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Demirpolat MT, İslam MM. Development and Validation of the GAASThyriC Model for Predicting Patients with Suboptimal Clinical Response After Laparoscopic Sleeve Gastrectomy and a Practical Calculator: A Retrospective Cohort Study. Surg Laparosc Endosc Percutan Tech 2024:00129689-990000000-00242. [PMID: 38898798 DOI: 10.1097/sle.0000000000001300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND It might not be possible to achieve the desired outcome in every patient following bariatric surgery, even though every patient is thoroughly examined before surgery. This study aimed to develop a regression model based on parameters that affect weight loss success in patients scheduled for laparoscopic sleeve gastrectomy (LSG) and thus preoperatively predict whether the patients will have an optimal clinical response in terms of weight loss at the end of the first year. MATERIALS AND METHODS Between January 2018 and August 2022, patients who underwent LSG were analyzed retrospectively. Age, sex, comorbidities, smoking status, alcohol use status, preoperative weight, preoperative body mass index (BMI), preoperative laboratory data, weight, and total weight loss (TWL)% values at the end of the first year were recorded. At the end of the first year following LSG, patients with TWL% above 20% were defined as having an optimal clinical response in terms of weight loss. This study is designed, conducted, and reported regarding the "transparent reporting of a multivariable prediction model for individual prognosis or diagnosis" (TRIPOD) statement. The final model was used to construct an Excel-based calculator. RESULTS Four hundred thirty-eight patients underwent the sleeve gastrectomy procedure, and 38 of them were excluded from the study because of a lack of 1-year follow-up information, resulting in 400 eligible patients for our study. Age, glucose, thyroid stimulating hormone (TSH), alcohol consumption, systemic immune inflammation index (SII), and tobacco were the independent predictors of optimal clinical response (P<0.001, P<0.001, P<0.001, P=0.011, P=0.039, P=0.045, respectively). The model was called the GAASThyriC score. When the final model was tested in the validation cohort, the AUC was 0.875 (95% CI, 0.742-0.999), the sensitivity was 83.3% (95% CI, 51.6-97.9), specificity was 86.4% (95% CI, 77.4-92.8), negative likelihood ratio was 0.19 (95% CI, 0.05-0.68), and accuracy was 86% (95% CI, 77.6-92.1) when the cutoff value was set to the optimal threshold (logit = 0.8451). CONCLUSION The GAASThyriC score can be used as an effective auxiliary tool to predict the patient population with suboptimal clinical response in terms of TWL% at the end of the first year after LSG.
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Affiliation(s)
| | - Mehmet Muzaffer İslam
- Department of Emergency Medicine, University of Health Sciences, Umraniye Education and Research Hospital, Istanbul, Turkey
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Dalaei F, de Vries CE, Poulsen L, Möller S, Kaur MN, Dijkhorst PJ, Thomsen JB, Hoogbergen M, Makarawung DJ, Mink van der Molen AB, Repo JP, Paul MA, Busch KH, Cogliandro A, Opyrchal J, Rose M, Juhl CB, Andries AM, Printzlau A, Støving RK, Klassen AF, Pusic AL, Sørensen JA. Body Contouring Surgery After Bariatric Surgery Improves Long-Term Health-Related Quality of Life and Satisfaction With Appearance: An International Longitudinal Cohort Study Using the BODY-Q. Ann Surg 2024; 279:1008-1017. [PMID: 38375665 PMCID: PMC11086676 DOI: 10.1097/sla.0000000000006244] [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: 02/21/2024]
Abstract
OBJECTIVE To examine health-related quality of life (HRQL) and satisfaction with appearance in patients who have undergone bariatric surgery (BS) with or without subsequent body contouring surgery (BCS) in relation to the general population normative for the BODY-Q. BACKGROUND The long-term impact of BS with or without BCS has not been established using rigorously developed and validated patient-reported outcome measures. The BODY-Q is a patient-reported outcome measure developed to measure changes in HRQL and satisfaction with appearance in patients with BS and BCS. METHODS Prospective BODY-Q data were collected from 6 European countries (Denmark, the Netherlands, Finland, Germany, Italy, and Poland) from June 2015 to February 2022 in a cohort of patients who underwent BS. Mixed-effects regression models were used to analyze changes in HRQL and appearance over time between patients who did and did not receive BCS and to examine the impact of patient-level covariates on outcomes. RESULTS This study included 24,604 assessments from 5620 patients. BS initially led to improved HRQL and appearance scores throughout the first postbariatric year, followed by a gradual decrease. Patients who underwent subsequent BCS after BS experienced a sustained improvement in HRQL and appearance or remained relatively stable for up to 10 years postoperatively. CONCLUSIONS Patients who underwent BCS maintained an improvement in HRQL and satisfaction with appearance in contrast to patients who only underwent BS, who reported a decline in scores 1 to 2 years postoperatively. Our results emphasize the pivotal role that BCS plays in the completion of the weight loss trajectory.
