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1.
Marcelo W. Hinojosa J. Esteban Varela Brian R. Smith Fredrick Che Ninh T. Nguyen 《Journal of gastrointestinal surgery》2009,13(4):793-797
Background Hypertension is a well-recognized and treatable risk factor for coronary heart disease and is one of the most common comorbidities
associated with obesity. The aim of this study was to characterize the clinical outcome of a cohort of patients with documented
hypertension who underwent laparoscopic gastric bypass.
Methods Ninety-five obese patients with documented hypertension and being treated with antihypertensive medication(s) underwent laparoscopic
gastric bypass. Main outcome measures included length of hypertensive condition, changes in systolic and diastolic blood pressures,
and changes in antihypertensive medication(s) at follow-up.
Results There were 69 (72%) females with a mean preoperative body mass index of 47 kg/m2. The mean duration of hypertension was 73 ± 70 months. The mean excess body weight loss at 12 months was 66%. The mean systolic
blood pressure significantly decreased from 140 ± 17 mmHg preoperatively to 120 ± 18 mmHg at 12 months (p < 0.01). The mean diastolic blood pressure also significantly decreased from 80 ± 11 mmHg preoperatively to 71 ± 8 mmHg at
12 months (p < 0.01). At 12 months follow-up, 44 (46%) patients had complete resolution of hypertension while 18 (19%) patients had improvement.
Patients with complete resolution had a shorter duration of disease as compared to patients without resolution (53 vs. 95 months,
respectively, p = 0.01).
Conclusion Weight loss associated with laparoscopic gastric bypass substantially improves and/or resolves hypertension in the majority
of patients. Improvement of hypertension occurs as early as 1 month postoperatively and is more frequently in patients with
a shorter preoperative duration of disease.
Presented at the 3rd Annual Academic Clinical Congress of the Association of Academic Surgery, Huntington Beach, CA, February
13th 2008. 相似文献
2.
Current widespread application of laparoscopic techniques in Roux-en-Y gastric bypass (RYGBP) is making surgical safety an
increasingly important issue. We report one case that resulted in death due to postoperative fulminant acute pancreatitis
after laparoscopic RYGBP was performed when this procedure was still relatively new in China. The patient was a chronically
obese 19-year-old male. Weight loss medications had been ineffective, and preoperative body mass index was 40.7. Preoperative
examination revealed moderate steatohepatitis. Laparoscopic RYGBP (LRYGBP) was performed. Early manifestations of clinical
shock appeared 13 h after the laparoscopic surgery. A second laparoscopic examination showed small-vessel hemorrhage at the
posterior wall of the jejunojejunal anastomosis, with blood clot formation resulting in Roux limb and afferent loop obstruction.
Fulminant acute pancreatitis developed in the patient 18 h after the second surgery. The patient died 15 days later from systemic
multiorgan insufficiency. LRYGBP (postcolon) is a technically demanding procedure for surgeons who are not experienced in
this operation. In addition, surgical tolerance is reduced in morbidly obese patients. Therefore, special care should be taken
during surgery, and hemostasis must be achieved at all bleeding sites. Increased perioperative surveillance allows for early
detection and management of severe complications. 相似文献
3.
4.
Escalona A Boza C Muñoz R Pérez G Rayo S Crovari F Ibáñez L Guzmán S 《Obesity surgery》2008,18(1):47-51
Background Preoperative evaluation and treatment of biliary lithiasis in morbid obese patients who are candidates to bariatric surgery
raise a series of questions which to date has no clear consensus. The aim of this study was to evaluate the results of routine
preoperative abdominal ultrasonography and selective cholecystectomy comparing patients who underwent laparoscopic Roux-en-Y
gastric bypass (RYGBP) with and without simultaneous cholecystectomy.
Methods The prospective database of all the patients who underwent laparoscopic RYGBP in our institution was reviewed. The demographic
characteristics, comorbidities, operative time, hospital stay, and postoperative complications were analyzed.
Results From August 2001 to December 2006, 1,311 patients underwent laparoscopic RYGBP, 137 (10.4%) of them were excluded due to previous
cholecystectomy. In 128 (10.9%) of the remaining 1,174 patients, a cholecystectomy associated to laparoscopic RYGBP was performed.
