PRATEEK GUPTA - Academia.edu (original) (raw)
Papers by PRATEEK GUPTA
Journal of Vascular Surgery, 2011
Surgical Endoscopy and Other Interventional Techniques, 2011
Background Outcomes for patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) surger... more Background Outcomes for patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery have improved, but a subset of patients who significantly utilize more resources exists. We identified preoperative variables that increase resource utilization in patients who undergo LRYGB. Methods Patients who underwent LRYGB in 2007 and 2008 were identified from the NSQIP database. Variables that indicated resource utilization were operative time (OT), length of stay (LOS), and occurrence of postoperative complications. Analyses were performed by using multivariate analysis of variance and logistic regression. Results Of 14,251 patients with a mean age of 44.6 (±11.1) years, 19.4% were men. The national 30-day morbidity and mortality were 4.5% and 0.17%, respectively. The median OT was 128 min (interquartile range (IQR), 100–167), and the median LOS was 2 days (IQR, 2–3). Bleeding disorder, male gender, African American race, increasing weight, and age were significantly associated with increased OT (p < 0.05 for all). Severe chronic obstructive pulmonary disease, bleeding disorder, increasing age, and anesthesia time were associated with increased length of stay (p < 0.05). Preoperative dialysis dependence (odds ratio (OR), 8.5; 95% confidence interval (CI), 2.3–32.3) and dyspnea at rest (OR, 3.3; 95% CI, 1.7–6.3) were the greatest predictors of postoperative complications. Emergency case, bleeding disorder, prior percutaneous coronary intervention, and increasing operative time also were significantly associated with increased postoperative complications on multivariate logistic regression analysis (p < 0.05 for all). Conclusions Age, sex, race, obesity, and some medical comorbidities affect outcomes and increase resource utilization. Optimization of modifiable factors and careful patient selection are needed to facilitate further improvement in outcomes and resource utilization.
Pharmaceuticals, 2009
Over the last few decades, treatment for aortic dissection and thoracic aortic aneurysms has evol... more Over the last few decades, treatment for aortic dissection and thoracic aortic aneurysms has evolved significantly with improvement in outcomes. Treatment paradigms include medical, endovascular and surgical options. As aortic dissection presents as a hypertensive emergency, diligent control of BP is of utmost importance in order to reduce the progression of dissection with possible aortic branch malperfusion. Treatment should begin on arrival to the emergency department and continues in the intensive care unit, endovascular suite or the operating room. Novel antihypertensive medications with improved pharmacological profile and improved surgical techniques, have improved the prognosis of patients with aortic aneurysm and/or aortic dissection. Nevertheless, morbidity and mortality remain high and hypertensive emergency poses a significant challenge in aortic dissection and thoracic aortic aneurysms.
Surgery for Obesity and Related Diseases
Background: Postoperative pneumonia (PP) and respiratory failure (PRF) are known to be the most c... more Background: Postoperative pneumonia (PP) and respiratory failure (PRF) are known to be the most common nonwound complications after bariatric surgery. Our objective was to identify their current prevalence after bariatric surgery and to study the preoperative factors associated with them using data from the American College of Surgeons' National Surgical Quality Improvement Program. Methods: Patients undergoing bariatric surgery were identified from the National Surgical Quality Improvement Program (2006 -2008), a multicenter, prospective database. Univariate analysis and multivariate logistic regression analysis were performed. Results: Of 32,889 patients, PP was diagnosed in 187 patients (.6%) and PRF in 204 patients (.6%). The overall 30-day morbidity rate was 6.4%, with PP and PRF accounting for 18.7%. The 30-day mortality rate was greater for the patients with PP and PRF than those without (4.3% versus .16% and 13.7% versus .10%, P Ͻ .0001). The hospital length of stay was also longer in patients with PP/PRF (P Ͻ .0001). On multivariate analysis, congestive heart failure (odds ratio 5.3, 95% confidence interval 1.20 -23.26) and stroke (odds ratio 4.1, 95% confidence interval 1.42-11.49) were the greatest preoperative risk factors for PP. Previous percutaneous coronary intervention (odds ratio 2.8, 95% confidence interval 1. 64 -4.74) and dyspnea at rest (odds ratio 2.64, 95% confidence interval 1.13-6.13) were the factors most strongly associated with PRF. Bleeding disorder, age, chronic obstructive pulmonary disease, and type of surgery were risk factors for both (P Ͻ .05). Smoking also predisposed to PP, and diabetes mellitus, anesthesia time, and increasing weight also predisposed to PRF (P Ͻ .05 for all). Conclusion: Although PP and PRF are infrequent, they account for one fifth of the postoperative morbidity and are associated with significantly increased 30-day mortality. They can be predicted by various risk factors, emphasizing the importance of patient optimization and careful selection before bariatric surgery. (Surg Obes Relat Dis 2011;xx:xxx.)
