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Zhao X, Wang Y, Li X, Wu N, Zhang S, Wu S, Hu P, Chen X, Zhou L, Wei A, Pan C, Liu Y, He B, Hu Y, Zhu T, Pan XF. Acupuncture for obesity:study protocol for a randomised controlled trial. BMJ Open 2024; 14:e083158. [PMID: 39187279 PMCID: PMC11367285 DOI: 10.1136/bmjopen-2023-083158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Obesity is a major public health issue in China and around the world. While acupuncture is often used in clinical practice, there is a lack of conclusive evidence for its weight-loss effect. Thus we will conduct a parallel, randomised, sham-controlled trial to evaluate the efficacy and safety of acupuncture for treating obesity. METHODS AND ANALYSIS A total of 160 eligible participants with obesity will be randomly assigned to the verum acupuncture group or sham acupuncture group at a ratio of 1:1. All participants will be treated three times a week for a duration of 12 weeks, and followed up for another 16 weeks. The primary outcome is the percentage change in body weight from baseline to Week 12. The secondary outcomes include body mass index (BMI), waist circumference (WC), body fat percentage (BF%), blood pressure, fasting blood glucose, insulin, glycosylated haemoglobin A1c, blood lipids, and physical functioning score on the Short Form 36 Health Survey. Other secondary outcomes including psychological and social functions will also be evaluated using the body image scale, psychological function scale, and social function scale of the BODY-Q, Rosenberg Self-Esteem Scale, Patient Health Questionnaire-9, and Dutch Eating Behaviour Questionnaire. BMI, WC, BF% and blood pressure will be evaluated at Week 0, 4, 8, 12 and 28. Other secondary outcomes will be measured at Week 0, 12 and 28, respectively. Adverse events will be recorded in detail during the trial. ETHICS AND DISSEMINATION Ethical approval of this trial was granted by the Ethics Committee of Chengdu Sport University (2023-102). Written informed consent will be obtained from study participants before enrolment. The findings will be disseminated through peer-reviewed journals. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR2200062092).
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Affiliation(s)
- Xinyu Zhao
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yang Wang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
- Postdoctoral Workstation, Affiliated Sport Hospital of Chengdu Sport University, Chengdu, Sichuan, China
| | - Xiaoyi Li
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Nianwei Wu
- Section of Epidemiology and Population Health & Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & National Medical Products Administration Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shanshan Zhang
- Section of Epidemiology and Population Health & Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & National Medical Products Administration Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shiyi Wu
- Section of Epidemiology and Population Health & Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & National Medical Products Administration Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Peiqun Hu
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Ximei Chen
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Lei Zhou
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Aiming Wei
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chongsheng Pan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yunlu Liu
- Institute of Laboratory Animal Sciences, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Benxiang He
- Sichuan Academy of Chinese Medicine Sciences, Chengdu, Sichuan, China
| | - Yushi Hu
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, Sichuan, China
| | - Tianmin Zhu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiong-Fei Pan
- Section of Epidemiology and Population Health & Department of Gynecology and Obstetrics, Ministry of Education Key Laboratory of Birth Defects and Related Diseases of Women and Children & National Medical Products Administration Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Shuangliu Institute of Women’s and Children’s Health, Shuangliu Maternal and Child Health Hospital, Chengdu, Sichuan, China
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2
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Amro C, Ryan IA, Lemdani MS, McGraw JR, Schafer S, Broach RB, Fischer JP. Accelerating Fleur-de-lis Panniculectomy with the Absorbable Dermal Stapler-A Study of Efficiency, Aesthetics, and Quality-of-life. Aesthetic Plast Surg 2024; 48:3137-3146. [PMID: 38769148 DOI: 10.1007/s00266-024-04068-0] [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: 11/29/2023] [Accepted: 04/09/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Fleur-de-lis panniculectomy (FDL), a contouring technique involving vertical and horizontal tissue resections, often involves longer operative times and potential complications. This study assessed operative time, postoperative outcomes, and patient-reported quality of life (PRO) with Insorb® Absorbable Subcuticular Skin Stapler versus traditional sutures during FDL. METHODS A retrospective review from 2015 to 2022 of FDL patients excluded those with complex concomitant procedures. Demographics, operative details, and surgical outcomes were compared between patients using the dermal stapler and those with suture-only closures. RESULTS Forty subjects were identified, with 25 (62.5%) in the dermal stapler cohort. The dermal stapler significantly reduced total procedure time (66.76 vs. 125.33 min, p < 0.05). There were no significant differences in surgical site occurrences, aesthetic outcomes, readmissions, or reoperations. Multivariate regression analysis further highlighted the choice of closure technique as an independent predictor of operative time, with traditional sutures indicating a significantly increased operative time compared to using the dermal stapler (AOR 76.53, CI 38.11-114.95, p < 0.001). Regarding PROs, both groups saw improvements across multiple BODY-Q domains, but the dermal stapler group reported greater enhancements (six out of nine domains vs. three for sutures). CONCLUSION The absorbable dermal stapler significantly reduces FDL operative time without increasing wound healing or aesthetic dissatisfaction incidents and maintains comparable quality-of-life improvements to standard suture closure. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://link.springer.com/journal/00266 .
