Quality of Life Outcomes of Bariatric Surgery: A Systematic Review

Overall Treatment Satisfaction 5 Years After Bariatric Surgery

INTRODUCTION

Up to 30 % of patients undergoing bariatric surgery are dissatisfied with treatment outcomes in the long term. The aim of this study was to examine overall satisfaction with treatment 5 years after bariatric surgery and its association with body mass index (BMI) and health-related quality of life (HRQOL).

METHODS

Patients were surveyed 5 years after bariatric surgery; 108 patients had duodenal switch (DS) and 153 patients had laparoscopic sleeve gastrectomy (LSG). The main outcome was overall treatment satisfaction, assessed by a single question, and analyzed by multiple logistic regression. Estimates for continuous independent variables represent the odds ratios (OR) for a 2-standard deviation difference.

RESULTS

Five years after surgery, 82.4 % of the patients were very satisfied or satisfied, whereas 17.6 % were unsure or dissatisfied. The following variables assessed at 5 years were associated with being dissatisfied/unsure: a higher BMI (OR = 6.1, 95 % CI = 2.7-14.0, p < 0.001), reduced obesity-specific HRQOL (OR = 3.0, 95 % CI = 1.1-7.8, p = 0.03), and reduced mental HRQOL (OR = 0.3, 95 % CI = 0.1-0.8, p = 0.02). We also found that a higher proportion of patients who underwent LSG, compared to DS, reported being dissatisfied/unsure (OR = 3.3, 95 % CI = 1.3-8.8, p = 0.01).

CONCLUSION

Reduced mental HRQOL and obesity-related HRQOL, as well as higher BMI, were associated with less satisfaction with overall treatment outcomes 5 years after bariatric surgery. Differences in overall treatment satisfaction by type of operation warrant further investigation.

Association of Bariatric Surgery With Risk of Fracture in Patients With Severe Obesity

IMPORTANCE

Given the complex relationship between body mass index, body composition, and bone density and the correlative nature of the studies that have established the prevailing notion that higher body mass indices may be protective against osteopenia and osteoporosis and, therefore, fracture, the absolute risk of fracture in patients with severe obesity who undergo either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) compared with those who do not undergo bariatric surgery is unknown.

OBJECTIVE

To assess the rates of fractures associated with obesity and compare rates between those who do not undergo bariatric surgery, those who undergo RYGB, and those who undergo SG.

DESIGN, SETTING, AND PARTICIPANTS

In this retrospective multicenter cohort study of Medicare Standard Analytic Files derived from Medicare parts A and B records from January 2004 to December 2014, patients classified as eligible for bariatric surgery using the US Centers of Medicare & Medicaid criteria who either did not undergo bariatric surgery or underwent RYGB or SG were exactly matched in a 1:1 fashion based on their age, sex, Elixhauser Comorbidity Index, hypertension, smoking status, nonalcoholic fatty liver disease, hyperlipidemia, type 2 diabetes, osteoporosis, osteoarthritis, and obstructive sleep apnea status. Data were analyzed from November to December 2019.

EXPOSURES

RYGB or SG.

MAIN OUTCOMES AND MEASURES

The primary outcome measured in this study was the odds of fracture overall based on exposure to bariatric surgery. Secondary outcomes included the odds of type of fracture (humerus, radius or ulna, pelvis, hip, vertebrae, and total fractures) based on exposure to bariatric surgery.

RESULTS

A total of 49 113 patients were included and were equally made up of 16 371 bariatric surgery-eligible patients who did not undergo weight loss surgery, 16 371 patients who had undergone RYGB, and 16 371 patients who had undergone SG. Each group consisted of an equal number of 4109 men (25.1%) and 12 262 women (74.9%) and had an equal distribution of ages, with 11 780 patients (72.0%) 64 years or younger, 4230 (25.8%) aged 65 to 69 years, 346 (2.1%) aged 70 to 74 years, and 15 (0.1%) aged 75 to 79 years. Patients undergoing RYGB were found to have no significant difference in odds of fractures compared with bariatric surgery-eligible patients who did not undergo surgery. Patients undergoing undergone SG were found to have decreased odds of fractures of the humerus (odds ratio [OR], 0.57; 95% CI, 0.45-0.73), radius or ulna (OR, 0.38; 95% CI, 0.25-0.58), hip (OR, 0.49; 95% CI, 0.33-0.74), pelvis (OR, 0.34; 95% CI, 0.18-0.64), vertebrae (OR, 0.60; 95% CI, 0.48-0.74), or fractures in general (OR, 0.53; 95% CI, 0.46-0.62). Compared with patients undergoing SG, patients undergoing RYGB had a significantly greater risk of total fractures (OR, 1.79; 95% CI, 1.55-2.06) and humeral fractures (OR, 1.60; 95% CI, 1.24-2.07).

CONCLUSIONS AND RELEVANCE

In this cohort study, bariatric surgery was associated with a reduced risk of fracture in bariatric surgery-eligible patients. Sleeve gastrectomy might be the best option for weight loss in patients in which fractures could be a concern, as RYGB may be associated with an increased fracture risk compared with SG.

Prospective Analysis Regarding Health-Related Quality of Life (HR-QOL) between Morbid Obese Patients Following Bariatric Surgery Versus on a Waiting List

BACKGROUND

Major impairment of health-related quality of life (HRQoL) is one of the main reasons why obese patients request surgical treatment.

OBJECTIVE

To prospectively analyze the impact of HRQoL between obese patients who underwent surgery and those who were wait-listed.

METHODS

Between April 2017 and March 2018, 70 surgical and 69 wait-listed patients were interviewed twice, at baseline and at the 12-month follow-up. Quality of life was measured by the SF-12v2 and the Impact of Weight on Quality of Life-Lite (IWQoL-Lite) questionnaires. Sociodemographic-, clinical-, and surgical-related variables were collected.

