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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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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by Julie M. Janeway, BBA, MSA, JD

Julie M. Janeway, BBA, MSA, JD, is from Little Victories™ Medical/Legal Consulting & Training in Onondaga, Michigan.

Introduction

If you are working as a healthcare provider in the US, chances are exceptionally high that you will at some point be called as a witness or a defendant in a medical malpractice, worker’s compensation, insurance, or other type of lawsuit. As lawyers, we tell our physicians, physician assistants (PA), and often our nursing clients as well: “It is not IF you get sued during your career, it is WHEN you get sued.” Given the litigiousness and blame-based nature of our society, many of you will be called upon to provide your testimony about a given set of facts at a deposition. Yet many healthcare providers are not even truly cognizant of what a deposition is, why they are needed, and their degree of importance in the litigation process.

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