A National Inpatient Sample Analysis of Racial Disparities After Segmental Colectomy for Inflammatory Colorectal Diseases.

BACKGROUND: Racial disparities and poor access to care are common among African Americans (AA), potentially adversely affecting surgical outcomes in inflammatory bowel conditions. We aimed to analyze the effect of race on outcomes in patients undergoing segmental colectomy for inflammatory bowel conditions. METHODS: Retrospective review of data from the National Inpatient Sample between 2010 and 2015 identified patients who underwent segmental colectomy without ostomy for Crohn's or diverticular disease. AA patients were compared with Caucasians using a multivariable analysis model. Primary outcomes of interest were overall complications, mortality, and extended hospital stay. RESULTS: 38,143 admissions were analyzed; AA patients constituted 8% of the overall cohort. Diagnoses included Crohn's (11%) and diverticular disease (89%). After multivariable analysis, AA patients had significantly higher overall risk of complications (OR = 1.27; 95% CI, 1.15-1.40) and extended hospital stay (OR = 1.59; 95% CI, 1.45-1.75) than Caucasians. On bivariate analysis, there was no significant difference in mortality between AA and Caucasian patients. AA patients had significantly higher rates of Medicaid insurance (14% vs 6%, P < .001), lower rates of private insurance (35% vs 47%, P < .001), and were less likely to undergo surgery at a private hospital (31% vs 41%, P < .001). CONCLUSIONS: AA patients requiring segmental colectomy for inflammatory colorectal conditions experience significantly higher rates of postoperative complications, longer hospital stays, and lower rates of private insurance. Direct correlation between insurance status and postoperative outcomes could not be established, but we speculate such great disparity in outcomes may stem from these socioeconomic differences.

Can surgical weight loss reduce the risk of developing coronary heart disease?

BACKGROUND: Coronary heart disease (CHD) accounts for one third of all deaths in people older than 35 years in the United States. OBJECTIVES: The aim of this study is to determine the impact of bariatric surgery, especially laparoscopic sleeve gastrectomy, on the risk of developing CHD. SETTING: Academic, University affiliated hospital. METHODS: We retrospectively reviewed all patients who underwent bariatric surgery from 2010-2016. All patients between 30 and 74 years of age without a previous history of CHD were included in our study. The risk score for predicting the incidence of CHD was measured preoperatively and at 12 months of follow-up. RESULTS: Of the 1330 patients studied, 225 patients (16.9%) had all the required variables to calculate the CHD risk score. The mean age of our population was 51.4 ± 11.3 years, mostly female (67%, n = 152) and white (58.7%, n = 132). At the preoperative setting, our patient population had a systolic blood pressure in the prehypertensive ranges, with 40% (n = 90) having type 2 diabetes and 60% (n = 134) having arterial hypertension. The preoperative CHD preoperative risk was 8.9 ± 7.7% or 8-fold higher than the ideal risk. After 12 months of follow-up, the CHD absolute risk reduction was 2.7%, and the relative risk reduction was 42.0% for female patients and 5.4% and 38.8%, respectively, for male patients. All the metabolic factors used to calculate the risk of developing CHD had a significant improvement after 12 months. CONCLUSIONS: Surgical weight loss reduces the risk of developing CHD. Further studies should assess these findings in a long-term follow-up.

Impact of rapid weight loss after bariatric surgery on the prevalence of arterial hypertension in severely obese patients with chronic kidney disease.

BACKGROUND: Arterial hypertension (HTN) is one of the most important risk factors for the development and progression of chronic kidney disease (CKD). Rapid weight loss after bariatric interventions has a positive impact on blood pressure levels of hypertensive patients. The aim of our study is to assess the prevalence of HTN in patients with CKD after bariatric surgery (BS). METHODS: We retrospectively reviewed severely obese patients who underwent BS from 2010 to 2017. We used guidelines of the American College of Cardiology to define HTN. Only patients meeting ACC criteria and the calculation of estimated glomerular filtration rate (eGFR) using CKD epidemiology collaboration study equation preoperatively and at 12-month follow-up were included in the analysis. RESULTS: From a total of 2900 patients, 29.13% (845) met the required criteria and had variables for the calculation of eGFR recorded preoperatively. 36.92% (312) had preoperative HTN and s classified as CKD stage ≥ 2. We observed a predominantly female population 63.83% (203) with mean age of 54.10 ± 11.58. Patients preoperatively classified in CKD 2, 3a, and 3b exhibited the greatest prevalence reduction of HTN at 12-month follow-up (68.59%, n = 214 vs. 36.59%, n = 114; 16.67%, n = 52 vs. 6.41%, n = 20; 7.69%, n = 24 vs. 1.28%, n = 4; p < 0.0001). A marked improvement in CKD was also observed along with improvement in HTN. The greatest benefit corresponded to patients classified preoperatively in CKD 2, 3a and 3b. A total of n = 70 (62.5%) patients with HTN were classified as CKD 2 preoperatively compared to n = 55 (49.11%) at 12-month follow-up (p = 0.0436). Similarly, n = 22 (19.64%) patients with HTN were classified preoperatively as CKD 3a compared to n = 7 (6.25%) and n = 12 (10.71%) patients as CKD 3b compared to n = 4 (3.57%) during the same time period (p = 0.0028, p = 0.0379, respectively). CONCLUSIONS: Rapid weight loss after BS significantly reduces prevalence of HTN in all stages of CKD at 12-month follow-up. Additionally, there was a positive impact on classification of CKD at 12-month follow-up.