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Santos-Sousa H, Amorim-Cruz F, Nogueiro J, Silva A, Amorim-Cruz I, Ferreira-Santos R, Bouça-Machado R, Pereira A, Resende F, Costa-Pinho A, Preto J, Lima-da-Costa E, Barbosa E, Carneiro S, Sousa-Pinto B. Preoperative risk factors for early postoperative bleeding after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:163. [PMID: 38775865 PMCID: PMC11111548 DOI: 10.1007/s00423-024-03346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Although bariatric surgery is an effective intervention for obesity, it comes with risks such as early postoperative bleeding (EPB). Identifying preoperative risk factors for this complication can help patients' risk stratification and optimization. We performed a systematic review and meta-analysis to find predictors for early postoperative bleeding after Roux-en-Y gastric bypass (RYGB). METHODS We conducted a systematic review, searching PubMed, Cochrane Library, and Web of Science until November 2023. We performed a random-effects meta-analysis to explore preoperative risk factors associated with early postoperative bleeding after RYGB. Sources of heterogeneity were explored by leave-one-out analyses. RESULTS 23 studies were included, comprising 232,488 patients. Male gender (meta-analytical RR = 1.42, 95%CI = 1.21-1.66, I2 = 18%, Q Cochran test p-value = 0.29) and revisional surgery (meta-analytical RR = 1.35, 95%CI = 1.12-1.62, I2 = 22%, Q Cochran test p = 0.21) were associated with higher risk of EPB. On average, patients with EPB were older than the remainder (MD for the mean age = 2.82 years, 95%CI = 0.97-4.67, I2 = 0.00%, Q Cochran test p = 0.46). Except for hypertension (meta-analytical RR = 1.33, 95%CI = 1.02-1.73, I2 = 66%, Q Cochran test p < 0.0001), comorbidities were not associated with a higher risk of EPB. CONCLUSION Preoperative risk factors, including age, gender, hypertension, and revisional bariatric surgery, are associated with early postoperative bleeding after RYGB. Further primary studies, with higher methodological quality, are required to detail more risk factors.
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Affiliation(s)
- Hugo Santos-Sousa
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal.
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal.
| | - Filipe Amorim-Cruz
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Jorge Nogueiro
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Alexandre Silva
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - Inês Amorim-Cruz
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | | | | | - André Pereira
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Fernando Resende
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - André Costa-Pinho
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - John Preto
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - Eduardo Lima-da-Costa
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Elisabete Barbosa
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
- Surgery Department, São João University Medical Center, Porto, Portugal
| | - Silvestre Carneiro
- Obesity Integrated Responsability Unit (CRI-O), São João University Medical Center, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, 4200 - 319, Portugal
| | - Bernardo Sousa-Pinto
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, MEDCIDS, University of Porto, Porto, Portugal
- CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal
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2
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Iranmanesh P, Shah SK, Chevallay M, Toso C, Mönig SP, Hagen ME, Wilson EB, Jung MK. Assessment of predictors of early postoperative complications after primary robotically assisted Roux-en-Y gastric bypass: a multicenter, retrospective cohort study. Surg Endosc 2022; 37:2851-2857. [PMID: 36484858 PMCID: PMC10082102 DOI: 10.1007/s00464-022-09766-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/06/2022] [Indexed: 12/14/2022]
Abstract
Abstract
Background
Robotic Roux-en-Y gastric bypass (RRYGB) is performed in an increasing number of bariatric centers worldwide. Previous studies have identified a number of demographic and clinical variables as predictors of postoperative complications after laparoscopic Roux-en-Y gastric bypass (LRYGB). Some authors have suggested better early postoperative outcomes after RRYGB compared to LRYGB. The objective of the present study was to assess potential predictors of early postoperative complications after RRYGB.
Methods
A retrospective analysis of two prospective databases containing patients who underwent RRYGB between 2006 and 2019 at two high volumes, accredited bariatric centers was performed. Primary outcome was rate of 30 day postoperative complications. Relevant demographic, clinical and biological variables were entered in a multivariate, logistic regression analysis to identify potential predictors.
