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Akinyemi OA, Weldeslase TA, Andine TF, Fasokun M, Griffiths Y, Odusanya E, Williams M, Hughes K, Cornwell E, Fullum T. Race, Insurance, and Socioeconomic Influences on Outcomes Following Roux-En-Y Gastric Bypass. Am Surg 2024; 90:2300-2304. [PMID: 38647079 DOI: 10.1177/00031348241248803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The effectiveness of Roux-en-Y gastric bypass (RYGB) might be shadowed by disparities in outcomes related to patient race and insurance type. We determine the influence of patient race/ethnicity and insurance types on complications following RYGB. We performed a retrospective analysis using data sourced from the National Inpatient Sample Database (2010 to 2019). A multivariate analysis was employed to determine the relationship between patient race/ethnicity and insurance type on RYGB complications. The analysis determined the interaction between race/ethnicity and insurance type on RYGB outcomes. We analyzed 277714 patients who underwent RYGB. Most of these patients were White (64.5%) and female (77.3%), with a median age of 46 years (IQR 36-55). Medicaid beneficiaries displayed less favorable outcomes than those under private insurance: Extended hospital stay (OR = 1.68; 95% CI 1.58-1.78), GIT Leak (OR = 1.83; 95% CI 1.35-2.47), postoperative wound infection (OR = 1.88; 95% CI 1.38-2.55), and in-hospital mortality (OR = 2.74; 95% CI 1.90-3.95).
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Affiliation(s)
- Oluwasegun A Akinyemi
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Terhas A Weldeslase
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Tsion F Andine
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Mojisola Fasokun
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yasmine Griffiths
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Eunice Odusanya
- Department of Surgery Outcomes Research Center, Howard University College of Medicine, Washington, DC, USA
| | - Mallory Williams
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Kakra Hughes
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Edward Cornwell
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Terrence Fullum
- Department of Surgery, Howard University Hospital, Washington, DC, USA
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Dijkhorst PJ, Makarawung DJS, Vanhommerig JW, Kleipool SC, Dalaei F, de Vries CEE, van der Molen AB, Poulsen L, Sorensen JA, Bonjer HJ, de Castro SMM, van Veen RN. Predictors of improved psychological function after bariatric surgery. Surg Obes Relat Dis 2023; 19:872-881. [PMID: 36842930 DOI: 10.1016/j.soard.2023.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND Negative psychological sequelae have been reported after bariatric surgery. It is unclear which factors affect psychological function in the first postoperative years. OBJECTIVE Evaluation of significant predictors of improved psychological function following bariatric surgery by analyzing data from the BODY-Q questionnaire. SETTING Multicenter prospective cohort in 3 centers located in The Netherlands and Denmark. METHODS The BODY-Q questionnaire was used to assess 6 domains of health-related quality of life. The domain of interest, psychological function, consists of 10 questions from which a converted score of 0 (low) to 100 (high) can be calculated. Linear mixed models were used to analyze which patient characteristics were most predictive of the psychological function score. Secondary outcomes of interest were cross-sectional scores of psychological function and the impact of weight loss, and the effect of major short-term complications on psychological function. RESULTS Data were analyzed from 836 patients who underwent bariatric surgery from 2015 to 2020. Patients with lower expectations concerning weight loss (<40% desired total weight loss), higher educational level, no history of psychiatric illness, and employment before bariatric surgery demonstrated the highest psychological function scores after bariatric surgery. At 1 and 2 years after bariatric surgery, more weight loss was associated with significantly higher psychological function scores. Experiencing a major short-term complication did not significantly impact psychological function. CONCLUSIONS Several relevant predictors of improved postoperative psychological function have been identified. This knowledge can be used to enhance patient education preoperatively and identify patients at risk for poor psychological functioning postoperatively.
