by clinical and socio-demographic considerations to optimize effi-cacy and equity in bariatric surgery.

Healthcare provider estimates of height, weight,and body mass index: implications for research andpatient safetyKimberly Hendershot MD, Linda Robinson RN, MA, MS,Samir Fakhry MD, FACS, Jason Roland MD, Khashayar Vaziri MD,Kevin Dwyer MD, Hani Seoudi MDInova Regional Trauma Center, Inova Fairfax Hospital, FallsChurch, VA

INTRODUCTION: Research suggests that weight impacts patient careand outcomes. Health care professionals (HCP) frequently rely on pa-tient self-reports or HCP estimates of height and weight (H/W). The pur-pose of this study was to determine the accuracy of self-reported H/Wand HCP estimations of H/W and corresponding BMI classification.

METHODS: Attendings, residents and nurses provided H/W andBMI estimates for 93 trauma patients. Self-reported and measuredH/W were obtained with appropriate calibrated devices. PatientBMIs based on estimated H/W and measured H/W were calculated.Data were analyzed using descriptive statistics.

RESULTS: Weight estimates by HCPs were 49% accurate(� 10%) and ranged from 74 lbs under to 100 lbs over measuredweight. BMI classification by HCPs was 54% accurate. Estimateswere most likely to be correct when BMI was in normal range. Self-reports were 68% accurate, however 28% were unavailable due tolanguage or injury. Patient reports had the lowest margin of error, butresulted in BMI misclassification of 32%.

CONCLUSIONS: This study demonstrates that HCPs estimates ofH/W and BMI are highly inaccurate. Patient self-reports of H/W areonly marginally better. Objective measurements with calibrated in-struments are necessary for accuracy for research studies and patientsafety in clinical practice.

Post-operative hyperbilirubinemia is an independentpredictor of long term outcome after coronaryartery bypass surgeryAlexander Kraev BA, Thomas Fabian MD,Mikhail Torosoff MD, PhD, R Anthony Perez-Tamayo MD, PhDAlbany Medical College, Rush University/Cook County Hospital,Chicago, IL

INTRODUCTION: Previous, decades-old, studies of cardiopulmo-nary bypass (CPB) patients documented 25-35% incidence of post-

operative hyperbilirubinemia, associated with increased in-hospitalmorbidity and mortality. Long-term consequences of this complica-tion are unknown.

METHODS: Medical records of CABG with CPB patients werereviewed; long-term outcomes were ascertained through NationalDeath Index. ANOVA, contingency, Kaplan-Meier, and logistic re-gression analyses were utilized.

RESULTS: Of 830 patients, Group I patients bilirubin did notexceed 1.4 mg/dl, 18% had bilirubin of less than 2.8 mg/dl (GroupII), 8.1% had bilirubin exceeding 2.8 mg/dl (Group III). Elevatedbilirubin was associated with older age, reduced ejection fraction,history of CHF or hemodynamic instability, prolonged bypass time,need for blood products, post-operative stroke, infection, renal orrespiratory failure. In-hospital mortality in Group II was 5.2% and25.4% in Group III, compared to 0.8% in Group I (p�0.0001).Long-term survival was 80% in Group I, 70% in Group II, and 40%in Group III patients (p�0.001). Multivariate predictors of long-term mortality were age, diabetes, need for transfusion, post-operative stroke, renal failure, and elevated bilirubin: 3-fold decreasein Group II 2-year survival (95% CI 1.511-5.906; p�0.005) and5.2-fold decrease in Group IIl (95% CI 2.248-12.006; p�0.001).

CONCLUSIONS: Post-operative bilirubin elevation, observed inCABG with CPB patients, is common and deadly. The predictivepower of hyperbilirubinemia is similar to such of post-operative CVAor renal failure. Etiology of post-bypass hyperbilirubinemia is un-known and is probably multi-factorial. Further prospective studies ofpost-operative hyperbilirubinemia are warranted.

Expansion of a laparoscopic colon and rectalsurgery practice does not adversely affect patientand practice outcomesImran Hassan MD, Heidi Nelson MD, FACS, David Larson MD,Robert Cima MD, Eric Dozois MD, Tonia Young-Fadok MD, FACSMayo Clinic, Rochester, MN

INTRODUCTION: The surgical community has expressed concernsregarding the safety and feasibility of integrating minimally invasivetechniques into colorectal surgical practices. A single institution’sprospective database was analyzed to investigate whether increasingthe number of surgeons performing laparoscopically-assisted colo-rectal procedures (LCP) would adversely affect patient and practiceoutcomes.

METHODS: One-thousand and seven LCP were performed be-tween 1992-2004. The number of staff colorectal surgeons perform-ing LCP (�20 cases/year) increased from 1 in 1992 to 2 in 1998 to6 in 2004 (3 senior/3 junior). The clinical characteristics of thelaparoscopic practice during these 3 times-periods (1992, 1998, and2004) were analyzed.

RESULTS: Gender distribution, median age (64, 56, 53 yrs) andmedian BMI (24,27,26 kg/m2) of patients were comparable. Indi-cations for LCP expanded from being limited to cancer/ polyps(48%/29%) in 1992, to include IBD (40%), cancer/polyps (17%/11%) and diverticular disease (18%) in 2004. Table.1 shows overall

Table 1: Percent correctly calculated BMI’s from estimatedheight and weight

Totaln � 93

Underweightn � 5

Normaln � 35

Overweightn � 28

Obesen � 21

SeverelyObesen � 3

Attendings 48 20 77 32 24 66

Residents 54 40 74 39 33 100

Nurses 60 0 83 50 29 100

Patients 68 40 73 65 68 100

S71Vol. 201, No. 3S, September 2005 Quality, Outcomes, and Cost II

conversion rates and percentage of laparoscopic right colon resec-tions (L-RC) and ileal pouch anal anastomosis (L-IPAA) performedof the total (open and laparoscopic) RC and IPAA practice in the 3time-periods. Mortality was 0.002%. Surgical re-intervention ratefor postoperative complications (grade IIIB) were similar (2%,0.15%, 0.2%). Incidence of grade I and II postoperative complica-tions was (0%, 8%, 11%).