Journal of Vascular Surgery, 2011
Objectives: Complex EVAR involving fenestrated and branched endografts, is associated with signif... more Objectives: Complex EVAR involving fenestrated and branched endografts, is associated with significant post operative complications. Increased use of iodinated contrast medium is associated with post operative contrast medium induced renal dysfunction and renal failure. We describe the use of CO2 as the primary contrast agent in patients undergoing complex EVAR.
Journal of Vascular Surgery, 2011
tical 8-year all cause survival despite higher secondary intervention with EVAR. Cardiovascular b... more tical 8-year all cause survival despite higher secondary intervention with EVAR. Cardiovascular burden is more treacherous than neoplasm.
Journal of The American College of Surgeons, 2011
BACKGROUND: While the epidemic of obesity continues to plague America, bariatric surgery is under... more BACKGROUND: While the epidemic of obesity continues to plague America, bariatric surgery is underused due to concerns for surgical risk among patients and referring physicians. A risk score estimating postoperative mortality (OS-MRS) exists, however, is limited by consideration of only 12 preoperative variables, failure to separate open and laparoscopic cases, a lack of robust statistical analyses, risk factors not being weighted, and being applicable to only gastric bypass surgery. The objective of this study was to develop a validated risk calculator for 30-day postoperative mortality after bariatric surgery. STUDY DESIGN: The National Surgical Quality Improvement Program (NSQIP) dataset (2006 to 2008) was used. Patients undergoing bariatric surgery for morbid obesity (n ϭ 32,889) were divided into training (n ϭ 21,891) and validation (n ϭ 10,998) datasets. Multiple logistic regression analysis was performed on the training dataset. The model fit from the training dataset was maintained and was used to estimate mortality probabilities for all patients in the validation dataset.
Surgical Endoscopy and Other Interventional Techniques, 2011
Background Laparoscopic adrenalectomy (LA) has become the standard of care for many conditions re... more Background Laparoscopic adrenalectomy (LA) has become the standard of care for many conditions requiring removal of the adrenal gland. Previous studies on outcomes after LA have had limitations. This report describes the 30-day morbidity and mortality rates after LA and analyzes factors affecting operative time, hospital length of stay (LOS), and postoperative morbidity. Methods Patients undergoing LA in 2007and 2008 were identified from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP). Using multivariate analysis of variance (ANOVA) and logistic regression, 52 demographic/comorbidity variables were analyzed to ascertain factors affecting operative time, LOS, and morbidity. Results The mean age of the 988 patients was 53.5 ± 13.7 years, and 60% of the patients were women. The mean body mass index (BMI) of the patients was 31.8 ± 7.9 kg/m2. The 30-day morbidity and mortality rates were 6.8% and 0.5%, respectively. The mean and median operative times were 146.7 ± 66.8 min and 134 min, respectively. The mean and median hospital stays were 2.6 ± 3.1 days and 2 days, respectively. Compared with independent status, totally dependent functional status was associated with a 9.5-day increase in LOS (P = 0.0006) and an increased risk for postoperative morbidity (odds ratio [OR], 14.7; 95% confidence interval [CI], 2.4–91.9; P < 0.0001). Peripheral vascular disease (OR, 7.3; 95% CI, 1.7–31.7; P = 0.008) also was associated with increased 30-day morbidity. Neurologic and respiratory comorbidities were associated with increased LOS (P < 0.05). American Society of Anesthesiology (ASA) class 4 patients had a longer operative time than ASA class 1 patients (P = 0.002). Conclusions The morbidity and mortality rates after LA are low. Dependent functional status and peripheral vascular disease predispose to postoperative morbidity. Dependent status, higher ASA class, and respiratory and neurologic comorbidities are associated with longer operative time and LOS.
