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Metabolic acuity score: effect on major complications after bariatric surgery.
Surg Obes Relat Dis. 2010 May-Jun; 6(3):267-73.SO

Abstract

BACKGROUND

Co-morbid conditions in obese patients contribute to the incidence and severity of major complications after bariatric surgery and significantly increase the cost of the procedure. Previous publications have validated the patient factors that increase the risk of mortality; however, it is currently a rare event. The development of a metabolic acuity score (MAS) to augment the body mass index might allow for accurate preoperative assessment and optimal treatment of patients. The present study has proposed a MAS for decreasing major complications.

METHODS

Prospectively collected outcomes of 2416 patients undergoing Roux-en-Y gastric bypass (n = 1821) or laparoscopic adjustable gastric banding (n = 595) in a community hospital were evaluated for the incidence of major complications, readmissions, and reoperations. Beginning in August of 2006, 1072 patients were divided into MAS groups of 1-4 according to age, body mass index, weight, history of deep vein thrombosis/pulmonary embolism, sleep apnea, diabetes, hypertension, immobility, heart disease, and psychological classification. The acuity groups were compared with each other and with 1344 patients who underwent treatment before the MAS was implemented.

RESULTS

A significant decrease occurred in the readmission rates within 30 days after the MAS was put into practice (8.5% before MAS versus 1.7% after MAS, P <.001) for the Roux-en-Y gastric bypass patients. The postoperative infection rates were lower after implementing the MAS (3.5% before MAS, .7% after MAS, P <.001). After adjusting for random and fixed effects of covariates, the implementation of the MAS significantly reduced the incidence of postoperative internal hernias, infections, deep vein thrombosis, readmissions, and reoperations.

CONCLUSION

Recognition of specific patient acuity characteristics through the implementation of MAS and aggressive preoperative and perioperative management led to lower major complication rates and decreased the incidence of readmissions and reoperations after bariatric surgery.

Authors+Show Affiliations

Scottsdale Bariatric Center, Scottsdale, Arizona 85258, USA. blackstonemd@scottsdalebariatric.comNo affiliation info available

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

20005783

Citation

Blackstone, Robin P., and Melisa C. Cortés. "Metabolic Acuity Score: Effect On Major Complications After Bariatric Surgery." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 6, no. 3, 2010, pp. 267-73.
Blackstone RP, Cortés MC. Metabolic acuity score: effect on major complications after bariatric surgery. Surg Obes Relat Dis. 2010;6(3):267-73.
Blackstone, R. P., & Cortés, M. C. (2010). Metabolic acuity score: effect on major complications after bariatric surgery. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 6(3), 267-73. https://doi.org/10.1016/j.soard.2009.09.010
Blackstone RP, Cortés MC. Metabolic Acuity Score: Effect On Major Complications After Bariatric Surgery. Surg Obes Relat Dis. 2010;6(3):267-73. PubMed PMID: 20005783.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metabolic acuity score: effect on major complications after bariatric surgery. AU - Blackstone,Robin P, AU - Cortés,Melisa C, Y1 - 2009/09/26/ PY - 2009/05/31/received PY - 2009/09/10/revised PY - 2009/09/16/accepted PY - 2009/12/17/entrez PY - 2009/12/17/pubmed PY - 2010/9/30/medline SP - 267 EP - 73 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 6 IS - 3 N2 - BACKGROUND: Co-morbid conditions in obese patients contribute to the incidence and severity of major complications after bariatric surgery and significantly increase the cost of the procedure. Previous publications have validated the patient factors that increase the risk of mortality; however, it is currently a rare event. The development of a metabolic acuity score (MAS) to augment the body mass index might allow for accurate preoperative assessment and optimal treatment of patients. The present study has proposed a MAS for decreasing major complications. METHODS: Prospectively collected outcomes of 2416 patients undergoing Roux-en-Y gastric bypass (n = 1821) or laparoscopic adjustable gastric banding (n = 595) in a community hospital were evaluated for the incidence of major complications, readmissions, and reoperations. Beginning in August of 2006, 1072 patients were divided into MAS groups of 1-4 according to age, body mass index, weight, history of deep vein thrombosis/pulmonary embolism, sleep apnea, diabetes, hypertension, immobility, heart disease, and psychological classification. The acuity groups were compared with each other and with 1344 patients who underwent treatment before the MAS was implemented. RESULTS: A significant decrease occurred in the readmission rates within 30 days after the MAS was put into practice (8.5% before MAS versus 1.7% after MAS, P <.001) for the Roux-en-Y gastric bypass patients. The postoperative infection rates were lower after implementing the MAS (3.5% before MAS, .7% after MAS, P <.001). After adjusting for random and fixed effects of covariates, the implementation of the MAS significantly reduced the incidence of postoperative internal hernias, infections, deep vein thrombosis, readmissions, and reoperations. CONCLUSION: Recognition of specific patient acuity characteristics through the implementation of MAS and aggressive preoperative and perioperative management led to lower major complication rates and decreased the incidence of readmissions and reoperations after bariatric surgery. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/20005783/Metabolic_acuity_score:_effect_on_major_complications_after_bariatric_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(09)00685-6 DB - PRIME DP - Unbound Medicine ER -