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Hofbauer LM, Rodriguez PFS. The Mediating Role of Lifestyle Activities in the Association Between Social Deprivation and Cognition in Older Adulthood: Results From the Health and Retirement (HRS) Study. J Aging Health 2024:8982643241273988. [PMID: 39137921 DOI: 10.1177/08982643241273988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
Objectives: We aimed to investigate the mediating role of lifestyle activities in the association between social deprivation and cognition. Methods: To investigate, we analysed data of 3867 respondents (Mean Age: 73.37, SD: 5.57) in the U.S. Health and Retirement Study (HRS) using growth curve and path analysis, adjusted for demographic and health covariates. Results: Being in the high (vs. moderate) Social Deprivation Index group was associated with lower cognition scores (β = -2.63, [95 % CI: -2.90, -2.36]). Conversely, higher (vs. lower) Lifestyle Index scores were associated with higher cognition scores (β = 1.17, [95 % CI: 0.72, 1.63]). In mediation analysis, the Lifestyle Index score explained 27 % of the association of So Dep Index group on cognition at the final follow-up. Discussion: While lifestyle activities did mediate the association between social deprivation and cognition, factors not investigated accounted for the majority of the variation. These may include systemic disadvantages.
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Affiliation(s)
- Lena M Hofbauer
- Research Group Psychosocial Epidemiology and Public Health, German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Pd Francisca S Rodriguez
- Research Group Psychosocial Epidemiology and Public Health, German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
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Sundbom M, Näslund I, Ottosson J, Stenberg E, Näslund E. Results from the Scandinavian Obesity Surgery Registry: A narrative review. Obes Rev 2024; 25:e13662. [PMID: 37962040 DOI: 10.1111/obr.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023]
Abstract
In 2007, the Scandinavian Obesity Surgery Registry (SOReg) was started by the profession to monitor the results of bariatric surgery and to provide a high-quality database for research. In the end of August 2023, SOReg contains 88,379 patients (body mass index [BMI] 41.7 kg/m2 , 41.2 years, 77.1% females, gastric bypass 76.8%). In this narrative review, we demonstrate that preoperative weight loss is of value and that the laparoscopic double omega-loop technique is highly suitable for gastric bypass. Closing the mesenteric openings is, however, important. Swedish bariatric surgery has low mortality, and our results are comparative to those of other countries. Significant long-term improvements are found in common obesity-related diseases such as diabetes, hypertension, and sleep apnea. Furthermore, the risk for cardiac failure and major adverse cardiovascular events is significantly reduced. Pregnancy-related outcomes are also improved. Gastric bypass results in significant improvements in quality of life and seems to be cost saving. We have revealed that low socioeconomic status is associated with reduced chance of undergoing bariatric surgery and inferior outcomes. Of note, we have performed several randomized clinical trials within the registry database. In conclusion, high-quality national registry databases, such as SOReg, are important for maintaining high-quality care and present a platform for extensive research.
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Affiliation(s)
- Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ingmar Näslund
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Stenberg
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Wallén S, Szabo E, Palmetun-Ekbäck M, Näslund I, Ottosson J, Näslund E, Stenberg E. Impact of socioeconomic status on new chronic opioid use after gastric bypass surgery. Surg Obes Relat Dis 2023; 19:1375-1381. [PMID: 37532668 DOI: 10.1016/j.soard.2023.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/02/2023] [Accepted: 06/17/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Socioeconomic status may influence weight loss, postoperative complications, and health-related quality of life after bariatric surgery. Chronic use of opioid analgesics is a known risk after bariatric surgery, but whether socioeconomic factors are associated with new chronic use of opioid analgesics has not been investigated in depth. OBJECTIVES The aim of this study was to identify socioeconomic factors associated with the development of new chronic use of opioid analgesics after gastric bypass surgery. SETTING All hospitals performing bariatric surgery in Sweden. METHODS This was a retrospective cohort study with prospectively collected data including all primary gastric bypass procedures in Sweden between 2007 and 2015. Data were collected from the Scandinavian Obesity Surgery Registry, the Swedish Prescribed Drug Register, and Statistics Sweden. The primary outcome was new chronic opioid use. RESULTS Of the 44,671 participants, 1438 patients became new chronic opioid users. Longer education (secondary education; odds ratio [OR] = .71; 95% CI, .62-.81) or higher education (OR = .45; 95% CI, .38-.53), higher disposable income (20th-50th percentile: OR = .75; 95% CI, .66-.85; 50th-80th percentile: OR = .50; 95% CI, .43-.58; and the highest 80th percentile: OR = .40; 95% CI, .32-.51) were significantly associated with lower risk for new chronic opioid use. Being a second-generation immigrant (OR = 1.54; 95% CI, 1.24-1.90), being on a disability pension or early retirement (OR = 3.04; 95% CI, 2.67-3.45), receiving social benefits (OR = 1.88; 95% CI, 1.59-2.22), being unemployed for <100 days (OR = 1.25; 95% CI, 1.08-1.45), being unemployed for >100 days (OR = 1.41; 95% CI, 1.16-1.71), and being divorced or a widow or widower (OR = 1.35; 95% CI, 1.17-1.55) were significantly associated with a higher risk for chronic opioid use. CONCLUSION Given that long-term opioid use has detrimental effects after bariatric surgery, it is important that information and follow-up are optimized for patients with shorter education, lower income, and disability pension or early retirement because they are at an increased risk of new chronic opioid analgesics use.