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Affiliation(s)
- Chris Amro
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone, New York, NY, USA.
| | - Isabel A Ryan
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Mehdi S Lemdani
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - J Reed McGraw
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Sogand Schafer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Robyn B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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3
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Kleipool SC, Willinge GJA, Mathijssen EGE, Romijnders KAGJ, de Castro SMM, Marsman HA, van Rutte PWJ, van Veen RN. Patient Satisfaction and Experience with Same-Day Discharge After Laparoscopic Roux-en-Y Gastric Bypass: A Mixed-Methods study. Obes Surg 2024; 34:2862-2871. [PMID: 38795202 PMCID: PMC11289211 DOI: 10.1007/s11695-024-07264-8] [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: 12/21/2023] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 05/27/2024]
Abstract
INTRODUCTION Same-day discharge (SDD) after laparoscopic Roux-en-Y gastric bypass (RYGB) is a safe and effective healthcare pathway. However, there is limited understanding of the patient perspective on SDD. The aim of this study was to explore patient satisfaction and experience with SDD after RYGB. METHODS A mixed-methods study with a concurrent design was conducted in a Dutch teaching hospital, using questionnaires and interviews. Patients who underwent RYGB and were discharged on the day of the surgery completed four questionnaires of the BODY-Q (satisfaction with the surgeon, satisfaction with the medical team, satisfaction with the office staff, and satisfaction with information provision) ± 4 months postoperative. The results of the questionnaires were compared with pre-existing data from a cohort of patients who stayed overnight after surgery (i.e., control group). A subset of patients was individually interviewed for an in-depth understanding of the patient perspective on SDD. RESULTS In the questionnaires, median scores for the control group (n = 158) versus the present group of patients (n = 51) were as follows: 92/100 vs. 92/100 (p = 0.331) for the surgeon, 100/100 vs. 92/100 (p = 0.775) for the medical team, 100/100 vs. 100/100 (p = 0.616) for the office staff, and 90/100 vs. 73/100 (p = 0.015) for information provision. Interviews with 14 patients revealed seven themes, describing high satisfaction, along with several points of interest. CONCLUSIONS Patient satisfaction with SDD after RYGB is high, although information provision regarding the day of surgery could be improved. However, not every medically eligible patient might be suitable for this healthcare pathway, as responsibilities are shifted.
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Affiliation(s)
| | | | - Elke G E Mathijssen
- The Healthcare Innovation Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim A G J Romijnders
- The Healthcare Innovation Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - Ruben N van Veen
- Department of Surgery, OLVG Hospital, Amsterdam, The Netherlands
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Chen A, Garvey SR, Nanda AD, Friedman R, Jia E, Morgenstern M, Barron S, Tobias A, Cauley RP. Patient-Reported Outcomes on Subjective Nipple Sensation After Double-Incision and Periareolar Mastectomy for Chest Masculinization: Subjective Nipple Sensation After Chest Masculinization. Ann Plast Surg 2024; 92:383-388. [PMID: 38527342 DOI: 10.1097/sap.0000000000003821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
ABSTRACT We evaluated patient-reported outcomes to assess for patient and procedural factors associated with postchest masculinization subjective nipple sensation. Patients who underwent double-incision or periareolar mastectomies for chest masculinization by a single senior surgeon (2015-2019) were surveyed at 2 time points regarding postoperative nipple sensation and satisfaction, including patient-reported outcomes using BODY-Q modules (Q-Portfolio.org). Demographic, operative, and postoperative variables were obtained from medical records. Patients were stratified according to survey responses. Univariate and multivariate analyses were performed.Response rate was 42% for survey 1 and 22% for survey 2. Of the 151 survey 1 responders, 138 (91.4%) received double-incision mastectomies and 13 (8.6%) received periareolar mastectomies. Among Survey 1 responders, 84.6% periareolar patients and 69.6% double-incision patients reported "completely" or "a little" nipple sensation preservation, and the difference trended toward significance (P = 0.0719). There was a stepwise increase in proportion of patients reporting sensation with greater recovery time until response to survey 1. Obesity (P = 0.0080) and greater tissue removed (P = 0.0247) were significantly associated with decreased nipple sensation. Nipple satisfaction scores were significantly higher for patients reporting improved nipple sensation (P = 0.0235). Responders to survey 2 who reported greater satisfaction with nipple sensation were significantly more likely to report preserved sensitivity to light touch (P = 0.0277), pressure (P = 0.0046), and temperature (P = 0.0031). Preserved erogenous sensation was also significantly associated with greater satisfaction (P = 0.0018).In conclusion, we found that nipple sensation may be associated with postoperative nipple satisfaction. Operative techniques to optimize nipple sensation preservation may improve this population's postoperative satisfaction.
