New medical technologies have been viewed as the primary cause of rising health are expenditures by health policy researchers in the United States. Since the mid 1990s, with the prevalence of obesity among Americans, the utilization of bariatric surgery, a medical innovation, has increased rapidly among U.S. hospitals. Generally, current literature only states that the volume of bariatric procedures is increasing dramatically.Very limited studies have been conducted to investigate the growth of bariatric procedures.The objective of this study is (1) to provide a detailed description about the adoption and utilization of bariatric procedure in hospitals in 11 states, and (2) to identify the factors significantly enhancing hospitals to adopt or expand the service of surgical treatment for obesity.A panel design from 1995 to 2000 was employed in this study. Several databases are merged together for the final analysis. The descriptive analyses show that the increase in bariatric procedures is coming from two contributors: the entry of hospitals into the market of bariatric surgery, and the continuous expansion of capacity of offering the surgery by antecedent adopters. The panel analyses provided mixed support to the factors influencing hospitals' decision on adoption or expansion of bariatric surgery. The fixed-effects logit model suggests that hospital size, competition and cumulative adoption rate in a local market are strong predictors of hospitals' adoption of the surgery. The fixed effects model shows that ownership status, payment mix improvement, and cumulative adoption rate in a local market are strongly impact the expansion rate of bariatric procedures in hospitals.These findings suggest determinants enhancing hospitals to adopt or expand the bariatric service program. As the provision of bariatric procedures continues to increase among U.S. hospitals, health plans and policy makers will face greater challenges to balance the demand of patients with morbid obesity and the rapid increasing healthcare expenditures related to the surgery.

No description available.

The main objectives of this dissertation were to examine the effects of bariatric surgery on medication and health services utilization among a cohort of Commercial and Medicare insured members from a large health benefits organization in the U.S.. A total of 1,492 members with morbid obesity underwent gastric bypass (n=785) or gastric banding (n=707) procedure between January 2005 and June 2008. Administrative claims databases were accessed and three data files including a member file, a medical file and a pharmacy file were merged at the member level. Non-parametric Wilcoxon signed rank tests revealed that the average number of all prescription claims were significantly lower during the 12 months post-surgery, compared to the 12 months pre surgery (p<0.0001). Moreover, McNemar’s Chi Square analyses showed that after the surgery, there was a statistically significant (p=<0001) decline in the proportion of members utilizing antihypertensives, antidiabetics and antihyperlipidemics. Our results also showed that the average number of prescription claims for each of these medication groups significantly declined during the 12-month post-surgery period, among members who had at least one prescription for these medications before the surgery (p<0.0001). Logistic regression modeling revealed that members who underwent bypass procedures were more likely to discontinue antihypertensives (OR=2.04; 95% CI= 1.30-3.23) , antihyperlipidemics (OR=3.25; 95% CI 1.96-5.40) and antidiabetics (OR=1.89; 95% CI 1.13–3.08) post-surgery than members who underwent banding procedures. In terms of medical services utilization, our results showed a significant decline in the average number of medical claims for all outpatient services overall from the 12 months pre to the 12 months post-surgery (p<0.0001). In contrast, the average number of medical claims for emergency room and inpatient hospitalizations were significantly increased from the pre to the post-surgery period (p<0.01). Logistic regression modeling revealed that the type of bariatric surgery was a significant positive predictor for inpatient hospitalizations post-surgery (OR =2.33; 95% CI= 1.76-3.08; p<0.0001) but not for emergency room visits (OR=1.23; 95% CI 0.97–1.56). The implications of the findings from a managed care perspective are discussed, along with limitation and future directions.