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Affiliation(s)
- Phillip J Dijkhorst
- Department of Surgery, OLVG & Dutch Obesity Clinic, Amsterdam, The Netherlands.
| | | | | | - Suzanne C Kleipool
- Department of Surgery, OLVG & Dutch Obesity Clinic, Amsterdam, The Netherlands
| | - Farima Dalaei
- Research Unit for Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Odense Explorative Patient Network (OPEN), Odense, Denmark
| | - Claire E E de Vries
- Department of Surgery, OLVG & Dutch Obesity Clinic, Amsterdam, The Netherlands
| | | | - Lotte Poulsen
- Research Unit for Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Odense Explorative Patient Network (OPEN), Odense, Denmark
| | - Jens A Sorensen
- Research Unit for Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Odense Explorative Patient Network (OPEN), Odense, Denmark
| | - H Jaap Bonjer
- Department of Surgery, Amsterdam Medical University Center, Amsterdam, The Netherlands
| | - Steve M M de Castro
- Department of Surgery, OLVG & Dutch Obesity Clinic, Amsterdam, The Netherlands
| | - Ruben N van Veen
- Department of Surgery, OLVG & Dutch Obesity Clinic, Amsterdam, The Netherlands
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Köhler H, Bollenbach IA, Gruner-Labitzke K, Bollenbach JN, Böker C, Markov V, Kröger C. Improvement of Work Ability After Weight Loss Surgery: Results of a Longitudinal Study of Patients Suffering from Extreme Obesity Before and 4 Years After Bariatric Surgery. Obes Surg 2023; 33:1347-1355. [PMID: 36935471 DOI: 10.1007/s11695-023-06548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE Body mass index (BMI) is directly associated with employment status. Our longitudinal prospective study is aimed at ascertaining whether work ability index (WAI) 4 years after surgery remains improved, such as 1 year after surgery, or changes and whether socio-demographic or psycho-social factors influence changes in work ability. MATERIALS AND METHODS 197 bariatric surgery candidates were recruited. Data on demographic and psycho-social characteristics were collected prior to surgery (t1) and at 6 (t2), 12 (t3), and 48 months (t4). Change effects over time in the WAI and BMI were investigated using a repeated-measures analysis of variance (ANOVA). A hierarchical multiple regression analysis was calculated to predict socio-demographic and psychosocial characteristics at t1 on WAI at t4. RESULTS Not only a significant increase in WAI was observed between t1 and t2 and between t3 and t4 but also a significant decrease between t2 and t4. BMI reduction was significant between t1 and t2 and t3 and t4, respectively. There was no significant interaction effect of BMI reduction 4 years after surgery on decreased work ability from t2 to t4. The hierarchical multiple regression analysis revealed an association of WAI scores at t1 on WAI scores at t4 only. CONCLUSIONS Work ability 4 years after surgery remained significantly improved compared to the values at t1-t3 assessment. Since work ability was the only predictor at t1, findings might indicate the use of psycho-social measures post bariatric surgery to increase work ability. There was no association between work ability and other socio-demographic or psycho-social factors.
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Affiliation(s)
- Hinrich Köhler
- Department of General, Visceral and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Str. 24, 38124, Brunswick, Germany
| | - Ioana A Bollenbach
- Department of General, Visceral and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Str. 24, 38124, Brunswick, Germany.