The mean age was 38.5 ± 10.1 years, and 106 (82.8%) were women. The mean operative time in patients with and without simultaneous
cholecystectomy was 129.8 ± 45 and 108.5 ± 43 min, respectively (p < 0.001). The hospital stay was 3.6 ± 0.8 days in patients with simultaneous cholecystectomy and 4 ± 3 days in patients without
simultaneous cholecystectomy (p = 0.003). There were no deaths. Postoperative complications were observed in 9 (7%) and 73 (6.9%) patients with and without
simultaneous cholecystectomy respectively (p = NS). Postoperative complications were not related to the cholecystectomy.
Conclusion Cholecystectomy associated to laparoscopic RYGBP should be considered in all patients with preoperative ultrasound diagnosis
of cholelithiasis. 相似文献
5.
The laparoscopic Roux-en-Y gastric bypass (LRYGBP) is increasingly popular for the treatment of morbid obesity, although its postsurgical complications are often underestimated. We report the case of a 22-year-old morbidly obese woman who underwent a LRYGBP, which was rapidly complicated by portal venous thrombosis and severe neurological complications due to vitamin deficiencies. She presented rapid body weight loss with optic and peripheral neuropathy. Clinical chemistry results showed low transthyretin and micronutrient levels. Intravenous micronutrient infusion and cyclic nocturnal enteral tube feeding were needed to slowly improve gait and visual acuity. We then discuss (1) factors that could have contributed to the nutritional deficiencies and (2) the preventive management of these types of nutritional complications. Gastric bypass procedures can cause multivitamin deficiencies. In the case presented here, complications occurred very soon after surgery. The increasing incidence of obesity and bariatric surgery warrants better patient education concerning strict adherence to vitamin supplementation. 相似文献
6.
Ashraf Aly Mohammad Bakr Tawfik Fahim 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》1998,2(1):57-61
Objective:
Surgery has been recognized as an effective long-term treatment for morbid obesity. The purpose of this study is to present our experience of laparoscopic adjustable gastric banding (LAGB) as a safe and effective treatment for morbid obesity.Methods and Procedures:
Over eight months, 39 morbidly obese patients, having a Body Mass Index (BMI) >40 kg/m2, were included in this study. Conservative measures failed to maintain weight loss in all patients. The procedure is performed through a 5-trocar technique. The procedure involves gastric partitioning and stoma formation by an inflatable band. The stoma can be adjusted by injection of saline in the band reservoir.Results:
The mean age of the patients was 31.3 years. The mean BMI was 44.2 Kg/m2. All procedures were completed laparoscopically. The mean hospital stay was 2.7 days. The morbidity rate was 15.32%. Patients were followed up for a mean period of 6.7 months. The mean BMI after six months (in 28 patients) was 36.6 Kg/m2.Conclusion:
Laparoscopic insertion of the adjustable gastric banding is a safe and effective method for the treatment of morbid obesity and should be the standard way of band insertion. 相似文献7.
Cholecystectomy during Laparoscopic Gastric Bypass has No Effect on Duration of Hospital Stay 总被引:1,自引:1,他引:0
Background Laparoscopic cholecystectomy can be safely performed at the time of laparoscopic Roux-en-Y gastric bypass (LRYGBP).This study
was primarily conducted to examine whether there is any difference in the length of hospital stay and duration of operation
in patients who undergo concomitant cholecystectomy with their LRYGBP. In addition, the frequency and nature of complications
in the two groups were compared.
Methods Retrospective chart analysis and comparison of 200 patients who underwent LRYGBP alone with 200 patients who underwent LRYGBP
with simultaneous cholecystectomy.
Results Concomitant cholecystectomy did not increase length of hospital stay (2.04 ± 0.20 days vs 2.06 ± 0.29 days in the LRYGBP alone
group, P = 0.43). Furthermore, the addition of cholecystectomy only added an extra 29 minutes to the operation (P < 0.01).
In both groups, there was no difference in the rate of postoperative complications (8.5% in both groups, P = 0.21), the nature
of which was more or less equally distributed amongst the two groups.
Conclusion Laparoscopic cholecystectomy performed at the time of LRYGBP does not alter length of hospital stay or frequency of postoperative
complications and only adds an extra half hour to total operation time. 相似文献
8.
Background Gastric bypass surgery is an effective and long-lasting treatment of morbidly obese patients. However, the bypass limb may
need to be tailored in morbidly obese patients with a wide range of obesity. The aim of the present study was to report clinical
result of tailored bypass limb in a group of patients receiving laparoscopic mini-gastric bypass surgery.
