2017 Bariatric Care Center. Outcomes Report

Transcription

1 217 Outcomes Report

2 Contents Surgical Procedure Volume 4 Quality of Care 5 Surgical Demographics 7 Surgical Percentage of Excess Body Weight Loss 9 Surgical Comorbidity Resolution 1 Fellowship Training 12 Nonsurgical Weight Management Program 14 Research and Education 16 Dear Colleagues, We are pleased to share the 217 quality outcomes for the Summa Health Bariatric Care Center, a critical component of Summa Health s Weight Management Institute. As you know, the pace at which obesity rates are growing has become one of the greatest public health challenges of our time. Today, more than two-thirds of U.S. adults are considered overweight or obese, and obesity is ranked the second-highest cause of preventable deaths in the country. To help reverse this obesity epidemic, Summa is committed to offering both surgical and nonsurgical options for medically supervised weight loss. While there is not yet agreement on a single best approach to nonsurgical weight loss management, there is consensus that the most effective and long-lasting treatment for morbid obesity is surgical weight loss intervention. Since starting the surgical program in 24, we have performed more than 3,6 primary and revisional weight loss surgeries, with primary weight loss surgeries in 217 alone. Moreover, in the past 1 years, the Summa Health Bariatric Care Center has grown by nearly 2%. Moving forward, weight loss management will continue to be a critical initiative for Summa Health. In 218, a tremendous amount of work has transpired to expand treatment options that produce the best possible outcomes for our current and future patients. As always, our goal is to help these patients achieve significant weight loss in order to eliminate or reduce medical problems caused by their obesity, as well as reclaim their lives. We appreciate you taking the time to review our 217 results. As you ll see, the Summa Health offers a successful program for any patient interested in losing weight. Therefore, please do not hesitate to contact us directly if you have questions or would like additional information for your patients. Sincerely, The surgery is totally worth it. I wouldn t go to any place except Summa Health. Margo Haren, Weight Loss Surgery Patient John Zografakis, M.D., FACS, FASMBS Director, Adrian Dan, M.D., FACS, FASMBS Director, Outcomes Report 3

3 Surgical Procedure Volume Volume Surgical weight loss procedures performed at Summa Health include laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, laparoscopic adjustable gastric banding and laparoscopic revisional procedures. Our bariatric surgeons are fellowship-trained in advanced laparoscopic and weight loss surgery. Some procedures can be done using a single incision or robotic-assisted approach Revisions Procedure Totals ,646 Adjustable Gastric Band Roux-en-Y Gastric Bypass Sleeve Gastrectomy Sleeve Gastrectomy.%.1% Metabolic and Bariatric Surgery Average Length of Stay Accreditation National and Quality 26 Summa Health s 237 Average Procedure Number of Improvement Number of Days 25 Days* Program Roux-en-Y Gastric Bypass (MBSAQIP) 2, Quality of Care Our bariatric care team collects and monitors quality of care data and works continuously to refine and improve its processes and program to make sure each patient receives the highest level of care. 3-day Mortality Procedure Roux-en-Y Gastric Bypass Summa Health s Percentage National Percentage*.%.2% Sleeve Gastrectomy Summa Health s Bariatric Care Center is a MBSAQIP Accredited Comprehensive Center. MBSAQIP works to advance safe, high-quality care for bariatric surgery patients through the accreditation of bariatric surgical centers. A bariatric surgical center achieves accreditation following a rigorous review process during which it proves that it can maintain certain physical resources, human resources and standards of practice. 4 *National Data for 213 taken from American College of Surgeons MBSAQIP Database 217 Outcomes Report 5

4 Surgical Demographics Demographics Candidates for a primary weight loss procedure at Summa Health range in ages from 17 to 7. These are patients with morbid obesity, with or without comorbid diseases such as type 2 diabetes, obstructive sleep apnea, hypertension and gastroesophageal reflux disease. The typical patient has usually tried many different approaches to weight loss but has been unsuccessful in sustaining weight loss. In many cases, patients also struggle with underlying issues such as binge eating, emotional eating or other behavioral health conditions which have contributed to their obesity. Male 5 (2%) African-American 412 (13%) Female 2,66 (8%) Caucasian 2,798 (86%) Gender <2 11 (.39%) I used to be very limited, but now I can do anything. Gary Jentes, Weight Loss Surgery Patient (25.7%) (26.6%) (16.7%) (2.6%) Race kg/m2 361 (11.1%) (6.7%) (21.3%) Hispanic/Other 51 (2%) kg/m2 1,681 (51.5%) Age kg/m2 851 (26.1%) BMI kg/m2 357 (1.9%) > 11 (.3%) Average BMI: 48.7 kg/m2 Average Age: 47 years Outcomes Report 7

