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APHA Scientific Session and Event Listing

Recorded presentation

Yosef Dlugacz, PhD¹, Lori Stier, EdD¹, Dominick Gadaleta, MD², Alan Geiss, MD³, Lawrence Gellman, MD², Mara Warren, MBA¹, Karen Miller, MPH¹, Charmaine Gentles Gentles, ANP², and Melanie Howard, RPA-C⁴. (1) Quality Management, North Shore-Long Island Jewish Health System, 145 Community Dr, Great Neck, NY 11021, 516-465-8313, rhussain@nshs.edu, (2) Department of Surgery, North Shore University Hospital at Manhasset, 310 East Shore Road, Suite 203, Great Neck, NY 11023, (3) Department of Surgery, North Shore University Hospital at Syosset, 221 Jericho Turnpike, Syosset, NY 11791, (4) Syosset Laparoscopy Center, North Shore University Hospital at Syosset, 221 Jericho Turnpike, Syosset, NY NY

Introduction: North Shore University Hospital (NSUH), with a large tertiary care hospital in Manhasset and a full service community hospital in Syosset, is one of the cornerstones of North Shore Long Island Jewish Health System, a 15 hospital system located across Queens, Long Island and Staten Island. At NSUH, the number of bariatric surgeries has increased dramatically from 44 in 1998 to 661 in 2005. Given that bariatric surgery is both a relatively new procedure and the recipient population, the obese, tend to have several comorbid conditions such as sleep apnea, depression, and hypertension, NSUH convened a multi-disciplinary bariatric surgery task force that embarked on standardizing and improving patient care. While the guidelines introduced were multifaceted, one primary objective was to improve patient assessment and reduce post-operative respiratory complications. Recommendations included a more focused pre-surgical screening, a peri-operative sleep apnea protocol, addition of specialized beds designed for bariatric surgery patients, and increased post-operative monitoring. Quality Management set forth in determining the success of this program. Specifically, this analysis evaluated if there was a reduction in post-operative respiratory complications pre-guideline versus the post-guideline period. Methods: Bariatric surgery patients treated between 1998 and 2005 were identified through an administrative database maintained by the hospital. Patient information was extracted from this database by using a series of targeted International Classification of Disease 9th Revision (ICD-9) codes. Patients who had surgery prior to May 2003 (the control group) were compared to the to patients who had surgery after May 2003. After taking into account surgery type and severity, patient outcomes, such as pulmonary collapse and post-operative respiratory complications were analyzed Results: Pulmonary collapse significantly declined from 8% to 5% (P<.05) in the gastric bypass population and a 10% decrease (P<.05) was noted in those identified as being high severity. In addition, the gastric bypass population's respiratory complications declined significantly by 50% from the pre-guideline to the post-guideline period (P<.05). Conclusion: Process changes that targeted improved patient assessment, airway management, specialized equipment and continuous post-operative monitoring resulted in significant reductions in post-operative respiratory complications and pulmonary collapse. The low rates have been sustained for two and half years post implementation. Physician acceptance of a single standard of care and targeted protocols that addressed patient comorbidities such as sleep apnea and known post-operative respiratory complications has enhanced patient safety.

Learning Objectives:

• Recognize risk factors associated with bariatric surgery.
• Identify steps taken to reduce post-operative complications associated with bariatric surgery.
• Evaluate the impact of a comprehensive bariatric surgery program.

Keywords: Quality Improvement,

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation