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Manasa M, Galvin K, Fazl Alizadeh R, Ruhi-Williams P, Choi A, Samarasena J, Chang K, Nguyen NT. Correlation of the Endoscopic Gastroesophageal Flap Valve with Pathologic Reflux. J Am Coll Surg 2024; 238:1148-1152. [PMID: 38551241 DOI: 10.1097/xcs.0000000000001088] [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] [Indexed: 05/16/2024]
Abstract
BACKGROUND The Hill classification characterizes the geometry of gastroesophageal junction and Hill grades (HGs) III and IV have a high association with pathologic reflux. This study aimed to understand the use of the Hill classification and correlate the prevalence of pathologic reflux across different HGs. STUDY DESIGN A retrospective review of 477 patients who underwent upper endoscopy and BRAVO pH monitoring between August 2018 and October 2021 was performed. These charts were reviewed for endoscopic findings for hiatal hernia and association of HGs with pathologic reflux, defined as an abnormal esophageal acid exposure time (AET) of ≥4.9%. RESULTS Of 477 patients, 252 (52.8%) had an HG documented on the endoscopy report. Of the 252 patients, 61 had HG I (24.2%), 100 had HG II (39.7%), 61 had HG III (24.2%), and 30 had HG IV (11.9%). The proportion of patients with abnormal AET increases with increasing HGs (p < 0.001) as follows: I (39.3%), II (52.5%), III (67.2%), and IV (79.3%). The mean overall AET is as follows: HG I (5.5 ± 6%), HG II (7.0 ± 5.9%), HG III (10.2 ± 10.3%), and HG IV (9.5 ± 5.5%). The proportion of patients with hiatal hernia was 18% for HG I, 28% for HG II, 39.3% for HG III, and 80% for HG IV. CONCLUSIONS Use of the Hill classification in clinical practice is low. There is an association of increasing HGs with increasing proportion of patients with abnormal AET. There is a high proportion of patients within HGs I and II with documented pathologic reflux and the presence of a hiatal hernia as observed on endoscopic examination. Our study suggests that endoscopic grading of the gastroesophageal junction may not adequately differentiate between normal vs abnormal reflux status, particularly for HGs I and II.
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Affiliation(s)
- Morgan Manasa
- From the Department of Surgery, University of California, Irvine Medical Center, Orange, CA (Manasa, Galvin, Fazl Alizadeh, Ruhi-Williams, Nguyen)
| | - Katie Galvin
- From the Department of Surgery, University of California, Irvine Medical Center, Orange, CA (Manasa, Galvin, Fazl Alizadeh, Ruhi-Williams, Nguyen)
| | - Reza Fazl Alizadeh
- From the Department of Surgery, University of California, Irvine Medical Center, Orange, CA (Manasa, Galvin, Fazl Alizadeh, Ruhi-Williams, Nguyen)
| | - Perisa Ruhi-Williams
- From the Department of Surgery, University of California, Irvine Medical Center, Orange, CA (Manasa, Galvin, Fazl Alizadeh, Ruhi-Williams, Nguyen)
| | - Alyssa Choi
- Division of Gastroenterology, Digestive Health Institute, University of California, Irvine Medical Center, Orange, CA (Choi, Samarasena, Chang)
| | - Jason Samarasena
- Division of Gastroenterology, Digestive Health Institute, University of California, Irvine Medical Center, Orange, CA (Choi, Samarasena, Chang)
| | - Kenneth Chang
- Division of Gastroenterology, Digestive Health Institute, University of California, Irvine Medical Center, Orange, CA (Choi, Samarasena, Chang)
| | - Ninh T Nguyen
- From the Department of Surgery, University of California, Irvine Medical Center, Orange, CA (Manasa, Galvin, Fazl Alizadeh, Ruhi-Williams, Nguyen)
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Ruhi-Williams P, Wu B, Nahmias J, Sagebin F, Fazl Alizadeh R, Gadde KM, Amin A, Nguyen NT. Analysis of Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19 Compared to Non-COVID Etiologies. Ann Surg 2023; 278:464-470. [PMID: 37325899 DOI: 10.1097/sla.0000000000005959] [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] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This study analyzed the characteristics and outcomes of veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) due to COVID-19 versus non-COVID causes at US academic centers. BACKGROUND DATA V-V ECMO support has been utilized for COVID-19 patients with ARDS since the beginning of the pandemic. Mortality for ECMO in COVID-19 has been reported to be high but similar to reported mortality for ECMO support for non-COVID causes of respiratory failure. METHODS Using ICD-10 codes, data of patients who underwent V-V ECMO for COVID-19 ARDS were compared with patients who underwent V-V ECMO for non-COVID causes between April 2020 and December 2022. The primary outcome was in-hospital mortality. Secondary outcome measures included length of stay and direct cost. Multivariate logistic regression modeling was performed to analyze differences in mortality between COVID and non-COVID groups, adjusting for other important risk factors (age, sex, and race/ethnicity). RESULTS We identified and compared 6382 patients who underwent V-V ECMO for non-COVID causes to 6040 patients who underwent V-V ECMO for COVID-19. There was a significantly higher proportion of patients aged ≥ 65 years who underwent V-V ECMO in the non-COVID group compared with the COVID group (19.8% vs. 3.7%, respectively, P <0.001). Compared with patients who underwent V-V ECMO for non-COVID causes, patients who underwent V-V ECMO for COVID had increased in-hospital mortality (47.6% vs. 34.5%, P <0.001), length of stay (46.5±41.1 days vs. 40.6±46.1, P <0.001), and direct hospitalization cost ($207,022±$208,842 vs. $198,508±205,510, P =0.02). Compared with the non-COVID group, the adjusted odds ratio (OR) for in-hospital mortality in the COVID group was 2.03 (95% CI: 1.87-2.20, P <0.001). In-hospital mortality for V-V ECMO in COVID-19 improved during the study time period (50.3% in 2020, 48.6% in 2021, and 37.3% in 2022). However, there was a precipitous drop in the ECMO case volume for COVID starting in quarter 2 of 2022. CONCLUSIONS In this nationwide analysis, COVID-19 patients with ARDS requiring V-V ECMO support had increased mortality compared with patients who underwent V-V ECMO for non-COVID etiologies.
