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Pimenta GP, Dandin O, Caporossi C, Aguilar Nascimento JE. RESIDUAL GASTRIC VOLUME IN MORBIDLY OBESE DIABETICS AFTER AN OVERNIGHT FASTING OR 3 HOURS OF A CARBOHYDRATE-ENRICHED SUPPLEMENT: A RANDOMIZED CROSSOVER PILOT STUDY. Arq Bras Cir Dig 2024; 36:e1791. [PMID: 38324852 PMCID: PMC10841525 DOI: 10.1590/0102-672020230073e1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/08/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND To reduce the risk of regurgitation during anesthesia for elective procedures, residual gastric volumes (RGV) have traditionally been minimized by overnight fasting. Prolonged preoperative fasting presents some adverse consequences and has been abandoned for most surgical procedures, except for obese and/or diabetic patients. AIMS The aim of this study was to assess the RGV in morbidly obese diabetic patients after traditional or abbreviated fasting. METHODS This study was approved by the Ethics Committee for Research with Human Beings from the Federal University of Mato Grosso, under number 179.017/2012. This is a prospective, randomized, and crossover design study in eight morbidly obese type II diabetic patients. RGV was measured endoscopically after either traditional overnight fasting of at least 8 hours, or after abbreviated fasting of 6 hours for solids and 3 hours for a drink containing water plus 25 g (12.5%) of maltodextrin. Data were expressed as mean and range and differences were compared with paired t-tests at p<0.05. RESULTS The study population had a mean age of 41.5 years (28-53), weight of 135 kg (113-196), body mass index of 48.2 kg/m2 (40-62.4), and type II diabetes for 4.5 years (1-10). The RGV after abbreviated fasting was 21.5 ml (5-40) vs 26.3 ml (7-65) after traditional fasting. This difference was not significant (p=0.82). CONCLUSIONS Gastric emptying in morbidly obese diabetic patients is similar after either traditional or abbreviated fasting with a carbohydrate drink.
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Affiliation(s)
| | | | - Cervantes Caporossi
- Universidade de Varzea Grande, Department of Surgery - Varzea Grande (MT), Brazil
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García-Honores L, Caballero-Alvarado J, Bustamante-Cabrejos A, Lozano-Peralta K, Zavaleta-Corvera C. LAPAROSCOPIC SLEEVE GASTRECTOMY VERSUS LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS FOR WEIGHT LOSS IN OBESE PATIENTS: WHICH IS MORE EFFECTIVE? A SYSTEMATIC REVIEW AND META-ANALYSIS. Arq Bras Cir Dig 2023; 36:e1782. [PMID: 38088727 PMCID: PMC10712920 DOI: 10.1590/0102-672020230064e1782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/18/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective option to reduce weight in morbid obesity patients. The techniques most employed are the restrictive surgery laparoscopic sleeve gastrectomy (LSG), surgical procedures of intestinal malabsorption, and both types (restrictive and intestinal malabsorption) such as the Roux-en-Y laparoscopic gastric bypass (RYLGB). AIMS To determine if LSG is more effective than RYLGB for weight loss. METHODS A systematic review and meta-analysis was carried out, including five clinical trials and sixteen cohorts comparing LSG versus RYLGB in weight loss and secondary outcomes: resolution of comorbidities, postoperative complications, operative time, hospital stay, and improvement in quality of life. RESULTS Excess weight loss was 10.2% (mean difference [MD] 10.2; 95%CI -10.14; -9.90) higher in patients undergoing LSG than in patients submitted to RYLGB. Diabetes mellitus type 2 was resolved in 17% (relative risk [RR] 0.83; 95%CI 0.77-0.90) of cases, more significantly after LSG, arterial hypertension in 23% (RR 0.77; 95%CI 0.69-0.84), and dyslipidemia in 17% (RR 0.83; 95%CI 0.77-0.90). Postoperative complications were 73% higher in patients undergoing RYLGB (MD 0.73; 95%CI 0.63-0.83). The operative time was 35.76 minutes shorter in the LSG (MD -35.76; 95%CI -37.28; -34.24). Finally, the quality of life improved more in patients operated by LSG (MD 0.37; 95%CI -0.48; -0.26). CONCLUSIONS The study demonstrated that LSG could be more effective than RYLGB in reducing the percentage of excess weight, comorbidities, postoperative complications, operative time, hospital stay, and in improving quality of life.
