STUDY ROUNDUP

Published in August Issue             

Bariatric Surgery Outcomes in US Accredited vs Non-Accredited Centers: A Systematic Review (Journal of the American College of Surgeons)

Stanford University School of Medicine researchers led by John Morton, MD, conducted a systematic review of medical literature to examine the impact of bariatric accreditation on surgical outcomes. Thirteen studies were included in the review and covered more than 1.5 million patients. Ten of the studies identified a substantial benefit of Center of Excellence accreditation for risk-adjusted outcomes. Six of 8 studies reported a considerable reduction in mortality in patients and two studies showed no significant difference. Similarly, morbidity was reduced in 8 of 11 studies. The results of the systematic review show a “preponderance of medical evidence supports accreditation for bariatric surgery.”


Changes in Functional Mobility and Musculoskeletal Pain After Bariatric Surgery in Teens With Severe Obesity (JAMA Pediatrics)

To shed light on the variability in practice patterns, the ASMBS Quality Improvement and Patient Safety (QIPS) Committee reviewed clinical pathways from Centers of Excellence across the country with the goal of sharing observations as a resource aimed at standardization for improved care. From June 2014 - April 2015, clinical pathways pertaining to preoperative, intraoperative and postoperative management of bariatric patients were solicited from the ASMBS Executive Council, QIPS committee members and state chapter presidents. Pathways were then analyzed based on metrics pertaining to preoperative, intraoperative and postoperative care. In total, 31 pathways were collected with the majority (80%) centering on perioperative care. Most pathways center on MBSAQIP accreditation parameters, patient satisfaction, or Surgical Care Improvement Protocol (SCIP) measures. The analysis demonstrated a considerable national variation in clinical pathways amongst practicing bariatric surgeons. However, a high concordance was identified for six variables: nutritional evaluation, psychological evaluation, intraoperative venous thromboembolism prophylaxis, utilization of antiemetics in the postoperative period, a dedicated pain pathway and postoperative laboratory evaluation.


Assessing National Provision of Care: Variability in Bariatric Clinical Care Pathways (SOARD)

To shed light on the variability in practice patterns, the ASMBS Quality Improvement and Patient Safety (QIPS) Committee reviewed clinical pathways from Centers of Excellence across the country with the goal of sharing observations as a resource aimed at standardization for improved care. From June 2014 - April 2015, clinical pathways pertaining to preoperative, intraoperative and postoperative management of bariatric patients were solicited from the ASMBS Executive Council, QIPS committee members and state chapter presidents. Pathways were then analyzed based on metrics pertaining to preoperative, intraoperative and postoperative care. In total, 31 pathways were collected with the majority (80%) centering on perioperative care. Most pathways center on MBSAQIP accreditation parameters, patient satisfaction, or Surgical Care Improvement Protocol (SCIP) measures. The analysis demonstrated a considerable national variation in clinical pathways amongst practicing bariatric surgeons. However, a high concordance was identified for six variables: nutritional evaluation, psychological evaluation, intraoperative venous thromboembolism prophylaxis, utilization of antiemetics in the postoperative period, a dedicated pain pathway and postoperative laboratory evaluation.


Two-Year Outcomes of Vagal Nerve Blocking (vBloc) for the Treatment of Obesity in the ReCharge Trial (Obesity Surgery)

The study reports 24-month results of the ReCharge Trial, which has demonstrated that a vagal blocking device (vBloc) is a safe and effective treatment for moderate to severe obesity based on 12-month data. Participants who presented at 24 months (n = 103) had a mean EWL of 21% (8% total weight loss [TWL]), 58% of participants had >=5% TWL and 34% had >=10 % TWL. Among the subset of participants with abnormal preoperative values, significant improvements were observed in mean LDL and HDL cholesterol, triglycerides, HbA1c, and systolic and diastolic blood pressures. Quality of life (QOL) measures were significantly improved. Heartburn/dyspepsia and implant site pain were the most frequently reported adverse events. The primary related serious adverse event rate was 4.3%. The results demonstrate that vBloc therapy results in medically meaningful weight loss with a favorable safety profile through 2 years. Weight loss, adverse events, comorbid risk factors and QOL will also be assessed at 5 years.