QS261. Outcomes of Bariatric Surgery in Morbidly Obese Who Manifest the Metabolic Syndrome

370 ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS Background: Concerns regarding variable quality of care prompted credentialing processes for bariatric surgery “Centers of Excellence” (COE). An integral aspect of the COE process is the assumption that high volume bariatric surgeons and hospitals have improved clinical outcomes. Objective: This population-based study examines the effect of bariatric surgery volume (surgeon and hospital) on mortality and resource utilization in Pennsylvania (PA). Methods: 14,716 patients having gastric bypass surgery in PA hospitals from 2000 and 2003 were identified using data from the Pennsylvania Health Care Cost Containment Council (PHC4) database. Individual surgeons and hospitals were stratified as High (⬎100 cases/yr), Medium (50-100 cases/yr) or Low-volume (⬍50 cases/yr). The relationship between surgeon and hospital volume on length of stay (LOS), inhospital and 30-day mortality was examined after adjusting for age, gender, ethnicity, payer, and admission MedisGroup severity (AMS). Results: There were 26-50 Low (n⫽2,158), 35-54 Medium (n⫽1,835), and 43-64 High (n⫽10,723) volume hospitals in PA. The mean surgical volume/hospital increased between 2000 and 2003 from 20 to 120 cases/yr and in-hospital mortality decreased from 0.8% to 0.2%. Thirty-day mortality was approximately two times the in-hospital mortality (1.15% to 0.37%). Male gender (OR 3.6, p⬍0.001), AMS (OR 2.5, p⬍0.001), hospital and surgeon volume were associated with increased in-hospital and 30-day mortality. After controlling for other factors, patients treated by Low and Medium-volume surgeons (OR 3.7, p⫽0.002; OR 2.8, p⫽0.015) and hospitals (OR 2.3, p⫽0.01;OR 2.44, p⫽0.017) had increased odds of 30-day mortality vs. High-volume surgeons and hospitals. LOS was significantly shorter at high-volume hospitals as well. Conclusions: In PA, bariatric surgery performed by high-volume surgeons and hospitals is associated with decreased mortality and LOS. The results support the use of surgeon and hospital volume as part of the COE credentialing process. QS260. OUTCOMES IN BARIATRIC SURGERY IN THE OLDER PATIENT POPULATION IN TEXAS. Victoria Gómez, Guillermo A. Gómez, Taylor S. Riall; The University of Texas Medical Branch, Galveston, TX Introduction: The prevalence of morbid obesity is still increasing. Whether the safety of bariatric surgery can span over a broad range of age groups is uncertain. This study evaluated the outcomes in gastric bypass surgery for morbid obesity in Texas from 1999 to 2004 in persons ⬍ 55 or ⱖ 55 years of age. Methods: Patients undergoing gastric bypass surgery were identified using the Texas Hospital Inpatient Discharge Public Use Datafile. Patient demographics, comorbidities, hospital stay and mortality rates were compared in patients ⬍ 55 or ⱖ 55 years of age. Results: Patients ⱖ 55 years of age accounted for 9.39% (n⫽2212) of the 23,816 gastric bypass procedures. The number of patients undergoing gastric bypass increased in both age groups. The percentage of patients ⱖ 55 years of age increased from 8% in 1999 to 12% in 2004. Comparing the older age group to the younger age group, persons ⱖ 55 years were less likely to be female (80% vs 87%, p⬍0.0001) but more likely to be white (79% vs 63%, p⬍0.0001) and have more co-morbidities (hypertension, diabetes mellitus, coronary artery disease). Older patients had a longer postoperative hospital stay (3.8 vs 3.1 days, p⬍0.0001). Mortality rates were 0.5% in the older group and 0.2% in the younger group (p⬍0.0001). In a multivariate logistic regression model, age was not an independent predictor of mortality after controlling for gender, race, year of surgery, and severity of illness. Conclusions: Bariatric surgery has increased in popularity amongst younger and older obese patients in Texas. Although morbidity and mortality rates are higher in patients ⱖ 55 years of age, these procedures can be performed safely. QS261. OUTCOMES OF BARIATRIC SURGERY IN MORBIDLY OBESE WHO MANIFEST THE METABOLIC SYNDROME. Esteban Varela1, Marcelo Hinojosa2, Ninh

