Psychometric Evaluation of Disordered Eating Measures in Bariatric Surgery Candidates

Introduction

Assessment of disordered eating is common in bariatric surgery candidates, yet psychometric properties of disordered eating measures in this population are largely unknown.

Methods

Measures were completed by 405 adult bariatric surgery candidates at pre-surgical consultation. Fit of the original scale structures was tested using confirmatory factor analysis (CFA) and alternative factor solutions were generated using exploratory factor analysis (EFA). Reliability (internal consistency), construct validity (convergent and divergent) and criterion validity (with the EDE as criterion) were assessed.

Materials

The measures prioritised for evaluation are the following: Eating Disorder Examination Questionnaire (EDE-Q; n?=?405), Three-Factor Eating Questionnaire (TFEQ; n?=?405), Questionnaire of Eating and Weight Patterns Revised (QEWP-R; n?=?204), Clinical Impairment Assessment (CIA; n?=?204) and the Eating Disorder Examination clinical interview (EDE; n?=?131).

Results

CFA revealed adequate fit for only the CIA in its current form (CFI?=?0.925, RMSEA?=?0.096). EFA produced revised scales with improved reliability for the EDE, EDE-Q and TFEQ. Reliability of revised subscales was improved (original scales α?=?0.43–0.82; revised scales α?=?0.67–0.93). Correlational analyses of the CIA and revised versions of remaining scales with measures of psychological wellbeing and impairment revealed adequate convergent validity. All measures differentiated an EDE-classified disordered eating group from a non-disordered eating group (criterion validity). Diagnostic concordance between the EDE, EDE-Q and QEWP-R was low, and identification of disordered eating behaviours was inconsistent across measures.

Conclusions

Findings highlight the limitations of existing disordered eating questionnaires in bariatric surgery candidates. Results suggest revised assessments are required to overcome these limitations and ensure that measures informing clinical recommendations regarding patient care are reliable and valid.

     

A Randomized,Double-Blind,Placebo-Controlled Trial of Intravenous Acetaminophen on Hospital Length of Stay in Obese Individuals Undergoing Sleeve Gastrectomy

Background

Retrospective studies indicate that acetaminophen iv administration reduces hospital length of stay (LoS) and opiate consumption in patients undergoing bariatric surgery.

Objective

This study sought to determine whether using acetaminophen iv in morbidly obese subjects undergoing sleeve gastrectomy decreased LoS and total hospital charges as compared to patients receiving saline placebo.

Setting

Single-center university hospital

Methods

Using a randomized, double-blind, placebo-controlled design, subjects were assigned to receive either acetaminophen iv (group A) or saline placebo iv (group P). Data were collected between Jan 1 and Dec 31, 2016. Group A received acetaminophen every 6 h for a total of four doses. The first dose was administered following the induction of general anesthesia; group P received saline iv on the same schedule. Anesthetic management and prophylactic antiemetic regimen were standardized in all subjects. Postoperative pain management consisted of hydromorphone via patient-controlled infusion pump. Primary outcomes include hospital LoS and associated hospital costs. Secondary outcomes include patient satisfaction and postoperative nausea and pain scores.

Results

Subject demographics (n?=?127) and intraoperative management were similar in the two groups. Across all subjects, median hospital LoS in group A (n?=?63) was 1.87 vs. 1.97 days in group P (n?=?64) (p?=?0.03, Wilcoxon rank-sum test). Postoperatively, daily quality-of-recovery (QoR-15) scores, narcotic consumption, and the use of rescue antiemetics were not significantly different between groups. Median hospital costs were as follows: group A, $12,885 vs. group P, $12,977 (n?=?64).

Conclusions

Acetaminophen iv may reduce hospital LoS in subjects undergoing sleeve gastrectomy.

     

Examining Nutrition Knowledge of Bariatric Surgery Patients: What Happens to Dietary Knowledge over Time?

Background

Nutrition education is a standard of care in bariatric surgery clinical practice guidelines. Despite its known importance, no studies have documented the trajectory of nutrition knowledge over the course of the bariatric surgery process. Primary objectives included determining changes in bariatric surgery nutrition knowledge scores from the pre-surgical phase to 1-month post-surgical intervention and investigating the impact of time on nutrition education retention in bariatric patients. Secondary objectives focused on the relationship between patients’ pre-operative anxiety and depression on nutrition knowledge retention.

