The Israel National Bariatric Surgery Registry: the inception process

Anemia rates after one-anastomosis gastric bypass versus sleeve gastrectomy: a retrospective cohort study

PURPOSE

To compare postoperative anemia rates after one-anastomosis gastric bypass (OAGB) with those after sleeve gastrectomy (SG) in a large nationwide, population-based cohort study.

METHODS

We sourced data from the Israeli Bariatric Surgery Registry. The study included a cohort of adults who underwent bariatric surgery (BS) between 2013 and 2017. Hemoglobin (Hb) was measured preoperatively and then 1 and 2 years post-BS. Anemia rates were compared between the patients who underwent OAGB and those who underwent SG, using multivariable analyses.

RESULTS

The study comprised 1,052 patients who underwent OAGB and 5,885 patients who underwent SG. Among them, 24.1% and 23.6% were men, respectively, and the preoperative mean body mass index values were 41.7 ± 5.0 and 42.1 ± 5.1 kg/m2, respectively. The 1-year and 2-year postoperative anemia rates were significantly higher after OAGB than after SG, when adjusted for age, pre-surgery BMI, sex and other covariates (1 year: 37.5% vs. 20.2%; adj-OR = 2.43; 95% CI 2.08-2.86; 2 years: 45.1% vs. 28.5%; adj-OR = 1.92; 95% CI 1.59-2.32).

CONCLUSIONS

Patients who underwent OAGB had significantly higher anemia rates 1 year and 2 years postoperatively than those who underwent SG. Consequently, vigilant surveillance and intervention strategies post-OAGB should be considered to mitigate the incidence of anemia and its associated complications.

MBSAQIP database: are the data reliable?

BACKGROUND

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database collects data from all accredited centers in the US. A prior study showed data quality issues limiting use of up to 20% of the 2015 database.

OBJECTIVES

To evaluate the completeness and data quality (internal validity, accuracy, and consistency) of the MBSAQIP database between 2015 and 2019.

SETTING

United States.

METHODS

All subsets of data from the MBSAQIP Participant User Data File (PUDF) were compiled into one main file. Completeness, internal validity, accuracy, and consistency were evaluated. Completeness was determined via missing values. Internal validity was assessed using the percentage of patients with a body mass index (BMI) < 30 kg/m2 who underwent primary bariatric surgery. Accuracy was evaluated using reported versus calculated BMI. Consistency was assessed using the percentage of patients with a gain of >5 or a loss of >20 units of BMI change in 30 days. Effects across years were assessed using a chi-squared test.

RESULTS

Missing data for age, BMI, and ASA was consistently low (<2.5%) with no significant difference across years. Only .02% of patients who underwent a primary bariatric procedure had a reported BMI <30 kg/m2. The mean difference between reported versus calculated BMI was -.02 units. A maximum of .33% of patients gained >5 units of BMI, and a maximum of .85% of patients lost > 20 units of BMI in early follow-up.

CONCLUSIONS

While the MBSAQIP is a database with acceptable data quality and minimal changes from 2015-2019, ongoing efforts are needed to improve data.

Can Consultation by a Clinical Pharmacist Prevent Morbidity and Mortality in Patients Undergoing Bariatric Surgery?

The purpose of this work was to investigate the effect of clinical pharmacist consultation on the long-term morbidity and mortality outcomes among patients undergoing bariatric surgery. In this retrospective cohort study, 165 bariatric patients at Herzliya Medical Center who were identified as complex cases and were consulted by a clinical pharmacist (2013-2019) were compared with a wider group of bariatric patients with chronic diseases who were recorded in the Israeli General Bariatric Registry during the same years. The primary outcomes were rates of surgical complications, re-hospitalizations, and death up to one year after surgery. The secondary outcome was the rate of re-hospitalizations in different time periods. The twelve (12)-month rate of re-hospitalization in the intervention group was 10.9% vs. 19.5% in the comparison group (p = 0.005); the rate of documented postoperative complications was 2.7% vs. 3.9% (p = 0.462), and mortality was null vs. 0.16%, respectively. As for the secondary outcomes, the rates of re-hospitalizations in the periods of 0-30, 31-90, 91-180, and 181-365 days after surgery were 1.8% vs. 5.3% (p = 0.046), 2.4% vs. 4.1% (p = 0.278), 3.6% vs. 4.8% (p = 0.476), and 7.3% vs. 9.9% (p = 0.256) in the intervention vs. comparison cohorts, respectively. In conclusion, this study demonstrates the importance and benefit of referring to a specialized clinical pharmacist around bariatric surgery for improving patient safety, especially in complex patients. This is the first study to look at the long-term effects of clinical pharmacist consultation on re-hospitalization and mortality among bariatric patients, and our encouraging outcomes should hopefully stimulate more studies to show the invaluable role of specialized clinical pharmacists.

Standardization of the One-anastomosis Gastric Bypass Procedure for Morbid Obesity: Technical Aspects and Early Outcomes

BACKGROUND

One-anastomosis gastric bypass (OAGB) has become an accepted metabolic/bariatric surgery procedure. This study aimed to describe our center's standardized OAGB operative technique and report early (≤30 d) safety outcomes in patients with severe obesity.

METHODS

The medical records of patients who had undergone either primary (n=681, 88.0%) or revisional OAGB (n=93, 12.0%) were retrospectively evaluated. Patient demographics, operative time, length of hospital stay, readmissions, reoperations, and ≤30-day morbidity and mortality rates were analyzed.

