The timing of pregnancies after bariatric surgery has no impact on children’s health—a nationwide population-based registry analysis

Purpose Bariatric surgery has a favorable effect on fertility in women. However, due to a lack of data regarding children’s outcomes, the ideal time for conception following bariatric surgery is unknown. Current guidelines advise avoiding pregnancy during the initial weight loss phase (12–24 months after surgery) as there may be potential risks to offspring. Thus, we aimed to analyze health outcomes in children born to mothers who had undergone bariatric surgery. The surgery-to-delivery interval was studied. Materials and Methods A nationwide registry belonging to the Austrian health insurance funds and containing health-related data claims was searched. Data for all women who had bariatric surgery in Austria between 01/2010 and 12/2018 were analyzed. A total of 1057 women gave birth to 1369 children. The offspring’s data were analyzed for medical health claims based on International Classification of Diseases (ICD) codes and number of days hospitalized. Three different surgery-to-delivery intervals were assessed: 12, 18, and 24 months. Results Overall, 421 deliveries (31%) were observed in the first 2 years after surgery. Of these, 70 births (5%) occurred within 12 months after surgery. The median time from surgery to delivery was 34 months. Overall, there were no differences noted in frequency of hospitalization and diagnoses leading to hospitalization in the first year of life, regardless of the surgery-to-delivery interval. Conclusion Pregnancies in the first 24 months after bariatric surgery were common. Importantly, the surgery-to-delivery interval had no significant impact on the health outcome of the children.publishedVersio

Sex‑Specifc Diferences in Mortality of Patients with a History of Bariatric Surgery: a Nation‑Wide Population‑Based Study

Purpose Bariatric surgery reduces mortality in patients with severe obesity and is predominantly performed in women. Therefore, an analysis of sex-specific differences after bariatric surgery in a population-based dataset from Austria was performed. The focus was on deceased patients after bariatric surgery. Materials and Methods The Austrian health insurance funds cover about 98% of the Austrian population. Medical health claims data of all Austrians who underwent bariatric surgery from 01/2010 to 12/2018 were analyzed. In total, 19,901 patients with 107,806 observed years postoperative were eligible for this analysis. Comorbidities based on International Classification of Diseases (ICD)-codes and drug intake documented by Anatomical Therapeutical Chemical (ATC)-codes were analyzed in patients deceased and grouped according to clinically relevant obesity-associated comorbidities: diabetes mellitus (DM), cardiovascular disease (CV), psychiatric disorder (PSY), and malignancy (M). Results In total, 367 deaths were observed (1.8%) within the observation period from 01/2010 to 04/2020. The overall mortality rate was 0.34% per year of observation and significantly higher in men compared to women (0.64 vs. 0.24%; p < 0.001(Chi-squared)). Moreover, the 30-day mortality was 0.19% and sixfold higher in men compared to women (0.48 vs. 0.08%; p < 0.001). CV (82%) and PSY (55%) were the most common comorbidities in deceased patients with no sex-specific differences. Diabetes (38%) was more common in men (43 vs. 33%; p = 0.034), whereas malignant diseases (36%) were more frequent in women (30 vs. 41%; p = 0.025). Conclusion After bariatric surgery, short-term mortality as well as long-term mortality was higher in men compared to women. In deceased patients, diabetes was more common in men, whereas malignant diseases were more common in women.publishedVersio

Unterschiede verschiedener AED-Modelle bei First-Responder-Einsätzen der Wiener Polizei zwischen 2013-2015 nach einem Out-of-Hospital Car-diac Arrest von Patient_innen mit initial schockbarem Erstrhythmus.

