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Katz-Summercorn AC, Arhi C, Agyemang-Yeboah D, Cirocchi N, Musendeki D, Fitt I, McGrandles R, Zalin A, Foldi I, Rashid F, Adil MT, Jain V, Mamidanna R, Jambulingam P, Munasinghe A, Whitelaw DE, Al-Taan O. Patient and operative factors influence delayed discharge following bariatric surgery in an enhanced recovery setting. Surg Obes Relat Dis 2024; 20:446-452. [PMID: 38218689 DOI: 10.1016/j.soard.2023.11.005] [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] [Received: 03/12/2023] [Revised: 08/29/2023] [Accepted: 11/04/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) programs have been widely adopted in bariatric surgery. However, not all patients are successfully managed in the ERAS setting and there is currently little way of predicting the patients who will deviate from the program. Early identification of these patients could allow for more tailored protocols to be implemented preoperatively to address the issues, thereby improving patient outcomes. OBJECTIVES The aim of this study was to elucidate the factors which preclude discharge by comparing patients who were successfully discharged by the end of the first postoperative day (POD 0/1) to those who stayed longer, including revisional surgery in this analysis. SETTING A tertiary, high-volume Bariatric Centre, United Kingdom. METHODS A retrospective analysis was performed of all patients undergoing bariatric surgery in a single centre in 1 year. Multivariate analyses compared patient and operative variables between patients who were discharged on POD 0/1 and those who stayed longer. RESULTS A total of 288 bariatric operations were performed: 78% of operations performed were laparoscopic Roux-en-Y gastric bypass; 22% laparoscopic sleeve gastrectomy. Of these cases, 13% were revisional operations. Four patients returned to theatre on the index admission. 81% of patients were discharged by POD 0/1. A re-presentation within 30 days was seen in 6% of patients. There was no significant difference in length of stay for the type of operation performed (P = .86). Patients who had a revisional procedure were not more likely to stay longer. Length of stay was also independent of age, BMI, and comorbidities. Caucasian patients were more likely to be discharged on POD 0/1 than those of other ethnicities (90% versus 78%; P = .02). Operations performed by trainee surgeons, under consultant supervision, were significantly more likely to be discharged on POD 0/1 (P = .03). However, a logistic regression analysis was unable to predict patients who had a prolonged stay. CONCLUSIONS Patient length of stay is independent of BMI, operation, and comorbidities and these factors do not need special consideration in ERAS pathways. Patients undergoing revisional procedures can be managed in the same way as those having primary procedures, with a routine POD 0/1 discharge. However, the impact of individual patient factors, and their interaction, is complex and cannot predict overstay.
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Affiliation(s)
- Annalise C Katz-Summercorn
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Chanpreet Arhi
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - David Agyemang-Yeboah
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Nicholas Cirocchi
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Debbie Musendeki
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Irene Fitt
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Rosie McGrandles
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Anjali Zalin
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Istvan Foldi
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Farhan Rashid
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Md Tanveer Adil
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Vigyan Jain
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Ravikrishna Mamidanna
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Periyathambi Jambulingam
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Aruna Munasinghe
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Douglas E Whitelaw
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Omer Al-Taan
- Department of Bariatric and Upper Gastrointestinal Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom.
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Rahimi AO, Soliman D, Hsu CH, Ghaderi I. The impact of gender, race, and ethnicity on bariatric surgery outcomes. Surg Obes Relat Dis 2024; 20:454-461. [PMID: 38326184 DOI: 10.1016/j.soard.2023.12.020] [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: 09/17/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND The rates of postoperative complications can vary among specific patient populations. OBJECTIVES The aim of this study is to examine how gender, race, and ethnicity can affect short-term postoperative complications in bariatric surgery patients. SETTING United States. METHODS Patients who underwent bariatric surgery between the years 2016 and 2021 were included and stratified based on gender, race/ethnicity, and procedure type. The 30-day outcomes were assessed using Clavien-Dindo (CD) classification of III-V. Wilcoxon rank-sum test was performed to compare continuous variables among groups and Chi-squared test for categorical variables. Logistic regression was performed to examine the effects of gender, race/ethnicity on CD classification ≥ III complications by the procedure type. RESULTS A total of 975,642 bariatric surgery patients were included. Descriptive univariate analysis showed that CD ≥ III complications were higher among non-Hispanic blacks (NHB) and lowest in Hispanic patients, regardless of their gender, except in the duodenal switch DS group, where non-Hispanic whites (NHW) had the lowest complication rate. There was no difference between male and female patients with regards to postoperative complications, except in the sleeve gastrectomy (SG) group, where NHW males had more complications than NHW females. Sleeve gastrectomy showed the lowest complication rates followed by gastric bypass and DS in all groups. In multivariate logistic regression model, for both females and males NHBs had higher odds of postoperative complications compared to NHWs in sleeve gastrectomy (Female aOR:1.31, 95% CI: [1.23-1.40]; Male aOR:1.24, 95% CI: [1.08-1.43], P < .001) and gastric bypass (Female aOR:1.24, 95% CI: [1.16-1.33]; Male aOR:1.25, 95% CI: [1.06-1.48], P < .01). CONCLUSIONS Non-Hispanic Black patients are at a higher rate of developing CD ≥ III complications compared to non-Hispanic Whites after bariatric surgery. The male gender was not a significant risk factor for serious postoperative complications. Among the different types of bariatric procedures, sleeve gastrectomy has the lowest rates of severe complications, followed by gastric bypass and duodenal switch. These results highlight the significance of considering gender, race, ethnicity, and procedure type during preoperative evaluation, surgical planning, and postoperative care.
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Affiliation(s)
- Ahmad Omid Rahimi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Diaa Soliman
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, Arizona
| | - Iman Ghaderi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona.
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Clapp B, Ponce J, Corbett J, Ghanem OM, Kurian M, Rogers AM, Peterson RM, LaMasters T, English WJ. American Society for Metabolic and Bariatric Surgery 2022 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis 2024; 20:425-431. [PMID: 38448343 DOI: 10.1016/j.soard.2024.01.012] [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: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS), despite being the most effective durable treatment for obesity, remains underused as approximately 1% of all qualified patients undergo surgery. The American Society for Metabolic and Bariatric Surgery established a Numbers Taskforce to specify the annual rate of obesity treatment interventions utilization and to determine if patients in need are receiving appropriate treatment. OBJECTIVE To provide the best estimated number of metabolic and bariatric procedures being performed in the United States in 2022. SETTING United States. METHODS We reviewed data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and National Surgical Quality Improvement Program. In addition, data from industry and state databases were used to estimate activity at non-accredited centers. Data from 2022 were compared mainly with data from the previous 2 years. RESULTS Compared with 2021, the total number of MBS performed in 2022 increased from approximately 262,893 to 280,000. The sleeve gastrectomy (SG) continues to be the most commonly performed procedure. The gastric bypass procedure trend remained relatively stable. The percentage of revision procedures and biliopancreatic diversion with duodenal switch procedures increased slightly. Intragastric balloon placement increased from the previous year. Endoscopic sleeve gastroplasty increased in numbers. CONCLUSIONS There was a 6.5% increase in MBS volume from 2021 to 2022 and a 41% increase from 2020, which demonstrates a recovery from the COVID-19 pandemic. SG continues to be the most dominant MBS procedure.
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Affiliation(s)
- Benjamin Clapp
- Texas Tech Paul Foster School of Medicine, El Paso, Texas.
| | - Jaime Ponce
- Bariatric Surgery Program, CHI Memorial Hospital, Chattanooga, Tennessee
| | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic Rochester, Rochester, Minnesota
| | - Marina Kurian
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Ann M Rogers
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Teresa LaMasters
- UnityPoint Clinic Weight Loss Specialists, West Des Moines, Iowa
| | - Wayne J English
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Chen ZW, Jin T, Liang PP, Li ZD, He FJ, Chen ZH, Song XH, Zhu YF, Hu JK, Yang K. Incidence of cancer for patients after bariatric surgery: evidence from 33 cohort studies. Surg Obes Relat Dis 2024; 20:467-481. [PMID: 38151417 DOI: 10.1016/j.soard.2023.11.010] [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: 03/11/2023] [Revised: 10/30/2023] [Accepted: 11/18/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND With the rising prevalence of severe obesity, bariatric surgery has emerged as a crucial treatment option. As the number of surgeries performed worldwide increases, there has been growing interest in the impact of bariatric surgery on cancer incidence. While several studies have examined this relationship, the topic remains controversial. OBJECTIVES We conducted this systematic review of cohort studies with meta-analysis to evaluate the effect of bariatric surgery versus nonsurgical treatment on overall cancer incidence. However, the effects may vary when focusing on specific cancer types, surgical procedures, or gender, so we conducted additional subgroup analyses. SETTING A meta-analysis. University hospital. METHODS The Cochrane, Embase, PubMed, and Web of Science databases were searched for studies from 1 January 2000 to 1 December 2022. Meta-analysis was conducted to evaluate the pooled effect and further implemented subgroup analysis stratified by cancer type, operation type, and sex. RESULTS All cohort studies were included in this meta-analysis from 18,216 studies. The overall cancer incidence demonstrated a significant decrease in the group with bariatric surgery (odds ratios [OR] = .56, P = .000, 95% CI .46 to .68). In subgroup analysis, similar decrease effect was found in 9 cancers. Furthermore, the incidence of cancer decreased significantly in male (OR = .66, P = .001, 95% CI .51 to .85) and female patients (OR = .63, P = .000, 95% CI .57 to .69) and patients undergoing gastric bypass (OR = .46, P = .000, 95% CI .33 to .63) or sleeve gastrectomy (OR = .44, P = .001, 95% CI .27 to .70). CONCLUSIONS In the overall analysis, bariatric surgery could reduce the incidence of cancer significantly. Further large-scale well-matched studies are needed to verify the protective effect of bariatric surgery on cancer incidence.