RESULTS

A total of 774 consecutive patients with severe obesity (647 female, 83.6%) underwent OAGB between January 2016 and December 2021. Their mean age was 36.2±10.8 years (range: 18 to 70 y) and mean body mass index was 42.7±4.2 kg/m 2 (range: 17.2 to 61 kg/m 2 ). Mean operating time was 52.6±19.9 minutes (range: 25 to 295 min) and length of hospital stay was 1.6±0.9 days (range: 1 to 9 d). Early postoperative complications occurred in 16 cases (2.1%), including 2 leaks with an intra-abdominal abscess (0.3%), bleeding (n=3, 0.4%), acute kidney failure (n=1, 0.15%), urinary tract infection (n=2, 0.3%), and intensive care unit stay (n=4, 0.5%). Seventy patients (9.1%) were readmitted, and re-laparoscopy was performed in 1 patient (0.1%). There was no mortality.

CONCLUSIONS

In the very early term, OAGB was a safe primary and revisional metabolic/bariatric surgery operation. Consistent performance of a standardized OAGB procedure contributed to low rates of morbidity and mortality in the hands of metabolic/bariatric surgeons with good laparoscopic skills at a high-volume center.

Micronutrient Deficiency Pre- and Post-bariatric Metabolic Surgery in Latin America: a Systematic Review

BACKGROUND

Persons submitted to bariatric metabolic surgery present micronutrient deficiency before and after surgery, due to the lack of proper supplementation. The aim of this study is to establish the prevalence of micronutrient deficiency in people before and after bariatric metabolic surgery in Latin America.

METHODS

This review was conducted in accordance with the 2020 PRISMA Guidelines.

RESULTS

Twenty-seven studies and 2135 participants were included. The highest prevalence of deficiency before surgery was reported for vitamin D (74%), zinc (71%), and hemoglobin (62%); after surgery, they were vitamin A (90.6%), vitamin D (90%), and zinc (68%).

CONCLUSIONS

There is a high prevalence of micronutrient deficiency before and after bariatric metabolic surgery from Latin American persons; the micronutrients with the highest deficiency prevalence were vitamin D before and vitamin A after bariatric metabolic surgery.

Bariatric Surgery Affects Plasma Levels of Alanine Aminotransferase Independent of Weight Loss: A Registry-Based Study

Patients that undergo bariatric surgery experience weight loss and a reduction in the plasma levels of the hepatic enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST). We used the Israeli national bariatric registry, which includes demographic, clinical, and biochemical data on 19,403 patients, of which 1335 patients had two-year follow-up data on ALT, AST, A1C, and BMI, to test the dependence of the reduction in the levels of ALT and AST on weight loss. The data were analyzed using regression models, retrospective matching, and time course analyses. Changes in liver enzymes did not correlate with change in BMI, and linear regression models did not demonstrate that the change in ALT and AST values were dependent on pre-operative levels of BMI or the extent of weight loss. ALT and AST levels were reduced two years after surgery compared with a cohort of retrospectively matched patients for ethnicity, sex, age, BMI, and A1C. Finally, patients who regained weight displayed a reduction in levels of liver enzymes. Our results suggest that bariatric surgery affects AST and ALT levels via weight loss dependent and independent mechanisms. Mechanistic studies that will identify the nature of this effect and the clinical relevance of ALT and AST levels to the post-bariatric liver function are warranted.

Sleeve Gastrectomy Is Associated with a Greater Reduction in Plasma Liver Enzymes Than Bypass Surgeries-A Registry-Based Two-Year Follow-Up Analysis

Bariatric surgeries may lead to an improvement in metabolic fatty liver disease, and a reduction in the levels of the hepatic enzyme Alanine Aminotransferase (ALT). We compared the effects of Sleeve Gastrectomy (SG), Roux en Y Gastric Bypass (RYGB) and One Anastomosis Gastric Bypass (OAGB) on the levels of ALT by analysis of two-year follow-up data from 4980 patients in the Israeli Bariatric Registry that included laboratory tests and demographic information. Pre-operative characteristics of patients, and particularly levels of liver enzymes, were similar across surgery types. Regression modeling and retrospective matching showed that SG was superior to RYGB and OAGB in reducing ALT levels, and in reducing the fraction of patients with abnormally high ALT levels. Two-year post-surgery, an increase in ALT levels from normal to abnormal levels was observed in 5% of SG patients, and in 18% and 23% of RYGB and OAGB patients. In conclusion, SG leads to a greater reduction in ALT levels compared with bypass surgeries and a lower incidence of post-surgical elevation of ALT levels. Further studies are required to identify the cause for the rise in liver enzymes, and to determine whether ALT levels correlate with liver pathology especially following bariatric surgery.

'We Don't Want You to Diet': Bariatric professionals' boundary work and negotiation of pleasure and control

Although patients who undergo weight-loss surgery (WLS/bariatric surgery) must follow severe eating restrictions in a manner similar to that of dieting, professionals strive to demarcate distinctions between the approaches and methods of WLS and diet. Drawing from ethnographic research, this study focuses on the content and interpretative dimensions of professionals' boundary work as well as its meaning and implications for patients. The post-surgical body is revealed as a site of dispute. Professionals portray the logic of diet as one that assumes individuals ought to discipline themselves - and not 'give in' to pleasure - in order to achieve an ideal body. In contrast, WLS is depicted as a more advanced and balanced method that negotiates pleasure and control. Professionals construct boundaries by shifting the causes for obesity from the individual to the context, by expanding the meaning of success and by portraying food as healing. These findings join recent critical literature that shows that the lived experiences of care practices contest the prevailing framing of obesity care as solely about exerting disciplinary power and control. WLS professionals negotiate fat stigma and question dominant discourses regarding body size, thin ideals and responsibility.