David Velázquez-Fernández

Identification of causes and preventable triggers for hospital readmission after bariatric surgery is very important to implement strategies for surgical outcome optimization. The aim of the study was to analyze our readmissions after a Roux-en-Y gastric bypass (RYGB). From our prospectively constructed database, patients who were readmitted to the hospital within the following 30 and 90 days after discharge were analyzed. Hospital charts were reviewed to determine the cause of readmission and the outcome. Potential risk factors for readmission were statistically analyzed. Between June 2004 and November 2013, 657 patients underwent a primary RYGB and 100 revisions. There were 442 (58 %) females and 315 (42 %) males with a mean age of 40.1 ± 11.5 years and a mean BMI of 42.4 ± 6.5 Kg/m². Comorbidities were present in 441 (58.2 %) patients. Operations were completed laparoscopically in 741 (97.8 %) patients. Mean hospital stay after the RYGB was 2.5 ± 1.6 days. The 30-day and 90-day readmission rate was 2.6 and 4.58 %, respectively. Most common causes for readmission at 30 days were gastrointestinal bleeding in 30 %, lung disease in 15 %, and food intolerance in 15 %. At 90 days, they were stricture of the gastrojejunostomy in 20 %, gastrointestinal bleeding in 13.3 %, and nephrolithiasis in 13.3 %. Open surgery and previous upper abdominal surgery were significant risk factors for 90-day readmission. Our readmission rate after RYGB was low. Most common causes for readmission were upper gastrointestinal bleeding and food intolerance. Associated risk factors were open surgery and previous upper abdominal surgery.

The value of spirometry as a routine preoperative test for bariatric surgery is debatable. The aim of this study was to assess the relationship between spirometry results and the frequency of postoperative pulmonary complications in 602 obese patients. Clinical files of patients undergoing bariatric surgery between 2004 and 2013 were reviewed. Demography, risk factors, respiratory symptoms, and spirometry results (forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), FEV₁/FVC) were recorded, and their relationship with postoperative pulmonary complications was evaluated. There were 256 males and 346 females with a mean age of 40.2 ± 11.6 years and a mean BMI of 42.1 ± 6.4 kg/m2. History of smoking was found in 408 patients (68 %). Preoperative respiratory symptoms were present in 328 (54.5 %). Most frequent symptoms were snoring (288), dyspnea (119), bronchospasm [6], and chronic productive cough [6]. In 153 patients, history of respiratory disease was documented. The obstructive sleep apnea syndrome (OSAS) was present in 124, 20 requiring continuous positive airway pressure (CPAP). Asthma was present in 27 and chronic obstructive pulmonary disease (COPD) in 2. Variables associated to a higher risk of pulmonary complications were OSAS (OR 2.3), an abnormal spirometry (OR 2.6), male gender (OR 1.9), and preoperative respiratory symptoms (OR 1.9). Using multivariate logistic regression, an abnormal spirometry was a significant predictor of postoperative pulmonary complications in patients with respiratory symptoms and/or OSAS. However, it lost prognostic significance when both conditions were subtracted. In obese patients undergoing bariatric surgery, abnormal preoperative spirometry predicts postoperative respiratory complications only in patients with OSAS.

Primary adrenal malignancies are rare and have a dismal prognosis. We report our experience in both adrenocortical carcinomas and malignant pheochromocytomas who received medical care at our Institution between 1994 and 2009. The data bases of hospital discharges, surgery and pathology were reviewed looking for patients with diagnosis of primary adrenal malignant tumors. Clinical presentation, laboratory and image characteristics, surgical details, histopathology findings and outcome were analyzed. A total of eight patients were identified, two men and six women with a mean age of 48.1 +/- 15.7 years (31-80). Six patients presented with adrenocortical carcinomas and two had malignant pheochromocytomas. Of the six cortical tumors four were functioning. Five were stage II, two were stage III and one was stage IV. All patients underwent surgery as initial treatment. Six patients underwent open and two, laparoscopic adrenalectomy. Three patients received adjuvant chemotherapy. In a mean follow up of 32 +/- 27 months, only three patients with stage II were alive and free of the disease. As in other series, primary adrenal carcinoma in our population proved to be a rare endocrine neoplasm with poor prognosis despite complete surgical resection. Treatment at initial stages provides better outcome.