RESULTS

One hundred thirty-nine patients were analyzed, showing similar baseline characteristics but differences in HRQoL. Performing more qualified work improved scores on some aspects of the SF-12 survey. In contrast, women scored worse on the self-esteem domain, and men scored worse on the mental health domain. By group, at the 12-month follow-up, statistically significant differences were found among all aspects of the questionnaires between both groups (P < 0.001) and between baseline and postoperative 12-month follow-up in the surgical group (P < 0.001). Furthermore, scores were lower in all domains in the evolution of wait-listed patients, with statistically significant differences among the Bodily Pain, Emotional Role, Mental Health, and Mental Component Summary Domains (P < 0.05).

CONCLUSION

HRQoL is a multimodal concept that allows the identification of factors impacting obese patients' quality of life. It promotes the benefit of surgery against waiting list delays, which can take up to 4 years in our hospital. Therefore, HRQoL is an important pillar to justify more resources for reducing unacceptable surgical delays.

Majority of female bariatric patients retain an obese identity 18-30 months after surgery

PURPOSE

When bariatric surgery is performed, a successful outcome is usually described as % total weight lost (EWL) or a change in BMI. These definitions fail to address the importance of post-operative psychosocial adjustment. Previous research has alluded to a 'mind-body lag' where the patient's experienced body feels larger than their physically smaller post-operative body, perhaps as a result of amygdalae conditioning. The purpose of this study is to further investigate this psychological issue and assess its relationship to health locus of control, alexithymia, health quality of life and weight regain in bariatric surgery patients.

METHODS

Forty female bariatric surgery patients between 18 and 30 months post-op completed demographic data, survey instruments and anthropometric testing. Their evolving self-view, health locus of control, tendency toward alexithymic thought, and health quality of life were measured to identify significant relationships. Hermans' Dialogical Self Theory was used to understand the conflicted self-view of the participants.

RESULTS

The majority of participants retained an obese view of self despite weight loss. Those who retained an 'I-obese' viewpoint were significantly more likely to see external situations and powerful others as controlling their weight, have difficulty identifying their feelings and score significantly lower in vitality, social functioning and mental health.

CONCLUSION

Despite losing weight, the majority of participants retained an obese view of self that was significantly associated with a lessened health quality of life. Use of the Evolving Self-View (ESV) exploratory tool may allow early identification of post-operative patients with a prolonged 'I-obese' self-view and provide an opportunity for intervention.

LEVEL OF EVIDENCE

Level III, cross-sectional case-control study.

Quality of Life One Year After Bariatric Surgery: the Moderator Role of Spirituality

BACKGROUND

This study aimed to assess quality of life in obese patients 1 year after bariatric surgery taking into consideration the influence of socio-demographic, clinical, and psychological variables.

METHODS

A sample of 90 patients undergoing bariatric surgery was assessed in two moments: before surgery and 1 year after surgery.

RESULTS

Social support, problem-focused coping strategies, and quality of life increased after surgery, while eating disorder behaviour and impulsiveness decreased. The presence of eating disorder behaviour predicted worse physical and mental quality of life and higher satisfaction with social support predicted better physical and mental quality of life. In addition, higher impulsiveness predicted worse mental quality of life. Spirituality moderated the relationship between impulsiveness and mental/physical quality of life.

CONCLUSIONS

Interventions should focus on promoting social support and coping strategies particularly spirituality since it played an important role in quality of life.

Weight Loss and Quality of Life After Sleeve Gastrectomy or One-Anastomosis Gastric Bypass: Results of a Prospective Study of 120 Women with Morbid Obesity

Our aim was to compare quality of life (QoL) after laparoscopic sleeve gastrectomy (SG) and laparoscopic one-anastomosis gastric bypass (OAGB) on obese female adult patients in the first 2 years following surgery. One hundred twenty patients with BMI over 40 kg/m² and who underwent either SG or OAGB agreed to take part in this study. Weight loss and QoL were assessed via an online platform (e-baros®) before surgery and every 6 months after it. Two years after the operation, results showed a clinically meaningful reduction in BMI of 40.4% and a significantly meaningful improvement of QoL. No significant difference was found between the two surgical techniques for each data collection. In conclusion, both SG and OAGB techniques are effective in reducing BMI and improving QoL.

Management of surgical complications of previous bariatric surgery in pregnant women. A systematic review from the BARIA-MAT Study Group

Considering the large and increasing population of women of childbearing age with history of bariatric surgery, surgical complications of bariatric surgery during pregnancy may become more frequent in the future. The aim of this study was to analyze the clinical presentation, diagnostic procedures, and treatment of surgical complications of bariatric surgery during pregnancies. A systematic literature search was performed in accordance with the PRISMA (preferred reporting items for systematic review and meta-analysis) guidelines to identify all studies published up to and including December 2018 that included women with previous bariatric surgery undergoing emergency surgery during pregnancy. Sixty-eight studies were selected, including 120 women with previous bariatric surgery undergoing emergency surgery during pregnancy. Fifty cases were reported as case reports and 70 in case series. Included patients had previous history of Roux-en-Y gastric bypass (n = 99), laparoscopic adjustable gastric banding (n = 17), Scopinaro procedure (n = 2), vertical banded gastroplasty (n = 1), or one-anastomosis gastric bypass (n = 1). Final diagnosis in 50 case reports was internal hernia in 26 cases, bowel intussusception in 10, intestinal obstruction in 2, laparoscopic adjustable gastric banding slippage in 3, bowel volvulus in 3, gastric or jejunal perforation in 2, and other complications in 4 cases. Maternal and fetal death occurred in 3 (2.5%) and 9 cases (7.5%), respectively. In the case series, the majority of women were operated for internal hernia and laparoscopic adjustable gastric banding slippage. Surgical complications of previous bariatric surgery during pregnancy have potentially severe outcomes. Availability of multidisciplinary expertise, including bariatric/digestive surgeons, and education of healthcare providers and women on clinical signs that require urgent surgical examination are recommended in this setting. Prompt diagnosis is fundamental and based on clinical and laboratory findings and on radiologic examinations if needed, including computed tomography scan or magnetic resonance if available. Rapid surgical exploration is mandatory in case of high clinical and/or radiologic suspicion.

