Trends in Drain Utilization in Bariatric Surgery: an Analysis of the MBSAQIP Database 2015-2017.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (SG) are the two most common bariatric operations. With the implementation of enhanced recovery protocols, the use of drains should decrease. METHODS: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was queried for the years 2015-2017. Our inclusion criteria included all patients undergoing a primary LRYGB, SG, and revisions. We examined demographics, operative characteristics, the use of drains, and postoperative complications. Continuous variables were summarized using means and standard deviations (SD). Categorical variables were summarized using frequencies and proportions. Student's T test (Wilcoxon sum rank test in the case of skewed data) and chi-squared analysis were used to assess the baseline differences in drain utilization. RESULTS: From 2015 to 2017, there were 388,239 bariatric cases performed without drains and 100,221 performed with drains. Twenty-nine percent of LRYGB patients had a drain placed but only 16.7% of SG patients. The percentage of LRYGB that had a drain dropped from 33.1 to 24.6% during the study period and that of SG dropped from 20.3 to 13.6%. Patients that had drains placed were more likely to have a provocative test at the time of surgery (prevalence ratio (PR) 2.24) and to have a postoperative swallow study (PR 1.93). CONCLUSIONS: Drains are still commonly used in bariatric patients. Over the study period, there was a decrease in the use of drains in both bypass and sleeve patients. Patients with a drain were more likely to have had a provocative test and a swallow study and have a higher rate of complications and mortality.

Where are sleeves performed? An analysis of inpatient versus outpatient databases in a large state.

BACKGROUND: The sleeve gastrectomy (SG) is the most common bariatric surgery in the United States today. There is a trend toward performing SG as an outpatient procedure, either in an ambulatory setting or as an outpatient at a larger hospital. The term "outpatient" is used to designate essentially any patient without an inpatient order. Texas maintains the Texas Inpatient Public Use Data File (IPUDF) database and the Texas Outpatient Public Use Data File (OPUDF) database for inpatient and outpatient settings, respectively. OBJECTIVES: To determine where SGs are performed by evaluating the Texas IPUDF and OPUDF for 2016. SETTING: University hospital, United States. METHODS: The Texas IPUDF and OPUDF were searched with the Current Procedural Terminology code of 43775 and the International Classification of Diseases, 10th revision, procedure code of 0DB64Z3. Patient demographic characteristics were also examined. We looked at the top 5 diagnoses in each database. RESULTS: Of the 16,855 SGs performed in Texas in 2016, outpatient SGs accounted for 31.0% (5227 cases), and inpatient SGs accounted for 69% of the total with 11,628 cases reported. For patients reported in the OPUDF, mean length of stay (LOS) was 2.1 (standard deviation 3.2) days with a median of 1.0 (interquartile range = 1, 2) days; for patients in the IPUDF, mean LOS was 1.6 (standard deviation 1.5) days, and the median was 1.0 (interquartile range = 1, 1) days. CONCLUSION: A third of SGs in Texas were performed under outpatient status. Further study is needed to determine the safety of this practice.

Utilization of Laparoscopic Colon Surgery in the Texas Inpatient Public Use Data File (PUDF).

BACKGROUND: Laparoscopic surgery has become the standard of care for the most common surgical procedures performed. However, laparoscopic techniques have not reached this same penetrance in colorectal surgery. We wanted to determine the percentage of colon operations performed in Texas that were done via laparoscopic, robotic and open techniques. METHODS: The Texas Inpatient Public Use Data File (PUDF) was queried using ICD-9-CM diagnostic and procedure codes to determine overall utilization of laparoscopic colectomies (LC) in Texas between 2013-14 for reporting facilities. We specifically looked at cost and the length of stay for LC, open colectomy (OC) and robotic assisted colectomy (RAC). RESULTS: In the state of Texas between 2013-14 there were 20,454 colectomies performed. Of these 12,328 (60.3%) were OC, 7,536 (36.8%) were LC, and 590 (3.9%) were RAC. Average total cost was $117,113 for OC, $75,741.9 for LC, and $81,996.2 for RAC. Average length of stay for each technique was 10.6 days for OC, 6.1 days for LC, and 5.1 days for RAC. The risk of a postoperative complication occurring was higher in the open procedure than a laparoscopic procedure. CONCLUSIONS: LC accounted for only 36.8% of all colectomies performed in Texas between 2013-14. OC costs twice as much as LC and increased the length of stay by nearly 4 d. LC and RAC are both associated with significantly less cost and length of stay for patients undergoing surgery, while lowering perioperative complications. DISCLOSURES: None of the authors have any relevant disclosures.

Retrospective Analysis of Population Demographic Characteristics, Medical Interventions, and Resource Use at a Medical Student-Run Clinic on the Texas-Mexico Border.

PURPOSE: The study's purpose was to assess population demographics and resource utilization of the Medical Student Run Clinic, which provides primary care services to patients in El Paso, Texas along the Texas-Mexico border. METHODS: A retrospective cross-sectional chart review was performed on 760 patients evaluated at the medical student-run clinic between 2013 and 2016. Data included demographic characteristics, chief complaints, diagnoses, and interventions, which were analyzed with calculations of means, standard deviations, and percentages. RESULTS: Most (79.7%) patients were female; average age was 38.43 years; 91% of patients were Hispanic, and 66.8% spoke Spanish. Average BMI was 30.9 kg/m2. Less than 1% of patients presented with a psychiatric complaint; however, 17.9% screened positive for anxiety, and 16.5% screened positive for depression. CONCLUSIONS: This study shows that diabetes, hypertension, obesity, anxiety, and depression represent avenues for future patient-centered interventions and provide insight into challenges patients face along the border.