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Affiliation(s)
- Perisa Ruhi-Williams
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Baolin Wu
- Department of Epidemiology and Biostatistics, Program in Public Health, Susan & Henry Samueli College of Health Sciences, University of California Irvine, Irvine, CA
| | - Jeffry Nahmias
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Fabio Sagebin
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Reza Fazl Alizadeh
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Kishore M Gadde
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Alpesh Amin
- Department of Medicine, University of California Irvine Medical Center, Orange, CA
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
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Ruhi-Williams P, Manasa M, Fazl Alizadeh R, Sullivan B, Kirby KA, Amin A, Nguyen NT. Impact of COVID-19 Pandemic on Management and Outcomes of Acute Cholecystitis at US Academic Centers. J Am Coll Surg 2023; 237:87-93. [PMID: 37318137 DOI: 10.1097/xcs.0000000000000668] [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] [Indexed: 03/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had wide-ranging effects on management of medical conditions. Many hospitals encountered staffing shortages, limited operating room availability, and shortage of hospital beds. There was increased psychological stress and fear of contracting COVID-19 infection, leading to delay in medical care for various disease processes. The objective of this study was to examine changes in management and outcomes attributed to the COVID-19 pandemic in patients presenting with acute calculus cholecystitis at US academic centers. STUDY DESIGN Using the Vizient database, patients with the diagnosis of acute calculus cholecystitis who underwent intervention during the 15 months before the pandemic (prepandemic, October 2018 to December 2019) were compared with 15 months during the pandemic (pandemic, March 2020 to May 2021). Outcomes measures included demographics, characteristics, type of intervention, length of stay, in-hospital mortality, and direct cost. RESULTS There were 146,459 patients with acute calculus cholecystitis identified (prepandemic: 74,605 vs pandemic: 71,854). Patients in the pandemic group were more likely to undergo medical management (29.4% vs 31.8%; p < 0.001) or percutaneous cholecystostomy tube placement (21.5% vs 18%; p < 0.001) and less likely to undergo laparoscopic cholecystectomy (69.8% vs 73.0%; p < 0.001). Patients in the pandemic group who underwent procedural intervention had longer length of stay (6.5 days vs 5.9 days; p < 0.001), higher in-hospital death (3.1% vs 2.3%; p < 0.001), and higher cost ($14,609 vs $12,570; p < 0.001). CONCLUSIONS In this analysis of patients with acute calculus cholecystitis, there were distinct changes in the management and outcomes of patients due to the COVID-19 pandemic. Changes in the type of intervention and outcomes are likely related to delayed presentation with increases in the severity and complexity of the disease.
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Affiliation(s)
- Perisa Ruhi-Williams
- From the University of California Irvine Medical Center, Department of Surgery, Orange, CA (Ruhi-Williams, Manasa, Alizadeh, Sullivan, Nguyen)
| | - Morgan Manasa
- From the University of California Irvine Medical Center, Department of Surgery, Orange, CA (Ruhi-Williams, Manasa, Alizadeh, Sullivan, Nguyen)
| | - Reza Fazl Alizadeh
- From the University of California Irvine Medical Center, Department of Surgery, Orange, CA (Ruhi-Williams, Manasa, Alizadeh, Sullivan, Nguyen)
| | - Brittany Sullivan
- From the University of California Irvine Medical Center, Department of Surgery, Orange, CA (Ruhi-Williams, Manasa, Alizadeh, Sullivan, Nguyen)
| | - Katharine A Kirby
- University of California Irvine, Center for Statistical Consulting, Department of Statistics, Irvine, CA (Kirby)
| | - Alpesh Amin
- University of California Irvine Medical Center, Department of Medicine, Orange, CA (Amin)
| | - Ninh T Nguyen
- From the University of California Irvine Medical Center, Department of Surgery, Orange, CA (Ruhi-Williams, Manasa, Alizadeh, Sullivan, Nguyen)
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Fazl Alizadeh R, Li S, Sullivan B, Manasa M, Ruhi-Williams P, Nahmias J, Carmichael J, Nguyen NT, Stamos MJ. Surgical Outcome in Laparoscopic Abdominal Surgical Operations with Clostridium Difficile Infection. Am Surg 2022; 88:2519-2524. [DOI: 10.1177/00031348221103644] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Postoperative Clostridium difficile infection (CDI) has associated morbidity, but it is unknown how it impacts different operations. We sought to determine the incidence and postoperative morbidity following abdominal surgery. Method: The National Surgical Quality Improvement Program database (2015-2019) was utilized to evaluate adult (≥18 years-old) patients who developed CDI following laparoscopic abdominal operations. Univariate and multivariate analysis were performed to evaluate outcomes. Results: A total of 973 338 patients were studied and the overall incidence of CDI was .3% within 30 days of operation. Colorectal surgery had the highest incidence of CDI (1601/167 949,1.0%) with significantly longer mean length of stay (LOS) (8.0 days± 9.0, P < .01) compared to other surgical procedures. CDI patients also had a longer mean length of stay (6.6± 8.0 vs 2.1 ± 3.6 days, P < .01) and increased mortality (1.8% vs .2%, AOR: 4.64, CI: 3.45-5.67, P < .01) compared to patients without CDI. Conclusions: This national analysis demonstrates that CDI is a significant complication following abdominal surgery and is associated with increased LOS and mortality. Furthermore, laparoscopic colorectal surgery appears to have the greatest risk of CDI. Future research is needed to determine the exact cause in order to decrease the incidence of CDI by reconsidering the protocol of antibiotic use within the high-risk population.
