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Sixty elderly sleeve gastrectomy patients performed in the outpatient setting
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ASMBS E-Poster Abstracts / Surgery for Obesity and Related Diseases 13 (2017) S66–S226
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SIXTY ELDERLY SLEEVE GASTRECTOMY PATIENTS PERFORMED IN THE OUTPATIENT SETTING Peter Billing1; Josiah Billing2; Robert Landerholm3; Jedediah Kaufman3; Eric Harris3; Kurtis Stewart3; 1Eviva, Seattle WA; 2Eviva, Shoreline WA; 3Eviva, Edmonds WA Background: Sleeve gastrectomy (SG) is currently the most widely performed operation for treatment of morbid obesity. According to the MBSAQIP criteria elderly patients cannot be performed in an ambulatory surgical center (ASC). Procedures performed in an ASC can provide several advantages over hospital-based surgery. We present results of 60 elderly patients who underwent SG in an ASC. Objective: Assess the safety and efficacy of outpatient SG in the elderly. Setting: Free-standing ASC, Eviva Bariatrics, Seattle WA Methods: Data was collected retrospectively for all patients undergoing SG in the ASC from Jan 1st 2010–Dec. 31st 2016, n¼1,996. Patients o 65 years of age and patients with a history of bariatric surgery were excluded from the study. After exclusion, 60 elderly patients met the criteria. Patients were excluded from the ASC if they weighed 4450 pounds, if anticipated surgery time was 4 2 hours, if the patient had impaired mobility limiting early ambulation, or if there were medical problems requiring postoperative monitoring beyond 23 hours. Patients with sleep apnea were required to spend the night at the ASC (23 hour stay). Results: Mean age was 67.3 years (range 65-74), mean preoperative body mass index (BMI) was 40.6 (29.9-54.2). Patient comorbidities included gastroesophageal reflux disease 28.3%, diabetes 40.0%, hypertension 58.3%, hyperlipidemia 51.7%, and sleep apnea 80.0%. One patient (1.67%) was readmitted 11 days post-op and had a re-operation to drain an infected hematoma. One patient (1.67%) had an emergent re-operation in the ASC for an active bleed at the staple line. One patient (1.67%) developed a deep vein thrombosis that was managed in the outpatient setting. One patient (1.67%) presented to the emergency department with urinary retention and had a Foley catheter placed. There were no staple line leaks, no open conversions and no deaths within 30 days or 1 year. Elderly SG patients lost on average 57.91% excess body weight lost (EWL) at six months and 65.95% EWL at one year. Total body weight loss was 19.6% and 22.6% at six months and one year respectively. Follow-up was 55/60 (91.7%) at six months and 45/60 (75.0%) at one year. Conclusion: With experienced surgeons, appropriate protocols, and a consistent operative team, SG can be performed safely on the elderly patient in a freestanding ASC. Biological age and comorbidity, not chronological age should be used to assess a patient’s eligibility for SG in the outpatient setting.
Medical Centre, Jerusalem Jerusalem; 3Shaare Zedek Medical Centre, Jerusalem Israel Introduction: Laparoscopic sleeve gastrectomy (LSG) has become the leading operative procedure for populations with obesity. However, data regarding the long-term improvements in medical comorbidities and long term weight loss profile are limited. Method: A retrospective analysis of all patients undergoing LSG between November 2011 and April 2012 was performed. Demographic data, pre-operative body mass index (BMI) and medical history were extrapolated from patient records. All patients were then contacted allowing current weight and improvement in medical comorbidities to be recorded. Surgical success was defined as excess weight loss (EWL) of greater than 50%. Diabetes and hypertension were considered improved or resolved if there was cessation or reduction in medical therapy. Results: 173 patients were contacted files were reviewed consisting of 105 female, 68 male (60.7 vs 39.3%) with an average age of 39.6 years (range 16-70 years). Mean pre-operative BMI was 42.41 (range 31.8-68.7) with women having a higher BMI than men (43.3 vs 40.9kg/m2, p ¼ 0.011). Mean BMI at 5 year follow up was 29 (range 19.9-48.7, IQR 7.58, p ¼ 0.000) with men losing more weight than women (26.5 vs 22.4kg/m2, p ¼ 0.049). EWL greater than 50% was achieved in 134/173 patients (77.5%) of whom 87 were women and 47 were men (p ¼ 0.109). In total, 135/173 or 78% of patients regained weight. When comparing lowest with current weight, current weight was significantly higher (75.2 vs 85.5kg, p ¼ 0.002) with an average weight gain of 8.9kg (interquartile range 8.75kg). Of the 134 patients who achieved EWL of greater than 50%, this weight regain resulted in 39 or 29.1% of patients now failing this target (p ¼ 0.000). Pre-operative diabetes was present in 35/173 patients (19.1%) in whom 26/35 (74.3%) had either reduction of cessation of medical therapy at five years. Similarly, of the 41/173 (21.9%) patients who were hypertensive pre-operatively, at 5 years 25/41 (61%) had either a reduction in the number of antihypertensive medications required or cessation of therapy completely. Conclusion: LSG is a successful bariatric procedure with a significant number of patients achieving greater than 50% EWL. However, a large number of patients subsequently regain weight with a significant number subsequently failing the EWL of 50% that they had achieved. Nevertheless, impressive improvements in the requirement for medical treatment of diabetes and hypertension are also noted.
