Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
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Surg Obes Relat Dis · Mar 2013
Importance of hospital versus surgeon volume in predicting outcomes for gastric bypass procedures.
A relationship between surgical volume and improved surgical outcomes has been described in gastric bypass patients but the relative importance of surgeon versus hospital volume is unknown. Our objective was to examine whether in-hospital and 30-day mortality are determined more by surgeon volume or hospital volume or whether each has an independent effect. A retrospective cohort study was performed of all hospitals in Pennsylvania providing gastric bypass surgery from 1999 to 2003. ⋯ In Pennsylvania, both higher surgeon and hospital volume were associated with better outcomes for bariatric surgical procedures. Although a high-surgeon volume correlated with lowered mortality, we also found that high-volume hospitals demonstrated improved outcomes, highlighting the importance of factors other than surgical expertise in determining the outcomes.
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Surg Obes Relat Dis · Jan 2013
Use of laparoscopy in general surgical operations at academic centers.
Laparoscopy is commonly being used in many different types of general surgical procedures. The aim of the present study was to examine the use of laparoscopy and perioperative outcomes in 7 general surgical operations commonly performed at U.S. academic medical centers. ⋯ Within the context of academic centers and elective, inpatient procedures, bariatric surgery had the greatest use of laparoscopy and the lowest rate of laparoscopic conversion to open surgery. The mortality for laparoscopic bariatric surgery is now comparable to that of laparoscopic cholecystectomy, ventral hernia repair, appendectomy, and antireflux surgery.
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Surg Obes Relat Dis · Jan 2013
Effects of bariatric surgery on diabetic nephropathy after 5 years of follow-up.
Studies have reported that the benefits of bariatric surgery extend beyond durable weight loss and include significant improvement in glycemic control. We hypothesized that improving diabetes control may have positive effects on end-organ complications of this disease, such as diabetic nephropathy (DN). ⋯ Bariatric surgery can induce a significant and sustainable improvement in T2DM and improve or halt the development of microvascular complications such as nephropathy. Considering that diabetes is often a progressive disease, these results are clinically important and warrant further investigation.
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Surg Obes Relat Dis · Nov 2012
Preoperative hemoglobin A1c and postoperative glucose control in outcomes after gastric bypass for obesity.
Hemoglobin A1c (HbA1c) is a reliable marker for long-term glycemic control in obese diabetic patients. Roux-en-Y gastric bypass improves HbA1c levels over time. However, it is not clear whether the preoperative HbA1c level is a predictor of the outcome in these patients. Our objectives were to understand the predictive capacity of the preoperative HbA1c level in gastric bypass patients at a single university-based Bariatric Center of Excellence. ⋯ Poor preoperative glycemic control is associated with worse glucose level control postoperatively, fewer diabetic remissions, and less weight loss. An elevated mean postoperative glucose level is independently associated with increased morbidity.