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Affiliation(s)
- Reza Fazl Alizadeh
- Department of Surgery, School of Medicine, University of California, Irvine, CA, USA
| | - Shiri Li
- Department of Surgery, New York Presbyterian Hospital, Weill Cornell College of Medicine, New York, NY, USA
| | - Brittany Sullivan
- Department of Surgery, School of Medicine, University of California, Irvine, CA, USA
| | - Morgan Manasa
- Department of Surgery, School of Medicine, University of California, Irvine, CA, USA
| | - Perisa Ruhi-Williams
- Department of Surgery, School of Medicine, University of California, Irvine, CA, USA
| | - Jeffery Nahmias
- Department of Surgery, School of Medicine, University of California, Irvine, CA, USA
| | - Joseph Carmichael
- Department of Surgery, School of Medicine, University of California, Irvine, CA, USA
| | - Ninh T. Nguyen
- Department of Surgery, School of Medicine, University of California, Irvine, CA, USA
| | - Michael J. Stamos
- Department of Surgery, School of Medicine, University of California, Irvine, CA, USA
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Alizadeh RF, Li S, Gambhir S, Hinojosa MW, Smith BR, Stamos MJ, Nguyen NT. Laparoscopic Sleeve Gastrectomy or Laparoscopic Gastric Bypass for Patients with Metabolic Syndrome: An MBSAQIP Analysis. Am Surg 2020. [DOI: 10.1177/000313481908501007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In patients undergoing bariatric surgery, the presence of metabolic syndrome (MetS) contributes to perioperative morbidity. We aimed to evaluate the utilization and outcome of severely obese patients with MetS who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB). Using the 2015 and 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, data were obtained for patients with MetS undergoing LSG or LRYGB. There were 29,588 MetS patients (LSG: 58.7% vs LRYGB: 41.3%). There was no significant difference in 30-day mortality (0.1% for LSG vs 0.2% for LRYGB, adjusted odds ratio (AOR) 0.58, confidence interval (CI) 0.32–1.05, P = 0.07) or length of stay between groups (2 ± 2 for LSG vs 2.2 ± 2 days for LRYGB, P = 0.40). Compared with LRYGB, LSG was associated with significantly shorter operative time (78 ± 39 vs 122 ± 54 minutes, P < 0.01), lower overall morbidity (2.3% vs 4.4%, AOR 0.53, CI 0.46–0.60, P < 0.01), lower serious morbidity (1.5% vs 2.3%, AOR 0.64, CI 0.53–0.76, P < 0.01), lower 30-day reoperation (1.2% vs 2.3%, AOR 0.52, CI 0.43–0.63, P < 0.01), and lower 30-day readmission (4.2% vs 6.6%, AOR 0.62, CI 0.55–0.69, P < 0.01). In conclusion, LSG is the predominant operation being performed for severely obese patients with MetS, and its popularity may in part be related to its improved perioperative safety profile.
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Affiliation(s)
- Reza Fazl Alizadeh
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Shiri Li
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Sahil Gambhir
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Marcelo W. Hinojosa
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Brian R. Smith
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Michael J. Stamos
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
| | - Ninh T. Nguyen
- Department of Surgery, Irvine Medical Center, University of California, Orange, California
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Ui T, Obi Y, Shimomura A, Lefor AK, Fazl Alizadeh R, Said H, Nguyen NT, Stamos MJ, Kalantar-Zadeh K, Sata N, Ichii H. High and low estimated glomerular filtration rates are associated with adverse outcomes in patients undergoing surgery for gastrointestinal malignancies. Nephrol Dial Transplant 2020; 34:810-818. [PMID: 29718365 DOI: 10.1093/ndt/gfy108] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Abnormally high estimated glomerular filtration rates (eGFRs) are associated with endothelial dysfunction and frailty. Previous studies have shown that low eGFR is associated with increased morbidity, but few reports address high eGFR. The purpose of this study is to evaluate the association of high eGFR with surgical outcomes in patients undergoing surgery for gastrointestinal malignancies. METHODS We identified patients who underwent elective surgery for gastrointestinal malignancies from 2005 to 2015 in the American College of Surgeons National Surgical Quality Improvement Program database. We evaluated associations of eGFR with surgical outcomes by Cox or logistic models with restricted cubic spline functions, adjusting for case mix variables (i.e. age, gender, race and diabetes). RESULTS The median eGFR is 83 (interquartile range 67-96) mL/min/1.73 m2. Thirty-day mortality was 1.9% (2555/136 896). There is a U-shaped relationship between eGFR and 30-day mortality. The adjusted hazard ratios (95% confidence intervals) for eGFRs of 30, 60, 105 and 120 mL/min/1.73 m2 (versus 90 mL/min/1.73 m2) are 1.73 (1.52-1.97), 1.00 (0.89-1.11), 1.42 (1.31-1.55) and 2.20 (1.79-2.70), respectively. Similar associations are shown for other surgical outcomes, including return to the operating room and postoperative pneumonia. Subgroup analyses show that eGFRs both higher and lower than the respective medians are consistently associated with a higher risk of adverse outcomes across age, gender and race. CONCLUSIONS High and low eGFRs are associated with more adverse surgical outcomes in patients undergoing surgery for gastrointestinal malignancies. The eGFR associated with the lowest postoperative risk is approximately at the median eGFR of a given population.
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Affiliation(s)
- Takashi Ui
- Department of Surgery, University of California, Irvine, Orange, CA, USA.,Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Yoshitsugu Obi
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California, Irvine, Orange, CA, USA
| | - Akihiro Shimomura
- Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Alan K Lefor
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Reza Fazl Alizadeh
- Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Hyder Said
- Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California, Irvine, Orange, CA, USA.,Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.,Los Angeles Biomedical Research Institute, Harbor-UCLA Hospital, Torrance, CA, USA
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Hirohito Ichii
- Department of Surgery, University of California, Irvine, Orange, CA, USA
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Alizadeh RF, Li S, Gambhir S, Hinojosa MW, Smith BR, Stamos MJ, Nguyen NT. Laparoscopic Sleeve Gastrectomy or Laparoscopic Gastric Bypass for Patients with Metabolic Syndrome: An MBSAQIP Analysis. Am Surg 2019; 85:1108-1112. [PMID: 31657304] [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: 06/10/2023]
Abstract
In patients undergoing bariatric surgery, the presence of metabolic syndrome (MetS) contributes to perioperative morbidity. We aimed to evaluate the utilization and outcome of severely obese patients with MetS who underwent laparoscopic sleeve gastrectomy (LSG) versus laparoscopic Roux-en-Y gastric bypass (LRYGB). Using the 2015 and 2016 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, data were obtained for patients with MetS undergoing LSG or LRYGB. There were 29,588 MetS patients (LSG: 58.7% vs LRYGB: 41.3%). There was no significant difference in 30-day mortality (0.1% for LSG vs 0.2% for LRYGB, adjusted odds ratio (AOR) 0.58, confidence interval (CI) 0.32-1.05, P = 0.07) or length of stay between groups (2 ± 2 for LSG vs 2.2 ± 2 days for LRYGB, P = 0.40). Compared with LRYGB, LSG was associated with significantly shorter operative time (78 ± 39 vs 122 ± 54 minutes, P < 0.01), lower overall morbidity (2.3% vs 4.4%, AOR 0.53, CI 0.46-0.60, P < 0.01), lower serious morbidity (1.5% vs 2.3%, AOR 0.64, CI 0.53-0.76, P < 0.01), lower 30-day reoperation (1.2% vs 2.3%, AOR 0.52, CI 0.43-0.63, P < 0.01), and lower 30-day readmission (4.2% vs 6.6%, AOR 0.62, CI 0.55-0.69, P < 0.01). In conclusion, LSG is the predominant operation being performed for severely obese patients with MetS, and its popularity may in part be related to its improved perioperative safety profile.
