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Tu1638 Laparoscopic Surgery for Gastric Malignancy: Outcomes of a Minimally Invasive Oncologic Resection
of the measured outcomes based on t-test analysis. There were few events in any of the cohorts. Of the 12 post-op outcome variables included, five had events: seven patients were noted to be perforated at the time of operation (average total symptom duration = 35 hours), one patient required conversion to open appendectomy (total symptom duration = 85 hours), one patient had superficial SSI (88 hours), one had deep SSI (22 hours) and one had deep organ space infection (29 hours); none required blood transfusion and no patients experienced MI, PE, ARF, sepsis, pneumonia or death. However, these events were distributed across cohorts; there was no statistically significant difference in the rate of occurrence of these outcomes based on the patients' duration of symptoms. Conclusion: Our data demonstrate no significant difference in the outcomes measured between the four cohorts. This data suggests that there may be a longer window for safe resuscitation prior to operative intervention, contradicting previous findings in acute appendicitis. Because the conclusions drawn from this study are derived from retrospective data, a prospective study is required to more strongly validate our results.
Tu1642 A Three State Analysis of Bariatric Procedures: Trends and Outcomes Cheguevara Afaneh, Gregory Giambrone, Jonathan Eskreis-Winkler, Akshay U. Bhat, Ramin Zabih, Gregory Dakin, Alfons Pomp, Peter Fleischut Introduction: The popularity of bariatric surgery has continued to grow over the last decade. The safety and efficacy of bariatric surgery has been previously established. Nevertheless, trends as well as patient characteristics continue to evolve and change in bariatric surgery. Herein, we report trends and outcomes following bariatric surgery from three major states over a six-year interval using the State Inpatient Databases (SID), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Methods: Using SID data from California, Florida, and New York, we retrospectively reviewed outcomes of all laparoscopic adjustable gastric bandings (LGB), laparoscopic sleeve gastrectomies (LSG), and laparoscopic roux-en-y gastric bypasses (LRYGB) performed on obese patients from 2006 to 2011. Discharges analyzed for distribution of age and Deyo Comorbidity Index (Deyo score) by procedure. Furthermore, postoperative complications and mortality rates were compared and reported. Results: A total of 160,472 bariatric procedures were performed during the study period; 22.2% LGB, 15.5% LSG, and 62.4% LRYGB. Overall, females had a higher frequency of bariatric surgery [Table 1]. LGB was the most frequently used procedure among males receiving bariatric procedures. The majority of patients undergoing bariatric surgery were under the age of 45 (50.4%). The highest proportion of patients undergoing LSG were > 75 were (Figure A). In general, patients with the lowest Deyo score underwent LGB (P<0.0001, Figure B). Over the last 5 years, the utilization of LGBs has decreased while the number of LSG has increased (Figure C). The number of LRYGB has remained relatively constant while the total number of bariatric procedures has increased. LSG had the highest proportion of pulmonary, cardiac and hematologic complications, while LGB had the lowest rates in the former categories (P<0.0001) [Table 1]. The incidence of postoperative ileus and nausea/vomiting was highest following LSG and lowest following LGB (P<0.0001). The length of stay was significantly shorter following LGB, while LSG and LRYGB were equivalent (P<0.0001). The proportion of mortality was lowest for LGB and highest for LSG (P<0.0001). The overall mortality for all bariatric procedures was 0.4%. Conclusion: Bariatric surgery remains safe and feasible. LSG is becoming more popular than LGB, especially for older patients with significantly more comorbidities; however, morbidity remains higher for LSG compared to LGB. The SID has important limitations; therefore, further analyses are necessary to identify the full impact of these findings.
