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Coughlin JW, Nauman E, Wellman R, Coley RY, McTigue KM, Coleman KJ, Jones DB, Lewis KH, Tobin JN, Wee CC, Fitzpatrick SL, Desai JR, Murali S, Morrow EH, Rogers AM, Wood GC, Schlundt DG, Apovian CM, Duke MC, McClay JC, Soans R, Nemr R, Williams N, Courcoulas A, Holmes JH, Anau J, Toh S, Sturtevant JL, Horgan CE, Cook AJ, Arterburn DE. Preoperative Depression Status and 5 Year Metabolic and Bariatric Surgery Outcomes in the PCORnet Bariatric Study Cohort. Ann Surg 2023; 277:637-646. [PMID: 35058404 PMCID: PMC9994793 DOI: 10.1097/sla.0000000000005364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether depression status before metabolic and bariatric surgery (MBS) influenced 5-year weight loss, diabetes, and safety/utilization outcomes in the PCORnet Bariatric Study. SUMMARY OF BACKGROUND DATA Research on the impact of depression on MBS outcomes is inconsistent with few large, long-term studies. METHODS Data were extracted from 23 health systems on 36,871 patients who underwent sleeve gastrectomy (SG; n=16,158) or gastric bypass (RYGB; n=20,713) from 2005-2015. Patients with and without a depression diagnosis in the year before MBS were evaluated for % total weight loss (%TWL), diabetes outcomes, and postsurgical safety/utilization (reoperations, revisions, endoscopy, hospitalizations, mortality) at 1, 3, and 5 years after MBS. RESULTS 27.1% of SG and 33.0% of RYGB patients had preoperative depression, and they had more medical and psychiatric comorbidities than those without depression. At 5 years of follow-up, those with depression, versus those without depression, had slightly less %TWL after RYGB, but not after SG (between group difference = 0.42%TWL, P = 0.04). However, patients with depression had slightly larger HbA1c improvements after RYGB but not after SG (between group difference = - 0.19, P = 0.04). Baseline depression did not moderate diabetes remission or relapse, reoperations, revision, or mortality across operations; however, baseline depression did moderate the risk of endoscopy and repeat hospitalization across RYGB versus SG. CONCLUSIONS Patients with depression undergoing RYGB and SG had similar weight loss, diabetes, and safety/utilization outcomes to those without depression. The effects of depression were clinically small compared to the choice of operation.
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Affiliation(s)
- Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | | | - Robert Wellman
- Kaiser Permanente Washington Health Research institute, Seattle, WA
| | - R Yates Coley
- Kaiser Permanente Washington Health Research institute, Seattle, WA
| | - Kathleen M McTigue
- Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA
| | - Daniel B Jones
- Department of Surgery, Beth israel Deaconess Medical Center and Harvard Medical School Boston, MA
| | - Kristina H Lewis
- Departments of Epidemiology & Prevention, and implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jonathan N Tobin
- Clinical Directors Network (CDN) and The Rockefeller University Center for Clinical and Translational Science, New York, NY
| | - Christina C Wee
- Department of Surgery, Beth israel Deaconess Medical Center and Harvard Medical School Boston, MA
| | | | | | - Sameer Murali
- Kaiser Permanente Southern California Medical Group, Oakland, CA
| | - Ellen H Morrow
- Department of Surgery, University of Utah, Salt Lake City, UT
| | - Ann M Rogers
- Penn State University College of Medicine, Penn State Health, Department of Surgery, Hershey, PA
| | - G Craig Wood
- Obesity Institute, Geisinger Medical Center, Danville, PA
| | | | | | | | | | - Rohit Soans
- Temple University Hospital, Philadelphia, PA
| | - Rabih Nemr
- Weill Cornell Medical College, New York, NY
| | | | | | - John H Holmes
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jane Anau
- Louisiana Public Health Institute, New Orleans, LA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Jessica L Sturtevant