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Alizadeh RF, Li S, Hinojosa MW, Smith BR, Stamos MJ, Nguyen NT. Minimally Invasive Surgery vs Open Esophagectomy: A Report from the Targeted NSQIP Database. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.220] [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: 10/28/2022]
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Alizadeh RF, Li S, Chaudhry HH, Jafari MD, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A. Adjuvant Chemotherapy Improves Survival in Patients with T4N0 Colon Adenocarcinoma. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.121] [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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10
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Alizadeh RF, Chaudhry HH, Li S, Jafari MD, Mills SD, Carmichael JC, Pigazzi A, Monson JR, Stamos MJ. Ileocolic Resection for Crohn's Disease: A Minimally Invasive Approach Claims Its Place. Am Surg 2018. [DOI: 10.1177/000313481808401021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Ileocolic resection is the most common operation performed for Crohn's disease patients with terminal ileum involvement. We sought to evaluate the outcomes in Crohn's disease patients who underwent open ileocolic resection (OIC) and laparoscopic ileocolic resection (LIC) by using the ACS-NSQIP database from 2006 to 2015. Of 5670 patients, 48.3 per cent (2737) patients had OIC and 51.7 per cent (2933) had LIC. The number of LIC increased from 40 per cent in 2006 to 60.7 per cent in 2015. Moreover, the annual number of LIC surgeries has exceeded the number of OIC surgeries since 2013. Patients in the LIC group had shorter hospital length of stay compared with OIC group (6 ± 5 days vs 8.6 ± 8 days, P < 0.01). The LIC procedure also had shorter operation time compared with OIC (148 ± 58 vs 153 ± 76 minutes, P = 0.01). Overall morbidity (15.8% vs 25.3%, AOR: 0.54, confidence interval (CI): 0.46–0.62, P < 0.01), serious morbidity (10.9% vs 18%, AOR: 0.55, CI: 0.46–0.65, P < 0.01), and SSI (9.9% vs 15.5%, AOR: 0.59, CI: 0.49–0.70, P < 0.01) rates were lower in the LIC group than the OIC group. We demonstrated that in Crohn's disease patients, LIC has improved outcomes for ileocolic resection compared with OIC and has been chosen as the preferential treatment approach for most patients.
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Affiliation(s)
- Reza Fazl Alizadeh
- Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California
| | - Haris H. Chaudhry
- Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California
| | - Shiri Li
- Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California
| | - Mehraneh D. Jafari
- Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California
| | - Steven D. Mills
- Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California
| | - Joseph C. Carmichael
- Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California
| | - John R.T. Monson
- Center for Colon and Rectal Surgery, Florida Hospital, Orlando, Florida
| | - Michael J. Stamos
- Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California
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Alizadeh RF, Li S, Hinojosa MW, Smith BR, Stamos MJ, Nguyen NT. Outcomes of Intragastric Balloon for Weight Loss: A Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Analysis. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.030] [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: 11/27/2022]
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12
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Alizadeh RF, Chaudhry HH, Li S, Jafari MD, Mills SD, Carmichael JC, Pigazzi A, Monson JRT, Stamos MJ. Ileocolic Resection for Crohn's Disease: A Minimally Invasive Approach Claims Its Place. Am Surg 2018; 84:1639-1644. [PMID: 30747686] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Ileocolic resection is the most common operation performed for Crohn's disease patients with terminal ileum involvement. We sought to evaluate the outcomes in Crohn's disease patients who underwent open ileocolic resection (OIC) and laparoscopic ileocolic resection (LIC) by using the ACS-NSQIP database from 2006 to 2015. Of 5670 patients, 48.3 per cent (2737) patients had OIC and 51.7 per cent (2933) had LIC. The number of LIC increased from 40 per cent in 2006 to 60.7 per cent in 2015. Moreover, the annual number of LIC surgeries has exceeded the number of OIC surgeries since 2013. Patients in the LIC group had shorter hospital length of stay compared with OIC group (6 ± 5 days vs 8.6 ± 8 days, P < 0.01). The LIC procedure also had shorter operation time compared with OIC (148 ± 58 vs 153 ± 76 minutes, P = 0.01). Overall morbidity (15.8% vs 25.3%, AOR: 0.54, confidence interval (CI): 0.46-0.62, P < 0.01), serious morbidity (10.9% vs 18%, AOR: 0.55, CI: 0.46-0.65, P < 0.01), and SSI (9.9% vs 15.5%, AOR: 0.59, CI: 0.49-0.70, P < 0.01) rates were lower in the LIC group than the OIC group. We demonstrated that in Crohn's disease patients, LIC has improved outcomes for ileocolic resection compared with OIC and has been chosen as the preferential treatment approach for most patients.
