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11. Quality in Bariatric Surgery

Author

Blackstone, Robin P., Petrick, Thomas P., Petrick, Anthony T., Nguyen, Ninh T., editor, Brethauer, Stacy A., editor, Morton, John M., editor, Ponce, Jaime, editor, and Rosenthal, Raul J., editor

Published
2020
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36. Revision paraesophageal hernia repair outcomes in patients with typical and atypical reflux.

Author

Addo, Alex J., Fatunmbi, Ayobami M., Ramdeen, Sanjhai L., Broda, Andrew, Obradovic, Vladan, Petrick, Anthony T., and Parker, David M.

Subjects
HERNIA surgery, REPAIRING, OLANZAPINE, TREATMENT effectiveness, HIATAL hernia, BODY mass index, GASTROESOPHAGEAL reflux
Abstract

Background: Revision laparoscopic anti-reflux surgery (RLARS) is effective in alleviating the typical symptoms of gastroesophageal reflux disease (GERD). RLARS outcomes in patients with atypical GERD symptoms has not been well established. A composite Reflux Symptom Index (RSI) score greater than 13 indicates extraesophageal manifestation of pathological reflux. In this study, we analyzed the differences in quality-of-life (QOL) and perioperative outcomes between patients with atypical versus typical GERD who underwent RLARS. Methods: A retrospective review was conducted of a prospectively maintained database of patients with pathologic reflux who underwent RLARS from February 2003 to October 2019. The cohort was divided into two groups, those with typical versus atypical manifestations of GERD, as defined by their RSI score. Patients with a RSI score of > 13 were assigned to the Atypical group and those ≤ 13 were assigned to the Typical group. Patient QOL outcomes were prospectively followed using the RSI survey. Significance was defined by p-value less than 0.05. Results: A total of 133 patients (Typical 61, Atypical 72) were included in the final analysis. The two groups were similar (p > 0.05) in mean age (58.1 ± 13.3 vs. 55.3 ± 15.5 years), body mass index (29.6 ± 5.0 vs. 30.3 ± 5.4), female sex distribution (60.7% vs. 59.7%) and age adjusted Charlson score (1.76 ± 1.58 vs. 1.98 ± 1.94). The Typical group had a higher frequency of type III hiatal hernia (62.3% vs. 29.2%) and Collis gastroplasty (29.5% vs. 5.6%). The groups had similar rates of partial and complete fundoplication with similar median length of stay (Typical: 3.0 ± 3.4 days vs. Atypical: 2.4 ± 1.7 days). After a mean follow-up of 30.2 ± 33.6 months, both groups reported similar rates of improvement in RSI outcome from baseline (58.1% vs 43.3%, p =.149). However, the RSI outcome at the latest follow-up for the Typical group was significantly better than the Atypical group after RLARS (2.8 ± 5.3 vs. 15.9 ± 11.1, respectively). Conclusion: Patients who undergo revision paraesophageal hernia repair with objective findings of GERD and subjective complaints of atypical reflux symptoms may show long-term improvement in QOL outcomes. However, these results are contingent on proper patient selection and a thorough work-up for pathological reflux in this population. Further research is needed to determine universal diagnostic criteria to assist in the early detection and surgical treatment of patients with atypical GERD. [ABSTRACT FROM AUTHOR]

Published
2023
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44. Impact of Urinary Catheterization on Postoperative Outcomes After Roux-En-Y Gastric Bypass Surgery in Propensity-Matched Cohorts

Author

Berglund, Derek D., Parker, David M., Fluck, Marcus, Dove, James, Falvo, Alexandra, Horsley, Ryan D., Gabrielsen, Jon, Petrick, Anthony T., and Daouadi, Mustapha

Abstract

Background The impact of urinary catheter avoidance in bariatric enhanced recovery after surgery (ERAS) protocols is yet to be established. The purpose of the current study is to determine whether urinary catheter use in patients undergoing Roux-en-Y gastric bypass (RYGB) procedures has an effect on postoperative outcomes.Methods An institutional database was utilized to identify adult patients undergoing primary minimally invasive RYGB surgery. Outcomes included incidence of urinary tract infection (UTI) within 30 days postoperatively, 30-day readmission rates, proportion of patients discharged after postoperative day 1 (delayed discharge), length of stay (LOS), and operating room time. These were compared between propensity-matched groups with and without urinary catheter placement.Results There were no significant differences in postoperative UTI’s (2.2% for both cohorts, P= .593) or 30-day readmission rates for patients with and without urinary catheters (6.6% and 4.4%, respectively, P= .260). Mean LOS (1.7 vs. 1.5 days, P= .001) and the proportion of patients having a delayed discharge (47.3% vs. 33.7%, P= .001) was greater in patients with a catheter. Operating room time was longer in the urinary catheter group (221.8 vs. 207.9 minutes, P= .002).Discussion Avoidance of indwelling urinary catheters in RYGB surgical patients decreased delayed discharges and LOS without affecting readmission or reoperation rates. Therefore, we recommend that avoidance of urinary catheters in routine RYGB surgery be considered for inclusion into standardized ERAS protocols. Urinary catheters should continue to be utilized in select cases, however, as these were not shown to affect rate of UTIs.

Published
2023
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50. Asymptomatic Cholelithiasis and Bariatric Surgery: a Comprehensive Long-Term Analysis of the Risks of Biliary Disease in Patients Undergoing Primary Roux-en-Y Gastric Bypass

Author

Cunningham, Robert M., primary, Jones, Katherine T., additional, Kuhn, Jason E., additional, Dove, James T., additional, Horsley, Ryan D., additional, Daouadi, Mustapha, additional, Gabrielsen, Jon D., additional, Petrick, Anthony T., additional, and Parker, David M., additional

Published
2020
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