Change, predictors and correlates of weight- and health-related quality of life in adolescents 2-years following bariatric surgery

Background/Objectives:

Weight-related quality of life (WRQOL) and generic health-related quality of life (HRQOL) have been identified as important patient reported outcomes for obesity treatment and outcome research. This study evaluated patterns of WRQOL and HRQOL outcomes for adolescents at 24-months post-bariatric surgery relative to a non-surgical comparator sample of youth with severe obesity, and examined potential weight-based (e.g., BMI, weight dissatisfaction) and psychosocial predictors and correlates of these outcomes.

Subjects/Methods:

Multi-site data from 139 adolescents undergoing bariatric surgery (M_age=16.9; 79.9% female, 66.2% White; M_{Body Mass Index [BMI]=} 51.5kg/m²) and 83 comparators (M_age=16.1; 81.9 % female, 54.2% White; M_BMI= 46.9kg/m²) were collected at pre-surgery/baseline, 6-, 12-, and 24-months post-surgery/baseline with high participation rates across time points (>85%). Self-reports with standardized measures of WRQOL/HRQOL as well as predictors/covariates (e.g., weight dissatisfaction, social support, peer victimization, family dysfunction, loss of control eating, self-worth, and internalizing symptoms) were obtained. Growth curve models using structural equation modeling examined WRQOL/HRQOL over time and linear regressions examined predictors and correlates of WRQOL/HRQOL outcomes.

Results:

Significant improvement in WRQOL and Physical HRQOL, particularly in the first post-operative year with a leveling off subsequently, was found for the surgical group relative to comparators, but with no significant Mental HRQOL change. At 24 months, the surgical group had signficantly greater WRQOL/HRQOL across most subscales. Within the surgical group at 24 months, weight-based variables were signficantly associated with WRQOL and Physical HRQOL, but not Mental HRQOL. Mental HRQOL was associated with greater internalizing symptoms and loss of control eating.

Conclusions:

For adolescents undergoing bariatric surgery, most clinically meaningful changes in WRQOL and Physical HRQOL occurred early post-operatively, with weight-based variables as the primary drivers of 24-month levels. In contrast, expectations for Mental HRQOL improvement following surgery should be tempered, with 24-month levels significantly associated with psychosocial rather than weight-based correlates.

Problematic Eating Behaviors and Eating Disorders Associated with Bariatric Surgery

Bariatric surgery candidates often report problematic and/or eating disordered behaviors. For most patients, these eating behaviors improve after surgery. A subset, however, experience a recurrence or new onset of problematic eating behaviors as early as 2 months to 18 months after surgery, which can result in compromised weight loss/excessive weight regain. Those most at risk are individuals with comorbid psychopathology (ie, loss-of-control eating or depression) after surgery. For some, such problems are present before surgery. Therefore, it is critical to monitor patients closely after surgery so that appropriate psychiatric treatments can be provided if indicated.

Revising the bariatric psychological evaluation to improve clinical and research utility

Although psychological evaluations are a routine component of the bariatric surgery process, the goals commonly identified for bariatric psychological evaluations have not been realized. This brief report describes a revised bariatric psychological evaluation designed to repurpose the evaluation towards more achievable and equally valuable goals. Changes include revisions to the evaluation contents and administration methods. The revised evaluation: (1) includes pre- and post-bariatric psychological assessments to capture important surgery-related changes in psychosocial status, physical functioning, and quality of life; (2) incorporates measures of functional capacity, treatment adherence, and patient-centered goals; (3) improves clinical utility by using the post-surgery assessment data to identify patients who may benefit from psychosocial interventions; (4) expands opportunities for bariatric psychology research.

Gastroesophageal reflux-related physiologic changes after sleeve gastrectomy and Roux-en-Y gastric bypass: a prospective comparative study

BACKGROUND

The development of gastroesophageal reflux disease (GERD) after laparoscopic sleeve gastrectomy (LSG) is a major concern as it affects the quality of life of the patients and potentially exposes them to the complications of GERD. The reported incidence of GERD after LSG is up to 35%. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the procedure of choice for patients with morbid obesity with GERD but objective evidence based on physiologic studies for the same are limited.

OBJECTIVE

The objectives of the study were to determine the physiologic changes related to gastroesophageal reflux based on symptoms index, 24-hour pH study, impedance, and manometry after LSG and LRYGB.

SETTINGS

Tertiary care teaching hospital, India.

METHODS

This registered study (CTRI/2017/06/008834) is a prospective, nonrandomized, open-label clinical trial comparing the incidence of GERD after LSG and LRYGB. In this study, non-GERD patients were evaluated for GERD based on clinical questionnaires, 24-hour pH study, and impedance manometry preoperatively and 6 months postoperatively.

RESULTS

Thirty patients underwent LSG, and 16 patients underwent LRYGB. The mean DeMeester score increased from 10.9 ± 11.8 to 40.2 ± 38.6 (P = .006) after LSG. The incidence of GERD after LSG was 66.6%. The increase in DeMeester score from 9.5 ± 4.6 to 12.2 ± 17.2 after LRYGB was not significant (P = .7). There was a significant increase in the nonacid reflux both after LSG and LRYGB.

CONCLUSION

The incidence of GERD after LSG is high, making it a contraindication for LSG. LRYGB remains the preferred procedure for patients with GERD. However, more studies are needed to understand the physiologic changes in patients with preexisting GERD.

Using the BODY-Q to Understand Impact of Weight Loss, Excess Skin, and the Need for Body Contouring following Bariatric Surgery

BACKGROUND

A consequence of bariatric surgery is redundant skin for most patients. The authors measured health-related quality of life and appearance following bariatric surgery in relation to weight loss, excess skin, and need for body contouring.

METHODS

The sample included Canadian participants from the BODY-Q field-test study recruited between November of 2013 and July of 2014. Participants were invited to complete BODY-Q scales and questions to assess weight loss, amount of excess skin, and need for body contouring between June 7, 2016, and November 29, 2016.