Journal of Vascular Surgery, 2011
Surgical Endoscopy and Other Interventional Techniques, 2011
Background Outcomes for patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) surger... more Background Outcomes for patients who undergo laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery have improved, but a subset of patients who significantly utilize more resources exists. We identified preoperative variables that increase resource utilization in patients who undergo LRYGB. Methods Patients who underwent LRYGB in 2007 and 2008 were identified from the NSQIP database. Variables that indicated resource utilization were operative time (OT), length of stay (LOS), and occurrence of postoperative complications. Analyses were performed by using multivariate analysis of variance and logistic regression. Results Of 14,251 patients with a mean age of 44.6 (±11.1) years, 19.4% were men. The national 30-day morbidity and mortality were 4.5% and 0.17%, respectively. The median OT was 128 min (interquartile range (IQR), 100–167), and the median LOS was 2 days (IQR, 2–3). Bleeding disorder, male gender, African American race, increasing weight, and age were significantly associated with increased OT (p < 0.05 for all). Severe chronic obstructive pulmonary disease, bleeding disorder, increasing age, and anesthesia time were associated with increased length of stay (p < 0.05). Preoperative dialysis dependence (odds ratio (OR), 8.5; 95% confidence interval (CI), 2.3–32.3) and dyspnea at rest (OR, 3.3; 95% CI, 1.7–6.3) were the greatest predictors of postoperative complications. Emergency case, bleeding disorder, prior percutaneous coronary intervention, and increasing operative time also were significantly associated with increased postoperative complications on multivariate logistic regression analysis (p < 0.05 for all). Conclusions Age, sex, race, obesity, and some medical comorbidities affect outcomes and increase resource utilization. Optimization of modifiable factors and careful patient selection are needed to facilitate further improvement in outcomes and resource utilization.
Pharmaceuticals, 2009
Over the last few decades, treatment for aortic dissection and thoracic aortic aneurysms has evol... more Over the last few decades, treatment for aortic dissection and thoracic aortic aneurysms has evolved significantly with improvement in outcomes. Treatment paradigms include medical, endovascular and surgical options. As aortic dissection presents as a hypertensive emergency, diligent control of BP is of utmost importance in order to reduce the progression of dissection with possible aortic branch malperfusion. Treatment should begin on arrival to the emergency department and continues in the intensive care unit, endovascular suite or the operating room. Novel antihypertensive medications with improved pharmacological profile and improved surgical techniques, have improved the prognosis of patients with aortic aneurysm and/or aortic dissection. Nevertheless, morbidity and mortality remain high and hypertensive emergency poses a significant challenge in aortic dissection and thoracic aortic aneurysms.
Surgery for Obesity and Related Diseases
Background: Postoperative pneumonia (PP) and respiratory failure (PRF) are known to be the most c... more Background: Postoperative pneumonia (PP) and respiratory failure (PRF) are known to be the most common nonwound complications after bariatric surgery. Our objective was to identify their current prevalence after bariatric surgery and to study the preoperative factors associated with them using data from the American College of Surgeons' National Surgical Quality Improvement Program. Methods: Patients undergoing bariatric surgery were identified from the National Surgical Quality Improvement Program (2006 -2008), a multicenter, prospective database. Univariate analysis and multivariate logistic regression analysis were performed. Results: Of 32,889 patients, PP was diagnosed in 187 patients (.6%) and PRF in 204 patients (.6%). The overall 30-day morbidity rate was 6.4%, with PP and PRF accounting for 18.7%. The 30-day mortality rate was greater for the patients with PP and PRF than those without (4.3% versus .16% and 13.7% versus .10%, P Ͻ .0001). The hospital length of stay was also longer in patients with PP/PRF (P Ͻ .0001). On multivariate analysis, congestive heart failure (odds ratio 5.3, 95% confidence interval 1.20 -23.26) and stroke (odds ratio 4.1, 95% confidence interval 1.42-11.49) were the greatest preoperative risk factors for PP. Previous percutaneous coronary intervention (odds ratio 2.8, 95% confidence interval 1. 64 -4.74) and dyspnea at rest (odds ratio 2.64, 95% confidence interval 1.13-6.13) were the factors most strongly associated with PRF. Bleeding disorder, age, chronic obstructive pulmonary disease, and type of surgery were risk factors for both (P Ͻ .05). Smoking also predisposed to PP, and diabetes mellitus, anesthesia time, and increasing weight also predisposed to PRF (P Ͻ .05 for all). Conclusion: Although PP and PRF are infrequent, they account for one fifth of the postoperative morbidity and are associated with significantly increased 30-day mortality. They can be predicted by various risk factors, emphasizing the importance of patient optimization and careful selection before bariatric surgery. (Surg Obes Relat Dis 2011;xx:xxx.)