Methods

Prior to data collection, patients attended a nutrition education class and met with a registered dietitian. One hundred and nineteen consented patients eligible for bariatric surgery completed a nutrition knowledge questionnaire, Eating After Bariatric Surgery (EABS) prior to and 1 month following bariatric surgery.

Results

Analyses revealed (1) patients’ nutrition knowledge (measured by EABS) significantly increased from the pre-operative phase (M?=?46.9; SD?=?14.4) to the post-operative phase ((M?=?56.9; SD?=?14.1), t(118)?=??8.01, p?<?.001); (2) time between the nutrition education class and patients’ surgery significantly impacted knowledge retained; (3) patients with higher pre-operative levels of depression and anxiety had significantly lower post-operative nutrition knowledge; and (4) gender differences in terms of patients’ nutrition knowledge.

Conclusions

This study confirmed that dietary knowledge significantly improves following surgical intervention. Furthermore, increased time in between receiving nutrition knowledge and surgery resulted in less retained knowledge 1-month post-op. Future education interventions for bariatric surgery programs should focus on addressing these factors to optimize patient knowledge and information retention after surgery.

     

Bariatric Surgery in Patients with Cirrhosis and Portal Hypertension

Introduction

Studies on bariatric patients with cirrhosis and portal hypertension are limited. The aim of this study was to review our experience in cirrhotic patients with portal hypertension who had bariatric surgery.

Method

All cirrhotic patients with portal hypertension who underwent laparoscopic bariatric surgery, from 2007 to 2017, were retrospectively reviewed.

Results

Thirteen patients were included; eight (62%) were female. The median age was 54 years (interquartile range, IQR 49–60) and median BMI was 48 kg/m² (IQR 43–55). Portal hypertension was diagnosed based on endoscopy (n?=?5), imaging studies (n?=?3), intraoperative increased collateral circulation (n?=?2), and endoscopy and imaging studies (n?=?3). The bariatric procedures included sleeve gastrectomy (n?=?10, 77%) and Roux-en-Y gastric bypass (n?=?3, 23%). The median length of hospital stay was 3 days (IQR 2–4). Three 30-day complications occurred including wound infection (n?=?1), intra-abdominal hematoma (n?=?1), and subcutaneous hematoma (n?=?1). No intraoperative or 30-day mortalities. There were 11 patients (85%) at 1-year follow-up and 9 patients (69%) at 2-year follow-up. At 2 years, the median percentage of excess weight loss (EWL) and total weight loss (TWL) were 49 and 25%, respectively. There was significant improvement in diabetes (100%), dyslipidemia (100%), and hypertension (50%) at 2 years after surgery.

Conclusion

Bariatric surgery in selected cirrhotic patients with portal hypertension is relatively safe and effective.

     

Bariatric Surgery Improves Hyperandrogenism,Menstrual Irregularities,and Metabolic Dysfunction Among Women with Polycystic Ovary Syndrome (PCOS)

Objective

To characterize the impact of bariatric surgery on reproductive and metabolic features common to polycystic ovary syndrome (PCOS) and to assess the relevance of preoperative evaluations in predicting likelihood of benefit from surgery.

Methods

A retrospective chart review of records from 930 women who had undergone bariatric surgery at the Cleveland Clinic Foundation from 2009 to 2014 was completed. Cases of PCOS were identified from ICD coding and healthy women with pelvic ultrasound evaluations were identified using Healthcare Common Procedure Coding System coding. Pre- and postoperative anthropometric evaluations, menstrual cyclicity, ovarian volume (OV) as well as markers of hyperandrogenism, dyslipidemia, and dysglycemia were evaluated.

Results

Forty-four women with PCOS and 65 controls were evaluated. Both PCOS and non-PCOS had significant reductions in body mass index (BMI) and markers of dyslipidemia postoperatively (p?<?0.05). PCOS had significant reductions in androgen levels (p?<?0.05) and percent meeting criteria for hyperandrogenism and irregular menses (p?<?0.05). OV did not significantly decline in either group postoperatively. Among PCOS, independent of preoperative BMI and age, preoperative OV associated with change in hemoglobin A1c (β 95% (confidence interval) 0.202 (0.011–0.393), p?=?0.04) and change in triglycerides (6.681 (1.028–12.334), p?=?0.03), and preoperative free testosterone associated with change in total cholesterol (3.744 (0.906–6.583), p?=?0.02) and change in non-HDL-C (3.125 (0.453–5.796), p?=?0.03).

