Perioperative Morbidity Associated With Bariatric Surgery: An Academic Center Experience

2007 ◽  
Vol 2007 ◽  
pp. 185-186
Author(s):  
D.J. Dries
Keyword(s):  
Bariatric Surgery ◽  
Perioperative Morbidity ◽  
Academic Center

scholarly journals Preoperative Cardiac Diagnostics in Bariatric Patients with Diabetes and Perioperative Morbidity: Results of a Cohort of 258 Patients

2021 ◽  
Author(s):  
Benjamin Stillhard ◽  
B. T. Truc Ngo ◽  
Ralph Peterli ◽  
Thomas Peters ◽  
Romano Schneider ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Myocardial Perfusion ◽  
Cardiac Catheterization ◽  
Myocardial Perfusion Scintigraphy ◽  
Perfusion Scintigraphy ◽  
Perioperative Morbidity ◽  
Obesity And Diabetes ◽  
Patients With Diabetes ◽  
Cardiac Assessment ◽  
Bariatric Patients

Abstract Purpose The combination of obesity and diabetes mellitus are well-known risk factors for cardiovascular complications and perioperative morbidity in metabolic surgery. The aim of this study was to evaluate effectivity and reliability of the cardiac assessment in patients with diabetes prior to bariatric surgery. Setting Private, university-affiliated teaching hospital, Switzerland Material and Methods Retrospective analysis of prospectively collected data on results and consequences of cardiac assessments in 258 patients with obesity and diabetes scheduled for primary bariatric surgery at our institution between January 2010 and December 2018. Results Out of 258 patients, 246 (95.3%) received cardiac diagnostics: 173 (67.1%) underwent stress-rest myocardial perfusion scintigraphy (MPS), 15 (5.8%) patients had other cardiac imaging including cardiac catheterization, 58 (22.5%) patients had echocardiography and/or stress electrocardiography, and 12 (4.7%) patients received no cardiac evaluation. Subsequently, cardiac catheterization was performed in 28 patients (10.9%), and coronary heart disease was detected and treated in 15 subjects (5.8%). Of these 15 individuals, 5 (33.3%) patients had diffuse vascular sclerosis, 8 (53.3%) patients underwent coronary angioplasty and stenting, and 2 (13.3%) patients coronary artery bypass surgery. Bariatric surgery was performed without perioperative cardiovascular events in all 258 patients. Conclusion Our data suggest that a detailed cardiac assessment is mandatory in bariatric patients with diabetes to identify those with yet unknown cardiovascular disease before performing bariatric surgery. We recommend carrying out myocardial perfusion scintigraphy as a reliable diagnostic tool in this vulnerable population. If not viable, stress echocardiography should be performed as a minimum.

Implementation of hepatic artery infusion (HAI) chemotherapy for unresectable colorectal liver metastases (CRLM): The University of Miami experience.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 96-96
Author(s):  
Agustin Pimentel ◽  
Joshua Kronenfeld ◽  
Vikas Dudeja ◽  
Nipun B. Merchant ◽  
Lauren Nicole Gallegos ◽  
...  
Keyword(s):  
Systemic Chemotherapy ◽  
Progression Free Survival ◽  
Tumor Location ◽  
Regional Chemotherapy ◽  
Complete Resection ◽  
Hepatic Artery Infusion ◽  
Braf Mutations ◽  
Perioperative Morbidity ◽  
Academic Center ◽  
Primary Colon

96 Background: In patients with unresectable liver-confined CRLM, regional chemotherapy via HAI in combination with modern systemic chemotherapy (CT) can achieve hepatic disease control and expand surgical resectability. We describe patient selection and early outcomes following implementation of a HAI program at our tertiary referral academic center. Methods: We analyzed demographics, previous systemic treatment, primary tumor location, molecular profiling, extent of hepatic/extrahepatic disease, perioperative HAI outcomes (toxicity, conversion to resection/ablation, radiographic response), and overall survival (OS) in CRLM patients selected for HAI treatment (01/2018—06/2020) after multidisciplinary review. Results: Of 35 patients with unresectable CRLM (primary: colon, n = 24; rectum, n = 11) selected for HAI, 57% were heavily pre-treated (with at least 2 lines of pre-HAI systemic chemotherapy), 71% had a Fong clinical risk score ≥3, 86% presented with synchronous disease, 80% had bilobar metastasis, and 86% had > 5 tumors. All tumors were microsatellite stable, with 20% harboring KRAS/NRAS mutations and none had class I/II BRAF mutations. HAI was initiated at a median 14 (IQR 3, 64) months after CRLM diagnosis, and administered for a median of 7 (range 2, 16) cycles; 91% of patients (31/34) received concurrent HAI and systemic chemotherapy. Although most (69%) patients experienced some degree of hepatic toxicity during HAI therapy resulting in FUDR dose reduction and steroid administration, biliary sclerosis requiring intervention was observed in only 3 (9%) of patients. The overall perioperative morbidity was 17%, and there were no surgical-related 90-day mortalities following HAI pump placement. Excluding patients who initiated HAI treatment within the last 3 months of the study period (n = 3), 13 of 32 patients (41%) were rendered disease-free in the liver following complete resection and/or ablation in combination with HAI/systemic chemotherapy; in the remaining 19 patients (59%), hepatic progression-free survival was 7.3 months (IQR 4, 12). At a median follow-up of 11.2 months, post-HAI median OS for the overall cohort was 12.3 (IQR 7, 20) months. Patients undergoing complete resection/ablation demonstrated improved survival compared with those with progressive disease (median 20 vs 12 months, respectively). Conclusions: Implementation of a HAI program for multimodality liver-directed management of unresectable CRLM is feasible and is associated with meaningful clinical outcomes unlikely to be achieved with systemic therapy alone in heavily pre-treated patients.

