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Moazzam Z, Lima HA, Endo Y, Noria S, Needleman B, Pawlik TM. A Paradigm Shift: Online Artificial Intelligence Platforms as an Informational Resource in Bariatric Surgery. Obes Surg 2023; 33:2611-2614. [PMID: 37322244 DOI: 10.1007/s11695-023-06675-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 670, OH, 43210, Columbus, USA
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 670, OH, 43210, Columbus, USA
| | - Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 670, OH, 43210, Columbus, USA
| | - Sabrena Noria
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 670, OH, 43210, Columbus, USA
| | - Bradley Needleman
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 670, OH, 43210, Columbus, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 670, OH, 43210, Columbus, USA.
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Outcomes and Trends of Endoscopic Bariatric Therapies (EBT) Among Minority Populations. Obes Surg 2023; 33:513-522. [PMID: 36477696 DOI: 10.1007/s11695-022-06399-w] [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: 08/07/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Endoscopic bariatric therapies (EBT) have emerged as effective options for weight loss. While the benefits of EBT have been documented, data regarding such therapies among minority populations remains scant. We aim to investigate EBT trends and outcomes in minority populations. METHODS Data were extracted from the 2015 to 2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) databases. Intragastric balloon (IGB) and endoscopic sleeve gastroplasty (ESG) cases were identified, and procedure volume assessed by year and race/ethnicity. Measures of interest included year-to-year mortality, surgical complications, and 30-day adverse outcomes. RESULTS Of 966,646 cases in the MBSAQIP databases, 5209 (0.54%) IGB and ESG cases were included. 10.7% were black, and 81.6% were female patients. Compared to white patients, black and Hispanic patients were younger (p < 0.01) with a higher body mass index (p < 0.001). Mortality (0.03% vs. 0% vs. 0%, p = 0.99), reoperation (1.1% vs. 0.8% vs. 0.6%, p = 0.30), and reintervention (3.9% vs. 3.2% vs. 2.3%, p = 0.09) rates were similar between racial/ethnic cohorts. All complications were similar between racial/ethnic cohorts, except a higher rate of venous thromboembolism, in Hispanic (1.04%, p < 0.01) compared to black (0.18%) and white (0.21%) patients. IGB and ESG were predominantly performed in white and Hispanic patients, respectively. ESG was associated with a higher leak (0.6% vs. 0.02%, p < 0.01) and venous thromboembolism (VTE) (1.0% vs. 0.12%, p < 0.01) rate. CONCLUSION While EBTs have increased annually, they are performed less in black patients. Future studies are needed to identify access barriers for black patients. They are safely performed with similar outcomes in racial/ethnic cohorts, except for a higher VTE rate in Hispanic patients.
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Shen MR, Jiang S, Millis MA, Bonner SN, Bonham AJ, Finks JF, Ghaferi A, Carlin A, Varban OA. Racial variation in baseline characteristics and wait times among patients undergoing bariatric surgery. Surg Endosc 2023; 37:564-570. [PMID: 35508664 PMCID: PMC9633573 DOI: 10.1007/s00464-022-09292-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/18/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Although bariatric surgery is the most effective treatment for obesity and weight-related comorbid diseases, utilization rates are disproportionately low among non-white patients. We sought to understand if variation in baseline characteristics or access to care exists between white and non-white patients. METHODS Using a statewide bariatric-specific data registry, we evaluated all patients who underwent bariatric surgery between 2006 and 2020 and completed a preoperative baseline questionnaire, which included a question about self-identification of race. Patient characteristics, co-morbidities, and time from initial preoperative clinic evaluation to date of surgery were compared among racial groups. RESULTS A total of 73,141 patients met inclusion criteria with 18,741 (25.5%) self-identified as non-white. These included Black/African American (n = 11,904), Hispanic (n = 3448), Asian (n = 121), Native Hawaiian/Pacific Islander (n = 41), Middle Eastern (n = 164), Multiple (n = 2047) and other (n = 608). Non-white males were the least represented group, accounting for only 4% of all bariatric cases performed. Non-white patients were more likely to be younger (43.0 years vs. 46.6 years, p < 0.0001), disabled (16% vs. 11.4%, p < 0.0001) and have Medicaid (8.4% vs. 3.8%, p < 0.0001) when compared to white patients, despite having higher rates of college education (78.0% vs. 76.6, p < 0.0001). In addition, median time from initial evaluation to surgery was also longer among non-white patients (157 days vs. 127 days, p < 0.0001), despite having higher rates of patients with a body mass index above 50 kg/m2 (39.0% vs. 33.2%, p < 0.0001). CONCLUSIONS Non-white patients undergoing bariatric surgery represent an extremely diverse group of patients with more socioeconomic disadvantages and longer wait times when compared to white patients despite presenting with higher rates of severe obesity. Current guidelines and referral patterns for bariatric surgery may not be equitable and need further examination when considering the management of obesity within diverse populations to reduce disparities in care-of which non-white males are particularly at risk.
