Yas Sanaiha

Predictive factors of mortality in bariatric surgery: Data from the Nationwide Inpatient Sample

BACKGROUND Understanding predictors of mortality in bariatric surgery enables surgeons to use these factors for analysis of risk-adjusted mortality and aids in the surgical decision making and informed consent process. OBJECTIVES To evaluate the effect of patient characteristics (age, gender, race, and payer type), preoperative comorbidities, and operative technique (laparoscopic versus open, gastric bypass versus gastric band) on mortality in patients who underwent bariatric operations. METHODS Using the National Inpatient Sample database, clinical data of patients with morbid obesity who underwent bariatric surgery from 2006 to 2008 were examined. Multivariate logistic regression analyses were performed to identify independent predictors of in-hospital mortality. RESULTS A total 304,515 patients underwent bariatric surgery over the 3-year period. The majority of patients were female (80%) and Caucasian (74%). Their mean age was 44 years and 31.6% were >50 years old. The most common payer type was private (73.5%). Laparoscopic approach was utilized in 86.2% of cases. The overall in-hospital mortality was 0.12%. Using multivariate regression analysis, male gender (adjusted odds ratio [AOR], 1.7), age >50 years (AOR, 3.8), congestive heart failure (AOR, 9.5), peripheral vascular disease (AOR, 7.4), chronic renal failure (AOR, 2.7), open procedure (AOR, 5.5), and gastric bypass operation (AOR, 1.6) were factors associated with greater mortality. Ethnicity, hypertension, diabetes, liver disease, chronic lung disease, sleep apnea, alcohol abuse, and payer type had no association with mortality in this study. CONCLUSION Modifiable risk factors predictive of mortality include open surgery and gastric bypass procedure; nonmodifiable risk factors include older age, male gender, and a history of congestive heart failure, peripheral vascular disease, and chronic renal failure. Surgeons should consider these factors in selection of patients to undergo bariatric operations, providing informed consent, and selection of the procedural type.

Trends in mortality and resource utilization for extracorporeal membrane oxygenation in the United States: 2008–2014

Background: Extracorporeal membrane oxygenation is used as a life‐sustaining measure in patients with acute or end‐stage cardiac or respiratory failure. We analyzed national trends in extracorporeal membrane oxygenation use and outcomes and assessed the influence of hospital demographics. Methods: Adult extracorporeal membrane oxygenation patients in the 2008–2014 National Inpatient Sample were evaluated. Patient and hospital characteristics, extracorporeal membrane oxygenation indication, mortality, and hospital costs were analyzed. Results: A total 17,020 adult extracorporeal membrane oxygenation patients were considered: 47.4% respiratory failure, 38.6% postcardiotomy, 5.5% lung transplantation, 5.5% cardiogenic shock, and 3.2% heart transplantation. Admissions rose 361% from 1,026 in 2008 to 4,815 in 2014 (P < .0001), and the fraction of respiratory failure increased 40.5%–49.8% (P < .001). Elixhauser scores rose from 3.1 to 4.1 (P < .0001). Mortality decreased among total admissions from 62.4% to 42.7% (P < .0001) associated with an observed decline in postcardiotomy mortality. Mean hospital costs and length of stay remained stable throughout the study period. Although extracorporeal membrane oxygenation occurred most frequently at large hospitals, small and medium‐sized hospitals showed significant expansion (P < .001). The Northeast exhibited a sustained three‐fold per capita increase in extracorporeal membrane oxygenation rate (P < .0001). Conclusion: The past decade has seen an exponential growth of ECMO extracorporeal membrane oxygenation in the United States, with the fraction for respiratory failure displaying considerable growth. Overall extracorporeal membrane oxygenation patients experienced substantially reduced mortality, driven by improved outcomes for postcardiotomy patients, along with a trend toward an increased risk profile. Disproportionate use of extracorporeal membrane oxygenation in the Northeast warrants investigation of access to this technology across the United States.