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Affiliation(s)
- Reza Fazl Alizadeh
- Department of Surgery, University of California, Irvine, School of Medicine, Irvine, California, USA
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Fazl Alizadeh R, Li S, Inaba CS, Dinicu AI, Hinojosa MW, Smith BR, Stamos MJ, Nguyen NT. Robotic versus laparoscopic sleeve gastrectomy: a MBSAQIP analysis. Surg Endosc 2018; 33:917-922. [PMID: 30128823 DOI: 10.1007/s00464-018-6387-6] [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: 05/09/2018] [Accepted: 08/10/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy has become the procedure of choice for the treatment of morbid obesity. Robotic sleeve gastrectomy is an alternative surgical option, but its utilization has been low. The aim of this study was to evaluate the contemporary outcomes of robotic sleeve gastrectomy (RSG) versus laparoscopic sleeve gastrectomy (LSG) using a national database from accredited bariatric centers. STUDY DESIGN Using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, clinical data for patients who underwent RSG or LSG were examined. Emergent and revisional cases were excluded. A multivariate logistic regression model was utilized to compare the outcomes between RSG and LSG. RESULTS A total of 75,079 patients underwent sleeve gastrectomy with 70,298 (93.6%) LSG and 4781 (6.4%) RSG. Preoperative sleep apnea and hypoalbumenia were significantly higher in the RSG group (P < 0.01). Mean length of stay was similar between RSG and LSG (1.8 ± 2.0 vs. 1.7 ± 2.0 days, P = 0.17). Operative time was longer in the RSG group (102 ± 43 vs. 74 ± 36 min, P < 0.01). There was no significant difference in 30-day mortality between the RSG versus LSG group (0.02% vs. 0.01%, AOR 0.85; 95% CI 0.11-6.46, P = 0.88). However, RSG was associated with higher serious morbidity (1.1% vs. 0.8%, AOR 1.40; 95% CI 1.05-1.86, P < 0.01), higher leak rate (1.5% vs. 0.5%, AOR 3.14; 95% CI 2.65-4.42, P < 0.01), and higher surgical site infection rate (0.7% vs. 0.4%, AOR 1.55; 95% CI 1.08-2.23, P = 0.01). CONCLUSIONS Robotic sleeve gastrectomy has longer operative time and is associated with higher postoperative morbidity including leak and surgical site infections. Laparoscopy should continue to be the surgical approach of choice for sleeve gastrectomy.
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Affiliation(s)
- Reza Fazl Alizadeh
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Shiri Li
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Colette S Inaba
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Andreea I Dinicu
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Marcelo W Hinojosa
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Brian R Smith
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA.
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Alizadeh RF, Li S, Inaba C, Penalosa P, Hinojosa MW, Smith BR, Stamos MJ, Nguyen NT. Risk Factors for Gastrointestinal Leak after Bariatric Surgery: MBASQIP Analysis. J Am Coll Surg 2018; 227:135-141. [PMID: 29605723 DOI: 10.1016/j.jamcollsurg.2018.03.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastrointestinal leak remains one of the most dreaded complications in bariatric surgery. We aimed to evaluate risk factors and the impact of common perioperative interventions on the development of leak in patients who underwent laparoscopic bariatric surgery. STUDY DESIGN Using the 2015 database of accredited centers, data were analyzed for patients who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass (LRYGB). Emergent, revisional, and converted cases were excluded. Multivariate logistic regression was used to analyze risk factors for leak, including provocative testing of anastomosis, surgical drain placement, and use of postoperative swallow study. RESULTS Data from 133,478 patients who underwent laparoscopic sleeve gastrectomy (n = 92,495 [69.3%]) and LRYGB (n = 40,983 [30.7%]) were analyzed. Overall leak rate was 0.7% (938 of 133,478). Factors associated with increased risk for leak were oxygen dependency (adjusted odds ratio [AOR] 1.97), hypoalbuminemia (AOR 1.66), sleep apnea (AOR 1.52), hypertension (AOR 1.36), and diabetes (AOR 1.18). Compared with LRYGB, laparoscopic sleeve gastrectomy was associated with a lower risk of leak (AOR 0.52; 95% CI 0.44 to 0.61; p < 0.01). Intraoperative provocative test was performed in 81.9% of cases and the leak rate was higher in patients with vs without a provocative test (0.8% vs 0.4%, respectively; p < 0.01). A surgical drain was placed in 24.5% of cases and the leak rate was higher in patients with vs without a surgical drain placed (1.6% vs 0.4%, respectively; p < 0.01). A swallow study was performed in 41% of cases and the leak rate was similar between patients with vs without swallow study (0.7% vs 0.7%; p = 0.50). CONCLUSIONS The overall rate of gastrointestinal leak in bariatric surgery is low. Certain preoperative factors, procedural type (LRYGB), and interventions (intraoperative provocative test and surgical drain placement) were associated with a higher risk for leaks.
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Affiliation(s)
- Reza Fazl Alizadeh
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Shiri Li
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Colette Inaba
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Patrick Penalosa
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Marcelo W Hinojosa
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Brian R Smith
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine School of Medicine, Orange, CA.
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Sujatha-Bhaskar S, Alizadeh RF, Inaba CS, Koh CY, Jafari MD, Mills SD, Carmichael JC, Stamos MJ, Pigazzi A. Respiratory complications after colonic procedures in chronic obstructive pulmonary disease: does laparoscopy offer a benefit? Surg Endosc 2018; 32:1280-1285. [PMID: 28812150 PMCID: PMC6281393 DOI: 10.1007/s00464-017-5805-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/29/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with severe chronic obstructive pulmonary disease (COPD) are at a higher risk for postoperative respiratory complications. Despite the benefits of a minimally invasive approach, laparoscopic pneumoperitoneum can substantially reduce functional residual capacity and raise alveolar dead space, potentially increasing the risk of respiratory failure which may be poorly tolerated by COPD patients. This raises controversy as to whether open techniques should be preferentially employed in this population. METHODS The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2011 to 2014 was used to examine the clinical data from patients with COPD who electively underwent laparoscopic and open colectomy. Patients defined as having COPD demonstrated either functional disability, chronic use of bronchodilators, prior COPD-related hospitalization, or reduced forced expiratory reserve volumes on lung testing (FEV1 <75%). Demographic data and preoperative characteristics were compared. Linear and logistic regressions were utilized to perform multivariate analysis and determine risk-adjusted outcomes. RESULTS Of the 4397 patients with COPD, 53.8% underwent laparoscopic colectomy (LC) while 46.2% underwent open colectomy (OC). The LC and OC groups were similar with respect to demographic data and preoperative comorbidities. Equivalent frequencies of exertional dyspnea (LC 35.4 vs OC 37.7%, P = 0.11) were noted. After multivariate risk adjustment, OC demonstrated an increased rate of overall respiratory complications including pneumonia, reintubation, and prolonged ventilator dependency when compared to LC (OR 1.60, 95% CI 1.30-1.98, P < 0.01). OC was associated with longer length of stay (10 ± 8 vs. 6.7 ± 7 days, P < 0.01) and higher readmission (OR 1.36, 95% CI 1.09-1.68, P < 0.01) compared to LC. CONCLUSION Despite the potential risks of laparoscopic pneumoperitoneum in the susceptible COPD population, a minimally invasive approach was associated with lower risk of postoperative respiratory complications, shorter length of stay, and decrease in postoperative morbidity.