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Ouni A, Khosla AA, Gómez V. Perception of Bariatric Surgery and Endoscopic Bariatric Therapies Among Primary Care Physicians. Obes Surg 2022; 32:3384-3389. [PMID: 35931932 DOI: 10.1007/s11695-022-06231-5] [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: 04/13/2022] [Revised: 07/24/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In the USA, less than 1% of eligible patients who qualify for bariatric surgery ultimately undergo surgery. Perceptions of endoscopic bariatric therapies (EBTs) for weight management remain unknown. METHODS A 22-question survey was distributed to primary care physicians (PCPs) across the Mayo Clinic healthcare system. Survey invitations were sent via email, and all surveys were unanimously conducted electronically. RESULTS A total of 130 PCPs participated in the survey (40% response rate). Twenty-four PCPs were between 20 and 24 years out of training (18.5%), and 71 (54.6%) were female. Most providers had a body mass index (BMI) between 18.5 and 24.9 kg/m2 (n = 62, 47.7%). Among the weight loss options discussed during clinic visits, PCPs discussed lifestyle modification including diet and exercise (n = 129; 99.2%), and 68 PCPs (52.3%) were not aware of EBTs as weight loss interventions. While 46.2% of the PCPs agreed that a bariatric endoscopy is an effective option for weight loss, only 24.6% of PCPs were familiar with the indications for EBTs. Most of the cohort (n = 69, 53.1%) experienced barriers in referring their patients. Moreover, most of the patients referred to bariatric clinics were from PCPs who had a BMI between 18.5 and 24.9 kg/m2 (n = 62, 47.7%) as compared to PCPs with a BMI of 40 kg/m2 and greater (n = 5, 3.8%). CONCLUSIONS Due to the rise of bariatric therapies in recent years, PCPs are increasingly involved in the referral and management of patients with obesity and obesity-related comorbidities. However, knowledge gaps regarding weight loss options, including EBTs, could limit optimal care to patients desiring medically monitored weight loss.
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Affiliation(s)
- Ahmed Ouni
- Department of Gastroenterology and Hepatology, Mayo Clinic in Florida, Jacksonville, FL, 32224, USA.
| | - Atulya Aman Khosla
- Department of Gastroenterology and Hepatology, Mayo Clinic in Florida, Jacksonville, FL, 32224, USA
| | - Victoria Gómez
- Department of Gastroenterology and Hepatology, Mayo Clinic in Florida, Jacksonville, FL, 32224, USA
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Bays HE, Kulkarni A, German C, Satish P, Iluyomade A, Dudum R, Thakkar A, Rifai MA, Mehta A, Thobani A, Al-Saiegh Y, Nelson AJ, Sheth S, Toth PP. Ten things to know about ten cardiovascular disease risk factors - 2022. Am J Prev Cardiol 2022; 10:100342. [PMID: 35517870 PMCID: PMC9061634 DOI: 10.1016/j.ajpc.2022.100342] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/19/2022] [Accepted: 04/01/2022] [Indexed: 12/12/2022] Open
Abstract
The American Society for Preventive Cardiology (ASPC) "Ten things to know about ten cardiovascular disease risk factors - 2022" is a summary document regarding cardiovascular disease (CVD) risk factors. This 2022 update provides summary tables of ten things to know about 10 CVD risk factors and builds upon the foundation of prior annual versions of "Ten things to know about ten cardiovascular disease risk factors" published since 2020. This 2022 version provides the perspective of ASPC members and includes updated sentinel references (i.e., applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful dietary intake, physical inactivity, dyslipidemia, pre-diabetes/diabetes, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis (with smoking as a potential contributor to thrombosis), kidney dysfunction and genetics/familial hypercholesterolemia. Other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the ASPC "Ten things to know about ten cardiovascular disease risk factors - 2022" to provide a tabular overview of things to know about ten of the most common CVD risk factors applicable to preventive cardiology and provide ready access to applicable guidelines and sentinel reviews.
