Factors Associated With Bariatric Surgery Referral Patterns: A Systematic Review

Premkumar, Agnes; Samaan, Jamil S.; Samakar, Kamran

doi:10.1016/j.jss.2022.01.023

Cited by 9 publications

(3 citation statements)

References 39 publications

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“…The referral system remains largely non-transparent, and it is difficult to know details such as how patients learned of our center, how many physicians they saw prior to us, or how long it took to be referred. Data in orthopedic surgery and bariatric surgery suggested that barriers to referral included lack of provider familiarity, minimal communication with subspecialists, and provider concerns or negative perceptions [35][36][37][38]. Further, there is no algorithm that primary care physicians can follow to best decide when to refer a patient out for management.…”

Section: Discussionmentioning

confidence: 99%

Racial and Socioeconomic Disparities in Complex Abdominal Wall Reconstruction Referrals

Holland,

Mead,

Lorenz

et al. 2024

J. Abdom. Wall Surg.

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Background: Health disparities are pervasive in surgical care. Particularly racial and socioeconomic inequalities have been demonstrated in emergency general surgery outcomes, but less so in elective abdominal wall reconstruction (AWR). The goal of this study was to evaluate the disparities in referrals to a tertiary hernia center.Methods: A prospectively maintained hernia database was queried for patients who underwent open ventral hernia (OVHR) or minimally invasive surgical (MISR) repair from 2011 to 2022 with complete insurance and address information. Patients were divided by home address into in-state (IS) and out-of-state (OOS) referrals as well as by operative technique. Demographic data and outcomes were compared. Standard and inferential statistical analyses were performed.Results: Of 554 patients, most were IS (59.0%); 334 underwent OVHR, and 220 underwent MISR. IS patients were more likely to undergo MISR (OVHR: 45.6% vs. 81.5%, laparoscopic: 38.2% vs. 14.1%, robotic: 16.2% vs. 4.4%; p < 0.001) when compared to OOS referrals. Of OVHR patients, 44.6% were IS and 55.4% were OOS. Patients’ average age and BMI, sex, ASA score, and insurance payer were similar between IS and OOS groups. IS patients were more often Black (White: 77.9% vs. 93.5%, Black: 16.8% vs. 4.3%; p < 0.001). IS patients had more smokers (12.1% vs. 3.2%; p = 0.001), fewer recurrent hernias (45.0% vs. 69.7%; p < 0.001), and smaller defects (155.7 ± 142.2 vs. 256.4 ± 202.9 cm2; p < 0.001). Wound class, mesh type, and rate of fascial closure were similar, but IS patients underwent fewer panniculectomies (13.4% vs. 34.1%; p < 0.001), component separations (26.2% vs. 51.4%; p < 0.001), received smaller mesh (744.2 ± 495.6 vs. 975.7 ± 442.3 cm2; p < 0.001), and had shorter length-of-stay (4.8 ± 2.0 vs. 7.0 ± 5.5 days; p < 0.001). There was no difference in wound breakdown, seroma requiring intervention, hematoma, mesh infection, or recurrence; however, IS patients had decreased wound infections (2.0% vs. 8.6%; p = 0.009), overall wound complications (11.4% vs. 21.1%; p = 0.016), readmissions (2.7% vs. 13.0%; p = 0.001), and reoperations (3.4% vs. 11.4%; p = 0.007). Of MISR patients, 80.9% were IS and 19.1% were OOS. In contrast to OVHR, MISR IS and OOS patients had similar demographics, preoperative characteristics, intraoperative details, and postoperative outcomes.Conclusion: Although there were no differences in referred patients for MISR, this study demonstrates the racial disparities that exist among our IS and OOS complex, open AWR patients. Awareness of these disparities can help clinicians work towards equitable access to care and equal referrals to tertiary hernia centers.

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Section: Discussionmentioning

confidence: 99%

Racial and Socioeconomic Disparities in Complex Abdominal Wall Reconstruction Referrals

Holland,

Mead,

Lorenz

et al. 2024

J. Abdom. Wall Surg.

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“…[1] Such trend has led to increased referrals for bariatric surgeries leading to more patients with altered upper gastrointestinal (UGI) anatomy. [2] Among bariatric surgery options, Roux-en-Y gastric bypass (RYGB) is offered to those with body mass index (BMI) ≥ 40 or BMI ≥ 35 with obesity-related comorbidities. This procedure consists of creation of a gastric pouch, biliopancreatic limb, jejunojenuostomy, and gastrojejunostomy.…”

Section: Introductionmentioning

confidence: 99%

“…

The prevalence of obesity within the United States has been on the rise, with a prevalence of 42.4 % between 2017 and 2018 [1]. Such a trend has led to increased referrals for bariatric sur-geries leading to more patients with altered upper gastrointestinal (UGI) anatomy [2]. Among bariatric surgery options, Rouxen-Y gastric bypass (RYGB) is offered to those with a body mass index (BMI) ≥ 40 or BMI ≥ 35 with obesity-related comorbidities.