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Affiliation(s)
- Stefan Wallén
- Pharmacology and Therapeutic Department, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Palmetun-Ekbäck
- Pharmacology and Therapeutic Department, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Jans A, Rask E, Ottosson J, Magnuson A, Szabo E, Stenberg E. Reliability of the DSS-Swe Questionnaire. Obes Surg 2023; 33:3487-3493. [PMID: 37798509 PMCID: PMC10603007 DOI: 10.1007/s11695-023-06841-7] [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: 01/25/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Symptomatic postbariatric hypoglycemia (PBH) is a known complication that can occur a few years after Roux-en-Y gastric bypass (RYGB). There is currently no established rating scale for PBH-associated symptoms developed for use in Swedish populations. The aim of the study was to translate an already existing questionnaire into Swedish and to test its reliability. METHODS The study included forward and backward translations of the original Dumping Severity Scale (DSS) questionnaire with 8 items regarding symptoms of early dumping and 6 items regarding hypoglycemia, with each item graded on a 4-point Likert scale. The reliability of the Swedish translated questionnaire (DSS-Swe) was estimated using internal consistency and test-retest methods. RESULTS A total of 200 patients were included in the study. Good internal consistency was demonstrated regarding the items related to early dumping symptoms, with a Cronbach's alpha coefficient of 0.82, and very good agreement in terms of test-retest reliability, with an overall intraclass correlation coefficient (ICC) of 0.91 (95% CI 0.88-0.93). The items related to hypoglycemia yielded a good Cronbach's alpha coefficient of 0.76 and an ICC of 0.89 (95% CI 0.85-0.91). CONCLUSION The DSS-Swe questionnaire shows good reliability regarding both internal consistency and test-retest performance for use in Swedish populations.
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Affiliation(s)
- Anders Jans
- Department of Surgery, Faculty of Medicine and Health, Örebro University, 70185, Örebro, Sweden.
| | - Eva Rask
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, 70185, Örebro, Sweden
| | - Anders Magnuson
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, 70185, Örebro, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, 70185, Örebro, Sweden
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Pratt KJ, Hanks AS, Miller HJ, Outrich M, Breslin L, Blalock J, Noria S, Brethauer S, Needleman B, Focht B. The BARI-hoods Project: neighborhood social determinants of health and postoperative weight loss using integrated electronic health record, census, and county data. Surg Obes Relat Dis 2023; 19:318-327. [PMID: 36739248 DOI: 10.1016/j.soard.2022.12.033] [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: 08/13/2022] [Revised: 10/16/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND While social determinants of health (SDoH) have gained attention for their role in weight loss following bariatric surgery, electronic health record (EHR) data provide limited information beyond demographics associated with disparities in weight loss. OBJECTIVE To integrate EHR, census, and county data to explore disparities in SDoH and weight loss among patients in the largest populous county of Ohio. SETTING Seven hundred seventy-two patients (82.1% female; 37.0% Black) who had primary bariatric surgery (48.7% gastric bypass) from 2015 to 2019 at Ohio State University. METHODS EHR variables included race, insurance, procedure, and percent total weight lost (%TWL) at 2/3, 6, 12, and 24 months. Census variables included poverty and unemployment rates. County variables included food stores, fitness/recreational facilities, and open area within a 5- and 10-minute walk from home. Two mixed multilevel models were conducted with %TWL over 24 months, with visits as the between-subjects factor; race, census, county, insurance, and procedure variables were covariates. Two additional sets of models determined within-group differences for Black and White patients. RESULTS Access to more food stores within a 10-minute walk was associated with greater %TWL over 24 months (P = .029). Black patients with access to more food stores within a 10-minute (P = .017) and White patients with more access within a 5-minute walk (P = .015) had greater %TWL over 24 months. Black patients who lived in areas with higher poverty rates (P = .036) experienced greater %TWL over 24 months. No significant differences were found for unemployment rate or proximity to fitness/recreational facilities and open areas. CONCLUSIONS Close proximity to food stores is associated with better weight loss 2 years after bariatric surgery. Lower poverty levels did not negatively affect weight loss in Black patients.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio; Department of General Surgery, College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Andrew S Hanks
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
| | - Harvey J Miller
- Department of Geography, Center for Urban and Regional Analysis, Ohio State University, Columbus, Ohio
| | - Michael Outrich
- Kirwan Institute for the Study of Race and Ethnicity, Ohio State University, Columbus, Ohio
| | - Lindsay Breslin
- Department of General Surgery, College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jamie Blalock
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
| | - Sabrena Noria
- Department of General Surgery, College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Stacy Brethauer
- Department of General Surgery, College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bradley Needleman
- Department of General Surgery, College of Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Brian Focht
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, Columbus, Ohio
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Liang C, Liu P, Kang S, Li W, Chen B, Ji M, Chen C. Risk factors for and delayed recognition of genitourinary fistula following radical hysterectomy for cervical cancer: a population-based analysis. J Gynecol Oncol 2023; 34:e20. [PMID: 36603848 PMCID: PMC9995873 DOI: 10.3802/jgo.2023.34.e20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/25/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer. METHODS This study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004-2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal-Wallis test. RESULTS In this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women's and children's hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040). CONCLUSION Intraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF.
