Effect of Significant Postoperative Complications on Decision Regret After Laparoscopic Sleeve Gastrectomy: a Case-Control Study

Patient expectations and decisional regret in the management of ventral hernias

INTRODUCTION

Older adult patients have many factors to contemplate when considering elective ventral hernia repair. In this study, we aimed to understand whether our novel shared decision-making (SDM) aid helped reduce this population's decisional regret when choosing hernia management strategy.

METHODS

Patients ≥ 60 years of age presenting for ventral hernia evaluation were randomized to two groups. The experimental group had their visit guided by our novel SDM aid. All patients took a survey prior to consultation outlining their treatment expectations. All patients were called within 6 months to complete the Decision Regret Scale, which measures remorse after a healthcare decision.

RESULTS

Seventy-two patients (36 control, 36 experimental) completed final follow-up. On initial expectations evaluation, 53 patients (74%) reported wanting surgical repair and 58 patients (81%) reported expecting surgical repair. Ultimately, 18 patients in the control group and 17 patients in the experimental group did not undergo surgery. The use of the SDM aid did not affect if patients chose observation (OR 0.44, p = 0.24) or result in a lower decision regret score (9.86 vs 9.31, p = 0.89). Surgery was associated with a lower decision regret score (3.38 vs 16.14; p = 0.001). Of those who did not undergo repair, patients initially wanting or expecting surgery had higher decision regret scores (22.83 vs 3.33, p < 0.001; 20.40 vs 5.50, p = 0.009). Nonoperative patients who chose observation had less regret than those needing medical optimization (9.50 vs 25.00, p = 0.04). There were no differences in decision regret scores based on initial wants or expectations for those who had surgical repair.

CONCLUSION

Decisional regret following ventral hernia management is associated with patients' expectations prior to initial surgical consultation. The use of a decisional aid did not lower decision regret scores. These findings emphasize the need for upfront expectation setting and longitudinal programs to help patients reach their treatment goals.

The relationship of decision regret with quality of life and comfort level in patients undergoing laparoscopic sleeve gastrectomy: a cross-sectional study

BACKGROUND

Laparoscopic sleeve gastrectomy (SG) is one of the effective methods of weight loss. It is essential to determine patients' regret and predictive factors to improve their quality of life and comfort. No study has investigated decision regret and affecting factors in patients undergoing SG in Turkey.

OBJECTIVES

The study aimed to determine the relationship of decision regret with quality of life and comfort level in patients undergoing SG.

SETTING

The research was carried out with patients who had undergone SG in a private hospital in the west of Turkey.

METHODS

The research was conducted as a descriptive, correlational, and cross-sectional study. Data were collected between March and May 2023, and the study was completed with 286 patients. Data were collected using the Personal Information Form, Decision Regret Scale (DRS), Quality of Life Following Obesity Surgery Scale (QoL-OS), and Comfort Scale.

RESULTS

Patients' mean score on the DRS was 5.27 ± 13.41 (0-100), the total mean score on the QoL-OS-Biopsychosocial dimension was 79.57 ± 9.35 (18-90), the mean score on the QoL-OS-Complications dimension was 17.17 ± 4.60 (7-35), and the environmental comfort score average was 8.87 ± 2.23 (0-10). Patients' decision regret was significantly affected by the QoL-OS-Biopsychosocial Area dimension in the first place (Beta = -.516; P < .001), social comfort in the second place (Beta = -.278; P < .001), postoperative weight gain in the third place (Beta = .221; P < .001), and complication development in the fourth place (Beta = .163; P < .001).

CONCLUSIONS

The study revealed that patients' decision regret levels were very low up to 3 years after surgery and found that low postoperative quality of life and social comfort level, postoperative weight gain, and complications affected decision regret.

