Browsing by Author "Selzer, Don"

Now showing 1 - 8 of 8
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    A behavioral rating system predicts weight loss and quality of life after bariatric surgery
    (Elsevier, 2018-08) Hilgendorf, William; Butler, Annabelle; Timsina, Lava; Choi, Jennifer; Banerjee, Ambar; Selzer, Don; Stefanidis, Dimitrios; Pediatrics, School of Medicine
    Background Bariatric surgery represents the most effective intervention for severe obesity available today; however, significant variability in postoperative outcomes exists. Effective tools that predict postoperative outcomes are needed for decision-making and patient counseling. Objectives We hypothesized that a validated behavioral assessment tool, the Cleveland Clinic Behavioral Rating Scale (CCBRS), would predict excess weight loss, health-related quality of life, depression, anxiety, and alcohol use after bariatric surgery. Setting Hospital in the United States. Methods A prospective observational study with 2-year planned follow-up was conducted with patients who completed a psychological clinical interview, the Short Form 36 (SF-36) v.2 Health Survey and brief self-report questionnaires measuring depression (PHQ-9), anxiety (GAD-7), and alcohol use (AUDIT) preoperatively. At the conclusion of the preoperative psychological evaluation, the psychologist completed the CCBRS. All questionnaires were readministered at 6, 12, 18, and 24 months after surgery. Generalized estimating equations were used to assess whether any CCBRS ratings predicted surgery outcomes. Results One hundred seventy-nine patients (113 Roux-en-Y gastric bypass and 66 sleeve gastrectomy) were included in the analyses. SF-36 scores, PHQ-9 scores, and the AUDIT total scores improved significantly after surgery, while GAD-7 scores did not change appreciably. Higher preoperative CCBRS ratings predicted higher SF-36 scores, and lower PHQ-9, GAD-7 and AUDIT scores. The CCBRS social support rating predicted higher postoperative percent excess weight loss. Conclusion A behavioral rating scale (CCBRS) completed before bariatric surgery predicted postoperative weight loss, quality of life, depression, and anxiety. Therefore, this tool may prove useful in patient counseling and expectation management before surgery.
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    Can a brief assessment of social support predict outcomes after bariatric surgery?
    (Wiley, 2021-02) Hilgendorf, William; Monfared, Sara; Hassan Beygi Monfared, Sina; Athanasiadis, Dimitrios I.; Selzer, Don; Choi, Jennifer N.; Banerjee, Ambar; Stefanidis, Dimitrios; Surgery, School of Medicine
    Social support is important to optimize bariatric surgery outcomes, but limited tools exist for brief and effective assessment preoperatively. The aims of the study were to determine the extent to which two ratings of social support can predict bariatric surgery outcomes, and to examine any associations between these two methods.In this retrospective study, patients were included for whom the Cleveland clinic behavioral rating system (CCBRS) and Flanagan quality of life scale (FQoLS) scores were obtained as part of their preoperative psychosocial evaluation. They were followed up for 6 to 24 months after bariatric surgery. Linear and logistic regressions were performed with patients' CCBRS and FQoLS scores as independent variables, and percent excess weight loss (%EWL), length of stay (LOS), complications, readmissions and loss to follow-up as dependent variables. The prediction of CCBRS ratings from FQoLS social support items was also evaluated. A total of 415 patients were included in the analysis. There were significant associations between the CCBRS and three of the four relevant FQoLS self-ratings. As CCBRS and FQoLS scores increased, complications decreased significantly. The CCBRS alone additionally predicted decreased length of hospital stay and approached significance for predicting decreased readmission rates. There were no associations between %EWL and behavior ratings. The degree of patients' social support is associated with important bariatric surgery outcomes. It is possible to obtain this valuable information via the administration of brief assessments prior to bariatric surgery.
