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Baldawi M, Ghaleb N, McKelvey G, Ismaeil YM, Saasouh W. Preoperative ultrasound assessment of gastric content in patients with diabetes: A meta-analysis based on a systematic review of the current literature. J Clin Anesth 2024; 93:111365. [PMID: 38134485 DOI: 10.1016/j.jclinane.2023.111365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/17/2023] [Revised: 12/09/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
STUDY OBJECTIVE To conduct a systematic literature review of the current evidence on the effect of diabetes mellitus on gastric volume observed during a preoperative ultrasound examination. Using the results of this systematic literature review, a meta-analysis was performed to investigate whether there was an association between diabetes mellitus and an increased risk of presenting with a high-risk stomach (gastric volume associated with an increased risk of pulmonary aspiration). DESIGN Review article and meta-analysis. SETTING Review of published literature. PATIENTS A total of 3366 patients underwent surgery. INTERVENTION Gastric ultrasound examination. MEASUREMENTS Data for the meta-analysis and literature review were collected from the PubMed/Medline, Embase, Web of Science, and Google Scholar databases of the National Library of Medicine from the date of inception to January 2023. All included studies measured the gastric antral cross-sectional area and/or gastric residual volume in patients with diabetes and those without diabetes. The data utilized in the meta-analysis included all studies that evaluated the incidence of high-risk stomachs based on ultrasonographic measurements of the gastric antral cross-sectional area or gastric residual volume. MAIN RESULTS Most collated studies revealed that diabetes mellitus was associated with increased antral cross-sectional area and gastric residual volume. A meta-analysis of published reports indicated that patients with diabetes have an increased rate of high-risk stomachs. CONCLUSIONS Diabetes mellitus is associated with an increased rate of high-risk stomachs. The authors recommend large prospective trials to ascertain the safety of the current fasting guidelines for patients with diabetes undergoing surgery.
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Affiliation(s)
- Mohanad Baldawi
- Wayne State University/Detroit Medical Center, Department of Anesthesiology, 3990 John R. Street, Detroit, MI 48201, USA.
| | - Nancy Ghaleb
- Wayne State University/Detroit Medical Center, Department of Anesthesiology, 3990 John R. Street, Detroit, MI 48201, USA
| | - George McKelvey
- Wayne State University/Detroit Medical Center, Department of Anesthesiology, 3990 John R. Street, Detroit, MI 48201, USA; NorthStar Anesthesia, 6225 State Hwy 161 #200, Irving, TX 75038, USA
| | - Yara M Ismaeil
- Eastern Michigan University, Division of Cellular and Molecular Biology, 900 Oakwood St, Ypsilanti, MI 48197, USA
| | - Wael Saasouh
- Wayne State University/Detroit Medical Center, Department of Anesthesiology, 3990 John R. Street, Detroit, MI 48201, USA; NorthStar Anesthesia, 6225 State Hwy 161 #200, Irving, TX 75038, USA; Outcomes Research Consortium, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Baldawi M, Awad ME, McKelvey G, Pearl AD, Mostafa G, Saleh KJ. Neuraxial Anesthesia Significantly Reduces 30-Day Venous Thromboembolism Rate and Length of Hospital Stay in Primary Total Hip Arthroplasty: A Stratified Propensity Score-Matched Cohort Analysis. J Arthroplasty 2023; 38:108-116. [PMID: 35843379 DOI: 10.1016/j.arth.2022.07.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND General anesthesia (GA) has been the commonly used protocol for total hip arthroplasty (THA); however, neuraxial anesthesia (NA) has been increasingly performed. Our purpose was to compare NA and GA for 30-day postoperative outcomes in United States veterans undergoing primary THA. METHODS A large veteran's database was utilized to identify patients undergoing primary THA between 1999 and 2019. A total of 6,244 patients had undergone THA and were included in our study. Of these, 44,780 (79.6%) had received GA, and 10,788 (19.2%) had received NA. Patients receiving NA or GA were compared for 30-day mortalities, cardiovascular, respiratory, and renal complications, and wound infections and hospital lengths of stay (LOS). Propensity score matching, multivariate regression analyses, and subgroup analyses by American Society of Anesthesiology classification were performed to control for selection bias and patient baseline characteristics. RESULTS Upon propensity-adjusted multivariate analyses, NA was associated with decreased risks for deep venous thrombosis (odds ratio [OR] = 0.63; 95% CI = 0.4-0.9; P = .02), any respiratory complication (OR = 0.63; 95% CI = 0.5-0.9; P = .003), unplanned reintubation (OR = 0.51; 95% CI = 0.3-0.9; P = .009), and prolonged LOS (OR = 0.78; 95% CI = 0.72-0.84; P < .001). Subgroup analyses by American Society of Anesthesiology classes showed NA decreased 30-day venous thromboembolism rate in low-risk (class I/II) patients and decreased respiratory complications in high-risk (class III/IV) patients. CONCLUSION Using a patient cohort obtained from a large national database, NA was associated with reduced risk of 30-day adverse events compared to GA in patients undergoing THA. Postoperative adverse events were decreased with NA administration with similar decreases observed across all patient preoperative risk levels. NA was also associated with a significant decrease in hospital LOS.