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Affiliation(s)
- Amy Chen
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Shannon R Garvey
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Asha D Nanda
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Rosie Friedman
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Emmeline Jia
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Monica Morgenstern
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Sivana Barron
- Division of Plastic and Reconstructive Surgery, University of Massachusetts Medical Center, Worcester, MA
| | - Adam Tobias
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
| | - Ryan P Cauley
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
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Barone M, Salzillo R, De Bernardis R, Cogliandro A, Persichetti P. Do Small Scars Lead to Better Results? Analysis of Long-term Outcomes and Satisfaction of Patients Undergoing Anchor-line Abdominoplasty Following Massive Weight Loss. Aesthetic Plast Surg 2024; 48:652-658. [PMID: 37679561 DOI: 10.1007/s00266-023-03641-3] [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: 05/25/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Do smaller scars lead to higher patient satisfaction? The aim of this study is to analyze long-term satisfaction of patients who underwent abdominoplasty after massive weight loss. METHODS Patients inclusion criteria: no previous abdominal remodeling procedures, previous bariatric surgery followed by a weight loss of at least 30 kg, weight stability for at least one year, good understanding of the Italian language and standardized pre- and postoperative photographs. We divided the population in 2 groups based on the surgical procedure: group 1, conventional abdominoplasty, and group 2, anchor-line abdominoplasty. All patients presented scars in the epigastric and mesogastric region resulting from previous laparoscopic or laparotomic bariatric surgery and/or other laparoscopic or laparotomic procedures. At least 2 years after surgery, we administered the Italian version of the post-operative BODY-Q module and the SCAR-Q questionnaire. RESULTS We enrolled 20 males and 69 females aged between 25 and 55 years, with a mean follow-up of 2 years. Analyzing the questionnaires, it resulted that patients undergoing anchor-line abdominoplasty were significantly more satisfied in the body perception of the result (p = 0.035) and in the satisfaction with abdomen domain (p = 0.0015) compared to the conventional abdominoplasty group. Scars assessment with the SCAR-Q did not show any significant differences between the groups. CONCLUSION Despite its long scars, the anchor-line pattern shows an overall higher satisfaction, due to the possibility of reducing the abdomen both cranio-caudally and circumferentially. These findings might be an important guide when approaching abdominoplasty in post-bariatric patients, debunking the myth "shorter is better". LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mauro Barone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Rosa Salzillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy.
| | - Riccardo De Bernardis
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Annalisa Cogliandro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Paolo Persichetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
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Humar P, Robinson B. Preparing Patients for Body Contouring Surgery and Postoperative Surveillance for Deep Venous Thrombosis. Clin Plast Surg 2024; 51:1-6. [PMID: 37945066 DOI: 10.1016/j.cps.2023.06.007] [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: 11/12/2023]
Abstract
This article highlights the importance of the preoperative evaluation and considerations necessary in preparing patients for body contouring surgery after massive weight loss (MWL). The importance of evaluating such factors as body mass index stabilization, medical comorbidities, nutritional optimization, social factors, deep venous thrombosis prophylaxis, and postoperative surveillance is critically important. Patients undergoing body contouring surgery after MWL are at increased risk of thromboembolic events, and prophylactic measures should be taken to minimize this risk. Overall, a thorough preoperative evaluation is essential to ensure patient safety, optimize surgical outcomes, and address the unique challenges presented by the MWL patient population.
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Affiliation(s)
- Pooja Humar
- Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA 15261, USA
| | - Brent Robinson
- Department of Plastic Surgery, University of Pittsburgh, 3550 Terrace Street, 6B Scaife Hall, Pittsburgh, PA 15261, USA.
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Lodewijks Y, Luyer M, van Montfort G, de Zoete J, Smulders F, Nienhuijs S. Additional preparation program for bariatric surgery: Two-year results of a large cohort study. Obes Sci Pract 2023; 9:493-500. [PMID: 37810522 PMCID: PMC10551114 DOI: 10.1002/osp4.677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 10/10/2023] Open
Abstract
Background Multidisciplinary screening of bariatric surgery candidates is recommended, and some centers provide an additional preparation program (APP) to optimize patients preoperatively. Objective To compare patients with APP to standard care 2 years after primary bariatric surgery regarding postoperative weight loss and resolution of obesity-related comorbidities. Methods A retrospective cohort study was conducted for patients undergoing primary Roux-en-Y gastric bypass and sleeve gastrectomy between September 2017 and March 2019. The first 12 months patients received an APP, after September 2018, the APP was no longer part of the weight loss trajectory. A multivariable linear regression model was built. Results Of the 384 patients receiving an APP advice, 50 were lost to follow up. In total, 192 (57%) received the APP and 142 (43%) received standard care. Percentage total weight loss after 2 years was significantly different, 28.8% for the APP group versus 32% for the standard group (p = 0.001). Postoperative weight loss after 2 years was increased in patients who had a gastric bypass, a higher baseline body mass index, and female gender in multivariable analysis. An APP was predictive for decreased postoperative weight. Diabetes mellitus was in remission significantly more often in the preparation group (84.1% of the cases) compared with the standard group (61.9%, p = 0.028). Conclusion A weight loss trajectory is at least as effective without additional preparation in terms of 2 years postoperative %TWL for primary gastric bypass and sleeve procedures. For comorbidities, diabetes mellitus was in remission more often in the APP group.
