- Email: [email protected]
15. Behavioral and Social-Emotional Outcomes in Morbidly Obese Adolescents After Laparoscopic Adjustable Gastric Banding
178
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
tified based on univariate and multivariate regression analyses. Results: Among our sample of manuscripts, oncology was the most common study subject (26%), followed by general surgery/GI (24%), and vascular, transplant, and/or cardiothoracic surgery (23%). The average number of study subjects was 417; the majority of manuscripts were from the U.S. (53%) and from a single institution (59%). Just 18% had a statistician-author. The mean number of citations was 128. Surgical manuscripts submitted to medical journals, as compared to surgical journals, had on average significantly better clinical (1.7 vs. 2.5, p⬍0.001), methodologic (2.1 vs. 2.7, p⬍0.001) and total quality scores (3.8 vs. 5.2, p⬍0.001). They had more subjects (mean ⫽ 891 vs. 259, p⬍.001) and were more likely to have a statistician as a co-author (43 vs.10%, p⬍0.001), a multiinstitutional, international collaboration (30 vs.8%, p⬍.001), and a high citation index (70 vs.10%, p⬍.001). They were more often from outside the U.S. (70% vs. 40%, p⬍0.001). Manuscripts stemming from direct journal submission had better methodologic scores than those submitted for publication after presentation at surgical society meetings (2.5 vs 2.7, p⬍.0.05), but were comparable in clinical and total quality scores. The best scores by subject were in vascular, transplant, and/or cardiothoracic surgery (p⬍0.01) Overall, significant independent predictors of surgical manuscript quality were having a statistician as a co-author, number of times the manuscript has been cited, and a larger number of study subjects. For all surgical manuscripts, quality assessment using our novel instrument predicted the number of citations ten years later (p⬍0.001). Conclusion: The quality of surgical manuscripts can be improved by including a statistician as a co-author. Efforts should be directed to implementing multi-institutional and interdisciplinary trials. Peerreview across journals can be standardized through the use of a validated instrument such as this one to measure the methodologic and clinical quality of manuscripts submitted for publication. 14. PTSD: INCIDENCE AND IMPACT ON QUALITY OF LIFE AFTER TRAUMATIC INJURY. J. L. Anderson, K. Brasel; Medical College of Wisconsin, Milwaukee, WI Introduction: PTSD is a strong correlate of post-injury quality of life. It occurs in 9-42% of patients after traumatic injury, with the variability partially driven by the method of diagnosis. There is also variable association with post-injury quality of life. We hypothesized that PTSD was related both to injury mechanism and quality of life. Methods: A screening program was implemented at a Level I trauma center on October 1, 2007. Patients were given the SF-36 and the 17-item PTSD checklist prior to discharge. Both surveys were self-administered, although patients were giving the option of completing them with trauma program personnel. A score ⱖ 44 categorized a patient as having PTSD on the 17-item PTSD civilian checklist. Individual SF-36 domain scores as well as the physical (PCS) and mental component scores (MCS) were calculated. Incidence of PTSD by injury mechanism was analyzed using the Chi-square Test. PCS and MCS in patients with and without PTSD were analyzed using the Student’s T-Test. Results: Between program implementation and July 10, 2008, 321 patients were given both surveys. 236 (73.5%) completed the surveys. PTSD was present in 21%. Patients with intentional injury had a significantly higher rate of PTSD than those with unintentional injury (43% vs 13%, p⬍0.0001). MCS was significantly lower in patients with PTSD (20.62 vs 22.44, p⬍0.005). There was no difference in PCS. Injured patients had lower MCS and PCS than population norms, regardless of the presence of PTSD, indicating poorer quality of life (both p⬍0.0001). Conclusion: The self-administered PTSD checklist is an efficient tool, saving inperson resources for those needing treatment or intervention. The incidence of PTSD varies significantly by injury mechanism. Understanding which patients are more likely to develop PTSD can help to triage and deploy appropriate patient care. The significant association of PTSD with quality of life suggests that early intervention for PTSD may impact the quality of life in this patient population.