Methods From Jan 2002 to Dec 2006, laparoscopic mini-gastric bypass was performed in 644 patients [469 women, 175 men: mean age 30.5 ± 8.1 years;
mean body mass index (BMI) 43.1 ± 6.0] in our department. The gastric bypass limb was tailored according to the preoperative
BMI. The clinical data and outcomes were analyzed. All the clinical data were prospectively collected and stored.
Results Two hundred eighty-six patients belonged to lower BMI (BMI < 40; mean 36.0), 286 patients moderate BMI (BMI 40–50; mean 43.2),
and 72 patients higher BMI (BMI > 50; mean 55.4). All procedures were completed laparoscopically. Mean operative time was
130 min, and mean hospital stay was 5.0 days. Twenty-three minor early complications (4.3%) and 13 major complications (2.0%)
were encountered, with one death occurred (0.016%). There was no significant difference in operation time and complication
rate between the groups. The mean bypass limb was 150 cm for the lower BMI group, 250 cm for moderate BMI group, and 350 cm
for the higher BMI group. The mean BMI reduction 2 years after surgery was 10.7, 15.5, and 23.3 for the lower, moderate, and
higher BMI group. The weight loss curves and resolution of obesity related comorbidities were compatible with the tailored
bypass limbs between the groups. However, the lower BMI patients had more severe anemia than the other two groups.
Conclusion Morbidly obese patients receiving gastric bypass surgery may need to tailor the bypass limb according to BMI. The application
of gastric bypass in lower BMI patients should be more carefully. 相似文献
9.
Intestinal malrotation is a congenital anomaly occurring in one of 500 live births. It typically presents during the first
months of life, but in rare instances, it can persist undetected into adulthood when it is identified during a radiographic
or surgical procedure. We present a case of intestinal malrotation discovered at the time of laparoscopic Roux-en-Y gastric
bypass (LRYGBP), detail the technical aspects needed to be incorporated to complete the operation, followed by a literature
review of this rare clinical scenario. Incomplete malrotation is not a contraindication to performing a LRYGBP for morbid
obesity. 相似文献
10.
Background Roux-en-Y gastric bypass (RYGBP) has become a common surgical procedure to treat morbid obesity. Furthermore, it strongly
reduces the incidence of type 2 diabetes and mortality. However, there is scant information on how magnesium status is affected
by RYGBP surgery. Previous bariatric surgery methods, like jejunoileal bypass, are associated with hypomagnesemia.
Methods Twenty-one non-diabetic morbidly obese patients who underwent RYGBP were evaluated before and 1 year after surgery and compared
to a matched morbidly obese control group regarding serum magnesium. Groups were matched regarding weight, BMI, abdominal
sagittal diameter and fasting glucose, blood pressure, and serum magnesium concentrations before surgery in the RYGBP group.
Results The serum magnesium concentrations increased by 6% from 0.80 to 0.85 mmol/l (p = 0.019) in the RYGBP group while a decrease by 4% (p = 0.132) was observed in the control group. The increase in magnesium concentration at the 1-year follow-up in the RYGBP
group was accompanied by a decreased abdominal sagittal diameter (r
2 = 0.32, p = 0.009), a lowered BMI (r
2 = 0.28, p = 0.0214), a lowered glucose concentration (r
2 = 0.28, p = 0.027) but not by a lowered insulin concentration (p = 0.242), a lowered systolic (p = 0.789) or a lowered diastolic (p = 0.785) blood pressure.
Conclusion RYGBP surgery in morbidly obese subjects is characterized by reduced visceral adiposity, lowered plasma glucose, and increased
circulating magnesium concentrations. The inverse association between lowered central obesity, lowered plasma glucose and
increased magnesium concentrations, needs further detailed studies to identify underlying mechanisms. 相似文献
11.
Background Anastomotic leaks after bariatric surgery carry high morbidity and mortality. We aimed to describe our experience of the diagnosis
and management of gastrointestinal anastomotic leaks in patients undergoing laparoscopic gastric bypass in a single institution.
Methods Of 1,200 patients who underwent laparoscopic Roux-en-Y gastric bypass with manual gastrojejunal anastomosis for morbid obesity
from January 2002 to January 2007, we retrospectively analyzed 59 patients with anastomotic leak. The location of the leak,
day of diagnosis, diagnostic methods, clinical manifestations, treatment modalities, associated complications, and length
of hospital stay were analyzed.
