- Email: [email protected]
Risk factors for postoperative mortality in bariatric surgery
283
ASSOCIATION FOR ACADEMIC SURGERY—ABSTRACTS 0.04). Conversely, patients with acute dissection had decreased CTGF mRNA expression compared with nondissection aneurysms (P ⫽ 0.019) and controls (P ⫽ 0.06). The increase in CTGF expression in chronic dissections compared to acute dissections approached statistical significance (P ⫽ 0.075). Conclusions. The altered tissue levels of CTGF in aneurysms and dissections suggest possibly different molecular pathology in these aortic disorders. Further investigation regarding the role of CTGF in thoracic aortic disease is warranted.
CLINICAL TRIALS/OUTCOMES PARALLEL SESSION
to identify risk factors of increased postoperative mortality in patients undergoing BaS on a national level. Methods. BaS patients ⱖ18 years old in the United States were identified from the 2001 Nationwide Inpatient Sample (NIS). The effect of gender, age, insurance status, and need for reoperation on postoperative mortality was examined using multivariate logistic regression accounting for the NIS stratified sampling design and using comorbidity adjustments appropriate for index hospitalization data. Results. Analysis of 7,452,727 discharges identified 10,503 bariatric surgical patients meeting inclusion criteria. Estimates were generalizable to a national cohort of 52,098 patients with age 41 ⫾ 10 years (mean ⫾ SE), 84% women, length of stay (LOS) 3.9 ⫾ 0.2 days, and overall mortality of 4 per 1000 BaS patients. Risk factors for postoperative in-hospital mortality are shown (Table).
TABLE—ABSTRACT 34
33. Has the Availability of Minimally Invasive Techniques Lowered the Threshold for Surgery in Elderly Patients with Hyperparathyroidism? Z.M. Pruhs, MD, E. Mack, MD, J. Starling, MD, and H. Chen, MD. University Of Wisconsin, Madison, WI. Introduction. Many elderly patients with primary hyperparathyroidism (HPT), which increases in incidence with age and is frequently asymptomatic, are often not referred for surgery. However, the development of minimally invasive techniques has facilitated complex operations even in the elderly. Therefore, we sought to determine if the introduction of minimally invasive radioguided parathyroidectomy (MIRP) would alter the threshold for surgical referral at our institution for patients over 70 years of age. Methods. From January 1990 to March 2004, 422 patients underwent surgery for primary HPT at our institution. Of these, 98 were 70 years or older. In 2001, we introduced MIRP. Patients were then analyzed based upon the availability of this technology (pre-MIRP era 1990 –2000, and MIRP era 2001–2004). Results. In the MIRP era, more elderly patients were referred for surgery when compared to the pre-MIRP era (30% versus 18%, P ⫽ 0.001). On average, 18 elderly patients/year had parathyroid surgery in the MIRP era compared to only 3 elderly patients/year pre-MIRP, representing a 6-fold increase. Furthermore, there were significantly more patients undergoing parathyroidectomy who were asymptomatic from HPT during the MIRP era (14% versus ⬍1%, P ⬍ 0.001). Importantly, MIRP was associated with a high cure rate, lower complication rate, and shorter hospital stay (see below). Conclusion. The introduction of MIRP has
Female Male Age 18–39 Age 40–49 Age 50–59 Private Insurance Medicaid No reoperation† Reoperation
% of BaS population
Odds ratio for death*
95% Confidence interval*
84 16 46 32 19 83 4.7 99 1
(ref) 2.1 (ref) 2.6 4.3 (ref) 3.9 (ref) 22
(ref) 1.1–4.3 (ref) 1.1–6.5 1.7–11 (ref) 1.2–13 (ref) 5.4–88
P value*
0.04 0.04 0.002 0.03 0.0001
* Adjusted for factors in table plus race, region and comorbidities; † Reoperation during original admission; ref ⫽ referent group Mean LOS of those who died was 17.6 ⫾ 3.7 days. Conclusion. Based on national data, risk factors for increased postoperative mortality in BaS patients include male gender, age ⬎ 39 years, Medicaid insured, and need for reoperation. These data can assist in optimizing BaS patient selection. 35. Carotid Angioplasty: The Need to Revise Post Surgical Duplex Velocity Criteria. L.S. Brevetti, MD, J.L. Nosher, MD, G.B. Nackman, MD, and M. Graham, MD. Robert Wood Johnson Medical School.