CONCLUSIONS: Our experience shows that expansion of a lapa-roscopic colorectal practice to include 75% of the surgeons is feasibleand has resulted in an increase in the number and complexity of LCPbeing performed without compromising patient and practice out-comes.

Should rural residents with colon cancer travel tourban hospitals for colectomy?Melissa Meyers MD, Samuel RG Finlayson MD, MPH, FACSDartmouth Medical School, Lebanon, NH

INTRODUCTION: Many rural patients travel to urban hospitalsexpecting better care. Whether rural patients requiring elective co-lectomy lower their risk of operative mortality by traveling to urbanhospitals is unknown.

METHODS: We used Medicare claims data to compare mortalityrates with colectomy for cancer in rural vs. urban hospitals in the USfrom 1994 to 1999. Urban and rural designations were based onRural-Urban Commuting Area codes. Multiple logistic regressionwas used to describe the relationship between mortality (combinedin-hospital and 30 day) and rural/urban hospital location, control-ling for patient and hospital characteristics.

RESULTS: Adjusted operative mortality in small rural hospitals(6.7%, 95% CI 6.4-7.0) was slightly higher than in urban hospitals(6.4%, 95% CI 6.3-6.5), but this difference was not statisticallysignificant. Nearly 90% of rural hospitals were in the lowest twoquintiles of hospital procedure volume (�57 colectomies/year),compared to 28% of urban hospitals. Adjusted operative mortality inthese low volume rural hospitals (6.6%, 95% CI 6.3-6.9%) wassignificantly lower than mortality in urban hospitals with similarprocedure volume (7.2%, 95% CI 7.0-7.4%).

CONCLUSIONS: Rural patients who choose to travel to an urbanhospital for colectomy may not experience lower mortality risk. Ourfinding that low volume urban hospitals have higher mortality ratesthan low volume rural hospitals suggests that patients who elect totravel to the city for care must choose their providers carefully.

Complementary therapy use in female long-termcolorectal cancer survivorsChris M Schussler-Fiorenza MD, Amy Trentham-Dietz PhD,Tara M Breslin MD, MS, John M Hampton MS,Patrick L Remington MD, MPHUniversity of Wisconsin, Madison, WI

INTRODUCTION: The aim of this study was to characterize the useof prayer, complementary and alternative medicine (CAM) in long-term female colorectal cancer survivors.

METHODS: Data from a 9 year follow-up questionnaire completedby long term survivors of a population-based sample of female colo-rectal cancer cases in Wisconsin were analyzed. Analysis with chi-squared statistics was conducted on the women (n�257) who com-pleted the CAM portion of the questionnaire.

RESULTS: We found that 74% of respondents reported usingCAM and/or prayer, 68% used prayer, 41% used CAM and 46% ofCAM users utilized more than one therapy. The three most commontherapies were chiropractic (14.1%), spiritual healing (11.7%) andmegavitamin therapy (10.6%). Younger age, higher income, workingoutside the home, and education were strongly associated with CAMuse (p�0.05). Depression/anxiety was strongly associated with bothmind-body (p�0.021) and energy/manual healing therapies. Think-ing about being diagnosed with cancer again was the only factorsignificantly associated with increased use of prayer (p�0.0012) andit also influenced rates of mind- body CAM use. (p�0.004) Cancercharacteristics were less strongly associated with CAM usage, al-though there was an association between site (colonrectum) andwhole-body/biologically based CAM use. (p�0.02)

CONCLUSIONS: CAM and prayer in colorectal cancer survivors iscommon and use is influenced by demographic factors, depression/anxiety and fear of cancer recurrence. Inquiring about CAM use andaddressing any associated psychologic factors is an important part ofthe care of long-term colorectal cancer survivors.

Risk indices predict adverse outcomes aftersurgery for small bowel obstruction (SBO)Julie A Margenthaler MD, Walter E Longo MD,Katherine S Virgo PhD, Frank E Johnson MD,Erik M Grossman MD, Tracy L Schifftner MS,William G Henderson PhD, Shukri F Khuri MD, FASCWashington University School of Medicine, St. Louis, MO

INTRODUCTION: The objective was to construct risk indices pre-dicting adverse outcomes after surgery for SBO.

METHODS: The VA NSQIP contains prospectively collected dataon �1,000,000 patients. Patients undergoing adhesiolysis only orsmall bowel resection for SBO between 1991-2002 were selected.Independent variables included 68 presurgical and 12 intraoperativerisk factors; dependent variables were 21 adverse outcomes includingdeath. Stepwise logistic regression was used to construct models pre-dicting 30-day morbidity and mortality and to derive risk indexvalues.

Year

Numbersurgeons (%all surgeons)

Total number oflaparoscopic

Cases

Overallconversion

rate, %

Right colon’sdone lap

(%)

IPAA’sdone lap

(%)

1992 1 (16) 28 28 6 0

1998 2 (28) 100 19 22 1

2004 6 (75) 270 8 34 55

S72 Quality, Outcomes, and Cost II J Am Coll Surg