Results
Data of 1276 patients were analyzed, including 958 female and 318 male patients. Rates of overall and severe 30 day complications were 12.5% (160/1276) and 3.9% (50/1276), respectively. Rate of 30 day reoperations was 1.6% (21/1276). The overall gastrointestinal leak rate was 0.2% (3/1276). Among various demographic, clinical and biological variables, male sex and ASA score >2 were significantly correlated with an increased risk of 30 day complication rates on multivariate analysis (OR 1.68 and 1.67, p=0.005 and 0.005, respectively).
Conclusion
This study identified male sex and ASA score >2 as independent predictors of early postoperative complications after RRYGB. These data suggest a potentially different risk profile in terms of early postoperative complications after RRYGB compared to LYRGB. The robotic approach might have a benefit for patients traditionally considered to be at higher risk of complications after LRYGB, such as those with BMI >50. The present study was however not designed to assess this hypothesis and larger, prospective studies are necessary to confirm these results.
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Affiliation(s)
- Pouya Iranmanesh
- Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shinil K Shah
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Mickael Chevallay
- Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Stefan P Mönig
- Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Monika E Hagen
- Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Erik B Wilson
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Minoa K Jung
- Division of Digestive Surgery, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland.
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3
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Suter M. Response to the Letter to the Editor: About Risk Factors in Early Bleeding After Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2022; 32:3780-3781. [PMID: 36169907 DOI: 10.1007/s11695-022-06291-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Michel Suter
- Department of Surgery, Riviera-Chablais Hospital, 1847, Rennaz, Switzerland. .,Department of Visceral Surgery, University Hospital (CHUV), Lausanne, Switzerland. .,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
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4
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Singhal R, Cardoso VR, Wiggins T, Super J, Ludwig C, Gkoutos GV, Mahawar K. 30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data. Int J Obes (Lond) 2022; 46:750-757. [PMID: 34912046 PMCID: PMC8671878 DOI: 10.1038/s41366-021-01048-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. MATERIALS AND METHODS This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien-Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. RESULTS In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). CONCLUSIONS This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts.
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Affiliation(s)
- Rishi Singhal
- Upper GI Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Victor Roth Cardoso
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Health Data Research UK Midlands, Birmingham, UK
| | - Tom Wiggins
- Upper GI Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan Super
- General Surgery Department, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, UK
| | - Christian Ludwig
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Health Data Research UK Midlands, Birmingham, UK
- NIHR Experimental Cancer Medicine Centre, Birmingham, B15 2TT, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, B15 2TT, UK
| | - Kamal Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
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5
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Early Postoperative Bleeding After Laparoscopic Roux-En-Y Gastric Bypass: a Single Center Analysis. Obes Surg 2022; 32:1902-1908. [PMID: 35201569 DOI: 10.1007/s11695-022-05973-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/08/2022] [Accepted: 02/17/2022] [Indexed: 12/20/2022]
Abstract
PURPOSE Early postoperative bleeding is a common complication after laparoscopic Roux-en-Y gastric bypass (LRYGB) and is associated with significant morbidity. We aimed to identify predictors of early postoperative bleeding after LRYGB and characterize hemorrhagic events and 30-day postoperative outcomes. MATERIAL AND METHODS We conducted a retrospective cohort study regarding all patients submitted to LRYGB in 2019 at a high-volume obesity center. Early postoperative bleeding was defined as any clinically significant evidence of hemorrhage in the early postoperative period. Demographic, preoperative, and intraoperative factors were evaluated for associations with postoperative bleeding. Postoperative outcomes were compared between patients with and without hemorrhage. RESULTS Of 340 patients submitted to LRYGB, 14 (4.1%) had early postoperative bleeding. Patients with bleeding had an increased preoperative left hepatic lobe diameter (8.4 vs. 7.3 cm, p = 0.048). Prior cholecystectomy (28.6 vs. 14.5%) and previous bariatric surgery (35.7 vs. 23.9%) tended to be more prevalent among these patients. Bleeding occurred at a median time of 31.2 [IQR 19.7-38.5] h. Thirteen patients presented with intraluminal bleeding and one with extraluminal bleeding. Melena was the most common symptom. All hemorrhages were clinically diagnosed, and 92.9% were managed conservatively. Postoperative bleeding was associated with longer hospital stay (3.5 vs. 2.0 days), higher reintervention (7.1 vs. 0%), and readmission (14.3 vs. 0%), all p < 0.05. CONCLUSIONS Bleeding was the most frequent early complication after LRYGB. Patients with hepatomegaly and prior surgeries may have technically challenging LRYGB and should be carefully assessed. Perioperative strategies should be encouraged in high-risk patients to prevent bleeding.