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Affiliation(s)
- Mohanad Baldawi
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan; Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan
| | - Mohamed E Awad
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan; Michigan State University College of Osteopathic Medicine, Detroit, Michigan; Wayne State University, School of Medicine, Detroit, Michigan
| | - George McKelvey
- NorthStar Anesthesia, Detroit Medical Center, Detroit, Michigan; Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan
| | - Adam D Pearl
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan; Wayne State University, School of Medicine, Detroit, Michigan
| | - Gamal Mostafa
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan; Wayne State University, School of Medicine, Detroit, Michigan
| | - Khaled J Saleh
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, Michigan; Michigan State University College of Osteopathic Medicine, Detroit, Michigan
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Baldawi M, McKelvey G, Patel VR, Krish B, Kumar AJ, Patel P. Battlefield Acupuncture Use for Perioperative Anesthesia in Veterans Affairs Surgical Patients: A Single-Center Randomized Controlled Trial. J Integr Complement Med 2022; 28:683-688. [PMID: 35527689 DOI: 10.1089/jicm.2021.0429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Introduction: The risks from opioid use are well known in and mandate nonpharmacological modalities for the management of postoperative pain. The aim of this study was to investigate the effectiveness of battlefield acupuncture (BFA) as an adjunct therapy for postoperative pain in U.S. veteran patients undergoing major surgery under general anesthesia. Methods: Patients undergoing major surgery performed under general anesthesia from June 2017 to June 2018 were enrolled in the study. Patients were randomly assigned to receive either BFA or sham acupuncture. Outcomes such as pain intensity measured by visual analog scale score, opioid consumption, and the incidence of analgesia-related adverse effects were compared between the study groups. Results: A total of 72 subjects were included in this study (36 subjects in each study group). The median 24-h opioid postoperative consumption measured in morphine milligram equivalent (MME) was lower in the BFA group compared to the sham acupuncture group (18.3 [±12.2] MME vs. 38.6 [±15.9] MME, p < 0.001). Pain intensity reported by patients at 6, 12, 18, and 24 h postoperatively was lower in the BFA group compared to the sham acupuncture group. The incidence of postsurgical nausea and vomiting was lower in patients receiving BFA compared to patients receiving sham acupuncture. There were no intergroup differences in terms of postoperative anxiety or hospital length of stay. Conclusion: The results from this study reveal the potential clinical benefits of using BFA for reducing pain intensity and opioid requirements in surgical patients.