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Affiliation(s)
- Laura García-Honores
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
| | - Jose Caballero-Alvarado
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
- Regional Hospital of Trujillo, Department of surgery - Trujillo, La Libertad, Peru
| | - Alexander Bustamante-Cabrejos
- Antenor Orrego Private University, School of Medicine - Trujillo, La Libertad, Peru
- Alta Complejidad Virgen de la Puerta Hospital, Department of surgery - Trujillo, La Libertad, Peru
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Cremonesi MDC, Duarte-Guerra L, Pajecki D, Santo MA, Lotufo F, Wang YP. VALIDITY OF THE BRAZILIAN-PORTUGUESE VERSION OF MOOREHEAD-ARDELT QUALITY OF LIFE QUESTIONNAIRE II AMONG PATIENTS WITH SEVERE OBESITY. Arq Bras Cir Dig 2023; 36:e1767. [PMID: 37851753 PMCID: PMC10578149 DOI: 10.1590/0102-672020230049e1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/08/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Patients with obesity present multiple comorbid psychiatric conditions and experience impairments in health-related quality of life. Reliable and valid tools that evaluate health-related quality of life are essential for clinical practice. AIMS This study aimed to investigate the reliability and validity of the six-item Moorehead-Ardelt Quality of Life Questionnaire II among Brazilian patients with severe obesity. METHODS We assessed 387 patients (mean age 43 years, 78.8% women, mean body mass index of 46.5 kg/m²) on the waiting list of a bariatric surgery center. Trained research assistants concurrently applied the Moorehead-Ardelt Quality of Life-II, the Montgomery-Åsberg Depression Rating Scale, and the Global Assessment of Functioning for assessing health-related quality of life, comorbid depressive symptoms, and patient functioning level, respectively. RESULTS The internal consistency of the Moorehead-Ardelt Quality of Life-II was considered acceptable. The total score was correlated with the severity of depressive symptoms and functioning level. The more body mass index increases, the more health-related quality of life worsens. The Moorehead-Ardelt Quality of Life-II presented a unidimensional structure. CONCLUSIONS The unidimensional Moorehead-Ardelt Quality of Life-II is a reliable and valid measure for evaluating health-related quality of life in Brazilian patients with severe obesity. The questionnaire allows to quickly assess the health-related quality of life of patients in different bariatric contexts, considering depression and functional level.
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Affiliation(s)
| | | | - Denis Pajecki
- Universidade de São Paulo, Department of Gastroenterology – São Paulo (SP), Brazil
| | - Marco Aurelio Santo
- Universidade de São Paulo, Department of Gastroenterology – São Paulo (SP), Brazil
| | - Francisco Lotufo
- Universidade de São Paulo, Department of Psychiatry – São Paulo (SP), Brazil
| | - Yuan-Pang Wang
- Universidade de São Paulo, Department of Psychiatry – São Paulo (SP), Brazil
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Meira MD, Oliveira FDESC, Coutinho LR, Leão LHDEA, Vasconcelos GDEP, Siqueira LTDE, Ferraz ÁAB. Long-term evaluation of patients with BMI = 50kg/m2 who underwent Bariatric Surgery. Rev Col Bras Cir 2023; 50:e20233397. [PMID: 37162040 PMCID: PMC10508685 DOI: 10.1590/0100-6991e-20233397-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 06/17/2022] [Accepted: 09/13/2022] [Indexed: 05/11/2023] Open
Abstract
PURPOSE to determine the risks and benefits of bariatric surgery in patients with super obesity (SO) in comparison with obesity grades II and III. METHODS retrospective cohort that included a study group of 178 patients with SO and a control group of 181 patients with BMI 35-49.9Kg/m2. The groups were formed in a 1:1 nearest neighbor matching. The main variables were pre- and postoperative BMI and comorbidities, occurrence of severe postoperative complications, bowel obstruction, marginal ulcer, fistulae and 30-day death, besides the necessity of emergency room (ER) admission and abdominal computed tomography (CT) scans in the postoperative period due to acute abdomen. RESULTS the study group comprised 74.0% of women while the control group had 56.7%. The mean follow-up time was similar between both groups (5.48 x 6.09 years, p=0.216). There was no statistically significant difference on the prevalence of hypertension and T2D between the groups according to the surgical technique. All deaths occurred in the Study group (BMI = 50kg/m2) who underwent RYGB. There was no difference between the groups regarding the occurrence of severe complications. Data on ER admissions and the need for abdominal CT to investigate postoperative abdominal pain did not show statistically significant difference between the groups. CONCLUSION despite the high risk related to bariatric surgery in patients with SO, the benefits related to the remission of comorbidities are significant; although being lower than those found in patients with milder grades of obesity.