5 I used to feel imprisoned by my health. Now I feel liberated. Jim Sommers, Weight Loss Surgery Patient Surgical Percentage of 1 Excess Body Weight Loss Laparoscopic Roux-en-Y Bypass The average percentage of excess body weight loss as a result of laparoscopic Roux-en-Y bypass is 64% after three years. 7 68% % Year 67.6% 68% 2 Years 68.4% 68.4% 364% Years 64.1% 64.1% 4 Years 61% 62.3% 62.3% 5 Years 6% 61.1% 61.1% Laparoscopic Sleeve Gastrectomy1 The average percentage of excess body weight lost as a result of a laparoscopic sleeve gastrectomy as a primary weight loss procedure is 49% after three years % 53% 54% 53.% 53.5% 53.% 53.5% 53% 59.4% % 49.2% 49.2% 52.1% 59.4% 52.1% 4 Laparoscopic Adjustable Gastric Band The average percentage of excess body weight loss as a result of an adjustable gastric band is 42% after three years % 41% 42% % 42% 41% % 4 Long-term weight loss for patients with diabetes using a nonsurgical, conservative 6% at one year and 4% at three years. 2 41%weight loss method is42% 4 Beginning in 21, the laparoscopic sleeve gastrectomy was performed as a primary weight loss surgery and as the first step in a staged procedure leading to a roux-en-y gastric bypass 2 Diabetes Prevention Program Research Group. Reduction of the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med 22: 346: Feb 7, Outcomes Report 9

6 Surgical Comorbidity Resolution Diagnosed Improved Resolved Improved & Resolved Type 2 Diabetes Mellitus 1,3 of 3,261 (31%) patients undergoing weight loss surgery had type 2 diabetes preoperatively. Following weight loss surgery: Two years post-operatively: 64% of patients have complete resolution of type 2 diabetes. 82% of patients experienced resolution and/or improvement of their type 2 diabetes. Five years post-operatively: 77% of patients experienced resolution and/or improvement of their type 2 diabetes. Hypertension 1,813 of 3,261 (56%) patients undergoing weight loss surgery had hypertension preoperatively. Following weight loss surgery: Two years post-operatively: of patients have complete resolution of their hypertension. 7% of patients experienced resolution and/or improvement of their hypertension. Five years post-operatively: 74% of patients experienced resolution and/or improvement % % % % 15 2 Year 4 23% Year 82% 48 7% % 131 % % 74 21% 28 5 Year 54% 117 2% 43 5 Year 77% 12 74% 16 Obstructive Sleep Apnea 1,862 of 3,261 (58%) patients undergoing weight loss surgery had obstructive sleep apnea preoperatively. Following weight loss surgery: Two years post-operatively: 71% of patients experienced complete resolution of their obstructive sleep apnea. Five years post-operatively: 8% of patients experienced resolution of their obstructive sleep apnea. Gastroesophageal Reflux Disease 1,714 of 3,261 (53%) patients undergoing weight loss surgery had gastroesophageal reflux disease preoperatively. Following weight loss surgery: Two years post-operatively: % of patients experienced complete resolution of their gastroesophageal reflux disease. Five years post-operatively: 64% of patients experienced resolution of their gastroesophageal reflux disease. Hypertriglyceridemia 1,19 of 3,261 (31%) patients undergoing weight loss surgery had hypertriglyceridemia preoperatively. Following weight loss surgery: Two years post-operatively: 53% of patients experienced complete resolution of their hypertriglyceridemia. Five years post-operatively: 64% of patients experienced resolution of their hypertriglyceridemia % Year % % Year 52% 53% Year 8% 135 % Year 62% 29 38% Year 64% 76 36% Year Outcomes Report 11

7 Fellowship Training Fellowship training offers physicians the opportunity to obtain additional, specialty-focused education after the completion of residency training. The ability of a hospital to provide care by fellowship trained physicians is a strong indicator of a higher level of care. Completion of a fellowship means a surgeon has spent additional time developing in-depth knowledge and surgical expertise in their chosen specialty. Our Fellows: Chandrutie Latchman, D.O Greg Johnston, D.O Summa Health offers a one-year fellowship in minimally invasive surgery with a focus on advanced laparoscopic and weight reductive surgery. It is a collaborative effort between the department of surgery and Summa Health Foundation. The fellow works closely with the four attending surgeons in our bariatric surgery program, performing high volumes of minimally invasive weight reductive and general surgeries. The fellow also works with the team, developing expertise in the clinical management of patients. All four of the surgeons at Summa s Bariatric Care Center are fellowship trained as follows: John G. Zogafakis, M.D., FACS, FASMBS: Evanston Northwestern Healthcare Adrian G. Dan, M.D., FACS, FASMBS: Cleveland Clinic Foundation Mark Pozsgay, D.O., FASMBS: University of Pittsburgh Medical Center Tyler Bedford, M.D.: Summa Health Mark Nuqui, D.O Tyler Bedford, M.D This fellowship is now in its eighth year, having started in 211. It is accredited by the MIS Fellowship Council for dual Minimally Invasive Surgery (MIS) and Bariatric Surgery. It is led by fellowship program director, Adrian G. Dan, M.D., FACS, FASMBS.. Lindsey Berbiglia, M.D Kristine Makiewicz, M.D Andrew Standerwick, M.D Outcomes Report 13

