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P-106 Effects of socioeconomic status on outcomes of gastric bypass surgery in hispanic patients
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Abstracts: Poster Session 2011 / Surgery for Obesity and Related Diseases 7 (2011) 372– 416
for cash-patients. It would be interesting to see the weightloss outcome where insurance-patients pay the surgery up front and only are reimbursed if goal weight loss is achieved. P-105
LAPAOSCOPIC PLACEMENT OF ADJUSTABLE GASTRIC BAND AFTER FAILED WEIGHT LOSS AFTER GASTRIC BYPASS Shomaf Nakhjo, DO1; Sebastian Eid, MD1; Hans Schmidt, MD1; Amit Trivedi, MD1; Doug R. Ewing, MD1; 1Hackensack Hospital, Hackensack, NJ, United States Background: Roux-en-Y gastric bypass (RYGB) is a common bariatric procedure performed in the United States. Although it is generally a successful procedure, it still has a long-term failure rate of 15-20%. This study looks at the outcomes of patients who underwent laparoscopic placement of adjustable gastric band (LAGB) after RYGB. Methods: All of the data was retrospectively collected and evaluated. We report on a total of 30 patients in our study. All patients had LAGB after RYGB surgery. The bands were place around the proximal gastric pouch. We evaluated and analyzed the patients BMI before and after each procedure, age, percent excess weight loss (EWL) and complications. Results: The mean age and mean body mass index (BMI) of patients in the study at the time of LAGB were 43.8 years and 43.1 kg/m2 respectively. The mean EWL was 50%. The ages ranged from 36-62 years and BMI from 37-54 kg/m2. Excessive weight loss at 6, 12, 18, 36, 48 months after revisional surgery was 24.1%, 40%, 60.4%, 61.1% and 65%, respectively. The average time of follow-up was 12.5 months. The mean EWL after RYGB was 45.6%. The average time from RYGB to LAGB was 7.28 years. There were no complications reported. Conclusion: The results we have obtained indicate that in patients who have failed to achieve significant weight loss after RYGB may benefit from LAGB placement. We have had no complications in our series of patients. LAGB placement is an effective and safe procedure in patients who have poor weight loss results after RYGB surgery. The long-term results are still unclear and will be further investigated in a future study. P-106
EFFECTS OF SOCIOECONOMIC STATUS ON OUTCOMES OF GASTRIC BYPASS SURGERY IN HISPANIC PATIENTS Mary DiGiorgi, MS, MPH1; Lorraine N. Mull, MS1; Nancy Restuccia1; Melissa Bagloo1; Beth Schrope1; Akuezunkpa Ude1; Marc Bessler, MD1; 1Columbia University Center for Metabolic and Weight Loss Surgery, New York Presbyterian Hospital, New York, NY, United States Background: Some studies have found that outcomes of bariatric surgery may not be different between Medicaid and private insurance patients when severity of obesity and comorbidities are taken into account. No studies have looked at these outcomes specifically in a Hispanic population. This study aims to determine preoperative characteristics, outcomes and follow-up Medicaid and private insurance/self pay patients following gastric bypass (GBP) in Hispanic patients.
