scholarly journals Nutritional Management of Bariatric Surgical Patients in the Peri-Operative Setting

2018 ◽  
pp. 18-20
Author(s):  
Jonathan Sivakumar
Keyword(s):  
Bariatric Surgery ◽  
Surgical Patients ◽  
Recent History ◽  
Nutritional Management ◽  
Evidenced Based ◽  
Surgical Treatments

Bariatric surgical treatments have increased in recent history, largely due to the growing rates of obesity. In light of this, correct nutritional management of these patients peri-operatively is as crucial as ever. This articles describes the evidenced-based approach to the nutritional management of patients in the setting of bariatric surgery in order to achieve the best possible outcome post-operatively

scholarly journals Bariatric Surgery vs Lifestyle Intervention for Diabetes Treatment: 5-Year Outcomes From a Randomized Trial

2020 ◽  
Vol 105 (3) ◽  
pp. 866-876 ◽  
Author(s):  
Anita P Courcoulas ◽  
James W Gallagher ◽  
Rebecca H Neiberg ◽  
Emily B Eagleton ◽  
James P DeLany ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Lifestyle Intervention ◽  
Controlled Trial ◽  
The United States ◽  
Diabetes Remission ◽  
University Of Pittsburgh ◽  
Lifestyle Treatment ◽  
Surgical Treatments ◽  
The University

Abstract Context Questions remain about bariatric surgery for type 2 diabetes mellitus (T2DM) treatment. Objective Compare the remission of T2DM following surgical or nonsurgical treatments. Design, setting, and participants Randomized controlled trial at the University of Pittsburgh, in the United States. Five-year follow-up from February 2015 until June 2016. Interventions 61 participants with obesity and T2DM who were initially randomized to either bariatric surgical treatments (Roux-en-Y gastric bypass [RYGB] or laparoscopic adjustable gastric banding [LAGB]) or an intensive lifestyle weight loss intervention (LWLI) program for 1 year. Lower level lifestyle weight loss interventions (LLLIs) were then delivered for 4 years. Main Outcomes and Measures Diabetes remission assessed at 5 years. Results The mean age of the patients was 47 ± 6.6 years, 82% were women, and 21% African American. Mean hemoglobin A1c level 7.8% ± 1.9%, body mass index (BMI) 35.7 ± 3.1 kg/m2, and 26 participants (43%) had BMI < 35 kg/m2. Partial or complete T2DM remission was achieved by 30% (n = 6) of RYGB, 19% (n = 4) of LAGB, and no LWLI participants (P = .0208). At 5 years those in the RYGB group had the largest percentage of individuals (56%) not requiring any medications for T2DM compared with those in the LAGB (45%) and LWLI (0%) groups (P = .0065). Mean reductions in percent body weight at 5 years was the greatest after RYGB 25.2% ± 2.1%, followed by LAGB 12.7% ± 2.0% and lifestyle treatment 5.1% ± 2.5% (all pairwise P < .01). Conclusions Surgical treatments are more effective than lifestyle intervention alone for T2DM treatment.

scholarly journals An Analysis of Methodologies That Can Be Used to Validate if a Perioperative Surgical Home Improves the Patient-centeredness, Evidence-based Practice, Quality, Safety, and Value of Patient Care

2013 ◽  
Vol 119 (6) ◽  
pp. 1261-1274 ◽  
Author(s):  
Thomas R. Vetter ◽  
Nataliya V. Ivankova ◽  
Lee A. Goeddel ◽  
Gerald McGwin ◽  
Jean-Francois Pittet
Keyword(s):  
Perioperative Care ◽  
Healthcare Delivery ◽  
Standard Of Care ◽  
The United States ◽  
Surgical Patients ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Perioperative Surgical Home ◽  
Future Demands ◽  
Evidenced Based