Bakgrund: Sjukligt feta människor upplever ofta ohälsa eller minskad livskvalité i form av fysiska komplikationer, stigmatisering och diskriminering. En metod att hjälpa sjukligt feta personer att gå ner i vikt är obesitaskirurgi. Majoriteten av människorna som väljer obesitaskirurgi är kvinnor. Detta tros bero på att kvinnor blir mer stigmatiserade än män och att de blir psykiskt påverkade vid relativt lågt BMI. Syfte: Syftet med studien var att belysa kvinnliga patienters upplevelser efter obesitaskirurgi. Metod: Studien genomfördes som en allmän litteraturstudie och baserades på elva vetenskapliga artiklar. Resultat: Kvinnorna upplevde att tiden efter operationen förändrade deras liv, vilket upplevdes som både positivt och negativt. Upplevelsen att få en andra chans i livet och upplevelsen av att få en förändrad relation till mat var vanligt förekommande känslor. Slutsats: Operationen hjälper kvinnorna att äta mindre genom den förminskade magsäcken, men ingreppet botar inte de psykosociala problem som de eventuellt har innan operationen. Sjuksköterskor har en viktig uppgift i att stödja och vägleda dessa kvinnor. / Background: Obese people often experience illness and low quality of life which can be expressed in physical complications, stigma and discrimination. Obesity surgery is a method to help obese people to lose weight. The majority of people who chose obesity surgery are women. Women are thought to be more effected mentally by their obesity in lower BMI than men. Aim: The aim of this study was to describe the experiences of female patients after obesity surgery. Method: The study was constructed as a general literature review based on eleven scientific articles. Results: The patients experienced that the time after surgery had changed their lives. The experience was both positive and negative. The experience of getting a second chance in life and the experience of changed relationship to food was common feelings. Conclusion: The surgery helps women to eat smaller portions because of the diminished stomach, but doesn’t cure the underlying psychosocial problems they might have before surgery. Nurses have an important task in supporting and guiding these women.

Gastric bypass achieves weight loss in the morbidly obese. Preoperative weight loss is used to reduce the enlarged fatty liver that otherwise reduces visibility during surgery. The purpose of gastric bypass is to provide patients with long-term weight loss. The aim of this thesis was to investigate the result of preoperative low calorie diet on liver volume and to evaluate the long-term result of gastric bypass. Paper I showed that four weeks of low calorie diet reduces intrahepatic fat by 40% and facilitates surgery mainly through improved visualisation. Paper II demonstrated that all of the reduction of liver volume occurs during the first two weeks of treatment with low calorie diet.  In paper I liver volume was reduced by 12% and in paper II by 18%. Paper III focused on long-term results and showed that gastric bypass achieves a mean 63% excess body mass index loss in obese patients after 11 years. However, of these 40% undergo abdominoplasty and 2% require additional bariatric surgery. Only 24% adhere to the lifelong recommendation on multivitamins and 72% to Vitamin B12 recommendations. Paper IV evaluated gastric bypass as a revisional procedure after earlier restrictive surgery had failed. Similar weight results as after primary gastric bypass are attained. No patient taking vitamin B12 supplementation was deficient at follow-up, regardless of whether the vitamin was taken as a pill or as intramuscular injections.

Η αύξηση του σωματικού βάρους και η παχυσαρκία αντιπροσωπεύουν μία ραγδαία αναπτυσσόμενη απειλή για την υγεία του πληθυσμού που επηρεάζει χώρες σε όλα τα γεωγραφικά μήκη και πλάτη, κατά μείζονα λόγο τις χώρες του αναπτυγμένου κόσμου και λιγότερο τις αναπτυσσόμενες, και αποτελεί μείζονα πηγή ανησυχίας για τους ασθενείς, τους παροχείς υγείας, τα εμπλεκόμενα στο σύστημα υγείας άτομα και τις κατά τόπου ρυθμιστικές υγειονομικές αρχές. Πράγματι πλέον στις ημέρες μας η παχυσαρκία είναι τόσο συχνό πρόβλημα που πιο κλασικές νοσηρές καταστάσεις όπως ο υποσιτισμός και τα λοιμώδη νοσήματα χάνουν τον πρωταγωνιστικό τους ρόλο σαν αιτιολογικοί παράγοντες κακής υγείας. Η μόνη αποδεκτή στρατηγική που θα μπορούσε να είναι αποδοτική, όχι μόνο με υγειονομικούς αλλά και οικονομοτεχνικούς όρους, θα ήταν μία πληθυσμιακή θεραπευτική προσέγγιση, όμως μία τέτοια στρατηγική σήμερα αν όχι ουτοπική, θα μπορούσε να χαρακτηριστεί τουλάχιστον θεραπευτική πρόκληση. Συνεπώς σήμερα στηριζόμαστε αποκλειστικά στους θεράποντες ιατρούς, οι οποίοι σε καθημερινή βάση έρχονται σε επαφή με παχύσαρκα άτομα. Η βασική επιθυμία αυτής της ομάδας ατόμων, είναι η απώλεια σωματικού βάρους και η μακροχρόνια διατήρηση αυτής της απώλειας. Έχοντας εξαντλήσει κάθε άλλη προσέγγιση (είτε πρόκειται για απλό διαιτητικό πρόγραμμα, είτε για δίαιτα με διαιτολογική καθοδήγηση, είτε για εμπορικά διαθέσιμα προγράμματα απώλειας βάρους), αποτυγχάνοντας να επιτύχουν σταθερή και μακροπρόθεσμη απώλεια βάρους μία μεγάλη ομάδα νοσηρά παχύσαρκων ατόμων φαίνεται να στρέφονται σήμερα στα χειρουργεία παχυσαρκίας. Φαίνεται πλέον σήμερα ότι η χειρουργική αντιμετώπιση της παχυσαρκίας είναι η πιο αποτελεσματική διαθέσιμη θεραπεία για τη νοσογόνο παχυσαρκία, η οποία εξασφαλίζει μακροπρόθεσμη απώλεια σωματικού βάρους και πλήρη ή σχεδόν πλήρη υποχώρηση μίας σειράς συνοσηρών καταστάσεων που σχετίζονται αιτιολογικά με την υπερβολική αύξηση του σωματικού βάρους. Ο σκοπός της μελέτης μας ήταν να δούμε εάν το γαστρικό bypass σχετίζεται με μεταβολές της λειτουργίας της αορτής και της αριστερής κοιλίας, σε νοσηρά παχύσαρκους ασθενείς 3 και 36 μήνες μετά από το χειρουργείο. Χρησιμοποιήθηκε υπερηχογράφημα καρδιάς για την εκτίμησης 60 νοσηρά παχύσαρκων ασθενών που υποβλήθηκαν σε χειρουργική επέμβαση , 20 νοσηρά παχύσαρκων ασθενών που δεν υποβλήθηκαν σε χειρουργική επέμβαση και 40 ατόμων με φυσιολογικό δείκτη σωματικής μάζας. Όλοι είχαν παρόμοια ηλικία, φύλο και παράγοντες κινδύνου στην επίσκεψη αναφοράς. Μετρήσαμε την αορτική τάνυση, διατασιμότητα, δείκτη ανενδοτότητας, το συντελεστή αορτική πίεσης – τάνυσης καθώς επίσης και υπερηχογραφικούς δείκτες doppler διαστολικής λειτουργίας της αριστερής κοιλίας (το λόγο του κύματος Ε προ; το κύμα Α, το χρόνο ισοογκωτικής χάλασης και το χρόνο επιβράδυνσης). Οι υπερηχογραφικές μετρήσεις που αφορούσαν τόσο την αορτή, όσο και τη διαστολική λειτουργία της αριστερής κοιλίας, ήταν επηρεασμένα στους νοσηρά παχύσαρκους ασθενείς σε σχέση με την ομάδα ελέγχου με φυσιολογικό δείκτη σωματικής μάζας. Κατά τη διάρκεια της παρακολούθησης τόσο στους 3 όσο και στου 36 μήνες, τόσο η μάζα της αριστερής κοιλίας, όσο και οι δείκτες λειτουργικότητας της αορτής και οι διαστολικοί δείκτες της αριστερής κοιλίας επανήλθαν στο φυσιολογικό(διατασιμότητα αορτής 1.9 προεγχειρητικά, 3,4 στους 3 μήνες και 4,3 στους 36 μήνες, συγκρινόμενο με το 3,36 των ατόμων με φυσιολογικό δείκτη σωματικής μάζας), φυσιολογικοποίηση ου δεν παρατηρήθηκε στη ομάδα των ασθενών που δεν έχασαν βάρος. Η ελάττωση του δείκτη σωματικής μάζας μετά το χειρουργείο σχετιζόταν σε στατιστικά σημαντικό ποσοστό (p < .01) με την ελάττωση τόσο των δεικτών της αορτικής λειτουργίας όσο και με το χρόνο ισοογκωτικής χάλασης, μετά από ρύθμιση με βάση την ηλικία, το φύλο, τη συνυπάρχουσα αρτηριακή πίεση, τα λιπίδια και τη συγκέντρωση χοληστερόλης. Συμπερασματικά η απώλεια σωματικού Βάρους που επιτυγχάνεται με τα χειρουργεία παχυσαρκίας, ελαττώνει την κοιλιακή υπερτροφία και συνεπώς, βελτιώνει τη λειτουργία της αριστερής κοιλίας σε νοσηρά παχύσαρκους ασθενείς σε μια περίοδο παρακολούθησης διάρκειας 3 ετών. / Body weight gain and obesity represent a rapidly growing threat for public health that affect countries all over the world, mainly of the developed world and less the developing countries, consisting a major topic of interest, for patients, health provider and persons involved in the health system. Nowadays obesity considered to be so frequent as a problem that other classic clinical entities as malnutrition and infectious diseases lose their main role as reasons for bad hygiene. The only acceptable strategy that could be efficient not only in relation to with health, but also under logistic conditions, would be a therapeutical approach for the entire population. However such a strategy could be characterized at least a therapeutic challenge if not utopic. Having depleted any other approach (either a simple dietary program, commercial weight loss programs or dietician guidance) and failing to achieve stable and long term weight loss, a large group of morbidly obese people seems to prefer surgical solutions. Surgical management of obesity seems to be the most efficient therapeutic approach that ensures complete resolution of comorbidities that are related with body weight gain. The purpose of our study was to observe if gastric bypass is related with aortic and LV functional changes, in morbidly obese patients in 3 and 36 months after surgery. We performed echocardiographic measurements in 60 morbidly obese patients who had gastric bypass, 20 morbidly obese that did not had surgery and 40 persons with normal body mass index. All of them had similar age, sex and risk factors as it was mentioned in the reference visit. We measured aortic tension, distensability and aortic