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Affiliation(s)
- Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Clinical Associate Professor, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville KY 40213
| | - Anandita Kulkarni
- Duke Clinical Research Institute, 200 Morris Street, Durham, NC, 27701
| | - Charles German
- University of Chicago, Section of Cardiology, 5841 South Maryland Ave, MC 6080, Chicago, IL 60637
| | - Priyanka Satish
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA 77030
| | - Adedapo Iluyomade
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL 33176
| | - Ramzi Dudum
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Aarti Thakkar
- Osler Medicine Program, Johns Hopkins Hospital, Baltimore MD
| | | | - Anurag Mehta
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Aneesha Thobani
- Emory University School of Medicine | Department of Cardiology, 101 Woodruff Circle, WMB 2125, Atlanta, GA 30322
| | - Yousif Al-Saiegh
- Lankenau Medical Center – Mainline Health, Department of Cardiovascular Disease, 100 E Lancaster Ave, Wynnewood, PA 19096
| | - Adam J Nelson
- Center for Cardiovascular Disease Prevention, Cardiovascular Division, Baylor Scott and White Health Heart Hospital Baylor Plano, Plano, TX 75093
| | - Samip Sheth
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007
| | - Peter P. Toth
- CGH Medical Cener, Sterling, IL 61081
- Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD
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Huppler L, Robertson AG, Wiggins T, Hollyman M, Welbourn R. How safe bariatric surgery is-An update on perioperative mortality for clinicians and patients. Clin Obes 2022; 12:e12515. [PMID: 35261160 DOI: 10.1111/cob.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/12/2022] [Indexed: 11/27/2022]
Abstract
Bariatric, metabolic or weight loss surgery produces sustained weight loss and imporovement in obesity related diseases. Bariatric surgery has existed for decades but there is limited reliable data on the risk of perioperative mortality following the procedures. This commentary focuses on a recent meta-analysis which has produced contemporaneous mortality data, and the findings are significant. Utilising data from 3.6 million patients the study has shown an overall pooled perioperative mortality of 0.08%, a significantly reduced risk compared to previous, smaller studies. This finding increases our knowledge of surgical risk for these procedures and should now equip health care groups to challenge barriers to uptake of bariatric surgery. Barriers currently include a worldwide lack of focus on treating obesity, lack of funding and resource from commissioners, and a general public and professional view that bariatric surgery may be high risk. In reality, this figure equates to mortality risk for procedures generally considered 'safe' such as laparoscopic cholecystectomy and knee arthroplasty. Bariatric surgery is a safe option for achieving sustained weight-loss and the treatment of obesity related diseases, and refusing access to surgery on the grounds of perioperative safety should now be an outdated premise.
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Ames GE, Koball AM, Clark MM. Behavioral Interventions to Attenuate Driven Overeating and Weight Regain After Bariatric Surgery. Front Endocrinol (Lausanne) 2022; 13:934680. [PMID: 35923629 PMCID: PMC9339601 DOI: 10.3389/fendo.2022.934680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Weight regain after bariatric surgery is associated with problematic eating behaviors that have either recurred after a period of improvement or are new-onset behaviors. Problematic eating behaviors after bariatric surgery have been conceptualized in different ways in the literature, such as having a food addiction and experiencing a loss of control of eating. The intersection of these constructs appears to be driven overeating defined as patients' experiences of reduced control of their eating which results in overeating behavior. The purpose of this review is to define patient experiences of driven overeating through the behavioral expression of emotion-based eating, reward-based eating, and executive functioning deficits-namely impulsivity-which is associated with weight regain after having bariatric surgery. Delineating concepts in this way and determining treatment strategies accordingly may reduce distress related to the inevitable return of increased hunger, cravings, portion sizes, and tolerance for highly palatable foods after surgery. Along with standard behavioral weight maintenance strategies, topics including acceptance, motivation, emotion-based eating, reward-based/impulsive eating, physical activity, and self-compassion are discussed. These concepts have been adapted for patients experiencing weight regain after having bariatric surgery and may be particularly helpful in attenuating driven overeating and weight regain.
