Epidemiology and Economic Burden of Acute Infectious Gastroenteritis Among Adults Treated in Outpatient Settings in US Health Systems.

INTRODUCTION: Acute infectious gastroenteritis (AGE) is a common reason for outpatient visits and hospitalizations in the United States. This study aimed to understand the demographic and clinical characteristics, common pathogens detected, health care resource utilization (HRU), and cost among adult outpatients with AGE visiting US health systems. METHODS: A retrospective cohort study was conducted using one of the largest hospital discharge databases (PINC AI Healthcare Database) in the United States. Adult patients (aged ≥18 years) with a principal diagnosis of AGE during an outpatient visit between January 1, 2016, and June 30, 2021, were included. Pathogen detection analysis was performed in those with microbiology data available. RESULTS: Among 248,896 patients, the mean age was 44.3 years (range 18-89+ years), 62.9% were female, and 68.5% were White. More than half (62.0%) of the patients did not have any preexisting comorbidity, and only 18.3% underwent stool workup at the hospital. Most patients (84.7%) were seen in the emergency department, and most (96.4%) were discharged home. Within 30 days of discharge, 1.0% were hospitalized, and 2.8% had another outpatient visit due to AGE. The mean cost of the index visit plus 30-day AGE-related follow-up was $1,338 per patient, amounting to $333,060,182 for the total study population. Among patients with microbiology data available (n = 12,469), common pathogens detected were Clostridioides difficile (32.2%), norovirus (6.3%), and Campylobacter spp. (4.0%). DISCUSSION: AGE is a common and costly disease affecting adults of all ages and more females than males, including individuals with or without baseline conditions in a hospital-based outpatient setting. C. difficile was the most common pathogen detected.

Relationship between Diagnostic Method and Pathogen Detection, Healthcare Resource Use, and Cost in U.S. Adult Outpatients Treated for Acute Infectious Gastroenteritis.

A retrospective observational study was performed to assess the relationship between diagnostic method (traditional work-up [TW], multiplex PCR panel with < 12 target pathogens [PCR < 12], or multiplex PCR panel with ≥ 12 target pathogens [PCR12]), and diagnostic yield, health care resource use (HRU), and cost in adult outpatients visiting U.S. hospitals for acute infectious gastroenteritis (AGE). Using data from PINC AI Healthcare Database during January 1, 2016-June 30, 2021, we analyzed adult patients with an AGE diagnosis and stool testing performed during an outpatient visit. Detection rates for different pathogens were analyzed for those with microbiology data available. Among 36,787 patients, TW was most often performed (57.0%). PCR12 testing was more frequent in patients from large, urban, and teaching hospitals, compared to TW (all P < 0.01). PCR12 was associated with a higher mean index visit cost (by $97) but lower mean 30-day AGE-related follow-up cost (by $117) than TW. Patients with PCR12 had a lower 30-day AGE-related hospitalization risk than TW (1.7% versus 2.7% P < 0.01). Among the 8,451 patients with microbiology data, PCR12 was associated with fewer stool tests per patient (mean 1.61 versus 1.26), faster turnaround time (mean 6.3 versus 25.7 h) and lower likelihood of receiving in-hospital antibiotics (39.4% versus 47.1%, all P < 0.01) than TW. A higher percentage of patients with PCR12 had a target pathogen detected (73.1%) compared to PCR < 12 (63.6%) or TW (45.4%, P < 0.01). Thus, we found that large multiplex PCR panels were associated with lower 30-day AGE-related follow-up cost and risk of AGE-related hospitalization, and increased diagnostic yield compared to TW.

Is Coronavirus Disease 2019 (COVID-19) Less Deadly Now? Trends in In-Hospital Mortality Among Hospitalized COVID-19 Patients in the United States.

After an initial decline from April through June 2020 (from 22.2% to 11.9%), adjusted in-hospital mortality in coronavirus disease 2019 (COVID-19) inpatients peaked twice and was significantly higher than June 2020 for subsequent months except in July and October 2020. Adjusted mortality trends differed across age groups between November 2020 and February 2021.