Hintergrund Die Chance, in Wien einen präklinischen Herz-Kreislaufstillstand (HKS) zu überleben, ist gering. Bei einer niedrigen Ersthelfer-Rate wurden Ansätze gesucht, um eine rasche Hilfeleistung zu gewährleisten, noch bevor der professionelle Rettungsdienst eintrifft. Deshalb wurde unter anderem vom Verein PULS und der Berufsrettung Wien ein First-Responder-System gemeinsam mit der Wiener Polizei etabliert, welche seither parallel zum Rettungsdienst zu Reanimationseinsätzen alarmiert wird, um dort Herzdruckmas-sage und Defibrillator (Automatischer Externer Defibrillator, AED) anzuwenden. Weil die AED-Ausstattung der Polizei über den Verein PULS durch Spenden finanziert wur-de, sind unterschiedliche Modelle im Einsatz. Es wurden fünf verschiedene AED-Modelle angeschafft, von denen nun die Anwendungsdaten vorliegen. Die Unterschie-de der eingesetzten AED-Modelle wurden in Hinblick auf ihre Anwendbarkeit und ei-nen eventuell damit zusammenhängenden Überlebensvorteil untersucht. Methoden Die Daten aller präklinisch durchgeführten Reanimationen zwischen August 2013 und September 2015 in Wien wurden ausgewertet und evaluiert. Insgesamt wurden 2109 Personen reanimiert, bei 140 von ihnen war die Wiener Polizei zeitlich vor dem Ret-tungsdienst am Berufungsort und die Beamt_innen wendeten Herzdruckmassage und AED an. Nach den Anwendungen wurden die eingesetzten AEDs der Polizei von der Berufsrettung Wien (Magistratsabteilung 70, MA 70) ausgelesen und die Einsatzdaten gesammelt. Überlebensvorteile und Zeiten der Anwendung von unterschiedlichen De-fibrillator-Modellen wurden mit Hilfe des Wiener Reanimationsregisters (Vienna Cardi-ac Arrest Registry, VICAR) verglichen. Die gewählten Parameter ließen nur den Ver-gleich zwischen Defibrillator-Einsätzen zu, bei denen ein primär schockbarer Erstrhythmus vorlag. Daher beläuft sich das endgültige Datenset und diese Analyse auf insgesamt 47 Fälle. Resultate Die primären Outcome-Parameter zeigten einen nicht signifikanten Unterschied bei Verwendung der unterschiedlichen AED-Modelle in Bezug auf Überlebenschance (p = .385), gutes neurologisches Outcome (p = .395) und Auftreten eines kurzfristigen oder länger anhaltenden Spontankreislaufes (return of spontaneous circulation, ROSC) (p =.818 respektive p = 588). Die geringe Fallzahl unter den einzelnen AED-Modellen er-laubte keine Signifikanzprüfung der sekundären Outcome Parameter, wie etwa dem Zeitintervall zwischen Einschalten des Gerätes und erster Schockabgabe, welches zwi-schen 48 (22-56) und 84 (28-105) Sekunden lag. Conclusio Obwohl der Outcome-Vergleich nicht signifikante Unterschiede ergab, zeigte die Be-trachtung der Anwendungszeiten die Tendenz, dass manche AED-Modelle zu einer schnelleren Schockabgabe führten. Um einen signifikanten Outcome-Effekt nachzuwei-sen, sollten daher Analysen mit größeren Fallzahlen angestellt werden.Background The probability to survive an Out-of-Hospital Cardiac Arrest (OHCA) in Vienna is low. With a low rate of bystander-CPR (cardio-pulmonary resuscitation), different initiatives were implemented to help the victim before professional medical staff arrives. To that end, the non-governmental organization (NGO) PULS Austrian Cardiac Arrest Awareness Association and the Vienna Emergency Medical Service (EMS) established a first-responder system in cooperation with the Vienna Police which since then re-sponds to OHCA-calls parallel to the EMS in order to deliver CPR and use an Automatic External Defibrillator (AED) if necessary. Because the equipment of the police with AEDs through the NGO PULS was financed by donations, different AED models are in use. Five different AED models have been purchased, of which the application data are now available. This paper investigates the difference in survival across the broad range of AED models in use. Methods The data of all OHCA between August 2013 and September 2015 in Vienna were eval-uated. A total of 2109 people were resuscitated. In 140 of those cases, the Vienna Po-lice was on site before the EMS crew and performed CPR and used their AEDs. The AEDs data were retrieved by the Vienna EMS personnel and further analyzed and linked to data of the Vienna Cardiac Arrest Registry (VICAR). The selected parameters only allowed for a comparison between cases with an initially shockable heart rhythm. Therefore, the final data set and this analysis amounts to a total of 47 cases. Results The primary outcome parameters showed a non-significant difference between the used AED models in terms of survival (p = .385), good neurological outcome (p = .395) and any return of spontaneous circulation (ROSC) (p =.818) or sustained ROSC (p = 588). The small number of use cases among individual AEDs did not allow a signifi-cance test of the secondary outcome parameters, such as the time interval between device start and first shock delivery span between 48 (22-56) and 84 (28-105) sec-onds. Conclusion Although the outcome comparison revealed non-significant differences between the tested AEDs results, the analisis showed that some AED models led to a faster shock delivery. In order to demonstrate a significant effect, an analysis of larger case num-bers should be attempted.Abweichender Titel laut Übersetzung der Verfasserin/des VerfassersArbeit an der Bibliothek noch nicht eingelangt - Daten nicht geprüftMedizinische Universität Wien, Diplomarb., 2019(VLID)397925