pressure, we conducted Doppler echocardiography for diastolic function of LV , E/A ratio, isovolumic relaxation time and deceleration time. Echocardiographic measurements of the aorta and diastolic function of LV were affected more in morbidly obese patients than the control group with normal blood pressure. During observation time in 3 and 36 months , LV mass, functional measurements of the aorta and diastolic function of LV were normalized. Aortic distensability 1,9 presurgically, 3,4 in 3 months and 4,3 in 36 months, correlated with 3,36 in persons with normal BMI. No relation was observed in the group of patients that did not lose weight. BMI reduction after surgery is correlated statistically significant with improvement of aortic function, as well as , isovolumic relaxation time based on age, sex, hypertension and lipid profile. Conclusively body weight loss achieved with obesity surgery, decreases ventricular hypertrophy and consequently improves LV function in morbidly obese patients in a period of 3 years.

Orientador: Daisy Maria Favero Salvadori / Banca: Denise Fecchio / Banca: Maria Rita Marques de Oliveira / Resumo: A obesidade é uma desordem multifatorial que envolve agentes hereditários, ambientais e estilo de vida, e suas consequências não são apenas sociais ou psicológicas, mas também estão relacionadas à presença de comorbidades como a hipertensão arterial, diabetes tipo 2 e doenças cardiovasculares, sendo considerada pela Organização Mundial da Saúde como uma epidemia global. A obesidade é definida como uma doença associada à inflamação crônica de baixo grau, caracterizada pelos elevados níveis circulantes de citocinas inflamatórias e proteínas de fase aguda e ao excesso de adipocinas no tecido adiposo. A cirurgia bariátrica, importante forma de tratamento para a obesidade mórbida, tem dentre seus efeitos positivos a melhora do perfil inflamatório devido à redução do tecido adiposo. Contudo, esse procedimento produz alterações na anatomia e fisiologia gastrointestinal, as quais têm consequências na absorção de alimentos, podendo resultar em deficiências de micronutrientes como vitaminas e sais minerais. Sabe-se que vários micronutrientes podem contribuir para a redução de distúrbios associados à obesidade devido à habilidade de regular a expressão gênica, modular a adipogênese e o processo inflamatório. Diante desse cenário, o presente estudo teve como objetivo avaliar a relação entre a ingestão de micronutrientes, o perfil de citocinas plasmáticas circulantes e o padrão de expressão dos genes IL-6, IL-10 e TNF-α em mulheres com obesidade mórbida (n =30), antes e após suplementação nutricional com as vitaminas A, B6, B12, C, E e D3, ácido fólico, ferro, selênio e zinco, e a cirurgia bariátrica. Os dados obtidos mostraram que apenas para as vitaminas C e D3 foram detectadas concentrações séricas abaixo dos valores de referência após a suplementação e cirurgia bariátrica. Com relação às citocinas TNF-α, VEGF e MCP-1, todas apresentaram concentrações mais altas nas mulheres... / Abstract: Obesity is a multifactorial disorder involving hereditary and environmental factors and lifestyle, its adverse effects are not only social or psychological, but are also related to the presence of comorbidities such as hypertension, type 2 diabetes and cardiovascular disease, being considered by World Health Organization as a global epidemic. Obesity is defined as a disease associated with chronic low-grade inflammation characterized by elevated levels of circulating cytokines and acute phase proteins and excess of adipokines in adipose tissue. Bariatric surgery, important treatment for morbid obesity, has among its positive effects the improvement of inflammatory profile promoted by the reduction of adipose tissue. However, this procedure leads to changes in the gastrointestinal anatomy and physiology and, consequently, alters the absorption process, which may result in micronutrient deficiencies such as vitamins and minerals. It is known that several micronutrients may contribute to the reduction of obesity-related disorders due to the ability to regulate gene expression, modulate adipogenesis and inflammation. In this context, the present study aimed to evaluate the relationship between micronutrient intake, the expression pattern of IL-6, IL-10 and TNF-α genes and the profile of circulating plasma cytokines in women with morbid obesity (n = 30) before and after dietary supplementation with vitamins A, B6, B12, C, D3, and E, folic acid, iron, selenium, zinc, and bariatric surgery. The data showed that only vitamin D3 and C serum concentrations were detected below reference values after supplementation and bariatric surgery. The circulation levels of TNF-α, VEGF and MCP-1 cytokines were significant higher in obese women compared to normal weight women, confirming the inflammatory state associated with obesity. IL-6, TNF-α and VEGF circulation levels were significant decreased after bariatric surgery. Gene expression data also showed ... / Mestre