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Affiliation(s)
- Mohanad Baldawi
- Department of Anesthesiology and Pain Services, Detroit Medical Center, Detroit, Michigan, USA
| | - George McKelvey
- Department of Anesthesiology and Pain Services, Detroit Medical Center, Detroit, Michigan, USA
- Department of Surgical Services, John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Vijval R Patel
- Department of Surgical Services, John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Brinda Krish
- Department of Anesthesiology and Pain Services, Detroit Medical Center, Detroit, Michigan, USA
| | - Aashish Jay Kumar
- Department of Anesthesiology and Pain Services, Detroit Medical Center, Detroit, Michigan, USA
| | - Padmavathi Patel
- Department of Anesthesiology and Pain Services, Detroit Medical Center, Detroit, Michigan, USA
- Department of Surgical Services, John D. Dingell VA Medical Center, Detroit, Michigan, USA
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Shahait A, Qadeer AF, Hasnain MR, Baldawi M, Gruber SA, Weaver D, Mostafa G. Hartmann's Reversal Outcomes: a VASQIP Study. J Gastrointest Surg 2021; 25:539-541. [PMID: 32968932 DOI: 10.1007/s11605-020-04807-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/15/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Awni Shahait
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA.,Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Afreen Fatma Qadeer
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Mohanad Baldawi
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Scott A Gruber
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Donald Weaver
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Gamal Mostafa
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit, MI, USA. .,Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI, USA.
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Shahait A, Mesquita-Neto JWB, Hasnain MR, Baldawi M, Girten K, Weaver D, Saleh KJ, Gruber SA, Mostafa G. Outcomes of cholecystectomy in US veterans with cirrhosis: Predicting outcomes using nomogram. Am J Surg 2020; 221:538-542. [PMID: 33358373 DOI: 10.1016/j.amjsurg.2020.12.031] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/16/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study examines the outcomes of open and laparoscopic cholecystectomy (OC/LC) in veterans with cirrhosis and develops a nomogram to predict outcomes. METHODS We analyzed the Veterans Affairs Surgical Quality Improvement Program to identify all patients with cirrhosis and ascites who underwent cholecystectomy from 2008 to 2015. Univariate and multivariate regression were used to identify predictors of morbidity and mortality. A predictive nomogram was constructed and internally validated. RESULTS A total of 349 patients were identified. Overall, complications occurred in 18.7% of patients, and mortality was 3.8%. LC was performed in 58.9%, and 19.2% were preformed emergently. Overall, Model for End-Stage Liver Disease score was an independent factor of morbidity and mortality, while laparoscopic approach had a protective effect on morbidity. CONCLUSIONS Although cholecystectomy is a high-risk operation in cirrhotic veterans, LC may have favorable outcomes than OC in selected patients. An easy-to-use nomogram to predict morbidity and mortality for cirrhotic patients undergoing cholecystectomy is proposed.
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Affiliation(s)
- Awni Shahait
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA.
| | - Jose Wilson B Mesquita-Neto
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | | | - Mohanad Baldawi
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Kara Girten
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Donald Weaver
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Khaled J Saleh
- Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Scott A Gruber
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
| | - Gamal Mostafa
- The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI, USA; Department of Surgery, John D Dingell Veterans Affairs Medical Center, Detroit, MI, USA
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Shahait AD, Alghanem L, Cmorej P, Tracy W, Hasnain MR, Baldawi M, Girten K, Weaver D, Saleh KJ, Gruber SA, Mostafa G. Postoperative outcomes of ventral hernia repair in veterans. Surgery 2020; 169:603-609. [PMID: 33077198 DOI: 10.1016/j.surg.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ventral hernia repair is a common procedure with reported 15% to 37% morbidity and 0.3% to 1.4% mortality rates. This study examines the 30-day morbidity and mortality of open and laparoscopic ventral hernia repair in veterans, along with the impact of body mass index on these outcomes. METHODS The Veterans Affairs Surgical Quality Improvement Program was queried for all ventral hernia repairs during the period 2008 to 2015. In this retrospective analysis, we compared outcomes of open ventral hernia repair versus laparoscopic ventral hernia repair and among different body mass index classes. RESULTS A total of 19,883 patients were identified (92.6% male, mean age 59.7, 53.1% obese, and 71.6% with American Society of Anesthesiologists class ≥III). There were 95 (0.5%) mortalities, and complications occurred in 1,289 (6.5%) patients. Open ventral hernia repair was performed in 60.2%; 14.5% were recurrent, and 3.3% were performed as an emergency operation. When compared with open ventral hernia repair, the laparoscopic ventral hernia repair group had higher mean body mass index, less patients with American Society of Anesthesiologists class ≥III, fewer emergency operations, longer operative time, less complications, decreased mortality, and shorter duration of stay. Body mass index 35.00 to 49.99 was predictive of overall complications in the open ventral hernia repair group. CONCLUSION Ventral hernia repair can be performed in the veteran population with outcomes comparable to those in the private sector. Morbid obesity has a negative impact on ventral hernia repair outcomes that is most prominent following open surgery. Laparoscopic ventral hernia repair may offer superior outcomes when compared to open ventral hernia repair and may be considered.
