Risk factors for early postoperative complications after bariatric surgery

PURPOSE: Vertical sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are currently the most common bariatric procedures. Although the safety of these operations has markedly improved, there continues to be a certain rate of complications. Such adverse events can have a significant deleterious effect on the outcome of these procedures and represent a costly burden on patients and society at large. A better understanding of these complications and their predictive factors may help ameliorate and optimize outcomes. METHODS: Seven hundred seventy-two consecutive patients who underwent SG or RYGB for morbid obesity between January 2011 and October 2015, in the Division of Bariatric Surgery at a tertiary institution, were included through retrospective review of the medical database. The complications were categorized and evaluated according to severity using the Clavien-Dindo classification system. Significant risk factors were evaluated by binary logistic regression to identify independent predictors and analyzed to identify their relationship with the type of complication. RESULTS: Independent predictors of severe complication after these procedures included male gender, open and revisional surgery, hypertension, and hypoalbuminemia. Hypoalbuminemia had significant associations with occurrence of deep surgical site infection and leak. Open surgery had significant associations with occurrence of superficial and deep surgical site infection and respiratory complications. Independent predictors of severe complication after laparoscopic primary RYGB included previous abdominal surgery. Previous abdominal surgery had significant associations with deep surgical site infection and leak. CONCLUSION: Recognition and optimization of these risk factors would be valuable in operative risk prediction before bariatric surgery.

A comparison of the restraint and seclusion experiences of patients with schizophrenia or other psychotic disorders.

OBJECTIVE: The purpose of this study was to understand how restrained and secluded patients felt about these interventions, and to compare the perceptions of the two groups. METHODS: Subjects were 25 restrained, and 25 secluded inpatients. A questionnaire was developed to explore patients' feelings and perceptions of the two interventions. Comparisons were made on the clinical data and the answers from both groups. RESULTS: Restrained and secluded patients seemed to view some aspects of their experience differently. Few (40%) of the secluded group reported finding positive aspects, compared to even fewer (20%) of restrained. Most patients in both groups felt negatively about staff involved, and disagreed with staff on the reported intensity of their documented threatening behavior. The interventions seemed to have only a brief modifying effect on patients' behavior following these interventions and did not seem to modify future behavior. CONCLUSIONS: Despite their differences, many patients in both groups reported negative feelings about the interventions and the staff involved. Both groups seemed not to perceive the procedural staff interactions as communication. Our study population seemed to be a subgroup of the admitted patient population who were repeatedly requiring seclusion or restraint. Screening this patient population during the admission process, and planning preventive and alternative interventions could decrease the need for restraint and seclusion.

The effect of intensive case management on hospitalization of patients with schizophrenia.

OBJECTIVE: The study aim was to determine if a community-based psychiatric rehabilitation program with intensive case management was more effective than traditional outpatient services in reducing hospitalization of chronic schizophrenic patients. METHODS: One hundred twelve schizophrenic patients enrolled in the intensive case management program were matched by age, number of previous hospitalizations, and days spent in the hospital with 112 schizophrenic patients who received medication services and minimal case management. The two groups were compared on the amount of services used and the number of hospitalizations and hospital days over a 24-month study period. RESULTS: Patients in the intensive case management program had been enrolled for a mean of 10.96 months, with a range from one to 24 months. They used significantly more mental health services during the study period compared with the patients in the control group. However, no significant differences were found between the two groups in number of hospitalizations and hospital days. Both groups showed an increase in the number of hospitalizations over the study period. CONCLUSIONS: A community-based psychiatric rehabilitation program with intensive case management was no more effective than medication services and minimal case management in reducing hospitalization among chronic schizophrenic patients.

Operant control of convective cooling and microwave irradiation by the squirrel monkey.

Adult male squirrel monkeys (Saimiri sciureus) were individually chair-restrained in an air-conditioned Styrofoam box in the far field of a horn antenna. Each monkey first received extensive training to regulate the temperature of the air circulating through the box by selecting between 10 and 50 degrees C air source temperatures. Then, to investigate the ability of the animals to utilize microwaves as a source of thermalizing energy, 2450-MHz continuous wave microwaves accompanied by thermoneutral (30 degrees C) air were substituted for the 50 degrees C air. Irradiation at each of three power densities was made available, ie, at 20, 25, and 30 mW/cm2 [SAR = 0.15 (W/kg)/(mW/cm2)]. The percentage of time that the monkeys selected microwave irradiation paired with thermoneutral air averaged 90% at 20 and at 25 mW/cm2. The mean percentage declined reliably (p less than 0.001) to 81% at 30 mW/cm2, confirming the monkey's ability to utilize microwave irradiation as a source of thermal energy during the course of behavioral thermoregulation. All animals readily made the warm-air to microwave-field transition, regulating rectal temperature with precision by sequentially selecting 10 degrees C air, then microwave irradiation accompanied by 30 degrees C air. Although the selection of cooler air resulted in a slight reduction of skin temperatures, normal rectal temperature was maintained. The results indicate that the squirrel monkey can utilize a microwave source in conjunction with convective cooling to regulate body temperature behaviorally.

A comparative study of human sensory thresholds: 2450-MHz microwaves vs far-infrared radiation.

Three male and female adults individually placed the ventral surface of the right and upright forearm against a 15-cm-diameter aperture in a wall of microwave-absorbent material. Ten-second exposures occurred to E-vector-vertically polarized, 2450-MHz-CW microwave (MW) fields. Comparable exposure to infrared (IR) waves was repeated with four of the six observers. Thresholds of detection of just-noticeable warming by MW and IR radiation were determined by the double-staircase psychophysical method. Although the exposed surface areas of male observers' arm were larger than those of female observers, thresholds of warming by either source of energy overlapped; the pooled means of irradiance at threshold are 26.7 mW/cm2 (MW) and 1.7 mW/cm2 (IR). Dosimetric measures on saline models indicated virtually perfect absorption of the incident IR, but nearly two-thirds of the MW energy was scattered. Accordingly, the 15-fold difference in means of MW and IR thresholds resolves to a 5-fold difference in threshold quantities of absorbed energy. In the light of the high correlation between thresholds of IR and MW irradiation (r = .97), it is concluded that the same set of superficial thermoreceptors was being stimulated, only less efficiently so, by the more deeply penetrating, more diffusely absorbed MW energy.