Surgery Quality Improvement Program Research Articles

Laparoscopic Surgical Management of Symptomatic Anastomotic Ulcers after Gastric Bypass: A 10-Year Single-Center Experience

Marginal ulceration has a reported incidence up to 34% following Roux-en-y gastric bypass. Bleeding or perforation may be a medical emergency and can be managed via a wide range of techniques. Traditional laparoscopy or robotically assisted laparoscopy offer minimally invasive approaches. We reviewed the experience at a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Center of Excellence.

Gastroesophageal Reflux Predicts Utilization of Dehydration Treatments After Bariatric Surgery.

Dehydration treatments (DT) provide intravenous fluids to patients in the outpatient setting; however, the utilization of DT is not well-described. We characterize the cohort receiving DT, the first year it was recorded in a bariatric-specific database. A retrospective cohort analysis of patients undergoing bariatric surgery between January 1, 2016, and December 31, 2016, in 791 centers in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data file. Patients ≥ 18years with a body mass index (BMI) ≥ 35kg/m2 who underwent laparoscopic adjustable gastric band (LAGB), sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (LRYGB), and biliopancreatic diversion with duodenal switch (LBPD/DS) were identified. Unadjusted and adjusted rates of DT were analyzed. In addition, adjusted rates and indication for readmission were reviewed. The overall rate of dehydration treatments was 3.5% for the 141,748 bariatric surgery cases identified. Patient comorbidities of gastroesophageal reflux (GERD) (odds ratio (OR) 1.49; 95% CI, 1.40-1.59), insulin-dependent diabetes (OR = 1.19; 95% CI, 1.07-1.33), and LRYGB (OR = 1.45; 95% CI, 1.36-1.54) were associated with higher odds of DT. DT only had the highest odds of readmission (OR = 6.22; 95% CI, 5.55-6.98) compared to other outpatient visits. Nausea and vomiting, or fluid, electrolyte, or nutritional depletion was the most common indication for readmission in all groups. Patients with GERD utilized dehydration treatments after bariatric surgery. DT was highly associated with readmissions, and a better understanding of the clinical application of DT will allow bariatric centers to develop programs to further optimize outpatient treatments.

Change in Total Body Water as a Metric for Predicting Need for Outpatient Intravenous Fluids in Postoperative Bariatric Patients

Dehydration drives a significant proportion of readmissions following bariatric surgery. Routinely performed body composition testing and total body water (TBW) calculations may present a novel method for diagnosing dehydration for outpatient intervention. We sought to determine if a change in TBW from preoperative baseline could help identify bariatric patients requiring outpatient intravenous fluid (IVF) administration for dehydration. The VUMC Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was retroactively queried for all patients undergoing bariatric surgery at an accredited bariatric surgery center from January 1, 2017 to May 31, 2018. Body composition test results presurgery and postsurgery were extracted from the electronic health record. Change in TBW was compared between patients requiring outpatient IVF and those who did not use multivariable logistic regression. 583 patients underwent surgery over the study period (388 laparoscopic Roux-en-Y gastric bypass, 195 sleeve). 62 (10.6%) required outpatient fluid administration for dehydration. After multivariable analysis, patients with an increased hospital length of stay at index operation were more likely to require outpatient IVF (odds ratio [OR] 1.65, 95% CI 1.22-2.2). Preexisting diabetes diagnosis was protective (OR 0.35, 95% CI 0.16-0.74). Neither 1-week nor 1-month change in TBW from preoperative baseline was significantly different between patients receiving outpatient IVF and those who did not. Increased hospital length of stay predicts patients at risk of postoperative dehydration requiring IVF administration. Body composition testing and TBW were not useful in distinguishing between populations. Further research is needed to examine the efficacy of outpatient IVF in preventing hospital readmissions for dehydration.

A280 Revisional Robotic Bariatric Surgery: Three Years of Data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

A280 Revisional Robotic Bariatric Surgery: Three Years of Data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

Impact of Diabetes Mellitus on Bariatric Surgery Outcomes: A Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Analysis

Impact of Diabetes Mellitus on Bariatric Surgery Outcomes: A Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Analysis

A328 Exploring perioperative outcomes in metabolic and bariatric surgery amongst the elderly: An analysis of the 2015-2017 MBSAQIP database

Abstract Background Metabolic and bariatric surgery (MBS) is increasingly performed in patients >65 years. Studies of perioperative outcomes have shown equivocal results. Objectives Our study objective was to explore perioperative outcomes in elderly MBS patients compared with those Setting Academic Hospital. Methods Primary sleeve (SG) and gastric bypass (RYGB) cases were identified from the 2015–2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Selected cases were stratified by age (≥65 yr versus Results 26,557 (5.6%) of MBS cases were performed in elderly patients, who were more likely to be white, male, have a lower mean body mass index (BMI), receive a gastric bypass, and robotic-assisted surgery. Elderly patients had a significantly higher disease burden, and most outcome measures were significantly higher in elderly patients, including mortality and morbidity. On multivariate regression analyses, elderly patients undergoing SG have significantly less risk of mortality and morbidity compared with RYGB. In general, co-morbidities were in most cases more strongly predictive of complications than age alone. The number needed to harm (NNH) for overall and related morbidity were 59 and 232, respectively. Conclusion Elderly MBS patients have higher disease burden and higher adverse outcomes following MBS; however, complications in this cohort remain overall rare. When performing bariatric surgery on elderly patients, procedure consideration should favor SG as RYGB is independently associated with worse outcomes.

Mo2037 – Clostridium Difficile After Laparoscopic Bariatric Surgery: An Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

Mo2037 – Clostridium Difficile After Laparoscopic Bariatric Surgery: An Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

1033 – Concurrent Laparoscopic Ventral Hernia Repair with Bariatric Surgery: A Propensity-Matched Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database

1033 – Concurrent Laparoscopic Ventral Hernia Repair with Bariatric Surgery: A Propensity-Matched Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database

Use of Modified Frailty Index to Predict Postoperative Complication Rates after Bariatric Surgery: An Analysis of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)

Use of Modified Frailty Index to Predict Postoperative Complication Rates after Bariatric Surgery: An Analysis of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)

Outcomes of Intragastric Balloon for Weight Loss: A Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Analysis

Outcomes of Intragastric Balloon for Weight Loss: A Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Analysis

American College of Surgeons Children's Surgery Verification Quality Improvement Program: What Anesthesiologists Need to Know Now.

A task force of pediatric surgical specialists with the support of The American College of Surgeons recently launched a verification program for pediatric surgery, the Children's Surgery Verification quality improvement program, with the goal of improving pediatric surgical, procedural, and perioperative care. Included in this program are specific standards for the delivery of pediatric anesthesia care across a variety of practice settings. We review the background, available evidence, requirements for verification, and verification process and its implications for the practice of pediatric anesthesia across the country. In addition, we have included a special roundtable interview of 3 recently Children's Surgery Verification-verified program directors to provide an up-to-date real-world perspective of this children's surgery quality improvement program.

Effects of Resident or Fellow Participation in Sleeve Gastrectomy and Gastric Bypass: Results from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)

Effects of Resident or Fellow Participation in Sleeve Gastrectomy and Gastric Bypass: Results from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)