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Affiliation(s)
- Cong Liang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shan Kang
- Department of Obstetrics and Gynecology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Biliang Chen
- Department of Obstetrics and Gynecology, Xijing Hospital, Air Force Military Medical University, Xi'an, China
| | - Mei Ji
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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The role of social deprivation and depression in dementia risk: findings from the longitudinal survey of health, ageing and retirement in Europe. Epidemiol Psychiatr Sci 2023; 32:e10. [PMID: 36786038 PMCID: PMC9971857 DOI: 10.1017/s2045796023000033] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
AIMS Knowledge on the link of individual social deprivation with dementia is incomplete. We thus aimed to see whether an association with dementia risk can be observed using a recently developed Social Deprivation Index (SoDep Index). Further, as deprivation is related to depression, we investigated the role of depression in the association. METHODS We analysed data of 11 623 Survey of Health, Ageing and Retirement in Europe (SHARE) respondents. Social deprivation status was determined by SoDep Index score. Dementia was determined by self-reported diagnosis. Dementia risk by social deprivation status was estimated using Cox proportional hazard models, including relevant covariates (gender, marriage status, chronic conditions). Depressive symptom status was added in a second step. Further, we completed subgroup analyses by social deprivation status and analysed the relevance of depressive symptoms in dementia risk in each deprivation group. In an additional sensitivity analyses we corrected for mortality and used impaired cognitive testing performance as an alternative outcome. RESULTS High (v. low) social deprivation status was associated with an increased dementia risk (hazard ratio (HR) = 1.79 [95% CI 1.31-2.45]) in the Cox analysis adjusted for covariates only. Further adjustment for depressive symptom status indicated a largely direct association between social deprivation status and dementia risk. Moreover, compared to not having experienced depressive symptoms in the past or at baseline, those with past (HR = 1.67 [95% CI 1.23-2.25]), baseline (HR = 1.48 [95% CI 1.04-2.10]) or stable depressive symptoms (HR = 2.96 [95% CI 2.12-4.14]) had an increased dementia risk. The association between stable depressive symptom status and dementia risk was in the high social deprivation subgroup particularly pronounced. Sensitivity analyses replicated results. CONCLUSIONS Results add to a growing body of evidence indicating that a public health approach to dementia prevention must address socioeconomic inequity. Results suggest a largely direct association between social deprivation and dementia risk. Adults who experience high social deprivation appear particularly affected by detrimental effects of depressive symptomatology on dementia risk and need intervention.
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Dahlberg K, Bylund A, Stenberg E, Jaensson M. An endeavour for change and self-efficacy in transition: patient perspectives on postoperative recovery after bariatric surgery-a qualitative study. Int J Qual Stud Health Well-being 2022; 17:2050458. [PMID: 35291912 PMCID: PMC8933016 DOI: 10.1080/17482631.2022.2050458] [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] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Self-efficacy plays a role in the process of making lifestyle changes. After bariatric surgery, patients must adapt to several lifelong lifestyle changes. The aim of this study was to explore patients' experiences of recovery after bariatric surgery in those reporting low preoperative self-efficacy. METHODS This qualitative inductive interview study included 18 participants. Individual interviews were conducted approximately one year after the surgery. Data were analysed using thematic analysis. RESULTS The analysis identified one theme, and five subthemes describing recovery after bariatric surgery. Participants described being at a crossroads before surgery and having to make a change. After surgery, they had to learn to handle their new situation, which included getting to know their new body, handling thoughts about themselves, and managing social relations. To enhance their situation, support and information were essential. Social relations, support, successes, and challenges influenced their self-efficacy, and thoughts about adopting lifestyle changes, maintaining motivation, and handling setbacks. CONCLUSIONS Recovery one year after bariatric surgery is an ongoing process that involves challenges encountered in lifestyle changes and physical and psychological transformations. Self-efficacy is not static and is influenced during the recovery process. Support and information are essential to enhance patient recovery after bariatric surgery.
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Affiliation(s)
- Karuna Dahlberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ami Bylund
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Jaensson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Mehta A, Awuah WA, Kalmanovich J, Huang H, Tanna R, Iqbal DJ, Garg T, Bulut HI, Abdul-Rahman T, Hasan MM. Investigating discrepancies in demand and access for bariatric surgery across different demographics in the COVID-19 era. Ann Med Surg (Lond) 2022; 82:104368. [PMID: 36268323 PMCID: PMC9577451 DOI: 10.1016/j.amsu.2022.104368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
Obesity affects over 650 million adults worldwide and increases the risk of cardiovascular events, diabetes, and hypertension. While lifestyle recommendations are popular management options, bariatric surgery has emerged as a standard of care in refractory cases, reported to cause at least a 30% reduction in mortality. In addition, it mitigates obesity-related complications leading to a significant improvement in the quality of life for morbidly obese patients (BMI >40). Despite the numerous benefits, demand and access to bariatric surgery vary across different demographics such as age, gender, and socioeconomic status. This demand and access were further reduced due to the COVID-19 pandemic. This has resulted in cancellations of elective surgeries such as weight loss procedures and promotes a sedentary lifestyle which has short-term and long-term detrimental consequences on the health of obese patients. In the context of the prevalent epidemiological trends, this reduction in bariatric services will disproportionately affect the elderly, males, low SES, and African Americans. This editorial highlights the prevalent discrepancies in demand and access to bariatric surgery amidst the COVID-19 pandemic, and possible recommendations to improve overall access and utilization of bariatric services in morbidly obese patients belonging to all demographics.
