Bariatric Care Center 2016 Outcomes Report by Summa Health

Bariatric Care Center

2016 Outcomes Report

Dear Colleagues, We are pleased to share with you the 2016 quality outcomes for the Summa Health Bariatric Care Center. As I am sure you are aware, more than one-third of U.S. adults have obesity, and many now consider it to be one of the greatest public health challenges of our time. It is associated with more than 30 other diseases that increase morbidity and mortality and reduce quality of life. While obesity rates are not rising, they are not falling, thus our work towards combating this disease is more important than ever. Our approach to weight loss management is two-fold. We offer both a surgical and nonsurgical option, so patients can feel comfortable knowing there is a solution that fits their needs.

Obesity — The Epidemic Crisis of Our Time Adrian Dan, M.D., FACS, FASMBS, Co-Medical Director of the Summa Health Bariatric Care Center, served as the editor of the August 2016 edition of The Surgical Clinics of North America Clinics Review Articles, entitled Metabolic and Bariatric Surgery. In the Preface, Obesity — The Epidemic Crisis of our Time, Dan addresses the critical levels of obesity that have been reached by the general population, a health concern which has become so serious that more individuals now suffer from obesity and its associated health conditions than endure hunger and malnutrition. He also notes that for the first time in the Surgery Clinics of North America history, Metabolic Surgery has taken precedence in the title of an issue, emphasizing the metabolic capabilities of surgical procedures that have been refined over the past six decades. He explains that these operations have been developed into some of the most effective and well-studied therapies in modern medicine. And he points out that bariatric/metabolic surgery is about much more than just weight loss. It is about the metabolic benefits made possible with surgical alterations of the gastrointestinal tract. Dan further explains that these changes impact every organ of the body, and result in increased longevity, reduction in the incidence of malignancies, and prevention and elimination of conditions caused by obesity. It was an honor to serve as the editor of this prestigious publication, and Dr. Dan was pleased to have the opportunity to work with some of the brightest and most talented surgical minds in an effort to create this comprehensive review of the major topics of this specialty. In addition to Dr. Dan serving as the editor of this edition, John Zografakis, M.D., FACS, FASMBS, Co-Medical Director of the Bariatric Care Center co-authored the chapter entitled Laparoscopic Roux-en-Y Gastric Bypass: Surgical Techniques and Perioperative Care with Lindsey Berbiglia, M.D. and Adrian Dan M.D., FACS, FASMBS.

Bariatric Care Center

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)

While there is not yet agreement on a single best approach to nonsurgical weight loss management, there is now consensus that the most effective and long-lasting treatment for morbid obesity is surgical weight loss intervention. Since starting our surgical program in 2004, we have performed a total of more than 3,000 primary and revisional weight loss surgeries and have grown by nearly 200% in the past 10 years, performing 355 primary weight loss surgeries in 2016.

While we have continued to increase the number of patients we serve, our focus on creating a positive patient experience has never wavered. We are proud that our patient experience scores for patients undergoing weight loss surgery have placed us in the 95th percentile nationally for the past ten years. As Summa Health continues to develop its population health strategy, weight loss management will continue to be a critical initiative for all of us. The Summa Health Bariatric Care Center can offer a successful program for any of your patients interested in losing weight. Thank you for taking the time to review our results. We are committed to helping our patients achieve significant weight loss, eliminate or reduce medical problems caused by their obesity and reclaim their life. As always, please do not hesitate to contact us directly if you have any questions, or if you need information for your patients.

Contents Surgical Procedure Volume

Quality of Care

Surgical Demographics 7 Surgical Percentage of Excess Body Weight Loss

Surgical Comorbidity Resolution 10 Fellowship Training

Nonsurgical Weight Management Program 14 Research and Education 16

Sincerely,

Summa Health’s Bariatric Care Center is a MBSAQIP Accredited – Comprehensive Center. MBSAQIP works to advance safe, high-quality care for bariatric surgery patients through the accreditation of bariatric surgical centers. A bariatric surgical center achieves accreditation following a rigorous review process during which it proves that it can maintain certain physical resources, human resources and standards of practice. John Zografakis, M.D., FACS, FASMBS Director, Bariatric Care Center

Adrian Dan, M.D., FACS, FASMBS Director, Bariatric Care Center 2016 Outcomes Report

400

427 380

350

Surgical Procedure Volume

Quality of Care

300

297

250

261

233

200

Our bariatric care team collects and monitors quality of care data and works continuously to refine and improve its processes and program to make sure each patient receives the highest level of care.