Results Leaks were located as follows: 67.8% in the gastrojejunostomy, 10.2% in the gastric pouch, 3.4% in the excluded stomach, 5.1%
in the jejunojejunal anastomosis, 3.4% in the gastrojejunostomy plus pouch, 3.4% in the pouch plus excluded stomach, and 6.8%
in undetermined sites. Routine upper gastrointestinal series revealed contrast extravasation in nine patients (15.3%). Leaks
were asymptomatic at diagnosis in 29 patients (49.2%). Surgical reintervention was carried out in 23 patients, and conservative
treatment was provided in the remaining 36. Transfer to the intensive care unit was required in 11 patients, with five deaths
(0.4%).
Conclusion In our experience, most anastomotic leaks can be managed with conservative measures alone. In many patients, abdominal drains
are effective in the management of leaks, obviating the need for reintervention. Nasoenteral nutrition was effective in the
non-operative management of gastrojejunal leaks in patients without signs of systemic toxicity. 相似文献
12.
Background Internal hernias have been described after laparoscopic Roux-en-Y gastric bypass (LRYGB) as a major problem. Thus, many routinely
close defects during LRYGB. In our technique, we do not close any defects. We hypothesize that not closing the defects would
not cause a significant internal hernia rate diagnosed during reoperations.
Methods Patients who were reoperated after LRYGB were included in this study. Only patients who had a laparoscopic or open exploration
focused on inspecting for internal hernias are reported here. The LRYGB technique that was utilized included an antecolic,
antegastric gastrojejunostomy, minimal division of the small bowel mesentery, a long jejunojejunostomy performed with three
staple lines, adequate division of the omentum, and placement of the jejunojejunostomy above the colon in the left upper quadrant.
Results There were a total of 387 patients who had LRYGB from 2002 to 2007 utilizing this particular technique. Fifty-four patients
had a reoperation at an average of 24 (Range: 1–60) months postoperatively. The procedures were abdominoplasty, cholecystectomy,
diagnostic laparoscopy, and lysis of adhesions. While two patients had a defect present, no patient had an internal hernia
despite aggressive attempts to diagnose one.
Conclusions Internals hernias are not common after our particular method of LRYGB. Before adopting and advocating routine closure, surgeons
should consider the surgical technique and the true associated incidence of internal hernias. We do not recommend routine
closure of these defects with our technique.
Presented in part at International Federation for the Surgery of Obesity annual meeting; August 2006; Sydney, Australia. 相似文献
13.
Background: Intra-operative pneumothorax (PTX) is an infrequent complication of laparoscopic surgery. Most cases are attributed
to CO2 diffusion across congenital diaphragmatic defects and resolve spontaneously. We report a case of PTX during a laparoscopic
Roux-en-Y gastric bypass (LRYGBP). When applied to this specific patient population, the current literature recommendations
for the management of intra-operative PTX are questioned. Material and Methods: A retrospective chart review of 400 consecutive
LRYGBP procedures performed over a 30-month period revealed 1 case of PTX (0.025%). Results: A bulging left diaphragm, hypotension,
bradycardia, decreased pO2, and elevated EtCO2 and airway pressures, were noted early in the case. She initially responded to conservative management but required multiple
subsequent hospital admissions for pulmonary complications. Conclusions: Pneumoperitoneum-induced PTX during laparoscopic
bariatric surgery is a rare complication. Its treatment must be based on the potential underlying cause, with consideration
of these patients' often delicate pulmonary status. In stable patients, where the PTX is attributed to diaphragmatic or hiatal
dissection, expectant treatment is appropriate. In all other situations, however, we believe that tube thoracostomy is indicated.
An algorithm for treatment of PTX in laparoscopic bariatric surgery is proposed. It follows the dictum of maintaining extreme
vigilance and a low threshold for aggressive intervention in this group of patients. 相似文献
14.