Tu1637 Can the Risk of Non-Home Discharge After Resection of Gastric Adenocarcinoma Be Predicted? Alexandra W. Acher, Shishir K. Maithel, Ryan Fields, George A. Poultsides, Carl Schmidt, Konstantinos I. Votanopoulos, Timothy M. Pawlik, Linda X. Jin, David C. Linehan, William G. Hawkins, Steven M. Strasberg, Aslam Ejaz, Malcolm H. Squires, David Kooby, David Worhunsky, Edward A. Levine, Neil D. Saunders, Gaya Spolverato, Emily Winslow, Clifford S. Cho, Ken Meredith, Glen Leverson, Sharon M. Weber
SSAT Abstracts
BACKGROUND: Currently, there are no validated methods to preoperatively identify patients with an increased risk of discharge to skilled nursing facilities (SNFs; non-home discharge) following resection of gastric cancer (GC). In these circumstances, length of stay is often prolonged while arrangements are completed. Utilizing a multi-institutional database of patients who underwent surgery for GC, we sought to identify preoperative predictors of non-home discharge in an effort to anticipate and optimize transitions of care to SNFs. METHODS: Patients who underwent resection of GC from 2000-2012 from the 7 participating institutions of the U.S. Gastric Cancer Collaborative were analyzed. In-hospital deaths following resection were excluded. Logistic regression and Fischer's exact test were used to identify preoperative factors predictive of non-home discharge. RESULTS: 923 patients were identified. Of these, 93 (10%) were discharged to a location other than home (SNF). Univariate analysis identified the following preoperative variables as significant risk factors for non-home discharge: age, ASA score, hypertension, diabetes, albumin, creatinine, bleeding, weight loss, and neoadjuvant chemotherapy. On multivariate analysis, advanced age (OR = 1.07, 95% CI = 1.04-1.09, p < 0.0001) and depressed pre-operative serum albumin (OR= 0.45, 95% CI = 0.30-0.67, p = 0.0001) were independently associated with non-home discharge. Patients 70 yrs or older with a preoperative albumin 3.4 g/dL; see Table). CONCLUSIONS: Older patients with compromised nutritional status are at increased risk for non-home discharge following resection of gastric cancer. In these patients, preoperative planning for transition to skilled nursing facilities may reduce demand on hospital resources as well as ease the burden of transition of care for patients and hospital care teams. Table: Odds of non-home discharge (NHD) in high-risk versus low risk populations
Tu1638 Laparoscopic Surgery for Gastric Malignancy: Outcomes of a Minimally Invasive Oncologic Resection Monica Young, Alana Gebhart, Stephen D. Vu, Nojan Toomari, Brian R. Smith, Ninh T. Nguyen Introduction: Controversy remains over the safety and efficacy of laparoscopic gastric operations. The objective of this study was to evaluate the outcomes of patients who underwent laparoscopic gastrectomy and palliative bypass procedures. Methods: 86 patients who underwent laparoscopic intervention for gastric malignancy between January 2001 and August 2013 were reviewed. 94% of patients underwent laparoscopic gastrectomy, while 6% were found to be unresectable and required a palliative bypass. Main outcome measures included operative findings, conversion rate, hospital stay, morbidity, mortality and pathology. Results: Mean age was 68 years and 52% of patients were male. The majority of cases were performed for gastric adenocarcinoma (90%). Other indications included gastrointestinal stromal tumor (5.8%), dysplasia (1.2%), carcinoid (1.2%), and pancreatic cancer (1.2%). Eight patients (9.3%) underwent neoadjuvant therapy. Procedures performed included laparoscopic total gastrectomy (20%), subtotal gastrectomy (41%), distal gastrectomy (25%), proximal gastrectomy (5%), gastric wedge resection (3%) and palliative gastrojejunal bypass (6%). There were no conversions to laparotomy. Eleven patients (13%) were monitored in the ICU postoperatively, with an overall mean ICU stay of 0.9 days. Median hospital stay was 4 days. There were no in-hospital or 30-day mortalities. Two intraoperative complications occurred in patients undergoing subtotal gastrectomy: ischemia of the Roux limb requiring resection and bleeding at the gastrojejunostomy anastomosis. The rate of major complications was 3.7% and minor complications was 9.9%. Anastomotic leak occurred in one patient following total gastrectomy (1.2%). Late complication rate was 11%, with stricture being the most common. Distribution of final pathology was: stage 0 (15%), stage I (47%), stage II (14%), stage III (10%) and stage IV (15%). Average number of lymph nodes resected was 19 ±12.3. Conclusion: Laparoscopic gastrectomy is safe and associated with low morbidity and mortality. A minimally invasive approach can provide good oncologic resection with equivalent lymph node harvest to open gastrectomy.