RESULTS

Two hundred fourteen participants responded (75 percent response rate). Of the 210 who underwent bariatric surgery, most were left with excess skin [n = 196 (93 percent)] and needed body contouring [n = 168 (80 percent)]. Higher percentage total weight loss correlated with more excess skin (r = 0.24, p = 0.001), the need for more body contouring procedures (r = 0.29, p < 0.001), and (worse) scores on seven of 13 BODY-Q scales. Having redundant skin correlated with more physical symptoms (r = 0.31, p < 0.001), the need for more body contouring procedures (r = 0.62, p < 0.001), and lower scores on 12 BODY-Q scales. The need for more body contouring procedures correlated with more physical symptoms (r = 0.23, p = 0.001) and lower scores on 12 BODY-Q scales.

CONCLUSIONS

Excess skin after bariatric surgery is a disabling problem. Additional research using the BODY-Q is needed to determine improvements that can be achieved following body contouring.

An Exploratory Study: A Head-to-Head Comparison of the EQ-5D-5L and AQoL-8D for Long-Term Publicly Waitlisted Bariatric Surgery Patients Before and 3 Months After Bariatric Surgery

BACKGROUND

Choice of a multi-attribute utility instrument (MAUI) that appropriately assesses an intervention's health-related quality-of-life (HRQoL) impacts is a vital part of healthcare resource allocation and clinical assessment.

OBJECTIVE

Our exploratory study compared the EuroQol (EQ)-5D-5L and Assessment of Quality of Life (AQoL)-8D MAUIs, which were used to assess the effect of bariatric surgery for a cohort of long-term publicly waitlisted, severely obese patients.

METHODS

The study was conducted at the Hobart Private Hospital (Tasmania, Australia). To compare the sensitivity and instrument content of the two MAUIs, we used dimensional comparisons by investigating the distribution of patient-reported responses (number/percentage) across the MAUIs' levels and dimensions; summary health-state utility valuations (utilities); and individual/super-dimension scores (AQoL-8D) to investigate discriminatory power and HRQoL improvements preoperatively and 3 months postoperatively.

RESULTS

Participants' (n = 23) overall MAUI completion rate was 74%. Postoperative total weight loss was 9.9%. EQ-5D-5L utilities were relatively higher pre- and postoperatively than AQoL-8D utilities [mean standard deviation (SD) EQ-5D-5L 0.70 (0.25) to 0.80 (0.25); AQoL-8D 0.51 (0.24) to 0.61 (0.24)]. AQoL-8D Psychosocial super dimension was relatively low postoperatively [0.37 (0.25)], driving the instrument's lower utility. These results were supported by the dimensional comparisons that revealed an overall greater dispersion for the AQoL-8D. Nevertheless, there were clinical improvements in utilities for both instruments. AQoL-8D utilities were lower than population norms; not so the EQ-5D-5L utilities. The AQoL-8D dimensions of Happiness, Coping, and Self-worth improved the most.

CONCLUSIONS

AQoL-8D more fully captured the impact of obesity and bariatric surgery on HRQoL (particularly psychosocial impacts) for long-term waitlisted bariatric surgery patients, even 3 months postoperatively. AQoL-8D preoperative utility revealed our population's HRQoL was lower than people with cancer or heart disease.

A review of systematic reviews on the effects of patient-reported outcome monitoring with clinical feedback systems on health-related quality of life-implications for a novel technology in obesity treatment

Patient-reported outcome monitoring with clinical feedback systems (PRO/CFS) has been employed in many disease states to measure and improve health-related quality of life (HRQOL). Exploring the role of PRO/CFS in treatment for obesity may prove valuable. Systematic reviews were summarized to determine the effectiveness of PRO/CFS on HRQOL in any disease area. Primary studies evaluating the effect of PRO/CFS on HRQOL in treatment for obesity were also considered for inclusion. Systematic searches were performed in The Cochrane Library, PROSPERO, Epistemonikos, HTA, DARE, CINAHL, Medline, Embase, PsycINFO, BMJ Clinical Evidence, PDQ-Evidence and PubPsych. Two reviewers independently screened references until final inclusion and critically appraised included reviews using PRISMA checklist. Five systematic reviews and no primary studies met inclusion criteria. Although results were inconsistent, effectiveness of PRO/CFS on HRQOL was demonstrated in some diseases/treatments (e.g. psychiatric treatment; symptom burden in cancer treatment). No trials using PRO/CFS in treatment for obesity were identified. In some trials, PRO/CFS was not fully integrated into consultations, thereby PRO/CFS was not extensively studied. General effectiveness of PRO/CFS on HRQOL is inconclusive due to heterogeneous and statistically insignificant findings, and lack of stringency in conceptualization and execution of PRO/CFS. There are no data relevant to treatment for obesity. Future studies should use rigorous methodology to examine the effectiveness of PRO/CFS in treatment for obesity.

Recommendations on the most suitable quality-of-life measurement instruments for bariatric and body contouring surgery: a systematic review

OBJECTIVE

The objective of this study is to systematically assess the quality of existing patient-reported outcome measures developed and/or validated for Quality of Life measurement in bariatric surgery (BS) and body contouring surgery (BCS).

METHODS

We conducted a systematic literature search in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Database Systematic Reviews and CENTRAL identifying studies on measurement properties of BS and BCS Quality of Life instruments. For all eligible studies, we evaluated the methodological quality of the studies by using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and the quality of the measurement instruments by applying quality criteria. Four degrees of recommendation were assigned to validated instruments (A-D).

RESULTS

Out of 4,354 articles, a total of 26 articles describing 24 instruments were included. No instrument met all requirements (category A). Seven instruments have the potential to be recommended depending on further validation studies (category B). Of these seven, the BODY-Q has the strongest evidence for content validity in BS and BCS. Two instruments had poor quality in at least one required quality criterion (category C). Fifteen instruments were minimally validated (category D).

CONCLUSION

The BODY-Q, developed for BS and BCS, possessed the strongest evidence for quality of measurement properties and has the potential to be recommended in future clinical trials.

Body mass index and health-related quality of life

OBJECTIVE

There are conflicting data regarding the association between body mass index (BMI) and health-related quality of life (HRQoL), especially among certain population subgroups and for mental and physical health domains.