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Affiliation(s)
- Yentl Lodewijks
- Department of SurgeryCatharina HospitalEindhovenThe Netherlands
| | - Misha Luyer
- Department of SurgeryCatharina HospitalEindhovenThe Netherlands
| | | | | | - Frans Smulders
- Department of SurgeryCatharina HospitalEindhovenThe Netherlands
| | - Simon Nienhuijs
- Department of SurgeryCatharina HospitalEindhovenThe Netherlands
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Greene ME, Goldman RE, Hutter MM. Selection of patient-reported outcomes measures for implementation in the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program. Surg Obes Relat Dis 2023; 19:897-906. [PMID: 37037688 DOI: 10.1016/j.soard.2023.01.031] [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: 08/23/2022] [Revised: 11/15/2022] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND The Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) assesses safety after metabolic and bariatric surgery and the impact on weight and obesity-related diseases. However, changes in quality of life are likely what matters most to patients, and these are not currently assessed. The best way to measure health-related quality of life (HRQoL) is to use validated patient-reported outcomes measures (PROMs), which capture patients' perspectives of their quality of life both before and after surgery. OBJECTIVES Identify the outcomes most important to bariatric surgery patients and identify the most appropriate validated PROMs to implement in a national program for the MBSAQIP. SETTING Five hospitals from a single healthcare system in New England. METHODS A series of 18 focus groups and/or interviews conducted with patients, patients' family members, and bariatric health providers determined the outcomes most important to bariatric patients and which validated PROMs would accurately measure those outcomes. Immersion crystallization was used to analyze focus group data and identify appropriate PROMs. RESULTS Focus group participants ranked health as the most important outcome for metabolic and bariatric surgery. Self-confidence, mobility, and everyday activities were the next highest ranked HRQoL domains. The Patient-Reported Outcomes Measurement Information System 10-Item Global Health Survey was selected as the general health measure. The Obesity-Related Problems scale and the Obesity and Weight-Loss Quality of Life Instrument were the disease-specific measures selected for inclusion in the MBSAQIP PROMs program. CONCLUSION The addition of PROMs to the MBSAQIP provides a unique opportunity to monitor HRQoL at the national level, which can foster improved shared decision-making before surgery.
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Affiliation(s)
- Meridith E Greene
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Matthew M Hutter
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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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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10
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Saadi A, Fellrath JM, Bec-Moussally J, Papastathi-Boureau C, Blanc C, Courtine V, Vanini L, Marechal M, Authier F, Curty B, Fournier P, Diana M, Saillant S. Using patient-reported outcome measures to assess the effectiveness of social media networking programs for people living with overweight and obesity to adopt a healthier lifestyle. Front Public Health 2023; 11:1161851. [PMID: 37377557 PMCID: PMC10291679 DOI: 10.3389/fpubh.2023.1161851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Overweight, obesity, and their associated health complications have become a major public health issue. Online approaches have been rarely attempted to address the problem. The aim of this study was to evaluate the effectiveness of using social media networking for people living with overweight and obesity to adopt a healthier lifestyle with a three-month multidisciplinary healthcare program. Effectiveness was assessed through questionnaires on patient-related outcome measures (PROMs). Materials and methods Two non-profit associations designed the program delivered to people living with overweight and obesity in a closed group via Facebook, the popular social network. The three-month program had three main axes, namely nutrition, psychology, and physical activity. Anthropomorphic data and sociodemographic profiles were collected. Quality of life (QoL) was assessed at the beginning and at the end of the intervention using PROM questionnaires for six different domains, i.e., body image, eating behavior, physical, sexual, social, and psychological functioning. Results Six hundred and twenty persons participated in the program; 567 persons consented for the study, and 145 completed the questionnaires entirely. QoL was significantly improved in five out of six domains, i.e., body image, eating behavior, as well as physical, sexual, and psychological functioning. The improvement was valid regardless of age, gender, initial body mass index, person with or without children, educational level (primary versus secondary versus high school), and occupation (employment compared to unemployment or any kind of social assistance). In multivariate analysis, living as a couple was an independent factor correlated to a positive progression in four domains, i.e., body image, eating behavior, as well as physical, and psychological functioning. Conclusion This study showed that an online lifestyle intervention might be a promising way of improving the quality of life of people living with overweight or obesity.
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Affiliation(s)
- Alend Saadi
- Department of Surgery, Neuchâtel Hospital, Neuchâtel, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Jean-Marc Fellrath
- Department of Surgery, Neuchâtel Hospital, Neuchâtel, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | | | - Céline Blanc
- Ligue Pulmonaire Neuchateloise, Neuchâtel, Switzerland
| | | | - Léo Vanini
- Ligue Pulmonaire Neuchateloise, Neuchâtel, Switzerland
| | - Marc Marechal
- Ligue Pulmonaire Neuchateloise, Neuchâtel, Switzerland
| | | | | | - Pierre Fournier
- Service de Chirurgie, Hôpital de Nyon, Nyon, Switzerland
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- Department of Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Stéphane Saillant
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Département de Psychiatrie Générale et de Liaison, Centre Neuchâtelois de Psychiatrie, Neuchâtel, Switzerland
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11
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Dijkhorst PJ, de Vries CEE, Mou D, Poulsen L, Sørensen JA, Hoogbergen MM, van Veen RN, Klassen AF, Pusic AL. Quantifying patients' expectations prior to bariatric surgery with the BODY-Q in an international multicentre cohort. Clin Obes 2023; 13:e12555. [PMID: 36181294 DOI: 10.1111/cob.12555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 01/19/2023]
Abstract
Many people living with obesity may have unrealistic expectations prior to undergoing bariatric surgery. These expectations can lead to frustration, regret and even worse psychological outcomes after surgery. Prior to undergoing bariatric surgery, patients completed the BODY-Q Expectations scale. This 15-item scale asks patients to imagine what their life will be like when 2 years have passed since bariatric surgery. Scores for expectations range from 0 (low) to 100 (high). Linear regression models were used to assess which of the patient characteristics could predict patients' expectations. From 2019 to 2020, a total of 333 patients were recruited from three different countries. The mean score on the BODY-Q Expectations scale was 73.1, ±20. Out of the 15 items on the Expectation scale, people living with obesity found it most likely that bariatric surgery would make them feel better and improve their energy, while it was reported least likely that they would look good without clothes on. Younger age (p = <.01) and race (non-white) (p = .046) were found to be significant predictors for higher scores on the Expectations scale. Participants who identified as non-white from the Netherlands and United States, and those aged under 40 years reported higher expectations compared with participants who identified as white race and were 40 years of age or older. Prior to bariatric surgery, patients aged under 40 years and those who identified as non-white for race had higher expectations that their life would change after bariatric surgery. These relevant findings should be considered when giving pre-operative counselling.