S-1095
SSAT Abstracts
Tu1642 A Three State Analysis of Bariatric Procedures: Trends and Outcomes Cheguevara Afaneh, Gregory Giambrone, Jonathan Eskreis-Winkler, Akshay U. Bhat, Ramin Zabih, Gregory Dakin, Alfons Pomp, Peter Fleischut Introduction: The popularity of bariatric surgery has continued to grow over the last decade. The safety and efficacy of bariatric surgery has been previously established. Nevertheless, trends as well as patient characteristics continue to evolve and change in bariatric surgery. Herein, we report trends and outcomes following bariatric surgery from three major states over a six-year interval using the State Inpatient Databases (SID), Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Methods: Using SID data from California, Florida, and New York, we retrospectively reviewed outcomes of all laparoscopic adjustable gastric bandings (LGB), laparoscopic sleeve gastrectomies (LSG), and laparoscopic roux-en-y gastric bypasses (LRYGB) performed on obese patients from 2006 to 2011. Discharges analyzed for distribution of age and Deyo Comorbidity Index (Deyo score) by procedure. Furthermore, postoperative complications and mortality rates were compared and reported. Results: A total of 160,472 bariatric procedures were performed during the study period; 22.2% LGB, 15.5% LSG, and 62.4% LRYGB. Overall, females had a higher frequency of bariatric surgery [Table 1]. LGB was the most frequently used procedure among males receiving bariatric procedures. The majority of patients undergoing bariatric surgery were under the age of 45 (50.4%). The highest proportion of patients undergoing LSG were > 75 were (Figure A). In general, patients with the lowest Deyo score underwent LGB (P<0.0001, Figure B). Over the last 5 years, the utilization of LGBs has decreased while the number of LSG has increased (Figure C). The number of LRYGB has remained relatively constant while the total number of bariatric procedures has increased. LSG had the highest proportion of pulmonary, cardiac and hematologic complications, while LGB had the lowest rates in the former categories (P<0.0001) [Table 1]. The incidence of postoperative ileus and nausea/vomiting was highest following LSG and lowest following LGB (P<0.0001). The length of stay was significantly shorter following LGB, while LSG and LRYGB were equivalent (P<0.0001). The proportion of mortality was lowest for LGB and highest for LSG (P<0.0001). The overall mortality for all bariatric procedures was 0.4%. Conclusion: Bariatric surgery remains safe and feasible. LSG is becoming more popular than LGB, especially for older patients with significantly more comorbidities; however, morbidity remains higher for LSG compared to LGB. The SID has important limitations; therefore, further analyses are necessary to identify the full impact of these findings.