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A5103
IMPACT OF SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS ON CHRONIC RESPIRATORY DISEASES: A SINGLE INSTITUTION EXPERIENCE Rafael A. Ramos Vecchio1; Alexandra Ferre1; Emanuele Lo Menzo1; Samuel Szomstein1; Raul Rosenthal2; 1Cleveland Clinic FL, Weston Florida; 2Cleveland Clinic of FL, North Miami Beach FL
WEIGHT REGAIN 5 YEARS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: BALANCING THE BENEFITS James Tankel1; Michael Neumann2; Alexander Mintz3; Josef Weiss3; Ohn Sibirsky3; Ram M Spira3; 1Shaare Zedek Medical Centre, Tsur Hadassah Jerusalem; 2Shaare Zedek
Background: Obesity has been frequently identified as a significant modifier of the immunologic response. Weight loss has shown to improve respiratory diseases and lung function. However, whether this improvement is equally substantial in different respiratory conditions such as bronchial asthma, chronic obstructive pulmonary
ASMBS E-Poster Abstracts / Surgery for Obesity and Related Diseases 13 (2017) S66–S226
A5102
SIXTY ELDERLY SLEEVE GASTRECTOMY PATIENTS PERFORMED IN THE OUTPATIENT SETTING Peter Billing1; Josiah Billing2; Robert Landerholm3; Jedediah Kaufman3; Eric Harris3; Kurtis Stewart3; 1Eviva, Seattle WA; 2Eviva, Shoreline WA; 3Eviva, Edmonds WA Background: Sleeve gastrectomy (SG) is currently the most widely performed operation for treatment of morbid obesity. According to the MBSAQIP criteria elderly patients cannot be performed in an ambulatory surgical center (ASC). Procedures performed in an ASC can provide several advantages over hospital-based surgery. We present results of 60 elderly patients who underwent SG in an ASC. Objective: Assess the safety and efficacy of outpatient SG in the elderly. Setting: Free-standing ASC, Eviva Bariatrics, Seattle WA Methods: Data was collected retrospectively for all patients undergoing SG in the ASC from Jan 1st 2010–Dec. 31st 2016, n¼1,996. Patients o 65 years of age and patients with a history of bariatric surgery were excluded from the study. After exclusion, 60 elderly patients met the criteria. Patients were excluded from the ASC if they weighed 4450 pounds, if anticipated surgery time was 4 2 hours, if the patient had impaired mobility limiting early ambulation, or if there were medical problems requiring postoperative monitoring beyond 23 hours. Patients with sleep apnea were required to spend the night at the ASC (23 hour stay). Results: Mean age was 67.3 years (range 65-74), mean preoperative body mass index (BMI) was 40.6 (29.9-54.2). Patient comorbidities included gastroesophageal reflux disease 28.3%, diabetes 40.0%, hypertension 58.3%, hyperlipidemia 51.7%, and sleep apnea 80.0%. One patient (1.67%) was readmitted 11 days post-op and had a re-operation to drain an infected hematoma. One patient (1.67%) had an emergent re-operation in the ASC for an active bleed at the staple line. One patient (1.67%) developed a deep vein thrombosis that was managed in the outpatient setting. One patient (1.67%) presented to the emergency department with urinary retention and had a Foley catheter placed. There were no staple line leaks, no open conversions and no deaths within 30 days or 1 year. Elderly SG patients lost on average 57.91% excess body weight lost (EWL) at six months and 65.95% EWL at one year. Total body weight loss was 19.6% and 22.6% at six months and one year respectively. Follow-up was 55/60 (91.7%) at six months and 45/60 (75.0%) at one year. Conclusion: With experienced surgeons, appropriate protocols, and a consistent operative team, SG can be performed safely on the elderly patient in a freestanding ASC. Biological age and comorbidity, not chronological age should be used to assess a patient’s eligibility for SG in the outpatient setting.