8 Nonsurgical Weight Management Program Summa Health also offers a nonsurgical alternative for long-term weight loss. Our nonsurgical weight management program focuses on the modification of food choices, intensive management of eating behaviors, exercise and lifelong follow-up. It s primarily for patients with a BMI between 25 and 34.9 kg/m2 that have a co-morbid condition caused by their obesity, as well as those with a BMI between 35 and 39.9 kg/m2 without one. The program offers several nonsurgical weight loss options depending on a patient s need: Comprehensive Two-Year Program This intense, all-encompassing approach includes: Six months of physician visits A foundational Kick-Off Workshop Three Intensive Outpatient Weight Loss Groups Ongoing physician follow-ups for meal planning Outcomes Patients who fully participate in our program typically achieve a weight loss of five to 2 pounds per month. Success is directly related to how closely they follow the prescribed program. Individual Physician Visits Specializing in Weight Loss For patients who: Don t have time for the full program Only want the physician component Are looking primarily for individualized meal planning May have more complicated medical conditions, such as diabetes Individual Psychologist Visits Specializing in Weight Loss & Eating Disorders Ken Wells, M.D. Certified Diplomate ABOM* Medical Director, Nonsurgical Weight Management Program For patients who: Don t have time for the full program Only want the behavioral component Struggle with eating in response to emotions or stress Struggle with depression and anxiety Unlike others in the area, the Summa nonsurgical weight management program is led by a multidisciplinary team that includes physicians, psychologists, dietitians and clinical exercise specialists. These professionals guide and educate patients throughout their weight loss journey, from setting realistic and achievable short- and long-term goals to ensuring they stay on track and remain successful. 14 Irene Dejak, M.D. Obesity Medicine Specialist Natasha Koren, M.D. Certified Diplomate ABOM* Obesity Medicine Specialist *The American Board of Obesity Medicine (ABOM) serves the public and field of obesity medicine by maintaining standards for assessment and credentialing physicians. ABOM diplomates undergo rigorous training and an extensive examination process to achieve this designation. The certification signifies specialized knowledge in the practice of obesity medicine and distinguishes those who have achieved competency in obesity care. They counsel you on how to eat healthy. I am about to change my life. Reggie Eggleston, Weight Loss Surgery (pre-op) Patient 217 Outcomes Report 15