Orientador: Maria Rita Marques de Oliveira / Banca: Vera Mariza Henriques de Miranda Costa / Banca: Telma Maria Braga Costa / Resumo: Apesar de muito estudada, a obesidade continua um tema que requer ainda muitos estudos. Ao classificá-la entre os distúrbios psicossomáticos, abre-se um vasto campo de exploração no sentido de entendê-la como um problema de saúde pública fortemente influenciado pelo meio e pela forma com que o sujeito interage com seu ambiente. O objetivo do trabalho foi caracterizar, a partir de relatos sobre a alimentação, os hábitos de vida, a idade de início e a evolução da obesidade entre mulheres adultas da fila de espera para o tratamento cirúrgico da obesidade pelo Sistema Único de Saúde. Participaram do estudo 35 mulheres com idade média de 39,511,7, variando de 21 a 67 anos, e índice de massa corporal (IMC, em Kg/m2) entre 36,1 e 60,1 kg ∕ m2, recrutadas na Clínica Bariátrica de Piracicaba - SP. Para efeito de análise, as mulheres foram agrupadas segundo o período de início da obesidade: 0 ┤10 anos, 10 ┤20 anos, 20 ┤30 anos e >30 anos. O perfil das candidatas, em termos de massa corporal, tempo de espera na fila para a cirurgia bariátrica, informações pessoais, prevalência de comorbidezes, limitações físicas para execução de tarefas da vida diária, bem como as razões para a procura da cirurgia, foram obtidos a partir de um formulário. A história de vida relativa à alimentação, a atividades físicas e de lazer e a tratamentos realizados para perda ponderal foi levantada com auxílio de instrumento de avaliação cronológica dos eventos, "Linha do tempo", criado para esse fim. A estimativa e a avaliação da adequação do consumo alimentar atual foram realizadas a partir dos dados obtidos em três recordatórios de 24 horas (R24h). Quanto às experiências de vida, não foram percebidas diferenças marcantes entre as mulheres, quando confrontadas conforme o período de início da obesidade. O ambiente obesogênico... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Even though obesity has been extensively studied, it is a theme that still requires extensive investigation. Once it became classified as a psychosomatic disorder, a broad field opened up for exploration, i.e., understanding that obesity is a public health problem that is strongly influenced by the environment and by the way individuals interact with the environment. This study used feeding reports to characterize the life habits, age of onset and progression of obesity in adult women recruited from the waiting list for surgical treatment of obesity of the Unified Health System. The participants included 35 women 39.511.7 mean of age, varying from 21 to 67 years, with a body mass index (BMI in kg/m2) of 36.1 to 60.1 kg/m2 seen at the Bariatric Clinic of Piracicaba, SP. Analysis was performed by grouping the women according to the age of onset of obesity: 0 ┤10 years, 10 ┤20 years, 20 ┤30 years and >30 years. A self-administered questionnaire was used to determine the profile of the participants in terms of body mass, time in the waiting list for bariatric surgery, personal information, prevalence of comorbidities, physical limitations that interfere with daily tasks and activities and reasons for seeking surgery. Their life story regarding feeding habits, physical and leisure activities and weight loss treatments was determined with an instrument that assesses the chronological order of events, "Time Line," created for this purpose. Data obtained from three 24-hour recalls (24HR) were used to estimate and verify the adequacy of actual food intake. Regarding life experiences, there were no marking differences among the women at the onset of obesity. Today's obesogenic environment, product of this new century, was the habitat of every one of those women from childhood, with its effects being manifested especially in adult life. These women sought surgical treatment in 2005... (Complete abstract click electronic access below) / Mestre