A systematic review of patient regret after surgery- A common phenomenon in many specialties but rare within gender-affirmation surgery

Regret after gender-affirming surgery (GAS) is a complex issue. Comparing regret after GAS to regret after plastic surgery operations and other major life decisions is a novel approach that can provide insight into the magnitude of this issue. A systematic review of three databases was conducted to investigate regret after common plastic surgery operations. Three separate literature reviews on regret after GAS, regret after elective operations, and regret after major life decisions were performed. A total of 55 articles examining regret after plastic surgery were included. The percentage of patients reporting regret ranged from 0 to 47.1 ​% in breast reconstruction, 5.1-9.1 ​% in breast augmentation, and 10.82-33.3 ​% in body contouring. In other surgical subspecialties, 30 ​% of patients experience regret following prostatectomy and up to 19.5 ​% following bariatric surgery. Rate of regret after GAS is approximately 1 ​%. Other life decisions, such as having children and getting a tattoo have regret rates of 7 ​% and 16.2 ​%, respectively. When comparing regret after GAS to regret after other surgeries and major life decisions, the percentage of patients experiencing regret is extremely low.

Decision regret up to 6 years after sleeve gastrectomy

BACKGROUND

Sleeve gastrectomy (SG) is one of the most popular types of weight loss surgery today but is neither risk-free nor universally effective. We previously demonstrated that 5% of Roux-en-Y gastric bypass (RYGB) patients and up to 20% of gastric banding patients report overall regret 4 years after surgery. This study explores patients' attitudes toward their decision to have SG and decision regret rates up to 6 years postoperatively.

METHODS

We surveyed 185 patients who were at least 6 months post-SG (response rate 30%). We used a modified version of the Decision Regret Scale developed by Brehaut et al. We converted responses to a 0-100 scale so that higher scores (> 50) reflect greater regret. We characterized patients who expressed having overall decision regret (score > 50) vs. those who did not (≤ 50). Demographic and preoperative clinical information was extracted from the online medical records.

RESULTS

Of 185 SG patients, only 13 (7%) reported regret scores > 50 (i.e. high decision regret). Mean time from SG to survey completion was 41 months (range 6-76 months). Unadjusted comparisons between the two groups revealed that patients with high regret scores had lower mean weight loss (32.1% vs. 48.9% EBMIL), and reported less improvement in quality-of-life (QoL), such as physical health (46.2% vs. 93.5% "somewhat" or "significantly" improved). The two groups were similar in short-term complications, but those reporting overall regret were more likely to report GI complaints such as bloating (61.5% vs. 30.4%). Finally, patients with regret scores > 50 were more likely to be further out from SG (median time since surgery 61.8 vs. 41.1 months).

CONCLUSION

In our study, very few patients reported regret (7%) up to 6 years postoperatively, in line with prior reports after RYGB. Those with regret reported poorer QoL.

The Impact of Reoperations Following Bariatric Surgery on Mid-term Outcomes

PURPOSE

With the obesity epidemic, the number of bariatric procedures is increasing, and although considered relatively safe, major postoperative complications still occur. In cancer surgery, major complications such as reoperations have been associated with deteriorated mid/long-term outcomes. In obesity surgery, the effects of reoperations on postoperative weight loss and associated comorbidities remain unclear. The aim of this study was to assess mid-term weight loss and comorbidities following early reoperations in obesity surgery.

METHODS

A population-based cohort study was performed within the Dutch Audit for Treatment of Obesity (DATO), including all patients that underwent a primary gastric bypass procedure or sleeve gastrectomy. Follow-up data was collected up until 5 years postoperatively on percentage total weight loss (%TWL) and comorbidities.

RESULTS

A total of 40,640 patients underwent a gastric bypass procedure or sleeve gastrectomy between 2015 and 2018. Within this cohort, 709 patients (1.7%) suffered a major complication requiring reoperation within 30 days. %TWL at 24 months was 33.1 ± 9.2 in the overall population, versus 32.9 ± 8.7 in the patients who underwent a reoperation (p=0.813). Both analysis per year and Cox regression techniques revealed no differences in long-term follow-up regarding percentage TLW, and weight loss success rates (%TWL>20%) in patients who underwent a reoperation compared to patients without reoperation. At 5 years, the availability of follow-up data was low. No differences were observed in the remission of comorbidities.

DISCUSSION

Major complications requiring reoperation within 30 days of gastric bypass surgery or sleeve gastrectomy did not affect long-term outcomes with regard to weight loss or remission of comorbidities.