Faisal Aziz

Do Support Groups Play a Role in Weight Loss after Laparoscopic Adjustable Gastric Banding

Background: Surgical intervention represents the only treatment with long-term efficacy for morbid obesity. Laparoscopic adjustable gastric banding (LAGB) is a minimally invasive operation that is increasing in popularity. We hypothesized that attending support groups is beneficial to achieve optimal weight loss after LAGB. Methods: 38 patients who underwent LAGB between Dec 2002 and Aug 2003 were studied retrospectively. Patients were divided into 2 groups; A included 28 patients who did not attend the support groups (surgery without support groups), and B included 10 patients who attended the support groups (surgery with support groups). Weight loss between the 2 groups was compared over a 1-year period. Results: Patients who attended support groups achieved more weight loss (mean decrease in BMI = 9.7 ± 1.9) than patients who did not attend support groups (mean decrease in BMI = 8.1 ± 2.1), P = 0.0437 (unpaired t-test). Conclusion: Support groups appear to be an important adjunct for patients who undergo LAGB, to achieve and maintain improved weight loss.

Reintervention after EVAR and open surgical repair of AAA: a 15-year experience.

Objective: This study examined the frequency and reason for reinterventions and their impact on survival in contemporaneously treated cohorts of EVAR and open surgical repair (OSR) patients. Background: EVAR has largely replaced OSR for anatomically appropriate AAA because of improved short-term outcomes. However, EVAR is associated with a notable reintervention rate. Methods: Data for patients undergoing elective AAA repair between 1996 and 2011 were collected and analyzed to assess time from initial procedure to reintervention and rate of reintervention. Patient demographics, comorbidities, number and type of reinterventions, graft type, and timing of reintervention were analyzed. Results: A total of 1144 patients underwent AAA repair; 558 had EVAR and 586 had OSR. In 76 EVAR patients, 123 reinterventions were performed; 46 reinterventions were performed in 30 OSR patients (P < 0.0001). Endoleak was responsible for 66% of EVAR reinterventions; colonic ischemia, bleeding, and incisional hernias caused 30%, 22%, and 22% of OSR reinterventions, respectively. Time to first reintervention was shorter in OSR patients (P < 0.001) and was related to AAA size (P < 0.001). Early reintervention at the index procedure in OSR patients had a 23% mortality rate. If reinterventions were not required, survival curves were similar. Current endografts require fewer reinterventions than earlier generation endografts. Conclusions: Reintervention was more common with EVAR and occurred later. Early reintervention after OSR is associated with significant mortality. If early reintervention in OSR patients can be avoided, there is no early survival advantage to EVAR. Current endografts require fewer reinterventions than earlier devices.

Anticoagulation monitoring by an anticoagulation service is more cost-effective than routine physician care

BACKGROUND Vitamin K antagonists (VKAs) are the mainstay of long-term anticoagulation but require careful monitoring for effectiveness and safety. Physicians manage anticoagulation for most patients, although anticoagulation services are becoming increasingly popular. A new anticoagulation service (AS) run by nurses and overseen by a physician was established and its effectiveness vs usual physician care was independently assessed using costs of emergency department (ED) visits and hospitalizations resulting from failure or complication of anticoagulation. We report the results of this independent analysis of anticoagulation monitoring of patients treated with VKAs. METHODS The AS-treated patients received VKAs according to a written protocol, whereas physician monitoring was performed according to individual practice. An independent analysis of ED visits and hospitalizations due to complications of anticoagulation in patients receiving long-term VKAs between July 1, 2008, and December 31, 2008, was performed. The average cost of ED visits and hospitalizations was calculated for each patient cohort. The expense of each was amortized for a 12-month period to determine the annual cost of anticoagulation morbidity per 100 patients treated. RESULTS Long-term VKAs were used to treat 2397 patients. Physicians managed 2266 patients (95%; group I) and the AS monitored 131 patients (5%; group II). In group I, 247 patients (10.9%) visited the ED, with an average cost of

Endovascular and Open Surgical Treatment of Brachiocephalic Arteries

288 per visit; the ED cost per patient treated was

Blood pressure and calf muscle oxygen extraction during plantar flexion exercise in peripheral artery disease

31. In group II, two patients (1.5%) visited the ED, with an average cost of

Abdominal Pain After Colonoscopy: Can It Be Acute Cholecystitis?

139 per patient. The ED cost per patient treated was

Unplanned return to operating room after lower extremity endovascular intervention is an independent predictor for hospital readmission

2, leading to annual savings of

Fecal Impaction Causing Pelvic Venous Compression and Edema.

5800 per 100 patients (P = .0006). Complications of anticoagulation required hospitalization in 289 group I patients (12.8%), with an average cost of

Vascular surgery trainees still need to learn how to sew: importance of learning surgical techniques in the era of endovascular surgery.

15,125 per hospitalization and

Development of a validated model to predict 30-day stroke and 1-year survival after carotid endarterectomy for asymptomatic stenosis using the Vascular Quality Initiative

1929 per patient treated and in three group II patients (2.3%), with an average cost of