Healthcare Resource Utilization of Patients With COVID-19 Visiting US Hospitals.

OBJECTIVES: Severe cases of COVID-19 have overwhelmed hospital systems across the nation. This study aimed to describe the healthcare resource utilization of patients with COVID-19 from hospital visit to 30 days after discharge for inpatients and hospital-based outpatients in the United States. METHODS: A retrospective cohort study was conducted using Premier Healthcare Database COVID-19 Special Release, a large geographically diverse all-payer hospital administrative database. Adult patients (age ≥ 18 years) were identified by their first, or "index," visit between April 1, 2020, and February 28, 2021, with a principal or secondary discharge diagnosis of COVID-19. RESULTS: Of 1 454 780 adult patients with COVID-19, 33% (n = 481 216) were inpatients and 67% (n = 973 564) were outpatients. Among inpatients, mean age was 64.4 years and comorbidities were common. Most patients (80%) originated from home, 10% from another acute care facility, and 95% were admitted through the emergency department. Of these patients, 23% (n = 108 120) were admitted to intensive care unit and 14% (n = 66 706) died during index hospitalization; 44% were discharged home, 15% to nursing or rehabilitation facility, and 12% to home health. Among outpatients, mean age was 48.8 years, 44% were male, and 60% were emergency department outpatients (n = 586 537). During index outpatient visit, 79% were sent home but 10% had another outpatient visit and 4% were hospitalized within 30 days. CONCLUSIONS: COVID-19 is associated with high level of healthcare resource utilization and in-hospital mortality. More than one-third of inpatients required post hospital healthcare services. Such information may help healthcare providers better allocate resources for patients with COVID-19 during the pandemic.

To oversew or not to oversew in robotic sleeve gastrectomy: a case against oversewing the staple line.

BACKGROUND: The benefits of oversewing the staple lines during laparoscopic sleeve gastrectomy have been controversial. No study examined the benefit of oversewing the staple lines in robotic sleeve gastrectomy (RSG). This retrospective study aims to examine the difference in immediate postoperative complications, readmissions, reoperations, and emergency room visits between RSG patients with and without oversewn staple lines at a single, large-volume, bariatric center. METHODS: A retrospective chart review was conducted on 623 patients who underwent RSG between November 1, 2017, and November 1, 2019. Of these, 316 had their staple line oversewn between November 1, 2017, and November 12, 2018, and 307 did not have their staple line oversewn between November 13, 2018, and November 1, 2019. RESULTS: A total of 623 patients underwent RSG, of which 50.7% (n = 316) had their staple line oversewn. The mean length of hospital stay was similar between the two groups. However, the mean operative time was significantly longer in the "oversew" group than "no oversew" group by 7.4 minutes (p < 0.001). Readmission, reoperation, and intervention rates during the 30-day postoperative period were similar between the two groups. However, the percentage of patients requiring outpatient emergency room visits during the 30 days after RSG was significantly higher in the "oversew" group than that of the "no oversew" group. CONCLUSIONS: No significant difference in major complications was found between RSG patients with and without oversewn staple lines. Oversewing of the staple line may be associated with increased emergency room visits.

Late Adiposity Rebound and the Probability of Developing and Reversing Childhood Obesity.

OBJECTIVE: To evaluate the associations between late adiposity rebound (at or after 7.0 years of age) and the probability of developing and reversing obesity during elementary school years. STUDY DESIGN: Using nationally representative cohorts from Early Childhood Longitudinal Studies, Kindergarten Class of 1998-1999 and 2010-2011, weighted extended Cox hazard models were used to assess the probability of developing and reversing obesity (cut-offs for extended models were 6 and 12 months after kindergarten entry, respectively). Measurements used in the study were collected 6 times between kindergarten and fifth grade (Early Childhood Longitudinal Studies, Kindergarten Class of 1998-1999) and 8 times between kindergarten through fourth grade (Early Childhood Longitudinal Studies, Kindergarten Class of 2010-2011). RESULTS: Among children with obesity at kindergarten entry, within 6 months, the risk of developing obesity was 73% and 76% lower for boys with late adiposity rebound than their classmates without late adiposity rebound (hazard ratio 0.27 and 0.24). Six months after entering kindergarten, similar association was observed for both boys and girls. Among children without obesity at kindergarten entry, within 12 months, the probability of reversing obesity was 52% and 54% higher for boys with late adiposity rebound than their peers without late adiposity rebound (hazard ratio 1.52 and 1.54). Twelve months after entering kindergarten, the probability of reversing obesity among both sexes with late adiposity rebound was 6-8 times that among children without late adiposity rebound. CONCLUSIONS: Late adiposity rebound was significantly associated with a decreased risk of developing obesity and an increased probability of reversing obesity among kindergarteners.

