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Jensen S, Baimas-George M, Yang H, Paton L, Barbat S, Matthews B, Reinke C, Schiffern L. Remote triage practices in general surgery patients from freestanding emergency departments: A 6-year analysis. Surgery 2024; 175:387-392. [PMID: 38016899 DOI: 10.1016/j.surg.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/07/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Freestanding emergency departments have risen in popularity as a means to expand access to care. Although some evaluation of freestanding emergency department utility in specific patient populations exists, management of surgical patients via remote triage and disposition has not been previously described. We report our experience with remote triage to discharge home, level I trauma center, or community hospital admission for general surgery patients who present to an affiliated freestanding emergency department. METHODS A retrospective cohort study of patients presenting to freestanding emergency departments requiring surgical consultation between 2016 and 2021 was conducted. Outcomes included disposition, length of stay, surgical intervention, 30-day mortality, and readmission. Undertriage and overtriage rates were calculated and defined as the following: (1) discharge undertriage-discharge home with 30-day emergency department visit/readmission; 2) transfer undertriage-transfers to community hospital requiring transfer to trauma center; and (3) overtriage-admissions <24 hours without surgery. RESULTS Of 1,105 patients, 15% were discharged home, 27% were transferred to trauma centers, and 58% were transferred to community hospitals. Patients admitted to trauma centers were older and had higher acuity pathology, whereas patients admitted to community hospitals had higher operative rates with shorter lengths of stay, operating room time, 30-day readmission, and mortality. Transfer undertriage was 0.9% (n = 6), with only 1 patient requiring transfer from a community hospital to a trauma center for disease acuity. Discharge undertriage was 12% (n = 20) due to worsening or persistent pathology. Overtriage was 5.5% (n = 52), with most having a partial small bowel obstruction or ambiguous diagnostic imaging requiring observation. CONCLUSION Remote surgery triage at freestanding emergency departments, without an in-person examination, demonstrated both low undertriage and overtriage rates, reflecting appropriate triage practices.
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Affiliation(s)
| | | | - Hongmei Yang
- Atrium Health, Information and Analytics Services, Charlotte, NC
| | - Lauren Paton
- Carolinas Medical Center, Department of Surgery, Charlotte, NC
| | - Selwan Barbat
- Carolinas Medical Center, Department of Surgery, Charlotte, NC
| | - Brent Matthews
- Carolinas Medical Center, Department of Surgery, Charlotte, NC
| | - Caroline Reinke
- Carolinas Medical Center, Department of Surgery, Charlotte, NC
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Lorenz W, Yang H, Paton L, Barbat S, Matthews B, Reinke CE, Schiffern L, Baimas-George M. Virtual triage from freestanding emergency departments: a propensity score-weighted analysis of short-term outcomes in emergency general surgery. Surg Endosc 2023; 37:7901-7907. [PMID: 37418149 DOI: 10.1007/s00464-023-10241-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Freestanding emergency departments (FSEDs) have generated improved hospital metrics, including decreased ED wait times and increased patient selection. Patient outcomes and process safety have not been evaluated. This study investigates the safety of FSED virtual triage in the emergency general surgery (EGS) patient population. METHODS AND PROCEDURES A retrospective review evaluated all adult EGS patients admitted to a community hospital between January 2016 and December 2021 who either presented at a FSED and received virtual evaluation from a surgical team (fEGS) or presented at the community hospital emergency department and received in-person evaluation from the same surgical group (cEGS). Patients' demographics, acute care utilization history, and clinical characteristics at the onset of the index visit were used to build a propensity score model and stabilized Inverse Probability of Treatment Weights (IPTW) were used to create a weighted sample. Multivariable regression models were then employed to the weighted sample to evaluate the treatment effect of virtual triage compared to in-person evaluation on short-term outcomes, including length of stay (LOS) and 30-day readmission and mortality. Variables which occurred during the index visit (such as surgery duration and type of surgery) were adjusted for in the multivariable analyses. RESULTS Of 1962 patients, 631 (32.2%) were initially evaluated virtually (fEGS) and 1331 (67.8%) underwent an in-person evaluation (cEGS). Baseline characteristics demonstrated significant differences between the cohorts in gender, race, payer status, BMI, and CCI score. Baseline risks were well balanced in the IPTW-weighted sample (SD range 0.002-0.18). Multivariable analysis found no significant differences between the balanced cohorts in 30-day readmission, 30-day mortality, and LOS (p > 0.05 for all). CONCLUSION Patients who undergo virtual triage have similar outcomes to those who undergo in-person triage for EGS diagnoses. Virtual triage at FSED for these EGS patients may be an efficient and safe means for initial evaluation.