| | - Kerstin Gruner-Labitzke
- Department of General, Visceral and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Str. 24, 38124, Brunswick, Germany
| | - Jan N Bollenbach
- Department of General, Visceral and Bariatric Surgery, Herzogin Elisabeth Hospital, Leipziger Str. 24, 38124, Brunswick, Germany
| | - Clara Böker
- Department of General, Visceral, Vascular and Bariatric Surgery, Klinikum Nordstadt, 30167, Hannover, Germany
| | - Valentin Markov
- Department of Psychology, University of Hildesheim, 31141, Hildesheim, Germany
| | - Christoph Kröger
- Department of Psychology, University of Hildesheim, 31141, Hildesheim, Germany
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Dahlberg K, Jaensson M, Cao Y, Näslund E, Stenberg E. Incidence of self-harm after bariatric surgery: A nationwide registry-based matched cohort study. Clin Obes 2023; 13:e12576. [PMID: 36610057 DOI: 10.1111/cob.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/02/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023]
Abstract
The aims of this study were to evaluate the longitudinal risk of self-harm and the risk factors for self-harm after bariatric surgery in patients and control subjects without prior self-harm. This observational cohort study was based on prospectively registered data. Patients 18-70 years at time of surgery, body mass index (BMI) > 30 kg/m2 , who underwent a primary Roux-en-Y gastric bypass (RYGB) procedure or a primary sleeve gastrectomy between 2007 and 2019 were considered for inclusion. All patients who met the inclusion criteria were matched 1:10 to the general population in Sweden (69 492 patients vs. 694 920 controls). After excluding patients and controls with previous self-harm, a self-harm event occurred in 1408 patients in the surgical group (incidence rate (IR) 3.54/1000 person-years, 95% confidence interval (CI) 3.36-3.73) versus in 3162 patients in the control group (IR 0.81/1000 person-years, 95% CI 0.78-0.84), with a hazard ratio (HR) of 4.38 (95% CI 4.11-4.66, p < .001). Median follow-up time was 6.1 years. Risk factors were younger age, lower BMI, cardiovascular, and chronic obstructive pulmonary disease, all aspects of psychiatric comorbidities (except neuropsychiatric disorder), lower socioeconomic status, RYGB, lower health-related quality of life, lower postoperative weight loss, and not attending postoperative follow-up visits. Self-harm is clearly higher after bariatric surgery than in the general population. A qualitative follow-up may be particularly important for patients at increased risk.
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Affiliation(s)
- Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Jaensson M, Josefsson E, Stenberg E, Dahlberg K. Do reasons for undergoing bariatric surgery influence weight loss and health-related quality of life?-A Swedish mixed method study. PLoS One 2022; 17:e0275868. [PMID: 36215261 PMCID: PMC9550063 DOI: 10.1371/journal.pone.0275868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background A wish for improved health or avoidance of ill health is often given as reason for wanting to undergo bariatric surgery. How such reasons relate to postoperative outcome is unclear. Objective The aim was to explore Swedish patients’ reasons for undergoing bariatric surgery. Also, we wanted to analyze if there were sex and age differences and associations with weight loss and health-related quality of life (HRQoL). Settings This was a single-center study conducted at a university hospital. Method Data on 688 patients (528 women and 160 men) including a free text response was analyzed inductively and deductively using predefined statements and was merged with data from the Scandinavian Obesity Surgery Registry. All data was analyzed using descriptive and analytic statistics. Result The most common reason for undergoing bariatric surgery was pain in different body parts. A wish for an improved medical condition was reported by most patients (59%, n = 408), followed by physical limitations making daily life difficult (42%, n = 288). Men and women reported similar reasons. Younger patients were more distressed about physical appearance (p = 0.001) and older patients wanted to improve their medical condition (p = 0.013). Health-related quality of life improved irrespective of reasons for undergoing surgery. Conclusion The most reported reasons for undergoing bariatric surgery were a wish for improved medical condition and to make daily life easier. Factors associated with the decision for surgery showed that there were few sex differences, but age seemed to be a factor. The HRQoL trajectory showed improvement regardless of reasons for undergoing surgery.