Conversions of Roux-en-Y gastric bypass to duodenal switch (SADI-S and BPD-DS) for weight regain.

BACKGROUND: Duodenal switch is a choice of conversion when patients fail to lose or regain weight after Roux-en-Y gastric bypass (RYGB). This study aims to evaluate the effectiveness and safety of duodenal switch as a secondary operation for patients who presented with insufficient weight loss or weight regain after a RYGB. METHODS: A retrospective chart review was performed on 15 patients who underwent a conversion of RYGB to single anastomosis duodeno-ileal bypass with sleeve (SADI-S) or biliopancreatic diversion with duodenal switch (BPD-DS) due to weight regain between December 31, 2013 and October 31, 2018. For the body mass index (BMI) analysis, the multilevel model for change was used. RESULTS: Of 15 patients, 10 underwent a conversion to SADI-S, and 5 underwent a conversion to BPD-DS. Also, 7 patients underwent the conversion in two-stages, while 8 did as single-stage. One patient had a duodenal stump leak after SADI-S, and another patient had a sleeve leak after BPD-DS. One patient underwent a reoperation to increase the common channel 20 months after the conversion to BPD-DS due to malnutrition. There was no mortality. Mean percentage of total weight loss (TWL) was 18.4% at 6 months, 25.0% at 12 months, 26.4% at 18 months, and 25.7% at 24 months after the conversion. The rate of decrease in BMI was slower in SADI-S patients than in BPD-DS patients (p < 0.01), adjusting for preoperative BMI. CONCLUSION: Conversions of RYGB to SADI-S and BPD-DS can provide significant additional weight loss. However, complications and malnutrition can develop after the conversion, and further research is needed for evaluating safety.

Safety and short-term effectiveness of endoscopic sleeve gastroplasty using overstitch: preliminary report from a multicenter study.

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) is an option for patients with Class I and II obesity or patients who refuse to undergo a laparoscopic bariatric surgery. The aims of this study are as follows: (1) to demonstrate a short-term outcome after primary ESG and (2) to compare the effectiveness of weight loss between Class I and Class II obesity patients. METHODS: Patients undergoing ESG at four bariatric centers in Brazil between April 1, 2017 and December 31, 2018 were prospectively enrolled in the study (BMI 30.0-39.9 kg/m2). ESG was performed using Overstitch (Apollo Endosurgery, Austin, TX). Descriptive analysis, t test, Chi-square test, and Mann-Whitney test were used to present the results. RESULTS: A total of 233 patients underwent primary ESG. The mean age and BMI of the patients were 41.1 years and 34.7 kg/m2, respectively. Following ESG, the mean percentage of total weight loss (TWL) was 17.1% at 6 months and 19.7% at 12 months. Percentage of excess BMI loss (EBMIL) was 47.3% at 6 months and 54.8% at 12 months after ESG. The mean EBMIL was significantly greater among patients with Class I obesity than those with Class II obesity at 6 (51.1% vs. 43.7%) and 12 months (60.2% vs. 49.2%). One patient experienced bleeding during the procedure that was managed with sclerotherapy. CONCLUSION: Short-term results suggest that ESG is a safe and effective option for patients with Class I and II obesity.