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Casie E Horgan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research institute, Seattle, WA
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2
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Coleman KJ, Wellman R, Fitzpatrick SL, Conroy MB, Hlavin C, Lewis KH, Coley RY, McTigue KM, Tobin JN, McBride CL, Desai JR, Clark JM, Toh S, Sturtevant JL, Horgan CE, Duke MC, Williams N, Anau J, Horberg MA, Michalsky MP, Cook AJ, Arterburn DE, Apovian CM. Comparative Safety and Effectiveness of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy for Weight Loss and Type 2 Diabetes Across Race and Ethnicity in the PCORnet Bariatric Study Cohort. JAMA Surg 2022; 157:897-906. [PMID: 36044239 PMCID: PMC9434478 DOI: 10.1001/jamasurg.2022.3714] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/02/2022] [Indexed: 11/14/2022]
Abstract
Importance Bariatric surgery is the most effective treatment for severe obesity; yet it is unclear whether the long-term safety and comparative effectiveness of these operations differ across racial and ethnic groups. Objective To compare outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) across racial and ethnic groups in the National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study. Design, Setting, and Participants This was a retrospective, observational, comparative effectiveness cohort study that comprised 25 health care systems in the PCORnet Bariatric Study. Patients were adults and adolescents aged 12 to 79 years who underwent a primary (first nonrevisional) RYGB or SG operation between January 1, 2005, and September 30, 2015, at participating health systems. Patient race and ethnicity included Black, Hispanic, White, other, and unrecorded. Data were analyzed from July 1, 2021, to January 17, 2022. Exposure RYGB or SG. Outcomes Percentage total weight loss (%TWL); type 2 diabetes remission, relapse, and change in hemoglobin A1c (HbA1c) level; and postsurgical safety and utilization outcomes (operations, interventions, revisions/conversions, endoscopy, hospitalizations, mortality, 30-day major adverse events) at 1, 3, and 5 years after surgery. Results A total of 36 871 patients (mean [SE] age, 45.0 [11.7] years; 29 746 female patients [81%]) were included in the weight analysis. Patients identified with the following race and ethnic categories: 6891 Black (19%), 8756 Hispanic (24%), 19 645 White (53%), 826 other (2%), and 783 unrecorded (2%). Weight loss and mean reductions in HbA1c level were larger for RYGB than SG in all years for Black, Hispanic, and White patients (difference in 5-year weight loss: Black, -7.6%; 95% CI, -8.0 to -7.1; P < .001; Hispanic, -6.2%; 95% CI, -6.6 to -5.9; P < .001; White, -5.9%; 95% CI, -6.3 to -5.7; P < .001; difference in change in year 5 HbA1c level: Black, -0.29; 95% CI, -0.51 to -0.08; P = .009; Hispanic, -0.45; 95% CI, -0.61 to -0.29; P < .001; and White, -0.25; 95% CI, -0.40 to -0.11; P = .001.) The magnitude of these differences was small among racial and ethnic groups (1%-3% of %TWL). Black and Hispanic patients had higher risk of hospitalization when they had RYGB compared with SG (hazard ratio [HR], 1.45; 95% CI, 1.17-1.79; P = .001 and 1.48; 95% CI, 1.22-1.79; P < .001, respectively). Hispanic patients had greater risk of all-cause mortality (HR, 2.41; 95% CI, 1.24-4.70; P = .01) and higher odds of a 30-day major adverse event (odds ratio, 1.92; 95% CI, 1.38-2.68; P < .001) for RYGB compared with SG. There was no interaction between race and ethnicity and operation type for diabetes remission and relapse. Conclusions and Relevance Variability of the comparative effectiveness of operations for %TWL and HbA1c level across race and ethnicity was clinically small; however, differences in safety and utilization outcomes were clinically and statistically significant for Black and Hispanic patients who had RYGB compared with SG. These findings can inform shared decision-making regarding bariatric operation choice for different racial and ethnic groups of patients.