Conclusions

Bariatric surgery improves key diagnostic features seen in women with PCOS and ovarian volume, and free testosterone may have utility in predicting likelihood of metabolic benefit from surgery.

     

Risk factors for complications after diverting ileostomy closure in patients who have undergone rectal cancer surgery

Purpose

To clarify the risk factors for complications after diverting ileostomy closure in patients who have undergone rectal cancer surgery.

Methods

The study group comprised 240 patients who underwent a diverting ileostomy at the time of lower anterior resection or internal anal sphincter resection, in our department, between 2004 and 2015. Univariate and multivariate analyses of 18 variables were performed to establish which of these are risk factors for postoperative complications.

Results

The most common complications were intestinal obstruction and wound infection. Univariate analysis showed that an age of 72 years or older (p?=?0.0028), an interval between surgery and closure of 6 months or longer (p?=?0.0049), and an operation time of 145 min or longer (p?=?0.0293) were significant risk factors for postoperative complications. Multivariate analysis showed that age (odds ratio, 3.4236; p?=?0.0025), the interval between surgery and closure (odds ratio, 3.4780; p?=?0.0039), and operation time (odds 2.5179; p?=?0.0260) were independent risk factors.

Conclusions

Age, interval between surgery and closure, and operation time were independent risk factors for postoperative complications after diverting ileostomy closure. Thus, temporary ileostomy closure should be performed within 6 months after surgery for rectal cancer.

     

The Correlation Between Obesity-Related Diseases and Non-alcoholic Fatty Liver Disease in Women in the Pre-operative Evaluation for Bariatric Surgery Assessed by Transient Hepatic Elastography

Background

Non-alcoholic fatty liver disease (NAFLD) is a common, severe disease in obese patients. However, NAFLD is usually underestimated by ultrasonography. Liver biopsy is not routinely done in bariatric surgery or during the follow-up. This study therefore examined the correlation between metabolic syndrome and NAFLD in morbidly obese patients based on an assessment using transient hepatic elastography (THE).

Material and Methods

This study involved 50 female patients in the pre-operative phase for bariatric surgery. Before surgery, we collected clinical, laboratory, and anthropometric variables. THE measurements were obtained using a FibroScan® device (Echosens, Paris, France), and steatosis was quantified using Controlled Attenuation Parameter software (CAP). Statistical analyses were done using linear correlation and the Kruskal-Wallis test.

Results

The mean of THE and CAP values were 7.56?±?4.78 kPa and 279.94?±?45.69 dB/m, respectively, and there was a significant linear correlation between the two measurements (r?=?0.651; p?<?0.001). The numbers of metabolic syndrome parameters did not influence the THE (p?=?0.436) or CAP (p?=?0.422) values. HbA1c and HOMA-IR showed a strong linear correlation with CAP (r?=?0.643, p?=?0.013 and r?=?0.668, p?=?0.009, respectively) and a tendency to some linear correlation with THE (r?=?0.500, p?=?0.05 and r?=?0.500, p?=?0.002, respectively).

Conclusion

Morbidly obese women submitted to FibroScan® presented a high prevalence of severe steatosis and advanced fibrosis in our sample. Insulin resistance parameters were correlated with steatosis, but less with fibrosis.

     

Outcomes of Sleeve Gastrectomy in Septuagenarians

Background

Few previous studies have assessed the safety of bariatric surgery in septuagenarians.

Methods

A retrospective analysis of all patients 70 years or older who underwent laparoscopic sleeve gastrectomy at our institution between 2012 and 2017 was performed. This group was compared to a matched cohort of younger LSG patients (18–50 years) who were operated during the same time period.

Results

Thirty septuagenarian LSG patients were compared to 60 younger patients. Gender distribution, preoperative weight, and preoperative body mass index (BMI) were comparable, although patients in the older age group suffered from more preoperative comorbidities (100 vs. 51.7%, p?<?0.001). Operative time was longer (77.2 vs. 57.3 min, p?=?0.005) and more hiatal hernias were repaired (46.7 vs. 8.3%, p?<?0.001) in the older age group. Intraoperative complications occurred more in the older age group (6.7 vs. 0%, p?=?0.04) but the overall complication rate (13.3 vs. 5.0%, p?=?0.17) and the postoperative complication rate (10.0 vs. 5.0%, p?=?0.38) were comparable. After a mean follow-up period of 31.3 and 33.5 months, the percentage of total body weight loss was 24.6 and 28.3% for the older and younger patients, respectively (p?=?0.11). Rates of improvement/remission of comorbidities were comparable between the groups.

