A rapid rise in laparoscopic sleeve gastrectomy (SG) has occurred in the field of bariatric surgery over the past several years such that it is now the most common procedure performed in the United States. Bariatric surgery patients (n=35,477) from 32 hospitals during the years 2006 through 2012. Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan bariatric surgery collaborative. Methods: This qualitative study evaluated 10 video coaching conversations between 20 bariatric surgeons at the Michigan Bariatric Surgery Collaborative meeting in October 2015. the Michigan Bariatric Surgery Collaborative (MBSC), a payer-funded consortium of hospitals and surgeons performing bariatric surgery in Michigan.13,14 The MBSC includes all 40 Michi- gan hospitals engaged in bariatric surgery and ... (deep-vein thrombosis or pulmonary embolism), myocardial infarction, cardiac arrest, and death. DecisionTools. 25. Even in well-designed cohort studies such as the Michigan Bariatric Surgery Collaborative Study, data for the clinical registry is collected via medical record review, 9,10 which would allow most intraoperative events to go undocumented unless specifically noted in the medical record by the surgical team. Patients undergoing bariatric surgery are at increased risk for VTE. The overall incidence of clinically evident deep venous thrombosis ( DVT) was 1.6% ... Data from the Michigan Collaborative of 3 ,464 patients on ... VTE is a challenging problem after bariatric surgery but there are few randomized controlled trials Collaborative Quality Initiatives The CQI component is weighted between 10 percent and 20 percent. Patients undergoing bariatric surgery for morbid obesity are at increased risk for VTE in the perioperative period . The Michigan Medicine Adult Bariatric Surgery Program offers a comprehensive, personalized weight loss surgery program designed to help patients reach their goals. doi: 10.1097/SLA.0b013e318230058c. However, our study lacked statistical power to prove harms associated with this practice. Since the publication of our prior study, the use of IVC filters in bariatric surgery has decreased significantly in Michigan. PATIENTS: Bariatric surgery patients (n535,477) from 32 hospitals during the years 2006 through 2012. Ann Surg 2012; 255:1100–1104. Michigan Bariatric Surgery Collaborative (MBSC) •Research group that collects data on bariatric patients across the state of Michigan. Birkmeyer JD, Finks JF, O'Reilly A, Oerline M, Carlin AM, Nunn AR, et al. Finks JF, Kole KL, Yenumula PR, et al. The modern iteration of this model is the Michigan Bariatric Surgery Collaborative (MBSC). The Michigan Bariatric Surgery Collaborative aims to advance the science and practice of bariatric surgery. The Michigan Bariatric Surgery Collaborative (MBSC) published the largest series to date regarding the efficacy of preoperative IVC filters in gastric bypass patients. The Michigan Bariatric Surgery Collaborative study, which was conducted to compare different types of thromboprophylaxis, showed that low-molecular-weight heparin (LMWH) was superior to unfractionated heparin (UFH) for thromboprophylaxis after bariatric surgery with a similar risk of bleeding . 35 The risk is even higher if 30-day postdischarge rates are considered. If you're already an ASMBS member, you can sign in to view it. Predicting risk for serious complications with bariatric surgery: results from the Michigan bariatric surgery collaborative. • Michigan Bariatric Surgery Collaborative • Michigan Surgical Quality Collaborative . They found that there was no difference in the rates of VTE, serious complications and death or permanent disability [ 26 ]. The content of this resource is only available to logged-in ASMBS members. The MBSC has developed a Bariatric Surgery Outcomes Calculator that can predict a patient's individual weight loss, comorbidity resolution and complication rate after bariatric surgery. The vast majority of patients with venous thromboembolism (VTE) are treated with anticoagulants, which effectively stop the abnormal clotting process and thereby prevent progression of deep vein thrombosis (DVT) as well as pulmonary embolism (PE) and recurrent VTE. Specific " Cardiac/Stroke, Pneumonia, DVT/PE, UTI, Renal Failure, Sepsis . efficacy and safety in the prevention of VTE prophylaxis in bariatric surgery patients; rather, most of them involved medically ill hospitalized obese patients (23). 