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6
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Srikanth N, Xie L, Morales-Marroquin E, Ofori A, de la Cruz-Muñoz N, Messiah SE. Intersection of smoking, e-cigarette use, obesity, and metabolic and bariatric surgery: a systematic review of the current state of evidence. J Addict Dis 2021; 39:331-346. [PMID: 33543677 DOI: 10.1080/10550887.2021.1874817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Millions of Americans qualify for metabolic and bariatric surgery (MBS) based on the proportion of the population with severe obesity. Simultaneously, the use of electronic nicotine/non-nicotine delivery systems (ENDS) has become epidemic. OBJECTIVE We conducted a timely systematic review to examine the impact of tobacco and ENDS use on post-operative health outcomes among MBS patients. METHODS PRISMA guidelines were used as the search framework. Keyword combinations of either "smoking," "tobacco," "e-cigarette," "vaping," or "ENDS" and "bariatric surgery," "RYGB," or "sleeve gastrectomy" were used as search terms in PUBMED, Science Direct, and EMBASE. Studies published in English between January 1990 and June 2020 were screened. RESULTS From the 3251 articles found, a total of 48 articles were included in the review. No articles described a relationship between ENDS and post-operative health outcomes in MBS patients. Seven studies reported smokers had greater post-MBS weight loss, six studies suggested no relationship between smoking and post-MBS weight loss, and one study reported smoking cessation pre-MBS was related to post-MBS weight gain. Perioperative use of tobacco is positively associated with several post-surgery complications and mortality in MBS patients. CONCLUSIONS Combustible tobacco use among MBS patients is significantly related to higher mortality risk and complication rates, but not weight loss. No data currently is available on the impact of ENDS use in these patients. With ENDS use at epidemic levels, it is imperative to determine any potential health effects among patients with severe obesity, and who complete MBS.
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Affiliation(s)
- Nimisha Srikanth
- School of Public Health, Dallas Regional Campus, University of Texas Health Science Center, Dallas, TX, USA.,Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA.,School of Public Health, Texas A&M University, College Station, TX, USA
| | - Luyu Xie
- School of Public Health, Dallas Regional Campus, University of Texas Health Science Center, Dallas, TX, USA.,Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| | - Elisa Morales-Marroquin
- School of Public Health, Dallas Regional Campus, University of Texas Health Science Center, Dallas, TX, USA.,Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| | - Ashley Ofori
- School of Public Health, Dallas Regional Campus, University of Texas Health Science Center, Dallas, TX, USA.,Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
| | | | - Sarah E Messiah
- School of Public Health, Dallas Regional Campus, University of Texas Health Science Center, Dallas, TX, USA.,Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, TX, USA
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7
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Comparison of short-term outcomes following Roux-en-Y gastric bypass in male and female patients using the MBSAQIP database. Surg Obes Relat Dis 2020; 16:1236-1241. [DOI: 10.1016/j.soard.2020.04.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 04/03/2020] [Accepted: 04/24/2020] [Indexed: 11/19/2022]
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8
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Fischer LE. Comment on: A comparison of short-term outcomes after Roux-en-Y gastric bypass in male and female patients using MBSAQIP. Surg Obes Relat Dis 2020; 16:e64-e66. [PMID: 32798127 DOI: 10.1016/j.soard.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Laura E Fischer
- OU Metabolic and Bariatric Surgery Program, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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9
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Laparoscopic bypass reversal for intractable nausea and vomiting using a circular stapler: a video case report. Surg Obes Relat Dis 2019; 15:1226-1228. [PMID: 31427106 DOI: 10.1016/j.soard.2019.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/03/2019] [Accepted: 04/17/2019] [Indexed: 11/20/2022]
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10