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Affiliation(s)
- Zheng-Wen Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Tao Jin
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Pan-Ping Liang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ze-Dong Li
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Feng-Jun He
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ze-Hua Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiao-Hai Song
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yun-Feng Zhu
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jian-Kun Hu
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Kun Yang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China; Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Vahtera V, Pajarinen J, Kivimäki M, Ervasti J, Pentti J, Stenholm S, Vahtera J, Salminen P. Cohort study on incidence of new-onset type 2 diabetes in patients after bariatric surgery and matched controls. Br J Surg 2024; 111:znae105. [PMID: 38682425 PMCID: PMC11056794 DOI: 10.1093/bjs/znae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/04/2024] [Accepted: 03/30/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Metabolic bariatric surgery the reduces risk of new-onset type 2 diabetes in individuals with obesity, but it is unclear whether the benefit varies by sex, age, or socioeconomic status. The aim was to assess the risk of new-onset type 2 diabetes after metabolic bariatric surgery in these subgroups. METHODS The Finnish Public Sector study, a follow-up study with matched controls nested in a large employee cohort, included patients without type 2 diabetes and with a diagnosis of obesity or self-reported BMI of at least 35 kg/m2. For each patient who had laparoscopic metabolic bariatric surgery (2008-2016), two propensity-score matched controls were selected. New-onset type 2 diabetes was ascertained from linked records from national health registries. RESULTS The study included a total of 917 patients and 1811 matched controls with obesity. New-onset type 2 diabetes was diagnosed in 15 of the patients who had metabolic bariatric surgery (4.1 per 1000 person-years) and 164 controls (20.2 per 1000 person-years). The corresponding rate ratio (RR) was 0.20 (95% c.i. 0.12 to 0.35) and the rate difference (RD) was -16.1 (-19.8 to -12.3) per 1000 person-years. The risk reduction was more marked in individuals of low socioeconomic status (RR 0.10 (0.04 to 0.26) and RD -20.6 (-25.6 to -15.5) per 1000 person-years) than in those with higher socioeconomic status (RR 0.35 (0.18 to 0.66) and RD -11.5 (-16.9 to -6.0) per 1000 person-years) (Pinteraction = 0.017). No differences were observed between sexes or age groups. CONCLUSION Metabolic bariatric surgery was associated with a reduced risk of new-onset type 2 diabetes in men and women and in all age groups. The greatest benefit was observed in individuals of low socioeconomic status.
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Affiliation(s)
- Viiko Vahtera
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - Jukka Pajarinen
- Department of Plastic and Reconstructive Surgery, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Finland
- UCL Brain Sciences, University College London, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Jaana Pentti
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Paulina Salminen
- Department of Surgery, University of Turku, Turku, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
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Wolfe G, Salehi V, Browne A, Riddle R, Hall E, Fam J, Tichansky D, Myers S. Metabolic and bariatric surgery for obesity in Prader Willi syndrome: systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:907-915. [PMID: 36872159 DOI: 10.1016/j.soard.2023.01.017] [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: 04/03/2022] [Revised: 01/12/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023]
Abstract
Obesity is the leading cause of morbidity and mortality in patients with Prader-Willi Syndrome (PWS). Our objective was to compare changes in body mass index (BMI) after metabolic and bariatric surgery (MBS) for the treatment of obesity (BMI ≥35 kg/m2) in PWS. A systematic review of MBS in PWS was performed using PubMed, Embase, and Cochrane Central, identifying 254 citations. Sixty-seven patients from 22 articles met criteria for inclusion in the meta-analysis. Patients were organized into 3 groups: laparoscopic sleeve gastrectomy (LSG), gastric bypass (GB), and biliopancreatic diversion (BPD). No mortality within 1 year was reported in any of the 3 groups after a primary MBS operation. All groups experienced a significant decrease in BMI at 1 year with a mean reduction in BMI of 14.7 kg/m2 (P < .001). The LSG groups (n = 26) showed significant change from baseline in years 1, 2, and 3 (P value at year 3 = .002) but did not show significance in years 5, 7, and 10. The GB group (n = 10) showed a significant reduction in BMI of 12.1 kg/m2 in the first 2 years (P = .001). The BPD group (n = 28) had a significant reduction in BMI through 7 years with an average reduction of 10.7 kg/m2 (P = .02) at year 7. Individuals with PWS who underwent MBS had significant BMI reduction sustained in the LSG, GB, and BPD groups for 3, 2, and 7 years, respectively. No deaths within 1 year of these primary MBS operations were reported in this study or any other publication.
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Affiliation(s)
- Gunnar Wolfe
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Vesta Salehi
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania; St. Christopher's Hospital for Children, Tower Health, Philadelphia, Pennsylvania
| | | | - Renee Riddle
- Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania
| | - Erin Hall
- Temple University College of Medicine, Philadelphia, Pennsylvania
| | - John Fam
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania
| | - David Tichansky
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania
| | - Stephan Myers
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania; St. Christopher's Hospital for Children, Tower Health, Philadelphia, Pennsylvania.
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Aminian A, Wilson R, Al-Kurd A, Tu C, Milinovich A, Kroh M, Rosenthal RJ, Brethauer SA, Schauer PR, Kattan MW, Brown JC, Berger NA, Abraham J, Nissen SE. Association of Bariatric Surgery With Cancer Risk and Mortality in Adults With Obesity. JAMA 2022; 327:2423-2433. [PMID: 35657620 PMCID: PMC9166218 DOI: 10.1001/jama.2022.9009] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Obesity increases the incidence and mortality from some types of cancer, but it remains uncertain whether intentional weight loss can decrease this risk. OBJECTIVE To investigate whether bariatric surgery is associated with lower cancer risk and mortality in patients with obesity. DESIGN, SETTING, AND PARTICIPANTS In the SPLENDID (Surgical Procedures and Long-term Effectiveness in Neoplastic Disease Incidence and Death) matched cohort study, adult patients with a body mass index of 35 or greater who underwent bariatric surgery at a US health system between 2004 and 2017 were included. Patients who underwent bariatric surgery were matched 1:5 to patients who did not undergo surgery for their obesity, resulting in a total of 30 318 patients. Follow-up ended in February 2021. EXPOSURES Bariatric surgery (n = 5053), including Roux-en-Y gastric bypass and sleeve gastrectomy, vs nonsurgical care (n = 25 265). MAIN OUTCOMES AND MEASURES Multivariable Cox regression analysis estimated time to incident obesity-associated cancer (a composite of 13 cancer types as the primary end point) and cancer-related mortality. RESULTS The study included 30 318 patients (median age, 46 years; median body mass index, 45; 77% female; and 73% White) with a median follow-up of 6.1 years (IQR, 3.8-8.9 years). The mean between-group difference in body weight at 10 years was 24.8 kg (95% CI, 24.6-25.1 kg) or a 19.2% (95% CI, 19.1%-19.4%) greater weight loss in the bariatric surgery group. During follow-up, 96 patients in the bariatric surgery group and 780 patients in the nonsurgical control group had an incident obesity-associated cancer (incidence rate of 3.0 events vs 4.6 events, respectively, per 1000 person-years). The cumulative incidence of the primary end point at 10 years was 2.9% (95% CI, 2.2%-3.6%) in the bariatric surgery group and 4.9% (95% CI, 4.5%-5.3%) in the nonsurgical control group (absolute risk difference, 2.0% [95% CI, 1.2%-2.7%]; adjusted hazard ratio, 0.68 [95% CI, 0.53-0.87], P = .002). Cancer-related mortality occurred in 21 patients in the bariatric surgery group and 205 patients in the nonsurgical control group (incidence rate of 0.6 events vs 1.2 events, respectively, per 1000 person-years). The cumulative incidence of cancer-related mortality at 10 years was 0.8% (95% CI, 0.4%-1.2%) in the bariatric surgery group and 1.4% (95% CI, 1.1%-1.6%) in the nonsurgical control group (absolute risk difference, 0.6% [95% CI, 0.1%-1.0%]; adjusted hazard ratio, 0.52 [95% CI, 0.31-0.88], P = .01). CONCLUSIONS AND RELEVANCE Among adults with obesity, bariatric surgery compared with no surgery was associated with a significantly lower incidence of obesity-associated cancer and cancer-related mortality.
