Evidence map›Paper›PMID 31214804›Full record

ArticleSurgical endoscopy2020

Surgeon variation in severity of reflux symptoms after sleeve gastrectomy.

Oliver A Varban, Jyothi R Thumma, Dana A Telem, Nabeel R Obeid, Jonathan F Finks, Amir A Ghaferi, Justin B Dimick

Abstract read
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In one paragraph

Article in Surgical endoscopy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Oliver A VarbanDepartment of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA. ovarban@med.umich.edu.
Jyothi R ThummaCenter for Healthcare Outcomes and Policy, University of Michigan, 2800 Plymouth Road, North Campus Research Complex, Bldg. 16, Ann Arbor, MI, 48109, USA.
Dana A TelemDepartment of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
Nabeel R ObeidDepartment of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
Jonathan F FinksDepartment of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
Amir A GhaferiDepartment of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.
Justin B DimickDepartment of Surgery, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPrior studies have demonstrated an increase in gastroesophageal reflux after laparoscopic sleeve gastrectomy (LSG). However, it is unknown whether symptom severity varies or if outcomes are surgeon-specific.

methodsA validated reflux symptom survey was obtained at baseline and at 1 year after primary LSG on 7358 patients participating in a state-wide quality improvement collaborative between 2013 and 2018. Patients with worsening symptoms after surgery were divided into terciles based on the degree of increase in survey score (0 = no symptoms, 50 = max symptoms). Surgeon-level data was obtained on 52 bariatric surgeons performing at least 25 LSG cases/year during the study period. Surgeon characteristics, operative experience, and risk-adjusted 30-day complication rates were compared between surgeons in the highest tercile for moderate worsening of symptoms vs those in the lowest.

resultsA total of 2294 (31.2%) patients had worsening symptoms of reflux after sleeve gastrectomy. Overall mean increase in severity score was 6.11 (range 1 to 48) and patients with minimal, mild, and moderate symptoms had a mean increase of 1.4, 4.2, and 13.8, respectively. There were no significant differences in surgeon-specific characteristics when comparing surgeons in the highest tercile for moderate worsening of symptoms (44.7% of patients) vs those in the lowest tercile (18.7% of patients). In addition, there were no significant differences in risk-adjusted rates of overall complications (3.70% vs. 4.33%, p = 0.686), endoscopic dilations (2.83% vs. 1.91%, p = 0.417), or concurrent hiatal hernia repair (34.3% vs. 27.0%, p = 0.415) between surgeons in the highest and lowest terciles.

conclusionsWe found that 1/3 of patients had worsening symptoms of reflux after LSG and that severity of symptoms varied. Surgeons with the highest rates of worsening reflux had similar operative experience and complication rates than those with the lowest. Further assessment of operative technique and skill may be informative.

Indexed as

FemaleGastrectomyGastroesophageal RefluxHumansMaleMiddle AgedBariatric surgeryGastroesophageal refluxPatient-reported outcomesSleeve gastrectomy

Identifiers

PMID31214804

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.