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Affiliation(s)
- William Lorenz
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Hongmei Yang
- Atrium Health, Information and Analytics Services, 720 East Morehead St, Charlotte, NC, 28203, USA
| | - Lauren Paton
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Selwan Barbat
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Brent Matthews
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Caroline E Reinke
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Lynnette Schiffern
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Maria Baimas-George
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.
- Carolinas Medical Center, 1025 Morehead Medical Plaza, Suite #300, Charlotte, NC, 28204, USA.
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Wang A, Wang H, Abdurakhmanov A, Vijayanagar V, Thompson KJ, Mckillop IH, Barbat S, Bauman R, Gersin KS, Kuwada TS, Nimeri A. Safety of Primary Versus Revisional Biliopancreatic Diversion with Duodenal Switch in Patients with Super Obesity Using the MBSAQIP database. Obes Surg 2022; 32:1459-1465. [PMID: 35137289 DOI: 10.1007/s11695-022-05953-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION For patients with super obesity (BMI > 50 kg/m2), biliopancreatic diversion/duodenal switch (BPD/DS) can be an effective bariatric operation. Technical challenges and patient safety concerns, however, have limited its use as a primary procedure. This study sought to assess the safety of primary versus revisional BPD/DS. MATERIALS AND METHODS The MBSAQIP database was queried for primary and revisional BPD/DS (2015-2018). Inclusion criteria were patients ≥ 18 years of age, BMI > 50 kg/m2, and with no concurrent procedures. Preoperative variables were compared using a chi-square test or Wilcoxon two-sample tests. Multivariate logistic or robust linear regression models were used to compare outcomes. RESULTS There were 3,378 primary BPD/DS and 487 revisional BPD/DS patients. Primary BPD/DS patients had higher BMI (56.5 [IQR4.4] versus 54.8 [IQR4] kg/m2, p < 0.0001) and had more diabetes mellitus type II (29.1% versus 17.2%, p < 0.0001). Intraoperatively, revisional BPD/DS had longer operative time (165 [IQR47] min versus 139 [IQR100] min, p < 0.0001). After adjusting for preoperative characteristics, there was no difference in 30-day readmission or ED visits (primary 12.9% versus revisional 14.6%), reoperation or reintervention (primary 5.7% versus revisional 7.8%), or mortality (primary 0.4% versus revisional 0.6%). In contrast, the revisional BPD/DS patients had higher odds of major morbidity (primary 3.4% versus revisional 5.3%, OR 1.9, CI 1.1-3.2, p = 0.019). CONCLUSIONS Revisional BPD/DS is associated with higher morbidity than primary BPD/DS in patients with super obesity. These patients should thus be counselled appropriately when choosing a primary or revisional bariatric procedure.
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Affiliation(s)
- Alice Wang
- Department of Surgery, Wright State University, Dayton, OH, 45324, USA
| | - Huaping Wang
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28204, USA
| | | | | | - Kyle J Thompson
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28204, USA
| | - Iain H Mckillop
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, 28204, USA
| | - Selwan Barbat
- Atrium Health Weight Management, Section of Bariatric & Metabolic Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, 2630 East 7th Street, Charlotte, NC, 28204, USA
| | - Roc Bauman
- Atrium Health Weight Management, Section of Bariatric & Metabolic Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, 2630 East 7th Street, Charlotte, NC, 28204, USA
| | - Keith S Gersin
- Atrium Health Weight Management, Section of Bariatric & Metabolic Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, 2630 East 7th Street, Charlotte, NC, 28204, USA
| | - Timothy S Kuwada
- Atrium Health Weight Management, Section of Bariatric & Metabolic Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, 2630 East 7th Street, Charlotte, NC, 28204, USA
| | - Abdelrahman Nimeri
- Atrium Health Weight Management, Section of Bariatric & Metabolic Surgery, Department of Surgery, Carolinas Medical Center, Atrium Health, 2630 East 7th Street, Charlotte, NC, 28204, USA.