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Affiliation(s)
- Karen J. Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle
| | | | | | - Callie Hlavin
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristina H. Lewis
- Departments of Epidemiology & Prevention, and Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - R. Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Kathleen M. McTigue
- Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan N. Tobin
- Clinical Directors Network and The Rockefeller University Center for Clinical and Translational Science, New York, New York
| | | | - Jay R. Desai
- HealthPartners Institute, Minneapolis, Minnesota
| | - Jeanne M. Clark
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sengwee Toh
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jessica L. Sturtevant
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Casie E. Horgan
- Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | | | | | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle
| | | | | | - Andrea J. Cook
- Kaiser Permanente Washington Health Research Institute, Seattle
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Rifas-Shiman SL, Bailey LC, Lunsford D, Daley MF, Eneli I, Finkelstein J, Heerman W, Horgan CE, Hsia DS, Jay M, Rao G, Reynolds JS, Sturtevant JL, Toh S, Trasande L, Young J, Lin PID, Forrest CB, Block JP. Early Life Antibiotic Prescriptions and Weight Outcomes in Children 10 Years of Age. Acad Pediatr 2021; 21:297-303. [PMID: 33130067 DOI: 10.1016/j.acap.2020.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/11/2020] [Accepted: 10/25/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We previously found that antibiotic use at <24 months of age was associated with slightly higher body weight at 5 years of age. In this study, we examine associations of early life antibiotic prescriptions with weight outcomes at 108 to 132 months of age ("10 years"). METHODS We used electronic health record data from 2009 through 2016 from 10 health systems in PCORnet, a national distributed clinical research network. We examined associations of any (vs no) antibiotics at <24 months of age with body mass index z-score (BMI-z) at 10 years adjusted for confounders selected a priori. We further examined dose response (number of antibiotic episodes) and antibiotic spectrum (narrow and broad). RESULTS Among 56,727 included children, 57% received any antibiotics at <24 months; at 10 years, mean (standard deviation) BMI-z was 0.54 (1.14), and 36% had overweight or obesity. Any versus no antibiotic use at <24 months was associated with a slightly higher BMI-z at 10 years among children without a complex chronic condition (β 0.03; 95% confidence interval [CI] 0.01, 0.05) or with a complex chronic condition (β 0.09; 95% CI 0.03, 0.15). Any versus no antibiotic use was not associated with odds of overweight or obesity at 10 years among children without (odds ratio 1.02; 95% CI 0.97, 1.07) or with a complex chronic condition (odds ratio 1.07; 95% CI 0.96, 1.19). CONCLUSIONS The small and likely clinically insignificant associations in this study are consistent with our previous 5-year follow-up results, suggesting that, if this relationship is indeed causal, early increases in weight are small but maintained over time.
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Affiliation(s)
- Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (SL Rifas-Shiman, J Young, P-ID Lin, and JP Block), Boston, Mass.
| | - L Charles Bailey
- Applied Clinical Research Center, Department of Pediatrics, Children's Hospital of Philadelphia (LC Bailey and CB Forrest), Philadelphia, Pa
| | - Doug Lunsford
- North Fork School District (D Lunsford), Utica, Ohio
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado (MF Daley), Denver, Colo
| | - Ihuoma Eneli
- Nationwide Children's Hospital (I Eneli), Columbus, Ohio
| | | | - William Heerman
- Department of Pediatrics, Vanderbilt University Medical Center (W Heerman), Nashville, Tenn
| | - Casie E Horgan
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (CE Horgan, JS Reynolds, JL Sturtevant, and S Toh), Boston, Mass
| | - Daniel S Hsia
- Pennington Biomedical Research Center (DS Hsia), Baton Rouge, La
| | - Melanie Jay
- Department of Population Health, New York University School of Medicine (M Jay), New York, NY
