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March 24, 2014

When a live-tweeted surgery gets complicated

Daily Briefing

Surgeons at Cincinnati Children's Hospital Medical Center last week encountered complications during a live-tweeted procedure that forced them to change course mid-surgery, the Cincinnati Business Courier reports.

Why the family opted to live-tweet the procedure

The hospital decided to live-tweet the operation because the patient—12-year-old Alexis Shapiro—had gained so much media attention when the family's insurer initially refused to pay for an operation to help treat Shapiro's rare condition, hypothalamic obesity.

About two-and-a-half years ago, Shapiro had a non-cancerous brain tumor removed. As a result, her brain no longer recognized when Shapiro had enough to eat and made her feel as though she was perpetually starving. She had been gaining about two pounds a week when her parents sought treatment at Cincinnati Children's. Now, the four-foot-seven girl weighs more than 200 pounds, despite following a strict diet and exercise regimen.

Surgeons decided to perform gastric bypass surgery to modify Shapiro's stomach and a vagotomy to improve signals between the brain and the gut. The insurer eventually agreed to pay, Shapiro's parents say.

Before the surgery, Shapiro's parents allowed the hospital to tweet live updates, saying that it would raise public awareness about the condition and help them keep family and friends updated about the procedure. It was the first time the hospital tweeted updates about an operation, according to Kate Setter, the hospital's senior associate for social media.

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Changing course mid-surgery

Setter was tweeting details of the routine procedure while standing outside of the OR dressed in scrubs, when surgeons signaled that they had run into a problem.

"Alexis Shapiro's liver is larger than surgical team anticipated, making necessary visualization difficult," @CincyChildrens tweeted at 10:43 a.m. Four minutes later, the hospital tweeted, "Planned gastric bypass & vagotomy no longer safest option for Alexis today given liver size."

Surgeons moved forward with a sleeve gastrectomy, which will "help Alexis lose weight, which will also reduce liver size," according to a follow-up tweet. The surgery was completed at 12:07 p.m., and Shapiro was sent to the pediatric ICU to recover.

Thomas Inge—Shapiro's physician—later explained to reporters that the issue was not a medical complication; it was a clinical decision to change course. "It's not disappointing at all," Inge said, adding, "Our goal is to do a safe operation under circumstances that are not always 100% predictable."

Shapiro's parents expressed a similar sentiment. "Yes, unexpected. But it's OK," Shapiro's mother said in an email to NBC News, adding, "We are OK with it. And it was what's best for her."

The gastric bypass and vagotomy may be considered again at a later date, according to @CincyChildrens (Brunsman, Cincinnati Business Courier, 3/21; Aleccia, NBC News, 3/21; Huffington Post, 3/21).

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