Surgical Technique for Weight Regain After Roux-En-Y Gastric Bypass: Pouch-Resizing and the Minimizer® Gastric Ring

Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is a commonly used method in bariatric surgery that leads to sufficient long-term weight loss and consequently to improvement or resolution of obesity-associated diseases. The nadir weight is commonly reached between six months and two years after surgery. Despite this initially good weight loss, weight regain is observed in up to 20% of the patients. Besides intensive dietological evaluation, bariatric re-operation can be an option in these cases. Before the surgical reintervention, an intensive evaluation of the esophagus, pouch, anastomosis, and adjacent small bowel using upper GI-endoscopy and radiological examinations (X-ray and/or 3D-CT volumetry) is mandatory. In patients with a dilated pouch, pouch-resizing with a MiniMIZER® Gastric Ring (Bariatric Solutions GmbH, Stein am Rhein, Switzerland) could be an option to reestablish restriction in the long term. Currently, there is no gold standard for the choice of the weight regain procedure or for the technique used in the procedure itself. This article focuses on the standardized procedure of pouch resizing with implantation of a MiniMIZER® Gastric Ring for the surgical therapy of weight regain due to pouch dilatation and/or dilatation of the gastrojejunostomy and the adjacent small bowel (usually approximately the first 20cm), resulting in a huge neo-stomach after RYGB, as performed at the Medical University of Vienna. Further, indications for revisional surgery for weight regain, mandatory examinations, and recommended conservative therapy options prior to surgery will be described. Next, the fast-track concept and its advantages are explained. Lastly, the surgical procedure, including positioning of the patient, placement of trocars, the intraoperative process, and special advice, is presented. Exact planning of the procedure and postoperative follow-up are indispensable for a further long-term success after weight regain surgery. In conclusion, pouch-resizing and implantation of the MiniMIZER® Gastric Ring represent a practical and effective solution in patients with dilated pouch/anastomosis/adjacent small bowel with weight regain after RYGB, if conservative therapy, including dietitian counseling and new drugs (e.g., Semaglutide), has failed

Bariatric Surgery–How Much Malabsorption Do We Need?—A Review of Various Limb Lengths in Different Gastric Bypass Procedures