Mechanism Unintentional injury MVC Fall Pedestrian struck MCC Recreational injury Intentional injury GSW SW Assault
PTSD present (n)
PTSD absent (n)
11 7 3 2 0
71 26 10 24 11
16 9 2
25 8 3
15. BEHAVIORAL AND SOCIAL-EMOTIONAL OUTCOMES IN MORBIDLY OBESE ADOLESCENTS AFTER LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING. A. Vazzana, H. Youn, C. Ren Fielding, G. Fielding, E. P. Nadler; NYU School of Medicine, New York, NY Background: As increasing data suggest that laparoscopic adjustable gastric banding (LAGB) represents a safe and effective treatment for morbidly obese adolescents, attention can begin to focus on secondary outcomes, including weight-related behavioral and socialemotional functioning. We hypothesized that LAGB would improve eating and exercise habits, interpersonal and psychological functioning, and self-esteem. Methods: Patients ages 14-17 who have undergone LAGB at our institution since 2005 were asked to complete the Revised Children’s Manifest Anxiety Scale, the Beck Depression Inventory-Short Form, the Harter Self-Esteem global self-worth subscale, and the SHAPEDOWN Habit Inventory. Patients completed the scale pre-operatively and one year after surgery. Twenty-one patients (15 females, 6 males) had at least one year of follow-up after surgery and completed the questionnaires at both time points. Repeated-measures analyses of variances (ANOVAs) were performed to compare pre- and post-surgical differences (Time). Statistical significance was assigned for p-values ⬍.05. Results: There were several significant main effects of Time that consistently indicated improvements across variables. Post-surgically, patients reported exercising more (F ⫽ 14.31, p ⬍ .01) and being generally more active throughout the day (F ⫽ 13.26, p ⬍ .05). Eating was characterized as slower paced (F ⫽ 17.85, p ⬍ .05), less frequent (F ⫽ 4.54, p ⬍ .05), and smaller portioned (F ⫽ 19.92, ⬍ .01) following surgery. Banded patients were more likely to eat in response to hunger cues (F ⫽ 7.01, p ⬍ .05), and less in response to environmental (F ⫽ 21.89, p ⬍ .01) or emotional (F ⫽ 5.23, p ⬍ .05) cues. They binged less often (F ⫽ 10.58, p ⬍ .01). No significant differences were found in either the types of food consumed (F ⫽ .83, ns) or the foods available in the home (F ⫽ .07, ns). Interpersonally, banded patients were more likely to disclose their feelings (F ⫽ 12.55, p ⬍ .01) and perceived greater peer support (F ⫽ 7.67, p ⬍ .01). There was a trend for greater familial support post-surgically (F ⫽ 3.13, p ⬍ .09). Patients who were banded had higher overall self-esteem (F ⫽ 18.18, p ⬍ .01), were less depressed (F ⫽ 8.48, p ⬍ .01) and anxious (F ⫽ 12.70, p ⬍ .01), and had a better body image (F ⫽ 29.28, p ⬍ .01). Weightrelated feelings of self-worth (F ⫽ 13.94, p ⬍ .01) and depression (F ⫽ 24.78, p ⬍ .01) also improved post-surgically. Conclusions: LAGB represents a life-altering procedure that extends beyond weight loss to enhance adolescent patients’ lifestyles and social-emotional functioning. Patients lead more active lifestyles, have better relationship dynamics, and feel good about themselves. Post-surgical eating patterns indicate compliance with the dietary protocol. Increased attention should be directed at improving the availability and selection of healthy food choices. Future studies should investigate whether the positive behavioral and social-emotional attributes associated with banding are sustainable and are related to weight maintenance.
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
tified based on univariate and multivariate regression analyses. Results: Among our sample of manuscripts, oncology was the most common study subject (26%), followed by general surgery/GI (24%), and vascular, transplant, and/or cardiothoracic surgery (23%). The average number of study subjects was 417; the majority of manuscripts were from the U.S. (53%) and from a single institution (59%). Just 18% had a statistician-author. The mean number of citations was 128. Surgical manuscripts submitted to medical journals, as compared to surgical journals, had on average significantly better clinical (1.7 vs. 2.5, p⬍0.001), methodologic (2.1 vs. 2.7, p⬍0.001) and total quality scores (3.8 vs. 5.2, p⬍0.001). They had more subjects (mean ⫽ 891 vs. 259, p⬍.001) and were more likely to have a statistician as a co-author (43 vs.10%, p⬍0.001), a multiinstitutional, international collaboration (30 vs.8%, p⬍.001), and a high citation index (70 vs.10%, p⬍.001). They were more often from outside the U.S. (70% vs. 40%, p⬍0.001). Manuscripts stemming from direct journal submission had better methodologic scores than those submitted for publication after presentation at surgical society meetings (2.5 vs 2.7, p⬍.0.05), but were comparable in clinical and total quality scores. The best scores by subject were in vascular, transplant, and/or cardiothoracic surgery (p⬍0.01) Overall, significant independent predictors of surgical manuscript quality were having a statistician as a co-author, number of times the manuscript has been cited, and a larger number of study subjects. For all surgical manuscripts, quality assessment using our novel instrument predicted the number of citations ten years later (p⬍0.001). Conclusion: The quality of surgical manuscripts can be improved by including a statistician as a co-author. Efforts should be directed to implementing multi-institutional and interdisciplinary trials. Peerreview across journals can be standardized through the use of a validated instrument such as this one to measure the methodologic and clinical quality of manuscripts submitted for publication. 14. PTSD: INCIDENCE AND IMPACT ON QUALITY OF LIFE AFTER TRAUMATIC INJURY. J. L. Anderson, K. Brasel; Medical College of Wisconsin, Milwaukee, WI Introduction: PTSD is a strong correlate of post-injury quality of life. It occurs in 9-42% of patients after traumatic injury, with the variability partially driven by the method of diagnosis. There is also variable association with post-injury quality of life. We hypothesized that PTSD was related both to injury mechanism and quality of life. Methods: A screening program was implemented at a Level I trauma center on October 1, 2007. Patients were given the SF-36 and the 17-item PTSD checklist prior to discharge. Both surveys were self-administered, although patients were giving the option of completing them with trauma program personnel. A score ⱖ 44 categorized a patient as having PTSD on the 17-item PTSD civilian checklist. Individual SF-36 domain scores as well as the physical (PCS) and mental component scores (MCS) were calculated. Incidence of PTSD by injury mechanism was analyzed using the Chi-square Test. PCS and MCS in patients with and without PTSD were analyzed using the Student’s T-Test. Results: Between program implementation and July 10, 2008, 321 patients were given both surveys. 236 (73.5%) completed the surveys. PTSD was present in 21%. Patients with intentional injury had a significantly higher rate of PTSD than those with unintentional injury (43% vs 13%, p⬍0.0001). MCS was significantly lower in patients with PTSD (20.62 vs 22.44, p⬍0.005). There was no difference in PCS. Injured patients had lower MCS and PCS than population norms, regardless of the presence of PTSD, indicating poorer quality of life (both p⬍0.0001). Conclusion: The self-administered PTSD checklist is an efficient tool, saving inperson resources for those needing treatment or intervention. The incidence of PTSD varies significantly by injury mechanism. Understanding which patients are more likely to develop PTSD can help to triage and deploy appropriate patient care. The significant association of PTSD with quality of life suggests that early intervention for PTSD may impact the quality of life in this patient population.