Methods: Patients age 18 to 60 who underwent primary GBP between 1997 and 2007 with private insurance or Medicaid were included in this study. Patients older than 60 or with Medicare were excluded from this study. Differences in preoperative characteristics, outcomes and follow-up between insurance types were determined. Results: Hispanic Medicaid patients were similar to Hispanic private insurance patients with regard to age, sex, and comorbidities. Hispanic Medicaid patients had a higher initial BMI than non-Medicaid patients, although the trend is not significant (p⫽.05). Hispanic Medicaid patients had poorer weight loss outcomes 6 and 12 months postop (38.1 vs. 47.0 kg/m2 and 47.3 vs. 59.6 %EWL respectively), were less likely to show an improvement in their diabetes and had a higher complication rate (21.2 vs. 6.3) following GBP. Conclusion: This data suggests that Hispanic Medicaid patients have poorer outcomes in terms of weight loss and complications compared to Hispanic patients with private insurance. This may be due in part to their more severe obesity, as well as cultural barriers or differences in access to care. Further studies are needed to elucidate possible barriers. P-107
PREDICTORS OF SUCCESS IN PERFORMING SINGLE INCISION BANDING John Cheregi2; Alfonso Torquati, MD, MSCI5; Fred Tiesenga4; Shabir Abadin, MD3; Rami E. Lutfi, MD, FACS1; 1Chicago Institute of Advanced Bariatrics, Chicago, IL, United States; 2 Metropolitan Group Hospitals Residency in General Surgery, University of Illinois, Chicago, IL, United States; 3General Surgery, St Joseph Hospital, Chicago, IL, United States; 4 General Surgery, Westlake Hospital, Melrose Park, IL, United States; 5Surgery, Duke University, Durham, NC, United States Background: Single Incision Laparoscopic Adjustable Gastric Banding (SI-LAGB) is a promising technique with potential to decrease pain, and improve cosmesis. It is, however, challenging and potentially time consuming. We aimed to identify preoperative patient characteristics predictive of a successful SI-LAGB. Methods: Demographic and anthropometric data were prospectively collected. Primary endpoint was operating time. Adequate Operating Time (AOT) was determined using a contemporary cohort of 100 subjects undergoing multi-port LAGB. The cut off for AT was defined as mean ⫾ 1 SD. Binary logistic regression analysis was used in univariate and multivariate modeling to identify independent preoperative variables associated with AOT. Results: 79 patients (71 female, 2/2009-10/2010) underwent SILAGB, no conversions to laparoscopy. Mean operating time 61⫾ 27 minutes. Cohort was divided into: AOT (n⫽53), and Excessive Operating Time, (EOT, n⫽26) based on cut-off value of 69 minutes (defined above). Demographic (age, sex, race), anthropometric (height, weight, BMI), and clinical (hiatal hernia) data was compared. On univariate analysis, preoperative BMI had significant (p⫽0.03) counterintuitive effect on Operative time (AOT 44.2⫾ 6.2 kg/m2 versus EOT 42.1⫾ 4.2 kg/m2). Hiatal hernia was also significant predictor of EOT (19.2% versus 3.7%; p ⫽ 0.001) and remained an independent predictor of EOT in multivariate logistic regression after
Abstracts: Poster Session 2011 / Surgery for Obesity and Related Diseases 7 (2011) 372– 416
for cash-patients. It would be interesting to see the weightloss outcome where insurance-patients pay the surgery up front and only are reimbursed if goal weight loss is achieved. P-105
LAPAOSCOPIC PLACEMENT OF ADJUSTABLE GASTRIC BAND AFTER FAILED WEIGHT LOSS AFTER GASTRIC BYPASS Shomaf Nakhjo, DO1; Sebastian Eid, MD1; Hans Schmidt, MD1; Amit Trivedi, MD1; Doug R. Ewing, MD1; 1Hackensack Hospital, Hackensack, NJ, United States Background: Roux-en-Y gastric bypass (RYGB) is a common bariatric procedure performed in the United States. Although it is generally a successful procedure, it still has a long-term failure rate of 15-20%. This study looks at the outcomes of patients who underwent laparoscopic placement of adjustable gastric band (LAGB) after RYGB. Methods: All of the data was retrospectively collected and evaluated. We report on a total of 30 patients in our study. All patients had LAGB after RYGB surgery. The bands were place around the proximal gastric pouch. We evaluated and analyzed the patients BMI before and after each procedure, age, percent excess weight loss (EWL) and complications. Results: The mean age and mean body mass index (BMI) of patients in the study at the time of LAGB were 43.8 years and 43.1 kg/m2 respectively. The mean EWL was 50%. The ages ranged from 36-62 years and BMI from 37-54 kg/m2. Excessive weight loss at 6, 12, 18, 36, 48 months after revisional surgery was 24.1%, 40%, 60.4%, 61.1% and 65%, respectively. The average time of follow-up was 12.5 months. The mean EWL after RYGB was 45.6%. The average time from RYGB to LAGB was 7.28 years. There were no complications reported. Conclusion: The results we have obtained indicate that in patients who have failed to achieve significant weight loss after RYGB may benefit from LAGB placement. We have had no complications in our series of patients. LAGB placement is an effective and safe procedure in patients who have poor weight loss results after RYGB surgery. The long-term results are still unclear and will be further investigated in a future study. P-106
EFFECTS OF SOCIOECONOMIC STATUS ON OUTCOMES OF GASTRIC BYPASS SURGERY IN HISPANIC PATIENTS Mary DiGiorgi, MS, MPH1; Lorraine N. Mull, MS1; Nancy Restuccia1; Melissa Bagloo1; Beth Schrope1; Akuezunkpa Ude1; Marc Bessler, MD1; 1Columbia University Center for Metabolic and Weight Loss Surgery, New York Presbyterian Hospital, New York, NY, United States Background: Some studies have found that outcomes of bariatric surgery may not be different between Medicaid and private insurance patients when severity of obesity and comorbidities are taken into account. No studies have looked at these outcomes specifically in a Hispanic population. This study aims to determine preoperative characteristics, outcomes and follow-up Medicaid and private insurance/self pay patients following gastric bypass (GBP) in Hispanic patients.