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Baimas-George M, Schiffern L, Yang H, Paton L, Barbat S, Matthews B, Reinke CE. Emergency general surgery transfer to lower acuity facility: The role of right-sizing care in emergency general surgery regionalization. J Trauma Acute Care Surg 2022; 92:38-43. [PMID: 34670959 DOI: 10.1097/ta.0000000000003435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Regionalization of emergency general surgery (EGS) has primarily focused on expediting care of high acuity patients through interfacility transfers. In contrast, triaging low-risk patients to a nondesignated trauma facility has not been evaluated. This study evaluates a 16-month experience of a five-surgeon team triaging EGS patients at a tertiary care, Level I trauma center (TC) to an affiliated community hospital 1.3 miles away. METHODS All EGS patients who presented to the Level I TC emergency department from January 2020 to April 2021 were analyzed. Patients were screened by EGS surgeons covering both facilities for transfer appropriateness including hemodynamics, resource need, and comorbidities. Patients were retrospectively evaluated for disposition, diagnosis, comorbidities, length of stay, surgical intervention, and 30-day mortality and readmission. RESULTS Of 987 patients reviewed, 31.5% were transferred to the affiliated community hospital, 16.1% were discharged home from the emergency department, and 52.4% were admitted to the Level I TC. Common diagnoses were biliary disease (16.8%), bowel obstruction (15.7%), and appendicitis (14.3%). Compared with Level I TC admissions, Charlson Comorbidity Index was lower (1.89 vs. 4.45, p < 0.001) and length of stay was shorter (2.23 days vs. 5.49 days, p < 0.001) for transfers. Transfers had a higher rate of surgery (67.5% vs. 50.1%, p < 0.001) and lower readmission and mortality (8.4% vs. 15.3%, p = 0.004; 0.6% vs. 5.0%, p < 0.001). Reasons not to transfer were emergency evaluation, comorbidity burden, operating room availability, and established care. No transfers required transfer back to higher care (under-triage). Bed days saved at the Level I TC were 693 (591 inpatients). Total operating room minutes saved were 24,008 (16,919, between 7:00 am and 5:00 pm). CONCLUSION Transfer of appropriate patients maintains high quality care and outcomes, while improving operating room and bed capacity and resource utilization at a tertiary care, Level I TC. Emergency general surgery regionalization should consider triage of both high-risk and low-risk patients. LEVEL OF EVIDENCE Prospective comparative cohort study, Level II.
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Affiliation(s)
- Maria Baimas-George
- From the Department of Surgery (M.B.-G., L.S., L.P., S.B., B.M., C.E.R.), Carolinas Medical Center, Charlotte, North Carolina; and Clinical Analytics, Department of Information and Analytics Services (H.Y.), Atrium Health, Charlotte, North Carolina
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Wang A, Poliakin L, Sundaresan N, Vijayanagar V, Abdurakhmanov A, Thompson KJ, Mckillop IH, Barbat S, Bauman R, Gersin KS, Kuwada TS, Nimeri A. The Role of Total Alimentary Limb Length in Roux-En-Y Gastric Bypass – A Systematic Review. Surg Obes Relat Dis 2021; 18:555-563. [DOI: 10.1016/j.soard.2021.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/04/2021] [Accepted: 08/21/2021] [Indexed: 12/21/2022]
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Sundaresan N, Sullivan M, Hiticas BA, Hui BY, Poliakin L, Thompson KJ, McKillop IH, Barbat S, Kuwada TS, Gersin KS, Nimeri A. Impacts of Gastrojejunal Anastomotic Technique on Rates of Marginal Ulcer Formation and Anastomotic Bleeding Following Roux-en-Y Gastric Bypass. Obes Surg 2021; 31:2921-2926. [PMID: 33939060 DOI: 10.1007/s11695-021-05292-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Marginal ulceration (MU) and bleeding are possible complications following laparoscopic Roux-en-Y gastric bypass (RYGB). Our institution utilizes three techniques for performing the gastrojejunal anastomosis (GJA), providing a means to compare postoperative MU and bleeding as it relates to GJA technique. OBJECTIVES We sought to analyze the incidence of MU and bleeding between the 25-mm end-to-end anastomosis (EEA) stapler, linear stapler (LS), and robotic hand-sewn (RHS) GJA techniques. METHODS Electronic health records for all patients who had an upper endoscopy (EGD) after RYGB were queried (2010-2014). Charts were retrospectively reviewed for type of GJA, complications, endoscopic interventions, and smoking and NSAID use. RESULTS Out of 1112 RYGBs, the GJA was created using an EEA, LS, or RHS approach in 58.6%, 33.6%, and 7.7% of patients, respectively. 