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Liakopoulos V, Franzén S, Svensson AM, Miftaraj M, Ottosson J, Näslund I, Gudbjörnsdottir S, Eliasson B. Pros and cons of gastric bypass surgery in individuals with obesity and type 2 diabetes: nationwide, matched, observational cohort study. BMJ Open 2019; 9:e023882. [PMID: 30782717 PMCID: PMC6340417 DOI: 10.1136/bmjopen-2018-023882] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Long-term effects of gastric bypass (GBP) surgery have been presented in observational and randomised studies, but there are only limited data for persons with obesity and type 2 diabetes mellitus (T2DM) regarding postoperative complications. DESIGN This is a nationwide observational study based on two quality registers in Sweden (National Diabetes Register, NDR and Scandinavian Obesity Surgery Register, SOReg) and other national databases. SETTING After merging the data, we matched individuals with T2DM who had undergone GBP with those not surgically treated for obesity on propensity score, based on sex, age, body mass index (BMI) and calendar time. The risks of postoperative outcomes (rehospitalisations) were assessed using Cox regression models. PARTICIPANTS We identified 5321 patients with T2DM in the SOReg and 5321 matched controls in the NDR, aged 18-65 years, with BMI >27.5 kg/m² and followed for up to 9 years. PRIMARY AND SECONDARY OUTCOME MEASURES We assessed risks for all-cause mortality and hospitalisations for cardiovascular disease, severe kidney disease, along with surgical and other medical conditions. RESULTS The results agree with the previously suggested lower risks of all-cause mortality (49%) and cardiovascular disease (34%), and we also found positive effects for severe kidney disease but significantly increased risks (twofold to ninefold) of several short-term complications after GBP, such as abdominal pain and gastrointestinal conditions, frequently requiring surgical procedures, apart from reconstructive plastic surgery. Long-term, the risk of anaemia was 92% higher, malnutrition developed approximately three times as often, psychiatric diagnoses were 33% more frequent and alcohol abuse was three times as great as in the control group. CONCLUSIONS This nationwide study confirms the benefits and describes the panorama of adverse events after bariatric surgery in persons with obesity and T2DM. Long-term postoperative monitoring and support, as better selection of patients by appropriate specialists in interdisciplinary settings, should be provided to optimise the outcomes.
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Affiliation(s)
- Vasileios Liakopoulos
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Stefan Franzén
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
- Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann-Marie Svensson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Mervete Miftaraj
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Soffia Gudbjörnsdottir
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- National Diabetes Register, Centre of Registers Västra Götaland, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
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11
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Husain F, Jeong IH, Spight D, Wolfe B, Mattar SG. Risk factors for early postoperative complications after bariatric surgery. Ann Surg Treat Res 2018; 95:100-110. [PMID: 30079327 PMCID: PMC6073041 DOI: 10.4174/astr.2018.95.2.100] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/05/2017] [Accepted: 12/12/2017] [Indexed: 12/22/2022] Open
Abstract
Purpose Vertical sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are currently the most common bariatric procedures. Although the safety of these operations has markedly improved, there continues to be a certain rate of complications. Such adverse events can have a significant deleterious effect on the outcome of these procedures and represent a costly burden on patients and society at large. A better understanding of these complications and their predictive factors may help ameliorate and optimize outcomes. Methods Seven hundred seventy-two consecutive patients who underwent SG or RYGB for morbid obesity between January 2011 and October 2015, in the Division of Bariatric Surgery at a tertiary institution, were included through retrospective review of the medical database. The complications were categorized and evaluated according to severity using the Clavien-Dindo classification system. Significant risk factors were evaluated by binary logistic regression to identify independent predictors and analyzed to identify their relationship with the type of complication. Results Independent predictors of severe complication after these procedures included male gender, open and revisional surgery, hypertension, and hypoalbuminemia. Hypoalbuminemia had significant associations with occurrence of deep surgical site infection and leak. Open surgery had significant associations with occurrence of superficial and deep surgical site infection and respiratory complications. Independent predictors of severe complication after laparoscopic primary RYGB included previous abdominal surgery. Previous abdominal surgery had significant associations with deep surgical site infection and leak. Conclusion Recognition and optimization of these risk factors would be valuable in operative risk prediction before bariatric surgery.