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Affiliation(s)
- Gretchen E. Ames
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States
- *Correspondence: Gretchen E. Ames,
| | - Afton M. Koball
- Department of Behavioral Health, Gundersen Health System, La Crosse, WI, United States
| | - Matthew M. Clark
- Department of Psychiatry and Psychology and Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, United States
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Dash S, Everett K, Jackson T, Okrainec A, Urbach DR, Sockalingam S, Shah BR, Farkouh ME. Cardiorenal outcomes in eligible patients referred for bariatric surgery. Obesity (Silver Spring) 2021; 29:2035-2043. [PMID: 34724336 DOI: 10.1002/oby.23294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/09/2021] [Accepted: 08/16/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Bariatric surgery is associated with reduced atherosclerotic cardiovascular disease (CVD) and heart failure hospitalization in people with type 2 diabetes (T2D) and those with prior CVD. Most patients undergoing bariatric surgery do not have T2D or CVD. Many otherwise eligible patients do not have surgery because of self-exclusion. Clinical outcomes in these groups are less established. METHODS This study retrospectively assessed cardiorenal outcomes in 8,568 patients after acceptance of referral for surgery. RESULTS A total of 63.8% patients did not undergo surgery. After multivariate adjustment for sex, age, BMI, income quintile, distance from hospital, hypertension, T2D, and CVD, hazard ratios (HR) for the primary (incident myocardial infarction, stroke, heart failure hospitalization, and death; HR = 0.52, 95% CI: 0.4-0.66) and secondary CVD outcomes (primary outcomes and coronary/carotid revascularization; HR = 0.53, 95% CI: 0.42-0.67) were lower in the surgery cohort. This reduction was seen in those with (primary: HR = 0.45, 95% CI: 0.32-0.63, secondary: HR = 0.47, 95% CI: 0.34-0.65) and without T2D (primary: HR = 0.61, 95% CI: 0.42-0.88, secondary: HR = 0.53, 95% CI: 0.42-0.67). Reduced kidney disease (HR = 0.46, 95% CI: 0.22-0.92) but increased liver disease hospitalization (HR = 2.5, 95% CI: 1.45-4.27) was observed with surgery. CONCLUSIONS Non-progression to surgery associates with increased CVD despite low baseline prevalence of CVD. The cardiorenal benefits of bariatric surgery warrant confirmation in a well-powered randomized clinical trial.
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Affiliation(s)
- Satya Dash
- Division of Endocrinology, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bariatric Program, University Health Network, Toronto, Ontario, Canada
| | - Karl Everett
- Division of Endocrinology, Sunnybrook Health Sciences Centre Toronto, Toronto, Ontario, Canada
| | - Timothy Jackson
- Bariatric Program, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allan Okrainec
- Bariatric Program, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David R Urbach
- Bariatric Program, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Bariatric Program, University Health Network, Toronto, Ontario, Canada
- Centre for Addiction, & Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Sunnybrook Health Sciences Centre Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- St. Michael's Hospital Research Institute, Toronto, Ontario, Canada
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Robertson AGN, Wiggins T, Robertson FP, Huppler L, Doleman B, Harrison EM, Hollyman M, Welbourn R. Perioperative mortality in bariatric surgery: meta-analysis. Br J Surg 2021; 108:892-897. [PMID: 34297806 DOI: 10.1093/bjs/znab245] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/02/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bariatric surgery is an established treatment for severe obesity; however, fewer than 1 per cent of eligible patients undergo surgery. The perceived risk of surgery may contribute to the low uptake. The aim of this study was to determine perioperative mortality associated with bariatric surgery, comparing different operation types and data sources. METHODS A literature search of Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted to identify studies published between 1 January 2014 and 31 July 2020. Inclusion criteria were studies of at least 1000 patients reporting short-term mortality after bariatric surgery. Data were collected on RCTs. Meta-analysis was performed to establish overall mortality rates across different study types. The primary outcome measure was perioperative mortality. Different operation types were compared, along with study type, in subgroup analyses. The study was registered at PROSPERO (2019: CRD 42019131632). RESULTS Some 4356 articles were identified and 58 met the inclusion criteria. Data were available on over 3.6 million patients. There were 4707 deaths. Pooled analysis showed an overall mortality rate of 0.08 (95 per cent c.i. 0.06 to 0.10; 95 per cent prediction interval 0 to 0.21) per cent. In subgroup analysis, there was no statistically significant difference between overall, 30-day, 90-day or in-hospital mortality (P = 0.29). There was no significant difference in reported mortality for RCTs, large studies, national databases or registries (P = 0.60). The pooled mortality rates by procedure type in ascending order were: 0.03 per cent for gastric band, 0.05 per cent for sleeve gastrectomy, 0.09 per cent for one-anastomosis gastric bypass, 0.09 per cent for Roux-en-Y gastric bypass, and 0.41 per cent for duodenal switch (P < 0.001 between operations). CONCLUSION Bariatric surgery is safe, with low reported perioperative mortality rates.