Pathologic findings of the removed stomach during sleeve gastrectomy.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is the preferred surgical intervention to treat morbid obesity. Despite the rising popularity of LSG, little is known on the histopathologic findings of the resected partial stomach specimens. Our study aims to identify prevalent pathologic findings of the removed stomach and explore the association between patient characteristics and abnormal findings. METHODS: A retrospective analysis was conducted using a prospectively maintained database of 649 patients who underwent LSG between November 1, 2013 and December 31, 2015 at our institution. Patient characteristics included age, body mass index, gender, and preoperative comorbidities (diabetes, hyperlipidemia, depression, gastroesophageal reflux, hypertension, and sleep apnea). Statistical analysis was performed using descriptive analysis and logistic regression models. RESULTS: Abnormal pathologic findings were identified in approximately one-fifth (n = 142, 21.9%) of the patients. The most common find is non-specific chronic gastritis (9.7%), followed by Helicobacter pylori gastritis (4.9%). Approximately 15% of patients had significant histopathological alterations that might require further investigation, treatment, or follow-up, including non-specific chronic gastritis, H. pylori gastritis, autoimmune atrophic gastritis, and gastrointestinal stromal tumor. The odds of abnormal findings in patients without hyperlipidemia was 0.09 times the corresponding odds in those with hyperlipidemia (95% CI 0.03-0.29), controlling for factors including age, body mass index, gender, and other preoperative comorbidities. CONCLUSION: Patients with gastroesophageal reflux and hyperlipidemia might suggest higher incidence rate of gastric histopathologic abnormalities. Routine preoperative screening may not be beneficial for patients undergoing sleeve gastrectomy.

Endoscopic treatment of food intolerance after a banded gastric bypass: inducing band erosion for removal using a plastic stent.

BACKGROUND AND STUDY AIMS: Ring complications after a banded Roux-en-Y gastric bypass (RYGB) are usually managed surgically. The aim of this study was to analyze the safety and effectiveness of endoscopic removal of noneroded rings after banded-RYGB, by inducing intragastric erosion of the ring using a self-expandable plastic stent (SEPS). PATIENTS AND METHODS: A total of 41 patients with banded RYGB who had noneroded rings and food intolerance were prospectively enrolled. Patients were treated with endoscopic SEPS placement and ring removal. Data from time of stenting, resolution of symptoms, need for endoscopic dilation, and complications were recorded. RESULTS: Successful ring removal was possible in all patients. In 21 cases, the SEPS induced complete erosion, and in 17 cases the ring was removed a month later because of incomplete erosion at the time of SEPS removal. Nine patients (22.0 %) needed endoscopic dilation after stent removal in order to treat fibrotic strictures. Food tolerance was observed in 32 patients (78.0 %) after the procedure. No patient needed surgery and there were no deaths. CONCLUSIONS: Endoscopic removal of the ring using SEPS appeared to be safe and effective after a banded RYGB.

Causes of small bowel obstruction after Roux-en-Y gastric bypass: a review of 2,395 cases at a single institution.

BACKGROUND: Internal hernia is a relatively common postoperative complication after Roux-en-Y gastric bypass (RYGB) procedure. It has been reported that 1-9 % of laparoscopic RYGB patients develop internal herniation through Peterson's or mesenteric defect. However, a considerable number of patients presenting with possible small bowel obstruction (SBO) after laparoscopic RYGB do not always have internal herniation. PURPOSE: The aim of our study was to determine the causes of SBO for patients in which both potential internal hernia spaces were closed at the time of the original operation. SETTING: Academic Practice, USA. MATERIALS AND METHODS: Of 2,395 patients who underwent laparoscopic RYGB between January 2004 and October 2012, a total of 93 (3.9 %) patients were reoperated for possible SBO at our institution. A retrospective review of a prospectively collected database was performed for all patients. RESULTS: A total of 93 patients had 105 reoperations in the study period, resulting in a reoperation rate for possible SBO of 3.9 %. The mean time period between the laparoscopic RYGB and the first 93 reoperations was 20.9 ± 18.1 months (range 0-100). Eleven patients required secondary reoperations at a mean period of 20.1 ± 17.7 months (range 0-52) after the first reoperation. Of these 105 reoperations, 29 (27.6 %) showed internal herniation at the mesenteric defect (N = 23), Peterson's defect (N = 5), and both (N = 1). A total of 50 (47.6 %) reoperations revealed extensive adhesions causing SBO. Of these 50 cases, 12 revealed adhesions at the jejunojejunostomy, causing it to kink and obstruct. Ten (9.5 %) cases showed intussusception of the jejunojejunal anastomosis. Overall, reoperation rate due to internal herniation was 1.1 % in our patient population. CONCLUSIONS: Our findings indicate a 3.9 % reoperation rate for abdominal pain and SBO, and more than 45 % of these patients had symptoms secondary to adhesions. Only 1.1 % of our laparoscopic RYGB patients developed internal herniation after closure of both internal hernia spaces.