236

204

Volume150

30-day Mortality

Surgical weight loss procedures 135 performed at Summa Health include laparoscopic Roux-en-Y gastric bypass,121 laparoscopic sleeve gastrectomy, laparoscopic adjustable gastric banding and laparoscopic revisional 100 procedures. Our bariatric 83 surgeons are fellowship-trained in advanced laparoscopic and weight loss surgery. Some procedures can be done using a single incision 50 or robotic-assisted approach. 0 Band Adjustable Gastric

Roux-en-Y Gastric Bypass

358 372 355

350

250 400 200 350 150 300 100 250 50 200 0 150 100

202 214 133

217

202 214

217

237

260

3,192 401

2560

Revisions

2,251

2010 2011 2012 2013 2014 2015 2016

125

1280

Bariatric Care Center

0.100%

2.14

400 300

Sleeve Gastrectomy

1.20

2.00

427 380

261 233

236

204

297 261

135

121

233

236

204

83 135

121

204

2010 2011 2012 2013 2014 2015 2016

200 100

National Average Number of Days*

380 2.40

297

350 250

336

0.000%

Roux-en-Y Gastric Bypass

100 0

640

Sleeve Gastrectomy

350

150 50

2010 2011 2012 2013 2014 2015 2016

0.200%

427 Summa Health’s Bariatric Care Center Number of Days

250 150

1920

125

0.003%

300 200

133 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2004 2005 2006 119

140 50 7 120 0 100 2004 2005 2006 2007 2008 2009 80 60 140 40 19 120 20 3 1 2 2 2 100 0 80 2004 2005 2006 2007 2008 2009 60 40 19 20 3 1 2 2 2 0 2004 2005 2006 2007 2008 2009

Roux-en-Y Gastric Bypass

Procedure

Procedure Totals 3200

302

80 7

260 358 372 355

119

National Percentage*

Average Length of Stay

400

302 237

Summa Health’s Bariatric Care Center Percentage

Sleeve Gastrectomy

400

300

Procedure

*National Data for 2013 taken from American College of Surgeons MBSAQIP Database

3200

3,192 401

2016 Outcomes Report

Surgical Demographics Demographics Candidates for a primary weight loss procedure at Summa Health range in ages from 17 to 70. These are patients with morbid obesity, with or without comorbid diseases such as type 2 diabetes, obstructive sleep apnea, hypertension and gastroesophageal reflux disease. The typical patient has usually tried many different approaches to weight loss but has been unsuccessful in sustaining weight loss. In many cases, patients also struggle with underlying issues such as binge eating, emotional eating or other behavioral health conditions which have contributed to their obesity.

Male 582 (20%)

African-American 337 (12%)

Female 2274 (80%)

Caucasian 2487 (87%)

Gender

<20 7 (0.2%)

“I used to be very limited, but now I can do anything.” Gary Jentes, Weight Loss Surgery Patient

40-49 720 (25%) 50-59 766 (27%) 60-69 490 (17%)

Race

35-39.9 kg/m2 301 (10%)

20-29 183 (6%) 30-39 609 (21%)

Hispanic/Other 32 (1%)

40-49.9 kg/m2 1485 (52%)

Age

50-59.9 kg/m2 738 (26%)

BMI

60-64.9 kg/m2 332 (12%) Average BMI: 49.17 kg/m2

70-79 81 (3%) Average Age: 48 years

Bariatric Care Center

2016 Outcomes Report

“I used to feel imprisoned by my health. Now I feel liberated.” Jim Sommers, Weight Loss Surgery Patient

Surgical Percentage of 1 Excess Body Weight Loss Laparoscopic Roux-en-Y Bypass The average percentage of excess body weight loss as a result of laparoscopic Roux-en-Y bypass is 64% after three years.

68%

65 70

1 Year

2 Years

60 65 70 55 60 65 50 55 60 45 50 55 40 45 50

68%

364% Years

4 Years 61%

64% 68%

68%

61%

5 Years 60% 60%

64% 61%

60%

40 45 40 70

Laparoscopic Sleeve Gastrectomy1 The average percentage of excess body weight lost as a result of a laparoscopic sleeve gastrectomy as a primary weight loss procedure is 50% after three years.

