The Effect of Social Determinants and Socioeconomic Status on Laparoscopic Roux-En-Y Gastric Bypass for Weight Loss: An Analysis of the National Inpatient Sample

Objective In the United States, Black and Hispanic patients have a higher prevalence of obesity than Whites (49.6 vs. 44.8 vs. 42.2%, respectively). Despite higher rates of obesity among minority populations, bariatric surgery is performed at higher obesity levels in minorities than in Whites. This study examines the effects of various socioeconomic factors such as race, payer type, and income on the likelihood of undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) at class II versus class III obesity and their associated complications. Materials and Methods National Inpatient Sample (NIS) from 2016 to 2017 was queried to identify patients at least 18 years of age with a concomitant diagnosis of class II or class III obesity who underwent LRYGB. We analyzed obesity level at the time of LRYGB (class II vs. class III), postoperative intestinal obstruction during the admission, and occurrence of any noninfectious complication related to the surgery as our main outcomes. A multivariate logistic regression model was utilized to assess the association between our outcomes and socioeconomic factors associated with the admission. Results A total of 76,405 LRYGB operations were included. Out of this total, 83% (63,640) LRYGB operations were in class III obesity. Black patients had a lower rate (11.6%) of LRYGB procedures at class II obesity than White (17.6%) and Hispanic (18%) patients (p < 0.001). Medicare, Medicaid, and lower income quartiles also showed lower rates of operation at class II obesity (p < 0.001). Black patients were 29% (95% confidence interval [CI]: 0.61–0.83, p < 0.001) less likely than Whites to have a LRYGB procedure at class II obesity, they were 119% (95% CI: 1.17–4.11, p = 0.0014) more likely to suffer a postoperative intestinal obstruction, and they were 93% (95% CI: 1.31–2.84, p < 0.001) more likely to suffer a noninfectious complication. Conclusion Socioeconomic disparities in the surgical management of severe obesity persist in the United States, especially for LRYGB. This study highlights multiple demographic factors that led to LRYGB at later obesity levels. Black patients were also more likely to be associated with postoperative complications during the admission. The determinants of health disparities in obese patients need to be examined further to reduce potential long-term morbidity and mortality in minorities. Further research is also required to identify the adverse effects of health disparities in patients with severe obesity and obesity-related comorbidities.

Postoperative intestinal obstruction in patients with biliary atresia impedes biliary excretion and results in subsequent liver transplantation

Purpose This study aimed to investigate the negative effects of intestinal obstruction for jaundice-free native liver survival after Kasai portoenterostomy (PE) for biliary atresia (BA). Methods We retrospectively reviewed the records of patients who underwent PE for BA between 2006 and 2019. We evaluated the postoperative morbidity of intestinal obstruction for up to 2 years after PE and the effects of intestinal obstruction on jaundice-free native liver survival. On the basis of their initial operation, patients were divided into open portoenterostomy (Open-PE) and laparoscopic portoenterostomy (Lap-PE) groups, and morbidity was compared. Results Of the 87 patients reviewed, 6 (6.9%) patients developed postoperative intestinal obstruction and underwent surgery to relieve the obstruction. The morbidity of early postoperative intestinal obstruction was 1.68 per 10,000 person days. The jaundice-free native liver survival rate among patients who once achieved jaundice-free status after PE was significantly lower in the patients with intestinal obstruction compared to in those without intestinal obstruction (0% vs. 73.8%; RR = 3.81, p = 0.007). No significant differences were seen in postoperative intestinal obstructions between the Open-PE and Lap-PE groups (p = 0.242). Conclusions Intestinal obstruction negatively impact jaundice-free native liver survival, even in patients who once achieved jaundice-free status after PE for BA.

Multivariate machine learning models for prediction of postoperative intestinal obstruction in patients underwent laparoscopic colorectal surgery: A retrospective observational study

Background Machine learning may predict postoperative intestinal obstruction (POI) in patients underwent laparoscopic colorectal surgery for malignant lesions.Methods We used five machine learning algorithms (Logistic regression, Decision Tree, Forest, Gradient Boosting and gbm), analyzed by 28 explanatory variables, to predict POI. The total samples were randomly divided into training and testing groups, with a ratio of 8:2. The model was evaluated by the area operation characteristic curve (AUC), F1-Measure, accuracy, recall, and MSE under the receiver.Results A total of 637 patients were enrolled in this study, 122 (19.15%) of them had POI. Gradient Boosting and gbm had the most accurate in training group and testing group respectively.The f1_score of Gradient Boosting was the highest in the training group (f1_score =0.710526), and the f1_score of gbm was the highest in the testing group (f1_score =0.500000). In addition, the results of the importance matrix of Gbdt algorithm model showed that the important variables that account for the weight of intestinal obstruction after the first five operations are time to pass flatus or passage of stool, cumulative dose of rescue opioids used in postoperative days 3 (POD 3), duration of surgery, height and weight.Conclusions Machine learning algorithms may predict the occurrence of POI in patients underwent laparoscopic colorectal surgery for malignant lesions, especially Gradient Boosting and GBM algorithms. Moreover, time to pass flatus or passage of stool, cumulative dose of rescue opioids used during POD 3, duration of surgery, height and weight play an important role in the development of POI.

SIMULTANEOUS INTERVENTIONS IN PATIENTS WITH COMPLICATED FORMS OF POSTOPERATIVE VENTRAL HERNIA AND ANTERIOR ABDOMINAL WALL DEFORMATIONS

The aim is to optimize the treatment of patients with postoperative ventral hernias, anterior abdominal wall deformations and cholelithiasis.Materials and methods. 36 patients with complicated forms of postoperative ventral hernias, anterior abdominal wall deformation and cholelithiasis aged 36–74 years, under the 12:24 male/ female ratio were studied. According to the classification of Toskin — Zhebrovsky, smallsized, medium-sized, extensive and gigantic hernias were observed in 3 (8.3%), 12 (33.3%), 15 (41.7%) and 6 (16.7%) patients, respectively. According to the SWR-classification, the hernia of the median, lateral and combined localization was observed in 14 (38.9%), 7 (19.4%) and 15 (41.7%) patients, respectively. All patients were operated. Both autoplastic and prosthetic techniques of operations were used. Various forms of the anterior abdominal wall deformation were eliminated with the help of abdominoplasty. Laparoscopic cholecystectomy was performed simultaneously in all patients.Results. Postoperative complications occurred in 11 (30.5%) patients, with persistent seroma prevailing (6–54.5% of patients). In 3 (27.2%) patients wound suppuration was observed, in 1 (9.1%) — early postoperative intestinal obstruction. Postoperative pneumonia was observed in one patient.Conclusion. Success in the surgical treatment of such patients is determined by whether an individualized differentiated approach was used in choosing the method of surgery and the management of patients in the postoperative period.

Jejunojejunal intussusception: an unusual case of postoperative intestinal obstruction

Intussusception is a rare cause for postoperative intestinal obstruction. We report a case of intussusception in the early postoperative period following resection of proximal jejunum and end to end anastomosis. Computed tomography showed jejunal intussusception, which was confirmed on exploration. The anastomotic site was acting as the lead point, which was resected after reduction and reanastomosed in a single layer. The patient had uneventful recovery. Very few similar cases are reported in the literature and all the reported cases are following free jejunal transfer for pharyngo-oesophageal reconstruction.