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Affiliation(s)
- Matheus Duarte Meira
- - Universidade Federal de Pernambuco (UFPE), Pós-graduação em Cirurgia - Recife - PE - Brasil
- - Hospital dos Servidores do Estado (HSE), Serviço de Cirurgia Geral - Recife - PE - Brasil
| | - Fernando DE Santa Cruz Oliveira
- - Universidade Federal de Pernambuco (UFPE), Pós-graduação em Cirurgia - Recife - PE - Brasil
- - Hospital dos Servidores do Estado (HSE), Serviço de Cirurgia Geral - Recife - PE - Brasil
| | | | | | - Géssica DE Paula Vasconcelos
- - Hospital das Clínicas da Universidade Federal de Pernambuco (HCUFPE), Serviço de Cirurgia Geral - Recife - PE - Brasil
| | - Luciana Teixeira DE Siqueira
- - Hospital das Clínicas da Universidade Federal de Pernambuco (HCUFPE), Serviço de Cirurgia Geral - Recife - PE - Brasil
- - Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia - Recife - PE - Brasil
| | - Álvaro Antônio Bandeira Ferraz
- - Hospital das Clínicas da Universidade Federal de Pernambuco (HCUFPE), Serviço de Cirurgia Geral - Recife - PE - Brasil
- - Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia - Recife - PE - Brasil
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Morrell ALG, Morrell-Junior AC, Morrell AG, Mendes JMF, Morrell AC. Robotic Roux-en-Y gastric bypass: surgical technique and short-term experience from 329 cases. Rev Col Bras Cir 2021; 48:e20212982. [PMID: 34852039 PMCID: PMC10683430 DOI: 10.1590/0100-6991e-20212982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 02/15/2021] [Accepted: 06/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE minimally invasive bariatric surgery is clearly superior over open procedures including better early outcomes. Different surgical approaches are used to treat the severely obese, having Roux-en-Y gastric bypass (RYGB) being a highly frequent procedure. Robotic surgery overcomes some laparoscopic limitations adding ergonomics, articulating instruments and a three-dimensional high definition camera. Based on our vast robotic experience, we present our referred group case series and a standardized Robotic Roux-en-Y gastric bypass (rRYGB) technique as well as its outcomes. METHODS a review of a prospective maintained database was conducted in patients submitted to robotic Roux en Y bariatric surgery between April 2015 and July 2019. Surgical technique is described and illustrated. We also reported patients demographics, outcomes and its follow-up. RESULTS a Retrospective analysis identified 329 patients submitted to Robotic Roux-en-Y gastric bypass. Both da Vinci Si and Xi platforms were used. Mean age was 34.4 years, with median BMI of 44.2 kg/m2. Mean console time was 102 min and there was no conversion. No surgical hospital readmission rates were seen in the first 30 days. CONCLUSION this study represents our initial experience of robotic Roux-en-Y gastric bypass (rRYGB), its short outcomes and a standardized surgical technique. Our results encourage that rRYGB is technically feasible and safe, and might offer some advantages showing good outcomes and minimal complications.