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Affiliation(s)
| | | | - Danny Mou
- Department of Surgery, Brigham and Women's Hospital, Massachusetts, USA
| | - Lotte Poulsen
- Research Unit of Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
- OPEN, Odense Explorative Patient Network, Odense, Denmark
| | - Jens A Sørensen
- Research Unit of Plastic Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
- OPEN, Odense Explorative Patient Network, Odense, Denmark
| | | | | | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, Massachusetts, USA
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12
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Dalaei F, de Vries CEE, Poulsen L, Kaur MN, Pfob A, Mou D, Jacobsen AL, Repo JP, Salzillo R, Opyrchal J, Klassen AF, Sørensen JA, Pusic AL. General population normative scores for interpreting the BODY-Q. Clin Obes 2022; 12:e12528. [PMID: 35611607 PMCID: PMC9541838 DOI: 10.1111/cob.12528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 12/22/2022]
Abstract
The BODY-Q is a patient-reported outcome measure used to assess outcomes in patients undergoing weight loss and/or body contouring surgery (BC) following massive weight loss. Normative values for the BODY-Q are needed to improve data interpretation and enable comparison. Thus, the aim of this study was to determine normative values for the BODY-Q. Participants were recruited internationally through two crowdsourcing platforms. The participants were invited to complete the BODY-Q scales through an URL link provided within the crowdsourcing platforms. General linear analyses were performed to compare normative means between countries and continents adjusted for relevant covariates. Normative reference values were stratified by age, body mass index (BMI), and gender. The BODY-Q was completed by 4051 (2052 North American and 1999 European) participants. The mean age was 36 years (±14.7 SD) and ranged from 17 to 76 years, the mean BMI was 26.4 (±6.7 SD) kg/m2 , and the sample consisted of 1996 (49.3%) females and 2023 (49.9%) males. Younger age and higher BMI were negatively associated with all BODY-Q scales (p < .001). This study provides normative values for the BODY-Q scales to aid in the interpretation of BODY-Q scores in research and clinical practise. These values enable us to understand the impact of weight loss and BC on patients' lives.
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Affiliation(s)
- Farima Dalaei
- Research Unit of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
- OPEN, Odense Explorative Patient NetworkOdenseDenmark
| | - Claire E. E. de Vries
- Department of Surgery, OLVGAmsterdamNetherlands
- Department of Surgery, Brigham and Women's HospitalHarvard UniversityBostonMassachusettsUSA
| | - Lotte Poulsen
- Research Unit of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Manraj N. Kaur
- Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - André Pfob
- University Breast Unit, Department of Obstetrics and GynecologyHeidelberg University HospitalHeidelbergBaden‐WürttembergGermany
| | - Danny Mou
- Department of General SurgeryBrigham and Women's Hospital, Harvard UniversityBostonMassachusettsUSA
| | - Amalie L. Jacobsen
- Department of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Jussi P. Repo
- Unit of Musculoskeletal Surgery, Department of Orthopedics and TraumatologyTampere University Hospital and University of TampereTampereFinland
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic SurgeryCampus Bio‐Medico University of RomeRomeItaly
| | - Jakub Opyrchal
- Department of Plastic SurgeryT. Marciniaka Specialized HospitalWroclawPoland
| | - Anne F. Klassen
- Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
| | - Jens Ahm Sørensen
- Research Unit of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Andrea L. Pusic
- Department of Surgery, Brigham and Women's HospitalHarvard UniversityBostonMassachusettsUSA
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13
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Jacobsen AL, DeVries CEE, Poulsen L, Mou D, Klassen AF, Pusic AL, Makarawung DJS, Wiezer MJ, van Veen RN, Sørensen JA. The impact of body mass index (BMI) on satisfaction with work life: An international BODY-Q study. Clin Obes 2022; 12:e12527. [PMID: 35575285 PMCID: PMC9539700 DOI: 10.1111/cob.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 12/05/2022]
Abstract
Obesity is a global health issue known to have a major influence on health-related quality of life (HR-QOL). HR-QOL is a concept evaluating physical and psychological health. Work life can impact HR-QOL in people with obesity. The aim of this study was to measure the association between body mass index (BMI) and satisfaction with work life. This study included participants from an international multicenter field-test study of BODY-Q scales. Recruitment took place at hospitals in Denmark, The Netherlands and USA between June 2019 and January 2020. The BODY-Q Work Life scale was used to measure work life satisfaction. The difference between BMI groups and work life satisfaction was examined using one-way analysis of variance. Multivariable linear regression analysis was used to examine the association between BMI and work life satisfaction, adjusted for significant confounders. Of 4123 participants, 2515 completed the BODY-Q Work Life scale. BMI groups showed significant difference in work life satisfaction (p < .0001). The Work Life scale mean score was 77.6 for the normal BMI group, 78.5 for the overweight group and 75.0, 68.9 and 63.8 for Class 1, 2 and 3 obesity, respectively. Furthermore, BMI was significantly associated with satisfaction with work life (adjusted regression coefficient -.962, p < .0001). Higher BMI was associated with lower work life satisfaction. This finding suggests that a reduction in BMI may have a positive influence on work life satisfaction in people with obesity.