| | - Goutham Rao
- Case Western Reserve University and University Hospitals of Cleveland (G Rao), Cleveland, Ohio
| | - Juliane S Reynolds
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (CE Horgan, JS Reynolds, JL Sturtevant, and S Toh), Boston, Mass
| | - Jessica L Sturtevant
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (CE Horgan, JS Reynolds, JL Sturtevant, and S Toh), Boston, Mass
| | - Sengwee Toh
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (CE Horgan, JS Reynolds, JL Sturtevant, and S Toh), Boston, Mass
| | - Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine (L Trasande), New York, NY
| | - Jessica Young
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (SL Rifas-Shiman, J Young, P-ID Lin, and JP Block), Boston, Mass
| | - Pi-I Debby Lin
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (SL Rifas-Shiman, J Young, P-ID Lin, and JP Block), Boston, Mass
| | - Christopher B Forrest
- Applied Clinical Research Center, Department of Pediatrics, Children's Hospital of Philadelphia (LC Bailey and CB Forrest), Philadelphia, Pa
| | - Jason P Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School (SL Rifas-Shiman, J Young, P-ID Lin, and JP Block), Boston, Mass
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Courcoulas A, Coley RY, Clark JM, McBride CL, Cirelli E, McTigue K, Arterburn D, Coleman KJ, Wellman R, Anau J, Toh S, Janning CD, Cook AJ, Williams N, Sturtevant JL, Horgan C, Tavakkoli A. Interventions and Operations 5 Years After Bariatric Surgery in a Cohort From the US National Patient-Centered Clinical Research Network Bariatric Study. JAMA Surg 2020; 155:194-204. [PMID: 31940024 DOI: 10.1001/jamasurg.2019.5470] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Additional data comparing longer-term problems associated with various bariatric surgical procedures are needed for shared decision-making. Objective To compare the risks of intervention, operation, endoscopy, hospitalization, and mortality up to 5 years after 2 bariatric surgical procedures. Design, Setting, and Participants Adults who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between January 1, 2005, and September 30, 2015, within the National Patient-Centered Clinical Research Network. Data from 33 560 adults at 10 centers within 4 clinical data research networks were included in this cohort study. Information was extracted from electronic health records using a common data model and linked to insurance claims and mortality indices. Analyses were conducted from January 2018 through October 2019. Exposures Bariatric surgical procedures. Main Outcomes and Measures The primary outcome was time until operation or intervention. Secondary outcomes included endoscopy, hospitalization, and mortality rates. Results Of 33 560 adults, 18 056 (54%) underwent RYGB, and 15 504 (46%) underwent SG. The median (interquartile range) follow-up for operation or intervention was 3.4 (1.6-5.0) years for RYGB and 2.2 (0.9-3.6) years for SG. The overall mean (SD) patient age was 45.0 (11.5) years, and the overall mean (SD) patient body mass index was 49.1 (7.9). The cohort was composed predominantly of women (80%) and white individuals (66%), with 26% of Hispanic ethnicity. Operation or intervention was less likely for SG than for RYGB (hazard ratio, 0.72; 95% CI, 0.65-0.79; P < .001). The estimated, adjusted cumulative incidence rates of operation or intervention at 5 years were 8.94% (95% CI, 8.23%-9.65%) for SG and 12.27% (95% CI, 11.49%-13.05%) for RYGB. Hospitalization was less likely for SG than for RYGB (hazard ratio, 0.82; 95% CI, 0.78-0.87; P < .001), and the 5-year adjusted cumulative incidence rates were 32.79% (95% CI, 31.62%-33.94%) for SG and 38.33% (95% CI, 37.17%-39.46%) for RYGB. Endoscopy was less likely for SG than for RYGB (hazard ratio, 0.47; 95% CI, 0.43-0.52; P < .001), and the adjusted cumulative incidence rates at 5 years were 7.80% (95% CI, 7.15%-8.43%) for SG and 15.83% (95% CI, 14.94%-16.71%) for RYGB. There were no differences in all-cause mortality between SG and RYGB. Conclusions and Relevance Interventions, operations, and hospitalizations were relatively common after bariatric surgical procedures and were more often associated with RYGB than SG. Trial Registration ClinicalTrials.gov identifier: NCT02741674.
