The effect of CKD on the risks of bariatric surgery is not well understood. Using the American College of Surgeons National Surgical Quality Improvement Program Participant Use File, we analyzed 27,736 patients who underwent bariatric surgery from 2006 through 2008. Before surgery, 34 (0.12%) patients were undergoing long-term dialysis. Among those not undergoing dialysis, 20,806 patients (75.0%) had a normal estimated GFR or stage 1 CKD, 5011 (18.07%) had stage 2 CKD, 1734 (6.25%) had stage 3 CKD, 94 (0.34%) had stage 4 CKD, and 91 (0.33%) had stage 5 CKD. In an unadjusted analysis, CKD stage was directly associated with complication rate, ranging from 4.6% for those with stage 1 CKD or normal estimated GFR to 9.9% for those with stage 5 CKD (test for trend, P,0.001). Multivariable logistic regression demonstrated that CKD stage predicts higher complication rates (odds ratio for each higher CKD stage, 1.30) after adjustment for diabetes and hypertension. Although patients with higher CKD stage had higher complication rates, the absolute incidence of complications remained ,10%. In conclusion, these data demonstrate higher risks of bariatric surgery among patients with worse renal function, but whether the potential benefits outweigh the risks in this population requires further study.
Background: The shoulder is a mobile joint at risk for dislocation that can lead to presentation to an emergency department (ED). Our objective was to study the impact of establishing an emergency medicine (EM) residency program on the orthopaedic resident experience in management of simple shoulder dislocations (SSD). Methods: A retrospective review of patients presenting to the ED with a diagnosis of an isolated SSD was conducted based on ICD-9/CPT code. The time intervals studied were: 2006-07 (Group 1, pre-EM residency) and 2012-13 (Group 2, post-EM residency). Forty-three patients met inclusion criteria in group 1; 38 patients met the inclusion criteria in group 2. Outcomes studied were reduction attempts and success rates by EM and orthopaedic residents. Results: In Group 1, orthopaedic residents attempted reductions in 37% (16 of 43) of the patients and were 100% successful in the ED. There was a mean of 2.67 reduction attempts per orthopaedic junior resident per year. In group 2, orthopaedics attempted reductions in 29% of the patients (11 of 38). Orthopaedic residents were successful in nine of 11 of ED reductions. There was a mean of 1.57 attempts at shoulder reductions per orthopaedic resident per year. The average number of shoulder reduction attempts per orthopaedic resident was not significantly different between the groups (P=0.566). Conclusions: No significant change in the number of reductions managed by either department was shown, but the discrepancy should be discussed. Orthopaedic residency directors should audit their trainees experience with SSDs and consider collaborating with the EM program to optimize training opportunities.
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