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Affiliation(s)
- Amalie L. Jacobsen
- Research Unit for Plastic SurgeryOdense University HospitalOdenseDenmark
- OPEN, Open Patient data Explorative NetworkOdense University HospitalOdenseDenmark
| | - Claire E. E. DeVries
- Department of SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
- Department of SurgeryOLVG WestAmsterdamThe Netherlands
| | - Lotte Poulsen
- Research Unit for Plastic SurgeryOdense University HospitalOdenseDenmark
- OPEN, Open Patient data Explorative NetworkOdense University HospitalOdenseDenmark
| | - Danny Mou
- Department of SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Anne F. Klassen
- Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
| | - Andrea L. Pusic
- Department of SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | | | | | | | - Jens A. Sørensen
- Research Unit for Plastic SurgeryOdense University HospitalOdenseDenmark
- Department of Plastic SurgeryUniversity of Southern DenmarkOdenseDenmark
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14
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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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15
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Wederfoort JLM, van Santbrink E, Hommes JE, Heuts EM, Van Kuijk SMJ, van der Hulst RRWJ, Piatkowski A. Donor Site Satisfaction Following Autologous Fat Transfer for Total Breast Reconstruction. Aesthet Surg J 2022; 43:40-48. [PMID: 35580058 PMCID: PMC9830977 DOI: 10.1093/asj/sjac125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND With evolving breast cancer survival and patient preferences, it is essential that reconstructive surgeons worldwide continue searching for the best reconstruction technique for patients. Autologous fat transfer (AFT) is a relatively new technique for total breast reconstruction that has already proven to be effective and safe with all advantages of autologous tissue. However, little is known about the aesthetic results and satisfaction concerning donor sites. OBJECTIVES The aim of this study was to measure donor site satisfaction following AFT for total breast reconstruction in breast cancer patients. METHODS Between May and August of 2021, participants of the BREAST- trial who were at least 24 months after their final reconstruction surgery were invited to complete an additional survey concerning donor sites. The BODY-Q was utilized for data collection. Results of AFT patients were compared with a control group of implant-based reconstruction patients who did not have a donor site. RESULTS A total of 51 patients (20 control, 31 intervention) completed the questionnaire. Satisfaction with body did not statistically differ between the groups. The most frequent complaint was contour irregularities (31 reports, 60.8%), with the least favorable donor site being thighs (23 reports, 53.5%) in the AFT group. CONCLUSIONS Satisfaction with body did not differ between breast cancer patients receiving AFT or implant-based reconstruction, meaning that large-volume liposuction does not aesthetically affect the utilized donor sites. Nevertheless, reconstructive surgeons should be aware of possible donor site complications, especially contour irregularities at the thighs, and discuss this with their patients.
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Affiliation(s)
- Jamilla L M Wederfoort
- Corresponding Author: Dr Jamilla Lonieke Maria Wederfoort, Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands. E-mail: ; Instagram: @jamzz21
| | - Esther van Santbrink
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Juliette E Hommes
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Esther M Heuts
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Sander M J Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Andrzej Piatkowski
- Department of Plastic, Reconstructive, and Hand Surgery, VieCuri Medical Center, Venlo, the Netherlands
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16
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Miseré RM, van Kuijk SM, Claassens EL, Heuts EM, Piatkowski AA, van der Hulst RR. Breast-related and body-related quality of life following autologous breast reconstruction is superior to implant-based breast reconstruction - A long-term follow-up study. Breast 2021; 59:176-182. [PMID: 34271290 PMCID: PMC8287213 DOI: 10.1016/j.breast.2021.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/09/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The better survival rates after breast cancer allow for setting of long-term goals, such as Quality of Life (QoL) and aesthetic outcomes following breast reconstruction. Studies find a higher breast-related QoL and greater satisfaction with breasts following autologous breast reconstruction (ABR) compared to implant-based breast reconstruction (IBR). However, aesthetic results from donor sites can influence body image. This concern is little addressed in the literature. Therefore, the aim of this study was to compare the long-term breast-related and body-related QoL of women who underwent ABR to women who underwent IBR. MATERIAL AND METHODS A multicenter, cross-sectional survey was conducted between November and December 2020 among women who underwent postmastectomy breast reconstruction between January 2015 and December 2018. A general questionnaire, the BREAST-Q, and the BODY-Q were used to collect data. Multivariable linear regression was performed to adjust differences in Q-scores for potential confounders. RESULTS In total, 336 patients were included (112 IBR, 224 ABR). Autologous reconstruction resulted in significantly higher mean scores in all subdomains of the BREAST-Q. On the BODY-Q, IBR scored significantly higher on scars, while ABR scored moderately to significantly higher on all other scales. Despite a lower mean score on Hips & outer thighs in women with Lateral Thigh Perforator (LTP) flap reconstruction, no negative influence on body image was found in these women. CONCLUSIONS Long-term breast-related and body-related outcomes of ABR are superior to IBR. Donor site aesthetic does not adversely affect body image in women who underwent free flap breast reconstruction.