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Affiliation(s)
- Ali Aminian
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Rickesha Wilson
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Abbas Al-Kurd
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Chao Tu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alex Milinovich
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Matthew Kroh
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Raul J. Rosenthal
- Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic Florida, Weston
| | - Stacy A. Brethauer
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus
| | - Philip R. Schauer
- Metamor Institute, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge
| | - Michael W. Kattan
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin C. Brown
- Cancer Metabolism Program, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge
| | - Nathan A. Berger
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Jame Abraham
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Steven E. Nissen
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, Ohio
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Seki Y, Kasama K, Yokoyama R, Maki A, Shimizu H, Park H, Kurokawa Y. Bariatric surgery versus medical treatment in mildly obese patients with type 2 diabetes mellitus in Japan: Propensity score-matched analysis on real-world data. J Diabetes Investig 2022; 13:74-84. [PMID: 34265175 PMCID: PMC8756306 DOI: 10.1111/jdi.13631] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/27/2022] Open
Abstract
AIMS/INTRODUCTION To compare glycemic control 1 year after treatment in patients with mildly obese (body mass index 27.5-34.9 kg/m2 ) type 2 diabetes mellitus who underwent bariatric surgery (BS) to those who received medical treatment (MT) in Japan. MATERIALS AND METHODS A retrospective study using real-world data was carried out in electronic medical records from a tertiary care hospital and in the Japanese Medical Data Center Inc. claim database from 2008 to 2019. Each patient was propensity score-matched between the BS and the MT group by age, sex, body mass index, glycated hemoglobin and type 2 diabetes mellitus duration, and compared from the index date to the 1 year post-index. RESULTS The study included 78 patients in the BS group and 238 patients in the MT group. The mean body mass index in the BS and the MT group was 32.1 and 32.0 kg/m2 , respectively. In the BS group, the patients underwent either laparoscopic sleeve gastrectomy with or without duodenojejunal bypass. The diabetes remission rate (glycated hemoglobin <6.5% without diabetes medication) at 1 year was 59.0% in the BS group and 0.4% in the MT group (P < 0.0001). Optimal glycemic control of glycated hemoglobin <7.0% was achieved in 75.6% in the BS group and in 29.0% in the MT group (P < 0.0001). The median monthly drug costs for metabolic syndrome decreased from $US126.5 (at baseline) to $US0.0 (at 1 year) in the BS group, whereas it increased from $US52.4 to $US58.3 in the MT group. CONCLUSIONS BS for mildly obese patients with type 2 diabetes mellitus is more clinically- and cost-effective than MT in Japan.
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Affiliation(s)
- Yosuke Seki
- Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
| | - Kazunori Kasama
- Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
| | - Renzo Yokoyama
- Weight Loss and Metabolic Surgery CenterYotsuya Medical CubeTokyoJapan
| | - Akihiro Maki
- Johnson & Johnson K.K. Medical CompanyTokyoJapan
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9
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Singhal R, Wiggins T, Super J, Alqahtani A, Nadler EP, Ludwig C, Tahrani A, Mahawar K. 30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic - The GENEVA study. Pediatr Obes 2021; 16:e12832. [PMID: 34240553 DOI: 10.1111/ijpo.12832] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/05/2021] [Revised: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. OBJECTIVES This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. METHODS This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. RESULTS One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2 , respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. CONCLUSIONS MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients.
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Affiliation(s)
- Rishi Singhal
- Upper GI Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Bariatric Surgery, Medical Director, Healthier Weight, Birmingham, UK
| | - Tom Wiggins
- Upper GI Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan Super
- Upper GI Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aayed Alqahtani
- Department of Bariatric Surgery, New You Medical Center, Riyadh, Saudi Arabia
| | - Evan P Nadler
- Department of Bariatric Surgery, Children's National Hospital, Washington, DC, USA
| | - Christian Ludwig
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Abd Tahrani
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Diabetes and Endocrinology, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Kamal Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
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Dash S, Everett K, Jackson T, Okrainec A, Urbach DR, Sockalingam S, Shah BR, Farkouh ME. Cardiorenal outcomes in eligible patients referred for bariatric surgery. Obesity (Silver Spring) 2021; 29:2035-2043. [PMID: 34724336 DOI: 10.1002/oby.23294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/09/2021] [Accepted: 08/16/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Bariatric surgery is associated with reduced atherosclerotic cardiovascular disease (CVD) and heart failure hospitalization in people with type 2 diabetes (T2D) and those with prior CVD. Most patients undergoing bariatric surgery do not have T2D or CVD. Many otherwise eligible patients do not have surgery because of self-exclusion. Clinical outcomes in these groups are less established. METHODS This study retrospectively assessed cardiorenal outcomes in 8,568 patients after acceptance of referral for surgery. RESULTS A total of 63.8% patients did not undergo surgery. After multivariate adjustment for sex, age, BMI, income quintile, distance from hospital, hypertension, T2D, and CVD, hazard ratios (HR) for the primary (incident myocardial infarction, stroke, heart failure hospitalization, and death; HR = 0.52, 95% CI: 0.4-0.66) and secondary CVD outcomes (primary outcomes and coronary/carotid revascularization; HR = 0.53, 95% CI: 0.42-0.67) were lower in the surgery cohort. This reduction was seen in those with (primary: HR = 0.45, 95% CI: 0.32-0.63, secondary: HR = 0.47, 95% CI: 0.34-0.65) and without T2D (primary: HR = 0.61, 95% CI: 0.42-0.88, secondary: HR = 0.53, 95% CI: 0.42-0.67). Reduced kidney disease (HR = 0.46, 95% CI: 0.22-0.92) but increased liver disease hospitalization (HR = 2.5, 95% CI: 1.45-4.27) was observed with surgery. CONCLUSIONS Non-progression to surgery associates with increased CVD despite low baseline prevalence of CVD. The cardiorenal benefits of bariatric surgery warrant confirmation in a well-powered randomized clinical trial.
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Affiliation(s)
- Satya Dash
- Division of Endocrinology, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bariatric Program, University Health Network, Toronto, Ontario, Canada
| | - Karl Everett
- Division of Endocrinology, Sunnybrook Health Sciences Centre Toronto, Toronto, Ontario, Canada
| | - Timothy Jackson
- Bariatric Program, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Allan Okrainec
- Bariatric Program, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David R Urbach
- Bariatric Program, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Bariatric Program, University Health Network, Toronto, Ontario, Canada
- Centre for Addiction, & Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, Sunnybrook Health Sciences Centre Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- St. Michael's Hospital Research Institute, Toronto, Ontario, Canada
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11
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Boyers D, Retat L, Jacobsen E, Avenell A, Aveyard P, Corbould E, Jaccard A, Cooper D, Robertson C, Aceves-Martins M, Xu B, Skea Z, de Bruin M. Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model. Int J Obes (Lond) 2021; 45:2179-2190. [PMID: 34088970 PMCID: PMC8455321 DOI: 10.1038/s41366-021-00849-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m2), who are more at risk of obesity related diseases. METHODS An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results. RESULTS RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption. CONCLUSIONS RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.
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Affiliation(s)
- D Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
| | | | - E Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - A Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
- NIHR Oxford Biomedical Research Centre (BRC) Obesity, Diet and Lifestyle Theme, Oxford, UK
- NIHR Applied Research Collaboration (ARC) Oxford and Thames Valley, Oxford, UK
| | | | | | - D Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - C Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - M Aceves-Martins
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - B Xu
- UK Health Forum, London, UK
| | - Z Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - M de Bruin
- Health Psychology, University of Aberdeen, Aberdeen, UK
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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Brown RM, Guerrero-Hreins E, Brown WA, le Roux CW, Sumithran P. Potential gut-brain mechanisms behind adverse mental health outcomes of bariatric surgery. Nat Rev Endocrinol 2021; 17:549-559. [PMID: 34262156 DOI: 10.1038/s41574-021-00520-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 02/06/2023]
Abstract
Bariatric surgery induces sustained weight loss and metabolic benefits via notable effects on the gut-brain axis that lead to alterations in the neuroendocrine regulation of appetite and glycaemia. However, in a subset of patients, bariatric surgery is associated with adverse effects on mental health, including increased risk of suicide or self-harm as well as the emergence of depression and substance use disorders. The contributing factors behind these adverse effects are not well understood. Accumulating evidence indicates that there are important links between gut-derived hormones, microbial and bile acid profiles, and disorders of mood and substance use, which warrant further exploration in the context of changes in gut-brain signalling after bariatric surgery. Understanding the basis of these adverse effects is essential in order to optimize the health and well-being of people undergoing treatment for obesity.
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Affiliation(s)
- Robyn M Brown
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Biochemistry and Pharmacology, School of Biomedical Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Eva Guerrero-Hreins
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Biochemistry and Pharmacology, School of Biomedical Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Wendy A Brown
- Department of Surgery, Central Clinical School, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College, Dublin, Ireland
| | - Priya Sumithran
- Department of Medicine (St Vincent's), University of Melbourne, Melbourne, Victoria, Australia.
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.
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13
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Paranjape CS, Gentry RD, Regan CM. Cost-Effectiveness of Bariatric Surgery Prior to Posterior Lumbar Decompression and Fusion in an Obese Population with Degenerative Spondylolisthesis. Spine (Phila Pa 1976) 2021; 46:950-957. [PMID: 33428363 DOI: 10.1097/brs.0000000000003940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cost-effectiveness analysis. OBJECTIVE To determine if bariatric surgery prior to posterior lumbar decompression and fusion (PLDF) for degenerative spondylolisthesis (DS) is a cost-effective strategy. SUMMARY OF BACKGROUND DATA Obesity poses significant perioperative challenges for DS. Treated operatively, obese patients achieve worse outcomes relative to non-obese peers. Concomitantly, they fare better with surgery than with nonoperative measures. These competing facts create uncertainty in determining optimal treatment algorithms for obese patients with DS. The role of bariatric surgery merits investigation as a potentially cost-effective optimization strategy prior to PLDF. METHODS We simulated a Markov model with two cohorts of obese individuals with DS. 10,000 patients with body mass index (BMI) more than or equal to 30 in both arms were candidates for both bariatric surgery and PLDF. Subjects were assigned either to (1) no weight loss intervention with immediate operative or nonoperative management ("traditional arm") or (2) bariatric surgery 2 years prior to entering the same management options ("combined protocol").Published costs, utilities, and transition probabilities from the literature were applied. A willingness to pay threshold of $100,000/QALY was used. Sensitivity analyses were run for all variables to assess the robustness of the model. RESULTS Over a 10-year horizon, the combined protocol was dominant ($13,500 cheaper, 1.15 QALY more effective). Changes in utilities of operative and nonoperative treatments in non-obese patients, the obesity cost-multiplier, cost of bariatric surgery, and the probability of success of nonoperative treatment in obese patients led to decision changes. However, all thresholds occurred outside published bounds for these variables. CONCLUSION The combined protocol was less costly and more effective than the traditional protocol. Results were robust with thresholds occurring outside published ranges. Bariatric surgery is a viable, cost-effective preoperative strategy in obese patients considering elective PLDF for DS.Level of Evidence: 3.