METHODS

This study analysed the relationship between BMI and HRQoL (Patient-Reported Outcomes Measurement Information System mental and physical health scales) using ordinary least squares regression. Each model allowed for the possibility of a non-linear relationship between BMI and the outcome, adjusting for age, gender, comorbidities, diet and physical activity.

RESULTS

A total of 10,133 respondents were predominantly female (71.7%), White (84.1%), median age of 52.1 years (interquartile range 37.2-63.3) and median BMI of 27.9 (interquartile range 24.0-33.2). In adjusted models, BMI was significantly associated with physical and mental HRQoL (p < 0.001). For physical HRQoL, there was a significant interaction with age (p = 0.02). For mental HRQoL, there was a significant interaction with sex (p = 0.0004) but not age (p = 0.7).

CONCLUSIONS

This study demonstrates a non-linear association of variable clinical relevance between BMI and HRQoL after adjusting for demographic factors and comorbidities. The relationship between BMI and HRQoL is nuanced and impacted by gender and age. These findings challenge the idea of obesity as a main driver of reduced HRQoL, particularly among women and with respect to mental HRQoL.

QUALITY OF LIFE AFTER VERTICAL GASTRECTOMY EVALUATED BY THE BAROS QUESTIONNAIRE

BACKGROUND

The satisfactory outcome in the surgical treatment of obesity must include, in addition to weight loss, a significant change in the pre-existing comorbidities and in the quality of life of the patients.

AIM

To evaluate the quality of life in the late postoperative period in patients that underwent videolaparoscopic sleeve gastrectomy.

METHODS

Was applied the questionnaire "Bariatric Analysis and Reporting Outcome System" (BAROS) in patients that underwent videolaparoscopic sleeve gastrectomy.

RESULTS

A total of 47 patients between 21-60 years old were evaluated. The total mean of the BMI before surgery was 43.06±5.87 kg/m². The average percentage of the reduction of excess weight after surgery was 85.46±23.6%. The score obtained by patients in the questionnaire about the improvement in the quality of life showed excellent (36.17%), very good (40.43%), good (21.28%) and reasonable (2.13%) results. There was clinical improvement after surgery in all comorbidities investigated.

CONCLUSION

BAROS showed excellent results in 36.17%, very good in 40.43%, good in 21.28% and reasonable in 2.13%. The weight loss was critical to improve the quality of life and offered the resolution or clinical improvement in all of the investigated comorbidities.

Outcomes After Spine Surgery Among Patients Who Have Had Prior Bariatric Surgery

STUDY DESIGN

Retrospective cohort study.

OBJECTIVES

We hypothesized that spine surgery patients with a history of bariatric surgery do not differ in expectations of surgery, perceived benefit of surgical intervention, or physician determined outcome of surgery from patients with no history of bariatric surgery.

METHODS

Patients seen in our spine clinic between January 1, 2 009 and December 30, 2 010 were reviewed. Included patients had a history of bariatric surgery and were 18 to 89 years old. We compared their expectations for recovery, self-perceived clinical outcome (Oswestry Disability Index [ODI] or Neck Disability Index [NDI] and visual analog scale [VAS]), satisfaction with surgery, and physician-perceived clinical outcome (Odom's criteria) to a matched cohort with no such history. Patients were matched by type of surgery (approach, levels, and procedure), diagnosis, sex, body mass index (BMI), weight category, age, and smoking status.

RESULTS

Of 210 included patients, 89 underwent spine surgery. One bariatric patient could not be matched. Seventeen received cervical spine surgery; 71 received lumbar spine surgery. The 2 cohorts had similar expectations and satisfaction. Patients with no history of bariatric surgery tended to be more satisfied than the bariatric surgery patients, but not significantly so. ODI/NDI and VAS scores were statistically worse for the bariatric cohort. Differences were attributed to differences among lumbar spine surgery patients; neck surgery patients were not different. Odom's scores were not different between the two.

CONCLUSIONS

Postoperative expectations and satisfaction of bariatric patients are similar to those of nonbariatric patients. Bariatric patients receiving lumbar spine surgery experienced inferior clinical outcomes compared with nonbariatric patients. Cervical spine surgery bariatric patients have similar clinical outcomes as nonbariatric patients.

Evaluation of quality of life, weight loss and comorbidities of patients undergoing bariatric surgery

OBJECTIVE

to assess the efficacy of weight loss, the evolution of comorbidities, the quality of life and the BAROS protocol (Bariatric Analysis and Reporting Outcome System) in the postoperative period of patients undergoing bariatric surgery.

METHODS

we conducted a cross-sectional, quantitative study with 95% true strength (P=0.05), with 103 patients submitted to SLEEVE Vertical Gastrectomy (40) and Roux-en-Y Gastric Bypass (63), from four months after surgery. We carried out the research at the Ambulatory of General Surgery of the Clinics Hospital of the Federal University of Pernambuco, using the BAROS protocol.

RESULTS

the majority of the patients were female (89.3%). The mean age was 44.23 years. The mean percentage loss of excess weight was 69.35%. The mean postoperative follow-up time was 41.87 months (±37.35). The comorbidities with the highest percentage of resolution were sleep apnea (90.2%), diabetes (80.7%) and hypertension (70.8%). The most frequent complications were hair loss (79.6%), nutritional deficiency (37.9%) and anemia (35%). The BAROS protocol demonstrated that patients positively evaluated quality of life in 93.2% of the cases. The Moorehead-Ardelt questionnaire showed that quality of life "improved" or "improved greatly" for 94.1% of patients.

CONCLUSION

bariatric surgery has been shown to be an effective procedure in the treatment of morbid obesity and in the control of comorbidities. Quality of life analysis was evaluated positively through the BAROS protocol.

The effect of laparoscopic sleeve gastrectomy on quality of life: A prospective cohort study with 5-years follow-up

BACKGROUND

Obesity has a negative effect on quality of life (QoL). Bariatric surgery results in significant weight loss with improvement of QoL. Very few studies have evaluated QoL after sleeve gastrectomy (SG), especially with a long-term follow-up.