Mechanism Unintentional injury MVC Fall Pedestrian struck MCC Recreational injury Intentional injury GSW SW Assault
PTSD present (n)
PTSD absent (n)
11 7 3 2 0
71 26 10 24 11
16 9 2
25 8 3
15. BEHAVIORAL AND SOCIAL-EMOTIONAL OUTCOMES IN MORBIDLY OBESE ADOLESCENTS AFTER LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING. A. Vazzana, H. Youn, C. Ren Fielding, G. Fielding, E. P. Nadler; NYU School of Medicine, New York, NY Background: As increasing data suggest that laparoscopic adjustable gastric banding (LAGB) represents a safe and effective treatment for morbidly obese adolescents, attention can begin to focus on secondary outcomes, including weight-related behavioral and socialemotional functioning. We hypothesized that LAGB would improve eating and exercise habits, interpersonal and psychological functioning, and self-esteem. Methods: Patients ages 14-17 who have undergone LAGB at our institution since 2005 were asked to complete the Revised Children’s Manifest Anxiety Scale, the Beck Depression Inventory-Short Form, the Harter Self-Esteem global self-worth subscale, and the SHAPEDOWN Habit Inventory. Patients completed the scale pre-operatively and one year after surgery. Twenty-one patients (15 females, 6 males) had at least one year of follow-up after surgery and completed the questionnaires at both time points. Repeated-measures analyses of variances (ANOVAs) were performed to compare pre- and post-surgical differences (Time). Statistical significance was assigned for p-values ⬍.05. Results: There were several significant main effects of Time that consistently indicated improvements across variables. Post-surgically, patients reported exercising more (F ⫽ 14.31, p ⬍ .01) and being generally more active throughout the day (F ⫽ 13.26, p ⬍ .05). Eating was characterized as slower paced (F ⫽ 17.85, p ⬍ .05), less frequent (F ⫽ 4.54, p ⬍ .05), and smaller portioned (F ⫽ 19.92, ⬍ .01) following surgery. Banded patients were more likely to eat in response to hunger cues (F ⫽ 7.01, p ⬍ .05), and less in response to environmental (F ⫽ 21.89, p ⬍ .01) or emotional (F ⫽ 5.23, p ⬍ .05) cues. They binged less often (F ⫽ 10.58, p ⬍ .01). No significant differences were found in either the types of food consumed (F ⫽ .83, ns) or the foods available in the home (F ⫽ .07, ns). Interpersonally, banded patients were more likely to disclose their feelings (F ⫽ 12.55, p ⬍ .01) and perceived greater peer support (F ⫽ 7.67, p ⬍ .01). There was a trend for greater familial support post-surgically (F ⫽ 3.13, p ⬍ .09). Patients who were banded had higher overall self-esteem (F ⫽ 18.18, p ⬍ .01), were less depressed (F ⫽ 8.48, p ⬍ .01) and anxious (F ⫽ 12.70, p ⬍ .01), and had a better body image (F ⫽ 29.28, p ⬍ .01). Weightrelated feelings of self-worth (F ⫽ 13.94, p ⬍ .01) and depression (F ⫽ 24.78, p ⬍ .01) also improved post-surgically. Conclusions: LAGB represents a life-altering procedure that extends beyond weight loss to enhance adolescent patients’ lifestyles and social-emotional functioning. Patients lead more active lifestyles, have better relationship dynamics, and feel good about themselves. Post-surgical eating patterns indicate compliance with the dietary protocol. Increased attention should be directed at improving the availability and selection of healthy food choices. Future studies should investigate whether the positive behavioral and social-emotional attributes associated with banding are sustainable and are related to weight maintenance.