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Bariatric Surgery: Looking at Long-Term Follow-Up

Bariatric Surgery: Looking at Long-Term Follow-Up

Many published studies on bariatric surgery are retrospective, short-term analyses with insufficient follow-up. “Obesity is a chronic illness that is linked to important comorbidities,” says Nancy Puzziferri, MD, MS. “Obesity treatments need to be assessed in long-term studies, particularly for invasive procedures like bariatric surgery.” There is plenty of short-term evidence about the benefits and risks of bariatric surgery for up to 1 year after the procedure, but few data are available about long-term outcomes. Some short-term reports may reach optimistic conclusions regarding the effect of bariatric surgery because follow-up is incomplete. This can lead to over-estimating the beneficial effects of these operations. A Systematic Review of Bariatric Surgery In a systematic review published in JAMA, Dr. Puzziferri and colleagues sought to determine the association of bariatric surgery with outcomes of weight loss, diabetes, hypertension, and hyperlipidemia. The analysis involved studies that lasted at least 2 years in duration and with at least 80% follow-up of patients. Of the more than 7,000 clinical studies reviewed in the analysis, less than 1% met inclusion criteria. Studies of the long-term outcomes of bariatric surgery demonstrated substantial and sustained weight loss for gastric bypass procedures that exceed outcomes from gastric banding. “Despite the increasing popularity of gastric sleeve operations, there were few long-term studies with reliable follow-up for these procedures,” says Dr. Puzziferri. The review in JAMA also found that just 16% of the studies reviewed reported outcomes at more than 2 years after bariatric surgery, and less than 3% reported weight loss outcomes for more than 80% of the original cohort. In addition, few studies measured comorbidity improvement after the completion...
AAOS 2015

AAOS 2015

New research was presented at AAOS 2015, the annual meeting of the American Academy of Orthopaedic Surgeons, from March 24 to 28 in Las Vegas. The features below highlight some of the studies emerging from the conference. TKA & THA Outcomes by Gender The Particulars: There is limited evidence suggesting that outcomes following total knee arthroplasty (TKA) and total hip arthroplasty (THA) differ by gender. However, little is known about gender-related morbidity and mortality rates following these procedures. Most gender studies involving TKA and THA have focused more on procedural failure rather than morbidity and mortality. Data Breakdown: Researchers reviewed patients who underwent first-time TKA or THA from 2002 to 2009 in a study. Women who underwent THA were significantly older than men, whereas no difference in age was observed by gender among TKA patients. Following surgery, men were: ♦  15% more likely to visit the emergency department within 30 days. ♦  60% more likely to have an acute myocardial infarction (AMI) within 4 months following THA. ♦  70% more likely to have an AMI within 4 months following TKA. ♦  50% more likely to require revision surgery within 2 years of total knee replacement (TKR). ♦  25% more likely to be readmitted within 2 years of TKR. ♦  70% more likely to experience an infection or need revision surgery within 2 years of TKR. Take Home Pearls: Women appear to undergo a first total joint replacement at an older age than men. However, women appear to be less likely than men to experience complications or require revision surgery. The Costs of Perioperative Delirium The Particulars: Few studies have...
Hello Darkness My Old Friend

Hello Darkness My Old Friend

My friend Nick, the ER doctor, called me the other day to tell me that one of my patients had died under his care. He didn’t have to do that, but he knew I had followed this woman for several years and knew her family well. She had nearly died under my own care a few years ago, but through outstanding work by the ICU and other nurses, had survived and gone home to her grandchildren and had seen the birth of her first great-grandchild. She had thanked me for saving her life, when in truth, I had been largely responsible for her getting in trouble in the first place. I hung up after the call and was suddenly overwhelmed by a rush of shame, despair and a feeling of loss so powerful that I had to stop the car and cry. Images of dead and dying patients flooded my head for reasons that I still don’t understand. I felt as if I had wasted most of my life pursuing an illusion and that the cost to my family and myself had been too high for too small a gain. I have been shedding a lot of tears lately. Those who have read these posts or who have read my novels know that I am at heart a hopeless romantic. Even my cynical, curmudgeonly rants are based in a vision of how things should be rather than the pragmatist’s view of how things actually are. I have always been sentimental, but as I have aged, I have found my control slipping. I tear up at trivial things. I’m liable...
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