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Fall J, Sundbom M, Stenberg E. The influence of summer closure on serious postoperative complications in bariatric surgery. Langenbecks Arch Surg 2022; 407:2769-2775. [PMID: 35654874 PMCID: PMC9640441 DOI: 10.1007/s00423-022-02566-w] [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] [Received: 01/03/2022] [Accepted: 05/21/2022] [Indexed: 11/30/2022]
Abstract
Introduction Bariatric surgery is an effective method of treating obesity, with gastric bypass and sleeve gastrectomy being the most common techniques used worldwide. Despite the technical challenges in these methods, little is known about the effects of summer closure on the incidence of serious postoperative complications in surgeries performed shortly after summer vacation. This has therefore been studied in our large cohort. Materials and methods A retrospective cohort study based on data from the Scandinavian Obesity Surgery Registry was conducted. Patients who underwent a primary gastric bypass or sleeve gastrectomy operation between 2010 and 2019 were included. The rate of serious complications within 30 days after surgery for patients who underwent surgery the first month after summer closure was compared to those who underwent surgery during the rest of the year using the χ2 test and adjusted logistic regression. Results The study included 42,404 patients, 36,094 of whom underwent gastric bypass and 6310 of whom received sleeve gastrectomy. Summer closure was associated with an increased risk for serious postoperative complications in gastric bypass surgery (adjusted odds ratio (adj-OR) = 1.17; 95% confidence interval (CI): 1.01–1.36). No statistically significant association was seen for sleeve gastrectomy (adj-OR = 1.17; 95% CI: 0.72–1.91), nor in overall complication rate. Conclusions Summer closure increases the risk of serious postoperative complications in gastric bypass surgery. No statistically significant association was found for sleeve gastrectomy surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-022-02566-w.
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Affiliation(s)
- Johanna Fall
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. .,Department of Surgery, Örebro University Hospital, 701 82, Örebro, Sweden.
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Pouchucq C, Menahem B, Le Roux Y, Bouvier V, Gardy J, Meunier H, Thomas F, Launoy G, Dejardin O, Alves A. Are Geographical Health Accessibility and Socioeconomic Deprivation Associated with Outcomes Following Bariatric Surgery? A Retrospective Study in a High-Volume Referral Bariatric Surgical Center. Obes Surg 2022; 32:1486-1497. [PMID: 35267150 DOI: 10.1007/s11695-022-05937-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Few studies have evaluated the association between non-clinical determinants (socioeconomic status and geographic accessibility to healthcare) and the outcomes of bariatric surgery, with conflicting results. This study aimed to evaluate this association. METHODS The medical records of 1599 consecutive patients who underwent either laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy between June 2005 and December 2017 were retrieved. All relevant data, including patient characteristics, biometric values before and after surgery, related medical problems, surgical history, medications, and habitus, for each patient were prospectively collected in a database. Logistic regressions were used to assess the influence of non-clinical determinants on surgical indications and complications. Multilevel linear or logistic regression was used to evaluate the influence of non-clinical determinants on long-term %TWL and the probability to achieve adequate weight loss (defined as a %TWL > 20% at 12 months). RESULTS Analysis of the 1599 medical records revealed that most geographically isolated patients were more likely to have undergone laparoscopic Roux-en-Y gastric bypass (odds ratio: 0.97; 95% confidence interval: 0.94 to 0.99; P = 0.018) and had a greater likelihood of adequate weight loss (β: 0.03; 95% CI: 0.01 to 0.05; P = 0.021). Conversely, socioeconomic status (measured by the European Deprivation Index) did not affect outcomes following bariatric surgery. CONCLUSION Geographical health isolation is associated with a higher probability to achieve adequate weight loss after 1 year of follow-up, while neither health isolation nor socioeconomic deprivation is associated with post-operative mortality and morbidity. This results suggests that bariatric surgery is a safe and effective tool for weight loss despite socioeconomic deprivation.
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Affiliation(s)
- Camille Pouchucq
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France.
- UMR INSERM U1086 "ANTICIPE", Centre François Baclesse, Anticipe, France.
- Department of Research, University Hospital of Caen, Caen, France.
