID: PMC5359154 DOI: 10.1007/s11606-016-3951-4] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA's capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.
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Affiliation(s)
- L M Funk
- William S. Middleton VA Hospital, Madison, WI, USA.,Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - W Gunnar
- The George Washington University, Washington, DC, USA
| | - J A Dominitz
- U.S. Department of Veterans Affairs, Washington, DC, USA.,Division of Gastroenterology, University of Washington, Seattle, WA, USA
| | - D Eisenberg
- VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - S Frayne
- VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - M Maggard-Gibbons
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - M A Kalarchian
- School of Nursing and Department of Psychology, Duquesne University, Pittsburgh, PA, USA
| | - E Livingston
- JAMA, Chicago, IL, USA.,Department of Surgery at the UT Southwestern School of Medicine, Dallas, TX, USA
| | - V Sanchez
- VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - B R Smith
- VA Long Beach Healthcare System, Long Beach, CA, USA.,Department of Surgery, UC Irvine Medical Center, Irvine, CA, USA
| | - H Weidenbacher
- Center for Health Services Research in Primary Care (152), Durham VA Medical Center, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27705, USA.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Matthew L Maciejewski
- Center for Health Services Research in Primary Care (152), Durham VA Medical Center, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27705, USA. .,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.
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Eisenberg D, Azagury DE, Ghiassi S, Grover BT, Kim JJ. ASMBS Position Statement on Postprandial Hyperinsulinemic Hypoglycemia after Bariatric Surgery. Surg Obes Relat Dis 2016; 13:371-378. [PMID: 28110984 DOI: 10.1016/j.soard.2016.12.005] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford School of Medicine, Stanford, California; Department of Surgery, Palo Alto VA Health Care System, Palo Alto, California.
| | - Dan E Azagury
- Section of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford, California
| | - Saber Ghiassi
- Yale School of Medicine, New Haven, Connecticut; Department of Surgery, Bridgeport Hospital, Fairfield, Connecticut
| | - Brandon T Grover
- Department of Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Julie J Kim
- Department of General Surgery, Tufts University School of Medicine, Boston, Massachusetts
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Eisenberg D, Lohnberg JA, Kubat EP, Bates CC, Greenberg LM, Frayne SM. Systems innovation model: an integrated interdisciplinary team approach pre- and post-bariatric surgery at a veterans affairs (VA) medical center. Surg Obes Relat Dis 2016; 13:600-606. [PMID: 28089437 DOI: 10.1016/j.soard.2016.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 10/04/2016] [Revised: 11/05/2016] [Accepted: 11/08/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Provision of bariatric surgery in the Veterans Health Administration must account for obese veterans' co-morbidity burden and the geographically dispersed location of patients relative to Veterans Affairs (VA) bariatric centers. OBJECTIVES To evaluate a collaborative, integrated, interdisciplinary bariatric team of surgeons, bariatricians, psychologists, dieticians, and physical therapists working in a hub-and-spokes care model, for pre- and post-bariatric surgery assessment and management. METHODS This is a description of an interdisciplinary clinic and bariatric program at a VA healthcare system and a report on program evaluation findings. Retrospective data of a prospective database was abstracted. For program evaluation, we abstracted charts to characterize patient data and conducted a patient survey. RESULTS Since 2009, 181 veterans have undergone bariatric surgery. Referrals came from 7 western U.S. states. Mean preoperative body mass index was 46 kg/m2 (maximum 71). Mean age was 53 years, with 33% aged>60 years; 79% were male. Medical co-morbidity included diabetes (70%), hypertension (85%), and lower back or extremity joint pain (84%). A psychiatric diagnosis was present in 58%. At 12 months, follow-up was 81% and percent excess body mass index loss was 50.5%. Among 54 sequential clinic patients completing anonymous surveys, overall satisfaction with the interdisciplinary team approach and improved quality of life were high (98% and 94%, respectively). CONCLUSION The integrated, interdisciplinary team approach using a hub-and-spokes model is well suited to the VA bariatric surgery population, with its heavy burden of medical and mental health co-morbidity and its system of geographically dispersed patients receiving treatment at specialty centers. As the VA seeks to expand the use of bariatric surgery as an option for obese veterans, interdisciplinary models crafted to address case complexity, care coordination, and long-term outcomes should be part of policy planning efforts.
