Bilateral Reduction Mammaplasty Facilitates Subsequent Weight Loss in Obese Patients (BMI ≥30).

BACKGROUND: One of the most commonly discussed benefits of macromastia treatment surgery, bilateral reduction mammaplasty, is the potential for subsequent weight loss. There is limited research examining weight change after reduction mammaplasty and a definitive relationship remains to be established. Our study aims to investigate this relationship and to identify potential preoperative and operative factors associated with postoperative changes in weight. METHODS: A retrospective chart review was performed of all patients who underwent bilateral reduction mammaplasty for symptomatic macromastia at a single academic institution (Stony Brook University Hospital) between January 1, 2000, and January 1, 2016. Patients had 12 months or longer of follow-up to track resultant postoperative weight. RESULTS: Two hundred and fifty-six patients met our eligibility criteria. The patients were stratified into 2 groups based on preoperative body mass index (BMI). Group 1 consisted of 112 patients (44%) with a BMI less than 30 (ie, nonobese); group 2 consisted of 145 patients (56%) with a BMI of 30 or higher (ie, obese). The mean total weight of bilateral breast tissue resected for each group was 982 and 1719 g for groups 1 and 2, respectively. For both groups, the mean patient age was 38 years, and the mean follow-up period was approximately 5 years. Patients in group 1 (the nonobese group) had a mean preoperative BMI of 26.25 and postoperative BMI of 26.78 (P = 0.108). Postoperatively, these patients demonstrated an overall mean BMI increase of 0.90. Patients in group 2 (the obese group) had a mean preoperative BMI of 34.99 and postoperative BMI of 34.13 (P = 0.045). Postoperatively, they demonstrated an overall mean BMI decrease of 0.20. The difference in change of BMI between the 2 groups was determined to be significant (P = 0.047). There is a significantly larger mean decrease in BMI in the obese group, 3.86 than the nonobese group, 2.01 (P = 0.006). CONCLUSIONS: We found that weight changes after undergoing bilateral reduction mammaplasty are significantly different between obese and nonobese patients. Obese patients (BMI, ≥30) experience greater weight loss than nonobese patients. As the desire for postoperative weight loss and increased physical activity are common reasons to undergo reduction mammaplasty, this study adds valuable data to the discussion.

The Presence of an Advanced Gastrointestinal (GI)/Minimally Invasive Surgery (MIS) Fellowship Program Does Not Impact Short-Term Patient Outcomes Following Fundoplication or Esophagomyotomy.

INTRODUCTION: The current surgical landscape reflects a continual trend towards sub-specialization, evidenced by an increasing number of US surgeons who pursue fellowship training after residency. Despite this growing trend, however, the effect of advanced gastrointestinal (GI)/minimally invasive surgery (MIS) fellowship programs on patient outcomes following foregut/esophageal operations remains unclear. This study looks at two representative foregut surgeries (laparoscopic fundoplication and esophagomyotomy) performed in New York State (NYS), comparing hospitals which do and do not possess a GI/MIS fellowship program, to examine the effect of such a program on perioperative outcomes. We also aimed to identify any patient or hospital factors which might influence perioperative outcomes. METHODS: The SPARCS database was examined for all patients who underwent a foregut procedure (specifically, either an esophagomyotomy or a laparoscopic fundoplication) between 2012 and 2014. We compared the following outcomes between institutions with and without a GI/MIS fellowship program: 30-day readmission, hospital length of stay (LOS), and development of any major complication. RESULTS: There were 3175 foregut procedures recorded from 2012 to 2014. Just below one third (n = 1041; 32.8%) were performed in hospitals possessing a GI/MIS fellowship program. Among our entire included study population, 154 patients (4.85%) had a single 30-day readmission, with no observed difference in readmission between hospitals with and without a GI/MIS fellowship program, even after controlling for potential confounding factors (p = 0.6406 and p = 0.2511, respectively). Additionally, when controlling for potential confounders, the presence/absence of a GI/MIS fellowship program was found to have no association with risk of having a major complication (p = 0.1163) or LOS (p = 0.7562). Our study revealed that postoperative outcomes were significantly influenced by patient race and payment method. Asians and Medicare patients had the highest risk of suffering a severe complication (10.00 and 7.44%; p = 0.0311 and p = 0.0036, respectively)-with race retaining significance even after adjusting for potential confounders (p = 0.0276). Asians and uninsured patients demonstrated the highest readmission rates (15.00 and 12.50%; p = 0.0129 and p = 0.0012, respectively)-with both race and payment method retaining significance after adjustment (p = 0.0362 and p = 0.0257, respectively). Lastly, payment method was significantly associated with postoperative LOS (p < 0.0001), with Medicaid patients experiencing the longest LOS (mean 3.99 days) and those with commercial insurance experiencing the shortest (mean 1.66 days), a relationship which retained significance even after adjusting for potential confounders (p < 0.0001). CONCLUSION: The presence of a GI/MIS fellowship program does not impact short-term patient outcomes following laparoscopic fundoplication or esophagomyotomy (two representative foregut procedures). Presence of such a fellowship should not play a role in choosing a surgeon. Additionally, in these foregut procedures, patient race (particularly Asian race) and payment method were found to be independently associated with postoperative outcomes, including postoperative LOS.