10. Finks JF, English WJ, Carlin AM, et al. Birnie DH, et al. Ann Surg. Birkmeyer NJ, et al. MBSC Outcomes Calculator. the Michigan Bariatric Surgery Collaborative. Michigan Bariatric Surgery Collaborative. We analyzed data from 25,469 patients undergoing bariatric surgery between June 2006 and December 2010. Assistant Professor of Surgery. But these shots are painful and expensive, and can cause bleeding on their own. Birkmeyer JD, Finks JF, O’Reilly A, et al. N … Ann Surg 2012;255:1100–4. Using grounded theory approach, the coaching encounter transcripts were coded in an iterative process with comparative analysis in order to identify emerging themes. 2011; 254 : 633-640 Crossref Michigan Bariatric Surgery Collaborative Improving outcomes and reducing costs in bariatric surgery John Birkmeyer, MD Professor of Surgery Co-Director, MBSC – A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 3d2c23-MzI2N The program is a unique partnership between Blue Cross Blue Shield of Michigan, researchers at the University of Michigan, and clinicians from 39 bariatric surgery programs across the state.1. 252, Number 2, August 2010. Acute renal failure, MI, DVT LE , DVT UE, Systemic sepsis. MSQC is a collaborative of Michigan hospitals dedicated to overall surgical quality improvement, including better patient care and lower costs. Our goal is simple: we work to make Michigan the best place for surgery in the country. 7. These coaching sessions are a side project of the Michigan Bariatric Surgery Collaborative (MBSC), an initiative between Blue Cross Blue Shield of Michigan, the University of Michigan Health System, 38 other hospitals and close to 70 bariatric surgeons statewide. Birkenmeyer et al., using The Michigan Bariatric Surgery Collaborative, conducted an observational cohort study to compare different methods of … MSQC is a true collaboration. Major risk factors for venous thromboembolism (VTE) include obesity and surgery. Prophylactic IVC filter insertion. The Michigan Bariatric Surgery Collaborative (MBSC), a state-wide quality improvement consortium that includes all 32 bariatric programs in the state of Michigan, recently published data comparing the efficacy and bleeding risk associated with the 3 dominant VTE prophylaxis strategies used by its members [11]. NEJM 2013;368:2084-2093. Predicting risk for serious complications with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Reports from the Michigan Collaborative of 3,464 patients on dual therapy showed a 1.7% risk of VTE with laparoscopic vs. 0.5% for right colectomy. Reduction in DVT: 45%. In an evaluation of risk factors for perioperative events following 25,469 bariatric procedures in the Michigan Bariatric Surgery Collaborative (MBSC) database , only 22 patients suffered a myocardial infarction or cardiac arrest (0.1 %) . The Michigan Bariatric Surgery Collaborative is a regional group of hospitals and surgeons that perform bariatric surgery in Michigan. Annals of Surgery, Vol. Formed in 2006, the collaborative slowly gained acceptance by most of the surgeons/programs in Michigan. According to a study from the Michigan Bariatric Surgery Collaborative, which predicts the risk of VTE with bariatric surgery, the most significant risk factor is procedure type, with duodenal switch carrying the highest risk for VTE Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. ASMBS Updated Position Statement on Prophylactic Measures to Reduce the Risk of Venous Thromboembolism in Bariatric Surgery Patients. The goals and objectives of MBSC include:2. Patients Twenty-four thousand seven hundred seventy-seven patients undergoing bariatric surgery between 2007 and 2012. MBSC Data Registry. developed the Michigan Bariatric Surgery Collaborative (MBSC) VTE risk calcula- Ann Surg. David S. Tichansky 1 and Ranjan Sudan 2 (1) Department of Surgery, Thomas Jefferson University Hospital, 211 S. 9th … The analysis included 24,775 Ann Surg. Hospital complication rates with bariatric surgery in Michigan. Tennessee Surgical Quality Collaborative ' 5-year reduction in surgical. A retrospective cohort study showed that bariatric patients had a mean of 3.4 risk factors (ranging from 2 to 7 factors) for the development of VTE . Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan bariatric surgery collaborative. This study is based on analysis of data from the Michigan Bariatric Surgery Collaborative (MBSC). One of the largest studies to date evaluating chemical prophylaxis was performed by the Michigan Bariatric Surgery Collaborative (MBSC), which evaluated 24,775 patients who underwent bariatric surgery between 2007 and 2012. Moller et al found that smoking cessation 6 to 8 weeks prior to surgery reduced the overall complication rate from 52% for those who continued smoking to 18%. Status Quo Data collection Analysis Reporting Vendor Society / coordinating center ... DVT LE , DVT UE, Systemic sepsis. ! However comparison data suggests that LMWH may be more effective than UFH for prevention of VTE among bariatric surgery patients. INTERVENTION. Crossref The incidence of VTE, presenting as deep vein thrombosis (DVT) or pulmonary embolism (PE), after bariatric surgery has been reported at between 0.5 and 2% , , .There is at present no consensus as to which prophylactic regimen is best for bariatric surgery patients in the peri-operative period, … Nabeel R. Obeid, MD FACS. Bariatric Surgeons. Finks JF, Kole KL, Yenumula PR, et al. Finks JF, English WJ, Carlin AM, et al. A study was conducted by the Michigan Bariatric Surgery Collaborative comparing VTE prophylaxis strategies. Preoperative Placement of Inferior Vena Cava Filters and Outcomes after Gastric Bypass Surgery, for Michigan Bariatric Surgery Collaborative. Among a group of patients undergoing colon surgery with or without cancer, there is a reduction in VTE using a combination of pneumatic compression intermittently and chemoprophylaxis. 2012;255(6):1100–1104. CMS Bariatric Surgery 2006. 2012; 255 : 1100-1104 Crossref If you are struggling to lose weight, are over the age of 18 years old, and are willing to make a lifelong commitment to your health, weight loss surgery may be for you. Ann Surg. INTERVENTION: Prophylactic IVC filter insertion. In the Michigan Bariatric Surgery Collaborative, the CSA technique was associated with a significantly higher rate of bleeding compared with HSA and linear stapled gastrojejunostomy [13]. Disclosures • AHRQ K08HS025778 • Medtronic - research funding • NIH (Co-I) R01DK115408. Birkmeyer NJ, Dimick JB, Share D, Hawasli A, et al. It appears as if the CSA technique is inherently associated with a higher rate of bleeding. 2011; 254 (4):633–640. pulmonary embolism among bariatric surgery patients. The overall incidence of clinically evident deep venous thrombosis (DVT) was 1.6% without prophylaxis. Download PDF Document. 2013;369:1434–1442 Book Chapters By OSSI Members August 21, 2015, Traverse City, Michigan- 8th Annual Michigan Bariatric Society Meeting . Finks JF, English WJ, Carlin AM, Krause KR, Share DA, Banerjee M, et al. The Michigan Bariatric Surgery Collaborative is supported by an unrestricted longitudinal research contract from Blue Cross and Blue Shield of Michigan and Blue Care Network. Hospitals are evaluated on their participation in the following six CQI programs: • Blue Cross Blue Shield of Michigan Cardiac Consortium (BMC2) • Michigan Cardiac Surgery Collaborative Initiative • Michigan Bariatric Surgery Collaborative Finks JF, Kole KL, Yenumula PR, et al. 2011;254(4):633–40. Sapala JA, Wood MH, Schuhknecht MP, Sapala MA. September 12, 2014 – Annual Meeting. Ann Surg. Reportedrates of VTE following bariatric surgery are 0.2% to 3.5% with ratesof PE up to 1.2%.1–10Although recent studies point to a decline inrates of VTE in bariatric surgery patients,7 PE remains in the top 3 N Engl J Med. Predicting risk for serious complications with bariatric surgery: results from the Michigan bariatric surgery collaborative. The Michigan Medicine Adult Bariatric Surgery Program offers a comprehensive, personalized weight loss surgery program designed to help patients reach their health goals. developed the Michigan Bariatric Surgery Collaborative (MBSC) VTE risk calcula- Significant risk factors for a VTE identified by the Michigan Bariatric Surgery Collaborative included previous VTE, male gender, extended OR time, BMI, age, and procedure type. Major cardiac events remain a major cause of perioperative mortality. Predictive tools in surgery have become increasingly rel-evant given the emphasis placed on shared decision-making and informed consent. Thus all patients are atleast at a moderate to high risk for VTE. Our surgeons participate in the Michigan Bariatric Surgery Collaborative (MBSC), a state-wide program aimed at continually improving the safety of bariatric surgery. Ann Surg. JAMA 2010;304:435-442. complications: 19.7% Estimated lives saved: 533 Savings: $75.2 Million. MSQC is a collaborative of Michigan Hospitals dedicated to overall surgical quality improvement, including better patient care and lower costs. PATIENTS. Finks JF, English WJ, Carlin AM, et al. Data from a state-wide quality improvement collaborative for bariatric surgery demonstrated that preoperative placement of an IVC filter before performance of gastric bypass surgery was not associated with a reduction in the rate of PE (0.84% versus 0.46%; odds ratio 2.0; 95% confidence interval (CI) 