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Affiliation(s)
- Sarath Sujatha-Bhaskar
- Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA
| | - Reza Fazl Alizadeh
- Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA
| | - Colette S Inaba
- Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA
| | - Christina Y Koh
- Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA
| | - Mehraneh D Jafari
- Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA
| | - Steven D Mills
- Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA
| | - Joseph C Carmichael
- Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine , 333 City Blvd. W. Ste. 850, Orange, CA, 92868, USA.
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Alizadeh RF, Sujatha-Bhaskar S, Li S, Stamos MJ, Nguyen NT. Venous thromboembolism in common laparoscopic abdominal surgical operations. Am J Surg 2017; 214:1127-1132. [DOI: 10.1016/j.amjsurg.2017.08.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 07/30/2017] [Accepted: 08/05/2017] [Indexed: 11/27/2022]
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Alizadeh RF, Sujatha-Bhaskar S, Li S, Stamos MJ, Nguyen NT. Discussion of: "Venous thromboembolism in common laparoscopic abdominal surgical operations". Am J Surg 2017; 214:1133-1134. [PMID: 29046219 DOI: 10.1016/j.amjsurg.2017.10.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Reza Fazl Alizadeh
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Sarath Sujatha-Bhaskar
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Shiri Li
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine School of Medicine, Irvine, CA, USA.
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Li S, Pigazzi A, Alizadeh RF, Nguyen N, Jafari M. Anti-diabetic Effects of Ileal Transposition Surgery on Obese mice. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.231] [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: 11/16/2022]
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Alizadeh RF, Li S, Inaba C, Hinojosa M, Smith B, Stamos M, Nguyen N. Outcomes of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass in Patients with Super-Super Obesity: A MBSAQIP Analysis. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alizadeh RF, Hinojosa M, Stamos M, Nguyen N. Impacts of Preoperative Obstructive Sleep Apnea on Respiratory Complications Following Bariatric Surgery. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.09.400] [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: 11/27/2022]
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Suematsu Y, Obi Y, Shimomura A, Alizadeh RF, Vaziri ND, Nguyen NT, Stamos MJ, Ichii H. Risk of Postoperative Venous Thromboembolism Among Pregnant Women. Am J Cardiol 2017; 120:479-483. [PMID: 28595858 DOI: 10.1016/j.amjcard.2017.04.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 12/18/2022]
Abstract
Venous thromboembolism (VTE) is a critical complication after surgery. Although pregnancy is a known risk factor of VTE, available data on the risk of postoperative VTE are scarce. Using the American College of Surgeons National Surgical Quality Improvement Program database between 2006 and 2012, we matched 2,582 pregnant women to 103,640 nonpregnant women based on age, race, body mass index, and modified Rogers score. Pregnant women, compared with matched nonpregnant women, experienced higher incidence of VTE (0.5% vs 0.3%; odds ratio 1.93, 95% confidence interval 1.1 to 3.37, p = 0.02). Pregnant women also showed higher risk of pneumonia, ventilator dependence ≥48 hours, bleeding, and sepsis than did the counterparts. In conclusion, pregnancy was associated with higher risk of VTE after surgery as well as other postoperative complications. The absolute risk difference was small, and careful evaluation against the potential risk and benefit should be given when surgical treatment is considered among pregnant women.
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Affiliation(s)
- Yasunori Suematsu
- Division of Nephrology and Hypertension, University of California Irvine, Orange, California
| | - Yoshitsugu Obi
- Division of Nephrology and Hypertension, University of California Irvine, Orange, California; Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California
| | - Akihiro Shimomura
- Department of Surgery, University of California Irvine, Orange, California
| | - Reza Fazl Alizadeh
- Department of Surgery, University of California Irvine, Orange, California
| | - Nosratola D Vaziri
- Division of Nephrology and Hypertension, University of California Irvine, Orange, California
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine, Orange, California
| | - Michael J Stamos
- Department of Surgery, University of California Irvine, Orange, California
| | - Hirohito Ichii
- Department of Surgery, University of California Irvine, Orange, California.
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Shimomura A, Obi Y, Fazl Alizadeh R, Li S, Nguyen NT, Stamos MJ, Kalantar-Zadeh K, Ichii H. Association of pre-operative estimated GFR on post-operative pulmonary complications in laparoscopic surgeries. Sci Rep 2017; 7:6504. [PMID: 28747700 PMCID: PMC5529443 DOI: 10.1038/s41598-017-06842-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/19/2017] [Indexed: 12/22/2022] Open
Abstract
Despite a large body of evidence showing the pandemic of chronic kidney disease, the impact of pre-operative kidney function on the risk of post-operative pulmonary complications (PPCs) is not well known. We used multivariable logistic regression analyses with 3-level hierarchical adjustments to identify the association of pre-operative estimated glomerular filtration rate (eGFR) with PPCs in laparoscopic surgeries. Among 452,213 patients between 2005 and 2013 in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database, a total of 3,727 patients (0.9%) experienced PPCs. We found a gradient association between lower eGFR and higher likelihood of PPCs in the unadjusted model. In the case-mix adjusted model, a reverse-J-shaped association was observed; a small albeit significant association with the highest eGFR category emerged. Further adjustment slightly attenuated these associations, but the PPCs risk in the eGFR groups of <30, 30-60, and ≥120 mL/min/1.73 m2 remained significant: odds ratios (95% confidence intervals) of 1.82 (1.54-2.16), 1.38 (1.24-1.54), and 1.28 (1.07-1.53), respectively (reference: 90-120 mL/min/1.73 m2). Our findings propose a need for careful pre-operative evaluation of cardiovascular and pulmonary functions and post-operative fluid management among patients with not only lower but also very high eGFR.