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Affiliation(s)
- Dan Eisenberg
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA; Department of Surgery, Stanford School of Medicine, Stanford, CA.
| | - Jessica A Lohnberg
- Psychology Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA
| | - Eric P Kubat
- Surgical Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA; Department of Surgery, Stanford School of Medicine, Stanford, CA
| | - Cheryl C Bates
- Medicine Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA
| | - Lauren M Greenberg
- Psychology Service, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA; War Related Illness and Injury Study Center, East Orange, NJ
| | - Susan M Frayne
- VA Health Services Research & Development Center for Innovation to Implementation (Ci2 i), Palo Alto Veterans Affairs Health Care System, Palo Alto, CA; Department of Medicine, Stanford School of Medicine, Stanford, CA
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Grace N, Kubat E, Bates C, Eisenberg D. Lorcaserin Halts Weight Regain after Bariatric Surgery – A Pilot Study. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.340] [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: 10/20/2022]
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Kubat E, Giori NJ, Hwa K, Eisenberg D. Osteoarthritis in veterans undergoing bariatric surgery is associated with decreased excess weight loss: 5-year outcomes. Surg Obes Relat Dis 2016; 12:1426-1430. [DOI: 10.1016/j.soard.2016.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 01/19/2016] [Accepted: 02/15/2016] [Indexed: 01/08/2023]
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Kubat E, Grace N, Bellatorre N, Eisenberg D. Bariatric Surgery in the Elderly Male Veteran Population: Low Readmission Rates and Successful Outcomes. Surg Obes Relat Dis 2016. [DOI: 10.1016/j.soard.2016.08.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chang SS, Eisenberg D, Zhao L, Adams C, Leib R, Morser J, Leung L. Chemerin activation in human obesity. Obesity (Silver Spring) 2016; 24:1522-9. [PMID: 27222113 DOI: 10.1002/oby.21534] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Chemerin is an inflammatory adipokine, whose activity is regulated by successive proteolytic cleavages at its C-terminus. It is secreted as an inactive precursor (chem163S); cleavage at Lys158 converts it to chem158K with modest activity. Chem157S is the most potent form and chem155A is inactive. The aim of this study was to determine if chemerin was activated in samples from patients with obesity. METHODS Using specific ELISAs for different chemerin forms and a pan-chemerin ELISA, chemerin forms in human obesity were characterized. RESULTS Plasma chemerin from patients with obesity (BMI 44.3 ± 1.3 kg/m(2) , n = 29) was significantly higher than in lean controls (BMI 20.9 ± 0.7 kg/m(2) , n = 10) (160 ± 11 vs. 76.2 ± 5.5 ng/mL, respectively, P < 0.0001). This increase in chemerin was due to increased previously unattributed chemerin, with further C-terminal truncation demonstrated by mass spectrometry, accounting for ∼35% of total plasma chemerin. Chemerin forms in adipose tissue showed a different profile, with minimal chem163S and significant levels of chem157S. Chem155A was present in omental but not in subcutaneous adipose tissue. Unattributed chemerin forms were undetectable in adipose tissue. CONCLUSIONS Chemerin is activated in adipose tissue of subjects with obesity, and further C-terminal processing occurs during the disposition of chemerin from adipose tissue, resulting in substantial levels of novel degraded forms in plasma that correlate with obesity.