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    Chylous ascites in the setting of internal hernia: a reassuring sign
    (Springer, 2022-04) Athanasiadis, Dimitrios I.; Carr, Rosalie A.; Painter, Robert; Selzer, Don; Lee, Nicole Kissane; Banerjee, Ambar; Stefanidis, Dimitrios; Choi, Jennifer N.; Surgery, School of Medicine
    BACKGROUND: Chylous ascites is often reported in cases with lymphatic obstruction or after lymphatic injuries such as intraabdominal malignancies or lymphadenectomies. However, chylous ascites is also frequently encountered in operations for internal hernias. We sought to characterize the frequency and conditions when chylous ascites is encountered in general surgery patients. METHODS: Data from patients who underwent operations for CPT codes related to open and laparoscopic abdominal and gastrointestinal surgery in our tertiary hospital from 2010 to 2019 were reviewed. Patients with the postoperative diagnosis of internal hernia were identified and categorized into three groups: Internal Hernia with chylous ascites, non-chylous ascites, and no ascites. Demographics, prior surgical history, CT findings, source of internal hernia, open or laparoscopic surgery, and preoperative labs were recorded and compared. RESULTS: Fifty-six patients were found to have internal hernias and were included in our study. 80.3% were female and 86% had a previous Roux-en-Y gastric bypass procedure (RYGBP). Laparoscopy was the main approach for all groups. Ascites was present in 46% of the cases. Specifically, chylous ascites was observed in 27% of the total operations and was exclusively (100%) found in patients with gastric-bypass history. Furthermore, it was more commonly associated with Petersen's defect (p < 0.001), while the non-chylous fluid group was associated with herniation through the mesenteric defect (p < 0.001). CONCLUSIONS: Chylous ascites is a common finding during internal hernia operations. Unlike other more morbid conditions, identification of chylous ascites during an internal hernia operation appears innocuous. However, in the context of a patient with a history of RYGBP, the presence of chylous fluid signifies the associated small bowel obstruction is likely related to an internal hernia through a patent Petersen's defect.
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    How are Bariatric Patients Coping During the COVID-19 Pandemic? Analysis of Factors Known to Cause Weight Regain Among Postoperative Bariatric Patients
    (Elsevier, 2020) Athanasiadis, Dimitrios I.; Hernandez, Edward; Hilgendorf, William; Roper, Alexandra; Embry, Marisa; Selzer, Don; Stefanidis, Dimitrios; Surgery, School of Medicine
    Background The global coronavirus disease 2019 (COVID-19) pandemic is wreaking havoc on society. Bariatric patients are more prone to severe infection due to their high body mass index (BMI) and are more vulnerable to the effects of isolation, such as depression or disruption of their health habits. Objectives To quantify the impact of self-quarantine on bariatric patients and self-quarantine’s relationship with weight gain. Setting Academic hospital, United States. Methods A 30-item survey examining several known contributors to weight regain was distributed among the postoperative bariatric patients of our clinic. Changes in eating habits, exercise, depression, social support, loneliness, and anxiety were studied, among others. Results A total of 208 patients completed the survey (29.3% response rate). A large percentage of patients reported increases in their depression (44.2%), loneliness (36.2%), nervousness (54.7%), snacking (62.6%), loss of control when eating (48.2%), and binge eating (19.5%) and decreases in their social support (23.2%), healthy food eating (45.5%), and activity (55.2%). Difficulty in accessing vitamins was reported by 13%. Patients more than 18 months out of surgery regained more than 2 kg during an average of 47 days. Risk factors for weight regain were found to be loss of control when eating, increases in snacking and binge eating, reduced consumption of healthy food, and reduced physical activity. Conclusion Bariatric patients are negatively affected by the COVID-19 pandemic and subsequent social isolation on many levels. This patient population is vulnerable to crisis situations; thus, additional intervention is needed to address behaviors that lead to weight regain.
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    Postoperative Dysphagia Following Esophagogastric Fundoplication: Does the Timing to First Dilation Matter?
    (Springer, 2021-11) Athanasiadis, Dimitrios I.; Selzer, Don; Stefanidis, Dimitrios; Choi, Jennifer N.; Banerjee, Ambar; Surgery, School of Medicine
    Background Postoperative dysphagia after anti-reflux surgery typically resolves in a few weeks. However, even after the initial swelling has resolved at 6 weeks, dysphagia can persist in 30% of patients necessitating esophageal dilation. The purpose of this study was to investigate the effect of esophageal dilation on postoperative dysphagia, the recurrence of reflux symptoms, and the efficacy of pneumatic dilations on postoperative dysphagia. Methods A prospectively collected database was reviewed for patients who underwent partial/complete fundoplication with/without paraesophageal hernia repair between 2006 and 2014. Patient age, sex, BMI, DeMeester score, procedure type, procedure duration, length of stay, postoperative dysphagia, time to first pneumatic dilation, number of dilations, and the need for reoperations were collected. Results The study included 902 consecutive patients, 71.3% females, with a mean age of 57.8 ± 14.7 years. Postoperative dysphagia was noted in 26.3% of patients, of whom 89% had complete fundoplication (p < 0.01). Endoscopic dilation was performed in 93 patients (10.3%) with 59 (63.4%) demonstrating persistent dysphagia. Recurrent reflux symptoms occurred in 35 (37.6%) patients who underwent endoscopic dilation. Patients who underwent a dilation for symptoms of dysphagia were less likely to require a revisional surgery later than patients who had dysphagia but did not undergo a dilation before revisional surgery (17.2% vs 41.7%, respectively, p < 0.001) in the 4-year follow-up period. The duration of initial dilation from surgery was inversely related to the need for revisional surgery (p = 0.047), while more than one dilation was not associated with additive benefit. Conclusion One attempt at endoscopic dilation of the esophagogastric fundoplication may provide relief in patients with postoperative dysphagia and can be used as a predictive factor for the need of revision. However, there is an increased risk for recurrent reflux symptoms and revisional surgery may ultimately be indicated for control of symptoms.