TABLE—ABSTRACT 33 ERA
N
Cure rate
Complications
Hospital stay (days)
Pre-MIRP MIRP p value
43 55 —
89% 99% ⬍0.001
7% 3% 0.05
2.0 ⫾ 0.4 0.5 ⫾ 0.1 ⬍0.001
led to an increase in the number of elderly patients with HPT referred for surgery as well as the proportion with only mild disease. MIRP has also resulted in improved surgical outcomes for elderly patients. Consequently, the availability of MIRP at our institution has lowered the threshold for surgical referral in elderly patients with HPT. 34. Risk Factors For Postoperative Mortality in Bariatric Surgery. B.K. Poulose, MD, M.R. Griffin, MD, MPH, D.E. Moore, MD, MPH, Y. Zhu, MD, MS, W. Smalley, MD, MPH, W.O. Richards, MD, J. Wright, MD, W. Melvin, MD, and M.D. Holzman, MD, MPH. Vanderbilt University School of Medicine. Introduction. Appropriate patient selection is crucial to the success of bariatric surgery (BaS). The objective of this study was
Purpose. To determine the appropriate duplex velocities post carotid artery angioplasty and stent compared with endarterectomy for recurrent stenosis. Methods. Retrospective analysis on patients with over 80% recurrent carotid artery stenosis treated at our institution was performed. Velocities from preoperative, postoperative (⬍1 week), and late postoperative duplex scans (1–121 months) were compared after re-do carotid endarterectomy (CEA) or carotid artery angioplasty and stent (CAS) placement. Variables within the groups were compared using analysis of variance (ANOVA). Stepwise-regression analysis was used to determine the independence of CAS as a factor causing elevated postoperative velocities. Mean peak systolic velocities (PSV) ⫾ SEM, end diastolic velocities (EDV) ⫾ SEM, and internal carotid artery/ common carotid artery PSV ratios (ICA/CCA) are reported. Results. Thirty-four patients with a mean age of 72 were studied. Sixteen patients underwent CAS, and 18 patients underwent CEA. The mean interval between first CEA and treatment for the recurrent stenosis (CEA or CAS) was 41 months. There was no significant difference in risk factors between groups (age, gender, patch, and contralateral occlusion). There was a significant difference in postoperative PSV between CEA and CAS, which resolved after 1.5 years. Similarly, the postoperative ICA/CCA was significantly different between CEA and
ASSOCIATION FOR ACADEMIC SURGERY—ABSTRACTS 0.04). Conversely, patients with acute dissection had decreased CTGF mRNA expression compared with nondissection aneurysms (P ⫽ 0.019) and controls (P ⫽ 0.06). The increase in CTGF expression in chronic dissections compared to acute dissections approached statistical significance (P ⫽ 0.075). Conclusions. The altered tissue levels of CTGF in aneurysms and dissections suggest possibly different molecular pathology in these aortic disorders. Further investigation regarding the role of CTGF in thoracic aortic disease is warranted.
CLINICAL TRIALS/OUTCOMES PARALLEL SESSION
to identify risk factors of increased postoperative mortality in patients undergoing BaS on a national level. Methods. BaS patients ⱖ18 years old in the United States were identified from the 2001 Nationwide Inpatient Sample (NIS). The effect of gender, age, insurance status, and need for reoperation on postoperative mortality was examined using multivariate logistic regression accounting for the NIS stratified sampling design and using comorbidity adjustments appropriate for index hospitalization data. Results. Analysis of 7,452,727 discharges identified 10,503 bariatric surgical patients meeting inclusion criteria. Estimates were generalizable to a national cohort of 52,098 patients with age 41 ⫾ 10 years (mean ⫾ SE), 84% women, length of stay (LOS) 3.9 ⫾ 0.2 days, and overall mortality of 4 per 1000 BaS patients. Risk factors for postoperative in-hospital mortality are shown (Table).