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Affiliation(s)
- Chinmay S Paranjape
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC
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14
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Mamidanna R, Askari A, Patel K, Adil MT, Jain V, Jambulingam P, Whitelaw D, Rashid F, Munasinghe A, Al-Taan O. Safety and feasibility of resuming bariatric surgery under the cloud of COVID-19. Ann R Coll Surg Engl 2021; 103:524-529. [PMID: 34192498 PMCID: PMC10751989 DOI: 10.1308/rcsann.2021.0053] [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] [Accepted: 01/11/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Because of the COVID-19 pandemic, numerous bariatric surgical units globally have halted weight loss surgery. Obesity itself has been shown to be a predictor of poor outcome in people infected with the virus. The aim of this study was to report our experience as a high-volume bariatric institution resuming elective weight loss surgery safely amidst emergency admissions of COVID-19-positive patients. METHODS A standard operating procedure based on national guidance and altered to accommodate local considerations was initiated across the hospital. Data were collected prospectively for 50 consecutive patients undergoing bariatric surgery following recommencement of elective surgery after the first national lockdown in the UK. RESULTS Between 28 June and 5 August 2020, a total of 50 patients underwent bariatric surgery of whom 94% were female. Median age was 41 years and median body mass index was 43.8 (interquartile range 40.0-48.8)kg/m2. Half of the patients (n = 25/50) underwent laparoscopic sleeve gastrectomy and half underwent Roux-en-Y gastric bypass (RYGB). Of these 50 patients, 9 (18%) had revisional bariatric surgery. Overall median length of hospital stay was 1 day, with 96% of the study population being discharged within 24h of surgery. The overall rate of readmission was 6% and one patient (2%) returned to theatre with an obstruction proximal to jejuno-jejunal anastomosis. None of the patients exhibited symptoms or tested positive for COVID-19. CONCLUSION With appropriately implemented measures and precautions, resumption of bariatric surgery during the COVID-19 pandemic appears feasible and safe with no increased risk to patients.
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Affiliation(s)
- R Mamidanna
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | - A Askari
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | - K Patel
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | - MT Adil
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | - V Jain
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | | | - D Whitelaw
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | - F Rashid
- Bedfordshire Hospitals NHS Foundation Trust,
UK
| | | | - O Al-Taan
- Bedfordshire Hospitals NHS Foundation Trust,
UK
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15
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Perez NP, Stanford FC, Williams K, Johnson VR, Nadler E, Bowen-Jallow K. A framework for studying race-based disparities in the use of metabolic and bariatric surgery for the management of pediatric obesity. Am J Surg 2021; 222:49-51. [PMID: 33288224 PMCID: PMC9909247 DOI: 10.1016/j.amjsurg.2020.11.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Numa P Perez
- Massachusetts General Hospital, Department of Surgery, 55 Fruit St, GRB 425, Boston, MA, 02114, USA; Massachusetts General Hospital, Healthcare Transformation Lab, 50 Staniford St, 7(th) Floor, Boston, MA, 02114, USA.
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine - Division of Endocrinology-Neuroendocrine, Department of Pediatrics - Division of Endocrinology, 50 Staniford Street, 4th Floor, Boston, MA, 02114, USA
| | - Kibileri Williams
- Children's National Hospital, Division of Pediatric Surgery, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Veronica R Johnson
- Center for Obesity Medicine and Metabolic Performance, Department of Surgery, McGovern Medical School, 6700 West Loop South, Suite 500, Bellaire, TX, 77401, USA
| | - Evan Nadler
- Children's National Hospital, Division of Pediatric Surgery, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Kanika Bowen-Jallow
- University of Texas Medical Branch, Department of Surgery, 301 University Boulevard, Galveston, TX, 77555, USA
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Abstract
Background Excess body weight has been associated with worsening breast cancer survival. While bariatric surgery has been associated with less incident of breast cancer, the role that bariatric surgery plays after breast cancer diagnosis in terms of both feasibility and in preventing breast cancer recurrence is unclear. Methods We report the outcomes of 13 individuals who underwent bariatric surgery after definitive breast cancer treatment at a single institution. Results Thirteen females diagnosed with breast cancer (69.2% stage I, 23.1% stage II) at a median age of 42 years received bariatric surgery between 2001 and 2017. The median age of bariatric surgery was 52 years. Of the 13 patients, 46.2% underwent laparoscopic Roux-en-Y gastric bypass and 38.5% laparoscopic sleeve gastrectomy. The median time from breast cancer treatment to bariatric surgery was 3 years. The procedures were well tolerated. One female developed an abdominal wall hematoma. The average weight loss after 1 year and 2 years was 28.1% and 28.2%, respectively. There was a single breast cancer recurrence with a median follow-up of 11.7 years after breast cancer diagnosis and 5.3 years after bariatric surgery. Conclusions Bariatric surgery after breast cancer treatment is feasible and well tolerated. Prospective trials evaluating bariatric surgery in obese breast cancer survivors should be considered.
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Affiliation(s)
- Shijia Zhang
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, 420 Delaware Street, SE, MMC 480, Minneapolis, MN, 55455, USA
| | - Sayeed Ikramuddin
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Heather C Beckwith
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, 420 Delaware Street, SE, MMC 480, Minneapolis, MN, 55455, USA
| | - Adam C Sheka
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Keith M Wirth
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Anne H Blaes
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, 420 Delaware Street, SE, MMC 480, Minneapolis, MN, 55455, USA.
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Almandoz JP, Xie L, Schellinger JN, Mathew MS, Bismar N, Ofori A, Kukreja S, Schneider B, Vidot D, Messiah SE. Substance use, mental health and weight-related behaviours during the COVID-19 pandemic in people with obesity. Clin Obes 2021; 11:e12440. [PMID: 33539652 PMCID: PMC7988649 DOI: 10.1111/cob.12440] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 12/14/2022]
Abstract
Studies have shown the negative impact of COVID-19 lockdown orders on mental health and substance use in the general population. The aim of this study was to examine the impact of the COVID-19 pandemic onsubstance use, mental health and weight-related behaviors in a sample of adults with obesity after lockdown orders were lifted (June-September 2020). A retrospective medical chart review identified patients with obesity from one university-based obesity medicine clinic, and two metabolic and bariatric surgery (MBS) practices. Patients who completed an online survey from June 1, 2020 to September 30, 2020 were included. The primary outcome measure was substance use (various drugs, alcohol, tobacco). Substance use and mental health survey questions were based on standardized, validated instruments. A total of 589 patients (83.3% female, mean age 53.6 years [SD 12.8], mean BMI 35.4 [SD 9.1], 54.5% Non-Hispanic white, 22.3% post-MBS) were included. Seventeen patients (2.9%) tested positive for SARS-CoV-2 and 13.5% reported symptoms. Nearly half (48.4%) of the sample reported recreational substance use and 9.8% reported increased use since the start of the pandemic. There was substantial drug use reported (24.3% opioids, 9.5% sedative/tranquilizers, 3.6% marijuana, and 1% stimulants). Patients who reported stockpiling food more (adjusted Odds Ratio [aOR] 1.50, 95% CI 1.03-2.18), healthy eating more challenging (aOR 1.47, 95% CI 1.01-2.16), difficulty falling asleep (aOR 1.64, 95% CI 1.14-2.34), and anxiety (aOR 1.47, 95% CI 1.01-2.14) were more likely to report substance use versus non-users. Results here show that the COVID-19 pandemic is having a deleterious impact on substance use, mental health and weight-related health behaviors in people with obesity regardless of infection status.