In-Hospital Mortality Among Hospitalized Coronavirus Disease 2019 Patients in the United States: How Did It Change in 2021?

In this retrospective observational study in a US national sample of 501 671 adults hospitalized with coronavirus disease 2019, adjusted in-hospital mortality decreased from 12% in February 2021 to 9% in April 2021. However, adjusted in-hospital mortality increased to 16% in September and October 2021. Adjusted intensive care unit admission fluctuated between 20% and 27% in 2021.

ANTI-REFLUX PROCEDURES AFTER ROUX-EN-Y GASTRIC BYPASS.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has been the choice of bariatric procedure for patients with symptomatic reflux - and is known to be effective in reducing the need for anti-reflux medication postoperatively. However, a small number of RYGB patients can still develop severe reflux symptoms that require a surgical intervention. AIM: To examine and describe the patient population that requires an anti-reflux procedure after RYGB evaluating demographics, characteristics, symptoms and diagnosis. METHODS: A retrospective chart review was performed on 32 patients who underwent a hiatal hernia repair and/or Nissen fundoplication after RYGB Jul 1st, 2014 and Dec 31st, 2019. Patients were identified using the MBSAQIP database and their electronic medical records were reviewed. RESULTS: Most patients were female (n=29, 90.6%). The mean age was 52.8 years and the mean body mass index (BMI) was 34.1 kg/m2 at the time of anti-reflux procedure. Patients underwent the anti-reflux procedure at a mean of 7.9 years after the RYGB procedure. The mean percentage of excess BMI loss during the time between RYGB and anti-reflux procedure was 63.4%. CONCLUSIONS: Female patients with a significant weight loss may develop a severe reflux symptoms years after RYGB. Complaints of reflux after RYGB should not be overlooked. Careful follow-up and appropriate treatment (including surgical intervention) is needed for this population.

Treatment patterns, healthcare resource use, and costs associated with uncomplicated urinary tract infection among female patients in the United States.

BACKGROUND: We evaluated associations between antibiotic prescription and healthcare resource use and costs (Part A), and between antibiotic switching and healthcare resource use, costs, and uncomplicated urinary tract infection recurrence (Part B) in female patients with uncomplicated urinary tract infection in the United States. METHODS: This retrospective cohort study of linked Optum and Premier Healthcare Database data included female patients ≥12 years old with an uncomplicated urinary tract infection diagnosis (index date), who were prescribed antibiotics during an outpatient/emergency department visit between January 1, 2013 and December 31, 2018. In Part A, patients were stratified by antibiotic prescription appropriateness: appropriate and optimal (compliant with Infectious Diseases Society of America 2011 guidelines for drug class/treatment duration) versus inappropriate/suboptimal (inappropriate drug class/treatment duration per Infectious Diseases Society of America 2011 guidelines, and/or treatment failure). In Part B, patients were stratified by treatment pattern (antibiotic switch vs no antibiotic switch). Healthcare resource use and costs during index episode (within 28 days of index date) and 12-month follow-up were compared. RESULTS: Of 5870 patients (mean age 44.5 years), 2762 (47.1%) had inappropriate/suboptimal prescriptions and 567 (9.7%) switched antibiotic. Inappropriate/suboptimal prescriptions were associated with higher healthcare resource use (mean number of ambulatory care and pharmacy claims [both p < 0.001]), and higher total mean cost (inpatient, outpatient/emergency department, ambulatory visits, and pharmacy costs) per patient ($2616) than appropriate and optimal prescriptions ($649; p < 0.001) (Part A). Antibiotic switching was associated with more pharmacy claims and higher total mean costs (p ≤ 0.01), and a higher incidence of recurrent uncomplicated urinary tract infection (18.9%) than no antibiotic switching (14.2%; p < 0.001) (Part B). CONCLUSIONS: Inappropriate/suboptimal prescriptions and antibiotic switching were associated with high costs, ambulatory care, and pharmacy claims, suggesting a need for improved uncomplicated urinary tract infection prescribing practices in the United States.