Conclusions

In a carefully selected group of severely obese patients ≥?70 years old, LSG may be safe, with acceptable postoperative complication rates, weight loss results, and improvement in comorbidities.

     

Accelerometer-Measured Versus Self-Reported Physical Activity Levels and Sedentary Behavior in Women Before and 9 Months After Roux-en-Y Gastric Bypass

Background

Roux-en-Y gastric bypass (RYGB) patients report significant pre- to post-surgery increases in physical activity (PA). Conversely, objectively assessed PA does not increase after RYGB. The aim of the study was to compare self-reported and accelerometer-measured changes in moderate-to-vigorous PA (MVPA) and exercise from pre- to post-surgery, in women undergoing RYGB.

Methods

Forty-three women with an average pre-surgery body mass index of 39.2 kg/m2 (SD 3.1) were recruited at Swedish hospitals. PA was measured by the Actigraph GT3X+ and by a previously validated short PA questionnaire, at home visits 3 months before and 9 months after surgery, thus limiting seasonal effects.

Results

Self-reported time spent in exercise increased with 75 % and time spent in MVPA increased with 51 %, whereas accelerometer-assessed time spent in exercise increased with 0.9 % and time spent in MVPA increased with 2.1 %, from before to after surgery. Correlations comparing accelerometers with the questionnaire were 0.35 (P?=?0.02) for MVPA and 0.13 (P?=?0.4) for exercise before RYGB and 0.52 (P?≤?0.001) for MVPA and 0.12 (P?=?0.4) for exercise after RYGB.

Conclusions

Pre- to post-RYGB surgery increases in self-reported PA were not confirmed by accelerometer-measured PA. Thus, health care workers should use objective measures of PA in patients undergoing RYGB, in order to assess whether patients achieve sufficient levels of PA.

     

The Effect of Bariatric Surgery on Urinary Incontinence in Women

Background

Little is known regarding the effect of bariatric surgery on urinary incontinence.

Methods

Between September 2008 and November 2014, 240 female patients underwent bariatric surgery.

Results

The prevalence of urinary incontinence preoperatively was 45 % (108). Eighty-two (76 %) completed urinary function questionnaires pre-operatively and post-operatively. Fifty-seven (70 %) underwent laparoscopic gastric bypass, twenty-four (29 %) underwent sleeve gastrectomy and one underwent a banding procedure. Thirty-one (38 %) reported leaking on sneezing or coughing—stress urinary incontinence (SUI). Thirteen (16 %) complained of leaking before reaching the toilet—overactive bladder syndrome (OAB). The remaining thirty-eight (46 %) reported mixed symptoms. The mean pre-operative weight and BMI were 133 (18)?kg and 50 (SD?=?6.2)?kg/m² respectively. The mean post-operative BMI drop was 16 (SD?=?5.2)?kg/m². Preoperatively, 61 (75 %) reported moderate to very severe urinary incontinence compared to 30 (37 %) post-operatively (χ ²?=?3.24.67, p?=?0.050). Twenty-seven (33 %) patients reported complete resolution of their urinary incontinence. Fifty-one (62 %) patients required incontinence pads on a daily basis pre-operatively, compared to 35 (43 %) post-operatively (χ ²?=?22.211.6, p?=?0.00). The mean International Consultation on Incontinence Questionnaire- Urinary Incontinence short form (ICIQ-UI SF) score was 9.3 (SD?=?4.4) pre-operatively compared to 4.9 (SD?=?5.3) post-operatively (t?=?7.2, p?=?0.000). The improvement score post-operatively was 8 (SD?=?3). A significant difference in the ICIQ-UI SF was identified between OAB and SUI groups when adjusting for age, number of children, type of delivery and pre-op BMI (t?=?1.98, p?=?0.05).

Conclusion

Bariatric surgery results in a clinically significant improvement in urinary incontinence. However, this is not proportional to pre-operative BMI, weight loss, age, parity and mode of delivery.