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Affiliation(s)
- Jaime P. Almandoz
- Department of Internal Medicine, Division of EndocrinologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Luyu Xie
- Department of Epidemiology, Human Genetics and Environmental SciencesUniversity of Texas Health Science Center, School of Public HealthDallasTexasUSA
- Center for Pediatric Population HealthChildren's Health System of Texas and UT Health School of Public HealthDallasTexasUSA
| | - Jeffrey N. Schellinger
- Department of Internal Medicine, Division of EndocrinologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - M. Sunil Mathew
- Department of Epidemiology, Human Genetics and Environmental SciencesUniversity of Texas Health Science Center, School of Public HealthDallasTexasUSA
- Center for Pediatric Population HealthChildren's Health System of Texas and UT Health School of Public HealthDallasTexasUSA
| | - Nora Bismar
- Department of Internal Medicine, Division of EndocrinologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ashley Ofori
- Department of Epidemiology, Human Genetics and Environmental SciencesUniversity of Texas Health Science Center, School of Public HealthDallasTexasUSA
- Center for Pediatric Population HealthChildren's Health System of Texas and UT Health School of Public HealthDallasTexasUSA
| | | | - Benjamin Schneider
- Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Denise Vidot
- School of NursingUniversity of MiamiMiamiFloridaUSA
| | - Sarah E. Messiah
- Department of Epidemiology, Human Genetics and Environmental SciencesUniversity of Texas Health Science Center, School of Public HealthDallasTexasUSA
- Center for Pediatric Population HealthChildren's Health System of Texas and UT Health School of Public HealthDallasTexasUSA
- Present address:
Paul M. Bass Administrative and Clinical CenterDallasTexasUSA
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Marco A, Marco P. Improvement in the cardiovascular profile of patients with morbid obesity following bariatric surgery: Effect on hypercoagulability. Medicine (Baltimore) 2021; 100:e25280. [PMID: 33761732 PMCID: PMC9281975 DOI: 10.1097/md.0000000000025280] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/03/2021] [Indexed: 01/05/2023] Open
Abstract
Obesity is an inflammatory state related to vascular endothelium dysfunction. It generates a biological situation of hypercoagulability increasing the risk of thrombosis. This prothrombotic condition could be improved by bariatric surgery.The main objective was to analyze the impact of bariatric surgery on cardiovascular risk factors (CVRF) associated with changes in thrombin generation and procoagulant activity of microparticles (MP).We present a prospective longitudinal study including consecutive patients candidate for bariatric surgery. We performed 3 sequential clinical visits: at inclusion, before surgery after completing the modified fasting phase, and 6 months after surgery. We analyzed CVRF, thrombin generation, and MP activity. The data analysis was performed using a logistic regression model to determine changes over time of hemostatic parameters and body mass index (BMI). McNemar test for binary variables was used to analyze the CVRF.We included 94 patients (66 women), with an average age of 45.7 ± 10.1 years. The mean BMI reduction at the end of the follow-up was 15.5 ± 4.2 kg/m2. We detected a statistically significant improvement in CVRF: hypertension, diabetes mellitus, dyslipidemia, and obstructive sleep apnea, as well as a significant reduction in thrombin generation capacity and procoagulant MP activity.Massive weight loss induced by bariatric surgery improves the cardiovascular profile, associated with a reduction in the hypercoagulable status.
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Affiliation(s)
- Ana Marco
- Hematology and Hemotherapy Service, Thrombosis and Hemostasis Department, University General Hospital
- Biomedical Research Institute
| | - Pascual Marco
- Hematology and Hemotherapy Service, Thrombosis and Hemostasis Department, University General Hospital
- Biomedical Research Institute
- Clinical Medicine Department, Miguel Hernández University, Alicante, Spain
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Purnell JQ, Dewey EN, Laferrère B, Selzer F, Flum DR, Mitchell JE, Pomp A, Pories WJ, Inge T, Courcoulas A, Wolfe BM. Diabetes Remission Status During Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study. J Clin Endocrinol Metab 2021; 106:774-788. [PMID: 33270130 PMCID: PMC7947785 DOI: 10.1210/clinem/dgaa849] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 07/14/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Few studies have examined the clinical characteristics that predict durable, long-term diabetes remission after bariatric surgery. OBJECTIVE To compare diabetes prevalence and remission rates during 7-year follow-up after Roux-en-Y gastric bypass (RYGB) and laparoscopic gastric banding (LAGB). DESIGN An observational cohort of adults with severe obesity recruited between 2006 and 2009 who completed annual research assessments for up to 7 years after RYGB or LAGB. SETTING Ten US hospitals. PARTICIPANTS A total sample of 2256 participants, 827 with known diabetes status at both baseline and at least 1 follow-up visit. INTERVENTIONS Roux-en-Y gastric bypass or LAGB. MAIN OUTCOME MEASURES Diabetes rates and associations of patient characteristics with remission status. RESULTS Diabetes remission occurred in 57% (46% complete, 11% partial) after RYGB and 22.5% (16.9% complete, 5.6% partial) after LAGB. Following both procedures, remission was greater in younger participants and those with shorter diabetes duration, higher C-peptide levels, higher homeostatic model assessment of β-cell function (HOMA %B), and lower insulin usage at baseline, and with greater postsurgical weight loss. After LAGB, reduced HOMA insulin resistance (IR) was associated with a greater likelihood of diabetes remission, whereas increased HOMA-%B predicted remission after RYGB. Controlling for weight lost, diabetes remission remained nearly 4-fold higher compared with LAGB. CONCLUSIONS Durable, long-term diabetes remission following bariatric surgery is more likely when performed soon after diagnosis when diabetes medication burden is low and beta-cell function is preserved. A greater weight-independent likelihood of diabetes remission after RYGB than LAGB suggests mechanisms beyond weight loss contribute to improved beta-cell function after RYGB.Trial Registration clinicaltrials.gov Identifier: NCT00465829.
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Affiliation(s)
- Jonathan Q Purnell
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Correspondence and Reprint Requests: Jonathan Q Purnell, MD, Knight Cardiovascular Institute, HRC5N, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239. E-mail:
| | - Elizabeth N Dewey
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Blandine Laferrère
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Faith Selzer
- Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - James E Mitchell
- Department of Clinical Neuroscience, University of North Dakota, Fargo, ND, USA
| | - Alfons Pomp
- Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Walter J Pories
- Department of Surgery, East Carolina University, Greenville, NC, USA
| | - Thomas Inge
- Department of Surgery, University of Colorado, Denver, CO, USA
| | - Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
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Zeller MH, Kidwell KM, Reiter-Purtill J, Jenkins TM, Michalsky MP, Mitchell JE, Courcoulas AP, Inge TH. Cigarette Use and Adolescent Metabolic and Bariatric Surgery. Obesity (Silver Spring) 2021; 29:579-586. [PMID: 33528876 PMCID: PMC8023426 DOI: 10.1002/oby.23084] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to track conventional cigarette smoking behaviors and associated correlates in adolescents with severe obesity who did or did not undergo metabolic and bariatric surgery to 4 years after surgery/baseline. METHODS Utilizing a prospective controlled design, surgical (n = 153; mean BMI = 52) and nonsurgical (n = 70; mean BMI = 47) groups that completed assessments before surgery/at baseline and at Years 2 and 4 post surgery (Year 4: n = 117 surgical [mean BMI = 38]; n = 56 nonsurgical [mean BMI = 48]) were compared. Separate logistic regression models tested correlates of Year 4 current smoking. RESULTS More than half of participants (surgical: 55%; nonsurgical: 60%) had ever smoked a cigarette, with current smoking increasing with time. Groups did not differ in Year 4 current smoking (surgical: 23%; nonsurgical: 33%), with ≈ 50% meeting criteria for "heavy" smoking (≥ half pack/day) and ≈ 40% smoking their first cigarette before ninth grade. Factors associated with higher odds of Year 4 current smoking included dysregulation (P < 0.001), internalizing symptoms (P = 0.01), alcohol use (P = 0.04), caregiver smoking (P < 0.001), friend smoking (P = 0.001), and perceiving low harm (P = 0.02), plus greater percent weight loss (P = 0.03) in the surgical group. CONCLUSIONS Smoking is a clinical health challenge for adolescents and young adults with severe obesity, including those who have undergone metabolic and bariatric surgery. Upstream identification, monitoring, and intervention to prevent smoking uptake and escalation in youth with obesity across settings should be prioritized.
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Affiliation(s)
- Meg H Zeller
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Katherine M Kidwell
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Reiter-Purtill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Todd M Jenkins
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Marc P Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - James E Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota, Fargo, North Dakota, USA
| | - Anita P Courcoulas
- Division of Minimally Invasive General and Bariatric Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Thomas H Inge
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
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21
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Çalikoğlu İ, Özgen G, Yerdel MA. Inadvertent stapling of the orogastric tube during bariatric surgery: Report of 3 cases and a systematic review. Medicine (Baltimore) 2021; 100:e24144. [PMID: 33466188 PMCID: PMC7808471 DOI: 10.1097/md.0000000000024144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Entrapment of an orally introduced tube by stapling/stitching is an intra-operative complication of bariatric surgery with grave consequences. Incidence is unknown. No prevention/management strategy is available. A systematic review was performed to assess the absolute reported observed risk and incidence. Additionally, data on 3 cases during our entire sleeve gastrectomy (SG) experience is evaluated. METHODS Literature is reviewed using PubMed/Web of science data-bases. Data was recorded prospectively. Videos of orally introduced tube staplings were re-watched, presentation/recognition/management were re-evaluated. A protocol ensuring the removal of the small caliber orogastric tube (OGT) by the surgeons direct inspection was introduced after the 3rd entrapment. RESULTS Review revealed OGT as the most commonly entrapped tube following temperature probe and bougie. SG/stapling were the most common causative operation/reason, respectively. Leak rates over 20%, conversion, early-late re-operations and mortality were reported. During our 948 consecutive SGs, 3 OGT entrapments (0.32%), third one with double stapling, occurred. All were recognized/managed intraoperatively by freeing the entrapped-end of the OGT from the sleeve part of the staple-line. In doubly stapled case, second transected end could only be recognized when routine reinforcement suturing come in proximity. Defects were continuously stitched with barbed suture. No morbidity occurred. One-year excess-weight-loss was 82%. A pre-protocol incidence of 0.56% (n: 3/534) dropped to nil in the remaining 414. CONCLUSION Iatrogenic stapling of the OGT during SG is rare, but morbid. It must be avoided by a strict protocol. Upon occurrence/recognition, stapling must immediately stop until the "entirety" of the tube, including the "specimen-part", is retrieved, to avoid double entrapment.