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France
- UMR INSERM U1086 "ANTICIPE", Centre François Baclesse, Anticipe, France
- Department of Research, University Hospital of Caen, Caen, France
| | - Yannick Le Roux
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France
| | - Véronique Bouvier
- UMR INSERM U1086 "ANTICIPE", Centre François Baclesse, Anticipe, France
- Department of Research, University Hospital of Caen, Caen, France
| | - Joséphine Gardy
- UMR INSERM U1086 "ANTICIPE", Centre François Baclesse, Anticipe, France
| | - Hugo Meunier
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France
| | - Flavie Thomas
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France
- UMR INSERM U1086 "ANTICIPE", Centre François Baclesse, Anticipe, France
- Department of Research, University Hospital of Caen, Caen, France
| | - Guy Launoy
- UMR INSERM U1086 "ANTICIPE", Centre François Baclesse, Anticipe, France
- Department of Research, University Hospital of Caen, Caen, France
| | - Olivier Dejardin
- UMR INSERM U1086 "ANTICIPE", Centre François Baclesse, Anticipe, France
- Department of Research, University Hospital of Caen, Caen, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033, Caen Cedex, France
- UMR INSERM U1086 "ANTICIPE", Centre François Baclesse, Anticipe, France
- Department of Research, University Hospital of Caen, Caen, France
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Santos FNAD, Pinto LLT, Silva MSDP, Bomfim ES, Lino RDS, Lagares LS, de Almeida LAB, Santos CPCD. The Relation Between the Socioeconomic Levels, Quality of Life Related to Health, Body Self-Image, and Level of Physical Activity in Obese Adults After Bariatric Surgery. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2021.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Felipe Nunes Almeida dos Santos
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Lélia Lessa Teixeira Pinto
- Study and Research Group in Health and Human Performance, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Mariana Sousa de Pina Silva
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Eric Simas Bomfim
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Department of Physical Education, Obesity Treatment and Surgery Center, Salvador, Brazil
| | - Ramon de Souza Lino
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Laura Souza Lagares
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Luiz Alberto Bastos de Almeida
- Research Group on Metabolic Diseases, Physical Exercise and Health Technologies, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Laboratory of Physical Activity, Feira de Santana State University, Feira de Santana, Brazil
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Pratt KJ, Blalock J, Breslin L, Kiser H, Hanks A, Focht BC, Outrich M, Noria S, Needleman B. Patient Access, Utilization, and Perceptions of Neighborhood and Built Environment Resources. Obes Surg 2021; 32:416-427. [PMID: 34783960 PMCID: PMC8593850 DOI: 10.1007/s11695-021-05788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
Abstract
Purpose There is a critical need to explore bariatric patients’ perceptions of existing neighborhood and built environment resources and supports to assist with postoperative behavior change and weight loss maintenance. The objective of this study was to survey postoperative patients to determine neighborhood food retail, fitness facility, and options for outdoor activity access, utilization, satisfaction, and perceptions of resources. Materials and Methods A convenience sample of postoperative patients from a single academic surgical center in the USA (N = 44) completed an online survey about access, utilization, satisfaction, and safety for food retail, fitness facility, and outdoor activity options in their neighborhoods. Analysis included descriptives (frequency, percent, Chi-square), and independent samples t tests and ANOVA determined differences based on race, insurance status, geographic location, and receipt of governmental assistance programs. Open-ended questions were analyzed using summative content analysis. Results Patients reported the highest access to lower-cost national food retailers and fitness facilities. The most prevalent challenge in finding food products to meet patients’ goals was financial (39%). Patients’ top suggestions for fitness facilities included training staff/facilities (59%) and trainers (35%) in postoperative patient care and exercise. The highest access for outdoor activity options was for walking/running trails, city/metro parks, and sidewalks. Significant differences in access, utilization, and safety were found based on geographic location, receipt of at least one assistant program, and race. Conclusion The development of targeted resources may benefit patients in non-suburban areas and who receive governmental assistant programs to increase safety of outdoor options and access to lower-cost food retailers and to increase utilization of lower-cost fitness facilities. Graphical abstract ![]()
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 129 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA.
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH, USA.
| | - Jamie Blalock
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 129 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Lindsay Breslin
- Information Technology Department, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Haley Kiser
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 129 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Andrew Hanks
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 129 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Brian C Focht
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 129 Campbell Hall, 1787 Neil Avenue, Columbus, OH, 43210, USA
| | - Michael Outrich
- The Kirwan Institute for the Study of Race and Ethnicity, The Ohio State University, Columbus, OH, USA
| | - Sabrena Noria
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH, USA
| | - Bradley Needleman
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH, USA
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Delanois RE, Tarazi JM, Wilkie WA, Remily E, Salem HS, Mohamed NS, Pollack AN, Mont MA. Social determinants of health in total knee arthroplasty : are social factors associated with increased 30-day post-discharge cost of care and length of stay? Bone Joint J 2021; 103-B:113-118. [PMID: 34053276 DOI: 10.1302/0301-620x.103b6.bjj-2020-2430.r1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Social determinants of health (SDOHs) may contribute to the total cost of care (TCOC) for patients undergoing total knee arthroplasty (TKA). The aim of this study was to investigate the association between demographic data, health status, and SDOHs on 30-day length of stay (LOS) and TCOC after this procedure. METHODS Patients who underwent TKA between 1 January 2018 and 31 December 2019 were identified. A total of 234 patients with complete SDOH data were included. Data were drawn from the Chesapeake Regional Information System, the Centers for Disease Control social vulnerability index (SVI), the US Department of Agriculture, and institutional electronic medical records. The SVI identifies areas vulnerable to catastrophic events with four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. Food deserts were defined as neighbourhoods located one or ten miles from a grocery store in urban and rural areas, respectively. Multiple regression analyses were performed to determine associations with LOS and costs after controlling for various demographic parameters. RESULTS Divorced status was significantly associated with an increased LOS (p = 0.043). Comorbidities significantly associated with an increased LOS included chronic obstructive pulmonary disease/asthma and congestive heart failure (p = 0.043 and p = 0.001, respectively). Communities with a higher density of tobacco stores were significantly associated with an increased LOS (p = 0.017). Comorbidities significantly associated with an increased TCOC included chronic obstructive pulmonary disease (p = 0.004), dementia (p = 0.048), and heart failure (p = 0.007). Increased TCOCs were significantly associated with patients who lived in food deserts (p = 0.001) and in areas with an increased density of tobacco stores (p = 0.023). CONCLUSION Divorced marital status was significantly associated with an increased LOS following TKA. Living in food deserts and in communities with more tobacco stores were significant risk factors for increased LOS and TCOC. Food access and ease of acquiring tobacco may both prove to be prognostic of outcome after TKA and an opportunity for intervention. Cite this article: Bone Joint J 2021;103-B(6 Supple A):113-118.