Methods: Patients age 18 to 60 who underwent primary GBP between 1997 and 2007 with private insurance or Medicaid were included in this study. Patients older than 60 or with Medicare were excluded from this study. Differences in preoperative characteristics, outcomes and follow-up between insurance types were determined. Results: Hispanic Medicaid patients were similar to Hispanic private insurance patients with regard to age, sex, and comorbidities. Hispanic Medicaid patients had a higher initial BMI than non-Medicaid patients, although the trend is not significant (p⫽.05). Hispanic Medicaid patients had poorer weight loss outcomes 6 and 12 months postop (38.1 vs. 47.0 kg/m2 and 47.3 vs. 59.6 %EWL respectively), were less likely to show an improvement in their diabetes and had a higher complication rate (21.2 vs. 6.3) following GBP. Conclusion: This data suggests that Hispanic Medicaid patients have poorer outcomes in terms of weight loss and complications compared to Hispanic patients with private insurance. This may be due in part to their more severe obesity, as well as cultural barriers or differences in access to care. Further studies are needed to elucidate possible barriers. P-107
PREDICTORS OF SUCCESS IN PERFORMING SINGLE INCISION BANDING John Cheregi2; Alfonso Torquati, MD, MSCI5; Fred Tiesenga4; Shabir Abadin, MD3; Rami E. Lutfi, MD, FACS1; 1Chicago Institute of Advanced Bariatrics, Chicago, IL, United States; 2 Metropolitan Group Hospitals Residency in General Surgery, University of Illinois, Chicago, IL, United States; 3General Surgery, St Joseph Hospital, Chicago, IL, United States; 4 General Surgery, Westlake Hospital, Melrose Park, IL, United States; 5Surgery, Duke University, Durham, NC, United States Background: Single Incision Laparoscopic Adjustable Gastric Banding (SI-LAGB) is a promising technique with potential to decrease pain, and improve cosmesis. It is, however, challenging and potentially time consuming. We aimed to identify preoperative patient characteristics predictive of a successful SI-LAGB. Methods: Demographic and anthropometric data were prospectively collected. Primary endpoint was operating time. Adequate Operating Time (AOT) was determined using a contemporary cohort of 100 subjects undergoing multi-port LAGB. The cut off for AT was defined as mean ⫾ 1 SD. Binary logistic regression analysis was used in univariate and multivariate modeling to identify independent preoperative variables associated with AOT. Results: 79 patients (71 female, 2/2009-10/2010) underwent SILAGB, no conversions to laparoscopy. Mean operating time 61⫾ 27 minutes. Cohort was divided into: AOT (n⫽53), and Excessive Operating Time, (EOT, n⫽26) based on cut-off value of 69 minutes (defined above). Demographic (age, sex, race), anthropometric (height, weight, BMI), and clinical (hiatal hernia) data was compared. On univariate analysis, preoperative BMI had significant (p⫽0.03) counterintuitive effect on Operative time (AOT 44.2⫾ 6.2 kg/m2 versus EOT 42.1⫾ 4.2 kg/m2). Hiatal hernia was also significant predictor of EOT (19.2% versus 3.7%; p ⫽ 0.001) and remained an independent predictor of EOT in multivariate logistic regression after