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Affiliation(s)
- İsmail Çalikoğlu
- İstanbul Bariatrics, Obesity and Advanced Laparoscopy Center, İstanbul, Turkey
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22
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de Sousa Paredes SC, Mota-Garcia F. Prevalence of nutritional deficiencies in bariatric surgery candidates and its effect on metabolic status. Hormones (Athens) 2020; 19:505-514. [PMID: 32812214 DOI: 10.1007/s42000-020-00234-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/20/2019] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Nutritional deficiencies are common among obese individuals and constitute one of the main concerns in the bariatric field. The aim of this study was to investigate nutritional status in bariatric surgery candidates, comparing individuals with and without metabolic syndrome (MetS) and to explore possible associations between nutritional and metabolic status. METHODS Patients accepted for gastric sleeve surgery between 2010 and 2015 were included and anthropometric and metabolic parameters were recorded before surgery. Univariate and multivariate analyses were applied in order to find possible associations between MetS, nutritional, anthropometric, and metabolic parameters. RESULTS A total of 330 patients were evaluated (285 females, mean age of 41.88 ± 10.4 years old, mean body mass index 43.91 ± 6.2 kg/m2) and MetS was present in 47% of them. Patients without MetS presented a higher prevalence of folate deficiency (12 vs. 2%, p < 0.001). Male gender, older age, lower magnesium levels, and higher BMI and calcium levels were predictors of a greater number of MetS components. Male gender, a greater number of MetS components, and lower magnesium were predictors of higher homeostatic model assessment for insulin resistance (HOMA-IR). CONCLUSIONS The rising prevalence of obesity is causing a parallel increase in the use of bariatric surgery. The high occurrence of preoperative nutritional deficiencies can impair metabolic status and contribute to a worse outcome after surgery. Nutritional assessment and improvement before surgery may be crucial to optimize patient status, and future studies should explore the effect of the correction of these deficiencies in the metabolic status of these patients.
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Affiliation(s)
- Sílvia Cristina de Sousa Paredes
- Endocrinology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal.
- Department of Public Health and Forensic Sciences, and Medical Education, Medical Education Unit, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal.
| | - Fernando Mota-Garcia
- Clinical Pathology Department, Hospital de Braga, Sete Fontes, São Victor, 4710-243, Braga, Portugal
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23
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Bianciardi E, Imperatori C, Niolu C, Campanelli M, Franceschilli M, Petagna L, Zerbin F, Siracusano A, Gentileschi P. Bariatric Surgery Closure During COVID-19 Lockdown in Italy: The Perspective of Waiting List Candidates. Front Public Health 2020; 8:582699. [PMID: 33313038 PMCID: PMC7706656 DOI: 10.3389/fpubh.2020.582699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/12/2020] [Indexed: 12/27/2022] Open
Abstract
Background: From the beginning of March 2020, lockdown regimens prevented patients with obesity from receiving bariatric surgery. Surgical emergencies and oncological procedures were the only operations allowed in public hospitals. Consequently, patients with morbid obesity were put in a standby situation. With the aim at exploring the viewpoint of our future bariatric surgery patients, we built a questionnaire concerning obesity and COVID-19. Method: A total of 116 bariatric surgery candidates were approached using a telephonic interview during the Italian lockdown. Results: Of the total sample, 73.8% were favorable to regular bariatric surgery execution. Forty percent were concerned about their own health status due to the COVID-19 emergency, and 61.1% were troubled by the temporary closure of the bariatric unit. The majority of the sample were eating more. Forty-five percent and the 27.5% of patients reported a worsening of the emotional state and physical health, respectively. Most of the patients (52.2%) considered themselves more vulnerable to COVID-19, especially individuals with class III obesity. Patients who reported an increased consumption of food were younger (43.44 ± 12.16 vs. 49.18 ± 12.66; F = 4.28, p = 0.042). No gender difference emerged. Conclusion: The lockdown had a negative result on Italian patients' psychological well-being and eating habits. The majority of patients would have proceeded with the surgery even during the COVID-19 emergency. Effective management and bariatric surgery should be restarted as soon as possible.
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Affiliation(s)
- Emanuela Bianciardi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Cinzia Niolu
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Michela Campanelli
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Marzia Franceschilli
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Lorenzo Petagna
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
| | - Francesca Zerbin
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome “Tor Vergata”, Rome, Italy
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24
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Gasoyan H, Soans R, Ibrahim JK, Aaronson WE, Sarwer DB. Do Insurance-mandated Precertification Criteria and Insurance Plan Type Determine the Utilization of Bariatric Surgery Among Individuals With Private Insurance? Med Care 2020; 58:952-957. [PMID: 32868693 PMCID: PMC7572545 DOI: 10.1097/mlr.0000000000001358] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Access to bariatric surgery is restricted by insurers in numerous ways, including by precertification criteria such as 3-6 months preoperative supervised medical weight management and documented 2-year weight history. OBJECTIVES To investigate if there is an association between the aforementioned precertification criteria, insurance plan type, and the likelihood of undergoing bariatric surgery, after controlling for potential sociodemographic confounders. RESEARCH DESIGN The study was conducted using the Pennsylvania Health Care Cost Containment Council's data in 5 counties of Pennsylvania in 2016 and records of preoperative insurance requirements maintained by the Temple University Bariatric Surgery Program.Privately insured bariatric surgery patients and individuals who met the eligibility criteria but did not undergo surgery were identified and 1:1 matched by sex, race, age group, and zip code (n=1054). Univariate tests and logistic regression analysis were utilized for data analysis. RESULTS The insurance requirement for 3-6 months preoperative supervised medical weight management was associated with smaller odds of undergoing surgery [odds ratio (OR)=0.459; 95% confidence interval (CI), 0.253-0.832; P=0.010], after controlling for insurance plan type and the requirement for documented weight history.Preferred provider organization (OR=1.422; 95% CI, 1.063-1.902; P=0.018) and fee-for-service (OR=1.447; 95% CI, 1.021-2.050; P=0.038) plans were associated with greater odds of undergoing surgery, compared with health maintenance organization plans, after controlling for the studied precertification requirements. The documented weight history requirement was not a significant predictor of the odds of undergoing surgery (P=0.132). CONCLUSIONS There is a need for consideration of insurance benefits design as a determinant of access to bariatric surgery.
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Affiliation(s)
- Hamlet Gasoyan
- Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Rohit Soans
- Bariatric Surgery Program, Temple University Hospital, Philadelphia, Pennsylvania
| | - Jennifer K. Ibrahim
- Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - William E. Aaronson
- Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - David B. Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
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Moussa O, Zakeri R, Arhi C, O'Kane M, Snowdon-Carr V, Menon V, Mahawar K, Purkayastha S. Impact of COVID-19 on Obesity Management Services in the United Kingdom (The COMS-UK study). Obes Surg 2020; 31:904-908. [PMID: 33048286 PMCID: PMC7552587 DOI: 10.1007/s11695-020-05005-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 12/15/2022]
Abstract
Coronavirus Disease-2019 (COVID-19) has had a severe impact on all aspects of global healthcare delivery. This study aimed to investigate the nationwide impact of the pandemic on obesity management services in the UK in a questionnaire-based survey conducted of professionals involved in the delivery. A total of 168 clinicians took the survey; the majority of which maintained their usual clinical roles and were not redeployed except physicians and nurse specialists. Nearly all (97.8%) elective bariatric surgery was cancelled, 67.3% of units cancelled all multidisciplinary meeting activity, and the majority reduced clinics (69.6%). Most respondents anticipated that the services would recommence within 1–3 months. This study found that the COVID-19 pandemic has had a severe impact on the services involved in the management of patients suffering from severe, complex obesity in the UK
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Affiliation(s)
- Osama Moussa
- Division of Surgery and Cancer, Imperial College London, London, W2 1NY, UK.
- Department of Surgery, University College London Hospital, London, UK.
| | - Roxanna Zakeri
- Department of Surgery, University College London Hospital, London, UK
| | - Chanpreet Arhi
- Department of Surgery, University Hospital Lewisham, London, UK
| | - Mary O'Kane
- Department of dietetics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Vinod Menon
- Department of Bariatric surgery, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Kamal Mahawar
- Department of Bariatric Surgery, Royal Sunderland Hospital, Sunderland, UK
| | - Sanjay Purkayastha
- Division of Surgery and Cancer, Imperial College London, London, W2 1NY, UK
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Benito E, Gómez-Martin JM, Vega-Piñero B, Priego P, Galindo J, Escobar-Morreale HF, Botella-Carretero JI. Fertility and Pregnancy Outcomes in Women with Polycystic Ovary Syndrome Following Bariatric Surgery. J Clin Endocrinol Metab 2020; 105:5868099. [PMID: 32754732 DOI: 10.1210/clinem/dgaa439] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 05/28/2020] [Accepted: 07/02/2020] [Indexed: 12/16/2022]
Abstract
CONTEXT Restoration of ovulation is quite common in women with polycystic ovary syndrome (PCOS) after surgically induced weight loss. Whether or not this results in an improvement of PCOS-associated infertility is uncertain. OBJECTIVE To study fertility and gestational outcomes in women with PCOS after bariatric surgery. DESIGN Unicenter cohort study. SETTING Academic hospital. PATIENTS Two hundred and sixteen premenopausal women were screened for PCOS before bariatric surgery. Women were followed-up after the intervention until mid-2019 regardless of having or not PCOS. INTERVENTIONS All participants underwent bariatric surgery from 2005 to 2015. MAIN OUTCOME MEASURES Pregnancy and live birth rates in the PCOS and control groups. RESULTS In women seeking fertility, pregnancy rates were 95.2% in PCOS and 76.9% in controls (P = 0.096) and live birth rates were 81.0% and 69.2%, respectively (P = 0.403). The time to achieve the first pregnancy after surgery was 34 ± 28 months in women with PCOS and 32 ± 25 months in controls. Albeit the mean birth weight was lower (P = 0.040) in newborns from women with PCOS (2763 ± 618 g) compared with those from controls (3155 ± 586 g), the number of newborns with low birth weight was similar in both groups (3 in the PCOS group and 1 in the controls, P = 0.137). Maternal (17.6% in PCOS and 22.2% in controls, P = 0.843) and neonatal (23.5% in PCOS and 14.8% in controls, P = 0.466) complications were rare, showing no differences between groups. CONCLUSIONS Pregnancy and fertility rates in very obese women with PCOS after bariatric surgery were high, with few maternal and neonatal complications.