     

Translation and validation of ICIQ-FLUTS for Tamil-speaking women

Aims

Research in to lower urinary tract symptoms (LUTS) in women in South Asia is hampered by lack of validated tools. Our aim was to validate the International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) from English to Tamil.

Method

After translation to Tamil, a validation study was carried out among women attending the gynecology clinic at District General Hospital-Mannar.

Results

Content validity assessed by the level of missing data was <2%. Construct validity was assessed by the ability of the questionnaire to identify patients with incontinence (n?=?45) from controls (n?=?93) using the incontinence score [patients?=?7.7 standard deviation (SD)?=?4.7, controls?=?1.4 SD?=?2.2, p?<?0.001] and those with symptomatic anterior wall prolapse (n?=?16) from controls (n?=?93) using voiding symptoms score (patients?=?4.8 SD?=?2.3, controls?=?0.3 SD?=?0.8, p?<?0.001). Internal consistency was assessed using Cronbach’s coefficient alpha score [0.80 (0.77–0.81)]. Test–retest reliability assessed by weighted kappa (κ) ranged from 0.73 to 0.87. Patients with incontinence (n?=?30, pretreatment incontinence score?=?7.9, SD?=?4.9 versus posttreatment incontinence score?=?3.3, SD?=?3.1) and symptomatic anterior wall prolapse (n?=?14, preoperative voiding symptoms score?=?4.9 SD?=?2.5 versus postoperative voiding symptoms score?=?0.9 SD?=?1.5) showed an improvement with treatment (Wilcoxon matched-–pairs signed-rank test p?<?0.001 and p?<?0.01, respectively). An incontinence score?≥?3 (sensitivity?=?86.7%, specificity?=?78.4%) and a voiding symptoms score?≥?3 (sensitivity?=?87.5%, specificity?=?96.2%) detected any form of incontinence and symptomatic anterior wall prolapse, respectively.

Conclusion

Tamil translation of ICIQ-FLUTS retained the psychometric properties of the original English questionnaire and will be an invaluable tool to detect LUTS among Tamil-speaking women.

     

Predictors for Adherence to Multidisciplinary Follow-Up Care after Sleeve Gastrectomy

Introduction

A considerable proportion of patients who undergo bariatric surgeries (BS) do not attend routine postoperative follow-up despite recommendations for such. Data are sparse regarding the various aspects of patient adherence to consultations following sleeve gastrectomy (SG).

Objectives

To examine predictors of adherence to SG follow-up, reasons for attrition from follow-up, and the relationship between adherence to follow-up and weight loss results.

Methods

A retrospective cohort study was performed with a mean follow-up of 3 years. Data were collected from electronic medical records and telephone questionnaires. Adherence was defined both as a numerical variable (ranking 0–9 according to the number of pre-scheduled postoperative visits) and as a dichotomous variable (adherent and non-adherent groups).

Results

Of 178 patients, 46.63% were defined as “adherent,” according to the dichotomous definition. Compared to the “non-adherent group,” patients in the “adherent group” more regularly used vitamin D after the surgery, had fewer rehospitalizations, and reported a lower intake of sweetened beverages. The main reasons for attrition were work-related and difficulties in mobility. Adherence to postoperative follow-up was not found to be correlated to weight loss. Older age (OR?=?1.04; p?=?0.026) and postoperative side effects (OR?=?2.33; p?=?0.035) were found to be positive predictors for adherence, whereas rehospitalizations (OR?=?0.08; p?=?0.028) and ethnical minority status were negative predictors (OR?=?0.42; p?=?0.019).

Conclusion

Adherence to postoperative follow-up was found to be associated with positive lifestyle behaviors; however, no correlation was found to mid-term weight loss outcomes.

     

Development of De Novo Diabetes in Long-Term Follow-up After Bariatric Surgery

Introduction

While bariatric surgery leads to significant prevention and improvement of type 2 diabetes, patients may rarely develop diabetes after bariatric surgery. The aim of this study was to determine the incidence and the characteristic of new-onset diabetes after bariatric surgery over a 17-year period at our institution.

Methods

Non-diabetic patients who underwent bariatric surgery at a single academic center (1997–2013) and had a postoperative glycated hemoglobin (HbA1c) ≥?6.5%, fasting blood glucose (FBG) ≥?126 mg/dl, or positive glucose tolerance test were identified and studied.