The Associations between Childhood Obesity, Academic Performance, and Perception of Teachers: From Kindergarten to Fifth Grade.

Background: Obesity is weakly associated with negative academic achievement among school-aged children. The purpose of this study is to demonstrate the relationships between reading/mathematics scores (objective) and teachers' perception of learning ability (subjective) and childhood obesity-from kindergarten to fifth grade. Methods: This study examined a longitudinal study of a nationally representative sample of 18,174 children who were enrolled in kindergarten in 2010 in the United States (ECLS-K:2011). Weighted multiple logistic regression models were used to examine the associations between objective scores, subjective scores, and obesity (vs. healthy-weight children). Results: In the crude analyses, obesity was negatively associated with achieving above-median reading and mathematics scores. After adjusting for sex, race/ethnicity, age, and socioeconomic status (SES), the association weakened but was still present. Children with obesity were less likely to achieve above-median reading and mathematics scores than their healthy-weight peers (odds ratio [OR] 0.77 and 0.86 for reading; OR 0.85, 0.67, 0.79, 0.82, and 0.75 for mathematics). Similarly, teachers reported that children with obesity did not have Approaches to Learning and Attentional Focusing as good as their healthy-weight peers regardless of their objective test scores and SES (OR 0.82, 0.80, 0.78, 0.69, and 0.77 for Approaches to Learning; OR 0.80, 0.81, 0.83, 0.82, 0.80, and 0.74 for Attentional Focusing). Conclusions: Obesity during elementary school years is negatively associated with both objective and subjective measures of academic performance. Further studies are needed to understand if the connection is stemming from behavioral issues of children, weight-based bias of teachers, or both.

Effect of Obesogenic Medication on Weight- and Fitness-Change Outcomes: Evidence from the Look AHEAD Study.

OBJECTIVE: This study evaluates whether obesogenic medications may decrease the effectiveness of lifestyle interventions. The authors of this study hypothesized that participants who took obesogenic medications would be less responsive to the intervention in the Look AHEAD trial. METHODS: In the trial, 5,145 participants with overweight or obesity, aged 45 to 76 years with type 2 diabetes, were randomly assigned to an intervention (vs. support and education). In this analysis, the association of exposure to obesogenic medications and successful weight loss (≥5% and ≥10% of total weight) and fitness gain (≥1 and ≥2 metabolic equivalents) was examined. For each outcome, multiple logistic regression models were fitted. RESULTS: Analytic sample sizes were 4,496 for weight-change analyses and 4,051 for fitness-change analyses. After adjusting for covariates, exposure to one or more obesogenic medications significantly decreased the odds of achieving ≥5% weight loss by 32% (odds ratio [OR] 0.68) and achieving ≥10% weight loss by 19% (OR 0.81). The association was dose-dependent-participants using two or more medications were less likely to achieve weight loss than those using one medication. Obesogenic medication exposure was not associated with decreased odds of achieving fitness gain overall. CONCLUSIONS: The results suggest that exposure to obesogenic medications could hinder successful weight loss in a lifestyle intervention for people with diabetes.

Impact of Weight Status on the Cardiopulmonary Fitness Outcome of a School-Based Physical Activity Program.