9 Research and Education Research is an integral component of a large, quality focused program. Summa contributed to research regarding surgical weight loss intervention as follows: Invited Lectures Emergent Surgical Care of the Bariatric Surgical Patient for the General Surgeon ; Ohio Chapter, American College of Surgeons, May 214. Metabolic Surgery ; Grand Rounds, Department of Obstetrics and Gynecology, Summa Akron City Hospital, Summa Health System; August 214. The Emergency Department Evaluation of the Weight Loss Surgery Patient. ; Grand Rounds, Department of Emergency Medicine, Summa Akron City Hospital, Summa Health System; March 19, 213 Evaluation and Management of the Weight Loss Surgery Patient ; Northeast Ohio Medical Universities (NEOMED); February 28, 212. Common Questions in the Office: The Postoperative Management of the Weight Loss Surgery Patient ; ASMBS, Ohio State Chapter Meeting 212; May 11, 212, Columbus, OH. Publications Dan AG; Shenoy R, Subichin M, Clanton J, Bohon A, Makuszewski M, Pozsgay M, Venkat A, Sievers C, Thompson M, Zografakis JG; Prevalence of Upper Gastrointestinal Gross and Microscopic Pathology in Patients with Morbid Obesity ;Published Abstract; Surgical Endoscopy 214 Dan AG, Mirhaidari S, Pozsgay M, Standerwick AB, Bohon AN, Zografakis JG. Two-Trocar Cholecystectomy by Strategic Laparoscopy for Improved Cosmesis. Accepted in 212 for publication in JSLS, Journal of the Society of Laparoendoscopic Surgeons. Pohle-Krauza RJ, McCarroll ML, Pasini D, Dan AG, Zografakis JG. The Effect of Marital Status on Weight Loss After Bariatric Surgery is Moderated by Depression. Journal of Obesity and Weight Loss Therapy 211; 1:14. doi:1.4172/jowt.114. Pohle-Krauza RJ, McCarroll ML,Volsko TA, Pasini D, Dan A, Zografakis JG. Differential effects of gender and age on dyslipidemia in bariatric surgery patients. Surgery for Obesity and Related Disease. 211; 7:7-75. Oral Presentations Dan AG, Subichin M, Pozsgay DO, Zografakis JG; Pathological findings of intra-operative liver tissue biopsy in patients undergoing weight loss operations ; Presented at the AHPBA Annual Meeting (Americas Hepato-Pancreato-Biliary Association) February 214. Subichin M, Clanton J, Makuszewski M, Bohon A, Zografakis JG, Dan AG; Body Mass Index and Age do not Influence Severity of Liver Disease: A Review of 1, Consecutive Patients Undergoing Weigh Loss Surgery Pathological findings of intra-operative liver tissue biopsy in patients undergoing weight loss operations ; Presented at the Twenty Second Annual Summa Health System Postgraduate Day, June 2, 214. Dan AG, Pozsgay M, Mirhaidari S, Reigstad K, Zografakis JG. Two Trocar Laparoscopic Cholecystectomy for Improved Cosmesis: Initial Experience & Technical Details ; SLIC (Strategic Laparoscopy for Improved Cosmesis) Summit, January 13-14, 212, Miami, FL. Childs D, Dan AG, Bohon A, Pohle-Krauza R, Pozsgay M, Zografakis JG. Factors Affecting Excess Weight Loss (EWL) in Patients Undergoing Laparoscopic Adjustable Gastric Banding (LAGB) ; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 212. Rosenbaum AA, Dan AG, Bohon A, Pohle-Krauza R, Pozsgay M, Zografakis JG. Effect of Postoperative Compliance on Weight Loss Success in Laparoscopic Adjustable Gastric Band (LAGB) Patients ; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 212. Pedersen J, Wagner D, Parker P. Panniculectomy as a Gateway ; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 212. Poster Presentations Dan AG; Shenoy R, Subichin M, Clanton J, Bohon A, Makuszewski M, Pozsgay M, Venkat A, Sievers C, Thompson M, Zografakis JG; Prevalence of Upper Gastrointestinal Gross and Microscopic Pathology in Patients with Morbid Obesity ; Poster Presentation; SAGES Scientific Session 214. Standerwick AB, Dan AG, Pozsgay M, Zografakis JG; Outcomes of Optimal Peritoneal Dialysis Catheter Placement Using a Laparoscopic Technique ; Poster Presentation; SAGES Scientific Session, April 213 Pasini D, Hanna E, Hawn K, Zografakis JG, Dan AG, Pozsgay M; Case Management of Bariatric Surgical Patients Results in Improved Patient Satisfaction Scores ; Poster Presentation; OHA Quality Institute s 6th Annual Quality Summit, Columbus, OH, June 213. Yoho D, Pozsgay M, Zografakis JG, Removing the Bag From Our Bag of Tricks; A Paradigm Shift in the Surgical Management of Acute Perforated Diverticulitis ; Poster Presentation; Presented at the Twenty-First Annual Summa Health System Postgraduate Day, June 3, 213 Subichin M, Shenoy R, Standerwick A, Pozsgay M, Zografakis JG, Bohon A, Dan AG; Pathological findings in intraoperative live tissue biopsy in patients undergoing weight loss operations Poster Presentation; Presented at the Twenty- First Annual