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Affiliation(s)
- Shwu-Shin Chang
- Division of Hematology, Stanford University School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Dan Eisenberg
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Lei Zhao
- Division of Hematology, Stanford University School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Christopher Adams
- Vincent Coates Foundation Mass Spectrometry Laboratory, Stanford University, Stanford, California, USA
| | - Ryan Leib
- Vincent Coates Foundation Mass Spectrometry Laboratory, Stanford University, Stanford, California, USA
| | - John Morser
- Division of Hematology, Stanford University School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Lawrence Leung
- Division of Hematology, Stanford University School of Medicine, Stanford, California, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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DeMaria EJ, El Chaar M, Rogers AM, Eisenberg D, Kallies KJ, Kothari SN. American Society for Metabolic and Bariatric Surgery position statement on accreditation of bariatric surgery centers endorsed by the Society of American Gastrointestinal and Endoscopic Surgeons. Surg Obes Relat Dis 2016; 12:946-954. [DOI: 10.1016/j.soard.2016.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 01/08/2023]
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Abstract
Background and Objectives: The need for more cost- and time-efficient provision of medical care has prompted an interest in remote or telehealth approaches to delivery of health care. We present a study examining the feasibility and outcomes of implementation of a telephone follow-up program for laparoscopic inguinal hernia repair. Methods: This is a retrospective review of consecutive patients who prospectively agreed to undergo telephone follow-up after laparoscopic inguinal hernia repair instead of standard face-to-face clinic visits. Patients received a telephone call from a dedicated physician assistant 2 to 3 weeks after surgery and answered a predetermined questionnaire. A face-to-face clinic visit was scheduled based on the results of the call or on patient request. Results: Of 62 patients who underwent surgery, all agreed to telephone follow-up instead of face-to-face clinic visits. Their mean round-trip distance to the hospital was 122 miles. Fifty-five patients (88.7%) successfully completed planned telephone follow-up. Three patients (4.8%) were lost to follow-up, and 4 (6.5%) were erroneously scheduled for a clinic appointment. Of the 55 patients who were reached by telephone, 50 (90.9%) were satisfied and declined an in-person clinic visit. Five patients (9.1%) returned for a clinic appointment based on concerns raised during the telephone call. Of these, 1 was found to have an early hernia recurrence and 1 had a seroma. Conclusion: Telephone follow-up by a midlevel provider after laparoscopic inguinal hernia repair is feasible and effective and is well received by patients.
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Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA
| | - Kimberly Hwa
- Department of Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA
| | - Sherry M Wren
- Department of Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA
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Hansen N, Hardin E, Bates C, Bellatorre N, Eisenberg D. Preoperative change in 6-minute walk distance correlates with early weight loss after sleeve gastrectomy. JSLS 2016; 18:JSLS-D-13-00383. [PMID: 25392673 PMCID: PMC4208909 DOI: 10.4293/jsls.2014.00383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 12/12/2022] Open
Abstract
Introduction: The 6-minute walk test (6MWT) is an objective preoperative measure of functional capacity and response to intervention in patients with heart or lung disease. In bariatric surgery, there has been no reliable preoperative measure predictive of postoperative success. Here we investigated the impact of bariatric surgery on changes in distance traveled in the 6MWT (the 6MWD) and whether preoperative changes in 6MWD correlated with weight change after surgery. Methods: This is a retrospective study of consecutive patients in which the 6MWT was performed before and after laparoscopic sleeve gastrectomy for weight loss. 6MWD and total weight were measured. Pearson correlation was used to determine association between variables. Results: Of 100 patients who underwent laparoscopic sleeve gastrectomy, 31 patients had a preoperative 6MWT. Thirty patients (97%) were available for follow-up after surgery. Percentage of excess weight loss was 45.7% over an average of 7 months after surgery. There was a weak correlation between the postoperative weight loss and the change in preoperative and postoperative 6MWD (r = 0.28; P = .13). In a subset of patients who demonstrated a change in distance traveled in 2 separate preoperative 6MWD measurements (average 18.5% increase in distance), there was a strong correlation with postoperative weight loss (r = 0.82; P = .02). Conclusions: A demonstrated increase in 6MWD before surgery correlates strongly with early postoperative weight loss after laparoscopic sleeve gastrectomy. A multidisciplinary team that includes a physical therapist is useful in preparing bariatric patients for surgery.
