Five Year Trends in the Utilization of Robotic Bariatric Surgery Procedures,United States 2015–2019

Purpose

Robotic approaches have been steadily replacing laparoscopic approaches in metabolic and bariatric surgeries (MBS); however, their superiority has not been rigorously evaluated. The main goal of the study was to evaluate the 5-year utilization trends of robotic MBS and to compare to laparoscopic outcomes.

Methods

Retrospective analysis of 2015–2019 MBSAQIP data. Kruskal-Wallis test/Wilcoxon and Fisher’s exact/chi-square were used to compare continuous and categorical variables, respectively. Generalized linear models were used to compare surgery outcomes.

Results

The use of robotic MBS increased from 6.2% in 2015 to 13.5% in 2019 (N= 775,258). Robotic MBS patients had significantly higher age, BMI, and likelihood of 12 diseases compared to laparoscopic patients. After adjustment, robotic MBS patients showed higher 30-day interventions and 30-day readmissions alongside longer surgery time (26–38 min).

Conclusion

Robotic MBS shows higher intervention and readmission even after controlling for cofounding variables.

Graphical Abstract

     

Drug-Induced Lung Diseases: Most Common Reaction Patterns and Corresponding High-Resolution CT Manifestations

Drug-induced lung disease is an increasingly common cause of morbidity and mortality. The diagnosis is based on clinical history and consistent radiologic findings. Lung biopsy is performed in a small percentage of cases. High-resolution CT may demonstrate parenchymal abnormalities in patients with normal radiographs and provides a better depiction of the pattern and distribution of findings. Knowledge of the most common high-resolution CT manifestations and the corresponding histologic patterns is important for early recognition and proper management of drug-induced lung disease.     

Chorioallantoic membrane angiogenesis model for tissue engineering: a new twist on a classic model

Tissue-engineering (TE) applications include the isolation, culture, and seeding of cells into a suitable matrix or scaffold before in vivo transplantation. After transplantation, vascularization of the scaffold is a principal limiting factor for cell viability for the first 6-8 days posttransplantation. A model for systematic analysis of this process has been developed. Fertilized White Leghorn eggs were incubated (at 37.8 degrees C in 60% relative humidity) and opened on day 3 of incubation. Preadipocyte-seeded fibrin constructs were implanted in a specially designed plastic cylinder and placed through the opening on the surface of the chorioallantoic membrane (CAM) on day 8 of incubation. Vascularization of the constructs by chorioallantoic blood vessels was assessed for up to 8 days posttransplantation. The survival rate for embryos receiving transplanted constructs was about 90%. Histology confirmed transplant cell viability at day 4 posttransplantation and vascularization of the constructs by avian endothelial cells began at this time. A new in vivo model to study the effect of angiogenesis in TE constructs, including assessments of viability, proliferation, and differentiation of transplanted cells and biomaterial properties, is presented. Advantages include easy access to the vascular network of the CAM, lack of immunocompetence, low costs, and avoidance of animal experiments.     

Developmental foundations of externalizing problems in young children: the role of effortful control

Examined associations between effortful control temperament and externalizing problems in 220 3-year-old boys and girls, controlling for co-occurring cognitive and social risk factors. We also considered possible additive and/or interactive contributions of child dispositional anger and psychosocial adversity, and whether relations between effortful control and early externalizing problems were moderated by child gender. Individual differences in children's effortful control abilities, assessed using behavioral and parent rating measures, were negatively associated with child externalizing problems reported by mothers, fathers, and preschool teachers. These associations were not overshadowed by other cognitive or social risk factors, or by other relevant child temperament traits such as proneness to irritability. Further analyses revealed that associations between externalizing problem behavior and effortful control were specific to components of child problem behavior indexing impulsive-inattentive symptoms. Thus, children's effortful control skills were important correlates of children's early disruptive behavior, a finding that may provide insight into the developmental origins of chronic behavioral maladjustment.     

Liposomal Bupivacaine Versus Bupivacaine/Epinephrine Intercostal Nerve Block as Part of an Enhanced Recovery After Thoracic Surgery (ERATS) Care Pathway for Robotic Thoracic Surgery

ObjectivesTo examine how postoperative pain control after robotic thoracoscopic surgery varies with liposomal bupivacaine (LipoB) versus 0.5% bupivacaine/1:200,000 epinephrine (Bupi/Epi) intercostal nerve blocks within the context of an enhanced recovery after thoracic surgery (ERATS) protocol.DesignA retrospective analysis of a prospectively maintained database of patients undergoing robotic thoracoscopic procedures between September 1, 2018 and October 31, 2019 was conducted.SettingUniversity of Miami, single-institutional.ParticipantsPatients.InterventionsTwo hundred fifty-two patients had either LipoB intercostal nerve blocks (n = 129) or Bupi/Epi intercostal nerve blocks (n = 123) when undergoing robotic thoracic surgery.Measurements and Main ResultsComparative analysis of patient-reported pain levels, in-hospital and post-discharge opioid requirements, 90-day operative complications, length of hospital stay, and hospital costs was performed. Data were stratified to either anatomic lung resection or pulmonary wedge resection/mediastinal-pleural procedures. Bupi/Epi patients reported significantly more acute postoperative pain than LipoB patients, which correlated with higher in-hospital and post-discharge opioid requirements. There were no differences in postoperative complications, length of hospital stay, or hospital costs between the two groups.ConclusionsAs part of an ERATS protocol, infiltration of intercostal spaces and surgical wounds with LipoB for robotic thoracoscopic procedures afforded better postoperative subjective pain control and decreased opioid requirements without an increase in hospital costs as compared with use of Bupi/Epi.     

Clinical specialization programs for dietitians: a needs assessment

This needs assessment was conducted to identify the perceived need for advancement and specialization through practicum programs in clinical dietetics. A questionnaire was developed and validated through a pilot study. It was mailed to a randomized sample of 950 dietitians (52%) registered with the ODA. Fifty two per cent responded, representing 27% of ODA members. Of those surveyed 89% were currently employed. The most current area of practice was clinical nutrition (55%) followed by foodservice (22%) and community nutrition (14%). Seventy two per cent of the respondents identified that they would consider enrolling in a specialized practicum. Most cited reasons for enrolling were increased knowledge/expertise (44%) and increased professional profile (25%). Areas of greatest interest were: nutrition assessment (9%), critical care/nutrition support (8%) and gerontology (7.5%). Sixty two per cent preferred the program to be offered part-time, 27% full-time and 9% were impartial. The most frequently cited length and cost per week for the program within specified part or full-time categories was: two weeks full-time (36.5%) at S200-299.00 (33%), four weeks full-time (25%) at S100-199.00 (31%) and two weeks part or full-time (23.5%) at S200-299.00 (57%). Desired ODA regions for program availability were: Toronto (34%), Kitchener/Waterloo/Hamilton (17.5%) and London (14%). Lastly, 92% of the respondents felt the program should be CDA and ODA approved and continuing education points be provided. These results indicate that dietitians are interested in pursuing professional self-development through specialized practicums.