Summa Health System Postgraduate Day, June 3, 213 Dan AG, Mirihaidari S, Standerwick A, Pozsgay M, Bohon A, Zografakis JG; Two Trocar Cholecystectomy by Strategic Laparoscopy for Improved Cosmesis Presented at the Twenty-First Annual Summa Health System Postgraduate Day, June 3, 213 Shenoy R, Subichin M, Standerwick A, Pozsgay M, Zografakis JG, Bohon A, Sievers C, Venkat A, Dan AG; Prevalence of anatomicaland pathological findings during upper gastrointestinal endoscopic exam in morbidly obese patients Poster Presentation; Presented at the Twenty-First Annual Summa Health System Postgraduate Day, June 3, 213 Bohon A, Bothe N, Pasini D, Pohle-Krauza RJ, Pozsgay M, Zografakis JG, Dan AG; Augmented Initial Weight- Loss Outcomes in Women and Non-Diabetics are Not Sustained Long Term after LAGB ; Poster Presentation: American Society for Metabolic and Bariatric Surgery (ASMBS); November 213 Pohle-Krauza RJ, Rosenbaum A, Bohon A, Bothe N, Pasini D, Pozsgay M, Zografakis JG, Dan AG; Compliance during the early postoperative period affects sustained weight loss in Laparoscopic Adjustable Gastric Band (LAGB) patients Poster Presentation: American Society for Metabolic and Bariatric Surgery (ASMBS); November 213 Dan AG, Standerwick A, Mirhaidari S. Outcomes of Optimal Peritoneal Dialysis Catheter Placement Using a Laparoscopic Technique, accepted in 212 for Poster Presentation at SAGES 213 Annual meeting. Dan AG, Reigstad K, Morocco M, Salem J, Mirhaidari S, Pozsgay M, Shaheen W, Zografakis JG. Totally Robotic Adrenalectomy Technical Details and Initial Results ; MISS (Minimally Invasive Surgery Symposium); February 2-25, 212; Salt Lake City, UT. Biswas D, Loth F, Krauza M, Pohle-Krauza R, Dan AG, Zografakis JG; Fluid Dynamic Analysis of Upper Airway of an Obstructive Sleep Apnea Patient Pre and Post Surgery ; Proceedings of the ASME 212 Summer Bioengineering Conference SBC212; June 2-23, 212; Puerto Rico, USA. Pasini D, Pohle-Krauza R, Ilg L, Bohon A, Dan A, Zografakis JG; Preoperative Education and Postoperative Follow-Up in Bariatric Surgery Patients ; American Society for Metabolic and Bariatric Surgery (ASMBS); June 212. San Diego, CA. Zografakis JG, Dan AG, Pozsgay M, Latchman C, Pasini D. A Novel Approach to the Repair of Incisional Hernias in Patients with Morbid Obesity ; Abdominal Wall Reconstruction (AWR); June 212. Arumugasaamy A, Dan AG, Bohon A, Pohle-Krauza R, Pozsgay M, Zografakis JG. Factors Influencing Surgical Re- Intervention for Laparoscopic Adjustable Gastric Band (LAGB) Patients ; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 212. Reigstad K, Dan AG, Pozsgay M, Zografakis JG. Robotic Adrenalectomy Initial Experience and Short-term Outcomes ; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 212. Dan AG. Strategic Laparoscopy for Improved Cosmesis- Cholecystectomy: A Retrospective Review of 8 Patients Undergoing SLIC-Cholecystectomy ; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 212. Schulz S, Dan AG. Single Incision Robotic Chlecystectomy: A Case Report. Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 212. Book Chapters Frantzides CT, Zografakis JG, Welle SN, Ruff, TM. Revisional Bariatric Surgery. In: Frantzides CT, Carlson MA. Video Atlas of Advanced Minimally Invasive Surgery. Philadelphia, PA: Saunders/ Elsevier; 212; Berbiglia, L., Zografakis, JG., Dan, AG. Laparoscopic Roux-en-Y Gastric Bypass: Surgical Technique and Perioperative Care. The Surgical Clinics of North America, Metabolic and Bariatric Surgery Aug 216, 96 (4): Book Editor Dan, Adrian G. (Editor).Preface Obesity The Epidemic Crisis of Our Time. The Surgical Clinics of North America, Metabolic and Bariatric Surgery Aug 216, 96 (4):xv Awards Subichin M, Clanton J, Makuszewski M, Bohon A, Zografakis JG, Dan AG; Body Mass Index and Age do not Influence Severity of Liver Disease: A Review of 1, Consecutive Patients Undergoing Weigh Loss Surgery Pathological findings of intra-operative liver tissue biopsy in patients undergoing weight loss operations ; Presented at the Twenty Second Annual Summa Health System Postgraduate Day, June 2, 214. Winner: William H. Falor, M.D. Award for Clinical Science Research Appointments 214 Zografakis JG; Vice President; Ohio Chapter of the American Society of Metabolic and Bariatric Surgery 213 Zografakis JG; Secretary; Ohio Chapter of the American Society of Metabolic and Bariatric Surgery Outcomes Report 17

10 Dr. Pozsgay gave me my life back. John Konneker, Weight Loss Surgery Patient

11 To refer a patient or for more information, call or go to summahealth.org/weightloss Summa Health System Akron Campus Richard M. and Yvonne Hamlin Pavilion 95 Arch St, Suite 26 Akron, OH 4434 BAR /CS/KG/8-18