Tu1637 Can the Risk of Non-Home Discharge After Resection of Gastric Adenocarcinoma Be Predicted? Alexandra W. Acher, Shishir K. Maithel, Ryan Fields, George A. Poultsides, Carl Schmidt, Konstantinos I. Votanopoulos, Timothy M. Pawlik, Linda X. Jin, David C. Linehan, William G. Hawkins, Steven M. Strasberg, Aslam Ejaz, Malcolm H. Squires, David Kooby, David Worhunsky, Edward A. Levine, Neil D. Saunders, Gaya Spolverato, Emily Winslow, Clifford S. Cho, Ken Meredith, Glen Leverson, Sharon M. Weber
SSAT Abstracts
BACKGROUND: Currently, there are no validated methods to preoperatively identify patients with an increased risk of discharge to skilled nursing facilities (SNFs; non-home discharge) following resection of gastric cancer (GC). In these circumstances, length of stay is often prolonged while arrangements are completed. Utilizing a multi-institutional database of patients who underwent surgery for GC, we sought to identify preoperative predictors of non-home discharge in an effort to anticipate and optimize transitions of care to SNFs. METHODS: Patients who underwent resection of GC from 2000-2012 from the 7 participating institutions of the U.S. Gastric Cancer Collaborative were analyzed. In-hospital deaths following resection were excluded. Logistic regression and Fischer's exact test were used to identify preoperative factors predictive of non-home discharge. RESULTS: 923 patients were identified. Of these, 93 (10%) were discharged to a location other than home (SNF). Univariate analysis identified the following preoperative variables as significant risk factors for non-home discharge: age, ASA score, hypertension, diabetes, albumin, creatinine, bleeding, weight loss, and neoadjuvant chemotherapy. On multivariate analysis, advanced age (OR = 1.07, 95% CI = 1.04-1.09, p < 0.0001) and depressed pre-operative serum albumin (OR= 0.45, 95% CI = 0.30-0.67, p = 0.0001) were independently associated with non-home discharge. Patients 70 yrs or older with a preoperative albumin 3.4 g/dL; see Table). CONCLUSIONS: Older patients with compromised nutritional status are at increased risk for non-home discharge following resection of gastric cancer. In these patients, preoperative planning for transition to skilled nursing facilities may reduce demand on hospital resources as well as ease the burden of transition of care for patients and hospital care teams. Table: Odds of non-home discharge (NHD) in high-risk versus low risk populations
Tu1638 Laparoscopic Surgery for Gastric Malignancy: Outcomes of a Minimally Invasive Oncologic Resection Monica Young, Alana Gebhart, Stephen D. Vu, Nojan Toomari, Brian R. Smith, Ninh T. Nguyen Introduction: Controversy remains over the safety and efficacy of laparoscopic gastric operations. The objective of this study was to evaluate the outcomes of patients who underwent laparoscopic gastrectomy and palliative bypass procedures. Methods: 86 patients who underwent laparoscopic intervention for gastric malignancy between January 2001 and August 2013 were reviewed. 94% of patients underwent laparoscopic gastrectomy, while 6% were found to be unresectable and required a palliative bypass. Main outcome measures included operative findings, conversion rate, hospital stay, morbidity, mortality and pathology. Results: Mean age was 68 years and 52% of patients were male. The majority of cases were performed for gastric adenocarcinoma (90%). Other indications included gastrointestinal stromal tumor (5.8%), dysplasia (1.2%), carcinoid (1.2%), and pancreatic cancer (1.2%). Eight patients (9.3%) underwent neoadjuvant therapy. Procedures performed included laparoscopic total gastrectomy (20%), subtotal gastrectomy (41%), distal gastrectomy (25%), proximal gastrectomy (5%), gastric wedge resection (3%) and palliative gastrojejunal bypass (6%). There were no conversions to laparotomy. Eleven patients (13%) were monitored in the ICU postoperatively, with an overall mean ICU stay of 0.9 days. Median hospital stay was 4 days. There were no in-hospital or 30-day mortalities. Two intraoperative complications occurred in patients undergoing subtotal gastrectomy: ischemia of the Roux limb requiring resection and bleeding at the gastrojejunostomy anastomosis. The rate of major complications was 3.7% and minor complications was 9.9%. Anastomotic leak occurred in one patient following total gastrectomy (1.2%). Late complication rate was 11%, with stricture being the most common. Distribution of final pathology was: stage 0 (15%), stage I (47%), stage II (14%), stage III (10%) and stage IV (15%). Average number of lymph nodes resected was 19 ±12.3. Conclusion: Laparoscopic gastrectomy is safe and associated with low morbidity and mortality. A minimally invasive approach can provide good oncologic resection with equivalent lymph node harvest to open gastrectomy.
S-1095
SSAT Abstracts