James H. Mehaffey

10-Year Outcomes After Roux-en-Y Gastric Bypass.

Objective(s): The aim of the study was to evaluate the clinical effectiveness and long-term durability of Roux-en-Y Gastric Bypass (RYGB) at an accredited center. Background: Short-term data have established the effectiveness of RYGB for weight loss and comorbidity amelioration. The long-term durability of this operation remains infrequently described in the American population. Methods: All patients (N = 1087) undergoing RYGB at a single institution over a 20-year study period (1985–2004) were evaluated. Univariate differences in preoperative comorbidities, operative characteristics (laparoscopic vs. open), postoperative complications, annual weight loss, and current comorbidities were analyzed to establish trends and outcomes 10 years after surgery. Results: Among 1087 RYGB patients, 651 (60%) had complete 10-year follow-up, including 335 open RYGB and 316 laparoscopic RYGB. Patients undergoing open RYGB had a higher preoperative body mass index. Otherwise, preoperative characteristics were similar. Postoperative incisional hernia rates were expectedly higher in open (vs laparoscopic) RYGB (16.9% vs 4.7%; P = 0.02). Annual % reduction in excess body mass index significantly improved over time, peaking at 74% by 24 months, with a slow trend down to 52% at 10 years (all P < 0.001). Importantly, a highly significant decrease in obesity-related comorbid disease persisted at 10 years of follow-up after RYGB. Conclusions: Roux-en-Y Gastric Bypass remains an excellent and durable operation for long-term weight loss and treatment of obesity-related comorbid disease. Laparoscopic RYGB results in highly favorable outcomes with reduced incisional hernia rates. These 10-year data help to more clearly define long-term outcomes and demonstrate outstanding reduction in comorbid disease following RYGB.

Expanding the donor lung pool: how many donations after circulatory death organs are we missing?

BACKGROUNDnThe number of patients with end-stage pulmonary disease awaiting lung transplantation is at an all-time high, while the supply of available organs remains stagnant. Utilizing donation after circulatory death (DCD) donors may help to address the supply-demand mismatch. The objective of this study is to determine the potential donor pool expansion with increased procurement of DCD organs from patients who die at hospitals.nnnMATERIAL AND METHODSnThe charts of all patients who died at a single, rural, quaternary-care institution between August 2014 and June 2015 were reviewed for lung transplant candidacy. Inclusion criteria were age <65xa0y, absence of cancer and lung pathology, and cause of death other than respiratory or sepsis.nnnRESULTSnA total of 857 patients died within a 1-year period and were stratified by age: pediatric <15xa0y (nxa0=xa032, 4%), young 15-64xa0y (nxa0=xa0328, 38%), and old >65xa0y (nxa0=xa0497, 58%). Those without cancer totaled 778 (90.8%) and 512 (59%) did not have lung pathology. This leaves 85 patients qualifying for DCD lung donation (pediatric nxa0=xa010, young nxa0=xa075, and old nxa0=xa00). Potential donors were significantly more likely to have clear chest X-rays (24.3% versus 10.0%, Pxa0<xa00.0001) and higher mean PaO2/FiO2 (342.1 versus 197.9, Pxa0<xa00.0001) compared with ineligible patients.nnnCONCLUSIONSnA significant number of DCD lungs are available every year from patients who die within hospitals. We estimate the use of suitable DCD lungs could potentially result in a significant increase in the number of lungs available for transplantation.

Smoking Cessation Counseling Improves Quality of Care and Surgical Outcomes with Financial Gain for a Vascular Practice

BACKGROUNDnCigarette smoking is strongly associated with atherosclerotic disease. It is incumbent on vascular surgeons to provide smoking cessation counseling (SCC) to their patients. The objective of this study was to determine the association of SCC and improvement in quality of care.nnnMETHODSnAs a quality project using retrospective data, the study received institutional review board exemption status. A retrospective review of prospectively maintained database from April 2014 through March 2015 of outpatient encounters in a vascular surgery clinic was performed of current smokers. Through the quality support team, providers were encouraged to counsel smokers to quit, document the discussion, and bill specific Evaluate and Management codes (99406 and 99407). The number of outpatients by smoking status, documentation and billing of SCC, demographics of current smokers, and monetary collections were collected. Data were compared using a correlation coefficient calculated and tested for statistical significant using two-tailed t-test.nnnRESULTSnA sample of 1,077 visits by 612 currently smoking patients accounted for 24% of all outpatient vascular surgery visits. The average age was 61xa0years, and 64% were male. Comorbidities included 77% with hypertension, 32% with diabetes mellitus, and 14% with chronic kidney disease. Medically, 72% were on aspirin, 71% on statin, and 48% on beta blocker. A total of 208 (34%) never underwent a vascular intervention, and 183 (30%) had an intervention during the study period (44% for peripheral artery disease, 10% for carotid stenosis, 14% amputations, and 10% abdominal aortic aneurysm). Documentation improved from 65% of encounters during the first month to 89% in the peak month and 79% of total encounters. All-cause mortality rate was 2%, and this cohort demonstrated 75% SCC for 28 encounters. Fifty-five patients (9%) quit smoking for more than 30xa0days at the end of the study period, and this cohort had 69% of their 97 encounters with documented SCC. Increased SCC was correlated with decreased 30-day readmissions during the concurrent month (rxa0=xa0-0.711, Pxa0=xa00.009) and the following month (rxa0=xa0-0.719, Pxa0=xa00.008). There was a weak correlation with decreased amputations the following month (rxa0=xa0-0.5, Pxa0=xa00.08). From a financial perspective,

Pre-implant left ventricular apex position predicts risk of HeartMate II pump thrombosis

1,373 was collected for 33 patients with a potential for collection of

Implementing a Computer-Based Glucose Management Protocol Improves Outcomes and Value in Cardiac Surgery

7,460 predicted for minimum Medicare payment of 1 visit per patient.nnnCONCLUSIONSnAdvising vascular patients in the arduous process of smoking cessation benefits both the patient and the health system. Proper documentation and billing decreases costs of early readmissions and increases departmental revenue.

Percutaneous Endoscopic Gastrostomy after Cardiac Surgery: A Temporary Measure in a High-risk Cohort

Thrombosis within a left ventricular assist device (LVAD) is a devastating complication that often necessitates device exchange. Few studies have evaluated the relationship between patient anatomy and pump thrombosis. We hypothesize that lateral displacement of the left ventricular (LV) apex increases risk for pump thrombosis.