Results

Out of 2263 non-diabetic patients at the time of bariatric surgery, 11 patients had new-onset diabetes in the median follow-up time of 9 years (interquartile range [IQR], 4–12). Bariatric procedures performed were Roux-en-Y gastric bypass (n?=?7), adjustable gastric banding (n?=?3), and sleeve gastrectomy (n?=?1). The median interval between surgery and diagnosis of diabetes was 6 years (IQR, 2–9). At the last follow-up, the median HbA1c and FBG values were 6.3% (IQR, 6.1–6.5) and 95 mg/dl (IQR, 85–122), respectively. Possible etiologic factors leading to diabetes were weight regain to baseline (n?=?6, 55%), steroid-induced after renal transplantation (n?=?1), pancreatic insufficiency after pancreatitis (n?=?1), and unknown (n?=?3).

Conclusion

De novo diabetes after bariatric surgery is rare with an incidence of 0.4% based on our cohort. Weight regain was common (>?50%) in patients who developed new-onset diabetes suggesting recurrent severe obesity as a potential etiologic factor. All patients had good glycemic control (HbA1c ≤?7%) in the long-term postoperative follow-up.

     

A systematic review of outcome and outcome-measure reporting in randomised trials evaluating surgical interventions for anterior-compartment vaginal prolapse: a call to action to develop a core outcome set

Introduction

We assessed outcome and outcome-measure reporting in randomised controlled trials evaluating surgical interventions for anterior-compartment vaginal prolapse and explored the relationships between outcome reporting quality with journal impact factor, year of publication, and methodological quality.

Methods

We searched the bibliographical databases from inception to October 2017. Two researchers independently selected studies and assessed study characteristics, methodological quality (Jadad criteria; range 1–5), and outcome reporting quality Management of Otitis Media with Effusion in Cleft Palate (MOMENT) criteria; range 1–6], and extracted relevant data. We used a multivariate linear regression to assess associations between outcome reporting quality and other variables.

Results

Eighty publications reporting data from 10,924 participants were included. Seventeen different surgical interventions were evaluated. One hundred different outcomes and 112 outcome measures were reported. Outcomes were inconsistently reported across trials; for example, 43 trials reported anatomical treatment success rates (12 outcome measures), 25 trials reported quality of life (15 outcome measures) and eight trials reported postoperative pain (seven outcome measures). Multivariate linear regression demonstrated a relationship between outcome reporting quality with methodological quality (β?=?0.412; P?=?0.018). No relationship was demonstrated between outcome reporting quality with impact factor (β?=?0.078; P?=?0.306), year of publication (β?=?0.149; P?=?0.295), study size (β?=?0.008; P?=?0.961) and commercial funding (β?=??0.013; P?=?0.918).

Conclusions

Anterior-compartment vaginal prolapse trials report many different outcomes and outcome measures and often neglect to report important safety outcomes. Developing, disseminating and implementing a core outcome set will help address these issues.

     

Bariatric Surgery in Patients on Chronic Anticoagulation Therapy

Background

Perioperative management of chronically anti-coagulated patients undergoing bariatric surgery requires a balance of managing hemorrhagic and thromboembolic risks. The aim of this study is to evaluate the incidence of hemorrhagic complications and their management in chronically anticoagulated (CAT) patients undergoing bariatric surgery.

Methods

A retrospective review of CAT patients undergoing bariatric surgery at an academic center from 2008 to 2015 was studied.

Results

A total of 153 patients on CAT underwent surgery [Roux-en-Y gastric bypass (n?=?79), sleeve gastrectomy (n?=?63), and adjustable gastric banding (n?=?11)] during the study period: 85 patients (55%) were females; median age was 56 years (interquartile range [IQR] 49–64), and median BMI was 49 kg/m² (IQR 43–56). The most common indications for CAT were venous thromboembolism (n?=?87) and atrial fibrillation (n?=?83). Median duration of procedure and estimated intraoperative blood loss was 150 min (IQR 118–177) and 50 ml (IQR 25–75), respectively. Thirty-day postoperative complications were reported in 33 patients (21.6%) including postoperative bleeding (n?=?19), anastomotic leak (n?=?3), and pulmonary embolism (n?=?1). Nineteen patients (12%) with early postoperative bleeding were further categorized to intra-abdominal (n?=?10), intraluminal (n?=?6), and at the port site or abdominal wall (n?=?3). All-cause readmissions within 30 days of surgery occurred in 19 patients (12%). There was no 30-day mortality.