TABLE—ABSTRACT 34
33. Has the Availability of Minimally Invasive Techniques Lowered the Threshold for Surgery in Elderly Patients with Hyperparathyroidism? Z.M. Pruhs, MD, E. Mack, MD, J. Starling, MD, and H. Chen, MD. University Of Wisconsin, Madison, WI. Introduction. Many elderly patients with primary hyperparathyroidism (HPT), which increases in incidence with age and is frequently asymptomatic, are often not referred for surgery. However, the development of minimally invasive techniques has facilitated complex operations even in the elderly. Therefore, we sought to determine if the introduction of minimally invasive radioguided parathyroidectomy (MIRP) would alter the threshold for surgical referral at our institution for patients over 70 years of age. Methods. From January 1990 to March 2004, 422 patients underwent surgery for primary HPT at our institution. Of these, 98 were 70 years or older. In 2001, we introduced MIRP. Patients were then analyzed based upon the availability of this technology (pre-MIRP era 1990 –2000, and MIRP era 2001–2004). Results. In the MIRP era, more elderly patients were referred for surgery when compared to the pre-MIRP era (30% versus 18%, P ⫽ 0.001). On average, 18 elderly patients/year had parathyroid surgery in the MIRP era compared to only 3 elderly patients/year pre-MIRP, representing a 6-fold increase. Furthermore, there were significantly more patients undergoing parathyroidectomy who were asymptomatic from HPT during the MIRP era (14% versus ⬍1%, P ⬍ 0.001). Importantly, MIRP was associated with a high cure rate, lower complication rate, and shorter hospital stay (see below). Conclusion. The introduction of MIRP has
Female Male Age 18–39 Age 40–49 Age 50–59 Private Insurance Medicaid No reoperation† Reoperation
% of BaS population
Odds ratio for death*
95% Confidence interval*
84 16 46 32 19 83 4.7 99 1
(ref) 2.1 (ref) 2.6 4.3 (ref) 3.9 (ref) 22
(ref) 1.1–4.3 (ref) 1.1–6.5 1.7–11 (ref) 1.2–13 (ref) 5.4–88
P value*
0.04 0.04 0.002 0.03 0.0001
* Adjusted for factors in table plus race, region and comorbidities; † Reoperation during original admission; ref ⫽ referent group Mean LOS of those who died was 17.6 ⫾ 3.7 days. Conclusion. Based on national data, risk factors for increased postoperative mortality in BaS patients include male gender, age ⬎ 39 years, Medicaid insured, and need for reoperation. These data can assist in optimizing BaS patient selection. 35. Carotid Angioplasty: The Need to Revise Post Surgical Duplex Velocity Criteria. L.S. Brevetti, MD, J.L. Nosher, MD, G.B. Nackman, MD, and M. Graham, MD. Robert Wood Johnson Medical School.
TABLE—ABSTRACT 33 ERA
N
Cure rate
Complications
Hospital stay (days)
Pre-MIRP MIRP p value
43 55 —
89% 99% ⬍0.001
7% 3% 0.05
2.0 ⫾ 0.4 0.5 ⫾ 0.1 ⬍0.001
led to an increase in the number of elderly patients with HPT referred for surgery as well as the proportion with only mild disease. MIRP has also resulted in improved surgical outcomes for elderly patients. Consequently, the availability of MIRP at our institution has lowered the threshold for surgical referral in elderly patients with HPT. 34. Risk Factors For Postoperative Mortality in Bariatric Surgery. B.K. Poulose, MD, M.R. Griffin, MD, MPH, D.E. Moore, MD, MPH, Y. Zhu, MD, MS, W. Smalley, MD, MPH, W.O. Richards, MD, J. Wright, MD, W. Melvin, MD, and M.D. Holzman, MD, MPH. Vanderbilt University School of Medicine. Introduction. Appropriate patient selection is crucial to the success of bariatric surgery (BaS). The objective of this study was
Purpose. To determine the appropriate duplex velocities post carotid artery angioplasty and stent compared with endarterectomy for recurrent stenosis. Methods. Retrospective analysis on patients with over 80% recurrent carotid artery stenosis treated at our institution was performed. Velocities from preoperative, postoperative (⬍1 week), and late postoperative duplex scans (1–121 months) were compared after re-do carotid endarterectomy (CEA) or carotid artery angioplasty and stent (CAS) placement. Variables within the groups were compared using analysis of variance (ANOVA). Stepwise-regression analysis was used to determine the independence of CAS as a factor causing elevated postoperative velocities. Mean peak systolic velocities (PSV) ⫾ SEM, end diastolic velocities (EDV) ⫾ SEM, and internal carotid artery/ common carotid artery PSV ratios (ICA/CCA) are reported. Results. Thirty-four patients with a mean age of 72 were studied. Sixteen patients underwent CAS, and 18 patients underwent CEA. The mean interval between first CEA and treatment for the recurrent stenosis (CEA or CAS) was 41 months. There was no significant difference in risk factors between groups (age, gender, patch, and contralateral occlusion). There was a significant difference in postoperative PSV between CEA and CAS, which resolved after 1.5 years. Similarly, the postoperative ICA/CCA was significantly different between CEA and