TITLE

The Application of Comorbidity Indices to Predict Early Postoperative Outcomes After Laparoscopic Roux-en-Y Gastric Bypass: A Nationwide Comparative Analysis of Over 70,000 Cases

AUTHOR(S)
Shin, Jin; Worni, Mathias; Castleberry, Anthony; Pietrobon, Ricardo; Omotosho, Philip; Silberberg, Mina; Østbye, Truls
PUB. DATE
May 2013
SOURCE
Obesity Surgery;May2013, Vol. 23 Issue 5, p638
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) often have substantial comorbidities, which must be taken into account to appropriately assess expected postoperative outcomes. The Charlson/Deyo and Elixhauser indices are widely used comorbidity measures, both of which also have revised algorithms based on enhanced ICD-9-CM coding. It is currently unclear which of the existing comorbidity measures best predicts early postoperative outcomes following LRYGB. Methods: Using the Nationwide Inpatient Sample, patients 18 years or older undergoing LRYGB for obesity between 2001 and 2008 were identified. Comorbidities were assessed according to the original and enhanced Charlson/Deyo and Elixhauser indices. Using multivariate logistic regression, the following early postoperative outcomes were assessed: overall postoperative complications, length of hospital stay, and conversion to open surgery. Model performance for the four comorbidity indices was assessed and compared using C-statistics and the Akaike's information criterion (AIC). Results: A total of 70,287 patients were included. Mean age was 43.1 years (SD, 10.8), 81.6 % were female and 60.3 % were White. Both the original and enhanced Elixhauser indices modestly outperformed the Charlson/Deyo in predicting the surgical outcomes. All four models had similar C-statistics, but the original Elixhauser index was associated with the smallest AIC for all of the surgical outcomes. Conclusions: The original Elixhauser index is the best predictor of early postoperative outcomes in our cohort of patients undergoing LRYGB. However, differences between the Charlson/Deyo and Elixhauser indices are modest, and each of these indices provides clinically relevant insight for predicting early postoperative outcomes in this high-risk patient population.
ACCESSION #
86879150

 

Related Articles

  • Intraoperative Endoscopy and Leaks after Laparoscopic Roux-en-Y Gastric Bypass. ALAEDEEN, DIYA; MADAN, ATUL K.; RO, CHARLES Y.; KHAN, KHURRAM A.; MARTINEZ, JOSE M.; TICHANSKY, DAVID S. // American Surgeon;Jun2009, Vol. 75 Issue 6, p485 

    Postoperative leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB) are a source of morbidity and mortality. Any intervention that would decrease leak rates after LRYGB would be useful. This investigation tested the hypothesis that postoperative leak rates are lower after LRYGB with the...

  • Incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. Clements, Ronald H.; Katasani, Venkata G.; Palepu, Rajendra; Leeth, Ruth R.; Leath, Teresa D.; Roy, Brandon P.; Vickers, Selwyn M. // American Surgeon;Dec2006, Vol. 72 Issue 12, p1196 

    Vitamin deficiency after gastric bypass surgery is a known complication. The purpose of this study was to measure the incidence of vitamin deficiency after laparoscopic Roux-en-Y gastric bypass in a university hospital setting. All patients who underwent laparoscopic Roux-en-Y gastric bypass...

  • Tensile Strength After Closure of Mesenteric Gaps in Laparoscopic Gastric Bypass: Three Techniques Tested in a Porcine Model. Jacobsen, Hedin; Dalenbäck, Jan; Ekelund, Mikael; Gislason, Hjörtur; Hedenbro, Jan // Obesity Surgery;Mar2013, Vol. 23 Issue 3, p320 

    Background: Internal hernias occur frequently after laparoscopic gastric bypass. We have found no data on the relative strength of the various techniques available for closing these defects. The present study was performed to obtain such data to form a theoretical basis for clinical studies....

  • Laparoscopic Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy as a Definitive Surgical Procedure for Morbid Obesity. Mid-Term Results. Vidal, Pablo; Ramón, José; Goday, Albert; Benaiges, David; Trillo, Lourdes; Parri, Alejandra; González, Susana; Pera, Manuel; Grande, Luís // Obesity Surgery;Mar2013, Vol. 23 Issue 3, p292 

    Background: Laparoscopic sleeve gastrectomy (LSG) has been gaining acceptance because it has shown good short- and mid-term results as a single procedure for morbid obesity. The aim of this study was to compare short- and mid-term results between laparoscopic Roux-en-Y gastric bypass (LRYGB) and...

  • Laparoscopic Adjustable Gastric Banded Plication: a Case-Matched Comparative Study with Laparoscopic Sleeve Gastrectomy. Huang, Chih-Kun; Chhabra, Navdeep; Goel, Rajat; Hung, Chao-Ming; Chang, Po-Chih; Chen, Yaw-Shen // Obesity Surgery;Aug2013, Vol. 23 Issue 8, p1319 

    Laparoscopic sleeve gastrectomy (LSG) has been accepted as stand-alone restrictive bariatric procedure; laparoscopic adjustable gastric banded plication (LAGBP) is an innovative technique combining gastric banding and plication of the stomach. This study aims to compare LAGBP with LSG in terms...

  • Small-diameter Bands Lead to High Complication Rates in Patients After Laparoscopic Adjustable Gastric Banding. Matlach, Juliane; Adolf, Daniela; Benedix, Frank; Wolff, Stefanie // Obesity Surgery;Apr2011, Vol. 21 Issue 4, p448 

    Background: While weight loss is the primary goal of bariatric procedures, the impact of quality of life (QoL), comorbidity, and surgery-related complications continue to grow. We report on our results of patients up to 12 years of follow-up undergoing laparoscopic adjustable gastric banding...

  • The Value of Continuous Wound Infusion Systems for Postoperative Pain Control Following Laparoscopic Roux-en-Y Gastric Bypass: an Analysis of Outcomes and Cost. Medbery, Rachel; Chiruvella, Amareshwar; Srinivasan, Jahnavi; Sweeney, John; Lin, Edward; Davis, S. // Obesity Surgery;Apr2014, Vol. 24 Issue 4, p541 

    Background: Current health-care reform is focusing on improving patient outcomes while cutting health-care costs, and as such, surgeons should consider that postoperative pain management techniques can contribute to the overall value of care delivered to patients. The current study aims to...

  • Complications of Adjustable Gastric Banding Surgery for Obesity. KODNER, CHARLES; HARTMAN, DANIEL R. // American Family Physician;5/15/2014, Vol. 89 Issue 10, p813 

    Laparoscopic adjustable gastric banding procedures have a favorable risk-benefit profile and are increasingly important as part of the overall management of obesity. These procedures are effective at inducing weight loss and improving comorbid conditions, including diabetes mellitus,...

  • Laparoscopic Revisional Bariatric Surgery. Cohen, Ricardo; Torres, Marcelo Cerdan // Bariatric Times;Feb2010, Vol. 7 Issue 2, p1 

    Video laparoscopy frequently has been used in obesity surgery with safe and excellent outcomes. Bariatric surgeries are growing exponentially, and as an expected consequence, the complications and need for reoperations has grown too. Revisional reoperations, traditionally performed by...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics