Publications by authors named "Jon Thompson"

112 Publications

Improving the Effectiveness of Root Cause Analysis in Hospitals.

Hosp Top 2020 Sep 24:1-14. Epub 2020 Sep 24.

Department of Health Professions, James Madison University, Harrisonburg, VA, USA.

Improving patient safety within hospitals has become a major focal point for administrative and clinical action. Root Cause Analysis (RCA) is an analytical tool used by hospitals in quality improvement and patient safety efforts. While hospitals have widely embraced RCA, the effectiveness of the RCA process has been questioned in recent years. Based on a literature review and feedback from practicing administrators, this paper identifies current barriers to the effectiveness of the RCA process, and suggests actions to overcome them. A more effective RCA process will enable hospitals to establish a safer and more trustworthy care environment for patients.
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http://dx.doi.org/10.1080/00185868.2020.1824137DOI Listing
September 2020

Patient factors influence surgical options in gastroparesis.

Am J Surg 2020 10 16;220(4):1093-1097. Epub 2020 Feb 16.

Department of Surgery, University of Nebraska Medical Center, USA.

Background: Patient selection for the diverse surgical procedures for gastroparesis remains poorly defined. Our aim was to evaluate how patient factors have determined our surgical approach to gastroparesis.

Methods: 95 patients undergoing 105 surgical procedures for gastroparesis were reviewed. Patient factors were compared across six surgical procedures: gastric neurostimulator, pyloroplasty, neurostimulator plus pyloroplasty, sleeve gastrectomy, gastric bypass and gastrectomy. Global symptom severity was determined preoperatively and at last follow up.

Results: There were significant differences in etiology, BMI and gastroesophageal reflux across the various operations. Patients undergoing pyloroplasty and gastrectomy; were more likely to have a postsurgical etiology. (p < .05) Patients undergoing sleeve gastrectomy and gastric bypass were more likely to have BMI >35. Those undergoing sleeve gastrectomy were less likely to have gastroesophageal reflux preoperatively. There was no difference in preoperative clinical stage across the procedures.

Conclusion: Patient factors influence choice of procedure in the surgical treatment of gastroparesis. Etiology of gastroparesis, BMI >35 and gastroesophageal reflux are important determinants.
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http://dx.doi.org/10.1016/j.amjsurg.2020.02.022DOI Listing
October 2020

Inflammatory Bowel Disease and Short Bowel Syndrome.

Surg Clin North Am 2019 Dec 23;99(6):1209-1221. Epub 2019 Sep 23.

Department of Surgery, Division of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA. Electronic address:

Short bowel syndrome / intestinal failure (SBS/IF) is a rare and debilitating disease process that mandates a multidisciplinary approach in its management. Inflammatory bowel disease (IBD), in particular Crohn's disease (CD), predisposes patients to development of SBS/IF. This review discusses SBS/IF from the perspective of IBD, with an emphasis on prevention and treatment in the setting of CD. The aims of this review are to emphasize the unique treatment goals of the newly diagnosed SBS/IF patient, and highlight the role of both medical and surgical therapies in the management of IBD-related SBS/IF, including intestinal transplantation.
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http://dx.doi.org/10.1016/j.suc.2019.08.010DOI Listing
December 2019

Organizational Factors Associated With Quality Perinatal Care.

Health Care Manag (Frederick) 2019 Jan/Mar;38(1):61-70

Author Affiliations: Union Institute and University, Cincinnati, Ohio (Dr Akers); and Health Services Administration (Dr Thompson) and Nonprofit & Community Leadership Concentration (Dr Sloan), School of Strategic Leadership Studies (Dr Ford), James Madison University, Harrisonburg, Virginia.

Perinatal care has been recognized as an integral part of ensuring quality health care in hospitals, and the focus on perinatal care quality is increasing. The previous hospital literature has focused much attention on measuring and improving quality of care generally, but recently there has been a call for a more comprehensive approach to measuring quality in the perinatal care setting. The perinatal literature is limited in addressing the association between organizational factors and perinatal quality. Using chart audit data for more than 10 000 maternity patients, we used multiple regression analysis to examine the association of organizational factors and perinatal quality of care. Findings show that ownership, setting (location), and hospital policy on infant feeding were statistically significant. Findings suggest that it is important that hospital boards and leaders develop and implement organizational policies to enhance perinatal quality of care.
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http://dx.doi.org/10.1097/HCM.0000000000000241DOI Listing
May 2019

The influence of medical school on career choice: A longitudinal study of students' attitudes toward a career in general surgery.

Am J Surg 2018 12 28;216(6):1215-1222. Epub 2018 Oct 28.

Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA.

Background: Less than 80% of general surgery (GS) residency positions are filled by graduates from allopathic, U.S. medical schools. The aim of this study was to gauge students' interest in pursuing GS throughout their medical school matriculation and explore students' changing perceptions of the specialty.

Methods: Students at two medical schools were surveyed annually for 4 years. Survey responses regarding interest were compared to actual NRMP match results.

Results: Interest in a GS career was highest at the outset of medical school and declined steadily during the program, which was similar at both schools, including a positive effect on interest from the surgical clerkship.

Conclusions: Our findings suggest that experiences during medical school impact students' perceptions of GS; specifically, lifestyle, work environment, and the length of training discouraged pursuit of GS. Perception of a GS's lifestyle and the educational environment are both highly modifiable factors that could increase interest in general surgery amongst graduates.
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http://dx.doi.org/10.1016/j.amjsurg.2018.10.036DOI Listing
December 2018

Laser-heating system for high-pressure X-ray diffraction at the Extreme Conditions beamline I15 at Diamond Light Source.

J Synchrotron Radiat 2018 Nov 24;25(Pt 6):1860-1868. Epub 2018 Oct 24.

Diamond Light Source Ltd, Harwell Science and Innovation Campus, Didcot OX11 0DE, UK.

In this article, the specification and application of the new double-sided YAG laser-heating system built on beamline I15 at Diamond Light Source are presented. This system, combined with diamond anvil cell and X-ray diffraction techniques, allows in situ and ex situ characterization of material properties at extremes of pressure and temperature. In order to demonstrate the reliability and stability of this experimental setup over a wide range of pressure and temperature, a case study was performed and the phase diagram of lead was investigated up to 80 GPa and 3300 K. The obtained results agree with previously published experimental and theoretical data, underlining the quality and reliability of the installed setup.
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http://dx.doi.org/10.1107/S1600577518013383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225745PMC
November 2018

Prophylactic cholecystectomy in short bowel syndrome: Is it being utilized?

Am J Surg 2018 07 27;216(1):73-77. Epub 2018 Apr 27.

University of Nebraska Medical Center, Omaha, NE, USA.

Introduction: Cholelithiasis is common in patients with short bowel syndrome (SBS). Prophylactic cholecystectomy (PC) of the non-diseased gallbladder has been recommended in SBS patients when laparotomy is being undertaken for other reasons. Our aim was to determine if PC is being utilized.

Methods: 500 adults with SBS were seen over a 25 year period. 215 undergoing cholecystectomy prior to SBS were excluded, leaving 285 patients for evaluation.

Results: 151 (53%) SBS patients underwent a subsequent laparotomy. 77 underwent cholecystectomy for cholelithiasis at the 1st opportunity. 27 patients underwent a PC at the 1st opportunity. 47 patients did not undergo PC at the 1st opportunity. 17 (36%) of these 47 patients subsequently developed cholelithiasis with 7 undergoing cholecystectomy. Age, gender, diagnosis and initial BMI and need for longterm parenteral nutrition were similar in patients who had PC or did not. PC patients were more likely to have intestinal remnant length <60 cm (59% vs 21%, p < .05).

Conclusions: Overall 10% of SBS patients underwent PC. However, only 36% of eligible patients undergoing laparotomy had a PC.
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http://dx.doi.org/10.1016/j.amjsurg.2018.04.002DOI Listing
July 2018

Going Beyond Compliance: A Strategic Framework for Promoting Information Security in Hospitals.

Health Care Manag (Frederick) 2017 Oct/Dec;36(4):364-371

Author Affiliations: Department of Health Administration, Virginia Commonwealth University, Richmond (Mr Zandona); and Health Services Administration Program, James Madison University, Harrisonburg, Virginia (Dr Thompson).

In the past decade, public and private organizations have experienced a significant and alarming rise in the number of data breaches. Across all sectors, there seems to be no safe haven for the protection of information. In the health care industry, the trend is even worse. Information security is at an unbelievable low point, and it is unlikely that government oversight can fix this issue. Health care organizations have ramped up their approaches to addressing the problem; however, these initiatives are often incremental rather than transformational. Hospitals need an overall organization-wide strategy to prevent breaches from occurring and to minimize effects if they do occur. This article provides an analysis of the literature related to health information security and offers a suggested strategy for hospital administrators to follow in order to create a more secure environment for patient health information.
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http://dx.doi.org/10.1097/HCM.0000000000000189DOI Listing
July 2018

Transanal endoscopic microsurgery and transanal minimally invasive surgery: is one technique superior?

Am J Surg 2016 Dec 28;212(6):1063-1067. Epub 2016 Sep 28.

Department of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.

Background: Transanal endoscopic microsurgery (TEM) and transanal minimally invasive surgery (TAMIS) have been shown to improve the quality of transanal resections, allowing for improved visibility and access to the proximal rectum. This study compares the short-term outcomes between TEM and TAMIS among experienced colorectal surgeons.

Method: A retrospective review was conducted for TEM and TAMIS performed from 2012 to 2015 by local colorectal surgeons. Baseline patient demographics, operative variables, pathology results, and short-term outcomes were assessed.

Results: Sixty-nine patients were identified (40 TEM and 29 TAMIS). Patient demographics, tumor characteristics, operative variables, margin status, and postoperative complications were similar for both. Volume of resection was higher for TAMIS (P < .001). Lymph node retrieval was achieved in 17.2% of TAMIS cases compared with 0% of TEM (P = .01).

Conclusions: TAMIS appears to have equivalent indications and outcomes compared with TEM. TAMIS is associated with larger specimens and more frequent presence of mesorectal lymph nodes.
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http://dx.doi.org/10.1016/j.amjsurg.2016.08.017DOI Listing
December 2016

Food cravings and food consumption after Roux-en-Y gastric bypass versus cholecystectomy.

Surg Obes Relat Dis 2017 Feb 9;13(2):220-226. Epub 2016 Sep 9.

Nebraska Medicine, Omaha, Nebraska.

Background: Food cravings and consumption of craved foods after Roux-en-Y gastric bypass (RYGB) are poorly understood. Food cravings after bariatric surgery may explain why some patients fail to change eating behaviors after RYGB, and understanding these cravings may provide better information for nutritional counseling to either enhance weight loss or prevent weight regain.

Objectives: To study cravings in RYGB patients and compare them with cholecystectomy (CC) control patients.

Setting: This study took place in a university hospital.

Methods: RYGB patients (n = 50) and CC control patients (n = 38) completed a validated food craving inventory before surgery and at 2 and 6 weeks postoperatively. In addition, RYGB patients completed the food craving inventory at 12, 24, 36, and 52 weeks postoperatively. A linear mixed-effect model with a first-order autoregressive structure for correlations was used to evaluate changes in food consumption and food cravings between visits. Correlations between food cravings and body mass index (BMI) or weight changes before and after RYGB were assessed with Spearman correlation coefficients. P<.05 was considered statistically significant.

Results: After RYGB, food consumption decreased significantly compared with CC control patients and was lowest at 2 weeks. Consumption progressively increased over time in the first year but remained significantly less than that from presurgery. In addition, a higher preoperative BMI was found to correlate moderately with higher preoperative cravings of the total of all 4 food groups studied (r = .3, P = .04); high-fat foods (r = .3, P = .04); and sweets (r = .3, P = .03). However, with the exception of preoperative cravings for high-fat foods, these scores were not predictive of changes in BMI after surgery. Overall, RYGB did not significantly affect food cravings after surgery compared with CC control patients.

Conclusion: These findings indicate that RYGB may limit food consumption but does not affect the drive to consume certain types of food. Because food cravings are high in patients with obesity before surgery and remain high after surgery, these findings suggest a possible reason for noncompliance with dietary recommendations after RYGB.
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http://dx.doi.org/10.1016/j.soard.2016.09.001DOI Listing
February 2017

Surgical treatment of gastrointestinal motility disorders.

Curr Probl Surg 2016 Nov 30;53(11):503-549. Epub 2016 Aug 30.

Department of Surgery, University of Nebraska Medical Center, Omaha, NE.

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http://dx.doi.org/10.1067/j.cpsurg.2016.08.006DOI Listing
November 2016

Predictive value of preoperative serum C-reactive protein for recurrence after definitive surgical repair of enterocutaneous fistula.

Authors:
Jon S Thompson

Am J Surg 2017 06 25;213(6):1186-1187. Epub 2016 Aug 25.

Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address:

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http://dx.doi.org/10.1016/j.amjsurg.2016.07.022DOI Listing
June 2017

Trends in the match rate and composition of candidates matching into categorical general surgery residency positions in the United States.

Am J Surg 2017 Jan 9;213(1):187-194. Epub 2016 Jul 9.

Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA.

Background: The aim of this study was to analyze the trends in the proportion of students from various educational backgrounds who matched into categorical general surgery (GS) residency positions.

Methods: National Resident Matching Program reports (1994 to 2014) were analyzed, and regression was used to estimate the trends for each group.

Results: The match rate into GS-categorical residency has remained stable; however, since 1994, we witnessed a 13% decrease in US seniors matching into GS. This has corresponded to proportional increases in matches for US citizens from international medical schools (US IMG, 1350%) and a 62% increase for non-US citizen international medical graduates (non-US IMG) into GS. In comparison, US IMG matches into all first-year postgraduate positions increased by 468%, whereas non-US IMG matches decreased by 15%.

Conclusions: The stable match rates into categorical GS residencies are not because of US seniors but rather because of a rise in the number of IMGs. In contrast to the decreased reliance on non-US IMGs in all other specialties, GS is accepting a larger proportion of non-US IMGs.
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http://dx.doi.org/10.1016/j.amjsurg.2016.03.015DOI Listing
January 2017

Variations in the Histopathologic Type of Esophageal Carcinoma Between the United States of America and India.

Indian J Surg Oncol 2016 Mar 22;7(1):52-5. Epub 2015 Oct 22.

Department of Surgery, University of Nebraska Medical Center, Omaha, NE USA.

The aim of this study was to compare the incidence of the different histopathologic types of esophageal carcinoma between the United States of American (US) and India. The Surveillance Epidemiology and End Result (SEER) database was analyzed to determine the incidence of different types of esophageal carcinoma in US. A retrospective review was conducted of all the patients that underwent resection for esophageal carcinoma at a regional oncology center in India from 2001 to 2007. Data relating to histopathologic variables was collected and compared to the patients in the SEER database for the same time period. Esophageal adenocarcinoma accounts for the majority of newly diagnosed cases in the US. Although squamous cell carcinoma is the dominant type of esophageal carcinoma in India, we noted a small but gradual increase (0 % in 2001 to 28 % in 2007) in the incidence of esophageal adenocarcinoma. The results of our study demonstrate a geographic variation in the histopathologic type of esophageal carcinoma. A recent increase in the incidence of esophageal adenocarcinoma in India was also demonstrated. Analysis of risk factors known to be associated with esophageal adenocarcinoma, in the context of India, can provide targets for implementing public health measures.
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http://dx.doi.org/10.1007/s13193-015-0468-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811830PMC
March 2016

Effect of proximal versus distal 50% enterectomy on nutritional parameters in rats preconditioned with a high-fat diet or regular chow.

Sci Rep 2015 Nov 27;5:17331. Epub 2015 Nov 27.

Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68198.

Obesity may protect against the nutritional consequences of short bowel syndrome. We hypothesized that rats preconditioned with an obesogenic diet would have better outcomes after surgical induction of short bowel syndrome compared to rats on regular chow. Rats were fed a high-fat diet or regular rat chow for six months, and then underwent 50% proximal, 50% distal, or sham enterectomy. Food intake, weight, and body composition were monitored before and for 4 weeks after surgery. The high-fat diet consistently produced obesity (>25% body fat). All procedures induced weight loss, but there was no discernable difference between resection vs. sham resection. Rats on the high-fat diet had a greater post-resection loss of body fat compared to rats on chow (36 vs. 26 g, respectively). There was a nonsignificant trend of less lean mass loss in the former compared to the latter rats (16 vs. 33 g, respectively). Enterectomy moderated serum ghrelin, GIP, PPY, insulin, and leptin. Intestinal adaptation was not different between obese vs. non-obese rats. Rats preconditioned with the high-fat diet may have had better retention of lean body mass after a surgical procedure compared to rats on chow. The effect of 50% enterectomy was less than expected.
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http://dx.doi.org/10.1038/srep17331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4661515PMC
November 2015

Hospital Acquisitions Before Healthcare Reform.

J Healthc Manag 2015 May-Jun;60(3):186-203

The hospital industry has experienced increased consolidation in the past 20 years. Since 2010, in particular, there has been a large rise in the number of hospital acquisitions, and observers have suggested this is due in part to the expected impact of federal healthcare reform legislation. This article reports on a study undertaken to identify the market, management, and financial factors affecting acute care, community hospitals acquired between 2010 and 2012. We identified 77 such hospitals and compared them to other acute care facilities. To assess how different factors were associated with acquisitions, the study used multiple logistic regressions whereby market factors were included first, followed by management and financial factors. Study findings show that acquired hospitals were located in markets with lower rates of preferred provider organization (PPO) penetration compared with nonacquired hospitals. Occupancy rate was found to be inversely related to acquisition rate; however, case-mix index was significantly and positively related to a hospital's being acquired. Financial factors negatively associated with a hospital's being acquired included age of plant and cash flow margin. In contrast to the findings from earlier studies of hospital acquisitions, our results showed that acquired hospitals possessed newer assets. However, similar to the findings of other studies, the cash flow margin of acquired hospitals was lower than that of nonacquired facilities.
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December 2015

Early Careerist Interest and Participation in Health Care Leadership Development Programs.

Health Care Manag (Frederick) 2015 Oct-Dec;34(4):350-8

Author Affiliations: Health Services Administration Program, James Madison University, Harrisonburg, Virginia.

Health care organizations are increasingly embracing leadership development programs. These programs include a variety of specific activities, such as formally structured leadership development, as well as mentoring, personal development and coaching, 360-degree feedback, and job enlargement, in order to increase the leadership skills of managers and high-potential staff. However, there is a lack of information on how early careerists in health care management view these programs and the degree to which they participate. This article reports on a study undertaken to determine how early careerists working in health care organizations view leadership development programs and their participation in such programs offered by their employers. Study findings are based on a survey of 126 early careerists who are graduates of an undergraduate health services administration program. We found varying levels of interest and participation in specific leadership development activities. In addition, we found that respondents with graduate degrees and those with higher compensation were more likely to participate in selected leadership development program activities. Implications of study findings for health care organizations and early careerists in the offering of, and participation in, leadership development programs are discussed.
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http://dx.doi.org/10.1097/HCM.0000000000000082DOI Listing
January 2017

Cholecystectomy and Liver Disease in Short Bowel Syndrome.

J Gastrointest Surg 2016 Feb 26;20(2):322-7. Epub 2015 Oct 26.

Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA.

Background: Recently, an association has been proposed between cholecystectomy and various liver diseases. Our aim was to determine whether cholecystectomy in short bowel patients influences the risk of liver disease.

Methods: We reviewed 422 adults: 182 underwent cholecystectomy prior to short bowel, 102 after developing short bowel, and 138 patients still had the gallbladder in place.

Results: Compared to pre and post short bowel, gallbladder patients were significantly less likely to have obesity (18 % and 21 % vs 9 %), central line infections (59 % and 69 % vs 46 %), intestine <60 cm (30 % and 39 % vs 26 %), and require parenteral nutrition >1 year (72 % and 77 % vs 64 %). The incidence of fatty liver was similar (31, 26, and 25 %). Fibrosis/cirrhosis was less common in the gallbladder group (26 % and 36 % vs 16 %). Frequency of end-stage liver disease was similar (15, 22, and 11 %). On multivariate analysis, cholecystectomy, parenteral nutrition >1 year, line infection, and intestine <60 cm were predictors of fibrosis/cirrhosis. Parenteral nutrition >1 year, line infection, and intestine <60 cm were predictors of end-stage liver disease.

Conclusions: Cholecystectomy does not appear to increase the incidence of liver disease in short bowel patients overall. Fibrosis/cirrhosis occurs significantly less frequently in patients with an intact gallbladder.
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http://dx.doi.org/10.1007/s11605-015-3008-8DOI Listing
February 2016

Risk of Intestinal Malignancy in Patients With Short Bowel Syndrome.

JPEN J Parenter Enteral Nutr 2017 05 29;41(4):562-565. Epub 2015 Sep 29.

1 Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska.

Background: Postresection intestinal adaptation is an augmented self-renewal process that might increase the risk of malignant transformation in the intestine. Furthermore, patients with short bowel syndrome (SBS) have other characteristics that might increase this risk. Our aim was to determine the incidence of new intestinal malignancy in SBS patients.

Methods: We reviewed the records of 500 adult SBS patients identified from 1982-2013. There were 199 men and 301 women ranging in age from 19-91 years. Follow-up from the time of diagnosis of SBS ranged from 12-484 months. A total of 186 (37%) patients were followed >5 years.

Results: The cause of SBS was postoperative in 35% of patients, malignancy/radiation in 19%, mesenteric vascular disease in 17%, Crohn's disease in 16%, and other in 13%. Twenty-eight (6%) patients received growth stimulatory medications. Fifteen percent of patients had a prior total colectomy. Twenty-eight (6%) patients underwent intestinal transplantation, and 115 (23%) patients had a previous abdominal malignancy, including colorectal cancer in 43 patients. Thirty-six (7%) received radiation therapy. Recurrent colon cancer was found in 2 patients, one at a stoma and the other with lung metastases. New colon cancer was found in 1 patient (0.2%), a 62-year-old woman with long-standing Crohn's disease.

Conclusion: The incidence of colon cancer in this heterogenous group of patients with SBS was similar to that of the normal population. This suggests that the risk of developing a new colon cancer in patients with SBS is not increased.
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http://dx.doi.org/10.1177/0148607115609587DOI Listing
May 2017

The Time to Weight-Loss Steady State After Gastric Bypass Predicts Weight-Loss Success.

Obes Surg 2016 Feb;26(2):327-31

Department of Surgery, University of Nebraska Medical Center, Wittson Hall 3030, 986426 Nebraska Medical Center, Omaha, NE, 68198-6426, USA.

Background: There is marked variability in weight loss achieved after laparoscopic Roux-en-Y gastric bypass (LRYGB) with little ability to predict pre-operatively poor weight-loss outcomes. In this study, we categorize the patterns of post-operative weight loss after LRYGB by using a novel method of measurement based on the time to weight-loss steady state (SS).

Methods: A bariatric database was retrospectively reviewed for patients who underwent a LRYGB from 01/2001-12/2010. SS was defined as the month when the patient had ≤3% excess weight loss (%EWL) or weight gain from the prior visit. Percent total weight loss (%TWL) and %EWL were compared based on time to SS.

Results: The average time to SS was 15.5 months (n = 178). A percentage of 7.3 of patients lost >5%EWL after achieving their SS weight. Patients with SS <12 months (n = 47) had a significantly lower %TWL and %EWL at SS and a 3-4-year follow-up compared to SS ≥12 months (n = 131, p < 0.05 for all). Initial weight loss velocity (IWLV) and body mass index (BMI) were not significantly associated with the time to SS. Patients with a SS <12 months were significantly older than patients with SS ≥months (42.7 ± 10.5 versus 46.5 ± 11.8 years, p = 0.05).

Conclusions: Few patients achieve meaningful weight loss after SS. The time to SS varies significantly among LRYGB patients and is not predicted by the IWLV or BMI. Achievement of SS within the first year after surgery is more common with increasing age and may represent rapid physiologic adaptation with significantly lower %TWL and %EWL.
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http://dx.doi.org/10.1007/s11695-015-1754-zDOI Listing
February 2016

Comparison of resident operative case logs during a surgical oncology rotation in the United States and an international rotation in India.

Indian J Surg Oncol 2015 Mar 18;6(1):36-40. Epub 2015 Mar 18.

Division of General Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE USA.

This study compared the operative case log experience between rotations during General Surgery residency in the United States and an international rotation in India. A resident from the General Surgery residency program at University of Nebraska Medical Center participated in an international rotation in Surgical Oncology at Mehdi Nawaz Jung Institute of Oncology in Hyderabad, India for 3 months in 2009. The operative case log of this resident (INT) was compared to those of another resident (US) on a rotation in surgical oncology at the parent institution during the same time period. Both institutions were tertiary care centers. We noted that the INT resident performed a greater number of cases (132) when compared to the US resident (61). The INT resident also performed cases in a wider variety of disease categories such as: head and neck (26 %), gynecology (19 %), breast (14 %) and urology (4 %). In contrast, abdominal cases accounted for 68 % of the cases performed by the US resident with fewer cases in the other categories. The INT resident performed 98 % of the cases by the open approach, whereas the US resident performed only 81 % of cases by the open approach, with the remaining 19 % of cases performed by the laparoscopic approach. The results demonstrate that the INT resident performed a greater number of operative cases when compared to a resident (US) at the parent institution, and performed cases in more diverse disease categories with an emphasis on the open operative approach.
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http://dx.doi.org/10.1007/s13193-015-0389-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412865PMC
March 2015

Surgical aspects of celiac disease.

Am Surg 2015 Feb;81(2):157-60

Department of Surgery, University of Nebraska Medical Center, Omaha Nebraska, USA.

Celiac disease, characterized by intestinal inflammation and malabsorption, occurs in 1 per cent of the population and is often undiagnosed. These patients are at increased risk for surgical procedures resulting from symptoms, associated intestinal disorders, and malignancy. Our aim was to determine the incidence and outcome of abdominal operations in patients with celiac disease. Records of 512 adult patients with celiac disease evaluated over a 22-year period were reviewed. Operations were classified as related or unrelated to celiac disease. One hundred eighty-eight (36%) of 512 patients underwent abdominal operations. One hundred twenty-seven (68%) of the 188 patients had unrelated procedures. Sixty-one (32%) had operations considered related to celiac disease. Twenty-six (43%) of 61 with related procedures were diagnosed preoperatively. Procedures were performed for pain, obstruction, motility disorders, and malignancy. Six patients had recurrent pancreatitis. Seven patients underwent liver transplantation. Thirty-five (57%) related procedures led to the diagnosis of celiac disease including "unmasking" (n = 25) and diagnostic findings (n = 10). One-third of patients with celiac disease undergo abdominal operations of which one-third are related to celiac disease. Operations are related to complications of celiac disease and often lead to the initial diagnosis.
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February 2015

Radiographic findings following irrigation of chronic perineal drain with hydrogen peroxide.

Int J Surg Case Rep 2015 3;6C:263-5. Epub 2014 Dec 3.

University of Nebraska Medical Center, Department of Surgery, United States.

Introduction: Hydrogen peroxide is a widely available agent used for irrigation and disinfecting. With misuse, significant side effects have been noted ranging from nausea to abdominal cramping to portal venous gas, air embolism and death.

Presentation Of Case: We present an 81 year old male who developed a rectovesicular fistula following radiation for metastatic prostate cancer. He had recurrent bleeding and infections and underwent a pelvic exenteration which was complicated by a persistent pelvic abscess requiring placement of a transperineal drainage catheter. After months of persistent drainage, he noted decreased output and irrigated the catheter with 3% hydrogen peroxide. He presented to the emergency room with fever, diarrhea and abdominal cramping but no rebound or guarding. CT depicted free air in the pre-sacral space extending into the retroperitoneum and diffusely throughout the peritoneum. Given his clinical exam and upon review of imaging, we assumed his radiographic findings were related to the direct instillation of hydrogen peroxide into his chronic pelvic cavity.

Discussion: Hydrogen peroxide has been used therapeutically for over 100 years. Hydrogen peroxide exerts direct cytotoxicity by corrosion and lipid peroxidation and indirectly by oxygen gas formation. When the oxygen produced exceeds the solubility in the blood, arterial and venous gas embolism occur. It is this sequelae of hydrogen peroxide that is described most frequently in the literature.

Conclusion: Instillation of hydrogen peroxide into a chronic pelvic cavity resulted in a benign pneumoperitoneum. This effect of hydrogen peroxide is a significant and potentially treatment altering radiographic finding.
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http://dx.doi.org/10.1016/j.ijscr.2014.10.052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334493PMC
January 2015

Alvimopan reduces length of stay and costs in patients undergoing segmental colonic resections: results from multicenter national administrative database.

Am J Surg 2014 Dec 22;208(6):919-25; discussion 925. Epub 2014 Sep 22.

Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address:

Background: Alvimopan (Entereg), a peripherally acting mu-opioid receptor antagonist, has been shown to expedite recovery of bowel function after colon resection surgery. Most data are available from industry-sponsored trials. This study aims to evaluate the clinical impact of this drug on perioperative outcomes and costs in patients undergoing segmental colonic resection for diverticular disease.

Methods: A large administrative database maintained by the University Health System Consortium, an alliance of over 200 academic and affiliate hospitals, was queried from 2008 to 2011. International Classification of Diseases, 9th Revision, Clinical Modification codes for segmental colon resection because of diverticular disease were used to identify 2 matched cohorts of adult patients. University Health System Consortium's clinical resource manager was used to access pharmacy data and compare it with patient outcomes.

Results: Five thousand two hundred ninety-nine patients met the above criteria. Four hundred thirty-eight patients received alvimopan and 4,861 did not. Regardless of laparoscopic or open approach, alvimopan significantly improved the postoperative length of stay (4.43 ± 2.02 vs 5.92 ± 3.79, P < .0001), cost (9,974 ± 4,077 vs 11,303 ± 6,968, P < .0001), and intensive care unit admission rate (1.83% vs 7.20%, P < .05), with no significant difference in mortality (.0% vs .19%, P = 1.000), morbidity (5.93% vs 8.39%, P = .08), or 30-day readmission rate (4.40% vs 4.63%, P = .90).

Conclusions: Alvimopan significantly reduced length of stay, days in the intensive care unit, and hospital cost for patients undergoing colonic segmental resections. Unlike some previously reported studies, we also observed a significant reduction in the length of stay in patients undergoing laparoscopic colectomies who received the drug. Alvimopan may reduce total healthcare costs if used as part of a best care practice model for colon resections.
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http://dx.doi.org/10.1016/j.amjsurg.2014.08.011DOI Listing
December 2014

Short bowel syndrome after laparoscopic procedures.

Am Surg 2014 Apr;80(4):382-5

Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.

Short bowel syndrome (SBS) is a potential postoperative complication after intra-abdominal procedures. Whether the laparoscopic approach is as likely to result in SBS or the causative mechanisms are similar to open procedures is unknown. Our aim was to evaluate potential mechanisms of SBS after laparoscopic procedures. The records of 175 adult patients developing SBS as a postoperative complication were reviewed. One hundred forty-seven patients had open procedures and 28 laparoscopic. Colectomy (39%), hysterectomy (11%), and appendectomy (11%) were the most common open procedures. SBS followed laparoscopic gastric bypass (46%) and cholecystectomy (32%) most frequently. The mechanisms of SBS were different: adhesive obstruction (57 vs 22%, P < 0.05) was more common in the open group, whereas volvulus (18 vs 46%, P < 0.05) was more common after laparoscopy. Overall, ischemia (25 vs 32%) was similar but significantly more laparoscopic patients had postoperative hypoperfusion (32 vs 67%, P < 0.05). Eleven of the 13 laparoscopic bariatric procedures had internal hernias and volvulus. Of the nine patients undergoing cholecystectomy, four developed ischemia early postoperatively presumably secondary to pneumoperitoneum. SBS is an increasingly recognized complication of laparoscopic procedures. The mechanisms of intestinal injury differ from open procedures with a higher incidence of volvulus and more frequent ischemia from hypoperfusion.
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April 2014

Short Bowel Syndrome and Malabsorption - Causes and Prevention.

Authors:
Jon S Thompson

Viszeralmedizin 2014 Jun;30(3):174-8

Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.

Background: The short bowel syndrome (SBS) is a condition caused by extensive intestinal resection for a variety of conditions. The etiology varies by age group. Necrotizing enterocolitis is the leading cause in infants. In older children, trauma and malignancies are most common. Postoperative SBS has become most common in adults, followed by mesenteric vascular disease and cancer/irradiation.

Methods: Systematic literature review.

Results: Prevention of SBS should be given high priority. Each of the etiologies has been evaluated and strategies to prevent extensive resection have been developed. These include a thoughtful approach to reoperation, early identification of complications, e.g. intestinal ischemia, reducing radiation enteritis, and bowel-conserving therapies in diseases such as Crohn's disease.

Conclusion: Several operative strategies to prevent SBS are useful. Timing and extent of reoperation need careful consideration. Minimizing intestinal resection, bowel-conserving techniques for complications such as fistula or strictures, and remodeling procedures are important.
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http://dx.doi.org/10.1159/000363276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513821PMC
June 2014

Pre-resection gastric bypass reduces post-resection body mass index but not liver disease in short bowel syndrome.

Am J Surg 2014 Jun 4;207(6):942-8. Epub 2014 Jan 4.

Department of Surgery, University of Nebraska Medical Center Omaha, Omaha, NE, USA.

Background: Obese patients developing short bowel syndrome (SBS) maintain a higher body mass index (BMI) and have increased risk of hepatobiliary complications. Our aim was to determine the effect of pre-resection gastric bypass (GBP) on SBS outcome.

Methods: We reviewed 136 adults with SBS: 69 patients with initial BMI < 35 were controls; 43 patients with BMI > 35 were the obese group; and 24 patients had undergone GBP before SBS.

Results: BMI at 1, 2, and 5 years was similar in control and GBP groups, whereas obese patients had a persistently increased BMI. Eight (33%) of the GBP patients had a pre-resection BMI > 35, but post-SBS BMI was similar to those <35. Obese patients were more likely to wean off PN (47% vs 20% control and 12% GBP, P < .05). Radiographic fatty liver tended to be higher in the GBP group (54% vs 19% control and 35% obese). End-stage liver disease occurred more frequently in obese and GBP patients (30% and 33% vs 13%, P < .05).

Conclusions: Pre-resection GBP prevents the nutritional benefits of obesity but does not eliminate the increased risk of hepatobiliary disease in obese SBS patients. This occurs independent of pre-SBS BMI suggesting the importance of GBP itself or history of obesity rather than weight loss.
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http://dx.doi.org/10.1016/j.amjsurg.2013.10.019DOI Listing
June 2014

Laparoscopic colon resection: is it being utilized?

Adv Surg 2013 ;47:29-43

Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.

Since its inception, the use of laparoscopy for colon surgery has slowly increased, albeit at a slower rate than for cholecystectomy. Initial concerns about the safety and efficacy of laparoscopy have been addressed, and it is now known to have several potential short-term and long-term benefits for the patient. Early studies likely underestimated use of laparoscopy because of coding error. Currently, 40% to 50% of colectomies in the United States are performed laparoscopically, with a 10% to 20% rate of conversion to an open operation. The definitions oflaparoscopy and conversion to open remain at the discretion of the surgeons and their coders. Disparities still exist among use based on several patient, hospital, and surgeon factors. In the future, we will likely see a continuing increase in use as the new generation of surgeons enters practice, and there will be an increasing role for laparoscopy in rectal surgery. The benefit and extent of robotic surgery, natural orifice surgery, and single-incision surgery for minimally invasive colectomies are yet to be defined.
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http://dx.doi.org/10.1016/j.yasu.2013.02.003DOI Listing
January 2014

Invited commentary: Left-sided malignant colonic obstruction: a systematic review.

Authors:
Jon S Thompson

Am J Surg 2014 Jan 30;207(1):139-40. Epub 2013 Sep 30.

Department of Surgery, University of Nebraska, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA. Electronic address:

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http://dx.doi.org/10.1016/j.amjsurg.2013.09.002DOI Listing
January 2014

A profile of hospitals with leadership development programs.

Health Care Manag (Frederick) 2013 Apr-Jun;32(2):179-88

Health Services Administration Program, James Madison University, Harrisonburg, Virginia, USA.

Community hospitals face increasing organizational and environmental complexities that challenge effective leadership. Hospitals are embracing leadership development programs in efforts to ensure leadership talent. While prior literature has described the intent and availability of these programs, the characteristics and performance of hospitals having such programs and their associated market characteristics have not been fully addressed. This article identifies significant differences in organizational, operational, performance, and market factors that are associated with hospitals offering a leadership development program, compared with those hospitals lacking such a program. The authors used American Hospital Association Survey data for 2008, the Area Resource File, and Centers for Medicare & Medicaid data to identify hospitals with and without leadership development programs and analyzed the differences for a number of organizational, operational, performance, and market variables. Findings indicate that hospitals having leadership development programs were large-bed-size facilities, had not-for-profit ownership, were system affiliated, were located in metropolitan statistical areas, and were teaching affiliated facilities. These hospitals also generated higher patient discharges, had higher occupancy, and had a longer average length of stay, compared with hospitals without such programs. In addition, these hospitals had higher net patient revenue per adjusted discharge and higher total profit margins relative to the comparison group.
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http://dx.doi.org/10.1097/HCM.0b013e31828ef677DOI Listing
January 2014