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Affiliation(s)
- Awni D Shahait
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Lana Alghanem
- The Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Peter Cmorej
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - William Tracy
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | | | - Mohanad Baldawi
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Kara Girten
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Donald Weaver
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI
| | - Khaled J Saleh
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Scott A Gruber
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Gamal Mostafa
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI.
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Kong J, Shahait A, Girten K, Baldawi M, Hasnain MR, Saleh KJ, Gruber SA, Weaver D, Mostafa G. Recent trends in cholecystectomy in US veterans. Surg Endosc 2020; 35:5558-5566. [PMID: 33025254 DOI: 10.1007/s00464-020-08056-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION We hypothesize that the recent trend in performing cholecystectomy in US Veterans shows wide adoption of the laparoscopic technique and improvement in the outcome following both laparoscopic (LC) and open cholecystectomy (OC). This study utilizes the Veterans Affairs Surgical Quality Improvement Program database to examine the status and outcome of cholecystectomy. METHODS A retrospective review of veterans who underwent cholecystectomy between 2008 and 2015 was performed. Data analysis included patient demographics, operations, and postoperative outcomes. Cochran-Armitage trend analysis was used to assess significant changes in outcome over the study period. p ≤ 0.05 was considered significant. RESULTS A total of 40,722 patients (average age of 61 years) were included in the study (males 85.6%). LC was performed in the majority of patients (86.4%). Patients in the OC group (13.6%) were more likely to have advanced age (≥ 65 years) (47.6% vs 32.0%, p < 0.001) and higher ASA class (III-V) (81.9% vs 65.4%, p < 0.001) than those in the LC group. Compared with LC, OC had higher mortality rates at 30 days (1.3% vs 0.3%; OR = 1.6, p = 0.03), 3 months (2.6% vs 0.7%; OR = 1.7, p < 0.001), 6 months (3.9% vs 1.1%; OR = 1.5, p < 0.001) and 1 year (5.7% vs 2.0%; OR = 1.5, p < 0.001); higher rates of morbidity, including pneumonia (OR = 1.9, p < 0.001), deep venous thrombosis (OR = 2.4, p = 0.02), reoperation (OR = 1.8, p < 0.001), and superficial (OR = 4.9, p < 0.001) and deep (OR = 1.5, p = 0.01) surgical site infections; and a longer length of stay (6.5 days vs 2.6 days, p < 0.001). Trend analysis showed a significant decrease in both mortality (p = 0.02) and morbidity (p < 0.001) for LC over the study period, but no improvement in mortality (p = 0.35) and a only a minimal improvement in morbidity (p = 0.04) for OC. CONCLUSION In the recent era, LC has been widely performed in the VA with significant improvement in outcome. Efforts are needed to adopt alternative approaches to planned OC and to improve postoperative outcomes.
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Affiliation(s)
- Joshua Kong
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA.,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Awni Shahait
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA.,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Kara Girten
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Mohanad Baldawi
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Mustafa Rashad Hasnain
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Khaled J Saleh
- Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Scott A Gruber
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA.,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA
| | - Donald Weaver
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA
| | - Gamal Mostafa
- Michael and Marian Ilitch Department of Surgery, Wayne State University/Detroit Medical Center, 6C, University Health Center, 4201 St. Antoine, Detroit, MI48201, USA. .,Department of Surgery, John D. Dingell Veteran Affairs Medical Center, Detroit, MI, 48201, USA.