17.4% had an EGD (19.9% EEA, 13.9% LS, and 14.0% RHS). Incidence of MU was 7.3% (9.3% EEA, 4.8% LS, and 5.8% RHS). Rates of EGD and MU were significantly higher after EEA vs. LS GJA (p<0.05). The bleeding rate was 1.5%, [1.1% EEA, 2.1% LS, and 2.3% RHS (p=NS)]. MU within 90 days of RYGB occurred in 4.1%, 0.8%, and 4.7%, respectively (p<0.05 for EEA vs LS only). NSAID and cigarette use were identified in 29.3%, 38.9%, and 60% and 17.2%, 22.2%, and 20%, respectively, for the EEA, LS, and RHS GJA (p=NS). CONCLUSION The method of GJA has an impact on rate of MU formation. A GJA fashioned with a 25-mm EEA stapler tends to have higher rates of EGD and MU.
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Affiliation(s)
- Naresh Sundaresan
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Mariel Sullivan
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Dr #300, Charlotte, NC, 28204, USA
| | - B Amy Hiticas
- Carolinas Medical Center-Mercy, Atrium Health, 2001 Vail Ave, Charlotte, NC, 28207, USA
| | - Benedict Y Hui
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Lauren Poliakin
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Kyle J Thompson
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Dr #300, Charlotte, NC, 28204, USA
| | - Iain H McKillop
- Division of Research, Department of Surgery, Carolinas Medical Center, Atrium Health, 1025 Morehead Medical Dr #300, Charlotte, NC, 28204, USA
| | - Selwan Barbat
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Timothy S Kuwada
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Keith S Gersin
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA
| | - Abdelrahman Nimeri
- Atrium Health Weight Management, Section of Bariatric and Metabolic Surgery, Department of Surgery, Atrium Health, 2630 E 7th St Suite 100, Charlotte, NC, 28204, USA.
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Sundaresan N, Roberts A, Thompson KJ, McKillop IH, Barbat S, Nimeri A. Examining the Hispanic paradox in bariatric surgery. Surg Obes Relat Dis 2020; 16:1392-1400. [DOI: 10.1016/j.soard.2020.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/13/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
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Barbat S, Thompson KJ, Mckillop IH, Kuwada TS, Gersin K, Nimeri A. Ambulatory bariatric surgery: does it really lead to higher rates of adverse events? Surg Obes Relat Dis 2020; 16:1713-1720. [PMID: 32830058 DOI: 10.1016/j.soard.2020.06.051] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Correlating patient outcomes with length of stay (LoS) is an important consideration in metabolic and bariatric surgery. At present, conflicting data exists regarding patient safety for ambulatory (AMB) metabolic and bariatric surgery. OBJECTIVE Outcomes for AMB-metabolic and bariatric surgery patients (LoS <1 d) undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) were compared with matched patients with LoS ≥1 day (non-AMB) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) registry. SETTING MBSAQIP national database. METHODS The MBSAQIP registry was queried for patients undergoing SG or RYGB (2015-2017) and patients grouped as AMB/non-AMB. Exclusion criteria included LoS >4 days, age <18 or >75 years, revision surgery, gastric banding, body mass index <35 kg/m2, and day of surgery mortality. Variables were combined into major/minor complications and 30-day mortality. Analysis was performed using univariate and multivariate logistic regression and propensity matching. RESULTS After exclusions were applied 408,895 patients remained (9973 AMB). Overall, 111,279 patients underwent RYGB (1032 AMB) and 297,616 underwent SG (8941 AMB), with similar demographic characteristics and co-morbidities between groups. For AMB patients, there was no increase in 30-day mortality, reoperation, or readmission, and fewer drains were placed versus matched non-AMB patients. In AMB-SG patients more surgical site infections were reported versus non-AMB-SG, although AMB-SG patients had fewer intensive care unit admissions. For AMB-RYGB, no differences in complications were detected versus non-AMB-RYGB. CONCLUSION Based on our analysis of the MBSAQIP database, patients undergoing laparoscopic RYGB or SG procedures can be safely discharged on the day of their procedure without increased incidence of mortality, reoperation, or readmission.