0.6–6.5).10 Gastric Information collected includes preoperative patients characteristics as well as perioperative clinical care and outcomes. References Definitions of high risk Bariatric patient groups Pharmacologic prophylaxis Outcomes Frezza et al. Across the Collaborative Dana A. Telem MD MPH Chief, Division of Minimally Invasive and Bariatric Surgery Associate Chair for Clinical Affairs Associate Professor of Surgery University of Michigan. Predicting risk for serious complications with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Injection of heparin in the perioperative period can reduce that risk. Although rare, it has been suggested that portomesenteric venous thrombosis (PVT) may be more prevalent after bariatric surgery. For this study, we identified all patients undergoing primary bariatric surgery between June 2006 and April 2011 and determined rates of VTE. Abigail Gaies | April 17, 2017. 1. [47] BMI 50 kg/m2, prior DVT or PE, prior pelvic surgery, cardiac failure High risk + IVCF, n = 15 Preop—LV 2 mg/kg SQ × 1 or UFH 7,000 U SQ × 1 No PE or DVT High risk + intraop UFH, n = 9 POD#1—LV 1.5–2 mg/kg SQ BID × 15 days then Coumadin… 2 In addition, percutaneous insertion of a vena cava filter (VCF) has been used for more than 40 years in selected … Bariatric surgery is commonly performed in patients with severe obesity (BMI ≥40 to 50 kg/m 2) and is associated with an in-hospital postoperative risk of VTE of up to 2.2%. Michigan Bariatric Surgery Collaborative Experience (Birkmeyer NJO, et al.Ann Surg2010;252: 313–318) 542 patients had IVC filters placed for PE prophylaxis prior to bariatric surgery Patients in the IVC filter group tended to be older, male, heavier, to have problems with mobility, and to have a history of VTE Pacemaker or Defibrillator Surgery without Interruption of Anticoagulation. The Caprini VTE risk score [18, 19] is widely used to determine the risk of VTE after a surgical procedure, and in 2012 Finks et al. The Percutaneous Cardiology Intervention CQI reduced in-hospital death by a relative 27%. MEASUREMENTS. Hospitals and surgeons statewide to benefit from real-time performance feedback and clinical decision support. Bariatric Risks Higher at Centers of Excellence . Ann Surg 2012;255:1100–4. The ASMBS Textbook of Bariatric Surgery 10.1007/978-1-4939-1206-3_7. Questions . Leaders of the Michigan Bariatric Surgery Collaborative have developed a way to teach practicing surgeons how to perform their operations better. "Weigh the Odds". The Michigan Bariatric Surgery Collaborative (MBSC) and the Michigan Surgical Quality Collaborative(MSQC) have selected ArborMetrix, a provider of real-time, cloud-based analytics solutions for acute and specialty care,to help accelerate their surgical care quality improvement efforts. Article Google Scholar 26. undergoing bariatric surgery in the State of Michigan through regional collaboration in a robust clinical outcomes registry and quality improvement program. Thus all patients are atleast at a moderate to high risk for VTE. Introduction. 2012; 255:1100–4. Michigan Bariatric Surgery Collaborative Experience” Nancy J.O. Data from Michigan Bariatric Surgery Collaborative reveals sleeve gastrectomy outpacing gastric bypassIn an analysis of the type of bariatric surgery… surgery, bariatric surgery has the lowest rate and splenectomy the highest.3 46% of the world’s 400 million obese people are from the developing world.4 Surgical risk The positive pressure during laparoscopic inflation has been associated with oxidative stress during surgery which, in turn, will cause endothelial Preoperative Care of the Bariatric Patient. Publish date: March 1, 2010 By Damian McNamara BACKGROUND AND AIM: Laparoscopic sleeve gastrectomy (LSG) is actually the most performed bariatric procedures in the world, and porto-mesenteric vein thrombosis (PVT) has been increasingly reported as a rare but serious complication. thromboembolism (VTE), including pulmonary embolism(PE) and deep vein thrombosis (DVT), remains a significantcause of mortality and morbidity after bariatric surgery. Ann Surg 2011;254: 633-640. Our bariatric surgeons are specialized in minimally-invasive techniques (laparoscopic surgery). Collaborative in general surgery patients by ACCP found reduced risk of asymptomatic proximal or distal DVT by 48%, symptomatic proximal DVT by 59%, and PE by 57% Data with moderate heterogeneity, no blinding in two studies, inconsistent outcomes, imprecision in RR of bleeding, and six studies used fibrinogen scanning for surveillance METHODS: The Michigan Bariatric Surgery Collaborative is a statewide consortium