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Affiliation(s)
- Farah Husain
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - In Ho Jeong
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA.,Department of Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Donn Spight
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Bruce Wolfe
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Samer G Mattar
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
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12
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Reiber BMM, Tenhagen M, Hunfeld MAJM, Cense HA, Demirkiran A. Calibration of the Gastric Pouch in Laparoscopic Roux-en-Y Gastric Bypass: Does It Matter? The Influence on Weight Loss. Obes Surg 2018; 28:3400-3404. [DOI: 10.1007/s11695-018-3352-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Lager CJ, Esfandiari NH, Subauste AR, Kraftson AT, Brown MB, Cassidy RB, Bellers D, Lockwood AL, Varban OA, Oral EA. Milestone Weight Loss Goals (Weight Normalization and Remission of Obesity) after Gastric Bypass Surgery: Long-Term Results from the University of Michigan. Obes Surg 2018; 27:1659-1666. [PMID: 28084587 DOI: 10.1007/s11695-016-2533-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Rates of weight normalization and obesity remission after Roux-en-Y gastric bypass (GB) are unknown. This study evaluated weight loss, rates of achieving body mass index (BMI) <25 or 30 kg/m2, recidivism, and predictors of success following GB. METHODS We retrospectively studied weight and BMI at baseline, 2 and 6 months, and annually at 1-7 years in 219 patients undergoing GB at the University of Michigan from January 2008 to November 2010. RESULTS Follow-up was excellent for a population traditionally associated with high attrition rates with data availability of 157/219, 145/219, 144/219, 134/219, 123/219, 82/161, and 29/64 patients at 1-7 years, respectively. Mean baseline BMI was 47.0 kg/m2. Weight normalization (BMI <25 kg/m2) occurred in 2.3-6.8% of patients. More importantly, 47% of patients achieved remission of obesity (BMI <30 kg/m2) at some time point and 24% (52/219) at the last observed time point. BMI <30 kg/m2 was associated with a lower initial BMI and follow-up for more than 2 years. CONCLUSIONS Rates of weight normalization are low after GB; however, a large number of patients achieved BMI <30 kg/m2. While the percent total weight loss and excess weight loss are both quite high in the entire cohort and this is likely associated with significant health benefits, our results still underscore the need to address obesity with intensive clinical attention earlier in its course.
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Affiliation(s)
- Corey J Lager
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Nazanene H Esfandiari
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Angela R Subauste
- Division of Endocrinology, University of Mississippi, 2500 N. State St., Jackson, MS, 39216, USA
| | - Andrew T Kraftson
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, M4039 SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Ruth B Cassidy
- Division of Minimally Invasive Surgery, Department of General Surgery, University of Michigan, 1500 E Medical Center Dr SPC 5343, Ann Arbor, MI, 48109, USA
| | - Darlene Bellers
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Amy L Lockwood
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| | - Oliver A Varban
- Division of Minimally Invasive Surgery, Department of General Surgery, University of Michigan, 1500 E Medical Center Dr SPC 5343, Ann Arbor, MI, 48109, USA
| | - Elif A Oral
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health Systems, Brehm Center for Diabetes, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA.