65 70 60 65 70 55 60 65 50 55 60 45 50 55 40 45 50

60% 53% 53%

54% 54%

53% 50% 53%

60% 60%

50% 53%

54%

53% 50%

40 45

Laparoscopic Adjustable Gastric Band The average percentage of excess body weight loss as a result of an adjustable gastric band is 42% after three years.

70 40 65 70 60 65 70 55 60 65 50 55 60 45 50 55 40 45 50

45% 41%

42% 45%

47%

42% 47% 47% 45% 40 Long-term weight loss for patients with diabetes using a nonsurgical, 45 conservative 6% at one year and 4% at three years. 2 41%weight loss method is42% 41%

40 Beginning in 2010, the laparoscopic sleeve gastrectomy was performed as a primary weight loss surgery and as the first step in a staged procedure leading to a roux-en-y gastric bypass 2 Diabetes Prevention Program Research Group. Reduction of the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med 2002: 346: 393-403. Feb 7, 2002 1

Bariatric Care Center

2016 Outcomes Report

Surgical Comorbidity Resolution Type 2 Diabetes Mellitus 875 of 2,852 (31%) patients undergoing weight loss surgery had type 2 diabetes preoperatively. Following weight loss surgery: Two years post-operatively: • 66% of patients have complete resolution of type 2 diabetes. • 84% of patients experienced resolution and/or improvement of their type 2 diabetes. Five years post-operatively: • 84% of patients experienced resolution and/or improvement of their type 2 diabetes.

Hypertension 1,683 of 2,852 (59%) patients undergoing weight loss surgery had hypertension preoperatively. Following weight loss surgery: Two years post-operatively: • 49% of patients have complete resolution of their hypertension. • 72% of patients experienced resolution and/or improvement of their hypertension. Five years post-operatively: • 72% of patients experienced resolution and/or improvement

20 20

90 90 80 90 80 70 80 70 60 70 60 50 60 50 40 50 40 30 40 30 20 30 20 10 20 10 18% 0 18% 10 80 0

10 10

90 90 80 80 70 70 60 60 50 50 40 40 30 30

50 50 40 40 30 30 20 20 10 10

Bariatric Care Center

71% 71% 348 348 71%

54% 54% 65 65 54%

84% 84% 88 88

348

144

66% 66% 69 69

13% 13% 66 66 13%

29% 29% 35 35 29% 35

33% 33% 105 105

17% 17% 20 20 17%

60% 60% 849 849

80 90 80 70 80 70 60 70 60 50 60 50 40 50 40 30 40 30 20 30 20 21% 21% 10 182 20 182 10 0 10 0 0

144 49% 49% 419 419

2 Year

13% 13% 66 66 13% 66

29% 29% 35 72% 35 72% 29%

348

54% 54% 65 65 54%

142 142 35

53% 53% 107 107

282

Resolved

Improved & Resolved

17% 17% 35 35

5 Year

17% 17% 20 20 17% 20

70 80 60 60 70 50 50 60 40 40 50 30 30 40 20

82% 82% 128

72% 72% 586

57% 57% 812

586 72% 586

812 57%

128 82% 128

50% 50% 157 157 50%

812

157

20 30 10 10 20 0

2 Year

5 Year

Gastroesophageal Reflux Disease

71% 71% 348 348 71% 57% 63% 57% 63% 282 201 201 282 57%

1,655 of 2,852 (58%) patients undergoing weight loss surgery had obstructive sleep apnea preoperatively.

5 Year

29% 72% 29% 14472% 601 144601 29%

Obstructive Sleep Apnea

80 80 70

0 10

18% 18% 19 19

Following weight loss surgery: Two years post-operatively: • 72% of patients experienced complete resolution of their obstructive sleep apnea. Five years post-operatively: • 82% of patients experienced resolution of their obstructive sleep apnea.