William W. Hope Ronald F. Sing Albert Y. Chen Amy E. Lincourt Keith S. Gersin Timothy S. Kuwada B. Todd Heniford 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(2):213-216
Background and Objectives:
Bowel obstructions following Roux-en-Y gastric bypass (RYGB) are a significant issue often caused by internal herniation. Controversy continues as to whether mesenteric defect closure is necessary to decrease the incidence of internal hernias after RYGB. Our purpose was to evaluate the effectiveness of closing the mesenteric defect at the jejunojejunostomy in patients who underwent RYGB by examining this potential space at reoperation for any reason.Methods:
We retrospectively reviewed medical records of patients undergoing surgery after RYGB from August 1999 to October 2008 to determine the status of the mesentery at the jejunojejunostomy.Results:
Eighteen patients underwent surgery 2 to 19 months after open (n=8) or laparoscopic (n=10) RYGB. All patients had documented suture closure of their jejunojejunostomy at the time of RYGB. Permanent (n=12) or absorbable (n=6) sutures were used for closures. Patients lost 23.6kg to 62.1kg before a reoperation was required for a ventral hernia (n=8), cholecystectomy (n=4), abdominal pain (n=4), or small bowel obstruction (n=2). Fifteen of the 18 patients had open mesenteric defects at the jejunojejunostomy despite previous closure; none were the cause for reoperation.Conclusion:
Routine suture closure of mesenteric defects after RYGB may not be an effective permanent closure likely due to the extensive fat loss and weight loss within the mesentery. 相似文献15.
BACKGROUND: Obstructive sleep apnea is a common condition in patients undergoing bariatric surgery. The aim of this study was to determine the clinical outcome of a cohort of morbidly obese patients with documented sleep apnea who underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP). METHODS: 56 morbidly obese patients with documented sleep apnea by polysomnography underwent LRYGBP. There were 36 females with mean age 46 years and mean BMI 49 kg/m2. The Epworth sleepiness scale (ESS) scores and the number of patients requiring the use of continuous positive airway pressure (CPAP) therapy were recorded preoperatively and at 3-month intervals. RESULTS: The mean length of sleep apnea condition was 44 +/- 55 months. Preoperative polysomnography scores were classified as severe in 50% of patients, moderate in 30%, and mild in 20%. 29 of 56 (52%) patients required CPAP therapy preoperatively. The mean excess body weight loss was 73 +/- 3% at 12 months. The mean ESS score decreased from 13.7 preoperatively to 5.3 at 1 month postoperatively (P<0.05) and maintained below the threshold level (<7) for the entire 12 months of follow-up. Of the 29 patients requiring preoperative CPAP, only 4 (14%) patients required CPAP at 3 months postoperatively and none required CPAP at 9 months. CONCLUSIONS: Weight loss associated with LRYGBP significantly improves the symptoms of sleep apnea and is effective in discontinuation in the clinical use of CPAP therapy. Improvement of obstructive sleep apnea symptoms occur as early as 1 month postoperatively. 相似文献
16.
Shafik Sidani Ehab Akkary Robert Bell 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2013,17(1):148-151
Marginal ulceration at the gastrojejunal anastomosis is a common complication following Roux-Y gastric bypass (RYGB). Hemodynamically significant hemorrhagic marginal ulcers are usually treated either endoscopically or surgically. We describe a unique case of life-threatening hemorrhagic marginal ulcer eroding into the main splenic artery. This condition was initially managed with angiographic embolization, followed by surgical intervention. 相似文献
17.
Effect of Location and Speed of Diagnosis on Anastomotic Leak Outcomes in 3828 Gastric Bypass Cases 总被引:1,自引:0,他引:1
Sukhyung Lee Brennan Carmody Luke Wolfe Eric DeMaria John M. Kellum Harvey Sugerman James W. Maher 《Journal of gastrointestinal surgery》2007,11(6):708-713
Introduction Leaks after Roux-en-Y gastric bypass are a major cause of mortality. This study attempts to define the relationship between
the leak site, time from surgery to detection, and outcome.
Methods Retrospective review of 3,828 gastric bypass procedures.
Results Of the leaks (3.9% overall), 60/2,337 (2.6%) occurred after open gastric bypass, 57/1,080 (5.2%) after laparoscopic gastric
bypass, and 33/411 (8.0%) after revisions. Overall leak-related mortality after Roux-en-Y gastric bypass was 0.6% (22/3,828).
Mortality rate from gastrojejunostomy leaks (38 in the open gastric bypass, and 43 in the laparoscopic) was higher in the
open group than the laparoscopic group (18.4 vs 2.3%, p = 0.015). Median time of detection for a gastrojejunostomy leak in the open group was longer than in the laparoscopic group
(3 vs 1 days, Wilcoxon score p < 0.001). Jejunojejunostomy (JJ) leak was associated with a 40% mortality rate. Initial upper gastrointestinal series did
not detect 9/10 jejunojejunostomy leaks. Median detection time was longer in the jejunojejunostomy leak group than the gastrojejunostomy
leak group (4 vs 2 days, p = 0.037).