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Affiliation(s)
- Ronald E Delanois
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - John M Tarazi
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York, USA
| | - Wayne A Wilkie
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Ethan Remily
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Hytham S Salem
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York, USA
| | - Nequesha S Mohamed
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA
| | - Andrew N Pollack
- Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.,Orthopaedic Surgery, University of Maryland Medical System, Baltimore, Maryland, USA
| | - Michael A Mont
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York, USA
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Stenberg E, Olbers T, Cao Y, Sundbom M, Jans A, Ottosson J, Naslund E, Näslund I. Factors determining chance of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a nationwide cohort study in 8057 Swedish patients. BMJ Open Diabetes Res Care 2021; 9:9/1/e002033. [PMID: 33990366 PMCID: PMC8127970 DOI: 10.1136/bmjdrc-2020-002033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/19/2021] [Accepted: 05/02/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Bariatric and metabolic surgery is an effective treatment option for type 2 diabetes (T2D). Increased knowledge regarding factors associated with diabetes remission is essential in individual decision making and could guide postoperative care. Therefore, we aimed to explore factors known to affect the chance of achieving diabetes remission after bariatric and metabolic surgery and to further investigate the impact of socioeconomic factors. RESEARCH DESIGN AND METHODS In this nationwide study, we assessed all patients with T2D who underwent Roux-en-Y gastric bypass (RYGB) surgery between 2007 and 2015 in the Scandinavian Obesity Surgery Registry. Remission was defined as absence of antidiabetic medication for T2D 2 years after surgery. Multivariable logistic regression was used to evaluate factors associated with diabetes remission, with missing data handled by multiple imputations. RESULTS A total of 8057 patients were included. Mean age±SD was 47.4±10.1 years, mean body mass index 42.2±5.7 kg/m2, mean hemoglobin A1c 59.0±17.33, and 61.7% (n=4970) were women. Two years after surgery, 6211 (77.1%) patients achieved T2D remission. Preoperative insulin treatment (OR 0.26, 95% CI 0.22 to 0.30), first-generation immigrant (OR 0.66, 95% CI 0.57 to 0.77), duration of T2D (OR 0.89, 95% CI 0.88 to 0.90), dyslipidemia (OR 0.71, 95% CI 0.62 to 0.81), age (OR 0.97, 95% CI 0.96 to 0.97), and high glycosylated hemoglobin A1c (HbA1c) (OR 0.99, 95% CI 0.98 to 0.99) were all associated with lower T2D remission rate. In contrast, residence in a medium-sized (OR 1.39, 95% CI 1.20 to 1.61) or small (OR 1.46, 95% CI 1.25 to 1.71) town and percentage of total weight loss (OR 1.04, 95% CI 1.03 to 1.04) were associated with higher remission rates. CONCLUSION Among patients with T2D undergoing RYGB surgery, increasing age, HbA1c, and diabetes duration decreased the chance of reaching diabetes remission without cut-offs, while postoperative weight loss demonstrated a positive linear association. In addition, being a first-generation immigrant and living in a large city were socioeconomic factors having a negative association.
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Affiliation(s)
- Erik Stenberg
- Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
| | - Torsten Olbers
- Department of Biomedical and Clinical Sciences and Wallenberg Center for Molecular Medicine, Linköping University, Linkoping, Sweden
- Department of Gastrosurgical Research, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Orebro, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Jans
- Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
| | - Johan Ottosson
- Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
| | - Erik Naslund
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Näslund
- Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden
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Stenberg E, Mohseni S, Cao Y, Näslund E. Limited Effect of Beta-blockade on Postoperative Outcome After Laparoscopic Gastric Bypass Surgery. Obes Surg 2020; 30:139-145. [PMID: 31346982 DOI: 10.1007/s11695-019-04108-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The benefit of beta-blockade on postoperative outcome remains controversial, though recent studies have suggested a role during major non-cardiac surgery. The benefit of beta-blockade during minimally invasive gastric bypass surgery remains unclear. The aim of the present study was to evaluate the possible association between preoperative beta-blocker therapy and postoperative outcome after laparoscopic gastric bypass surgery. METHODS Patients operated with primary laparoscopic gastric bypass surgery in Sweden between 2007 and 2017 were identified through the Scandinavian Obesity Surgery Registry. The dataset was linked to the Swedish National Patient Registry, the Swedish Prescribed Drug Registry, and Statistics Sweden. The main outcome was serious postoperative complication within 30 days of surgery; with postoperative complication, 90-day and 1-year mortality, and weight loss at 2 years after surgery as secondary endpoints. The Poisson regression model was used to evaluate primary and secondary categorical outcomes. A general mixed model was performed to evaluate 2-year weight loss. RESULTS In all, 50281 patients were included in the study. No difference was seen between patients on beta-blockade and the control group regarding postoperative complications (adjusted incidence rate ratio 1.04 (95%CI 0.93-1.15), p = 0.506), serious postoperative complication (adjusted IRR 1.06 95%CI 0.89-1.27), p = 0.515), 90-day mortality (adjusted IRR 0.71 (95%CI 0.24-2.10), p = 0.537), and 1-year mortality (adjusted IRR 1.26 (95%CI 0.67-2.36), p = 0.467). Weight loss 2 years after surgery was slightly greater in patients on beta-blockade (adjusted coefficient 0.53 (95%CI 0.19-0.87), p = 0.002). CONCLUSIONS Beta-blockade has limited impact on postoperative outcome after laparoscopic gastric bypass surgery.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden.