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mentioning

confidence: 99%

Direct percutaneous endoscopic jejunostomy tube placement in patients post Roux-en-Y gastric bypass, a single tertiary care center experience

et al. 2022

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Background and study aims: Obesity prevalence continues to rise in the United States with Roux-en-Y gastric bypass (RYGB) surgery being one of the most common bariatric procedures. With this trend, more patients with altered upper gastrointestinal (UGI) anatomy have required endoscopic intervention including direct percutaneous endoscopic jejunostomy (DPEJ) placement. We aim to assess the safety and success rates of DPEJ in RYGB patients. Patients and Methods: All patients at a tertiary care referral center who underwent DPEJ during an 8-year period were queried from a prospectively maintained registry of all enteroscopy procedures. Duplicate cases and altered upper UGI anatomy subtypes other than RYGB were excluded. The final cohort consisted of 2 groups: RYGB vs native anatomy (NA). Demographic, procedural, readmission, follow-up, and complication data were recorded. Comparative analysis was performed. Results: Seventy-two patients were included where 28 had RYGB and 44 had NA. Both groups had similar baseline and pre-procedure data. Procedure success rate was 89% in RYGB patients and 98% in NA patients (p=0.13). There were no intraprocedural complications. Early and late postprocedural complication rates were similar between the groups (both 4% vs 7%). Average follow-up time in the RYGB and NA groups were 12.97 ± 9.35 and 13.44 ± 9.21 months respectively. Although readmission rates at one-month and six-month were higher in the NA versus the RYGB group (21% vs 7% and 25% vs 15%), these differences were not significant. Conclusion: DPEJ can be successful and safely placed in RYGB patients with no significant difference in procedure success, complication, or readmission rates when compared to control.

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Assessing the Accuracy of Responses by the Language Model ChatGPT to Questions Regarding Bariatric Surgery

Samaan¹,

Yeo²,

Rajeev³

et al. 2023

OBES SURG

127

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Purpose ChatGPT is a large language model trained on a large dataset covering a broad range of topics, including the medical literature. We aim to examine its accuracy and reproducibility in answering patient questions regarding bariatric surgery. Materials and methods Questions were gathered from nationally regarded professional societies and health institutions as well as Facebook support groups. Board-certified bariatric surgeons graded the accuracy and reproducibility of responses. The grading scale included the following: (1) comprehensive, (2) correct but inadequate, (3) some correct and some incorrect, and (4) completely incorrect. Reproducibility was determined by asking the model each question twice and examining difference in grading category between the two responses. Results In total, 151 questions related to bariatric surgery were included. The model provided “comprehensive” responses to 131/151 (86.8%) of questions. When examined by category, the model provided “comprehensive” responses to 93.8% of questions related to “efficacy, eligibility and procedure options”; 93.3% related to “preoperative preparation”; 85.3% related to “recovery, risks, and complications”; 88.2% related to “lifestyle changes”; and 66.7% related to “other”. The model provided reproducible answers to 137 (90.7%) of questions. Conclusion The large language model ChatGPT often provided accurate and reproducible responses to common questions related to bariatric surgery. ChatGPT may serve as a helpful adjunct information resource for patients regarding bariatric surgery in addition to standard of care provided by licensed healthcare professionals. We encourage future studies to examine how to leverage this disruptive technology to improve patient outcomes and quality of life. Graphical Abstract

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Factors Associated With Bariatric Surgery Referral Patterns: A Systematic Review

Cited by 9 publications

References 39 publications

Racial and Socioeconomic Disparities in Complex Abdominal Wall Reconstruction Referrals

Racial and Socioeconomic Disparities in Complex Abdominal Wall Reconstruction Referrals

Direct percutaneous endoscopic jejunostomy tube placement in patients post Roux-en-Y gastric bypass, a single tertiary care center experience

Assessing the Accuracy of Responses by the Language Model ChatGPT to Questions Regarding Bariatric Surgery

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