BACKGROUND: The effectiveness of school-based physical activity interventions for improving cardiopulmonary fitness (CPF) of overweight and obese children is not well established. In this study, we evaluated whether overweight and obese children had similar changes in body mass index (BMI) and CPF as normal weight children after participating in a program for one academic year. METHODS: Using purposive sampling at the school level, we selected 16 program and 7 control schools in a large metropolitan area in the Southeast during the 2015-2016 academic year. In these schools, 3396 fourth-graders participated with parental consent. Of these, 2332 (68.7%) participated in BMI measures and 1780 (52.4%) in Progressive Aerobic Cardiovascular Endurance Run (PACER) measures for CPF at two time points. RESULTS: Students of all weight statuses pre-program did not show changes in BMI after program implementation. All students showed statistically significant improvements in the PACER test at follow-up, regardless of their participation in the program. However, overweight and obese children showed less improvement in CPF level than their normal weight classmates, regardless of their participation in the program. CONCLUSION: Special attention for improving engagements of overweight and obese children may be needed to achieve improvements in their CPF level similar to that of normal weight students.

Preoperative Exposure to Low-Calorie Sweeteners and Bariatric Surgery Outcomes.

PURPOSE: Low-calorie (LCSs) may be negatively associated with weight and metabolic health. We hypothesized that LCS exposure may hinder the effectiveness of bariatric procedures. The aim of this study was to examine the association between preoperative LCS use and weight loss/comorbidity remission following sleeve gastrectomy and gastric bypass. MATERIAL AND METHODS: We performed a retrospective chart review of 653 patients who underwent one of the two bariatric procedures and provided preoperative diet information. Patients who selected LCS as one of their most commonly consumed sweeteners and/or included "diet" drinks or sugar-free foods in their 24-h diet recall were categorized as "LCS users." We used multiple logistic regression models to address the study objectives. RESULTS: Of 653 patients, 470 (72.0%) regularly consumed LCSs. LCS users were more likely to be older, have lower preoperative BMI, diabetic, using insulin, and have hyperlipidemia than non-LCS users. LCS consumption was not associated with the odds of achieving BMI < 35 kg/m2 nor the odds of achieving TBWL ≥ 20% in the adjusted models. While 39.6% of diabetic LCS users did not show remission, only 22.7% of diabetic non-LCS users did so at their last follow-up (p = 0.04). However, this association was attenuated when adjusted for insulin dependency. CONCLUSIONS: There is no clear harm or benefit of preoperative consumption of LCS on weight loss or comorbidity remission after bariatric procedures. Further study is needed to more accurately assess the effect of LCSs on bariatric surgery outcomes.

Feasibility and safety of robot-assisted bariatric conversions and revisions.

BACKGROUND: Conversions and revisions after bariatric procedures are inevitable and associated with longer operative time and higher complication rates. Because robot-assisted procedures allow better dissection, robotic conversions and revisions may be more beneficial to the patients than laparoscopic ones. OBJECTIVES: This study aimed to compare the feasibility and safety of robot-assisted conversions and revisions to laparoscopic procedures. SETTING: Academic Hospital, United States. METHODS: A retrospective chart review was performed on 94 consecutive patients who underwent a bariatric conversion or revision (revision of gastrojejunostomy, conversions of vertical sleeve gastrectomy to Roux-en-Y gastric bypass, adjustable gastric banding to sleeve gastrectomy, Roux-en-Y gastric bypass to sleeve gastrectomy, adjustable gastric banding to Roux-en-Y gastric bypass, Roux-en-Y gastric bypass to duodenal switch, and adjustable gastric banding to duodenal switch) between January 1, 2017, and February 28, 2019. Of these, 30 underwent a robot-assisted conversion or revision. RESULTS: Patients who underwent a robot-assisted approach were more likely to be older (45.4-versus 38.8-yr old) and lighter (44.6 versus 50.3 kg/m2) than patients who underwent a laparoscopic approach. The mean operative time was longer in the robot-assisted group (155.5 min) than in the laparoscopic group (113.3 min). No difference was observed between the 2 groups in the mean length of hospital stay, 30-day readmission rate, or 30-day reoperation rate. Results were similar when the baseline difference in age and body mass index were accounted for. CONCLUSIONS: Robot-assisted conversions and revisions were as feasible and safe as laparoscopic procedures. However, operative time was longer in robot-assisted conversions.