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Affiliation(s)
- Andre Luiz Gioia Morrell
- - Instituto Morrell, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Albert Einstein, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or São Luiz, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Hospital Vila Nova Star, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia do Aparelho Digestivo, Bariátrica e Metabólica Robótica - São Paulo - SP - Brasil
| | - Alexander Charles Morrell-Junior
- - Instituto Morrell, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Albert Einstein, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or São Luiz, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Hospital Vila Nova Star, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia do Aparelho Digestivo, Bariátrica e Metabólica Robótica - São Paulo - SP - Brasil
| | - Allan Gioia Morrell
- - Instituto Morrell, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Albert Einstein, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or São Luiz, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Hospital Vila Nova Star, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia do Aparelho Digestivo, Bariátrica e Metabólica Robótica - São Paulo - SP - Brasil
| | - Jose Mauricio Freitas Mendes
- - Instituto Morrell, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Albert Einstein, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or São Luiz, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Hospital Vila Nova Star, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia do Aparelho Digestivo, Bariátrica e Metabólica Robótica - São Paulo - SP - Brasil
| | - Alexander Charles Morrell
- - Instituto Morrell, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Sociedade Beneficente Israelita Brasileira Albert Einstein, Cirurgia Geral e do Aparelho Digestivo Minimamente Invasiva e Robótica - São Paulo - SP - Brasil
- - Rede D'Or São Luiz, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Hospital Vila Nova Star, Cirurgia do Aparelho Digestivo Robótica e Minimamente Invasiva - São Paulo - SP - Brasil
- - Grupo Leforte, Cirurgia do Aparelho Digestivo, Bariátrica e Metabólica Robótica - São Paulo - SP - Brasil
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Cintra Junior W, Modolin MLA, Colferai DR, Rocha RI, Gemperli R. Post-bariatric body contouring surgery: analysis of complications in 180 consecutive patients. Rev Col Bras Cir 2021; 48:e20202638. [PMID: 34287547 PMCID: PMC10683460 DOI: 10.1590/0100-6991e-20202638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 05/27/2020] [Accepted: 03/09/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION bariatric surgery is the main treatment for cases of severe obesity and body contour surgery to correct body dysmorphia resulting from weight loss. However, these procedures are associated with a significant number of postoperative complications. OBJECTIVE this study aims to analyze complications in post-bariatric patients undergoing body contour surgeries and correlating them with the age and BMI of these patients. METHODS the current study is a retrospective study evaluating 180 consecutive patients undergoing body contour surgery after bariatric surgery within a period of three years (2014-2016). Data such as age, gender, Body Mass Index before bariatric and plastic surgeries, type of surgery performed and complications were collected, and correlated the age as well as the BMI of the patients in the pre-bariatric (PB) and pre-plastic (PP) periods with the complications presented. RESULTS of the 180 patients evaluated, 91.7% were females (n = 165), and the mean age was 46.3 ± 1.7 years. The most performed surgery was abdominoplasty (48.9%), followed by mammaplasty (21.1%). Some complications occurred in 26.1% of the patients with partial dehiscence (40.4%) and seroma (14.9%) being the most frequent. Patients who presented complications had a higher mean age (50.8 years) than those who presented with no complications, and major complications accounted for 2.7% of the sample. CONCLUSIONS a statistically significant number of surgeries progressed without complications and, when they occurred, there were minor complications in most of the sample. Complications were more frequent in older patients with some of them having a BMI over 30 Kg/m2.