Conclusion

In our experience, patients who require chronic anticoagulation medication are higher than average risk for postoperative complications and all-cause readmission rates. Careful surgical technique and close attention to postoperative anticoagulation protocols are essential to decrease perioperative risk in this high-risk cohort.

     

LBP rs2232618 polymorphism contributes to risk of sepsis after trauma

Background

Previous study revealed that rs2232618 polymorphism (Phe436Leu) within LBP gene is a functional variant and associated with susceptibility of sepsis in traumatic patients. Our aim was to confirm the reported association by enlarging the population sample size and perform a meta-analysis to find additional evidence.

Methods

Traumatic patients from Southwest (n?=?1296) and Southeast (n?=?445) of China were enrolled in our study. After genotyping, the relationship between rs2232618 and the risk of sepsis was analyzed. Furthermore, we proceeded with a comprehensive literature search and meta-analysis to determine whether the rs2232618 polymorphism conferred susceptibility to sepsis.

Results

Significance correlation was observed between rs2232618 and risk of sepsis in Southwest patients (P?=?0.002 for the dominant model, P?=?0.006 for the recessive model). The association was confirmed in Southeast cohort (P?=?0.005 for the dominant model) and overall combined cohorts (P =?4.5?×?10^?4, P?=?0.041 for the dominant and recessive model). Multiple logistical regression analyses suggested that rs2232618 polymorphism was related to higher risk of sepsis (OR?=?1.77, 95% CI?=?1.26–2.48, P?=?0.001 in Southwest patients; OR?=?2.11, 95% CI?=?1.24–3.58, P?=?0.006 in Southeast cohort; OR?=?1.54, 95% CI?=?1.34–2.08, P?=?0.006 in overall cohort). Furthermore, meta-analysis of four studies (including the present study) confirmed that rs2232618 within LBP increased the risk of sepsis (OR?=?1.75, P?<?0.001 for the dominant model; OR?=?6.08, P?=?0.003 for the recessive model; OR?=?2.72, P?<?0.001 for the allelic model).

Conclusions

The results from our replication study and meta-analysis provided firm evidence that rs2232618T allele significantly increased the risk of sepsis.

     

Surgical treatment of symptomatic cerebral cavernous malformations in eloquent brain regions

Background

Despite the increased risk of hemorrhage and deteriorating neurological function of once-bled cerebral cavernous malformations (CM), the management of eloquently located CMs remains controversial.

Methods

All eloquently located CMs (n?=?45) surgically treated between 03/2006 and 04/2011 in our department were consecutively evaluated. Eloquence was characterized according to Spetzler and Martin's definition. The following locations were approached: brainstem, n?=?16; sensorimotor, n?=?8; visual pathway, n?=?7; cerebellum (deep nuclei and peduncles), n?=?7; basal ganglia, n?=?4, and language, n?=?3. Follow-up data was available for 41 patients (91 %) with a median interval of 14 months. Outcomes were evaluated according to the Glasgow outcome and the modified Rankin scale.

Results

Immediately after surgery, 47 % (n?=?21) had a new deficit. At follow-up, 80 % (n?=?36) recovered to at least preoperative status or were better than before surgery, 9 % (n?=?4) exhibited a slight, and 7 % (n?=?3) had a moderate neurological impairment. Only two cases (4 %) with a new permanent severe deficit were observed, both related to dorsal brainstem surgery. The outcome after the surgery of otherwise located brainstem CMs was as beneficial as that for non-brainstem CMs. Patients with initially poor neurological performance fared worse than oligosymptomatic patients.

Conclusions

Despite the high postoperative transient morbidity, the majority improved profoundly during follow-ups. Compared with natural history, surgical treatment should be considered for all eloquent symptomatic CMs. Dorsal brainstem location and poor preoperative neurological status are associated with an increased postoperative morbidity.

     

Results of the treatment of first carpometacarpal joint osteoarthritis: trapeziectomy alone versus trapeziectomy associated with suspensionplasty

Backgrounds

The goal of this study was to compare trapeziectomy alone to trapeziectomy associated with a technique of suspensionplasty using the abductor pollicis longus with a minimum of 6 years of follow-up in the treatment of osteoarthritis of the first carpometacarpal joint.