The number of obese individuals worldwide continues to increase every year, thus, the number of bariatric/metabolic operations performed is on a constant rise as well. Beside exclusively restrictive procedures, most of the bariatric operations have a more or less malabsorptive component. Several different bypass procedures exist alongside each other today and each type of bypass is performed using a distinct technique. Furthermore, the length of the bypassed intestine may differ as well. One might add that the operations are performed differently in different parts of the world and have been changing and evolving over time. This review evaluates the most frequently performed bariatric bypass procedures (and their variations) worldwide: Roux-en-Y Gastric Bypass, One-Anastomosis Gastric Bypass, Single-Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy, Biliopancreatic Diversion + Duodenal Switch and operations due to weight regain. The evaluation of the procedures and different limb lengths focusses on weight loss, remission of comorbidities and the risk of malnutrition and deficiencies. This narrative review does not aim at synthesizing quantitative data. Rather, it provides a summary of carefully selected, high-quality studies to serve as examples and to draw tentative conclusions on the effects of the bypass procedures mentioned above. In conclusion, it is important to carefully choose the procedure and small bowel length excluded from the food passage suited best to each individual patient. A balance has to be achieved between sufficient weight loss and remission of comorbidities, as well as a low risk of deficiencies and malnutrition. In any case, at least 300 cm of small bowel should always remain in the food stream to prevent the development of deficiencies and malnutrition

Surgical Technique of Single Anastomosis Duodeno-Ileal Bypass With Sleeve Gastrectomy (Sadi-S)

Laparoscopic Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) is a bariatric/metabolic procedure that has been gaining popularity in recent years. SADI-S strongly affects the secretion of various gut hormones, adipocytokines and incretins. From a mechanistic point of view, the operation combines malabsorption and restriction, and has been shown to have a long-lasting and significant impact on weight loss and remission of comorbidities. With regard to the technique, first, a Sleeve is created and then the duodenum is tran-sected approximately 3-4cm after the pylorus at the level of the gastroduodenal artery (GDA). Next, 250-300cm of small bowel is measured from the caecum and a hand-sewn duo-deno-ileal anastomosis is performed. The length of the biliopancreatic limb is variable in this procedure. Because of the standardized common limb length in all patients, weight loss is very precise within a low range. Nevertheless, due to the complex hand-sewn anastomosis and the delicacy necessary when handling the duodenum, this procedure should be reserved for experienced bariatric surgeons in specialized centers. This article provides an overview of the standard surgical technique at the Department of Visceral Surgery at the Medical University of Vienna, as well as information about patient selection and pre- and postoperative care

Gender and age-specific aspects of awareness and knowledge in basic life support

<div><p>Background</p><p>The ‘chain of survival’—including early call for help, early cardiopulmonary resuscitation (CPR) and early defibrillation—represents the most beneficial approach for favourable patient outcome after out-of-hospital cardiac arrest (OHCA). Despite increasing numbers of publicly accessible automated external defibrillators (AED) and interventions to increase public awareness for basic life support (BLS), the number of their use in real-life emergency situations remains low.</p><p>Methods</p><p>In this prospective population-based cross-sectional study, a total of 501 registered inhabitants of Vienna (Austria) were randomly approached via telephone calls between 08/2014 and 09/2014 and invited to answer a standardized questionnaire in order to identify public knowledge and awareness of BLS and AED-use.</p><p>Results</p><p>We found that more than 52 percent of participants would presume OHCA correctly and would properly initiate BLS attempts. Of alarming importance, only 33 percent reported that they would be willing to perform CPR and 50 percent would use an AED device. There was a significantly lower willingness to initiate BLS attempts (male: 40% vs. female: 25%; OR: 2.03 [95%CI: 1.39–2.98]; p<0.001) and to use an AED device (male: 58% vs. female: 44%; OR: 1.76 [95%CI: 1.26–2.53]; p = 0.002) in questioned female individuals compared to their male counterparts. Interestingly, we observed a strongly decreasing level of knowledge and willingness for BLS attempts (-14%; OR: 0.72 [95%CI: 0.57–0.92]; p = 0.027) and AED-use (-19%; OR: 0.68 [95%CI: 0.54–0.85]; p = 0.001) with increasing age.</p><p>Conclusion</p><p>We found an overall poor knowledge and awareness concerning BLS and the use of AEDs among the Viennese population. Both female and elderly participants reported the lowest willingness to perform BLS and use an AED in case of OHCA. Specially tailored programs to increase awareness and willingness among both the female and elderly community need to be considered for future educational interventions.</p></div

The impact of a high-quality basic life support police-based first responder system on outcome after out-of-hospital cardiac arrest.