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Affiliation(s)
| | - T Wiggins
- Heartlands Hospital, Birmingham, Birmingham, UK
| | | | | | - B Doleman
- University of Nottingham, Nottingham, UK
| | - E M Harrison
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Wiggins T, Pournaras DJ, Priestman E, Osborne A, Titcomb DR, Finlay I, Hopkins J, Hollyman M, Mason M, Noble H, Mahon D, Welbourn R. Effect of Preoperative Weight Loss and Baseline Comorbidity on Short-Term Complications and Reoperations After Laparoscopic Roux-en-Y Gastric Bypass in 2,067 Patients. Obes Surg 2021; 31:2444-2452. [PMID: 33768433 DOI: 10.1007/s11695-021-05331-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Decreasing popularity of Roux-en-Y gastric bypass (RYGB) in bariatric-metabolic surgery may be due to higher perceived peri-operative complications. There are few studies on whether preoperative weight loss can reduce complications or reoperations following RYGB. We investigated this using a standardised operative technique. MATERIALS AND METHODS Retrospective single-centre study of RYGB from 2004 to 2019 using a prospective database. Preoperative behavioural management included intentional weight loss. Maximum preoperative weight, weight on the day of operation, and Obesity-Surgery Mortality Risk Score (OS-MRS) class were recorded. Short-term outcomes (post-operative stay, 30-day complication and reoperation rates) were analysed. RESULTS In 2,067 RYGB patients (1,901 primary and 166 revisional), median preoperative total body weight loss (TWL) was 6.2% (IQR: 2.5-10.7%). The median age was 46 (interquartile range (IQR) 38-54) and 80.4% were female (n=1,661). For primary surgery, the median body mass index (BMI) was 47.6 kg/m2 (IQR: 43.1-53.3). Excluding the 100-procedure learning curve, the complication rate for primary cases was 4.4% and reoperation rate of 2.8% and one peri-operative mortality (0.06%). OS-MRS ≥2 (class B or C) predicted higher risk of complications (6.1%) compared to those with a score <2 (class A) (3.8%, p=0.021), but not reoperations. Five percent preoperative TWL did not decrease complications compared to <5% TWL. Patients with ≥10% TWL had greater baseline risk and had an increased risk of complications (6.6% vs 3.7%, p=0.017) and reoperations (4.5% vs 2.7%, p<0.001). CONCLUSIONS RYGB performed using a standardised technique has low overall risk. The influence of preoperative weight loss on outcomes was inconsistent.
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Affiliation(s)
- Tom Wiggins
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Dimitri J Pournaras
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Elena Priestman
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Alan Osborne
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Daniel R Titcomb
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Ian Finlay
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - James Hopkins
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Marianne Hollyman
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Matthew Mason
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Hamish Noble
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - David Mahon
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK.
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Guigui A, Bétry C, Khouri C, Borel AL. Impact of Bariatric Surgery on Medication Efficacy: an Analysis of World Health Organization Pharmacovigilance Data. Obes Surg 2021; 31:2823-2830. [PMID: 33576906 DOI: 10.1007/s11695-021-05258-4] [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: 12/08/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Abstract
Bariatric surgery is the most effective treatment of severe obesity. However, this surgery can have an impact on the bioavailability and metabolism of oral drugs as it modifies absorption, intestinal, and hepatic metabolism, and efflux transporter activity. The clinical impact of such modifications often remains unknown. To investigate, we extracted and summarized all reports of changes in drug efficacy associated with bariatric surgery registered in the WHO pharmacovigilance database. We identified 165 drug reports affecting 128 patients. The majority involved gastric bypass surgery (77.3%). Most reports concerned drug ineffectiveness (74.7%). The most frequent modifications concerned psychotropic drugs with a reduction in efficacy. This study underlines the urgent need for more research to better characterize the impact of bariatric surgery on drug pharmacokinetics and clinical efficacy.
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Affiliation(s)
- Alicia Guigui
- Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France.