Abstract Approximately 80 million inpatient and outpatient surgeries are performed annually in the United States. Widely variable and fragmented perioperative care exposes these surgical patients to lapses in expected standard of care, increases the chance for operational mistakes and accidents, results in unnecessary and potentially detrimental care, needlessly drives up costs, and adversely affects the patient healthcare experience. The American Society of Anesthesiologists and other stakeholders have proposed a more comprehensive model of perioperative care, the Perioperative Surgical Home (PSH), to improve current care of surgical patients and to meet the future demands of increased volume, quality standards, and patient-centered care. To justify implementation of this new healthcare delivery model to surgical colleagues, administrators, and patients and maintain the integrity of evidenced-based practice, the nascent PSH model must be rigorously evaluated. This special article proposes comparative effectiveness research aims or objectives and an optimal study design for the novel PSH model.

Nutrition

2019 ◽  
pp. 188-196
Author(s):  
George W. Williams
Keyword(s):  
Infectious Disease ◽  
Wound Healing ◽  
Critical Care ◽  
Nutritional Status ◽  
Respiratory Function ◽  
Surgical Patients ◽  
Nutritional Management ◽  
Equal Degree ◽  
Perioperative Nutrition

Nutrition is the second of two principal concepts (the first being infectious disease) in critical care not heavily emphasized in core anesthesiology training for reasons that are obvious. Optimal nutritional management is imperative to achieve positive outcomes in surgical patients. Wound healing, mobilization, and respiratory function are all particularly affected by nutritional status, and the optimal application assessment of nutrition directly affects surgical patients in the long term. Clinically, many physicians may take nutrition for granted and potentially conclude that it is not acutely important. Following consuming this content, the reader will be better equipped to educate their colleagues on the optimal assessment and application of perioperative nutrition. This chapter provides clinically useful and examination-oriented substrate to an equal degree, while being optimally digestible by the reader (no pun intended).

scholarly journals Five-year direct medical costs and comorbidities after bariatric surgery of obese patients with type 2 diabetes mellitus: A population-based propensity score-matched study

2020 ◽  
Author(s):  
Tingting Wu ◽  
Simon Kin Hung Wong ◽  
Betty Tsz Ting Law ◽  
Eleanor Grieve ◽  
Olivia Wu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Type 2 Diabetes Mellitus ◽  
Medical Costs ◽  
Population Based ◽  
Surgical Patients ◽  
Obese Patients ◽  
Direct Medical Costs

Abstract Background: Bariatric surgery is effective in weight reduction and diabetes remission. This study aimed to estimate direct medical costs and changes of comorbidities after bariatric surgery up to five years among obese patients with type 2 diabetes mellitus. Methods: A population-based retrospective cohort of obese type 2 diabetes patients from Hong Kong Hospital Authority between 2006 and 2017 was assembled. One-to-five propensity score matching method was applied to match 401 eligible surgical patients with 1,894 non-surgical patients. Frequency of healthcare service utilization and dispense of diabetes medication were collected for both groups to estimate the direct medical costs from baseline to up to 60 months; Charlson Comorbidity Index (CCI) and number of comorbidities were measured to compare the changes of comorbidities between two groups over the 5 years. Results: Direct medical costs were US$40,889 for surgical patients and US$6,163 for controls in the index year (p<0.001), with incremental costs of US$34,726. Bariatric surgery and hospitalization were the main cost drivers for surgical patients in the year of surgery. Although surgical patients had significantly lower annual costs than control patients in the subsequent four years, five-year cumulative costs incurred by surgical patients were significantly greater than controls (US$60,174 vs US$33,374, p<0.001), regardless of subgroups. Surgical patients had better profile of comorbidities than controls, as they had significantly lower CCI after baseline and fewer percentages of them proceeded to higher CCI categories. Conclusions: Over 5 years, bariatric surgery was associated with increased medical costs in the year of surgery and cumulative costs. Although bariatric surgery is not cost-saving for type 2 diabetes patients at 5 years, it is associated with improved comorbidity profile.

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