80 80

60 60

29% 29% 144 144 29%

Improved

85 85

282

290 Year

90 90

70 70

66% 66% 298 298

0 0

32% 32% 452 452

57% 57% 282 282 57%

84% 84% 378 378

Diagnosed

1,583 of 2,852 (55%) patients undergoing weight loss surgery had gastroesophageal reflux disease preoperatively. 71% Following weight loss surgery: 71% 85 Two years post-operatively: 85 • 71% 56% of patients experienced complete 85 resolution of their gastroesophageal reflux disease. Five years post-operatively: • 63% of patients experienced resolution of their gastroesophageal reflux disease.

Hypertriglyceridemia 939 of 2,852 (33%) patients undergoing weight loss surgery had hypertriglyceridemia preoperatively. Following weight loss surgery: Two years post-operatively: • 54% of patients experienced complete resolution of their hypertriglyceridemia. Five years post-operatively: • 64% of patients experienced resolution of their hypertriglyceridemia.

80 80 70 70 80 60 60 70 50 50 60 40 40 50 30

63% 63% 813

56% 56% 451

813 63%

451 56%

813

451

63% 63% 122

61% 61% 194 194 61%

122 63%

194

122

30 40 20 20 30 10 10 20 0 0 10

2 Year

5 Year

0 80 80 70 70 80 60 60 70 50

64% 64% 70

54% 54% 269 269 54%

70 64%

50 60 40 40 50 30

35% 35% 496

30 40 20 20 30 10

496 35%

109 34%

496

109

269

34% 34% 109

10 20 0 0 10 0

2 Year

5 Year 2016 Outcomes Report

Fellowship Training

Our Fellows:

Fellowship training offers physicians the opportunity to obtain additional, specialty-focused education after the completion of residency training. The ability of a hospital to provide care by fellowship trained physicians is a strong indicator of a higher level of care. Completion of a fellowship means a surgeon has spent additional time developing in-depth knowledge and surgical expertise in their chosen specialty. Summa Health offers a one-year fellowship in minimally invasive surgery with a focus on advanced laparoscopic and weight reductive surgery. It is a collaborative effort between the department of surgery and Summa Health Foundation. The fellow works closely with the four attending surgeons in our bariatric surgery program, performing high volumes of minimally invasive weight reductive and general surgeries. The fellow also works with the Bariatric Care Center team, developing expertise in the clinical management of patients. This fellowship is now in its seventh year, having started in 2011. It is accredited by the MIS Fellowship Council for dual Minimally Invasive Surgery (MIS) and Bariatric Surgery. Led by fellowship program director, Adrian G. Dan, M.D., FACS, FASMBS, it is Summa’s only general surgery fellowship.

Bariatric Care Center

Chandrutie Latchman, D.O. 2011-2012

Andrew Standerwick, M.D. 2012-2013

Mark Nuqui, D.O. 2013-2014

Greg Johnston, D.O. 2014-2015

Lindsey Berbiglia, M.D. 2015-2016

Tyler Bedford, M.D. 2016-2017

All four of the surgeon’s at Summa’s Bariatric Care Center are fellowship trained as follows: • John G. Zogafakis, M.D., FACS, FASMBS: Evanston Northwestern Healthcare • Adrian G. Dan, M.D., FACS, FASMBS: Cleveland Clinic Foundation • Mark Pozsgay, D.O., FASMBS: University of Pittsburgh Medical Center • Tyler Bedford, M.D.: Summa Health

2016 Outcomes Report

Nonsurgical Weight Management Program Summa Health also offers a nonsurgical option for weight loss. Our program’s comprehensive approach to nonsurgical weight loss is based upon the current obesity medicine research and years of experience gained from working with patients. We help patients reach their weight loss goals by teaching them how to make better choices about eating and exercise, and by working with patients to address underlying behaviors which are preventing them from reaching their goals.

Outcomes Patients who have fully participated in our program have achieved a weight loss of as much as five to fifteen pounds per month.

Nonsurgical weight management at Summa Health is primarily for patients with a BMI between 25 and 34.9 kg/ m2 or between 35 and 39.9 kg/m2 who do not have another co-morbid condition caused by their obesity. It includes both medical and behavioral components, and is a physicianled, comprehensive, multidisciplinary, two year intensive program.