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Affiliation(s)
- Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jeanne M Clark
- General Internal Medicine, Johns Hopkins University and Health Plan, Baltimore, Maryland
| | | | - Elizabeth Cirelli
- Department of Nursing, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kathleen McTigue
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Sengwee Toh
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Cheri D Janning
- Duke Clinical Translational Science Institute, Duke University, Durham, North Carolina
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Jessica L Sturtevant
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Casie Horgan
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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5
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McTigue KM, Wellman R, Nauman E, Anau J, Coley RY, Odor A, Tice J, Coleman KJ, Courcoulas A, Pardee RE, Toh S, Janning CD, Williams N, Cook A, Sturtevant JL, Horgan C, Arterburn D. Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass: The National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study. JAMA Surg 2020; 155:e200087. [PMID: 32129809 PMCID: PMC7057171 DOI: 10.1001/jamasurg.2020.0087] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Question How do type 2 diabetes (T2DM) outcomes compare across the 2 most common bariatric procedures? Findings In this cohort study of 9710 adults with T2DM who underwent bariatric surgery, most patients who had Roux-en-Y gastric bypass or sleeve gastrectomy experienced T2DM remission at some point over 5 years of follow-up. Patients who had Roux-en-Y gastric bypass showed slightly higher T2DM remission rates, better glycemic control, and fewer T2DM relapse events than patients who had sleeve gastrectomy. Meaning Understanding diabetes outcomes of different bariatric procedures will help surgeons and patients with diabetes make informed health care choices. Importance Bariatric surgery can lead to substantial improvements in type 2 diabetes (T2DM), but outcomes vary across procedures and populations. It is unclear which bariatric procedure has the most benefits for patients with T2DM. Objective To evaluate associations of bariatric surgery with T2DM outcomes. Design, Setting, and Participants This cohort study was conducted in 34 US health system sites in the National Patient-Centered Clinical Research Network Bariatric Study. Adult patients with T2DM who had bariatric surgery between January 1, 2005, and September 30, 2015, were included. Data analysis was conducted from April 2017 to August 2019. Interventions Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Main Outcome and Measures Type 2 diabetes remission, T2DM relapse, percentage of total weight lost, and change in glycosylated hemoglobin (hemoglobin A1c). Results A total of 9710 patients were included (median [interquartile range] follow-up time, 2.7 [2.9] years; 7051 female patients [72.6%]; mean [SD] age, 49.8 [10.5] years; mean [SD] BMI, 49.0 [8.4]; 6040 white patients [72.2%]). Weight loss was significantly greater with RYGB than SG at 1 year (mean difference, 6.3 [95% CI, 5.8-6.7] percentage points) and 5 years (mean difference, 8.1 [95% CI, 6.6-9.6] percentage points). The T2DM remission rate was approximately 10% higher in patients who had RYGB (hazard ratio, 1.10 [95% CI, 1.04-1.16]) than those who had SG. Estimated adjusted cumulative T2DM remission rates for patients who had RYGB and SG were 59.2% (95% CI, 57.7%-60.7%) and 55.9% (95% CI, 53.9%-57.9%), respectively, at 1 year and 86.1% (95% CI, 84.7%-87.3%) and 83.5% (95% CI, 81.6%-85.1%) at 5 years postsurgery. Among 6141 patients who experienced T2DM remission, the subsequent T2DM relapse rate was lower for those who had RYGB than those who had SG (hazard ratio, 0.75 [95% CI, 0.67-0.84]). Estimated relapse rates for those who had RYGB and SG were 8.4% (95% CI, 7.4%-9.3%) and 11.0% (95% CI, 9.6%-12.4%) at 1 year and 33.1% (95% CI, 29.6%-36.5%) and 41.6% (95% CI, 36.8%-46.1%) at 5 years after surgery. At 5 years, compared with baseline, hemoglobin A1c was reduced 0.45 (95% CI, 0.27-0.63) percentage points more for patients who had RYGB vs patients who had SG. Conclusions and Relevance In this large multicenter study, patients who had RYGB had greater weight loss, a slightly higher T2DM remission rate, less T2DM relapse, and better long-term glycemic control compared with those who had SG. These findings can help inform patient-centered surgical decision-making.