Discussion Leak mortality and time of detection was higher after open gastric bypass than laparoscopic gastric bypass. GBP patients with
normal upper gastrointestinal (UGI) studies may harbor leaks, especially at the JJ or excluded stomach. Normal UGI findings
should not delay therapy if clinical signs suggest a leak.
This paper was presented at The Society for Surgery of the Alimentary Tract, 47th Annual Meeting at Digestive Disease Week
2006, May 20–24, 2006, Los Angeles, California. 相似文献
18.
Background Visceral fat, especially the greater omentum, seems to be an important factor in the development of some metabolic disturbances
such as insulin resistance, hyperglycemia, and dyslipidemia. Therefore, we wanted to evaluate the influence of resecting or
leaving in situ the greater omentum in a group of patients with morbid obesity.
Methods Seventy patients with morbid obesity were submitted to laparotomic resectional gastric bypass and an omentectomy was randomly
performed in some patients. Body mass index (BMI), serum levels of sugar, insulin, total cholesterol, and triglycerides were
determined prior to surgery and followed up on for 2 years afterwards.
Results Two years after surgery, no differences were seen in BMI levels in either group. Blood sugar levels, serum insulin, total
cholesterol levels, and serum triglycerides had similar values in both groups. Arterial hypertension had similar behavior.
Conclusions Based on these results, omentectomy is not justified as part of bariatric surgery. Its theoretical advantages are not reflected
in this prospective random trial. 相似文献
19.
Background The concern about internal hernias has prompted recommendations for routine closure of defects during laparoscopic Roux-en-Y
gastric bypass (LRYGBP). Our belief is that not all techniques require closure of defects. We hypothesize that nonclosure
of defects with our particular technique would not cause a significant clinically evident internal hernia rate.
Methods All patients who were operated on between December 2002 and June 2005 were included in this study. The technique that was
utilized included an antecolic antegastric gastrojejunostomy (GJ), division of the greater omentum, a long jejunojejunostomy
(JJ) performed with three staple-lines, a short (<4 cm) division of the small bowel mesentery, and placement of the JJ above
the colon in the left upper quadrant. Clinical records were reviewed for reoperations.
Results here was a total of 300 patients, and no incidence of internal hernia. In the first 100 patients, there was 97% follow-up
for 1 year or more. Four patients underwent reoperations for unexplained abdominal pain. Intraoperative findings included
an adhesive band from the JJ to the colon (1), an adhesive band from the JJ to the anterior abdominal wall (1), an adhesive
band 3 cm from the GJ to the anterior abdominal wall (1), and adhesions of the jejunum to the anterior abdominal wall (1).
No patient had an internal hernia.
Conclusions Internal hernias are not common after this particular method of LRYGBP. Before adopting routine closure of potential spaces,
surgeons should consider their technique, follow-up, and incidence of internal hernias. Routine closure of these defects is
not always necessary. 相似文献
20.
Background Socioeconomic status has been a predictor of poor outcome in many surgical diseases including morbid obesity. Potential differences
in treatment and initial severity of disease have often not been well controlled in patients with bariatric surgery. This
study was performed to compare the results of bariatric procedures in financially disadvantaged Medicaid patients compared
to patients with Medicare and those with Commercial insurance under controlled conditions.
Methods Prospectively collected data from 183 Medicaid, 77 Medicare and 570 Commercial/self-pay insurances were compared to determine
the influence of poor economic status on outcome. All the patients received surgical care by the same surgeon at a large University-affiliated
private hospital.
Results Medicaid patients were larger (BMI 58.4 vs. 52.8 and 50.9, respectively) and had a greater incidence of serious comorbid conditions
at outset. The death rate and complications were also significantly higher postoperatively in Medicaid patients. However,
when the patients were matched for age and BMI, results became similar.
Conclusion Increases in postoperative mortality and morbidity appear to be associated with advanced disease because of poor access to
care. When matched for age, BMI, and severity of disease, outcomes are similar. Changes in Medicaid policies could improve
access and outcome.
Disclosure of commercial interest or source of financial or material support: N/A. 相似文献