Program Components • An evaluation with our obesity medicine specialist who is board certified in internal medicine and obesity medicine. He has specialized in weight management for more than 12 years • An evaluation with our psychologist who specializes in eating behaviors to determine if there are any underlying eating challenges contributing to your weight • Our Lifestyle Change Kick-off Workshop, which provides foundational information on exercise, nutrition and behavior • Three intensive outpatient weight loss groups with our psychologist which provide an individualized patient focus on the behavioral challenges associated with weight loss • Life-long physician follow-up care from the time of enrollment Our comprehensive team—including physicians, psychologists, dietitians, and clinical exercise specialist— will guide and educate patients throughout this journey, ensuring they stay on track and remain successful. Our multidisciplinary team is what makes Summa’s weight management programs different from others in the area.

Bariatric Care Center

Ken Wells, M.D. Certified Diplomate ABOM Medical Director, Nonsurgical Weight Management Program Ken Wells, M.D., has more than 12 years of experience treating obesity. In 2016, he was certified by the American Board of Obesity Medicine (ABOM) as an ABOM diplomate. ABOM diplomates are physicians who undergo rigorous training and an extensive examination process to achieve this designation. The American Board of Obesity Medicine serves the public and the field of obesity medicine by maintaining standards for assessment and credentialing physicians. Certification as an ABOM diplomate signifies specialized knowledge in the practice of obesity medicine and distinguishes a physician as having achieved competency in obesity care.

“They counsel you on how to eat healthy. I am about to change my life.” Reggie Eggleston, Weight Loss Surgery (pre-op) Patient

2016 Outcomes Report

Research and Education Research is an integral component of a large, quality focused program. Summa contributed to research regarding surgical weight loss intervention as follows:

Invited Lectures • “Emergent Surgical Care of the Bariatric Surgical Patient for the General Surgeon”; Ohio Chapter, American College of Surgeons, May 2014. • “Metabolic Surgery”; Grand Rounds, Department of Obstetrics and Gynecology, Summa Akron City Hospital, Summa Health System; August 2014. • “The Emergency Department Evaluation of the Weight Loss Surgery Patient.”; Grand Rounds, Department of Emergency Medicine, Summa Akron City Hospital, Summa Health System; March 19, 2013 • “Evaluation and Management of the Weight Loss Surgery Patient”; Northeast Ohio Medical Universities (NEOMED); February 28, 2012. • “Common Questions in the Office: The Postoperative Management of the Weight Loss Surgery Patient”; ASMBS, Ohio State Chapter Meeting 2012; May 11, 2012, Columbus, OH.

Publications • Dan AG; Shenoy R, Subichin M, Clanton J, Bohon A, Makuszewski M, Pozsgay M, Venkat A, Sievers C, Thompson M, Zografakis JG; “Prevalence of Upper Gastrointestinal Gross and Microscopic Pathology in Patients with Morbid Obesity”;Published Abstract; Surgical Endoscopy 2014 • Dan AG, Mirhaidari S, Pozsgay M, Standerwick AB, Bohon AN, Zografakis JG. Two-Trocar Cholecystectomy by Strategic Laparoscopy for Improved Cosmesis. Accepted in 2012 for publication in JSLS, Journal of the Society of Laparoendoscopic Surgeons. • Pohle-Krauza RJ, McCarroll ML, Pasini D, Dan AG, Zografakis JG. The Effect of Marital Status on Weight Loss After Bariatric Surgery is Moderated by Depression. Journal of Obesity and Weight Loss Therapy 2011; 1:104. doi:10.4172/jowt.1000104. • Pohle-Krauza RJ, McCarroll ML,Volsko TA, Pasini D, Dan A, Zografakis JG. Differential effects of gender and age on dyslipidemia in bariatric surgery patients. Surgery for Obesity and Related Disease. 2011; 7:70-75.

Oral Presentations • Dan AG, Subichin M, Pozsgay DO, Zografakis JG; “Pathological findings of intra-operative liver tissue biopsy in patients undergoing weight loss operations”; Presented at the AHPBA Annual Meeting (Americas Hepato-Pancreato-Biliary Association) February 2014.