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Affiliation(s)
- Kathleen M McTigue
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle
| | | | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Alberto Odor
- Center for Health Technology, University of California, Davis, Davis
| | - Julie Tice
- PaTH Clinical Data Research Network, Pennsylvania State University, Hershey
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roy E Pardee
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Cheri D Janning
- Duke Clinical & Translational Science Institute, Durham, North Carolina
| | - Neely Williams
- Mid-South Clinical Data Research Network, Meharry-Vanderbilt Alliance Community Partner, Nashville, Tennessee.,Now with Community Partners Network Inc, Nashville, Tennessee
| | - Andrea Cook
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Jessica L Sturtevant
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Casie Horgan
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle
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6
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Toh S, Rifas-Shiman SL, Lin PI, Bailey LC, Forrest CB, Horgan CE, Lunsford D, Moyneur E, Sturtevant JL, Young JG, Block JP. Privacy-protecting multivariable-adjusted distributed regression analysis for multi-center pediatric study. Pediatr Res 2020; 87:1086-1092. [PMID: 31578038 PMCID: PMC7113085 DOI: 10.1038/s41390-019-0596-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/08/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Privacy-protecting analytic approaches without centralized pooling of individual-level data, such as distributed regression, are particularly important for vulnerable populations, such as children, but these methods have not yet been tested in multi-center pediatric studies. METHODS Using the electronic health data from 34 healthcare institutions in the National Patient-Centered Clinical Research Network (PCORnet), we fit 12 multivariable-adjusted linear regression models to assess the associations of antibiotic use <24 months of age with body mass index z-score at 48 to <72 months of age. We ran these models using pooled individual-level data and conventional multivariable-adjusted regression (reference method), as well as using the more privacy-protecting pooled summary-level intermediate statistics and distributed regression technique. We compared the results from these two methods. RESULTS Pooled individual-level and distributed linear regression analyses produced virtually identical parameter estimates and standard errors. Across all 12 models, the maximum difference in any of the parameter estimates or standard errors was 4.4833 × 10-10. CONCLUSIONS We demonstrated empirically the feasibility and validity of distributed linear regression analysis using only summary-level information within a large multi-center study of children. This approach could enable expanded opportunities for multi-center pediatric research, especially when sharing of granular individual-level data is challenging.
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Affiliation(s)
- Sengwee Toh
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA.
| | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Pi-I Lin
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - L. Charles Bailey
- Applied Clinical Research Center, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher B. Forrest
- Applied Clinical Research Center, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Casie E. Horgan
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | | | | | - Jessica L. Sturtevant
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Jessica G. Young
- Therapeutics Research and Infectious Disease Epidemiology Group, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
| | - Jason P. Block
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
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Block JP, Bailey LC, Gillman MW, Lunsford D, Daley MF, Eneli I, Finkelstein J, Heerman W, Horgan CE, Hsia DS, Jay M, Rao G, Reynolds JS, Rifas-Shiman SL, Sturtevant JL, Toh S, Trasande L, Young J, Forrest CB. Early Antibiotic Exposure and Weight Outcomes in Young Children. Pediatrics 2018; 142:peds.2018-0290. [PMID: 30381474 PMCID: PMC6317759 DOI: 10.1542/peds.2018-0290] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/27/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5839981580001PEDS-VA_2018-0290Video Abstract OBJECTIVES: To determine the association of antibiotic use with weight outcomes in a large cohort of children. METHODS Health care data were available from 2009 to 2016 for 35 institutions participating in the National Patient-Centered Clinical Research Network. Participant inclusion required same-day height and weight measurements at 0 to <12, 12 to <30, and 48 to <72 months of age. We assessed the association between any antibiotic use at <24 months of age with BMI z score and overweight or obesity prevalence at 48 to <72 months (5 years) of age, with secondary assessments of antibiotic spectrum and age-period exposures. We included children with and without complex chronic conditions. RESULTS Among 1 792 849 children with a same-day height and weight measurement at <12 months of age, 362 550 were eligible for the cohort. One-half of children (52%) were boys, 27% were African American, 18% were Hispanic, and 58% received ≥1 antibiotic prescription at <24 months of age. At 5 years, the mean BMI z score was 0.40 (SD 1.19), and 28% of children had overweight or obesity. In adjusted models for children without a complex chronic condition at 5 years, we estimated a higher mean BMI z score by 0.04 (95% confidence interval [CI] 0.03 to 0.05) and higher odds of overweight or obesity (odds ratio 1.05; 95% CI 1.03 to 1.07) associated with obtaining any (versus no) antibiotics at <24 months. CONCLUSIONS Antibiotic use at <24 months of age was associated with a slightly higher body weight at 5 years of age.