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Affiliation(s)
- Selwan Barbat
- Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina.
| | - Kyle J Thompson
- Surgical Research, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Iain H Mckillop
- Surgical Research, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Timothy S Kuwada
- Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Keith Gersin
- Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Abdelrahman Nimeri
- Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
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Maloney SR, Dugan N, Prasad T, Colavita PD, Mckillop IH, Gersin KS, Kuwada T, Barbat S, Roberts A, Nimeri A. Correction to: Impact of age on morbidity and mortality following bariatric surgery. Surg Endosc 2020; 34:4193. [PMID: 32076855 DOI: 10.1007/s00464-020-07390-1] [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: 11/24/2022]
Abstract
This article was updated to correct the spelling of Nicholas Dugan's first name: it is correct as displayed here.
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Affiliation(s)
- Sean R Maloney
- Division of Gastrointestinal & Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Nicholas Dugan
- Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, 2630 E. 7th Street, Charlotte, NC, 28204, USA
| | - Tanushree Prasad
- Division of Gastrointestinal & Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Paul D Colavita
- Division of Gastrointestinal & Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Iain H Mckillop
- Surgical Research, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Keith S Gersin
- Division of Gastrointestinal & Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.,Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, 2630 E. 7th Street, Charlotte, NC, 28204, USA
| | - Timothy Kuwada
- Division of Gastrointestinal & Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.,Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, 2630 E. 7th Street, Charlotte, NC, 28204, USA
| | - Selwan Barbat
- Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, 2630 E. 7th Street, Charlotte, NC, 28204, USA
| | - Amanda Roberts
- Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, 2630 E. 7th Street, Charlotte, NC, 28204, USA
| | - Abdelrahman Nimeri
- Division of Gastrointestinal & Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA. .,Divison of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, 2630 E. 7th Street, Charlotte, NC, 28204, USA.
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Barbat S, Thompson K, Raheem E, Mckillop I, Dugan N, Roberts A, Kuwada T, Gersin K, Nimeri A. A166 Ambulatory Bariatric Surgery And Risk For Adverse Events. Surg Obes Relat Dis 2019. [DOI: 10.1016/j.soard.2019.08.111] [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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Abstract
A 65-year-old man with dysphagia underwent placement of a percutaneous endoscopic gastrostomy tube. He was cared for at a nursing facility where the tube became dislodged and was replaced with similar size Foley catheter. Patient was brought to the hospital with dislodged feeding Foley but none was found at the bedside. Diagnostic workup revealed antegrade migration of the catheter into the small bowel. Push enteroscopy was unsuccessful in retrieving the catheter because it was too far distal. Patient was observed for a total of 7 days. Due to lack of progress with conservative measures, a colonoscopy was performed to extract the catheter, thus avoiding the need for more invasive surgical measures. If a Foley catheter is used as a gastrostomy tube, it should be replaced with a dedicated feeding tube as quickly as possible and should always be affixed to the skin to prevent antegrade migration and associated complications.
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Affiliation(s)
- Peter Cmorej
- Department of Surgery, Wayne State University, Detroit, Michigan, USA
| | - Selwan Barbat
- Department of Surgery, Wayne State University, Detroit, Michigan, USA
| | - Choichi Sugawa
- Department of Surgery, Wayne State University, Detroit, Michigan, USA
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Razafindramaro N, Merle C, Messica O, Faure C, Barbat S, Mohn A, Haroche J, Ory JP. Histiocytose BRAF-muté : à propos de 2 observations personnelles, améliorées par le traitement spécifique. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.097] [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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Beytout J, Guilloux C, Barbat S, Cottrelle B, Pourtier JL, Bafoil JP, Monghal M. J-01 La vaccination contre les papillomavirus en Auvergne (2007-8). Med Mal Infect 2009. [DOI: 10.1016/s0399-077x(09)74425-7] [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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Ruan J, El-Jawahri R, Barbat S, Prasad P. Comparison of simulation-based human thorax impact response with volunteer impact. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)83538-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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