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Affiliation(s)
- Estela Benito
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Jesús M Gómez-Martin
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Belén Vega-Piñero
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Pablo Priego
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Julio Galindo
- Department of General and Digestive Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Héctor F Escobar-Morreale
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Centro de Investigación Biomédica en Red Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) & Instituto Ramón y Cajal de Investigación Sanitaria (IRyCIS), Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - José I Botella-Carretero
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN) & IRyCIS, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
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27
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Lazaridis II, Kraljević M, Schneider R, Klasen JM, Schizas D, Peterli R, Kow L, Delko T. The Impact of the COVID-19 Pandemic on Bariatric Surgery: Results from a Worldwide Survey. Obes Surg 2020; 30:4428-4436. [PMID: 32654018 PMCID: PMC7352090 DOI: 10.1007/s11695-020-04830-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The ongoing "coronavirus disease 19" (COVID-19) pandemic has had a strong effect on the delivery of surgical care worldwide. Elective surgeries have been canceled or delayed in order to reallocate resources to the treatment of COVID-19 patients. Currently, the impact of the COVID-19 pandemic on bariatric and metabolic surgical practice remains unclear. METHODS An internet-based online survey was performed among bariatric surgeons worldwide. The survey was sent to bariatric surgeons via the International Bariatric Club Facebook group and by electronic mail via the International Federation for the Surgery of Obesity and metabolic disorders (IFSO) secretariat to members of the associated national IFSO societies. RESULTS One hundred sixty-nine (n = 169) bariatric surgeons participated in the survey. The majority of the respondents postponed preoperative upper gastrointestinal tract endoscopies, appointments in the outpatient clinic and bariatric operations. Most surgeons performed video calls for follow-up appointments instead of meeting the patients in the outpatient clinics. Laparoscopy was still the preferred treatment for surgical emergencies, but a trend towards conservative treatment of acute appendicitis and acute cholecystitis was shown. Rapid preoperative COVID-19 testing availability was poor; therefore, routine screening of emergency bariatric cases was not widely provided. A wide variance occurred regarding precautions and personal protection equipment among the participants. CONCLUSION The COVID-19 pandemic showed a strong impact on bariatric surgical practice regarding surgical and outpatient planning as well as personnel management. Coordinated effort from the national bariatric societies should focus on strict implementation of the current recommendations regarding precaution measures and personal protection equipment. Further studies should evaluate how this impact will evolve in the near future.
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Affiliation(s)
- Ioannis I Lazaridis
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Marko Kraljević
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Romano Schneider
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Jennifer M Klasen
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Dimitrios Schizas
- First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ralph Peterli
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Lilian Kow
- Adelaide Bariatric Centre, Flinders Private Hospital, Bedford Park, Adelaide, South Australia, Australia
| | - Tarik Delko
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland.
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Wiggins T, Guidozzi N, Welbourn R, Ahmed AR, Markar SR. Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003206. [PMID: 32722673 PMCID: PMC7386646 DOI: 10.1371/journal.pmed.1003206] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Previous clinical trials and institutional studies have demonstrated that surgery for the treatment of obesity (termed bariatric or metabolic surgery) reduces all-cause mortality and the development of obesity-related diseases such as type 2 diabetes mellitus (T2DM), hypertension, and dyslipidaemia. The current study analysed large-scale population studies to assess the association of bariatric surgery with long-term mortality and incidence of new-onset obesity-related disease at a national level. METHODS AND FINDINGS A systematic literature search of Medline (via PubMed), Embase, and Web of Science was performed. Articles were included if they were national or regional administrative database cohort studies reporting comparative risk of long-term mortality or incident obesity-related diseases for patients who have undergone any form of bariatric surgery compared with an appropriate control group with a minimum follow-up period of 18 months. Meta-analysis of hazard ratios (HRs) was performed for mortality risk, and pooled odds ratios (PORs) were calculated for discrete variables relating to incident disease. Eighteen studies were identified as suitable for inclusion. There were 1,539,904 patients included in the analysis, with 269,818 receiving bariatric surgery and 1,270,086 control patients. Bariatric surgery was associated with a reduced rate of all-cause mortality (POR 0.62, 95% CI 0.55 to 0.69, p < 0.001) and cardiovascular mortality (POR 0.50, 95% CI 0.35 to 0.71, p < 0.001). Bariatric surgery was strongly associated with reduced incidence of T2DM (POR 0.39, 95% CI 0.18 to 0.83, p = 0.010), hypertension (POR 0.36, 95% CI 0.32 to 0.40, p < 0.001), dyslipidaemia (POR 0.33, 95% CI 0.14 to 0.80, p = 0.010), and ischemic heart disease (POR 0.46, 95% CI 0.29 to 0.73, p = 0.001). Limitations of the study include that it was not possible to account for unmeasured variables, which may not have been equally distributed between patient groups given the non-randomised design of the studies included. There was also heterogeneity between studies in the nature of the control group utilised, and potential adverse outcomes related to bariatric surgery were not specifically examined due to a lack of available data. CONCLUSIONS This pooled analysis suggests that bariatric surgery is associated with reduced long-term all-cause mortality and incidence of obesity-related disease in patients with obesity for the whole operated population. The results suggest that broader access to bariatric surgery for people with obesity may reduce the long-term sequelae of this disease and provide population-level benefits.
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Affiliation(s)
- Tom Wiggins
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - Nadia Guidozzi
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Richard Welbourn
- Department of Bariatric Surgery, Musgrove Park Hospital, Taunton, United Kingdom
| | - Ahmed R. Ahmed
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Sheraz R. Markar
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Ciardullo S, Ronchetti C, Muraca E, Oltolini A, Perra S, Bianconi E, Zerbini F, Cannistraci R, Manzoni G, Gastaldelli A, Lattuada G, Perseghin G. Impact of using different biomarkers of liver fibrosis on hepatologic referral of individuals with severe obesity and NAFLD. J Endocrinol Invest 2020; 43:1019-1026. [PMID: 32008185 DOI: 10.1007/s40618-020-01188-7] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to estimate how many individuals with severe obesity and NAFLD should be referred to hepatologists according to the EASL-EASD-EASO guidelines and whether the choice of specific indicators of liver fibrosis would significantly impact the number of referrals. METHODS This was a single-center retrospective study of 495 individuals with severe obesity screened at our institution between 2012 and 2018 for a bariatric surgery intervention. The guidelines were applied using the NAFLD Liver Fat Score (NLFS) to assess the presence of steatosis and the NAFLD fibrosis score (NFS), Fibrosis-4 (FIB-4) and Hepamet Fibrosis Score (HFS) to assess the risk of advanced fibrosis. RESULTS Three hundred and seventy-nine patients (76.6%) had evidence of liver steatosis. The application of the guidelines would lead to referral of 66.3% of patients using NFS, 31.7% using FIB-4 and 34.2% using HFS. When referrals due to abnormal liver function tests were excluded, these percentages dropped to 55.8%, 7.3% and 12.1%, respectively. The strongest inter-biomarker agreement was found between FIB-4 and HFS (κ = 0.86, 95% CI 0.815-0.910). CONCLUSION Strict application of the guidelines in individuals with severe obesity would probably lead to over-referral, although a great variability exists among the different scores.
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Affiliation(s)
- S Ciardullo
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
| | - C Ronchetti
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
| | - E Muraca
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - A Oltolini
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - S Perra
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - E Bianconi
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - F Zerbini
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - R Cannistraci
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy
| | - G Manzoni
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - A Gastaldelli
- Cardiometabolic Risk Laboratory, Institute of Clinical Physiology (IFC), CNR, Pisa, Italy
| | - G Lattuada
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy
| | - G Perseghin
- Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy.
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.
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Matos O, Ruthes EMP, Malinowski AKC, Lima AL, Veiga MS, Krause MP, Farah L, Souza CJF, Lass AD, Castelo-Branco C. Changes in bone mass and body composition after bariatric surgery. Gynecol Endocrinol 2020; 36:578-581. [PMID: 32406280 DOI: 10.1080/09513590.2020.1762558] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Aim: To analyze the effects of body weight loss on bone mineral density (BMD) on hip (Hip BMD) and lumbar spine (Lumbar BMD) after six months of bariatric surgery. Bariatric surgery is an effective treatment for morbid obesity. Nonetheless, there are scant data on the effect of weight bearing on bone structure.Material and methods: Seventeen obese women aged 41.2 ± 11.3 yrs. who underwent Roux-en-Y gastric bypass (RYGB) were included. Body composition assessments were performed through dual-energy X-ray absorptiometry immediately before and after 6-months RYGB. Data collected pre- and post-RYGB included total body weight, body mass index (BMI), lean body mass (LM), fat mass (FM) and bone mineral content. The pre- (PRE) and post-operative (POST) results were compared.Results: Lumbar BMD POST presented a non-significant loss of 1.8% whereas Hip BMD POST showed a significant loss of 17.8%. The analysis demonstrated that BMI and LM PRE explained 26% and 49%, respectively, of Hip BMD PRE variability. In addition, LM POST explained 30% of hip BMD POST variability and was not significant for Lumbar BMD POST.Conclusions: Obesity and rapid weight loss showed direct influence in Hip BMD after six months of bariatric surgery. However, its effect on the lumbar spine area was smaller due to the higher capacity of the spine to dissipate loads through its curvature.