scholarly journals Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center

2021 ◽  
Author(s):  
Fernando Crovari ◽  
Martin Inzunza ◽  
María J. Irarrázaval ◽  
Cecilia Romero ◽  
Pablo Achurra ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Academic Center ◽  
Opening Phase

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Metabolic effects of bariatric surgery

2016 ◽  
Vol 174 (1) ◽  
pp. R19-R28 ◽  
Author(s):  
Ricard Corcelles ◽  
Christopher R Daigle ◽  
Philip R Schauer
Keyword(s):  
Cardiovascular Disease ◽  
Bariatric Surgery ◽  
Metabolic Syndrome ◽  
Weight Loss ◽  
Metabolic Effects ◽  
Perioperative Morbidity ◽  
Increased Risk ◽  
Long Term Impact

Obesity is associated with an increased risk of type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, osteoarthritis, numerous cancers and increased mortality. It is estimated that at least 2.8 million adults die each year due to obesity-related cardiovascular disease. Increasing in parallel with the global obesity problem is metabolic syndrome, which has also reached epidemic levels. Numerous studies have demonstrated that bariatric surgery is associated with significant and durable weight loss with associated improvement of obesity-related comorbidities. This review aims to summarize the effects of bariatric surgery on the components of metabolic syndrome (hyperglycemia, hyperlipidemia and hypertension), weight loss, perioperative morbidity and mortality, and the long-term impact on cardiovascular risk and mortality.

Revisional bariatric surgery: perioperative morbidity is determined by type of procedure

2013 ◽  
Vol 27 (12) ◽  
pp. 4504-4510 ◽  
Author(s):  
D. Stefanidis ◽  
K. Malireddy ◽  
T. Kuwada ◽  
R. Phillips ◽  
E. Zoog ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Revisional Bariatric Surgery ◽  
Perioperative Morbidity

scholarly journals Feasibility and Safety of Bariatric Surgery in High-Risk Patients: A Single-Center Experience

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Yusef Moulla ◽  
Orestis Lyros ◽  
Matthias Blüher ◽  
Philipp Simon ◽  
Arne Dietrich
Keyword(s):  
Bariatric Surgery ◽  
High Risk ◽  
Postoperative Complications ◽  
Length Of Hospital Stay ◽  
High Volume ◽  
University Hospital ◽  
Perioperative Morbidity ◽  
High Risk Patients ◽  
Operative Revision ◽  
Risk Patients

Introduction. Despite the feasibility and safety of bariatric procedures nowadays, high-risk patients with vast obesity and severe comorbidities demonstrate relatively high perioperative morbidity and mortality rates and, therefore, form a distinguished challenge for the bariatric surgeons. Methods. We retrospectively analyzed high-risk patients, who underwent bariatric surgery in University Hospital Leipzig between May 2012 and December 2016. High-risk patients were defined when (Bergeat et al., 2016) at least one of the following risk factors was met: age ≥ 70 years, body mass index (BMI) > 70 kg/m2, liver cirrhosis, end-organ failure, or immunosuppression by status after organ transplantation along with (Birkmeyer et al., 2010) at least two comorbidities associated with obesity. Our analysis included early postoperative complications. Results. A total of 25 high-risk obese patients were identified. All patients had a standardized postoperative management with a mean length of hospital stay of 4 ± 1.4 days. One patient required an operative revision due to a stapler line leak after sleeve gastrectomy. No other major postoperative complications occurred. Conclusion. Bariatric surgery for severe high-risk patients can be performed safely in high-volume centers following standardized procedures.

scholarly journals Laparoscopic Sleeve Gastrectomy or Laparoscopic Gastric Bypass for Patients with Metabolic Syndrome: An MBSAQIP Analysis

2019 ◽  
Vol 85 (10) ◽  
pp. 1108-1112 ◽  
Author(s):  
Reza Fazl Alizadeh ◽  
Shiri Li ◽  
Sahil Gambhir ◽  
Marcelo W. Hinojosa ◽  
Brian R. Smith ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Metabolic Syndrome ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Obese Patients ◽  
Improvement Program ◽  
Perioperative Morbidity ◽  
Significant Difference ◽  
Severely Obese

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.

scholarly journals Quality of Life 10 Years After Bariatric Surgery

2020 ◽  
Vol 30 (10) ◽  
pp. 3675-3684 ◽  
Author(s):  
Piotr Major ◽  
Tomasz Stefura ◽  
Błażej Dziurowicz ◽  
Joanna Radwan ◽  
Michał Wysocki ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Study Group ◽  
Academic Center ◽  
Sf 36 ◽  
Significant Difference

Abstract Purpose Improvement of the quality of life after bariatric surgery is an important outcome of the treatment. Assessing the long-term QoL results provides better insights into the effectiveness of bariatric surgery. Materials and Methods This is a cohort study including patients who underwent bariatric surgery between June 2009 and May 2010 in one academic center. Patients underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). Overall, 34 patients underwent LSG (52.3%) and 31 patients underwent LRYGB (47.7%). Preoperatively, and after 1 and 10 years, QoL was assessed using two standardized questionnaires: SF-36 and MA-QoLII. After 10 years, 72% of patients filled out these questionnaires. Results The global QoL score before surgery was 48.3 ± 20.6. At the 1-year follow-up, the global total QoL score was 79.7 ± 9.8. At the 10-year follow-up, the global total QoL score was 65.1 ± 21.4. There was a significant increase in total QoL between measurements before the operation and 10 years after surgery in the whole study group (p = 0.001) and for patients who underwent LSG (p = 0.001). There was no significant difference between total QoL prior to surgery and 10 years after for patients who underwent LRYGB (p = 0.450). Conclusion LSG led to significant improvement in QoL.

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