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Shahait AD, Neto Jose Wilson M, Rashad Hasnain M, Baldawi M, Girten K, Weaver DD, Gruber SA, Mostafa GD. Umbilical Hernia Repair in Cirrhotic Veterans. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Alharthi S, Baldawi M, Das C, Wiesnewski A, Adair M, Markowiak S, Osman M, Nazzal M. Revisiting Endovascular Repair for Ruptured Abdominal Aortic Aneurysms. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.142] [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: 10/26/2022]
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Alharthi S, Baldawi M, Bauer K, Ford A, Siddiq A, Albeshri H, Qu W, Osman M, Nazzal M. Impact of Targeted Sclerotherapy in Management of Refractory Venous Ulcer. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Adair MJ, Alharthi S, Ortiz J, Qu W, Baldawi M, Nazzal M, Baskara A. Robotic Surgery is More Expensive with Similar Outcomes in Sleeve Gastrectomy: Analysis of the NIS Database. Am Surg 2019. [DOI: 10.1177/000313481908500120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The aim of this study was to compare postoperative outcomes after robotic-assisted and laparoscopic bariatric sleeve gastrectomy (SG). Sleeve gastrectomy is traditionally performed using laparoscopic techniques. Robotic-assisted surgery enables surgeons to perform minimally invasive SG, but with unknown benefits. Using a national database, we compared postoperative outcomes after laparoscopic SG and robotic-assisted SG. National data from individuals undergoing elective SG in the National Inpatient Sample database between 2011 and 2013 were analyzed. Propensity score matching was used to match robotic and laparoscopic groups by demographics, comorbidities, and hospital characteristics. The matching cohorts were compared. A total of 26,195 patients who underwent elective SG for morbid obesity were included. Of these, 25,391 (96.9%) were completed via laparoscopy, whereas 804 (3.1%) were performed with robotic assistance. There were no significant differences in demographics and subsequent postoperative complications. The inhospital mortality was similar. Length of hospital stay was statistically different, with a mean of 1.88 in laparoscopic versus 2.08 days in robotic (P < 0.001). Higher total hospital charges were noted in the robotic-assisted SG group (median US$38,569 vs US$54,658, P < 0.001). These differences were evident even after adjusting for confounding factors: wound infection, atelectasis, bowel obstruction, pneumonia, and bowel obstruction (P < 0.001).
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Affiliation(s)
- Marcus J. Adair
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Samer Alharthi
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Jorge Ortiz
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Weikai Qu
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Mohanad Baldawi
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Munier Nazzal
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
| | - Arunkumar Baskara
- From the Department of Surgery, University of Toledo College of Medicine, Toledo, Ohio
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Adair MJ, Alharthi S, Ortiz J, Qu W, Baldawi M, Nazzal M, Baskara A. Robotic Surgery Is More Expensive with Similar Outcomes in Sleeve Gastrectomy: Analysis of the NIS Database. Am Surg 2019; 85:39-45. [PMID: 30760343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of this study was to compare postoperative outcomes after robotic-assisted and laparoscopic bariatric sleeve gastrectomy (SG). Sleeve gastrectomy is traditionally performed using laparoscopic techniques. Robotic-assisted surgery enables surgeons to perform minimally invasive SG, but with unknown benefits. Using a national database, we compared postoperative outcomes after laparoscopic SG and robotic-assisted SG. National data from individuals undergoing elective SG in the National Inpatient Sample database between 2011 and 2013 were analyzed. Propensity score matching was used to match robotic and laparoscopic groups by demographics, comorbidities, and hospital characteristics. The matching cohorts were compared. A total of 26,195 patients who underwent elective SG for morbid obesity were included. Of these, 25,391 (96.9%) were completed via laparoscopy, whereas 804 (3.1%) were performed with robotic assistance. There were no significant differences in demographics and subsequent postoperative complications. The inhospital mortality was similar. Length of hospital stay was statistically different, with a mean of 1.88 in laparoscopic versus 2.08 days in robotic (P < 0.001). Higher total hospital charges were noted in the robotic-assisted SG group (median US$38,569 vs US$54,658, P < 0.001). These differences were evident even after adjusting for confounding factors: wound infection, atelectasis, bowel obstruction, pneumonia, and bowel obstruction (P < 0.001).
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