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Affiliation(s)
- Nathan Hansen
- Department of Surgery, Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Eric Hardin
- Department of Physical Medicine and Rehabilitation, Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Cheryl Bates
- Department of Medicine, Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Nina Bellatorre
- Department of Surgery, Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Dan Eisenberg
- Department of Surgery, Palo Alto VA Health Care System, Palo Alto, CA, USA
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Kubat E, Hansen N, Nguyen H, Wren SM, Eisenberg D. Urgent and Elective Robotic Single-Site Cholecystectomy: Analysis and Learning Curve of 150 Consecutive Cases. J Laparoendosc Adv Surg Tech A 2016; 26:185-91. [PMID: 26756715 DOI: 10.1089/lap.2015.0528] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The use of robotic single-site cholecystectomy has increased exponentially. There are few reports describing the safety, efficacy, and operative learning curve of robotic single-site cholecystectomy either in the community setting or with nonelective surgery. MATERIALS AND METHODS We performed a retrospective review of a prospective database of our initial experience with robotic single-site cholecystectomy. Demographics and perioperative outcomes were evaluated for both urgent and elective cholecystectomy. Cumulative sum analysis was performed to determine the surgeon's learning curve. RESULTS One hundred fifty patients underwent robotic single-site cholecystectomy. Seventy-four (49.3%) patients underwent urgent robotic single-site cholecystectomy, and 76 (50.7%) underwent elective robotic single-site cholecystectomy. Mean total operative time for robotic single-site cholecystectomy was 83.3 ± 2.7 minutes. Mean operative time for the urgent cohort was significantly longer than for the elective cohort (95.0 ± 4.4 versus 71.9 ± 2.6 minutes; P < .001). There was one conversion in the urgent cohort and none in the elective cohort. There was one bile duct injury (0.7%) in the urgent cohort. Perioperative complications occurred in 8.7% of patients, and most consisted of superficial surgical-site infections. There were no incisional hernias detected. The surgeon's learning curve, inclusive of urgent and elective cases, was 48 operations. CONCLUSIONS Robotic single-site cholecystectomy can be performed safely and effectively in both elective and urgent cholecystectomy with a reasonable learning curve and acceptable perioperative outcomes.
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Affiliation(s)
- Eric Kubat
- 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California
| | - Nathan Hansen
- 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California
| | - Huy Nguyen
- 2 Department of Surgery, Regional Medical Center , San Jose, California
| | - Sherry M Wren
- 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California
| | - Dan Eisenberg
- 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California
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Kim J, Eisenberg D, Azagury D, Rogers A, Campos GM. American Society for Metabolic and Bariatric Surgery position statement on long-term survival benefit after metabolic and bariatric surgery. Surg Obes Relat Dis 2015; 12:453-459. [PMID: 26944548 DOI: 10.1016/j.soard.2015.11.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 12/20/2022]
Abstract
The following position statement has been issued by the American Society for Metabolic and Bariatric Surgery in response to numerous inquiries made to the Society by patients, physicians, society members, hospitals, health insurance payors, the media, and others regarding the benefit of metabolic and bariatric surgery on long-term survival. An overview of the current available published peer-reviewed scientific evidence is presented.
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Affiliation(s)
- Julie Kim
- Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts.
| | - Dan Eisenberg
- Department of Surgery, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Dan Azagury
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Ann Rogers
- Department of Surgery, Penn State University, Hershey, Pennsylvania
| | - Guilherme M Campos
- Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia
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Kubat E, Hwa K, Hardin E, Bellatorre N, Eisenberg D. Lower Extremity Joint and Back Pain is Common in Veterans Undergoing Bariatric Surgery. Surg Obes Relat Dis 2015. [DOI: 10.1016/j.soard.2015.08.299] [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: 11/30/2022]
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48
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Kim J, Azagury D, Eisenberg D, DeMaria E, Campos GM. ASMBS position statement on prevention, detection, and treatment of gastrointestinal leak after gastric bypass and sleeve gastrectomy, including the roles of imaging, surgical exploration, and nonoperative management. Surg Obes Relat Dis 2015; 11:739-48. [DOI: 10.1016/j.soard.2015.05.001] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Wasser T, Eisenberg D. Increased Accuracy of Distribution Based Missing Value Imputation: An Alternative to Mean Inputation in Real World Environment Survey Research. Value Health 2014; 17:A555. [PMID: 27201821 DOI: 10.1016/j.jval.2014.08.1820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- T Wasser
- HealthCore, Inc., Wilmington, DE, USA
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Affiliation(s)
- Dan Eisenberg
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California2Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Sherry M Wren
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California2Palo Alto Veterans Affairs Health Care System, Palo Alto, California
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