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Affiliation(s)
- Akihiro Shimomura
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California, Irvine, Orange, California, USA.
| | - Reza Fazl Alizadeh
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - Shiri Li
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California, Irvine, Orange, California, USA
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles, Torrance, California, USA
| | - Hirohito Ichii
- Department of Surgery, University of California, Irvine, Orange, California, USA.
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Alizadeh RF, Moghadamyeghaneh Z, Whealon MD, Hanna MH, Mills SD, Pigazzi A, Stamos MJ, Carmichael JC. Body Mass Index Significantly Impacts Outcomes of Colorectal Surgery. Am Surg 2016. [DOI: 10.1177/000313481608201015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are limited data regarding the association between body mass index (BMI) and colorectal surgery outcomes. We sought to evaluate the effect of BMI on short-term surgical outcomes in colon and rectal surgery patients in the United States. The American College of Surgeons National Surgery Quality Improvement Project database was used to identify all patients who underwent colon or rectal resection from 2005 to 2013. Multivariate regression analysis was used to assess the independent effect of BMI on outcomes. A total of 206,360 patients underwent colorectal resection during the study period. Of these, 3.2 per cent of patients were underweight (BMI < 18.5), 23.8 per cent patients were normal weight (18.5 ≤, BMI < 25), 26.5 per cent were overweight (25 ≤, BMI < 30), 25.2 per cent were obese (30 ≤, BMI < 40), and 5.3 per cent were morbidly obese (BMI ≥ 40). Underweight patients had longer length of stay (confidence interval: 2.70–3.49, P < 0.001) and higher mortality (adjusted odds ratio: 1.45, P < 0.01) compared with patients with a normal BMI. Morbidly obese patients had the highest overall morbidity rate compared with normal BMI patients (adjusted odds ratio: 1.53, confidence interval: 1.42–1.64, P < 0.01). BMI is associated with outcomes in colon and rectal surgery patients. Underweight and morbidly obese patients have a significantly increased risk of postsurgical complications compared with those with normal BMI.
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Affiliation(s)
- Reza Fazl Alizadeh
- From the Department of Surgery, School of Medicine, University of California, Irvine, Orange, California
| | - Zhobin Moghadamyeghaneh
- From the Department of Surgery, School of Medicine, University of California, Irvine, Orange, California
| | - Matthew D. Whealon
- From the Department of Surgery, School of Medicine, University of California, Irvine, Orange, California
| | - Mark H. Hanna
- From the Department of Surgery, School of Medicine, University of California, Irvine, Orange, California
| | - Steven D. Mills
- From the Department of Surgery, School of Medicine, University of California, Irvine, Orange, California
| | - Alessio Pigazzi
- From the Department of Surgery, School of Medicine, University of California, Irvine, Orange, California
| | - Michael J. Stamos
- From the Department of Surgery, School of Medicine, University of California, Irvine, Orange, California
| | - Joseph C. Carmichael
- From the Department of Surgery, School of Medicine, University of California, Irvine, Orange, California
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Fazl Alizadeh R, Stamos MJ. Minimally invasive surgery for rectal cancer. MINERVA CHIR 2016; 71:311-321. [PMID: 27442916] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Minimally invasive surgical treatments for colon cancers have revolutionized surgical approaches and have been implemented broadly over the last two decades. On the other hand, robotic-assisted versus laparoscopic resections for rectal cancer and comparison of these minimally invasive approaches with the traditional open operation are controversial and challenging topics to discuss between the different surgical investigators. Recent published studies have shown somewhat differing data and results from randomized controlled and non-randomized trials comparing laparoscopic with open rectal resections as well as robotic-assisted with both open and laparoscopic approaches. The surgical approach for rectal cancer is a fascinating subject since there are several different endpoints which have been used to measure quality and outcome. Overall survival, disease free survival, and quality of life (QOL) are the most relevant endpoints of rectal cancer treatment. Among minimally invasive approaches, the robotic approach seems to be less invasive than conventional laparoscopic surgery (LS) and less than hand assisted approach due partly to the less traumatic intra-abdominal handling of tissues. A convincing clinical benefit of minimally invasive rectal cancer approaches could be due to diminished surgical stress response leading to reduced morbidity. For this review, we have performed a systematic review of rectal cancer surgical management focusing on minimally invasive approaches, focusing specifically on the latest results of randomized trials for robotic assisted and laparoscopic rectal cancer resection.
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Affiliation(s)
- Reza Fazl Alizadeh
- Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine School of Medicine, Orange, CA, USA -
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25
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Alizadeh RF, Moghadamyeghaneh Z, Whealon MD, Hanna MH, Mills SD, Pigazzi A, Stamos MJ, Carmichael JC. Body Mass Index Significantly Impacts Outcomes of Colorectal Surgery. Am Surg 2016; 82:930-935. [PMID: 27779976] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
There are limited data regarding the association between body mass index (BMI) and colorectal surgery outcomes. We sought to evaluate the effect of BMI on short-term surgical outcomes in colon and rectal surgery patients in the United States. The American College of Surgeons National Surgery Quality Improvement Project database was used to identify all patients who underwent colon or rectal resection from 2005 to 2013. Multivariate regression analysis was used to assess the independent effect of BMI on outcomes. A total of 206,360 patients underwent colorectal resection during the study period. Of these, 3.2 per cent of patients were underweight (BMI < 18.5), 23.8 per cent patients were normal weight (18.5 ≤ BMI < 25), 26.5 per cent were overweight (25 ≤ BMI < 30), 25.2 per cent were obese (30 ≤ BMI < 40), and 5.3 per cent were morbidly obese (BMI ≥ 40). Underweight patients had longer length of stay (confidence interval: 2.70-3.49, P < 0.001) and higher mortality (adjusted odds ratio: 1.45, P < 0.01) compared with patients with a normal BMI. Morbidly obese patients had the highest overall morbidity rate compared with normal BMI patients (adjusted odds ratio: 1.53, confidence interval: 1.42-1.64, P < 0.01). BMI is associated with outcomes in colon and rectal surgery patients. Underweight and morbidly obese patients have a significantly increased risk of postsurgical complications compared with those with normal BMI.