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Affiliation(s)
- Jason P. Block
- Division of Chronic Disease Research Across the
Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care
Institute and
| | - L. Charles Bailey
- Applied Clinical Research Center and Department of
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
| | - Matthew W. Gillman
- Division of Chronic Disease Research Across the
Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care
Institute and,Environmental Influences on Child Health Outcomes
Program, National Institutes of Health, Bethesda, Maryland
| | | | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente
Colorado, Denver, Colorado
| | | | - Jonathan Finkelstein
- Department of Pediatrics, Harvard Medical School,
Harvard University, Boston, Massachusetts
| | - William Heerman
- Department of Pediatrics, Vanderbilt University
Medical Center, Nashville, Tennessee
| | - Casie E. Horgan
- Division of Chronic Disease Research Across the
Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care
Institute and
| | - Daniel S. Hsia
- Pennington Biomedical Research Center, Baton Rouge,
Louisiana
| | | | - Goutham Rao
- Department of Family Medicine and Community Health,
Case Western Reserve University and University Hospitals of Cleveland,
Cleveland, Ohio
| | | | - Sheryl L. Rifas-Shiman
- Division of Chronic Disease Research Across the
Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care
Institute and
| | | | - Sengwee Toh
- Therapeutics Research and Infectious Disease
Epidemiology Group and
| | - Leonardo Trasande
- Pediatrics, School of Medicine, New York University,
New York City, New York; and
| | - Jessica Young
- Division of Chronic Disease Research Across the
Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care
Institute and
| | - Christopher B. Forrest
- Applied Clinical Research Center and Department of
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
Pennsylvania
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Toh S, Rasmussen-Torvik LJ, Harmata EE, Pardee R, Saizan R, Malanga E, Sturtevant JL, Horgan CE, Anau J, Janning CD, Wellman RD, Coley RY, Cook AJ, Courcoulas AP, Coleman KJ, Williams NA, McTigue KM, Arterburn D, McClay J. The National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study Cohort: Rationale, Methods, and Baseline Characteristics. JMIR Res Protoc 2017; 6:e222. [PMID: 29208590 PMCID: PMC5736875 DOI: 10.2196/resprot.8323] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 08/24/2017] [Indexed: 12/04/2022] Open
Abstract
Background Although bariatric procedures are commonly performed in clinical practice, long-term data on the comparative effectiveness and safety of different procedures on sustained weight loss, comorbidities, and adverse effects are limited, especially in important patient subgroups (eg, individuals with diabetes, older patients, adolescents, and minority patients). Objective The objective of this study was to create a population-based cohort of patients who underwent 3 commonly performed bariatric procedures—adjustable gastric band (AGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG)—to examine the long-term comparative effectiveness and safety of these procedures in both adults and adolescents. Methods We identified adults (20 to 79 years old) and adolescents (12 to 19 years old) who underwent a primary (first observed) AGB, RYGB, or SG procedure between January 1, 2005 and September 30, 2015 from 42 health systems participating in the Clinical Data Research Networks within the National Patient-Centered Clinical Research Network (PCORnet). We extracted information on patient demographics, encounters with healthcare providers, diagnoses recorded and procedures performed during these encounters, vital signs, and laboratory test results from patients’ electronic health records (EHRs). The outcomes of interest included weight change, incidence of major surgery-related adverse events, and diabetes remission and relapse, collected for up to 10 years after the initial bariatric procedure. Results A total of 65,093 adults and 777 adolescents met the eligibility criteria of the study. The adult subcohort had a mean age of 45 years and was predominantly female (79.30%, 51,619/65,093). Among adult patients with non-missing race or ethnicity information, 72.08% (41,248/57,227) were White, 21.13% (12,094/57,227) were Black, and 20.58% (13,094/63,637) were