A obesidade grau III ou também chamada obesidade mórbida é uma condição clínica freqüente e que vem apresentado crescimento progressivo, estando associada a elevadas taxas de morbi-mortalidade. Trata-se de uma doença de origem multifatorial, freqüentemente associada a comorbidezes, necessitando uma abordagem terapêutica que propicie redução de peso, melhora das doenças associadas e conseqüente melhora da qualidade de vida. O tratamento convencional deve ser sempre a primeira escolha, principalmente nos casos de inicio recente e sem antecedentes de tratamentos adequados prévios. A taxa de insucesso, contudo, é extremamente elevada, ocorrendo falha em mais de 90% dos casos. O tratamento cirúrgico atualmente é a alternativa com melhores resultados, porém com riscos de complicações a curto, médio e longo prazo, caso não seja realizado um rigoroso acompanhamento clinico, nutricional e psicológico em equipe multidisciplinar experiente. Esta revisão tem por objetivo discorrer sobre as morbidades associadas à obesidade grave, as opções de tratamento convencional e cirúrgico bem como riscos relacionados à persistência de um grande excesso de peso versus risco cirúrgico. / Morbid obesity is a frequent disease with a progressive increase in incidence and associated with high morbid and mortality rates. It is a multifactorial disease, and is usually associated with comorbidities. It is necessary specific treatment to reduce weight, to improve the comorbidities and obtain a better quality of life. The classic treatment, diet and exercise, should be the first choice, especially in cases of recent onset of severe obesity and poor quality previous treatments. Unfortunately, in more than 90% of the patients this kind of treatment will fail. Bariatric surgery is, nowadays, the best option of treatment, but has several risks of complications in the short, medium or long time followup, mostly in patients not followed by a specialized multidisciplinary team. This is a review about morbid obesity, comorbidities, options of treatment and the risks of stay severely obese versus surgical procedures.

Purpose: We aim to characterize a large cohort of CVS patients seen at MGH in order to better understand this disorder. In addition, as CVS patients are known to have a higher cannabis use than those with other functional disorders, characteristics specific to CVS marijuana user patients have yet to be determined. Therefore, we aim to determine the variables that are patient specific predictors of cannabis use in CVS. Methods: All patients with a CVS diagnosis were seen at our facility as inpatient, outpatient or in the emergency department and medical record numbers were identified via Research Patient Data Registry (RPDR) query search tool. From the medical records, we verified a diagnosis of CVS based on Rome III criteria and collected information on demographics, co-morbidities, health care utilization and substance abuse history over a 16 year time period (1997-2013). We then proposed patient specific predictor variables of marijuana use based on our experience with CVS patients and incorporated these variables into a model for predicting marijuana use. We used this model to examine the effect of patient characteristics on marijuana use via logistic regression with estimation of odds ratio and 95% confidence ratio. Results: A total of 91 CVS patients were obtained, 67% of which were male with a mean age of 28 years old, average age of first attack of 20.2 years and employment or full time student status in 62% of patients. Psychiatric conditions were present in 73% of individuals with anxiety present in 50% and depression in 47%. The presence of a chronic pain syndrome was found in 40%. Marijuana use was present in 76% of our cohort, daily alcohol use 53%, and narcotic use 27%. Men with CVS were at significantly greater risk for marijuana use compared to women (OR .23, 95% CI .07-.77) as well as daily alcohol use (OR 5.26, 95% CI 1.469-18.828). Individuals with a chronic pain syndrome were at significantly lower risk for cannabis use (OR .15, 95% CI .039-.575) and psychiatric illness, age and narcotic use were found not to be associated with marijuana use. On average, individuals presented to the ED 1.6 times/year with one patient having a high of 208 ED visits/year. Of those that presented more than once during the time period in study there was a median interval between visits of 103.6 days. Conclusion: We found that CVS patients had significant psychiatric co-morbidities, chronic pain syndromes, and history of substance abuse. We found male gender and alcohol use to be two variables that were predictors of marijuana use in the CVS population while the presence of a chronic pain syndrome decreased the likelihood of marijuana use. The significant employment rate and full time student status of our cohort suggests a higher degree of functionality. Further prospective studies are needed to determine the role of marijuana use in the CVS population in terms of quality of life, health care utilization, and severity of disease.