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Affiliation(s)
- Renée Ml Miseré
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
| | - Sander Mj van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
| | - Eva L Claassens
- Faculty of Health Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands.
| | - Esther M Heuts
- Department of General Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
| | - Andrzej A Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
| | - René Rwj van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
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17
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Elfanagely O, Othman S, Mellia JA, Messa CA, Fischer JP. Quality of Life and Complications in the Morbidly Obese Patient following Post-Bariatric Body Contouring. Aesthetic Plast Surg 2021; 45:1105-1112. [PMID: 33196865 DOI: 10.1007/s00266-020-02046-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND With a growing obesity epidemic, an increasing number of patients are seeking body contouring procedures (BCP). The aim of this study was to assess the association of morbid obesity (BMI > 40 kg/m2) with both clinical and health-related quality of life (H-RQOL) outcomes following BCP. METHODS Patients evaluated for post-bariatric BCP at a large academic hospital by one surgeon were retrospectively identified. Patients were surveyed using the BODY-Q© during initial and postoperative visits. Demographic, clinical, operative characteristics, and surgical outcomes data were extracted. BODY-Q domain scores were compared between morbidly obese (MO) and non-morbidly obese (NMO). The absolute change in HR-QOL scores for MO and NMO was also compared. RESULTS Overall, 59 patients were included (MO 72.9% vs. NMO 27.1%). The median age was 50 years old (Interquartile range [IQR] ± 17); the majority were non-Hispanic (89.8%), non-diabetic (81.4%), non-smokers (67.8%). Assessment of surgical site occurrences, reoperations, and the complication composite outcome revealed no statistical differences between groups (p >0.05). MO patients showed lower net improvement in three HR-QOL domains: satisfaction with body (median 30 [IQR ± 53] vs. 65 [IQR ± 54]; p = 0.036), body image (median 39 [IQR ± 55] vs. 52 [IQR ± 44]; p = 0.025), and social function (median 12 [IQR ± 18] vs. 19 [IQR ± 35]; p = 0.015). CONCLUSION Post-bariatric BCP can be safely performed in the MO patient without increased risk of complication. However, the benefit of truncal BCP is less in MO as it pertains to specific QOL domains: satisfaction with body, body image, and social function. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Omar Elfanagely
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, United States
| | - Sammy Othman
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, United States
| | - Joseph A Mellia
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, United States
| | - Charles A Messa
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, United States
| | - John P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 51 North 39th Street, Wright Saunders Building, Philadelphia, PA, 19104, United States.
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18
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Smith JR, Sheehan M, Casas LA. Using the BODY-Q to Evaluate Appearance and Quality of Life Following Treatment of Skin Laxity of the Outer Thigh with Microfocused Ultrasound and Calcium Hydroxylapatite. Aesthet Surg J 2020; 40:1219-1231. [PMID: 31875882 DOI: 10.1093/asj/sjz372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Two procedures that have demonstrated collagen-stimulating properties and improvements in skin laxity in a variety of aesthetic indications are microfocused ultrasound with visualization (MFU-V) and injection with calcium hydroxylapatite (CaHA). OBJECTIVES By treating skin laxity with a combination of these therapies, it was hypothesized that our patients would experience improved appearance and quality of life as measured by the BODY-Q. METHODS A total of 60 consecutive female patients aged 30 to 60 years with body mass index less than 28 kg/m2 who expressed interest in treatment for skin laxity affecting the outer thighs completed selected scales (Body Image, Appraisal of Excess Skin, Satisfaction with Hips and Outer Thighs, and Appearance-Related Psychosocial Distress) from the BODY-Q within 1 week of treatment. At the time of treatment, MFU-V was directed to the outer thighs (150 lines at focal depths of 3.0 and 4.5 mm per outer thigh). Immediately following MFU-V, patients received treatment with CaHA injected into the subdermis (1.5 mL diluted 1:1 with 1.5 mL of 2% lidocaine solution per outer thigh). At 90 days posttreatment, these patients repeated the BODY-Q. RESULTS At 90 days posttreatment, with 100% follow-up among the 60 consecutive female patients treated, scores from the BODY-Q scales showed statistically significant improvement (P < 0.01). CONCLUSIONS Following treatment of skin laxity on the outer thighs with a combination of MFU-V and CaHA, our patients reported a statistically significant improvement in appearance and quality of life at 90 days posttreatment. This protocol may be applicable to other areas of the body. LEVEL OF EVIDENCE: 4
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19
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The development and validation of the CARe Burn Scale: Child Form: a parent-proxy-reported outcome measure assessing quality of life for children aged 8 years and under living with a burn injury. Qual Life Res 2020; 30:239-250. [PMID: 32902793 PMCID: PMC7847857 DOI: 10.1007/s11136-020-02627-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Patient-reported outcome measures (PROMs) identify patient needs and therapeutic progress. This paper outlines the development and validation of the CARe Burn Scale: Child Form, a parent-proxy-reported outcome measure that assesses quality of life in children aged 8 and under living with a burn injury. METHODS A literature review and interviews with 12 parents of children with a burn and seven health professionals informed the development of a conceptual framework and draft PROM. Cognitive debriefing interviews with 18 parents and eight health professionals provided feedback to ascertain content validity, and 311 parents took part in field testing. Rasch and traditional psychometric analyses were conducted to create a shortened version. Further psychometric analyses with 133 parents tested the shortened CARe Burn Scale in relation to other parent-proxy measures. RESULTS The final conceptual framework included 5 domains: Social and Emotional Difficulties, Social and Emotional Well-Being, Wound/Scar Discomfort, Wound/Scar Treatment and Physical Abilities. Two scales fulfilled Rasch and traditional psychometric analyses, providing evidence of construct validity, acceptability, and reliability. Three scales did not fulfil the Rasch criteria and were retained as checklists. Compared to other parent-proxy measures, individual CARe Burn Scales correlated moderately with similar constructs and had low correlations with dissimilar constructs, indicating evidence of criterion validity (concurrent and discriminant). CONCLUSIONS The CARe Burn Scale: Child Form can be used to measure children's quality of life after having a burn injury which can inform rehabilitation and surgical decision-making.