Hispanic. The average highest body mass index (BMI) recorded in the year prior to surgery was 49 kg/m2. RYGB was the most common bariatric procedure among adults (49.48%, 32,208/65,093), followed by SG (45.62%, 29,693/65,093) and AGB (4.90%, 3192/65,093). The mean age of the adolescent subcohort was 17 years and 77.5% (602/777) were female. Among adolescent patients with known race or ethnicity information, 67.3% (473/703) were White, 22.6% (159/703) were Black, and 18.0% (124/689) were Hispanic. The average highest recorded BMI in the year preceding surgery was 53 kg/m2. The majority of the adolescent patients received SG (60.4%, 469/777), followed by RYGB (30.8%, 239/777) and AGB (8.9%, 69/777). A BMI measurement (proxy for follow-up) was available in 84.31% (44,978/53,351), 68.09% (20,783/30,521), and 68.56% (7159/10,442) of the eligible adult patients at 1, 3, and 5 years of follow-up, respectively. The corresponding proportion was 82.0% (524/639), 49.9% (174/349), and 38.8% (47/121) in the adolescent subcohort. Conclusions Our study cohort is one of the largest cohorts of patients with bariatric procedures in the United States. Patients are geographically and demographically diverse, which improves the generalizability of the research findings and allows examination of treatment effect heterogeneity. Ongoing and planned investigations will provide real-world evidence on the long-term benefits and risks of these most commonly used bariatric procedures in current clinical practice.
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Affiliation(s)
- Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | | | | | - Roy Pardee
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Rosalinde Saizan
- Ochsner Surgical Weight Loss Center, New Orleans, LA, United States
| | | | - Jessica L Sturtevant
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Casie E Horgan
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Cheri D Janning
- Duke Clinical & Translational Science Institute, Durham, NC, United States
| | - Robert D Wellman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Andrea J Cook
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | | | - Kathleen M McTigue
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - David Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - James McClay
- University of Nebraska Medical Center, Omaha, NE, United States
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Sturtevant JL, Anema A, Brownstein JS. The new International Health Regulations: considerations for global public health surveillance. Disaster Med Public Health Prep 2008; 1:117-21. [PMID: 18388639 DOI: 10.1097/dmp.0b013e318159cbae] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Global public health surveillance is critical for the identification and prevention of emerging and reemerging infectious diseases. The World Health Organization recently released revised International Health Regulations (IHR) that serve as global legislation and provide guidelines for surveillance systems. The IHR aim to identify and prevent spread of these infectious diseases; however, there are some practical challenges that limit the usability of these regulations. IHR requires Member States to build necessary infrastructure for global surveillance, which may not be possible in underdeveloped countries. A large degree of freedom is given to each individual government and therefore different levels of reporting are common, with substantial emphasis on passive reporting. The IHR need to be enforceable and enforced without impinging on government autonomy or human rights. Unstable governments and developing countries require increased assistance in setting up and maintaining surveillance systems. This article addresses some challenges and potential solutions to the ability of national governments to adhere to the global health surveillance requirements detailed in the IHR. The authors review some practical challenges such as inadequate surveillance and reporting infrastructure, and legal enforcement and maintenance of individual human rights.
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Affiliation(s)
- Jessica L Sturtevant
- Harvard School of Public Health and the Children's Hospital Informatics Program (CHIP) at the Harvard-MIT Division of Health Sciences and Technology, MA, USA
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