Methods

Our series included 46 trapeziectomies in 35 patients, aged 69 years in average, among which 27 were women. In 27 cases group I, a trapeziectomy alone was performed, and in 19 cases group II, a trapeziectomy associated with an abductor pollicis longus suspensionplasty was performed.

Results

At the last follow-up, the difference between pre- and postoperative Quick DASH was ??36.104 in average in group I and ??38.877 in average in group II p?=?0.7717. The difference between pre- and postoperative pain was ??3.926 in average in group I and ??4.368 in average in group II p?=?0.35. The difference of pre- and postoperative thumb opposition was 0.630 in group I and 0.421 in group II p?=?0.3033. The average difference of pre- and postoperative key pinch was 0.389 in group I and 0.842 in group II p?=?0.3303. No complication was reported.

Conclusions

Our results suggest that it is unnecessary to perform a ligamentoplasty when a trapeziectomy is indicated.

     

Altmetric Versus Bibliometric Perspective Regarding Publication Impact and Force

Background

Bibliometric and Altmetric analyses highlight key publications, which have been considered to be the most influential in their field. The hypothesis was that highly cited articles would correlate positively with levels of evidence and Altmetric scores (AS) and rank.

Methods

Surgery as a search term was entered into Thomson Reuter’s Web of Science database to identify all English-language full articles. The 100 most cited articles were analysed by topic, journal, author, year, institution, and AS.

Results

By bibliometric criteria, eligible articles numbered 286,122 and the median (range) citation number was 574 (446–5746). The most cited article (Dindo et al.) classified surgical complications by severity score (5746 citations). Annals of Surgery published most articles and received most citations (26,457). The country and year with most publications were the USA (n?=?50) and 1999 (n?=?11). By Altmetric criteria, the article with the highest AS was by Bigelow et al. (AS?=?53, hypothermia’s role in cardiac surgery); Annals of Surgery published most articles, and the country and year with most publications were USA (n?=?4) and 2007 (n?=?3). Level-1-evidence articles numbered 13, but no correlation was found between evidence level and citation number (SCC 0.094, p?=?0.352) or AS (SCC?=?0.149, p?=?0.244). Median AS was 0 (0–53), and in articles published after the year 2000, AS was associated with citation number (r?=?0.461, p?=?0.001) and citation rate index (r?=?0.455, p?=?0.002). AS was not associated with journal impact factor (r?=?0.160, p?=?0.118).

Conclusion

Bibliometric and Altmetric analyses provide important but different perspectives regarding article impact, which are unrelated to evidence level.

     

Total arch replacement versus debranching thoracic endovascular aortic repair for aortic arch aneurysm: what indicates a high-risk patient for arch repair in octogenarians?

Objectives

This study aimed to reveal the differences in intermediate outcomes between TAR and d-TEVAR in octogenarians and to identify risk factors for adverse events after aortic arch repair in octogenarians.

Methods

We reviewed medical records of 125 patients aged?>?80 years who underwent surgical intervention for aortic aneurysm between 2008 and 2016. Of these, 60 underwent conventional TAR (43 men; age, 82?±?2.2 years) and 65 underwent d-TEVAR (49 men; age, 84?±?3.4 years).

Results

Freedom from all causes of mortality at 2 and 4 years was similar (80 and 66% in TAR, 80 and 51% in d-TEVAR, p?=?0.17). Freedom from aortic death at 2 and 4 years was similar (88 and 88% in TAR, 87 and 76% in d-TEVAR, p?=?0.86). Using Cox regression analysis, chronic obstructive pulmonary disease (COPD) [hazard ratio (HR), 6.0; p?=?0.008], malignancy (HR, 8.8; p?=?0.004), previous cardiac and thoracic aortic surgery (required median sternotomy) (HR, 65.9; p?=?0.012), perioperative stroke (HR, 12.6; p?=?0.012), and postoperative pneumonia (HR, 5.8; p?=?0.026) were identified as independent positive predictors of overall postoperative mortality for TAR, whereas neurological dysfunction (HR, 3.0; p?=?0.016) and perioperative stroke (HR, 12.1; p?=?0.023) were identified for d-TEVAR.

Conclusions

TAR in octogenarians with COPD and/or malignancy showed higher mortality rates; d-TEVAR is more appropriate in these situations. The prevention of perioperative stroke, which is related with poor prognosis in both the groups, is critical.