OBJECTIVES

To assess long-term longitudinal changes of QoL of a laparoscopic SG cohort, with the obesity specific Moorehead-Ardelt II questionnaire (MAII) and to identify parameters associated with QoL outcome.

SETTING

Bariatric Unit, University Hospital of Heraklion, Greece.

METHODS

Morbidly obese patients admitted for laparoscopic SG over a 30-month period were prospectively studied. QoL was assessed using the Greek version of the MAII questionnaire and a visual analog scale preoperatively and at 6, 12, 24, and 60 months postoperatively. Anthropometric data and obesity-related co-morbidities were recorded.

RESULTS

A total of 95 patients with mean age of 37.4 ± 9.2 years and body mass index of 48.3 ± 7.1 kg/m² completed the 5-year follow-up. Percentage excess body mass index loss was 51.7 ± 14.2, 64.8 ± 16.9, 67.4 ± 17.7, and 55.8 ± 25.5 at 6, 12, 24, and 60 months, respectively. All obesity-related co-morbidities improved significantly. MAII score increased from -.38 ± 1.3 preoperatively to 1.77 ± .8, 2.08 ± 0.8, 2.12 ± .7, and 1.67 ± 1.1 at the above time points, respectively (trend P < .001), and visual analog scale increased from 3.05 ± 1.6 to 9.11 ± 1.0, 9.2 ± 1.1, 9.03 ± 1.3, and 7.85 ± 2.4 (P < .001). Overall QoL scores at 6 and 24 months (P < .001), as well as patients' female sex, correlated significantly with higher QoL at the end of the study.

CONCLUSIONS

Laparoscopic SG is an effective bariatric operation, resulting in significant weight loss and improvements in QoL. Female sex and higher MAII score at 6 and 24 months predict better long-term QoL outcome.

Health-Related Quality of Life, Anxiety, and Depression in Bariatric Surgery Candidates Compared to Patients from a Psychosomatic Inpatient Hospital

BACKGROUND AND AIM

Past research indicated high psychiatric comorbidity and poor health-related quality of life (HRQOL) in patients seeking surgical treatment for obesity. This study investigated if preoperative bariatric surgery patients perceive equally poor HRQOL and increased levels of anxiety and depression as mentally ill patients.

METHODS

The study included four groups: 192 bariatric surgery candidates (PRE, 71% women, BMI 48.35 ± 8.98 kg/m²), 96 psychotherapy inpatients with mental disorders (PSY, 77% women, BMI 27.12 ± 9.17 kg/m²), 103 postoperative bariatric surgery patients (POST, 78% women, BMI 30.38 ± 2.88 kg/m²), and a convenience sample of 96 non-clinical volunteers with pre-obesity or obesity grade 1 (CG, 52% women, BMI 29.22 ± 2.64 kg/m²). HRQOL was measured using the 12-item short form health survey (SF-12), and psychopathology was assessed with the hospital anxiety and depression scale (HADS).

RESULTS

The PRE group exhibited the lowest physical HRQOL, and the PSY group the lowest mental HRQOL. The highest mental/physical HRQOL was reported by the POST group and the CG, without significant differences between these two groups. While the PSY group scored higher on HADS-anxiety scale than the PRE group, neither group differed with regards to symptoms of depression. The lowest levels of HADS-depression were found in the POST group and the CG.

CONCLUSIONS

The present findings suggest that bariatric surgery candidates may suffer from equally high levels of depression as psychotherapy inpatients, but they perceive better mental well-being. Routine mental health evaluation should incorporate assessments for both psychopathology and HRQOL.

TRIAL REGISTRATION

DRKS00009901.

An Exploratory Study of Long-Term Publicly Waitlisted Bariatric Surgery Patients' Quality of Life Before and 1 Year After Bariatric Surgery, and Considerations for Healthcare Planners

BACKGROUND

Long-term publicly waitlisted bariatric surgery patients typically experience debilitating physical/psychosocial obesity-related comorbidities that profoundly affect their quality of life.

OBJECTIVES

We sought to measure quality-of-life impacts in a study population of severely obese patients who had multiyear waitlist times and then underwent bariatric surgery.

METHODS

Participants were recruited opportunistically following a government-funded initiative to provide bariatric surgery to morbidly obese long-term waitlisted patients. Participants self-completed the EQ-5D-5L and AQoL-8D questionnaires pre- and postoperatively. Utility valuations (utilities) and individual/super dimension scores (AQoL-8D only) were generated.

RESULTS

Participants' (n = 23) waitlisted time was mean [standard deviation (SD)] 6.5 (2) years, body mass index reduced from 49.3 (9.35) kg/m² preoperatively to 40.8 (7.01) 1 year postoperatively (p = 0.02). One year utilities revealed clinical improvements (both instruments). AQoL-8D improved significantly from baseline to 1 year, with the change twice that of the EQ-5D-5L [EQ-5D-5L: mean (SD) 0.70 (0.25) to 0.78 (0.25); AQoL-8D: 0.51 (0.24) to 0.67 (0.23), p = 0.04], despite the AQoL-8D's narrower algorithmic range. EQ-5D-5L utility plateaued from 3 months to 1 year. AQoL-8D 1-year utility improvements were driven by Happiness/Coping/Self-worth (p < 0.05), and the Psychosocial super dimension score almost doubled at 1 year (p < 0.05). AQoL-8D revealed a wider dispersion of individual utilities.

CONCLUSIONS

Ongoing improvements in psychosocial parameters from 3 months to 1 year post-surgery accounted for improvements in overall utilities measured by the AQoL-8D that were not detected by EQ-5D-5L. Selection of a sensitive instrument is important to adequately assess changes in quality of life and to accurately reflect changes in quality-adjusted life-years for cost-utility analyses and resource allocation in a public healthcare resource-constrained environment.

Gastrointestinal Quality of Life Improves Significantly After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass-a Prospective Cross-Sectional Study Within a 2-Year Follow-up

INTRODUCTION

Morbidly obese patients have lower quality of life (QOL) when compared to the general population. So far, no studies have compared gender and procedural differences in gastrointestinal QOL after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).