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Affiliation(s)
- Farima Dalaei
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Explorative Patient Network, Odense, Denmark
| | - Claire E.E. de Vries
- Department of Surgery, OLVG West Hospital, Amsterdam, The Netherlands
- Department of Surgery, Brigham and Women’s Hospital, Harvard University, Boston, MA
| | - Lotte Poulsen
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- OPEN—Odense Patient data Explorative Network, Odense, University Hospital and University of Southern Denmark, Odense, Denmark
| | - Manraj N. Kaur
- Brigham and Women’s Hospital, Harvard University, Boston, MA
| | - Phillip J. Dijkhorst
- Department of Surgery, OLVG West Hospital, Amsterdam, The Netherlands
- Dutch Obesity Clinic (NOK), Amsterdam, The Netherlands
| | - Jørn Bo Thomsen
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Maarten Hoogbergen
- Department of Plastic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Dennis J.S. Makarawung
- Department of Plastic and Reconstructive Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Aebele B. Mink van der Molen
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jussi P. Repo
- Unit of Musculoskeletal Diseases, Department of Orthopaedic, Tampere University Hospital and University of Tampere, Tampere, Finland
| | | | - Kay-Hendrik Busch
- Department of Plastic Surgery, Johanniter-Krankenhaus und Waldkrankenahaus Bonn, Bonn, Germany
| | - Annalisa Cogliandro
- Fondazione Policlinico Universitario Campus Bio-Medico, Research Unit of Plastic, Reconstructive and Aesthetic Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy
| | - Jakub Opyrchal
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie Memorial National Cancer Center, Gliwice, Poland
| | - Michael Rose
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Science in Malmö, Lund University, Lund, Sweden
| | - Claus B. Juhl
- University Hospital of Southwest Jutland, Institute for Regional Health Research, University of Southern Denmark and Steno Diabetes Center, Odense, Denmark
| | - Alin M. Andries
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | | | - René K. Støving
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Andrea L. Pusic
- Department of Surgery, Brigham and Women’s Hospital, Harvard University, Boston, MA
| | - Jens A. Sørensen
- Research Unit of Plastic Surgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
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Samaan JS, Srinivasan N, Mirocha J, Premkumar A, Toubat O, Qian E, Subramanyam C, Malik Y, Lee N, Sandhu K, Dobrowolsky A, Samakar K. Association of Postoperative Dieting, Exercise, Dietitian, and Surgeon Follow up With Bariatric Surgery Outcomes. Am Surg 2022; 88:2445-2450. [PMID: 35575161 DOI: 10.1177/00031348221101491] [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: 01/09/2023]
Abstract
Although postoperative diet modification, exercise, and regular dietitian and surgeon follow-up are often recommended after bariatric surgery (BS), their impact on weight loss is unclear. A Retrospective chart review was conducted for patients who received sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) between August 2000 and November 2017 with telephone follow-up. Multivariable logistic regression models were used for analyses. There were 514 patients included in our study. Most were female (76.3%), mean age was 46.9 years (Standard Deviation [SD] = 11.8), and mean weight loss was 11.6 (SD = 6.5) BMI points at a mean follow-up of 7 years (SD = 4.3). Current surgeon follow-up OR = 2.08 (P < .01) was positively associated with postoperative weight loss, while current dietitian follow-up=OR .41 (P < .01) was negatively associated. Current weight loss supplement use OR = .45 (P = .03) was associated with reduced willingness to undergo surgery again. Increasing preoperative BMI OR = 1.06 (P = .04) and increasing age OR = 1.04 (P = .02) were associated with improved quality of life (QoL) due to BS. Lack of surgeon follow-up and regular dietician consultation was associated with suboptimal weight loss after BS. Older age was positively associated with improved QoL, while current weight loss supplement use was associated with lower likelihood of undergoing surgery again, both independent of weight loss.