Bariatric Care Center

• Subichin M, Clanton J, Makuszewski M, Bohon A, Zografakis JG, Dan AG; “Body Mass Index and Age do not Influence Severity of Liver Disease: A Review of 1,000 Consecutive Patients Undergoing Weigh Loss Surgery” Pathological findings of intra-operative liver tissue biopsy in patients undergoing weight loss operations”; Presented at the Twenty Second Annual Summa Health System Postgraduate Day, June 2, 2014. • Dan AG, Pozsgay M, Mirhaidari S, Reigstad K, Zografakis JG. “Two Trocar Laparoscopic Cholecystectomy for Improved Cosmesis: Initial Experience & Technical Details”; SLIC (Strategic Laparoscopy for Improved Cosmesis) Summit, January 13-14, 2012, Miami, FL. • Childs D, Dan AG, Bohon A, Pohle-Krauza R, Pozsgay M, Zografakis JG. “Factors Affecting Excess Weight Loss (EWL) in Patients Undergoing Laparoscopic Adjustable Gastric Banding (LAGB)”; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 2012. • Rosenbaum AA, Dan AG, Bohon A, Pohle-Krauza R, Pozsgay M, Zografakis JG. “Effect of Postoperative Compliance on Weight Loss Success in Laparoscopic Adjustable Gastric Band (LAGB) Patients”; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 2012. • Pedersen J, Wagner D, Parker P. “Panniculectomy as a Gateway”; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 2012.

Poster Presentations • Dan AG; Shenoy R, Subichin M, Clanton J, Bohon A, Makuszewski M, Pozsgay M, Venkat A, Sievers C, Thompson M, Zografakis JG; “Prevalence of Upper Gastrointestinal Gross and Microscopic Pathology in Patients with Morbid Obesity”; Poster Presentation; SAGES Scientific Session 2014. • Standerwick AB, Dan AG, Pozsgay M, Zografakis JG; “Outcomes of Optimal Peritoneal Dialysis Catheter Placement Using a Laparoscopic Technique”; Poster Presentation; SAGES Scientific Session, April 2013 • Pasini D, Hanna E, Hawn K, Zografakis JG, Dan AG, Pozsgay M; “Case Management of Bariatric Surgical Patients Results in Improved Patient Satisfaction Scores”; Poster Presentation; OHA Quality Institute’s 6th Annual Quality Summit, Columbus, OH, June 2013. • Yoho D, Pozsgay M, Zografakis JG, “Removing the ‘Bag’ From Our Bag of Tricks; A Paradigm Shift in the Surgical Management of Acute Perforated Diverticulitis”; Poster Presentation; Presented at the Twenty-First Annual Summa Health System Postgraduate Day, June 3, 2013

• Subichin M, Shenoy R, Standerwick A, Pozsgay M, Zografakis JG, Bohon A, Dan AG; “Pathological findings in intraoperative live tissue biopsy in patients undergoing weight loss operations” Poster Presentation; Presented at the Twenty- First Annual Summa Health System Postgraduate Day, June 3, 2013 • Dan AG, Mirihaidari S, Standerwick A, Pozsgay M, Bohon A, Zografakis JG; “Two Trocar Cholecystectomy by Strategic Laparoscopy for Improved Cosmesis” Presented at the Twenty-First Annual Summa Health System Postgraduate Day, June 3, 2013 • Shenoy R, Subichin M, Standerwick A, Pozsgay M, Zografakis JG, Bohon A, Sievers C, Venkat A, Dan AG; “Prevalence of anatomicaland pathological findings during upper gastrointestinal endoscopic exam in morbidly obese patients” Poster Presentation; Presented at the Twenty-First Annual Summa Health System Postgraduate Day, June 3, 2013 • Bohon A, Bothe N, Pasini D, Pohle-Krauza RJ, Pozsgay M, Zografakis JG, Dan AG; “Augmented Initial WeightLoss Outcomes in Women and Non-Diabetics are Not Sustained Long Term after LAGB”; Poster Presentation: American Society for Metabolic and Bariatric Surgery (ASMBS); November 2013 • Pohle-Krauza RJ, Rosenbaum A, Bohon A, Bothe N, Pasini D, Pozsgay M, Zografakis JG, Dan AG; “Compliance during the early postoperative period affects sustained weight loss in Laparoscopic Adjustable Gastric Band (LAGB) patients” Poster Presentation: American Society for Metabolic and Bariatric Surgery (ASMBS); November 2013 • Dan AG, Standerwick A, Mirhaidari S. “Outcomes of Optimal Peritoneal Dialysis Catheter Placement Using a Laparoscopic Technique”, accepted in 2012 for Poster Presentation at SAGES 2013 Annual meeting. • Dan AG, Reigstad K, Morocco M, Salem J, Mirhaidari S, Pozsgay M, Shaheen W, Zografakis JG. “Totally Robotic Adrenalectomy – Technical Details and Initial Results”; MISS (Minimally Invasive Surgery Symposium); February 20-25, 2012; Salt Lake City, UT. • Biswas D, Loth F, Krauza M, Pohle-Krauza R, Dan AG, Zografakis JG; “Fluid Dynamic Analysis of Upper Airway of an Obstructive Sleep Apnea Patient Pre and Post Surgery”; Proceedings of the ASME 2012 Summer Bioengineering Conference SBC2012; June 20-23, 2012; Puerto Rico, USA. • Pasini D, Pohle-Krauza R, Ilg L, Bohon A, Dan A, Zografakis JG; “Preoperative Education and Postoperative Follow-Up in Bariatric Surgery Patients”; American Society for Metabolic and Bariatric Surgery (ASMBS); June 2012. San Diego, CA. • Zografakis JG, Dan AG, Pozsgay M, Latchman C, Pasini D. “A Novel Approach to the Repair of Incisional Hernias in Patients with Morbid Obesity”; Abdominal Wall Reconstruction (AWR); June 2012.