| | - Shahin Mohseni
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-70185, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Alves A, Civet A, Laurent A, Parc Y, Penna C, Msika S, Hirsch M, Pocard M. Social deprivation aggravates post-operative morbidity in carcinologic colorectal surgery: Results of the COINCIDE multicenter study. J Visc Surg 2020; 158:211-219. [PMID: 32747307 DOI: 10.1016/j.jviscsurg.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM OF THE STUDY Evaluate the impact of social deprivation on morbidity and mortality in surgery for colorectal cancer. METHODS The COINCIDE prospective cohort included nearly 2,000 consecutive patients operated on for colorectal cancer at the Assistance Publique-Hospitals of Paris (AP-HP) from 2008 to 2010. The data on these patients were crossed with the PMSI administrative database. The European Social Deprivation Index (EDI) was calculated for each patient and classified into five quintiles (quintiles 4 and 5 being the most disadvantaged patients). Thirty-day post-operative morbidity was determined according to the Dindo-Clavien classification, with a Had®Hoc re-analysis of each file. Statistical analysis was performed using the proprietary Q-finder® algorithm. RESULTS One thousand two hundred and fifty nine curative colorectal resections were analyzed. Mortality was 2.7% and severe morbidity (Dindo-Clavien≥3) occurred in 16.4%. Mortality was not statistically significantly increased among the most disadvantaged who made up almost two thirds of the population (64.2%). Patients in quintiles 4 and 5 had a statistically significant increase in severe morbidity. The relative risk remained 1.5 even after adjustment for the known risk factors found in the analysis: age>70 years, ASA score, urgency, and laparotomy. CONCLUSIONS The EDI represents an independent risk factor for severe morbidity after carcinologic colorectal resection. This study suggests that the determinants of health are multidimensional and do not depend solely on the quality and performance of the care system. The inclusion of this index in our surgical databases is therefore necessary, as is its use in health policy for the distribution of resources.
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Affiliation(s)
- A Alves
- Service de chirurgie digestive CHU Caen, registre des tumeurs digestive du calvados, Inserm U1086 ANTICIPE, 14000 Caen, France
| | - A Civet
- Quinten-France, 8, rue Vernier, 75017 Paris, France
| | - A Laurent
- AP-HP, groupe hospitalier Henri-Mondor, service de chirurgie digestive et hépatobiliaire, 94000 Créteil, France
| | - Y Parc
- AP-HP, service de chirurgie generale et digestive, hôpital Saint-Antoine, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - C Penna
- AP-HP, service de chirurgie digestive, hôpital Bicètre, Le Kremlin-Bicètre, France, Université Paris Sud, Orsay, 94270 Le Kremlin-Bicètre, France
| | - S Msika
- AP-HP, service de chirurgie digestive, oeso-gastrique et bariatrique. CHU Bichat, HUPNVS Université Paris Diderot, PRES Sorbonne Paris Cité, 46, rue Henri Huchard, 75018 Paris, France
| | - M Hirsch
- AP-HP, Avenue Victoria, 75004 Paris, France
| | - M Pocard
- AP-HP, service de chirurgie digestive et cancérologique, hôpital Lariboisière, université de Paris, Unité Inserm U1275 CAP Paris-Tech, Carcinose péritoine Paris technologiques, 2, rue Ambroise-Paré, 75010 Paris, France.
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The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery. Int J Obes (Lond) 2020; 44:2279-2290. [PMID: 32651450 PMCID: PMC7577856 DOI: 10.1038/s41366-020-0637-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 06/04/2020] [Accepted: 07/01/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Patients with low socioeconomic status have been reported to have poorer outcome than those with a high socioeconomic status after several types of surgery. The influence of socioeconomic factors on weight loss after bariatric surgery remains unclear. The aim of the present study was to evaluate the association between socioeconomic factors and postoperative weight loss. MATERIALS AND METHODS This was a retrospective, nationwide cohort study with 5-year follow-up data for 13,275 patients operated with primary gastric bypass in Sweden between January 2007 and December 2012 (n = 13,275), linking data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, the Swedish National Patient Register, and the Swedish Prescribed Drugs Register. The assessed socioeconomic variables were education, profession, disposable income, place of residence, marital status, financial aid and heritage. The main outcome was weight loss 5 years after surgery, measured as total weight loss (TWL). Linear regression models, adjusted for age, preoperative body mass index (BMI), sex and comorbid diseases were constructed. RESULTS The mean TWL 5 years after surgery was 28.3 ± 9.86%. In the adjusted model, first-generation immigrants (%TWL, B -2.4 [95% CI -2.9 to -1.9], p < 0.0001) lost significantly less weight than the mean, while residents in medium-sized (B 0.8 [95% CI 0.4-1.2], p = 0.0001) or small towns (B 0.8 [95% CI 0.4-1.2], p < 0.0001) lost significantly more weight. CONCLUSIONS All socioeconomic groups experienced improvements in weight after bariatric surgery. However, as first-generation immigrants and patients residing in larger towns (>200,000 inhabitants) tend to have inferior weight loss compared to other groups, increased support in the pre- and postoperative setting for these two groups could be of value. The remaining socioeconomic factors appear to have a weaker association with postoperative weight loss.