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Affiliation(s)
- Jamil S Samaan
- Department of Medicine, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nitin Srinivasan
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - James Mirocha
- Cedars-Sinai Medical Center, Biostatistics and Bioinformatics Research Center, Los Angeles, CA, USA
| | - Agnes Premkumar
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Omar Toubat
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Elaine Qian
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Chaitra Subramanyam
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Yousaf Malik
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Nayun Lee
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Kulmeet Sandhu
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Adrian Dobrowolsky
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Kamran Samakar
- Division of Upper GI & General Surgery, Department of Surgery, 12223Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Hayotte M, Gioda J, d'Arripe-Longueville F. Effects and Acceptability of Technology-Based Physical Activity Interventions in Bariatric Surgery: a Scoping Review. Obes Surg 2022; 32:2445-2456. [PMID: 35501637 DOI: 10.1007/s11695-022-06049-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Abstract
The aim of this scoping review is to highlight current trends in the emerging field of technology-based physical activity interventions (TbPAI) in pre- and post-bariatric surgery. Original articles published between 2000 and 2020 on eHealth, bariatric surgery, and physical activity were identified through electronic searches of eight databases. Screening, data extraction, and charting were performed independently by two authors and disagreements were resolved by consensus. Nine full-text articles were included in this review. The studies reported that the physical activity outcomes had improved and the interventions were positively perceived by the target population. We highlight some consistent findings, as well as knowledge gaps, and suggest how future studies could be improved.
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Increased Frequency of Nutritional Counseling Improves Weight Status and Lipids in Renal Transplant Recipients. TOP CLIN NUTR 2021. [DOI: 10.1097/tin.0000000000000231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Bariatric surgery is the most effective treatment for severe and complex obesity; however, the risk of developing nutrient deficiencies varies based upon the type of surgery, degree of malabsorption, and level of nutrition intervention. There are numerous factors that can impact the nutrition status of a patient during their pre- and postoperative journey. We review the critical components and considerations needed in order to provide optimal nutrition care for patients with bariatric surgery. RECENT FINDINGS A dietitian, specializing in bariatric surgery, is the best equipped healthcare provider to prepare and support patients in achieving and maintaining optimal nutrition status. We present best practices for both the pre- and postoperative nutrition-related phases of a patient's journey. The dietitian specialist is integral in the assessment and ongoing nutrition care of patients with bariatric surgery. Further consideration should be given to enable access for lifelong follow-up and monitoring.
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Affiliation(s)
- Julie M Parrott
- Metabolic and Bariatric Surgery Program, Penn Medicine, Clinical Practices of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | | | | | - Mary O'Kane
- Department of nutrition and dietetics, The General Infirmary at Leeds, Great George Street, Leeds, West Yorkshire, LS1 3EX, UK.
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Xia Q, Campbell JA, Ahmad H, Si L, de Graaff B, Otahal P, Palmer AJ. Health state utilities for economic evaluation of bariatric surgery: A comprehensive systematic review and meta-analysis. Obes Rev 2020; 21:e13028. [PMID: 32497417 DOI: 10.1111/obr.13028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 11/27/2022]
Abstract
Health state utilities (HSUs) are health economic metrics that capture and assess health-related quality of life (HRQoL). They are essential in health-economic evaluations when calculating quality-adjusted life years. We investigated published studies reporting bariatric surgery-related HSUs elicited through direct or indirect (multiattribute utility instrument [MAUI]) patient-reported methods (PROSPERO registration number: CRD42019131725). Mean HSUs for different time points and HSU changes over time (where feasible) were meta-analysed using random-effects models. Of the 950 potentially relevant identified studies, n = 28 (2004-2018) qualified for data extraction, with n = 85 unique HSUs elicited mainly from the EQ-5D (88%). Most (75%) studies were published after 2013. The follow-up duration varied between studies and was often limited to 12 months. The pooled mean HSU was 0.72 (0.67-0.76) at baseline/presurgery (n = 18) and 0.84 (0.79-0.89) one-year postsurgery (n = 11), indicating a 0.11 (0.09-0.14) utility unit increment. EQ-5D showed the similar results. This positive difference can be partially explained by BMI and/or co-morbidities status improvement. This study provides a valuable summary of HSUs to future bariatric surgery-related cost-utility models. However, more well-designed higher-quality bariatric-related HSU studies are expected for future reviews to improve the available evidence. We suggest that researchers select an MAUI that is preferentially sensitive to the study population.
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Affiliation(s)
- Qing Xia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Centre for Health Economics, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
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