Bariatric surgery for obesity: surgical approach and variation in in-hospital complications in New York State.

BACKGROUND: The purpose of this study was to demonstrate the relationship between the surgical approach employed for adults undergoing bariatric surgery for obesity in New York State and in-hospital postoperative complications. Understanding the differences among surgical approaches in terms of the type, extent, and likelihood of postoperative complications and the patient characteristics associated with them, particularly as the annual volume of bariatric surgery increases, can inform decisions about the appropriate bariatric surgical approach for patients with particular characteristics. METHODS: Using New York's inpatient hospital discharge database, we identified 8,413 adults who underwent a bariatric surgical procedure during calendar year 2006. The three most common bariatric surgical approaches were identified, postoperative complication rates and descriptive statistics for the demographic characteristics and comorbidities for patients of each surgical approach were generated, and a logistic regression model was constructed to predict the likelihood of postoperative complications. RESULTS: Of all bariatric surgical patients, 8.1% experienced a postoperative complication, but complication rates varied dramatically across the surgical approaches, with open bypass patients having the highest complication rate and laparoscopic banding patients having the lowest rate. Different complications were associated with the three surgical approaches, as were the various patient demographic characteristics and comorbidities. The multivariate logistic regression indicated that open bypass patients were 5.4 times and laparoscopic bypass patients were 3.2 times more likely to experience a complication compared to laparoscopic banding patients. CONCLUSION: Analyses of bariatric postoperative surgical complications must take into account the surgical approach employed.

The needs of children with life-limiting conditions: a healthcare-provider-based model.

Pediatric hospice and palliative care has progressed in recent years with the development of new programs and models of care. Missing from the empirical literature, however is a model of the needs of children. The purpose of the present study was to develop an empirically based conceptual model of the needs of children with life-limiting conditions. Recognizing the value of both qualitative and quantitative data, concept mapping methodology was selected as an effective way to obtain data that reflected both the "big picture" and subtleties of pediatric end-of-life needs. The seven-cluster concept map appeared best in terms of both interpretability and parsimony. This model includes the following clusters of needs: 1) pain, 2) decision making, 3) medical system access and quality, 4) dignity and respect, 5) family-oriented care, 6) spirituality, and 7) psychosocial issues. We believe that the development of a comprehensive model of the needs of such children is a step toward concrete, measurable, and effective support for children and their families.