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Affiliation(s)
- Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- * E-mail:
| | - Emma Josefsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Makarawung DJS, de Vries CEE, List EB, Monpellier VM, Mou D, Klassen AF, Pusic AL, van Veen RN, Mink van der Molen AB. Patient-Level Factors Associated with Health-Related Quality of Life and Satisfaction with Body After Bariatric Surgery: a Multicenter, Cross-Sectional Study. Obes Surg 2022; 32:3079-3087. [PMID: 35859022 DOI: 10.1007/s11695-022-06214-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Health-Related Quality of Life (HRQL) is a key outcome of success after bariatric surgery. Not all patients report improved HRQL scores postoperatively, which may be due to patient-level factors. It is unknown which factors influence HRQL after surgery. Our objective was to assess patient-level factors associated with HRQL after surgery. METHODS This international cross-sectional study included 730 patients who had bariatric surgery. Participants completed BODY-Q scales pertaining to HRQL and satisfaction with body, and demographic characteristics were obtained. The sample was divided into three groups based on time since surgery: 0 - 1 year, 1 - 3 years and more than 3 years. Uni- and multivariable linear regression analyses were conducted to identify variables associated with the BODY-Q scales per group. RESULTS The 0 - 1 year postoperative group included 377 patients (50.9%), the 1 - 3 years postoperative group 218 (29.4%) and the more than 3 years postoperative group 135 patients (18.2%). Lower current body-mass index (BMI), more weight loss (%TWL), being employed, having no comorbidities, higher age and shorter time since surgery were significantly associated with improved HRQL outcomes postoperatively. None of these factors influenced all BODY-Q scales. The effect of current BMI increased with longer time since surgery. CONCLUSION Factors including current BMI, %TWL, employment status, presence of comorbidities, age and time since surgery were associated with HRQL postoperatively. This information may be used to optimize patient-tailored care, improve patient education and underline the importance of long-term follow-up with special attention to weight regain to ensure lasting improvement in HRQL.
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Affiliation(s)
- Dennis J S Makarawung
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands.
- Department of Plastic Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands.
| | - Claire E E de Vries
- Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Emile B List
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Valerie M Monpellier
- Dutch Obesity Clinic (Nederlandse Obesitas Kliniek), Amersfoortseweg 43, 3712 BA, Huis Ter Heide, the Netherlands
| | - Danny Mou
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Ruben N van Veen
- Department of Surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
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de Vries CEE, Makarawung DJS, Monpellier VM, Janssen IMC, de Castro SMM, van Veen RN. Is the RAND-36 an Adequate Patient-reported Outcome Measure to Assess Health-related Quality of Life in Patients Undergoing Bariatric Surgery? Obes Surg 2022; 32:48-54. [PMID: 34729711 PMCID: PMC8752557 DOI: 10.1007/s11695-021-05736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE The RAND-36 is the most frequently used patient-reported outcome measure (PROM) to evaluate health-related quality of life (HRQoL) in bariatric surgery. However, the RAND-36 has never been adequately validated in bariatric surgery. The purpose of this study was to validate the RAND-36 in Dutch patients undergoing bariatric surgery. MATERIAL AND METHODS To validate the RAND-36, the following measurement properties were assessed in bariatric surgery patients: validity (the degree to which the RAND-36 measures what it purports to measure (HRQoL)), reliability (the extent to which the scores of the RAND-36 are the same for repeated measurement for patients who have not changed in HRQoL), responsiveness (the ability of the RAND-36 to detect changes in HRQoL over time). RESULTS Two thousand one hundred thirty-seven patients were included. Validity was not adequate due to the irrelevance of some items and response options, the lack of items relevant to patients undergoing bariatric surgery, and the RAND-36 did not actually measure what it was intended to measure in this study (HRQoL in bariatric surgery patients). Reliability was insufficient for the majority of the scales (the scores of patients who had not changed in HRQoL were different when the RAND was completed a second time (intraclass correlation coefficient (ICC) values 0.10-0.69)). Responsiveness was insufficient. CONCLUSION The RAND-36 was not supported by sufficient validation evidence in patients undergoing bariatric surgery, which means that the RAND-36 does not adequately measure HRQoL in this patient population. Future research studies should use PROMs that are specifically designed for assessing HRQoL in patients undergoing bariatric surgery.
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Affiliation(s)
- Claire E E de Vries
- Department of Surgery, Obesity Center Amsterdam, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands.
| | - Dennis J S Makarawung
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Amersfoortseweg 43, 3712, Huis Ter Heide, the Netherlands
| | - Valerie M Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Amersfoortseweg 43, 3712, Huis Ter Heide, the Netherlands
| | - Ignace M C Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Amersfoortseweg 43, 3712, Huis Ter Heide, the Netherlands
| | - Steve M M de Castro
- Department of Surgery, Obesity Center Amsterdam, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
| | - Ruben N van Veen
- Department of Surgery, Obesity Center Amsterdam, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands
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