2017 Resarch Forum

SG: M-2

Applicant: Kyle Ota MD Principal Investigator: Andrea Pakula MD MPH FACS

Acute care surgery in populations with obesity: Does bariatric/minimally invasive surgical training impact outcomes? Kyle Ota MD Ruby Skinner MD FACS FCCP FCCM, Maureen Martin MD FACS, Andrea Pakula MD MPH FACS

INTRODUCTION : It is becoming more common for surgeons to manage people with obesity in the acute setting, and it is unclear if bariatric surgical training impacts outcomes in non-bariatric emergencies. PURPOSE: We sought to evaluate our experience in the obese population requiring acute surgery, and to compare outcomes based on surgeon expertise in bariatric surgery versus surgeons without bariatric surgery training. METHOD : A retrospective chart review was performed on records from January 2013-January 2014 for adult patients requiring acute surgical intervention. Surgeons were classified as bariatric (B) (n=2) versus non-bariatric (NB) (n=4). Patient demographics, BMI, ASA, Charlson comorbidity index (CCI), OR times, hospital length of stay (LOS), readmissions, mortality were investigated. RESULTS: Demographics: A total of 203 patient records were studied. The overall was BMI (37kg/m ) and there were n=60 with a BMI>40 kg/m 2 . The mean age was 37 + 14 and the majority were male (n=110). Standard laparoscopic cases were the majority: cholecystectomies n=75, appendectomies n=45. Non routine laparoscopic cases performed: intestinal obstructions n=9, incarcerated hernias n=17, traumatic injuries n=48, intestinal ischemia/perforation n=9. Bariatric vs. Non bariatric surgeons : Bariatric surgeons performed 35% of the cases vs. 65% (NB). Both groups operated on patients with similar risk: A BMI of >40 were 35% B vs. 26% NB, P=0.19. Patients with an ASA>3 were, 50% B vs. 50% NB, P=1.0. A Charlson comorbidity index of 2-5 was 4% B vs. 10% NB, P=0.11. A Charlson comorbidity index of >6 was 2% B vs. 2% NB, P=1.0. Operative Data: Laparoscopic cholecystectomy operative times were similar (B; 80 min. + 25 vs. NB; 82 min. + 29). Laparoscopic appendectomies were similar, (63 min. + 21 vs. 64 + 26). Operative times for complex cases were also similar (B vs NB): 80 min vs 83 min. Bariatric surgeons performed the majority of advanced laparoscopic cases (7% B vs. 2% NB, P=0.001). Outcomes: B vs NB surgical site infections were low, (2%vs4% P=0.4). Re-exploration was required 2% in both groups. Early readmission at 30 days was 6% B vs. 7% NB, P=1.0. Overall hospital LOS was higher in the NB group: 9 vs 5 days, P=0.05. Mortality was 5% for both groups. DISCUSSION/CONCLUSIONS: Acute surgical procedures were completed on obese patients with low morbidity and mortality, despite risk factors such as morbid obesity, high ASA scores and high comorbid indices. Bariatric surgical expertise seemed to favorably impact hospital LOS and the application of more complex minimally invasive approaches in cases not routinely done laparoscopically. Further study is warranted to determine if acute care surgeons would benefit from bariatric or other minimally invasive training.