Journal of Vascular Surgery, 2011
Objectives: Complex EVAR involving fenestrated and branched endografts, is associated with signif... more Objectives: Complex EVAR involving fenestrated and branched endografts, is associated with significant post operative complications. Increased use of iodinated contrast medium is associated with post operative contrast medium induced renal dysfunction and renal failure. We describe the use of CO2 as the primary contrast agent in patients undergoing complex EVAR.
Journal of Vascular Surgery, 2011
tical 8-year all cause survival despite higher secondary intervention with EVAR. Cardiovascular b... more tical 8-year all cause survival despite higher secondary intervention with EVAR. Cardiovascular burden is more treacherous than neoplasm.
Journal of The American College of Surgeons, 2011
BACKGROUND: While the epidemic of obesity continues to plague America, bariatric surgery is under... more BACKGROUND: While the epidemic of obesity continues to plague America, bariatric surgery is underused due to concerns for surgical risk among patients and referring physicians. A risk score estimating postoperative mortality (OS-MRS) exists, however, is limited by consideration of only 12 preoperative variables, failure to separate open and laparoscopic cases, a lack of robust statistical analyses, risk factors not being weighted, and being applicable to only gastric bypass surgery. The objective of this study was to develop a validated risk calculator for 30-day postoperative mortality after bariatric surgery. STUDY DESIGN: The National Surgical Quality Improvement Program (NSQIP) dataset (2006 to 2008) was used. Patients undergoing bariatric surgery for morbid obesity (n ϭ 32,889) were divided into training (n ϭ 21,891) and validation (n ϭ 10,998) datasets. Multiple logistic regression analysis was performed on the training dataset. The model fit from the training dataset was maintained and was used to estimate mortality probabilities for all patients in the validation dataset.
Surgical Endoscopy and Other Interventional Techniques, 2011
Background Laparoscopic adrenalectomy (LA) has become the standard of care for many conditions re... more Background Laparoscopic adrenalectomy (LA) has become the standard of care for many conditions requiring removal of the adrenal gland. Previous studies on outcomes after LA have had limitations. This report describes the 30-day morbidity and mortality rates after LA and analyzes factors affecting operative time, hospital length of stay (LOS), and postoperative morbidity. Methods Patients undergoing LA in 2007and 2008 were identified from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP). Using multivariate analysis of variance (ANOVA) and logistic regression, 52 demographic/comorbidity variables were analyzed to ascertain factors affecting operative time, LOS, and morbidity. Results The mean age of the 988 patients was 53.5 ± 13.7 years, and 60% of the patients were women. The mean body mass index (BMI) of the patients was 31.8 ± 7.9 kg/m2. The 30-day morbidity and mortality rates were 6.8% and 0.5%, respectively. The mean and median operative times were 146.7 ± 66.8 min and 134 min, respectively. The mean and median hospital stays were 2.6 ± 3.1 days and 2 days, respectively. Compared with independent status, totally dependent functional status was associated with a 9.5-day increase in LOS (P = 0.0006) and an increased risk for postoperative morbidity (odds ratio [OR], 14.7; 95% confidence interval [CI], 2.4–91.9; P < 0.0001). Peripheral vascular disease (OR, 7.3; 95% CI, 1.7–31.7; P = 0.008) also was associated with increased 30-day morbidity. Neurologic and respiratory comorbidities were associated with increased LOS (P < 0.05). American Society of Anesthesiology (ASA) class 4 patients had a longer operative time than ASA class 1 patients (P = 0.002). Conclusions The morbidity and mortality rates after LA are low. Dependent functional status and peripheral vascular disease predispose to postoperative morbidity. Dependent status, higher ASA class, and respiratory and neurologic comorbidities are associated with longer operative time and LOS.