METHODS

Patients before and after bariatric surgery completed the gastrointestinal quality of life index (GIQLI), a 36-item questionnaire with five subscores. Differences between SG and RYGB were analyzed, as were gender differences.

RESULTS

Some 186 patients completed the questionnaire, 75 before surgery, 56 within 6 months, and 55 within 24 months after surgery. Total GIQLI score and all subscores were significantly better within 24 months after surgery (80.9 ± 19.2 vs. 109.2 ± 17.7, p < 0.001). The specific gastrointestinal items 'feeling of fullness', 'eating pleasure', 'slow speed of eating', and 'diarrhea' were also significantly better after surgery whereas many other gastrointestinal items were not different. Total GIQLI score was significantly higher for SG than for RYGB within 6 months, while there were no significant differences within 24 months after surgery. There were also no significant differences in specific gastrointestinal items between SG and RYGB within 24 months after surgery and in total GIQLI score between female and male patients.

CONCLUSION

Total GIQLI score and all subscores were higher within 24 months after bariatric surgery. Total GIQLI score was significantly higher after SG when compared to RYGB within 6 months, but not different within 24 months after surgery. There was no difference in total GIQLI score between female and male patients.

[Quality indicators for metabolic and bariatric surgery in Germany : Evidence-based development of an indicator panel for the quality of results, indications and structure]

An expert committee was appointed by the German Society for General and Visceral Surgery to develop a panel of appropriate quality indicators to collate the quality of results, indications and structure in metabolic and bariatric surgery. This entailed assimilating the available evidence (systematic literature search), results from the national registry of the society (StuDoQ|MBE) and specific socioeconomic aspects (e. g. severely limited access to metabolic and bariatric surgery in Germany). These quality parameters were to be incorporated into the national guidelines and the rules of procedure for certification in the future. The committee concluded that mortality, MTL30 and severe complications needing intervention (Clavien-Dindo ≥ 3b) are suitable indicators to measure surgical outcome quality due to their relevance, scientific soundness and practicability. As a systematic follow-up is mandatory after bariatric surgery, a minimum follow-up quota is now required using reported quality of life data as an indicator of process quality. As intestinal bypass procedures have been shown to be superior in the treatment of type 2 diabetes, these procedures should be offered to eligible patients and also be performed. The proposed threshold values based on the results of the available literature and StuDoQ registry are to be considered as preliminary and need to be validated and adjusted if necessary in the future. The StuDoQ|MBE is considered a valuable tool to gather this information and also represents the appropriate infrastructure for the collation of relevant risk adjustors.

Further psychometric validation of the BODY-Q: ability to detect change following bariatric surgery weight gain and loss

Background

Recent systematic reviews have identified that current patient-reported outcome instruments have content limitations when used to measure change following bariatric surgery. The aim of this study was to measure change after bariatric surgery using the BODY-Q, a PRO instrument designed for weight loss and body contouring.

Methods

The BODY-Q is composed of 18 independently functioning scales and an obesity-specific symptom checklist that measure appearance, health-related quality of life (HR-QOL) and experience of health-care. The sample for this study included patients who were exploring or seeking bariatric surgery in Hamilton (Canada) at the time of the BODY-Q field-test study and who agreed to further contact from the research team. These patients were invited to complete 12 BODY-Q scales and the symptom checklist between 7 June 2016 and 29 November 2016. Data were collected online (REDCap) and via postal surveys. Clinical change was measured using paired t-tests with effect sizes and standardized response means.

Results

The survey was completed by 58 of 89 (65%) pre-bariatric participants from the original BODY-Q field-test sample. The non-participants did not differ from participants in terms of age, gender, ethnicity, BMI or initial BODY-Q scale scores. Participants who had undergone bariatric surgery had a mean BMI of 49 (SD = 7) at time 1 and 35 (SD = 7) at time 2. Time since bariatric surgery was on average 2 years (SD = 0.5) (range 0.4 to 3 years). Percentage total weight loss ranged from 12 to 51 (mean 31, SD = 9). The difference in the proportion of patients to report an obesity-specific symptom on the BODY-Q checklist was significantly lower at follow-up for 5 of 10 symptoms. Participants improved on BODY-Q scales measuring appearance (of abdomen, back, body, buttocks, hips/outer thighs, inner thigh), body image and physical function (p < 0.001 on paired t-tests) and social function (p = 0.002 on paired t-test). These changes were associated with moderate to large effect sizes (0.60 to 2.29) and standardized response means (0.47 to 1.35).

Conclusions

The BODY-Q provides a set of independently functioning scales that measure issues important to patients who undergo weight loss. BODY-Q scales were responsive to measuring clinical change associated with weight loss 2 years after bariatric surgery.

Quality of Life and Bariatric Surgery: Cross-Sectional Study and Analysis of Factors Influencing Outcome

Purpose

The aims of our study were to compare quality of life (QOL) in obese patients after bariatric surgery with that in controls seeking surgery and to investigate which factors are associated with QOL in the Moorehead–Ardelt Quality of Life Questionnaire II (MA II).

Materials and Methods

This was a cross-sectional study. The operated group consisted of patients after laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass. The MA II was administered by e-mail to 305 patients 12–18 months after surgery. The control groups consisted of 101 obese patients. We compared the QOL scores and considered good and very good outcomes to be satisfactory. Multiple logistic regression and correlation analysis was performed to identify factors associated with QOL.

Results

In the operated group, the total MA II score was 1.70 ± 0.76, which was higher than 0.59 ± 1.17 in the control group. The score adjusted for the type of surgery was comparable. The prevalence of satisfactory QOL outcomes was similar in both post-operative subgroups and was still higher than in the control group. We identified four factors associated with higher QOL in obese patients. Weight loss was not correlated with total score in MAII.

Conclusions

This study demonstrates that patients after bariatric surgery have a higher score in MA II, which reflects better QOL. The scoring adjusted by type of operation is comparable. QOL among obese patients is dependent on age, gender, history of bariatric surgery, and partnered status. Body mass reduction was not associated with outcome in MAII.