• Arumugasaamy A, Dan AG, Bohon A, Pohle-Krauza R, Pozsgay M, Zografakis JG. “Factors Influencing Surgical Re- Intervention for Laparoscopic Adjustable Gastric Band (LAGB) Patients”; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 2012. • Reigstad K, Dan AG, Pozsgay M, Zografakis JG. “Robotic Adrenalectomy – Initial Experience and Short-term Outcomes”; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 2012. • Dan AG. “Strategic Laparoscopy for Improved CosmesisCholecystectomy: A Retrospective Review of 8 Patients Undergoing SLIC-Cholecystectomy”; Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 2012. • Schulz S, Dan AG. “Single Incision Robotic Chlecystectomy: A Case Report. Presented at the Twentieth Annual Summa Health System Postgraduate Day, June 4, 2012.

Book Chapters • Frantzides CT, Zografakis JG, Welle SN, Ruff, TM. Revisional Bariatric Surgery. In: Frantzides CT, Carlson MA. Video Atlas of Advanced Minimally Invasive Surgery. Philadelphia, PA: Saunders/ Elsevier; 2012; 71-78. • Berbiglia, L., Zografakis, JG., Dan, AG. Laparoscopic Roux-en-Y Gastric Bypass: Surgical Technique and Perioperative Care. The Surgical Clinics of North America, Metabolic and Bariatric Surgery Aug 2016, 96 (4):773-787.

Book Editor • Dan, Adrian G. (Editor).Preface – Obesity – The Epidemic Crisis of Our Time. The Surgical Clinics of North America, Metabolic and Bariatric Surgery Aug 2016, 96 (4):xv

Awards • Subichin M, Clanton J, Makuszewski M, Bohon A, Zografakis JG, Dan AG; “Body Mass Index and Age do not Influence Severity of Liver Disease: A Review of 1,000 Consecutive Patients Undergoing Weigh Loss Surgery” Pathological findings of intra-operative liver tissue biopsy in patients undergoing weight loss operations”; Presented at the Twenty Second Annual Summa Health System Postgraduate Day, June 2, 2014. Winner: William H. Falor, M.D. Award for Clinical Science Research

Appointments • 2014 Zografakis JG; Vice President; Ohio Chapter of the American Society of Metabolic and Bariatric Surgery • 2013 Zografakis JG; Secretary; Ohio Chapter of the American Society of Metabolic and Bariatric Surgery

2016 Outcomes Report

“The surgery is totally worth it. I wouldn’t go to any place except Summa Health.” Margo Haren, Weight Loss Surgery Patient

To refer a patient or for more information, call 330.375.6590 or go to summahealth.org/weightloss

Summa Health System Akron Campus Bariatric Care Center Richard M. and Yvonne Hamlin Pavilion 95 Arch St, Suite 260 Akron, OH 44304

BAR-17-30012/CS/KH/10-17/