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Impact of gastric bypass on survival
482
Letters
Correction
J Am Coll Surg
ing outcomes in trauma and nontrauma centers outside of New York City echoes our views about the desirability of having the city’s nontrauma centers contribute consistently to this important data set. Making this happen would seem a simple administrative task; the city and state Departments of Health need only mandate compliance on the part of New York City’s nontrauma centers. Resources to do so may be problematic, but hospitals must often meet unfunded mandates. Their description of an analysis of trauma registry data for injured patients outside of New York City seems to confirm our findings using SPARCS (Statewide Planning and Research Cooperative System) data within New York City. Regardless of the data source (SPARCS, Trauma Registry), when comparing adjusted mortality risk, trauma centers do not seem to produce superior results in comparison to nontrauma centers. We agree that important public policy issues are raised by such findings. At the heart of these concerns lies the question of how a regional trauma system should be evaluated, and, particularly, how the effectiveness of a trauma center should be assessed for purposes of accreditation. Most accreditation requirements focus on processes, rather than outcomes. Providing surgeons and other specialists, operating rooms, blood bank and radiology facilities, using diagnostic and treatment protocols, and so on are no doubt vital to effective trauma care, but effective use of these costly resources must produce measurable benefits to injured patients and the larger community. For example, is care rendered in trauma centers cost effective? Does the public benefit from a “volume discount” derived from more efficient resource use in highvolume trauma centers? Do patients in trauma centers receive rehabilitation services that optimize their functional recovery? What is the role of trauma centers in developing effective injury-prevention strategies in their local communities? Some of these questions can be explored using administrative databases, such as SPARCS, which contain significant financial information, for example. ZIP code analyses
of mechanism of injury embedded in SPARCS might provide important insights into injury-prevention strategies at the community level. Data unexamined will never be useful, and we believe important insights can be selectively retrieved from SPARCS and other similar administrative databases.
Impact of Gastric Bypass on Survival G Wesley Clark, MD San Diego, CA I write concerning the article titled “Impact of Gastric Bypass Operation on Survival: A Population-Based Analysis,”1 and the statement by the authors that the “laparoscopic era was considered to be 1997 to the present after the first report of laparoscopic gastric bypass in 1996.” The accompanying citation refers to an article by Lonroth and colleagues, published in 1996.2 I call to your attention that the first laparoscopic gastric bypass was performed in October 1993 by AC Wittgrove and me, as cosurgeons. Our report of our first 5 patients was published in 1994.3 Shortly after, I discussed the laparoscopic procedure with Dr Lonroth personally, while in Stockholm, and learned that he performed his first laparoscopic gastric bypass, using an omega-loop rather than a Roux-en-Y, in the same general time frame, approximately early 1994. I continue to believe that our first case was the first performed, and that it was certainly the first reported. REFERENCES 1. Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg 2004;199: 543–551. 2. Lonroth H, Dalenback J, Haglind E, Lundell L. Laparoscopic gastric bypass. Another option in bariatric surgery. Surg Endosc 1996;10:636–638. 3. Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 1994;4:353–357.
CORRECTION In the original scientific article titled “Profile of Mothers at Risk: An Analysis of Injury and Pregnancy Loss in 1,195 Trauma Patients” by Danagra G Ikossi, MD, Ann A Lazar, MS, Diane Morabito, RN, MPH, John Fildes, MD, FACS, M Margaret Knudson, MD, FACS,
which appeared in the January 2005 issue of the Journal of the American College of Surgeons, volume 200, pages 49–56, an error occurred throughout the article. “Abbreviated Injury Score” is the correct term (AIS). “Adjusted Injury Score,” which appears in the article is incorrect.
Letters
Correction
J Am Coll Surg
ing outcomes in trauma and nontrauma centers outside of New York City echoes our views about the desirability of having the city’s nontrauma centers contribute consistently to this important data set. Making this happen would seem a simple administrative task; the city and state Departments of Health need only mandate compliance on the part of New York City’s nontrauma centers. Resources to do so may be problematic, but hospitals must often meet unfunded mandates. Their description of an analysis of trauma registry data for injured patients outside of New York City seems to confirm our findings using SPARCS (Statewide Planning and Research Cooperative System) data within New York City. Regardless of the data source (SPARCS, Trauma Registry), when comparing adjusted mortality risk, trauma centers do not seem to produce superior results in comparison to nontrauma centers. We agree that important public policy issues are raised by such findings. At the heart of these concerns lies the question of how a regional trauma system should be evaluated, and, particularly, how the effectiveness of a trauma center should be assessed for purposes of accreditation. Most accreditation requirements focus on processes, rather than outcomes. Providing surgeons and other specialists, operating rooms, blood bank and radiology facilities, using diagnostic and treatment protocols, and so on are no doubt vital to effective trauma care, but effective use of these costly resources must produce measurable benefits to injured patients and the larger community. For example, is care rendered in trauma centers cost effective? Does the public benefit from a “volume discount” derived from more efficient resource use in highvolume trauma centers? Do patients in trauma centers receive rehabilitation services that optimize their functional recovery? What is the role of trauma centers in developing effective injury-prevention strategies in their local communities? Some of these questions can be explored using administrative databases, such as SPARCS, which contain significant financial information, for example. ZIP code analyses
of mechanism of injury embedded in SPARCS might provide important insights into injury-prevention strategies at the community level. Data unexamined will never be useful, and we believe important insights can be selectively retrieved from SPARCS and other similar administrative databases.
Impact of Gastric Bypass on Survival G Wesley Clark, MD San Diego, CA I write concerning the article titled “Impact of Gastric Bypass Operation on Survival: A Population-Based Analysis,”1 and the statement by the authors that the “laparoscopic era was considered to be 1997 to the present after the first report of laparoscopic gastric bypass in 1996.” The accompanying citation refers to an article by Lonroth and colleagues, published in 1996.2 I call to your attention that the first laparoscopic gastric bypass was performed in October 1993 by AC Wittgrove and me, as cosurgeons. Our report of our first 5 patients was published in 1994.3 Shortly after, I discussed the laparoscopic procedure with Dr Lonroth personally, while in Stockholm, and learned that he performed his first laparoscopic gastric bypass, using an omega-loop rather than a Roux-en-Y, in the same general time frame, approximately early 1994. I continue to believe that our first case was the first performed, and that it was certainly the first reported. REFERENCES 1. Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg 2004;199: 543–551. 2. Lonroth H, Dalenback J, Haglind E, Lundell L. Laparoscopic gastric bypass. Another option in bariatric surgery. Surg Endosc 1996;10:636–638. 3. Wittgrove AC, Clark GW. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 1994;4:353–357.
CORRECTION In the original scientific article titled “Profile of Mothers at Risk: An Analysis of Injury and Pregnancy Loss in 1,195 Trauma Patients” by Danagra G Ikossi, MD, Ann A Lazar, MS, Diane Morabito, RN, MPH, John Fildes, MD, FACS, M Margaret Knudson, MD, FACS,
which appeared in the January 2005 issue of the Journal of the American College of Surgeons, volume 200, pages 49–56, an error occurred throughout the article. “Abbreviated Injury Score” is the correct term (AIS). “Adjusted Injury Score,” which appears in the article is incorrect.