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Affiliation(s)
- Reza Fazl Alizadeh
- Department of Surgery, School of Medicine, University of California, Irvine, Orange, California, USA
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Alizadeh RF, Hanna M, Moghadamyeghaneh Z, Whealon MD, Mills SD, Carmichael JC, Pigazzi A, Stamos MJ. Evaluation of Open vs Laparoscopic Colectomy Resections in Stage IV Colon Cancer Patients: American College of Surgeons NSQIP Analysis. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.218] [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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Alizadeh RF, Hanna M, Whealon MD, Moghadamyeghaneh Z, Mills SD, Carmichael JC, Pigazzi A, Stamos MJ. Resident Participation in Colorectal Surgeries: A Double Edged Sword? J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.224] [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: 11/29/2022]
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Moghadamyeghaneh Z, Alizadeh RF, Phelan M, Carmichael JC, Mills S, Pigazzi A, Zell JA, Stamos MJ. Trends in colorectal cancer admissions and stage at presentation: impact of screening. Surg Endosc 2015; 30:3604-10. [PMID: 26541735 DOI: 10.1007/s00464-015-4662-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 06/11/2015] [Accepted: 10/28/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) incidence is rising among patients under age 50. As such, we set out to determine the proportion of CRC-related hospital admissions and distribution of colon cancer by stage in different age groups. METHODS The NIS database for 2002-2012 was used to investigate trends of colorectal cancer resection by age, and the ACS NSQIP database for 2012-2013 was used to investigate contemporary stage at diagnosis for colon cancer in different age groups. RESULTS A total of 1,198,421 patients were admitted to a hospital with a diagnosis of CRC and captured by the NIS database. Although the number of hospitalized CRC patients decreased from 2002 to 2012, the observed decrease was predominant in patients older than 65 years (P < 0.01) and in colon cancer compared to rectal cancer patients (P < 0.01). The proportion of patients younger than 65 years increased from 32.8 % in 2002 to 41.1 % in 2012, and the proportion of patients under age 50 increased from 9 to 12 %. In the NSQIP database, the age <50 group also had a significantly higher proportion of advanced disease (stage III/IV) compared to patients age 50 and older (62.3 vs. 47.5 %, P < 0.01). In 2012, it was observed that most patients with rectal cancer were younger than 65 years (55.8 %). CONCLUSION There was a steady decrease in the number of hospitalized patients with colorectal cancer during the last decade, primarily attributable to a decrease in the older than 65 years age patients and colon cancer patients. The proportion of hospitalized patients age <50 is rising. In addition, patients younger than 50 years were more likely to have advanced disease compared to older patients.
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Affiliation(s)
- Zhobin Moghadamyeghaneh
- Department of Surgery, University of California Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Reza Fazl Alizadeh
- Department of Surgery, University of California Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Michael Phelan
- Department of Statistics, University of California, Irvine, CA, USA
| | - Joseph C Carmichael
- Department of Surgery, University of California Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Steven Mills
- Department of Surgery, University of California Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Department of Surgery, University of California Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA
| | - Jason A Zell
- Chao Family Comprehensive Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Michael J Stamos
- Department of Surgery, University of California Irvine, School of Medicine, 333 City Blvd. West Suite 1600, Orange, CA, 92868, USA.
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Moghadamyeghaneh Z, Hanna MH, Alizadeh RF, Carmichael JC, Mills S, Pigazzi A, Stamos MJ. Contemporary management of anastomotic leak after colon surgery: assessing the need for reoperation. Am J Surg 2015. [PMID: 26525533 DOI: 10.1016/j.jamcollsurg.2015.08.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We sought to investigate contemporary management of anastomosis leakage (AL) after colonic anastomosis. METHODS The American College of Surgeons National Surgical Quality Improvement Program database 2012 to 2013 was used to identify patients with AL. Multivariate regression analysis was performed to find predictors of the need for surgical intervention in management of AL. RESULTS A total of 32,280 patients underwent colon resection surgery with 1,240 (3.8%) developing AL. Overall, 43.9% of patients with AL did not require reoperation. Colorectal anastomosis had significantly higher risk of AL compared with ileocolonic anastomosis (adjusted odds ratio [AOR], 1.20; P = .04). However, the rate of need for reoperation was higher for AL in colocolonic anastomosis compared with ileocolonic anastomosis (AOR, 1.48; P = .04). White blood cell count (AOR, 1.07; P < .01), the presence of intra-abdominal infection with leakage (AOR, 1.47; P = .01), and protective stoma (AOR, .43, P = .02) were associated with reoperation after AL. CONCLUSIONS Nonoperative treatment is possible in almost half of the patients with colonic AL. The anatomic location of the anastomosis impacts the risk of AL. Severity of leakage, the presence of a stoma, and general condition of patients determine the need for reoperation.
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Affiliation(s)
- Zhobin Moghadamyeghaneh
- Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA
| | - Mark H Hanna
- Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA
| | - Reza Fazl Alizadeh
- Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA
| | - Joseph C Carmichael
- Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA
| | - Steven Mills
- Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA
| | - Alessio Pigazzi
- Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA
| | - Michael J Stamos
- Department of Surgery, School of Medicine, University of California, 333 City Boulevard West Suite 1600, Irvine, CA, USA.
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Moghadamyeghaneh Z, Hanna MH, Alizadeh RF, Obi Y, Foster CE, Stamos MJ, Ichii H. Kidney auto-transplantation: a nationwide analysis of an underutilized transplant modality. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.08.266] [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: 10/22/2022]
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Hanna MH, Moghadamyeghaneh Z, Alizadeh RF, Nguyen A, Yamamoto M, Stamos MJ, Demirjian AN, Imagawa DK. Readmission after Pancreaticoduodenectomy: An Analysis of Risk Factors and Timing of Complications. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.214] [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: 10/23/2022]
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Hanna MH, Moghadamyeghaneh Z, Hwang GS, Alizadeh RF, Nguyen A, Yamamoto M, Stamos MJ, Imagawa DK, Demirjian AN. Contemporary pancreatic necrosectomy: an analysis of outcomes, mortality and timing of intervention. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.08.145] [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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Heydari A, Merolla E, Alizadeh RF, Giuratrabocchetta S, Piccoli M, Melotti G. Hemorrhoids treatment with transanal hemorrhoidal dearterialization method. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.08.055] [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: 11/16/2022]
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