Sleeve Gastrectomy: the first 3 Years: evaluation of emergency department visits, readmissions, and reoperations for 14,080 patients in New York State.

INTRODUCTION: The purpose of our study was to evaluate the indications for and incidence of both emergency department (ED) visits and hospital readmissions within the first postoperative year. We also sought to identify the rate of reoperation within the first 3 years following a SG operation in New York State (NYS). METHODS: The SPARCS database was examined for all SGs performed between 2011 and 2013. Using a unique identifier, patients were followed for at least 1 year. Patients were followed for reoperation and/or conversion to Roux-en-Y Gastric Bypass (RYGB), as well as for any other hospital-based encounter. Using primary diagnosis codes, the top five reasons for ED visits and readmission were identified. RESULTS: There were 14,080 SG between 2011 and 2013. Among all patients, just over one-third of patients visited the ED (33.9%). One in every ten of these visits resulted in readmission (9.5%), with 12.5% of the total postoperative patient population undergoing readmission within their first year after SG surgery. ED visits were unrelated to surgery in just over half of the patients (n = 4977; 53.88%). However, ED visits for abdominal pain (n = 1029; 11.14%), vomiting (n = 237; 2.57%), dehydration (n = 224; 2.43%), and syncope (n = 206; 2.23%) were attributed to surgery. The top five causes for readmission within the first year after SG were unrelated to surgery (n = 1101; 41.74%), complication related to bariatric surgery (n = 211; 8%), dehydration (n = 171; 6.48%), postoperative wound complication (n = 89; 3.37%), abdominal pain (n = 78; 2.96%). Overall, there was a low reoperation rate (0.32%); specifically, rates of sleeve revision and conversion to RYBG were 0.11 and 0.21%, respectively. CONCLUSION: SG has increasing popularity in NYS. Although postoperative ED visits are high, SG has a low overall reoperation rate (0.32%), and of these patients, most undergo conversion to RYGB compared to sleeve revision. Overall 1-year readmission rates after SG are 12.5%.

Academic status does not affect outcome following complex hepato-pancreato-biliary procedures.

INTRODUCTION: There is a growing debate regarding outcomes following complex hepato-pancreato-biliary (HPB) procedures. The purpose of our study is to examine if facility type has any impact on complications, readmission rates, emergency department (ED) visit rates, and length of stay (LOS) for patients undergoing HPB surgery. METHODS: The SPARCS administrative database was used to identify patients undergoing complex HPB procedures between 2012 and 2014 in New York. Univariate generalized linear mixed models were fit to estimate the marginal association between outcomes such as overall/severe complication rates, 30-day and 1-year readmission rates, 30-day and 1-year ED-visit rates, and potential risk factors. Univariate linear mixed models were used to estimate the marginal association between possible risk factors and LOS. Facility type, as well as any variables found to be significant in our univariate analysis (p = 0.05), was further included in the multivariable regression models. RESULTS: There were 4122 complex HPB procedures performed. Academic facilities were more likely to have a higher hospital volume (p < 0001). Surgery at academic facilities were less likely to have coexisting comorbidities; however, they were more likely to have metastatic cancer and/or liver disease (p = 0.0114, < 0. 0001, and = 0.0299, respectively). Postoperatively, patients at non-academic facilities experienced higher overall complication rates, and higher severe complication rates, when compared to those at academic facilities (p < 0.0001 and = 0.0018, respectively). Further analysis via adjustment for possible confounding factors, however, revealed no significant difference in the risk of severe complications between the two facility types. Such adjustment also demonstrated higher 30-day readmission risk in patients who underwent their surgery at an academic facility. CONCLUSION: No significant difference was found when comparing the outcomes of academic and non-academic facilities, after adjusting for age, gender, race, region, insurance, and hospital volume. Patients from academic facilities were more likely to be readmitted within the first 30-days after surgery.

The Use of Statins in the Treatment and Prevention of Atrial Fibrillation.

The hydroxy-methyl-glutaryl-CoA reductase inhibitors (statins) are used extensively in the treatment of hyperlipidemia and in the primary and secondary prevention of cardiovascular and cerebrovascular diseases. Statins have also been demonstrated to confer secondary pleiotropic benefits in a variety of other disease processes, including a potential advantage in treating and preventing atrial fibrillation. These effects are primarily due to the up-regulation of endothelial nitric oxide synthase activity and a decrease in nicotinamide adenine dinucleotide phosphate oxidase production, which leads to downstream effects that improve the electromechanical function of atrial and myocardial tissue. The following serves as a focused and updated review of the published clinical data regarding the pleiotropic effects of statins in atrial fibrillation.