BACKGROUND:Laypersons' efforts to initiate basic life support (BLS) in witnessed Out-of-Hospital Cardiac Arrest (OHCA) remain comparably low within western society. Therefore, in order to shorten no-flow times in cardiac arrest, several police-based first responder systems equipped with automated external defibrillators (Pol-AED) were established in urban areas, which subsequently allow early BLS and AED administration by police officers. However, data on the quality of BLS and AED use in such a system and its impact on patient outcome remain scarce and inconclusive. METHODS:A total of 85 Pol-AED cases were randomly assigned to a gender, age and first rhythm matched non-Pol-AED control group (n = 170) in a 1:2 ratio. Data on quality of BLS were extracted via trans-thoracic impedance tracings of used AED devices. RESULTS:Comparing Pol-AED cases and the control group, we observed a similar compression rate per minute (p = 0.677) and compression ratio (p = 0.651), mirroring an overall high quality of BLS administered by police officers. Time to the first shock was significantly shorter in Pol-AED cases (6 minutes [IQR: 2-10] vs. 12 minutes [IQR: 8-17]; p<0.001). While Pol-AED was not associated with increased sustained return of spontaneous circulation (p = 0.564), a strong and independent impact on survival until hospital discharge (adj. OR: 1.85 [95%CI: 1.06-3.23; p = 0.030]) and a borderline significance for the association with favorable neurological outcome (adj. OR: 1.58 [95%CI: 0.96-2.89; p = 0.052) were observed. CONCLUSION:We were able to demonstrate an early start and a high quality of BLS and AED use in Pol-AED assessed OHCA cases. Moreover, the presence of Pol-AED care was associated with better patient survival and borderline significance for favorable neurological outcome

Sex‑Specifc Diferences in Mortality of Patients with a History of Bariatric Surgery: a Nation‑Wide Population‑Based Study

Purpose Bariatric surgery reduces mortality in patients with severe obesity and is predominantly performed in women. Therefore, an analysis of sex-specific differences after bariatric surgery in a population-based dataset from Austria was performed. The focus was on deceased patients after bariatric surgery. Materials and Methods The Austrian health insurance funds cover about 98% of the Austrian population. Medical health claims data of all Austrians who underwent bariatric surgery from 01/2010 to 12/2018 were analyzed. In total, 19,901 patients with 107,806 observed years postoperative were eligible for this analysis. Comorbidities based on International Classification of Diseases (ICD)-codes and drug intake documented by Anatomical Therapeutical Chemical (ATC)-codes were analyzed in patients deceased and grouped according to clinically relevant obesity-associated comorbidities: diabetes mellitus (DM), cardiovascular disease (CV), psychiatric disorder (PSY), and malignancy (M). Results In total, 367 deaths were observed (1.8%) within the observation period from 01/2010 to 04/2020. The overall mortality rate was 0.34% per year of observation and significantly higher in men compared to women (0.64 vs. 0.24%; p < 0.001(Chi-squared)). Moreover, the 30-day mortality was 0.19% and sixfold higher in men compared to women (0.48 vs. 0.08%; p < 0.001). CV (82%) and PSY (55%) were the most common comorbidities in deceased patients with no sex-specific differences. Diabetes (38%) was more common in men (43 vs. 33%; p = 0.034), whereas malignant diseases (36%) were more frequent in women (30 vs. 41%; p = 0.025). Conclusion After bariatric surgery, short-term mortality as well as long-term mortality was higher in men compared to women. In deceased patients, diabetes was more common in men, whereas malignant diseases were more common in women