Nguyen2; 1UT Southwestern, Dallas, TX; 2UC Irvine, Orange, CA Background: The metabolic syndrome (MS) is associated with significant cardiovascobidity and mortality and is present in more than 2/3 of obese individuals. The aim of this study was to determine the effect of the metabolic syndrome over the outcomes after bariatric surgery performed at US academic centers and compare it to a control group without comorbidities. Methods: Using ICD-9 codes, clinical data for 30,954 patients with the MS (defined as morbid obesity, hypertension, diabetes and hyperlipidemia) and without comorbidities that underwent bariatric surgery over a 5-year period (2003-2007) were obtained from the University Health-System Consortium database. Procedures included laparoscopic gastric bypass, open gastric bypass and laparoscopic gastric banding. There were 85% females, 81% Caucasians, 14% African-Americans, and 5% Hispanics in the study. Gender, ethnicity, morbidity and risk adjusted mortality ratio (RAM⫽observed/expected mortality) were analyzed. Results: *⫽ p⬍.05 between and within groups, Z-test Groups

MS (n ⫽ 23,192)

Control (n ⫽ 7,762)

Outcome variables

Morbidity (%)

RAM

Morbidity (%)

RAM

Female Male Caucasian African-American Hispanic Cohort

8.3 8.7 8.9 8.2 11.7* 8.7

0.5 0.9 0.8 1.4 0 0.9

5.8 6.8 6.1 6.0 5.1 6.0

0.3 0 0 2.2 0 0.2

Subgroup analysis revealed that African-Americans males with the MS have a 12-fold increase in RAM (6.0) compared to females, 8-fold vs. Caucasian males and 30-fold vs. controls. Conclusion: Compared to patients without comorbidities, Hispanics who manifest the MS present significantly higher overall complication rates after bariatric surgery without mortality. However, African-Americans have the highest risk adjusted mortality. Even more, African-American males with the MS are at greater risk of demise after bariatric surgery. These data suggests that the presence of the MS negatively affects inter-ethnic and gender specific outcomes after bariatric surgery. QS262. POSTOPERATIVE HYPOXEMIA: A COMMON, UNDETECTED AND UNSUSPECTED COMPLICATION AFTER BARIATRIC SURGERY. Krista L. Haines1, John B. Downs2, Carinne Cuculich2, Byers Bowen2, Michel M. Murr2, Scott F. Gallagher2; 1Lake Erie College of Osteopathic Medicine, Bradenton, FL; 2University of South Florida; USF Health, Tampa, FL Intro: Postoperative respiratory depression is a common sequelae of patient controlled analgesia (PCA), especially in patients with obstructive sleep apnea (OSA). Bariatric patients often have OSA, abdominal operations, and PCA; therefore, these patients are at great risk. The purpose of this study was to quantify the magnitude of the problem. Methods: Patients (n⫽13) scheduled for gastric bypass gave IRB-approved, informed consent to have oxygen saturation (SpO 2) recorded continuously, but not displayed, for 24 hours beginning in preoperative holding, in addition to standard monitoring during anesthesia, in recovery (including pulse oximetry) as well as on the ward, as indicated. Patients breathed supplemental oxygen (O 2) in recovery or until maintaining SpO 2⬎92% breathing room air. All received narcotic IV PCA, with no basal rate. All oximeter data were reviewed for SpO 2⬍90%, for more than 10 seconds (sec). Results are Mean⫾SD. Results: Patients were 46⫾13 years old; 80% were female, and BMI was 50⫾11kg/m 2. Most (80%) had sleep study confirmed OSA. Every patient (100%) had at least one episode of SpO 2⬍90% for more than 10 sec, undetected by routine monitoring;