Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system.

BACKGROUND: A registry was created for patients having procedures for weight loss from 2004 to the present time at a large integrated healthcare system. The objective of this study was to compare findings to the literature and national quality monitoring databases and present 3-year weight loss outcomes. METHODS: Patients are passively enrolled in the registry with the following characteristics: a bariatric procedure for weight loss after January 1, 2004 and actively enrolled in the health plan at the time of surgery. RESULTS: Compared to national surgical quality databases, the registry (n = 20,296) has a similar proportion of Roux-en-Y gastric bypass (RYGB; 58%), more vertical sleeve gastrectomy (SG; 40%), fewer banding (2%) procedures, more Hispanic patients (35%), and higher rates of 1 year follow-up (78%). RYGB patients lost more weight at every time point up to 3 years after surgery compared with SG patients (P<.001). Non-Hispanic white RYGB patients had a higher percent excess weight loss than non-Hispanic black (P<.001) and Hispanic (P<.001) RYGB patients. There were no differences between SG racial/ethnic groups in percent excess weight loss throughout the 3-year follow-up period. CONCLUSION: We are one of the first groups to publish comparison weight outcomes for RYGB and SG in a diverse patient population, showing that the responses to RYGB and not SG vary by race/ethnicity.

Gender and racial/ethnic background predict weight loss after Roux-en-Y gastric bypass independent of health and lifestyle behaviors.

Our study investigated how demographic, health, and behavioral factors interacted to affect weight outcomes in bariatric patients. Roux-en-Y gastric bypass (RYGB) patients who were non-Hispanic black, Hispanic, or non-Hispanic white race/ethnicity, had no revisions to their RYGB during 2004-2009, and had at least 1 year of follow-up data for body weight after surgery (n = 860) were surveyed by phone about their health and behaviors. The main outcomes of interest were percent excess weight loss and percent of initial weight lost. Participants were 47 ± 11 years old, 54 % non-Hispanic white, 25 % Hispanic, and 21 % non-Hispanic black, 82 % female, 60 % married, 82 % had some college education, and 47 % had an annual income between $35,000 and $80,000. At the time of surgery, patients had lost 50 ± 29 % of their excess weight and had achieved 24 ± 15 % initial weight lost after an average of 54 months of follow-up. After accounting for weight at the time of surgery, demographics, and self-reported health and behavior, non-Hispanic black men had significantly greater weight loss compared to non-Hispanic white men (p < .05). There were no differences between racial/ethnic groups of women in weight outcomes. Percent excess weight loss was related to greater diet soda intake, and percent initial weight lost was related to greater water intake. Independent of health status and lifestyle behaviors, age, and weight at the time of surgery, race/ethnicity, gender, and diet soda and water intake were the strongest predictors of weight outcomes after RYGB surgery.

Surgical team behaviors and patient outcomes.

BACKGROUND: Little evidence exists that links teamwork to patient outcomes. We conducted this study to determine if patients of teams with good teamwork had better outcomes than those with poor teamwork. METHODS: Observers used a standardized instrument to assess team behaviors. Retrospective chart review was performed to measure 30-day outcomes. Multiple logistic regressions were calculated to assess the independence of the association between teamwork with patient outcome after adjusting for American Society of Anesthesiologists (ASA) score. RESULTS: In univariate analyses, patients had increased odds of complications or death when the following behaviors were exhibited less frequently: information sharing during intraoperative phases, briefing during handoff phases, and information sharing during handoff phases. Composite measures of teamwork across all operative phases were significantly associated with complication or death after adjusting for ASA score (odds ratio 4.82; 95% confidence interval, 1.30-17.87). CONCLUSION: When teams exhibited infrequent team behaviors, patients were more likely to experience death or major complication.