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Gryth K, Persson C, Näslund I, Sundbom M, Näslund E, Stenberg E. The Influence of Socioeconomic Factors on Quality-of-Life After Laparoscopic Gastric Bypass Surgery. Obes Surg 2020; 29:3569-3576. [PMID: 31190262 DOI: 10.1007/s11695-019-04028-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Patients with low socioeconomic status have been reported to experience poorer outcome after several types of surgery. The influence of socioeconomic factors on health-related quality-of-life (HRQoL) after bariatric surgery is unclear. MATERIALS AND METHODS Patients operated with a primary laparoscopic gastric bypass procedure in Sweden between 2007 and 2015 were identified in the Scandinavian Obesity Surgery Register. Patients with a completed assessment of health-related quality-of-life based on the Obesity-related Problem Scale (OP Scale) were included in the study. Socioeconomic status was based on data from Statistics Sweden. RESULTS A total of 13,723 patients (32% of the 43,096 operated during the same period), with complete OP scores at baseline and two years after surgery, were included in the study. Age, lower preoperative BMI, male gender, higher education, professional status and disposable income as well as not receiving social benefits (not including retirement pension), and not a first- or second-generation immigrant, were associated with a higher postoperative HRQoL. Patients aged 30-60 years, with lower BMI, higher socioeconomic status, women and those born in Sweden by Swedish parents experienced a higher degree of improvement in HRQoL. Postoperative weight-loss was associated with higher HRQoL (unadjusted B 16.3, 95%CI 14.72-17.93, p < 0.0001). CONCLUSION At 2 years, a strong association between weight loss and improvement in HRQoL was seen, though several factors influenced the degree of improvement. Age, sex, preoperative BMI and socioeconomic status all influence the postoperative HRQoL as well as the improvement in HRQoL after laparoscopic gastric bypass surgery.
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Affiliation(s)
- Karin Gryth
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, SE-701 85, Örebro, Sweden
| | - Carina Persson
- Department of Community Medicine and Public Health, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department for Sustainable Development, Region Örebro County, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, SE-701 85, Örebro, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, SE-701 85, Örebro, Sweden.
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Risk factors and long-term impact of urologic complications during radical hysterectomy for cervical cancer in China, 2004-2016. Gynecol Oncol 2020; 158:294-302. [PMID: 32507516 DOI: 10.1016/j.ygyno.2020.05.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/18/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The primary objective was to describe the incidence and risk factors of urologic complications during radical hysterectomy for cervical cancer. The secondary objective was to investigate the impact of urologic complications on long-term survival. METHODS Patients who underwent radical hysterectomy for cervical cancer from 2004 to 2016 were identified in the MSCCCC (Major Surgical Complications of Cervical Cancer in China) database. Data on demographic characteristics, clinical characteristics, hospital characteristics and urologic complications were collected. Multivariable logistic regression was used to assess the risk factors of urologic complications and Cox proportional hazards models were performed to identify prognostic factors. RESULTS A total of 21,026 patients undergoing radical hysterectomy for cervical cancer were identified. The incidence of any urologic complications was 1.54%: 83 (0.39%) ureteral injuries, 17 (0.08%) bladder injuries, 1 (0.005%) ureteral injury combined with bladder injury, and 223 (1.05%) genitourinary fistulas. In a multivariable analysis, surgery at a women and children's hospital (OR = 2.26, 95% CI 1.47-3.48), surgery at a facility in a first-tier city (OR = 2.08, 95% CI 1.24-3.48), and laparoscopic surgery (OR = 4.68, 95% CI 3.44-6.36) were associated with a higher risk of urologic complications. Cox proportional hazards models revealed that the occurrence of urologic complications was a significant predictor of 2-year overall survival (OR = 1.78, 95% CI = 1.09-2.92), but was not a predictor of 5-year overall survival (OR = 1.27, 95% CI = 0.83-1.94). CONCLUSION The incidence of urologic complications during radical hysterectomy is low. The risk of urologic complications may be higher for patients who are treated at a women and children's hospital, are treated in first-tier city hospitals, and receive laparoscopic surgery. Urologic complications have an impact on short-term survival, but not on long-term survival.
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Kitamura R, Chen R, Trickey A, Eisenberg D. Positive and Negative Independent Predictive Factors of Weight Loss After Bariatric Surgery in a Veteran Population. Obes Surg 2020; 30:2124-2130. [DOI: 10.1007/s11695-020-04428-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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