Predictors of long-term mortality after bariatric surgery performed in Veterans Affairs medical centers.

Group Health Center for Health Studies and Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, USA.
Archives of surgery (Chicago, Ill.: 1960) (Impact Factor: 4.3). 10/2009; 144(10):914-20. DOI: 10.1001/archsurg.2009.134
Source: PubMed

ABSTRACT The purpose of this study was to examine patient factors associated with mortality among veterans who undergo bariatric surgery.
Prospective study that uses data from the Veterans Affairs (VA) National Surgical Quality Improvement Program.
Group Health Center for Health Studies, the VA North Texas Health Care System, the Denver VA Medical Center, and the Durham VA Medical Center.
We identified 856 veterans who had undergone bariatric surgery in 1 of 12 VA bariatric centers from January 1, 2000, through December 31, 2006.
The risk of death was estimated via Cox proportional hazards.
The 856 veterans had a mean body mass index (BMI) of 48.7, a mean age of 54 years, and a mean DCG score of 0.76; 73.0% were men, 83.9% were white, and 7.0% had an ASA class equal to 4. Fifty-four veterans (6.3%) had died by the end of 2006. In our Cox models, patients with a BMI greater than 50 (superobesity; hazard ratio [HR], 1.8; P = .04) or a DCG score greater than or equal to 2 (HR, 3.4; P < .001) had an increased risk of death.
Superobese veterans and those with a greater burden of chronic disease had a greater risk of death after bariatric surgery from 2000 through 2006.

  • [Show abstract] [Hide abstract]
    ABSTRACT: The bond index and the valency proposed by Armstrong, Perkins and Stewart coincides very well with chemist's intuition and is used in MOPAC. Their method is extended for general molecular orbital methods including DV-Xa. Furthermore, the energy partition method using the Fock matrix is adopted to indicate bond strengths. Bond indices and partitioned energies can be calculated using the standard DV-Xα output file and draw more quantitative and vivid image of chemical bonds than Mulliken's population analysis. The procedures of new method and some interesting results are described.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bariatric surgery provides significant reductions in weight and comorbidity, and has the potential to reduce health care utilization. It is unknown whether health care utilization and expenditures are reduced for veterans after bariatric surgery. To examine health care utilization and expenditures of severely obese individuals before and after bariatric surgery within the Veterans Health Administration. We conducted a retrospective, longitudinal cohort study of health care use and expenditures among all veterans who underwent bariatric surgery in 1 of 12 approved Department of Veterans Affairs bariatric centers from 2000 to 2006. Bariatric patients were identified via Current Procedural Terminology-4 codes from a database of major surgical procedures maintained by the National Surgical Quality Improvement Program. The main outcomes of interest for our analysis were multivariable adjusted inpatient and outpatient health care utilization and expenditures in the 3 years prior to surgery and in the 3 years after surgery. Between 2000 and 2006, 846 veterans had bariatric surgery, 25% of whom underwent a laparoscopic procedure. The mean initial body mass index was 48.5, the mean age was 51; and 73% were male. In multivariable models including all years of data, outpatient, inpatient, and overall expenditures significantly decreased in the years after surgery because of higher clinical resources required in the months before and during surgery. When excluding the 6 months leading up to surgery and the 6 months just after surgery, outpatient expenditures remained lower in the postsurgical period, but inpatient and overall expenditures were significantly higher. Our analyses indicate that this cohort of older, male bariatric surgery patients does not achieve a reduction in health care expenditures 3 years after their procedure. These results are at variance from other, similar published studies and may reflect differences in study populations or systems of care.
    Medical care 10/2010; 48(11):989-98. DOI:10.1097/MLR.0b013e3181ef9cf7 · 2.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Previously, Midwestern veteran patients had limited bariatric surgery access because they lived long distances from a bariatric surgery center (BSC). The creation and outcomes of a network to increase bariatric surgery access and patient satisfaction with teleconsultation are discussed. Several referring Midwestern Veterans Affairs Medical Centers (VAMCs) performed pre- and postoperative management and were linked by teleconferencing and a computerized patient record system to a single BSC. Twenty-eight high-risk patients (older, male) residing an average distance of 324.5 miles from the BSC underwent gastric bypass. Eighty-two percent used teleconferencing for the initial surgical consultation with excellent patient satisfaction saving at least 19,000 miles and 69 travel days. Surgical outcomes were equivalent and follow-up was excellent (96.6%) compared with non-Veterans Affairs patients. A cooperative network using teleconference and computerized records facilitated bariatric surgery in high-risk, remotely located VA patients with high patient satisfaction and without compromising surgical outcomes.
    American journal of surgery 05/2011; 202(1):71-6. DOI:10.1016/j.amjsurg.2010.06.016 · 2.41 Impact Factor