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Identifying Factors Most Important to Lower Extremity Trauma Patients: Key Concepts from the Development of a Patient-Reported Outcome Instrument for Lower Extremity Trauma, The LIMB-Q. Plast Reconstr Surg 2020; 145:1292-1301. [PMID: 32332555 DOI: 10.1097/prs.0000000000006760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe lower extremity injuries are challenging to treat. The aspects of limb salvage and amputation most important to patients are not well-defined. This study's aim is to develop a conceptual framework for a patient-reported outcome instrument for lower extremity trauma patients, by defining issues and concepts most important to this patient population. METHODS This is an interpretative description of transcripts collected from semistructured qualitative interviews at a single institution. High-energy lower extremity trauma patients were recruited by means of purposeful sampling to maximize variability. Thirty-three participant interviews were needed to reach content saturation. These participants were aged 19 to 79 years; 21 were men (63.6 percent); participation was after reconstruction [n= 15 (45.5 percent)], after amputation [n = 11 (33.3 percent)], or after amputation after failed reconstruction [n = 7 (21.2 percent)]. Interviews were recorded, transcribed, and coded line-by-line. Concepts were labeled with major and minor themes and refined through a process of constant comparison. Analysis led to the development of a conceptual framework and item pool to inform the development of a patient-reported outcome measure. RESULTS In total, 2430 unique codes were identified and used to generate the conceptual framework covering 10 major themes: appearance, environment, finances, physical, process of care, prosthesis, psychological, sexual, social, and treatment. CONCLUSIONS This study establishes a comprehensive set of concepts, identifying what is most important to severe lower extremity trauma patients. These findings can be used to inform and focus research and clinical care, and provides the framework to develop a lower extremity trauma-specific patient-reported outcome instrument: the LIMB-Q.
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Poulsen L, Simonsen N, Klassen AF, Cano S, Rose M, Juhl CB, Stoving RK, Andries A, Sorensen JA. Comparison of the Moorehead-Ardelt quality of life questionnaire and the BODY-Q in Danish patients undergoing weight loss and body contouring surgery. Clin Obes 2020; 10:e12351. [PMID: 31898419 DOI: 10.1111/cob.12351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
This study compared the measurement properties of the Moorehead-Ardelt quality of life questionnaire-II (MAQOL-II) and the BODY-Q, to determine which was more suitable for measuring patient-reported outcome (PRO) in Danish bariatric surgery (BS) and body contouring surgery (BC) patients. We examined content validity against the COSMIN guidelines and compared psychometric performance using Rasch measurement theory methods and criteria. MAQOL-II data were obtained from the Danish Bariatric Surgery Database from September 2010 to November 2017, and BODY-Q data were collected from June 2015 to March 2018. The MAQOL-II failed to meet recommended standards for content validity, while all criteria were met for the BODY-Q. A total of 16 965 MAQOL-II and 2259 BODY-Q assessments were obtained. A random sample was selected from the MAQOL-II dataset to match the BODY-Q sample. Psychometrically, the BODY-Q performed better than the MAQOL-II. For example, Cronbach's α was 0.82 for the MAQOL-II vs ≥0.90 for all BODY-Q scales. Fifty percent (3/6) of MAQOL-II items had disordered thresholds, while all BODY-Q items had ordered thresholds (123/123). Poor item fit was revealed for 17% (1/6) of MAQOL-II and 8% (10/123) of BODY-Q items. For scale reliability, person separation index was 0.79 for the MAQOL-II and 0.88 (0.81-0.93) for the BODY-Q. In conclusion, the MAQOL-II does not meet today's standards for a rigorously developed PRO measure. The BODY-Q, on the other hand, gives substantial, accurate and interpretable measurement and should be recommended for use in PRO in BS and BC patients.
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Affiliation(s)
- Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Nina Simonsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Michael Rose
- Department of Plastic Surgery, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Claus B Juhl
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Rene K Stoving
- Department of Endocrinology and The Psychiatric Services of Southern Denmark, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Alin Andries
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Jens A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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Poore SO. The Classification and Surgical Treatment of Adult Acquired Buried Penis Syndrome: A Call for Data and Collaboration. Aesthet Surg J 2020; 40:NP83-NP84. [PMID: 31877210 PMCID: PMC6988514 DOI: 10.1093/asj/sjz300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Samuel O Poore
- Division of Plastic Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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