A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life

This is the first systematic review of reviews to assess the effect of obesity and weight loss on health-related quality of life (HRQoL). We identified 12 meta-analyses/systematic reviews published between January 2001 and July 2016. They addressed the following themes: (i) the relationship between weight/body mass index and HRQoL (baseline/pre-intervention; n = 2). (ii) HRQoL after weight loss (varied interventions and/or study design; n = 2). (iii) HRQoL after weight loss (randomized controlled trials only; n = 2). (iv) HRQoL after bariatric surgery (n = 6). We found that in all populations, obesity was associated with significantly lower generic and obesity-specific HRQoL. The relationship between weight loss and improved HRQoL was consistently demonstrated after bariatric surgery, perhaps due to a greater than average weight loss compared with other treatments. Improved HRQoL was evident after non-surgical weight loss, but was not consistently demonstrated, even in randomized controlled trials. This inconsistency may be attributed to variation in quality of reporting, assessment measures, study populations and weight-loss interventions. We recommend longer-term studies, using both generic and obesity-specific measures, which go beyond HRQoL in isolation to exploring mediators of HRQoL changes and interactions with other variables, such as comorbidities, fitness level and body image.

Psychosocial predictors of quality of life and weight loss two years after bariatric surgery: Results from the Toronto Bari-PSYCH study

OBJECTIVES

Studies exploring the impact of pre-surgery psychiatric status as a predictor of health related quality of life (QOL) after bariatric surgery have been limited to short-term follow-up and variable use of psychosocial measures. We examined the effect of pre-operative psychiatric factors on QOL and weight loss 2-years after surgery.

METHODS

156 patients participated in this prospective cohort study, the Toronto Bariatric Psychosocial Cohort Study, between 2010 and 2014. Patients were assessed pre-surgery for demographic factors, weight, psychiatric diagnosis using the MINI International Neuropsychiatric Interview and symptom measures for QOL, depression and anxiety at pre-surgery and at 1 and 2years post-surgery.

RESULTS

At 2-years post-bariatric surgery, patients experienced a significant decrease in mean weight (-48.43kg, 95% [-51.1, -45.76]) and an increase only in physical QOL (+18.91, 95% [17.01, 20.82]) scores as compared to pre-surgery. Multivariate regression analysis identified pre-surgery physical QOL score (p<0.001), younger age (p=0.005), and a history of a mood disorder as significant predictors of physical QOL. Only a history of a mood disorder (p=0.032) significantly predicted mental QOL (p=0.006). Pre-surgery weight (p<0.001) and a history of a mood disorder (p=0.047) were significant predictors of weight loss 2-years post-surgery.

CONCLUSIONS

Bariatric surgery had a sustained impact on physical QOL but not mental QOL at 2-years post-surgery. A history of mood disorder unexpectedly increased physical QOL scores and weight loss following surgery. Further research is needed to determine if these results are due to bariatric surgery candidate selection within this program.

Does Bariatric Surgery Improve Obesity Associated Comorbid Conditions

Obesity is a constantly growing health problem which reduces quality of life and life expectancy. Bariatric surgery for obesity is taken into account when all other conservative treatment modalities have failed. Comparison of the multidisciplinary programs with bariatric surgery regarding to weight loss showed that substantial and durable weight reduction have been achieved only with bariatric surgical treatments. However, the benefits of weight loss following bariatric procedures are still debated regarding the pro-inflammatory and metabolic profile of obesity.

QUALITY OF LIFE AFTER VERTICAL GASTRECTOMY EVALUATED BY THE BAROS QUESTIONNAIRE

Background

The satisfactory outcome in the surgical treatment of obesity must include, in addition to weight loss, a significant change in the pre-existing comorbidities and in the quality of life.

Aim

To evaluate the quality of life in the late postoperative period in patients that underwent videolaparoscopic sleeve gastrectomy.

Methods

It was applied the questionnaire "Bariatric Analysis and Reporting Outcome System" (BAROS) in patients that underwent videolaparoscopic sleeve gastrectomy.

Results

A total of 47 patients between 21-60 years old were evaluated. The total mean of BMI before surgery was 43.06±5.87 kg/m². The average percentage of the reduction of excess weight after surgery was 85.46±23.6%. The score obtained by patients in the questionnaire about the improvement in the quality of life showed excellent (36.17%), very good (40.43%), good (21.28%) and reasonable (2.13%) results. There was clinical improvement after surgery in all comorbidities investigated.

Conclusion

The weight loss was critical to improve the quality of life and offered the resolution or clinical improvement in all of the investigated comorbidities in patients submitted to sleeve gastrectomy.

Quality of life and bariatric surgery: a systematic review of short- and long-term results and comparison with community norms

Currently the effects of bariatric surgery are generally expressed in excess weight loss or comorbidity reduction. Therefore the aim of this review was to provide insight in the available prospective evidence regarding the short and long-term effects of bariatric surgery on Quality of Life (QoL) and a comparison with community norms. A systematic multi-database search was conducted for 'QoL' and 'Bariatric surgery'. Only prospective studies with QoL before and after bariatric surgery were included. The 'Quality Assessment Tool for Before-After Studies with No Control Group' was used to assess the methodological quality. Thirty-six studies met the inclusion criteria. Most studies were assessed to be of 'fair' to 'good' methodological quality. Ten different questionnaires were used to measure QoL. Follow-up ranged from 6 months to 10 years, sample sizes from 26 to 1276 and follow-up rates from 45 to 100%. A significant increase in QoL after bariatric surgery was found in all studies (P⩽0.05), however, mostly these outcomes stay below community norms. Only outcomes of the IWQoL, SF-36 and OWQoL show QoL outcomes that exceed community norms. The QoL is increased after bariatric surgery on both the short and long term. However, due to the heterogeneity of the studies and the generality of the questionnaires is it hard to make a distinction between different surgeries and difficult to see a relation with medical profit. Therefore, tailoring QoL measurements to the bariatric population is recommended as the focus of future studies.