Background: The purpose of this study was to assess whether differences exist in health behaviors (dietary quality, physical activity) and weight loss strategies between those who underwent weight ...loss surgery (WLS) and those seeking non-surgical weight loss (NSWL). Methods: This study used data from the 2013-2018 National Health and Nutrition Examination Survey, specifically using the measurements of self-reported dietary quality and physical activity, adaptive and maladaptive weight loss behaviors, and weight loss history for 6,616,151,067 participants. Data was analyzed using SAS 9.4. Weighted analyses included descriptives, ANOVAs, and chi-square tests. Results: There were 6,982,652 participants who underwent WLS; 209,718,492 sought NSWL. Time since surgery ranged from < 1 year to 39 years, with approximately 23% having had surgery in the last 3 years. There was no significant difference between the two groups in dietary quality (F = 2.42, p = 0.12), but those who underwent WLS consumed less calories than those seeking NSWL (F = 13.60, p< .001). Those who underwent WLS had 50% lower odds of meeting physical activity recommendations (>150 minutes per week); only 27.5% of WLS participants compared to 43.4% of NSWL participants met the guidelines (OR = 0.51, 95%CI = .0.31-0.84). Those who underwent WLS endorsed higher use of healthy weight loss strategies (OR = 0.02, 95% CI = 0.01-0.05) compared to NSWL participants; there were no differences in unhealthy weight loss strategies (OR = 1.11, 95% CI = 0.64-1.90). There were also no significant differences in health outcomes (stroke, hypertension, hyperlipidemia, glucose levels) in those who had WLS compared to NSWL seekers. Conclusions: Those who underwent WLS reported lower daily caloric intake and more use of healthy weight loss strategies, but less physical activity compared to those seeking NSWL. As the surgery directly impacts patients' eating, WLS patients may be able to modify eating habits more so than physical activity level.
BACKGROUND:Dupuytren’s disease is a common, chronic, fibroproliferative disease of the palmar fascia. The cause is unclear but includes genetic predisposition alongside environmental factors. Several ...studies have suggested an association between Dupuytren’s disease and excess mortality. The authors aimed to evaluate this association in adult patients in the United Kingdom and identify the causes of mortality.
METHODS:The authors used a large primary care database (Clinical Practice Research Datalink) linked to the Office of National Statistics to identify patients with Dupuytren’s disease between January 1, 1995, and December 31, 2013. Each patient was matched by age, sex, and general practitioner to five control patients without the disease. Cox regression models were used to study the association between Dupuytren’s disease and all-cause and cause-specific mortality, adjusting for confounders.
RESULTS:A total of 41,965 Dupuytren’s disease patients and 209,825 control patients were identified. The all-cause mortality rate was increased in both unadjusted (hazard ratio, 1.48; 99% CI, 1.29 to 1.70; p < 0.0001) and multivariable adjusted (hazard ratio, 1.43; 99% CI, 1.25 to 1.65; p < 0.0001) models in patients with Dupuytren’s disease, 12 years after diagnosis. Excess mortality was secondary to a wide range of causes, including cancer (hazard ratio, 1.66; 99% CI, 1.27 to 2.17; p < 0.0001), an effect that persisted after adjustment for confounders.
CONCLUSIONS:There is excess mortality associated with Dupuytren’s disease that can be partially explained through environmental factors. From time of diagnosis in primary care, there is a 12-year window of opportunity for intervention to reduce the impact of these factors. The authors observed an increased risk of cancer mortality independent of confounders, and hypothesize a shared genetic risk between Dupuytren’s disease and cancer.
CLINICAL QUESTION/LEVEL OF EVIDENCE:Risk, II.
Introduction
Intrahepatic cholangiocarcinoma (ICC) remains an uncommon disease with a rising incidence worldwide. We sought to identify trends in therapeutic approaches and differences in patient ...outcomes based on facility types.
Methods
Between January 1, 2004, and December 31, 2015, a total of 27,120 patients with histologic diagnosis of ICC were identified in the National Cancer Database and were enrolled in this study.
Results
The incidence of ICC patients increased from 1194 in 2004 to 3821 in 2015 with an average annual increase of 4.16% (
p
< 0.001). Median survival of the cohort improved over the last 6 years of the study period (2004–2009: 8.05 months vs. 2010–2015: 9.49 months;
p
< 0.001). Among surgical patients (
n
= 5943, 21.9%), the incidence of R0 resection, lymphadenectomy and harvest of ≥6 lymph nodes increased over time (
p
< 0.001). Positive surgical margins (referent R0: R1, HR 1.49, 95% CI 1.24–1.79,
p
< 0.001) and treatment at community cancer centers (referent academic centers; HR 1.24, 95% CI 1.04–1.49,
p
= 0.023) were associated with a worse prognosis. Patients treated at academic centers had higher rates of R0 resection (72.4% vs. 67.7%;
p
= 0.006) and lymphadenectomy (55.6% vs. 49.5%,
p
= 0.009) versus community cancer centers. Overall survival was also better at academic versus community cancer programs (median OS: 11 months versus 6 months, respectively;
p
< 0.001).
Conclusions
The incidence of ICC has increased over the last 12 years in the USA with a moderate improvement in survival over time. Treatment at academic cancer centers was associated with higher R0 resection and lymphadenectomy rates, as well as improved OS for patients with ICC.
Introduction
The utilization of laparoscopy in colorectal surgery is increasing. However, conversion to open surgery remains relatively high.
Objective
We evaluated (1) conversion rates in ...laparoscopic colorectal surgery; (2) the outcomes of converted cases compared with successful laparoscopic and open colorectal operations; (3) predictive risk factors of conversion of laparoscopic colorectal surgery to open surgery.
Methods
Using the National Inpatient Sample database, we examined the clinical data of patients who underwent colon and rectal resection from 2009 to 2010. Multivariate regression analysis was performed to identify factors predictive for conversion of laparoscopic to open operation.
Results
A total of 207,311 patients underwent intended laparoscopic colorectal resection during this period. The conversion rate was 16.6 %. Considering resection type and pathology, the highest conversion rates were observed in proctectomy (31.4 %) and Crohn’s disease (20.2 %). Using multivariate regression analysis, Crohn’s disease (adjusted odds ratio AOR, 2.80), prior abdominal surgery (AOR, 2.45), proctectomy (AOR, 2.42), malignant pathology (AOR, 1.90), emergent surgery (AOR, 1.82), obesity (AOR, 1.63), and ulcerative colitis (AOR, 1.60) significantly impacted the risk of conversion. Compared with patients who were successfully completed laparoscopically, converted patients had a significantly higher complication rate (laparoscopic: 23 %; vs. converted: 35.2 % vs. open: 35.3 %), a higher in-hospital mortality rate (laparoscopic: 0.5 %; vs. converted: 0.6 %; vs. open: 1.7 %) and a longer mean hospital stay (laparoscopic: 5.4 days; vs. converted: 8.1 days; vs. open: 8.4 days); however, converted patients had better outcomes compared with the open group.
Conclusions
The conversion rate in colorectal surgery was 16.6 %. Converted patients had significantly higher rates of morbidity and mortality compared to successfully completed laparoscopic cases, although lower than open cases. Crohn’s disease, prior abdominal surgery, and proctectomy are the strongest predictors for conversion of laparoscopic to open in colorectal operations.
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