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Affiliation(s)
- Wilson Cintra Junior
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Cirurgia Plástica - São Paulo - SP - Brasil
| | - Miguel Luiz Antonio Modolin
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Cirurgia Plástica - São Paulo - SP - Brasil
| | - Diego Ricardo Colferai
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Cirurgia Plástica - São Paulo - SP - Brasil
| | - Rodrigo Itocazo Rocha
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Cirurgia Plástica - São Paulo - SP - Brasil
| | - Rolf Gemperli
- - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Cirurgia Plástica - São Paulo - SP - Brasil
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Zilberstein B, Santo MA, Carvalho MH. CRITICAL ANALYSIS OF SURGICAL TREATMENT TECHNIQUES OF MORBID OBESITY. Arq Bras Cir Dig 2019; 32:e1450. [PMID: 31644670 PMCID: PMC6812144 DOI: 10.1590/0102-672020190001e1450] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/16/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Obesity is a disease of high prevalence in Brazil and in the world, and bariatric surgery, with its different techniques, is an alternative treatment. OBJECTIVE To compare techniques: adjustable gastric band (AGB), sleeve gastrectomy), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) analyzing leaks, bleeding, death, weight loss, resolution of type 2 diabetes, systemic arterial hypertension, dyslipidemia and obstructive sleep apnea. METHODS Were selected studies in the PubMed database from 2003 to 2014 using the descriptors: obesity surgery; bariatric surgery; biliopancreatic diversion; sleeve gastrectomy; Roux-en-Y gastric bypass and adjustable gastric banding. Two hundred and forty-four articles were found with the search strategy of which there were selected 116 studies through the inclusion criteria. RESULTS Excess weight loss (EWL) after five years in AGB was 48.35%; 52.7% in SG; 71.04% in RYGB and 77.90% in BPD. The postoperative mortality was 0.05% in the AGB; 0.16% on SG; 0.60% in RYGB and 2.52% in BPD. The occurrence of leak was 0.68% for GBA; 1.93% for SG; 2.18% for RYGB and 5.23% for BPD. The incidence of bleeding was 0.44% in AGB; 1.29% in SG; 0.81% in RYGB and 2.09% in BPD. The rate of DM2 resolved was 46.80% in AGB, 79.38% in SG, 79.86% in RYGB and 90.78% in BPD. The rate of dyslipidemia, apnea and hypertension resolved showed no statistical differences between the techniques. CONCLUSION The AGB has the lowest morbidity and mortality and it is the worst in EWL and resolution of type 2 diabetes. The SG has low morbidity and mortality, good resolution of comorbidities and EWL lower than in RYGB and BPD. The RYGB has higher morbidity and mortality than AGB, good resolution of comorbidities and EWL similar to BPD. The BPD is the worst in mortality and bleeding and better in EWL and resolution of comorbidities.
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Affiliation(s)
- Bruno Zilberstein
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marco Aurélio Santo
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Marnay Helbo Carvalho
- Department of Gastroenterology, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Kelles SMB, Barreto SM, Guerra HL. Costs and usage of healthcare services before and after open bariatric surgery. SAO PAULO MED J 2011; 129:291-9. [PMID: 22069127 PMCID: PMC10868943 DOI: 10.1590/s1516-31802011000500003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 07/04/2011] [Accepted: 07/05/2011] [Indexed: 01/09/2023] Open
Abstract
CONTEXT AND OBJECTIVE Morbidly obese individuals are major consumers of healthcare services, with high associated costs. Bariatric surgery is an alternative for improving these individuals' comorbidities. There are no studies comparing costs before and after bariatric surgery in Brazil. The aim here was to analyze results relating to healthcare usage and direct costs among morbidly obese patients undergoing bariatric surgery. DESIGN AND SETTING Historical cohort study on patients receiving healthcare through a private health plan in Belo Horizonte, Minas Gerais. METHODS All healthcare services and their associated costs were included in the analysis: hospitalization, hospital stay, elective outpatient consultations, emergency service usage and examinations. The analyses were treated as total when including the whole years before and after surgery, or partial when excluding the three-month periods adjacent to the operation. RESULTS For 382 obese patients who underwent open bariatric operations, there were 53 hospitalizations one year before and 95 one year after surgery (P = 0.013). Gastrointestinal complications were the main indications for post-procedure hospitalizations. The partial average cost almost doubled after the operation (US$ 391.96 versus US$ 678.31). In subgroup analysis, the costs from patients with gastrointestinal complications were almost four times greater after bariatric surgery. Even in the subgroup without complications, the partial average cost remained significantly higher. CONCLUSION Although bariatric surgery is the only path towards sustained weight loss for morbidly obese patients, the direct costs over the first year after the procedure are greater. Further studies, with longer follow-up, might elucidate whether long-term reversal of this trend would occur.
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Affiliation(s)
- Silvana Marcia Bruschi Kelles
- Postgraduate Program on Adult Health Sciences, School of Medicine, Universidade Federal de Minas Gerais-UFMG, Belo Horizonte, Minas Gerais, Brazil.
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