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    Social support provided to bariatric surgery patients through a facebook group may improve weight loss outcomes
    (Springer, 2022) Athanasiadis, Dimitrios I.; Carr, Rosalie A.; Smith, Craig; Dirks, Rebecca C.; Hilgendorf, William; Stefanidou, Maria Nefeli; Selzer, Don; Stefanidis, Dimitrios; Surgery, School of Medicine
    Background: Patients' social support has been shown to impact outcomes after bariatric surgery. We have previously shown that a Facebook group administered by bariatric providers offers an effective alternative social support mechanism to in-person support groups, with higher patient participation. Our aim was to determine whether participation in this Facebook group could improve patient outcomes after bariatric surgery. Methods: After institutional board approval, our center's Facebook group members were electronically surveyed about their perceived value of group participation and their Facebook group usage frequency. We also collected patient age, sex, insurance, preoperative weight, type of procedure, hospital stay, postoperative complications, and weight loss from the electronic medical record. To assess the impact of Facebook group participation we compared patient outcomes between "frequent users" (those checking the Facebook group's activity at least once a week), "infrequent users", and a control group of all patients operated on during the year prior to the establishment of the Facebook group. The groups were compared after adjusting for potential confounding factors. Results: 250 out of 1400 Facebook group patients responded to the survey (18%). 195 patients were frequent and 55 were infrequent users. Outcomes were compared with 211 control patients. The groups did not differ in their baseline characteristics apart from their sex. Frequent users had a higher weight loss compared to the other groups up to 2 years postoperatively but no difference in the overall complications. On multivariable analysis, frequency of Facebook use was the main factor associated with 0.5-, 1-, and 2-year weight loss. Conclusion: Frequent participation in a Facebook support group after bariatric surgery was associated with improved early weight loss outcomes. If additional longer-term studies confirm our findings, offering similar social support groups may become essential after bariatric surgery, especially during times of social isolation when in-person social support meetings may not be feasible.
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    Web-Based Educational Seminars Compare Favorably with In-House Seminars for Bariatric Surgery Patients
    (Springer, 2019-03) Monfared, Sara; Martin, Anna; Gupta, Kamna; Stefanidis, Dimitrios; Selzer, Don; Choi, Jennifer; Butler, Annabelle; Banerjee, Ambar; Surgery, School of Medicine
    Background Comprehensive preparative patient education is a key element in bariatric patient success. The primary objective of this study was to compare attrition rates, demographics, and surgery outcomes between patients who participated in the online vs in-house preparative seminars. Methods A retrospective chart review was performed involving patients who chose to participate in online vs in-house educational seminar between July of 2014 and December of 2016. The patients were divided into two groups based on their choice of educational seminar and tracked to see how many made it to an initial visit and to surgery. In those who had bariatric surgery, data was collected on age, type of insurance, length of stay (LOS), longest follow-up, and change in body mass index. Results Total of 1230 patients were included in this study. There was no difference in attrition rate to initial consultation visit (29.1% vs 29.9%), but there was a statistically higher attrition to surgery in the in-house seminar attendees (72.9%) compared to online participants (66.6%, p < 0.05). Between January 2015 and December 2016, 291 patients underwent primary bariatric surgery. The online group was on average 3 years younger which was statistically significant. There were no differences in LOS, longest follow-up, and weight loss at 12 months between the groups. Conclusion When comparing attrition rates and bariatric surgery outcomes, no overall difference was noted between patients who received web- or hospital-based preparative education. Bariatric programs should provide access to online seminars to attract younger population and save resources and cost.