complications revisions miss 2010 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Complications: Revisions MISS 2010 PowerPoint Presentation
Download Presentation
Complications: Revisions MISS 2010

Loading in 2 Seconds...

play fullscreen
1 / 23

Complications: Revisions MISS 2010 - PowerPoint PPT Presentation


  • 91 Views
  • Uploaded on

Complications: Revisions MISS 2010. Bruce M. Wolfe Professor of Surgery Oregon Health & Science University. Complications: Revisions. Provider error Large gastric pouch Incomplete gastric division Incorrect limbs. Complications: Revisions. Patient and/or provider factors Marginal ulcer

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Complications: Revisions MISS 2010' - kyran


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
complications revisions miss 2010

Complications: RevisionsMISS 2010

Bruce M. Wolfe

Professor of Surgery

Oregon Health & Science University

complications revisions
Complications: Revisions
  • Provider error
    • Large gastric pouch
    • Incomplete gastric division
    • Incorrect limbs
complications revisions1
Complications: Revisions
  • Patient and/or provider factors
    • Marginal ulcer
    • Stricture
    • Intestinal obstruction
complications revisions2
Complications: Revisions
  • Poor weight loss or regain
    • Anatomic factor
      • Gastric pouch size
      • Dilated gastrojejunostomy
      • Gastrogastric fistula
    • Patient factor
      • Operative anatomy as expected
marginal ulcer
Marginal Ulcer
  • Evaluation
    • Endoscopy
    • UGI
  • Intraoperative endoscopy
    • Define pouch
    • Confirm resection
    • Test anastomosis
  • ± Vagotomy
background
Background
  • Revisional bariatric surgery
    • Indications:
      • Side effects or complications of prior bariatric surgery
      • Inadequate weight loss
    • Higher morbidity than with first time procedures
slide7

UWashington/

VMason

NRI/UND

OHSU/

Legacy

Sacramento

Bariatric

GSPH

Columbia/

Cornell

UPMC

NIDDK/

ORWH

ECU

Clinical Center

Data Coordinating Center

NIDDK / ORWH

slide8
Aim
  • To determine independent risk factors for adverse outcome in patients undergoing revisional bariatric surgery
  • To compare the outcome between first-time and revisional bariatric cases
slide9

LABS-1

Total 5069 patients/operations

30 Second stage procedures

6 Other secondary obesity procedures

5033 Primary, revisional or reversal operations

1230 Adjustable gastric banding

3803 stapled bariatric procedures

1 patient underwent 2 separate procedures: a revision followed by a reversal; The reversal was excluded from the analysis

3802 patients/operations

3577 primary procedures

225 revision/reversal procedures

data definitions
Data definitions
  • Composite endpoint (CE)
    • Death
    • Deep venous thrombosis (DVT) or venothromboembolism (VTE)
    • Re-intervention with percutaneous, endoscopic or operative techniques
    • Failure to discharge within 30-days of surgery
statistical analysis
Statistical Analysis
  • Characteristics across subgroups:
    • Categorical variables:
      • Pearson’s chi-square test
    • Continuous:
      • Kruskal-Wallis test
  • 30-day adverse outcomes:
    • Fisher’s exact test
  • Association between baseline patient characteristics and the odds of 30-day adverse outcome :
    • Multivariable generalized linear logistic regression models
revisional vs primary
Revisional vs. Primary

Unadjusted Odds of CE is more than twice high for revisional surgeries compared to primary surgeries (OR = 2.4, 95% CI 1.6-3.6)

revisional vs primary1
Revisional vs. Primary

Adjusted for important comorbidities and other patient characteristics, odds of CE was more than twice as high for revisional surgeries compared to primary surgeries (OR = 2.3, 95% CI 1.5-3.8)

conclusions
Conclusions
  • Revisional bariatric surgery can be performed without substantial mortality but with a greater incidence of adverse outcome compared to primary surgery
acknowledgments
Acknowledgments

This clinical study was a cooperative agreement funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Grant numbers: DCC -U01 DK066557; Columbia-Presbyterian - U01-DK66667; University of Washington - U01-DK66568 (in collaboration with GCRC, Grant M01RR-00037); Neuropsychiatric Research Institute - U01-DK66471; East Carolina University – U01-DK66526; University of Pittsburgh Medical Center – U01-DK66585; Oregon Health & Science University – U01-DK66555.

The authors thank the LABS study participants for their contributions.