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Bariatric Surery

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Submitted By ciociwawa
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Analysis of Research Report Paper
Mary Ellen Strout
HCS/438
Ann Impen
April 11, 2011

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Analysis of a Research Report Paper The article I chose was from the Annals of Surgery, called Multivariate Analysis of Risk Factors for Death Following Gastric Bypass for Treatment. I chose this article, because I did have this surgery done with no complications, and it is also a fascinating procedure and hope to one day work in this area. Pre operative mortality is the most feared outcome of bariatric surgery, it is reported to happen between 0.5 ad 1.5% of patients. In this article it identifies mortality fore either open or laparoscopic Roux-en-y bypass. The database is from Virginia Commonwealth university and was queried for patients who had undergone either an open gastric bypass (O-GBP) or a laparoscopic gastric bypass (L-GBP). A multivariate logistic regression analysis to identify factors related to perioperative mortality was performed. The factors examined included was age, gender, body mass index, preoperative weight, hypertension, diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, venous
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Analysis of a Research Report Article stasis ulcers, intestinal leak, small bowel obstruction, and pulmonary embolus. The data was found to find independent factors related to early death. Early death was defined as death that occurs within 30 days of the initial procedure or as a direct result of a complication of the original procedure (Annals of Surgery p3).
In this article tables were used to compare demographic information of the O-GBP and L-GBP groups. The O-GBP has a higher incidence of male gender and heavier patients. Except for diabetes mellitus, that is found in the L-GBP, the incidence of the rest of the recorded comorbid conditions is significantly higher in the O-GBP group. The rates of life threatening postoperative complications are similar between the groups. The leak approaches falls short, of a statistical difference between the 2 groups (P=0.0506).
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Analysis of a Research Report Paper The overall mortality from all causes in the population was a 1.5% (31 deaths); 0.7% (n=4) in L-GBP, 1.9% (n=27) in O-GBP, 0.2% (n=1) in P-GBP, and 2.9% (n=26) in the LL-GBP group. Multivariate logistic regression analysis identified the independent risk factors associated with early death, as leak, pulmonary embolus, preoperative weight and hypertension. The analysis with the O-GBP group identified leak, pulmonary embolus, age , weight, and hypertension. Leak and pulmonary embolus were the independent predictors for death in the L-GBP group. In this study it used a multivariate statistical analysis of a large database from a tertiary care center, that specializes in bariatric surgery for more than 2 decades. The patient set contains an unusually high percentage of high risk patients, those with obstructive sleep apnea, obesity hypoventilation syndrome, and high body mask indexes. This article reported on a cohort of 1067 patients, and found that
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Analysis of a Research Report Paper Male gender was the only factor independently predictive of severe life threatening adverse outcomes by multistep logistic regression. The article also reported that the mortality rate was threefold higher in patients older than 55, it did not report that age was independently predictive of mortality. The contrast in which age was predictive of a higher mortality risk in the open gastric bypass group even though not having any deaths in patients older than 60 years (n=65,3.2% of all patients. In another study it was reported that case volume loads, along with the patient gender and comorbidity significantly affect complication rates in their demographic study of bariatric surgery in California. Hospitals in which 0 to 50 or 50-99 gastric bypasses were performed annually were more likely to have a complication (odds ratios, 2.72 and 2.70, than those in which more than 200 operations were performed. Another study in this article was in Pennsylvania noted a 0.6%
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Analysis of a Research Report Paper
The overall mortality rate in 4685 gastric bypass operations between 1999 and 2001. It was reported that an operative mortality rate of 5 % in surgeons performing fewer than 10 procedures per year, compared with a 0.3% mortality rate for higher volume surgeons (P=0.06). Adverse outcomes were 17.4 and 14% respectively (P<0.05) for the 2 groups of surgeons. The above information is important to give prospective patients with accurate risk information. The findings that risks in open are significantly higher for older patients and for those with higher preoperative weights and hypertension is an argument for offering gastric bypass at younger ages and for patients with lower weights and less comorbidity. Laparoscopic gastric bypass has now been expanded to nearly all patient categories, will result in lower operative mortality rates in the future means remains to be seen. The conclusion is that risk factors for perioperative death can be
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Analysis of a Research Report Paper separated into patient characteristics and complications. The access method, open versus laparoscopic, was not independently predictive of death, but the operation type, proximal versus long limb, was predictive. The dat doesn’t suggest that superobese patients should not undergo surgery, as they are high risk for early death due to their body weight and comorbidities without surgery. Surgery should not be reserved as a desperate last measure for weight loss. Univariate and multivariate logistic regression analysis were performed to identify early death. Analysis of variance, Fisher exact t test and x to the second power were performed. P<0.05 were considered significant. Mortality was also significantly higher in the O-GBP group. Since 1992, more than 2000 patients had either an O-GBP (n=1431) or a L-GBP (n=580). Of the 547 patients had a proximal GBP (p=GBP) and 884 su[erobese (body mass index>50kg/m to the second power) patients had a long limb GBP (LL-GBP). The difference in patients
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Analysis of a Research Report Paper demographics, complications, and perioperative mortality rates were examined. The independent risk factors associated with perioperative death included leak, pulmonary embolus, preoperative weight, and hypertension. The conclusion that the study reached was from 10 years ago and if you can find statistical information about this surgery presently you will see that the surgery is safer and that more than 20,000 of these surgeries are performed yearly with less of a mortality rate. Any type of surgeries have a mortality rate of the above mentioned. The findings are not statistically significant, because I am sure the statistical information presented now a days have changed. I could guess that at the time this study was done it was significant.

References
Fernandez, A., Demaria, E., Tichansky, J, Kellum, L., (2004) The Annals of Surgery. Multivariate Analysis of Risk Factors for Death Following Gastric Bypass for Treatment. Retrieved from http://ncbi.nlm.nih.gov/pmc/articles/PMC1356278/

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