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Moulla Y, Lyros O, Blüher M, Simon P, Dietrich A. Feasibility and Safety of Bariatric Surgery in High-Risk Patients: A Single-Center Experience. J Obes 2018; 2018:7498258. [PMID: 29593899 PMCID: PMC5821962 DOI: 10.1155/2018/7498258] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/04/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Despite the feasibility and safety of bariatric procedures nowadays, high-risk patients with vast obesity and severe comorbidities demonstrate relatively high perioperative morbidity and mortality rates and, therefore, form a distinguished challenge for the bariatric surgeons. METHODS We retrospectively analyzed high-risk patients, who underwent bariatric surgery in University Hospital Leipzig between May 2012 and December 2016. High-risk patients were defined when (Bergeat et al., 2016) at least one of the following risk factors was met: age ≥ 70 years, body mass index (BMI) > 70 kg/m2, liver cirrhosis, end-organ failure, or immunosuppression by status after organ transplantation along with (Birkmeyer et al., 2010) at least two comorbidities associated with obesity. Our analysis included early postoperative complications. RESULTS A total of 25 high-risk obese patients were identified. All patients had a standardized postoperative management with a mean length of hospital stay of 4 ± 1.4 days. One patient required an operative revision due to a stapler line leak after sleeve gastrectomy. No other major postoperative complications occurred. CONCLUSION Bariatric surgery for severe high-risk patients can be performed safely in high-volume centers following standardized procedures.
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Affiliation(s)
- Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Orestis Lyros
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Matthias Blüher
- Integrated Treatment and Research Centre (IFB) for Obesity Diseases, Philipp-Rosenthal-St. 27, 04103 Leipzig, Germany
- Department of Internal Medicine, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Philipp Simon
- Department of Anesthesia and Intensive Care Medicine, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Arne Dietrich
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
- Integrated Treatment and Research Centre (IFB) for Obesity Diseases, Philipp-Rosenthal-St. 27, 04103 Leipzig, Germany
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15
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[Quality indicators for metabolic and bariatric surgery in Germany : Evidence-based development of an indicator panel for the quality of results, indications and structure]. Chirurg 2017; 89:4-16. [PMID: 29209749 DOI: 10.1007/s00104-017-0563-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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.
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Veldheer S, Yingst J, Rogers AM, Foulds J. Completion rates in a preoperative surgical weight loss program by tobacco use status. Surg Obes Relat Dis 2017; 13:842-847. [DOI: 10.1016/j.soard.2017.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/20/2017] [Accepted: 02/06/2017] [Indexed: 01/08/2023]
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García-García ML, Martín-Lorenzo JG, Lirón-Ruiz R, Torralba-Martínez JA, García-López JA, Aguayo-Albasini JL. Perioperative complications following bariatric surgery according to the clavien-dindo classification. Score validation, literature review and results in a single-centre series. Surg Obes Relat Dis 2017; 13:1555-1561. [PMID: 28601534 DOI: 10.1016/j.soard.2017.04.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/23/2017] [Accepted: 04/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is no unified system for reporting surgical complications after bariatric surgery. One increasingly used system for notifying postoperative complications is the Clavien-Dindo classification, which focuses on their therapeutic implications. OBJECTIVE The aim of this study is to validate and apply the Clavien-Dindo scale to a series of cases of bariatric surgery and systematically review its use worldwide. SETTING University hospital. METHODS A cohort of 321 patients with morbid obesity (Mean BMI: 45.4±5.5 kg/m2) underwent surgery by the same team of surgeons, fundamentally using a laparoscopic gastric bypass. Initially, the Clavien-Dindo scale was translated and validated for its acceptability and reproducibility using the Kappa index. The scale was then applied to the whole of the bariatric series. A systematic review was also conducted in the literature regarding the use of the Clavien-Dindo classification after bariatric surgery. Lastly, a comparison was made with our results. RESULTS The classification was validated without any difficulty. Most of the postoperative complications are grades I (8.4%) and III (7.8%). We found it used in 15 series (including our own), which accounts for 10,347 patients. The overall results are analogous to our series. CONCLUSIONS The Clavien-Dindo scale has been validated and translated into Spanish. Application is quick and simple and enables comparisons to be made between centers and series. Our results are similar to those reported by other authors.
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Affiliation(s)
| | | | - Ramón Lirón-Ruiz
- Department of Surgery, University Hospital "Jose María Morales Meseguer," at Murcia, Murcia, Spain
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