- Hypoxia pathophysiology laboratory (HP2), Inserm U1042, 38000, Grenoble, France.
| | - Cécile Bétry
- Endocrinology, Diabetology, Nutrition Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Charles Khouri
- Clinical Pharmacology Department, INSERM CIC1406, Grenoble Alpes University Hospital, Grenoble, France
- Hypoxia pathophysiology laboratory (HP2), Inserm U1042, 38000, Grenoble, France
- Pharmacovigilance Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Anne-Laure Borel
- Hypoxia pathophysiology laboratory (HP2), Inserm U1042, 38000, Grenoble, France
- Endocrinology, Diabetology, Nutrition Department, Grenoble Alpes University Hospital, Grenoble, France
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Sarma S, Sockalingam S, Dash S. Obesity as a multisystem disease: Trends in obesity rates and obesity-related complications. Diabetes Obes Metab 2021; 23 Suppl 1:3-16. [PMID: 33621415 DOI: 10.1111/dom.14290] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/05/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
Obesity is a chronic multisystem disease associated with increased morbidity and mortality. The increasing prevalence of obesity makes it a major healthcare challenge across both developed and developing countries. Traditional measures such as body mass index do not always identify individuals at increased risk of comorbidities, yet continue to be used in deciding who qualifies for weight loss treatment. A better understanding of how obesity is associated with comorbidities, in particular non-metabolic conditions, is needed to identify individuals at risk in order to prioritize treatment. For metabolic disorders such as type 2 diabetes (T2D), weight loss can prevent T2D in individuals with prediabetes. It can improve and reverse T2D if weight loss is achieved early in the course of the disease. However, access to effective weight loss treatments is a significant barrier to improved health for people with obesity. In the present paper, we review the rising prevalence of obesity and why it should be classed as a multisystem disease. We will discuss potential mechanisms underlying its association with various comorbidities and how these respond to treatment, with a particular focus on cardiometabolic disease, malignancy and mental health.
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Affiliation(s)
- Shohinee Sarma
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Satya Dash
- Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Banting and Best Diabetes Centre, University of Toronto, Toronto, Ontario, Canada
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Bays HE, Taub PR, Epstein E, Michos ED, Ferraro RA, Bailey AL, Kelli HM, Ferdinand KC, Echols MR, Weintraub H, Bostrom J, Johnson HM, Hoppe KK, Shapiro MD, German CA, Virani SS, Hussain A, Ballantyne CM, Agha AM, Toth PP. Ten things to know about ten cardiovascular disease risk factors. Am J Prev Cardiol 2021; 5:100149. [PMID: 34327491 PMCID: PMC8315386 DOI: 10.1016/j.ajpc.2021.100149] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Given rapid advancements in medical science, it is often challenging for the busy clinician to remain up-to-date on the fundamental and multifaceted aspects of preventive cardiology and maintain awareness of the latest guidelines applicable to cardiovascular disease (CVD) risk factors. The “American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2021 Update” is a summary document (updated yearly) regarding CVD risk factors. This “ASPC Top Ten CVD Risk Factors 2021 Update” summary document reflects the perspective of the section authors regarding ten things to know about ten sentinel CVD risk factors. It also includes quick access to sentinel references (applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the “ASPC Top Ten CVD Risk Factors 2021 Update” to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.
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Affiliation(s)
- Harold E. Bays
- Medical Director / President, Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY USA
- Corresponding author.
| | - Pam R. Taub
- University of California San Diego Health, San Diego, CA USA
| | | | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard A. Ferraro
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison L. Bailey
- Chief, Cardiology, Centennial Heart at Parkridge, Chattanooga, TN USA
| | - Heval M. Kelli
- Northside Hospital Cardiovascular Institute, Lawrenceville, GA USA
| | - Keith C. Ferdinand
- Professor of Medicine, John W. Deming Department of Medicine, Tulane University School of Medicine, New Orleans, LA USA
| | - Melvin R. Echols
- Assistant Professor of Medicine, Department of Medicine, Cardiology Division, Morehouse School of Medicine, New Orleans, LA USA
| | - Howard Weintraub
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - John Bostrom
- NYU Grossman School of Medicine, NYU Center for the Prevention of Cardiovascular Disease, New York, NY USA
| | - Heather M. Johnson
- Christine E. Lynn Women's Health & Wellness Institute, Boca Raton Regional Hospital/Baptist Health South Florida, Clinical Affiliate Associate Professor, Florida Atlantic University, Boca Raton, FL USA
| | - Kara K. Hoppe
- Assistant Professor, Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Charles A. German
- Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC USA
| | - Salim S. Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Aliza Hussain
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Christie M. Ballantyne
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Ali M. Agha
- Department of Medicine and Center for Cardiometabolic Disease Prevention, Baylor College of Medicine, Houston, TX USA
| | - Peter P. Toth
- CGH Medical Center, Sterling, IL USA
- Cicarrone center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
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