by James W. Saxton, JD; Maggie M. Finkelstein, JD;
and Susan Gallagher Camden, RN, MSN, PhD

Both from Stevens & Lee, Lawyers and Consultants

This third installment of our newest Bariatric Times column serves to answer all of your legal, managerial, treatment-related, and universal bariatric questions. Keep in the loop simply by reading your fellow bariatric professionals’ questions and our experts’ answers in the coming issues, or by sending in your own inquiries involving issues in your bariatric practice.

We are really interested in creating a customer-centered practice. Can you give one example of a bariatric surgery program that provides a high level of customer service?

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Popularity: unranked [?]

by Louis J. Aronne, MD, FACP,and Kathy Keenan Isoldi, MS, RD, CDE

Dr. Aronne is Former President of the North American Association for the Study of Obesity and a Fellow of the American College of Physicians. He has authored more than 40 papers and book chapters on obesity, and edited the National Institutes of Health Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. He is a consultant to the VA Weight Management/ Physical Activity Executive Council. Kathy Keenan Isoldi, MS, RD, CDE, is Coordinator of Nutrition Services at The Comprehensive Weight Control Program, New York, New York. Ms. Isoldi has been counseling adult and pediatric clients seeking weight management for the past 19 years. She is currently a doctoral candidate at New York University.

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Popularity: unranked [?]

by Carol Bradley, RN, CS, MSN

From the Saint Mary’s Regional Medical Center; Adjunct Clinical Professor, Orvis School of Nursing, University of Nevada, Reno, Nevada

Address for correspondence:
Carol Bradley, RN, CS, MSN, Saint Mary’s Center for Health, Bariatric Surgery Center of Excellence, 645 N Arlington Ave., Suite 200, Reno, NV 89503; Phone: (775) 770-3174; Fax: (775) 770-6908; Email: carol.bradley@saintmarysreno.com.

Background

There is increasing consensus that bariatric surgery is superior to medical intervention for long-term weight loss in morbidly obese persons.[1] Most postoperative patients are able to lose a significant amount of weight, profit from reduced or resolved comorbidities, and have an improved quality of life (QOL).

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Popularity: 2% [?]

by Paul E. O’Brien, MD

Dr. O’Brien is from the Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.

Address for Correspondence: Professor Paul O’Brien, Centre for Obesity Research and Education, Monash Medical School, The Alfred Hospital, Melbourne 3004, Australia; E-mail: paul.obrien@med.monash.edu.au.

Background

Laparoscopic adjustable gastric banding (LAGB) has now been available through most of the world for more than 12 years with the introduction of the LAP-BAND® System in 1993.[1] By the mid-1990s, this approach had rapidly become the dominant bariatric surgical procedure in Europe, the Middle East, Mexico, much of South America, and Australia. The US became one of the last to gain access for clinical use in mid-2001. Regulatory requirements and unfavorable funding by insurers or health providers have been important factors in its slower introduction to Brazil and the US.

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Popularity: 12% [?]

by Edward E. Mason, MD, PhD, FACS; and Kathleen E. Renquist, BS

Dr. Mason and Ms. Renquist are from The Roy J. and Lucille A. Carver College of Medicine, Department of Surgery; The University of Iowa, Iowa City, Iowa.

Correspondence address: Kathleen Renquist, BS; University of Iowa, Department of Surgery, 4125 Westlawn, Iowa City, Iowa 52242-1178. Telephone: (319) 335-8917. Fax: (319) 356-8378. Email: kathleen-renquist@uiowa.edu.

Abstract

Objective: To report the 20-year experience of a large data repository for surgical treatment of obesity with emphasis on development, problems, and outcomes. Design: Standardized data collection and analysis of voluntarily collected preoperative, operative, and postoperative information following surgical treatment for obesity. Setting: This represents the first outcome research facility organized for bariatric surgery in the United States involving multiple data collection sites using standardized software (1986 to the present). Participants: The 85 data collection sites include 148 surgeons. Information represents 45,294 patients from seven international sites and 28 sites in the US. Measurements: NBSR and IBSR data collection software, SAS analyses, and National Death Index searches to study longevity and cause of death. Results: Early publications and COE requests have concentrated on early outcomes. From 1986 to 2005, changes occurred in operative selection from predominately open, simple procedures (63% to 6%) to complex, bypass operations (36.9% to 94.0%) with an increase in the laparoscopic technique (0% to 22%). In addition, mean days of postoperative hospital stay declined from 4.9 to 3.3, while major 30-day complications increased (2.6% to 4.1%). Conclusion: In 2007, reporting results for surgical treatment of obesity must focus more on long-term mortality and cause of death. The IBSR can obtain this information if sufficient financial support is attained.

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Popularity: unranked [?]