Zhamak Khorgami

Predicting the unpredictable: Comparing readmitted versus non-readmitted colorectal surgery patients

BACKGROUND To evaluate readmissions to determine predictors and patterns of readmission. METHODS Prospective database review identified readmitted and non-readmitted patients after colorectal surgery. Variables for the index and readmission episode were examined. RESULTS A total of 212 readmissions and 3,292 nonreadmissions were analyzed. The majority was elective. Readmitted patients were older (P = .003), had more comorbidities (P < .0001), longer operative times (P < .0001), length of stay (P < .0001), and higher costs (P = .002). At the time of discharge, more readmitted patients required temporary nursing (P < .0001). Independent readmission predictors were higher American Society of Anesthesiologists score, previous abdominal operation, intensive care unit stay, and dysmotility/constipation surgery. At the time of readmission, 29.2% required reoperation. More than half had an open procedure initially (55.2%). After initial open procedures, reoperative time (P = .05) and LOS were longer (P = .028), and more patients required temporary nursing care at the time of discharge (P = .046). Readmissions caused an additional mean hospital cost of

Ten-year trends in traumatic injury mechanisms and outcomes: A trauma registry analysis

12,670.89. CONCLUSIONS Readmitted patients have distinct demographic and outcomes variables. As most were elective cases, stratifying patients preoperatively may enable perioperative planning for this higher risk group.

A Nationwide Safety Analysis of Discharge on the First Postoperative Day After Bariatric Surgery in Selected Patients

BACKGROUND The Oklahoma Trauma Registry (OTR) collects data from all state-licensed acute care hospitals. This study investigates trends and outcomes of trauma in Oklahoma using OTR. METHODS 107,549 patients (2005-2014) with major severity and one of the following criteria were included: length of hospital stay ≥48 h, dead on arrival or death in the hospital, hospital transfer, ICU admission, or surgery on the head, chest, abdomen, or vascular system. Patient characteristics, mechanisms of injury, and outcomes of trauma were analyzed. RESULTS Hospital admissions due to falls increased with an annual percent change of 4.0% (95%CI: 3.1%-4.9%) while hospital admissions due to motor vehicle crashes decreased. The number of overall deaths per year remained stable except for the fall-related deaths, which increased proportionate to the increase in the incidence of fall. Fall-related mortality was 4.2% and intracranial bleeding was present in 60% in these patients. CONCLUSION Falls are significantly increasing as a mechanism of trauma admissions and trauma-related deaths in Oklahoma. Analysis of state-based trauma registries can identify trends in etiologies of injuries and may indicate a reference point to prioritize preventive plans.

Radiofrequency Ablation for Lower Extremity Venous Reflux

BackgroundEnhanced recovery after surgery has led to early recovery and shorter hospital stay after laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). This study aims to assess feasibility and outcomes of postoperative day (POD) 1 discharge after LRYGB and LSG from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) 2015 dataset.MethodsPatients who underwent elective LRYGB and LSG and were discharged on POD 1 and 2 were extracted from the MBSAQIP dataset. A 1:1 propensity score matching was performed between cases with POD 1 vs POD 2 discharge, and the 30-day outcomes of the cohorts were compared.ResultsA total of 80,464 patients met the study criteria: 8862 LRYGB and 31,370 LSG cases, which were discharged on POD 1, and matched 1:1 with those discharged on POD 2. Within the LRYGB cohort, patients discharged on POD 2 had higher all-cause morbidity (7.5% vs 6.1%; p < 0.001) and 30-day re-intervention (2.0% vs 1.5%; p = 0.004) in comparison with patients discharged on POD 1. There were no statistical differences with respect to serious morbidity (0.5% vs 0.4%; p = 0.15), 30-day readmission (4.9% vs 4.5%; p = 0.2), and 30-day reoperation (1.3% vs 1.2%; p = 0.7). Within the LSG cohort, patients discharged on POD 2 had higher all-cause morbidity (4.2% vs 3.4%; p < 0.001), serious morbidity (0.4% vs 0.3%; p < 0.001), 30-day re-intervention (1.0% vs 0.6%; p < 0.001), and 30-day readmission (2.9% vs 2.5%; p = 0.002) in comparison with patients discharged on POD 1.ConclusionsEarly discharge on POD 1 may be safe in a selective group of bariatric patients without significant comorbidities.

Clinical significance of perioperative hyperglycemia in bariatric surgery: evidence for better perioperative glucose management

Lower extremity chronic venous disease is a significant public health problem and can have considerable negative effects on functional status in its advanced stages. Invasive interventions are indicated when the disease is symptomatic and refractory to compression therapy. Radiofrequency ablation (RFA) is much less invasive than surgical vein stripping with an excellent long-term success rate and acceptable recurrence rates compared to surgery. Postoperative pain and discomfort after RFA is much less than surgery, and patients have faster recovery with a higher quality of life during the perioperative period. Attention to proper technique, knowledge of venous anatomy and pathophysiology, and an understanding of ultrasound imaging while performing RFA will assure the best possible clinical results and diminish potential complications. RFA has been demonstrated to have less pain and bruising compared with laser ablation methods. It is now a well-established clinical treatment for superficial venous reflux and will be used as a standard of comparison for future technologies.

Cost of bariatric surgery and factors associated with increased cost: an analysis of national inpatient sample

BACKGROUND Uncontrolled hyperglycemia in patients undergoing surgery has been shown to be a risk factor for postoperative complications. OBJECTIVE To assess the clinical significance of perioperative hyperglycemia on infectious complications and clinical outcomes in patients undergoing bariatric surgery. SETTING Single academic center. METHODS Retrospective chart review of all patients who underwent primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between 2013 and 2016 was performed. The association between any elevated perioperative glucose value (hyperglycemia: ≥126 mg/dL) and level of elevation (≥126 or ≥200 mg/dL) with 30-day infectious complications, reoperation, length of hospital stay, and readmission was assessed. Patients who developed early complications (within 3 d of surgery), which could potentially lead to immediate postoperative hyperglycemia, were not included in the analysis. Outcomes of patients with and without diabetes were separately analyzed. RESULTS A cohort of 1981 patients was studied, including Roux-en-Y gastric bypass (n = 1171, 59%) and sleeve gastrectomy (n = 810, 41%) patients. In patients with diabetes (n = 751, 38%), perioperative hyperglycemia was independently associated with higher composite infectious complications (defined as presence of any of 6 infectious complications; odds ratio [OR] 3.1, 95% confidence interval [CI] 1.2-8.2, P = .018) and higher readmission rate (OR 2.2, 95% CI 1.1-4.6, P = .027). In patients without diabetes (n = 1230, 62%), 19.2% had perioperative hyperglycemia (≥126 mg/dL). Perioperative hyperglycemia in patients without diabetes was associated with higher composite infectious complications (OR 2.6, 95% CI 1.1-5.5, P = .018) and prolonged length of stay (OR 3.0, 95% CI 1.5-5.9, P = .001). CONCLUSIONS An elevated perioperative glucose value is adversely associated with infectious complications and key clinical outcomes after bariatric surgery. The increased risk is correlated with the extent of glucose elevation (dose-response relationship). Our findings highlight the importance of glucose control during the perioperative period in bariatric surgical patients.