Medical Centre, Jerusalem Jerusalem; 3Shaare Zedek Medical Centre, Jerusalem Israel Introduction: Laparoscopic sleeve gastrectomy (LSG) has become the leading operative procedure for populations with obesity. However, data regarding the long-term improvements in medical comorbidities and long term weight loss profile are limited. Method: A retrospective analysis of all patients undergoing LSG between November 2011 and April 2012 was performed. Demographic data, pre-operative body mass index (BMI) and medical history were extrapolated from patient records. All patients were then contacted allowing current weight and improvement in medical comorbidities to be recorded. Surgical success was defined as excess weight loss (EWL) of greater than 50%. Diabetes and hypertension were considered improved or resolved if there was cessation or reduction in medical therapy. Results: 173 patients were contacted files were reviewed consisting of 105 female, 68 male (60.7 vs 39.3%) with an average age of 39.6 years (range 16-70 years). Mean pre-operative BMI was 42.41 (range 31.8-68.7) with women having a higher BMI than men (43.3 vs 40.9kg/m2, p ¼ 0.011). Mean BMI at 5 year follow up was 29 (range 19.9-48.7, IQR 7.58, p ¼ 0.000) with men losing more weight than women (26.5 vs 22.4kg/m2, p ¼ 0.049). EWL greater than 50% was achieved in 134/173 patients (77.5%) of whom 87 were women and 47 were men (p ¼ 0.109). In total, 135/173 or 78% of patients regained weight. When comparing lowest with current weight, current weight was significantly higher (75.2 vs 85.5kg, p ¼ 0.002) with an average weight gain of 8.9kg (interquartile range 8.75kg). Of the 134 patients who achieved EWL of greater than 50%, this weight regain resulted in 39 or 29.1% of patients now failing this target (p ¼ 0.000). Pre-operative diabetes was present in 35/173 patients (19.1%) in whom 26/35 (74.3%) had either reduction of cessation of medical therapy at five years. Similarly, of the 41/173 (21.9%) patients who were hypertensive pre-operatively, at 5 years 25/41 (61%) had either a reduction in the number of antihypertensive medications required or cessation of therapy completely. Conclusion: LSG is a successful bariatric procedure with a significant number of patients achieving greater than 50% EWL. However, a large number of patients subsequently regain weight with a significant number subsequently failing the EWL of 50% that they had achieved. Nevertheless, impressive improvements in the requirement for medical treatment of diabetes and hypertension are also noted.
A5104
A5103
IMPACT OF SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS ON CHRONIC RESPIRATORY DISEASES: A SINGLE INSTITUTION EXPERIENCE Rafael A. Ramos Vecchio1; Alexandra Ferre1; Emanuele Lo Menzo1; Samuel Szomstein1; Raul Rosenthal2; 1Cleveland Clinic FL, Weston Florida; 2Cleveland Clinic of FL, North Miami Beach FL
WEIGHT REGAIN 5 YEARS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY: BALANCING THE BENEFITS James Tankel1; Michael Neumann2; Alexander Mintz3; Josef Weiss3; Ohn Sibirsky3; Ram M Spira3; 1Shaare Zedek Medical Centre, Tsur Hadassah Jerusalem; 2Shaare Zedek
Background: Obesity has been frequently identified as a significant modifier of the immunologic response. Weight loss has shown to improve respiratory diseases and lung function. However, whether this improvement is equally substantial in different respiratory conditions such as bronchial asthma, chronic obstructive pulmonary