of hospitals and surgeons, which maintains an externally-audited prospective clinical registry. Smoking cessation prior to surgery can be helpful in reducing complication rates. The Michigan Bariatric Surgery Collaborative has reduced complications from 8.7% to 6.6%. Formed in 2005, MBSC aims to innovate the science and practice of metabolic and bariatric surgery through comprehensive, lifelong, patient-centered obesity care-in Michigan and across the United States. Setting The Michigan Bariatric Surgery Collaborative, a statewide clinical registry and quality improvement program. [Google Scholar] Besides leaks, deep vein thrombosis and pulmonary embolism (blood clots) is one of the most feared complications after weight loss surgery. Patients undergoing bariatric surgery for morbid obesity are at increased risk for VTE in the perioperative period . The Michigan Arthroplasty Registry Collaborative Quality Initiative has implemented initiatives to reduce transfusions and prevent deep vein thrombosis (DVT), pulmonary embolism, infections, and readmissions. A retrospective cohort study showed that bariatric patients had a mean of 3.4 risk factors (ranging from 2 to 7 factors) for the development of VTE . Published July 2013. Birkmeyer, PhD “Risk Modeling Using Large Datasets: An examination of VTE after outpatient surgery” Chris Pannucci, MD MS . The Caprini VTE risk score [18, 19] is widely used to determine the risk of VTE after a surgical procedure, and in 2012 Finks et al. Michigan Bariatric Surgery Collaborative. ; Michigan Bariatric Surgery Collaborative . However, the data concerning appropriate thromboprophylaxis after bariatric surgery is uncertain. Participating hospital submit data from a review of medical records on all patients undergoing bariatric surgery. Predictive tools in surgery have become increasingly rel-evant given the emphasis placed on shared decision-making and informed consent. Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. Background: While consistently recommended, the significance of early ambulation after surgery has not been definitively studied. Objective: To identify the relationship between ambulation on the day of surgery (postoperative day (POD)#0) and 90-d adverse events after lumbar surgery. Methods: The Michigan Bariatric Surgery Collaborative maintains a prospective clinical registry of bariatric surgery patients. Predicting risk for venous thromboembolism with bariatric surgery: results from the Michigan Bariatric Surgery Collaborative. CAG-00250R Bariatric Surgery Decision Memo 2006 (link provided) As described in greater detail elsewhere, the MBSC is a regional consortium of hospitals and surgeons performing bariatric surgery in Michigan.18,19 The MBSC now enrolls more than 95% of … Methods: We analyzed data from the prospective, statewide clinical registry of the Michigan Bariatric Surgery Collaborative. The Michigan Bariatric Surgery Collaborative (MBSC), a state-wide quality improvement consortium that includes all 32 bariatric programs in the state of Michigan, recently published data comparing the efficacy and bleeding risk associated with the 3 dominant VTE prophylaxis strategies used by its members [11]. DVT (0.22%), PE (0.2%) & Portal vein thrombosis (0.04%) PVT usually presents as abdominal pain 1-4 weeks after sleeve gastrectomy Can potentially result in intestinal gangrene Only known risk factor is h/o prior DVT From Michigan Bariatric Surgery Collaborative The prospective, statewide, clinical registry of the Michigan Bariatric Surgery Collaborative. Two of Michigan’s bariatric surgeons meet at one of the sessions. The ideal method of prophylaxis for VTE complications in bariatric surgery has yet to be elucidated. Patients undergoing bariatric surgery are considered at moderate to high risk for having thrombotic complications. Published literature varies widely on optimal guidelines for the prevention of perioperative VTE events. Photo Courtesy Justin Dimick. Quarterly Michigan Bariatric Surgery Collaborative (MBSC) meetings sharing best practices, discussing challenging cases, building collegiality among clinicians and surgeons; beginning video coaching study The best algorithm for PVT's prevention and therapy is still under discussion. Surgical skill and complication rates after bariatric surgery. We are multidisciplinary and inclusive as we work together to transform surgical quality and deliver care that is cost effective. Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a known cause of morbidity and mortality after bariatric surgery.

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