Predicting Risk for Serious Complications With Bariatric Surgery

Finks, Jonathan F.; Kole, Kerry; Yenumula, Panduranga R.; English, Wayne J.; Krause, Kevin R.; Carlin, Arthur M.; Genaw, Jeffrey A.; Banerjee, Mousumi; Birkmeyer, John D.; Birkmeyer, Nancy J. O.

doi:10.1097/sla.0b013e318230058c

Cited by 203 publications

(60 citation statements)

References 28 publications

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“…21 Weight regain, which is typically seen after 1 year of intensive weight loss therapy 8,9 and at 1 to 10 years after bariatric surgery, 22-24 was not seen in this study. In addition, although serious complications and death occur in 2.5% to 4.2% and 0.04% to 0.3% of patients who undergo bariatric surgery, respectively, 25-27 these events did not occur in any subject in the AT group. Furthermore, there was no evidence of adverse effects on eating patterns, eating disorder psychopathology, or hunger in the AT group.…”

Section: Discussionmentioning

confidence: 81%

Aspiration Therapy Leads to Weight Loss in Obese Subjects: A Pilot Study

et al. 2013

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Background & Aims Obese patients rarely achieve long-term weight loss with only lifestyle interventions. We evaluated the use of endoscopic aspiration therapy for obesity. Aspiration therapy involves endoscopic placement of a gastrostomy tube (A-Tube) and the AspireAssist siphon assembly (Aspire Bariatrics, King of Prussia, PA) to aspirate gastric contents 20 minutes after meal consumption. Methods We performed a pilot study of 18 obese subjects who were randomly assigned (2:1) to groups that underwent aspiration therapy for 1 year plus lifestyle therapy (n = 11; mean body mass index, 42.6 ± 1.4 kg/m2) or lifestyle therapy only (n = 7; mean body mass index, 43.4 ± 2.0 kg/m). Lifestyle intervention comprised a 15-session diet and behavioral education program. Results Ten of the 11 subjects who underwent aspiration therapy and 4 of the 7 subjects who underwent lifestyle therapy completed the first year of the study. After 1 year, subjects in the aspiration therapy group lost 18.6% ± 2.3% of their body weight (49.0% ± 7.7% of excess weight loss [EWL]) and those in the lifestyle therapy group lost 5.9% ± 5.0% (14.9% ± 12.2% of EWL) (P < .04). Seven of the 10 subjects in the aspiration therapy group completed an additional year of therapy and maintained a 20.1% ± 3.5% body weight loss (54.6% ± 12.0% of EWL). There were no adverse effects of aspiration therapy on eating behavior and no evidence of compensation for aspirated calories with increased food intake. No episodes of binge eating in the aspiration therapy group or serious adverse were reported. Conclusions In a pilot study, aspiration therapy appears to be a safe and effective long-term weight loss therapy for obesity. ClinicalTrials.gov, Number: NCT00773903.

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Section: Discussionmentioning

confidence: 81%

Aspiration Therapy Leads to Weight Loss in Obese Subjects: A Pilot Study

et al. 2013

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“…(5,15,16) The overall 30-day major adverse complication rate of 2.0% is similarly consistent with or favorable to that reported in similar studies despite a slightly different criteria of what constitutes a major complication. (17,18,19) We believe multiple factors contributed to producing the excellent results observed in this study. All patients were required to attend dietary and behavior modification classes and to conform to the program's suggested high protein, low carbohydrate diet; patients had an average BMI decrease of 4.5 kg/m 2 prior to surgery.…”

Section: Discussionmentioning

confidence: 63%

Bariatric surgery results: reporting clinical characteristics and adverse outcomes from an integrated healthcare delivery system

Li¹,

Fisher²,

Dutta³

et al. 2015

Surgery for Obesity and Related Diseases

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“…The MBSC is a consortium of 29 Michigan hospitals and 75 surgeons performing bariatric surgery and has been described in detail elsewhere [3, 10, 11]. Participation in the MBSC is voluntary and any hospital that performs at least 25 bariatric procedures per year is eligible to participate.…”

Section: Methodsmentioning

confidence: 99%

“…For the purposes of this study, we included all serious complications (grade 2 or higher) in our primary outcome variable [11]. Grade 2 complications included abdominal abscess (requiring percutaneous drainage or reoperation), bowel obstruction (requiring reoperation), leak (requiring percutaneous drainage or reoperation), bleeding (requiring blood transfusion > 4 units, endoscopy, reoperation or splenectomy), wound infection or dehiscence (requiring reoperation), respiratory failure (requiring 2–7 days mechanical ventilation), renal failure (requiring in-hospital dialysis), venous thromboembolism (deep venous thrombosis or pulmonary embolism) and band-related problems requiring reoperation (port site infection, gastric perforation, band slippage and outlet obstruction).…”

Section: Methodsmentioning

confidence: 99%

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Composite Measures for Profiling Hospitals on Bariatric Surgery Performance

et al. 2014

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Objective We sought to develop a novel composite measure for profiling hospital performance with bariatric surgery. Design, Setting, and Patients Using clinical registry data from the Michigan Bariatric Surgery Collaborative (MBSC), we studied all patients undergoing bariatric surgery from 2008 to 2010. For gastric bypass surgery, we used empirical Bayes techniques to create a composite measure by combining several measures, including serious complications, reoperations, and readmissions; hospital and surgeon volume; and outcomes with other, related procedures. Hospitals were ranked based on 2008-09 and placed in one of 3 groups: 3-star (top third), 2-star (middle third), and 1-star (bottom third). We assessed how well these ratings predicted outcomes in the next year (2010), compared to other widely used measures. Main Outcome Measures Risk-adjusted serious complications. Results Composite measures explained a larger proportion of hospital-level variation in serious complication rates with gastric bypass than other measures. For example, the composite measure explained 89% of the variation compared to only 28% for risk-adjusted complication rates alone. Composite measures also appeared better at predicting future performance compared to individual measures. When ranked on the composite measure, 1-star hospitals (bottom 20%), had 2-fold higher serious complication rates (4.6% vs. 2.4%; OR 2.0; 95% CI, 1.1 to 3.5) compared to 3-star (top 20%) hospitals. Differences in serious complications rates between 1-star and 3-star hospitals were much smaller when hospitals were ranked using serious complications (4.0% vs. 2.7%; OR 1.6; 95% CI, 0.8-2.9) and hospital volume (3.3% vs. 3.2%; OR 0.85; 95% CI, 0.4 to 1.7) Conclusions Composite measures are much better at explaining hospital-level variation in serious complications and predicting future performance than other approaches. In this preliminary study, it appears that such composite measures may be better than existing alternatives for profiling hospital performance with bariatric surgery.

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Predicting Risk for Serious Complications With Bariatric Surgery

Cited by 203 publications

References 28 publications

Aspiration Therapy Leads to Weight Loss in Obese Subjects: A Pilot Study

Aspiration Therapy Leads to Weight Loss in Obese Subjects: A Pilot Study

Bariatric surgery results: reporting clinical characteristics and adverse outcomes from an integrated healthcare delivery system

Composite Measures for Profiling Hospitals on Bariatric Surgery Performance

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