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.
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.
The American Society for Metabolic and Bariatric Surgery Pediatric Committee updated their evidence-based guidelines published in 2012, performing a comprehensive literature search (2009-2017) with ...1387 articles and other supporting evidence through February 2018. The significant increase in data supporting the use of metabolic and bariatric surgery (MBS) in adolescents since 2012 strengthens these guidelines from prior reports. Obesity is recognized as a disease; treatment of severe obesity requires a life-long multidisciplinary approach with combinations of lifestyle changes, nutrition, medications, and MBS. We recommend using modern definitions of severe obesity in children with the Centers for Disease Control and Prevention age- and sex-matched growth charts defining class II obesity as 120% of the 95th percentile and class III obesity as 140% of the 95th percentile. Adolescents with class II obesity and a co-morbidity (listed in the guidelines), or with class III obesity should be considered for MBS. Adolescents with cognitive disabilities, a history of mental illness or eating disorders that are treated, immature bone growth, or low Tanner stage should not be denied treatment. MBS is safe and effective in adolescents; given the higher risk of adult obesity that develops in childhood, MBS should not be withheld from adolescents when severe co-morbidities, such as depressed health-related quality of life score, type 2 diabetes, obstructive sleep apnea, and nonalcoholic steatohepatitis exist. Early intervention can reduce the risk of persistent obesity as well as end organ damage from long standing co-morbidities.
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