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Affiliation(s)
- Oslei Matos
- Laboratory for Studies in Biomedical Engineering and Health, Federal University of Technology, Curitiba, Brazil
| | - Elena M P Ruthes
- Laboratory for Studies in Biomedical Engineering and Health, Federal University of Technology, Curitiba, Brazil
| | - Anna Karolyna C Malinowski
- Laboratory for Studies in Biomedical Engineering and Health, Federal University of Technology, Curitiba, Brazil
| | - Alice Lerias Lima
- Laboratory for Studies in Biomedical Engineering and Health, Federal University of Technology, Curitiba, Brazil
| | - Matheus S Veiga
- Laboratory for Studies in Biomedical Engineering and Health, Federal University of Technology, Curitiba, Brazil
| | - Maressa P Krause
- Laboratory for Studies in Biomedical Engineering and Health, Federal University of Technology, Curitiba, Brazil
| | - Leonardo Farah
- Laboratory for Studies in Biomedical Engineering and Health, Federal University of Technology, Curitiba, Brazil
| | | | - Andre D Lass
- Laboratory for Studies in Biomedical Engineering and Health, Federal University of Technology, Curitiba, Brazil
| | - Camil Castelo-Branco
- Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Faculty of Medicine, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Abstract
As the prevalence of obesity has increased, bariatric surgery has become more common because of its proven efficacy at promoting weight loss and improving weight-related medical comorbidities. Although generally successful, bariatric surgery may also lead to complications and negatively affect health. This article highlights some common and rare complications of bariatric surgery. Specifically, it discusses the risk of nutrient deficiencies (which is influenced by surgery type) and their downstream effects, including ill-effects on bone health. Rarer complications, such as postbypass hypoglycemia and alcohol use disorder, are also discussed.
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Affiliation(s)
- Maria L Collazo-Clavell
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Meera Shah
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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Abstract
IMPORTANCE Given the complex relationship between body mass index, body composition, and bone density and the correlative nature of the studies that have established the prevailing notion that higher body mass indices may be protective against osteopenia and osteoporosis and, therefore, fracture, the absolute risk of fracture in patients with severe obesity who undergo either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) compared with those who do not undergo bariatric surgery is unknown. OBJECTIVE To assess the rates of fractures associated with obesity and compare rates between those who do not undergo bariatric surgery, those who undergo RYGB, and those who undergo SG. DESIGN, SETTING, AND PARTICIPANTS In this retrospective multicenter cohort study of Medicare Standard Analytic Files derived from Medicare parts A and B records from January 2004 to December 2014, patients classified as eligible for bariatric surgery using the US Centers of Medicare & Medicaid criteria who either did not undergo bariatric surgery or underwent RYGB or SG were exactly matched in a 1:1 fashion based on their age, sex, Elixhauser Comorbidity Index, hypertension, smoking status, nonalcoholic fatty liver disease, hyperlipidemia, type 2 diabetes, osteoporosis, osteoarthritis, and obstructive sleep apnea status. Data were analyzed from November to December 2019. EXPOSURES RYGB or SG. MAIN OUTCOMES AND MEASURES The primary outcome measured in this study was the odds of fracture overall based on exposure to bariatric surgery. Secondary outcomes included the odds of type of fracture (humerus, radius or ulna, pelvis, hip, vertebrae, and total fractures) based on exposure to bariatric surgery. RESULTS A total of 49 113 patients were included and were equally made up of 16 371 bariatric surgery-eligible patients who did not undergo weight loss surgery, 16 371 patients who had undergone RYGB, and 16 371 patients who had undergone SG. Each group consisted of an equal number of 4109 men (25.1%) and 12 262 women (74.9%) and had an equal distribution of ages, with 11 780 patients (72.0%) 64 years or younger, 4230 (25.8%) aged 65 to 69 years, 346 (2.1%) aged 70 to 74 years, and 15 (0.1%) aged 75 to 79 years. Patients undergoing RYGB were found to have no significant difference in odds of fractures compared with bariatric surgery-eligible patients who did not undergo surgery. Patients undergoing undergone SG were found to have decreased odds of fractures of the humerus (odds ratio [OR], 0.57; 95% CI, 0.45-0.73), radius or ulna (OR, 0.38; 95% CI, 0.25-0.58), hip (OR, 0.49; 95% CI, 0.33-0.74), pelvis (OR, 0.34; 95% CI, 0.18-0.64), vertebrae (OR, 0.60; 95% CI, 0.48-0.74), or fractures in general (OR, 0.53; 95% CI, 0.46-0.62). Compared with patients undergoing SG, patients undergoing RYGB had a significantly greater risk of total fractures (OR, 1.79; 95% CI, 1.55-2.06) and humeral fractures (OR, 1.60; 95% CI, 1.24-2.07). CONCLUSIONS AND RELEVANCE In this cohort study, bariatric surgery was associated with a reduced risk of fracture in bariatric surgery-eligible patients. Sleeve gastrectomy might be the best option for weight loss in patients in which fractures could be a concern, as RYGB may be associated with an increased fracture risk compared with SG.
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Affiliation(s)
- Syed I. Khalid
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Philip A. Omotosho
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Anna Spagnoli
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Alfonso Torquati
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
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Timmerman M, Basille D, Basille-Fantinato A, Baud ME, Rebibo L, Andrejak C, Jounieaux V, Lalau JD. Short-Term Assessment of Obstructive Sleep Apnea Syndrome Remission Rate after Sleeve Gastrectomy: a Cohort Study. Obes Surg 2020; 29:3690-3697. [PMID: 31346929 DOI: 10.1007/s11695-019-04110-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/14/2022]
Abstract
BACKGROUND Severe obesity is associated with a high prevalence of moderate-to-severe obstructive sleep apnea syndrome (OSA). Bariatric surgery has been shown to effectively reduce excess weight and comorbidities. METHODS We evaluated the remission rate of moderate-to-severe OSA (apnea-hypopnea index (AHI) ≥ 15) following sleeve gastrectomy. We performed a single-center retrospective chart review of all patients who underwent preoperative polysomnography (PSG) or polygraphy before primary sleeve gastrectomy. Patients with moderate-to-severe OSA treated by continuous positive airway pressure (CPAP) also underwent postoperative PSG. Bivariate analysis was performed to evaluate the criteria associated with remission of moderate-to-severe OSA. RESULTS From 2013 to 2018, 39 of 162 patients (24.1%) scheduled for sleeve gastrectomy (SG) presented moderate-to-severe OSA requiring CPAP. Postoperative PSG was performed in 36 patients a mean of 9.9 ± 6.1 months after SG. Mean BMI decreased from 47.4 ± 8.4 to 36.3 ± 7.1 kg/m2 (p < 0.001), and all patients reported clinical improvement of OSA symptoms. A remission of moderate-to-severe OSA was observed in 72.2% of patients with a mean decrease of AHI from 45.8 events/h to 11.3 events/h (p < 0.001). Postoperative neck circumference was the only factor associated with OSA remission. CONCLUSION SG is associated with a rapid improvement of moderate-to-severe OSA partially as a result of a reduction of neck circumference. However, the absence of correlation with excess weight loss suggests that other weight-independent factors may also be involved.
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Affiliation(s)
- Marine Timmerman
- Department of Endocrinology, Metabolic Diseases and Nutrition, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Damien Basille
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France.
- AGIR Unit, University Picardie Jules Verne, 80054, Amiens Cedex, France.
| | | | - Mickaël E Baud
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Lionel Rebibo
- Department of Digestive Surgery, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, 46 rue Henri Huchard, F-75018, Paris, France
| | - Claire Andrejak
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- AGIR Unit, University Picardie Jules Verne, 80054, Amiens Cedex, France
- Sleep and Vigilance Disorder Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Vincent Jounieaux
- Department of Respiratory Diseases and Intensive Care Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- AGIR Unit, University Picardie Jules Verne, 80054, Amiens Cedex, France
- Sleep and Vigilance Disorder Unit, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
| | - Jean-Daniel Lalau
- Department of Endocrinology, Metabolic Diseases and Nutrition, University Hospital Amiens-Picardie, 80054, Amiens Cedex, France
- PériTox Unit, UMR-I 01, University Picardie Jules Verne, 80054, Amiens Cedex, France
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Abstract
The association between obesity and malignancies has been identified epidemiologically. Meanwhile, the increasing global number of bariatric surgeries is reported annually; bariatric surgery's effect on different types of cancers is not well understood. Unfortunately, nonspecific presentations and difficulties regarding investigations make diagnosis challenging. The aim of this study is to compile available data about gastro-intestinal (GI) cancers, occurring after different bariatric surgeries. Although GI cancers are considered a rare complication of obesity surgery, they do exist, and diagnosis needs a high index of suspicion.
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Affiliation(s)
- Reza Ebrahimi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Center of Excellence of International Federation for Surgery of Obesity, Hazrat e Rasool Hospital, Tehran, Iran.
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Foolad Eghbali
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of International Federation for Surgery of Obesity, Hazrat e Rasool Hospital, Tehran, Iran
| | - Ali Mousavi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of International Federation for Surgery of Obesity, Hazrat e Rasool Hospital, Tehran, Iran
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Murray SM, Tweardy S, Geliebter A, Avena NM. A Longitudinal Preliminary Study of Addiction-Like Responses to Food and Alcohol Consumption Among Individuals Undergoing Weight Loss Surgery. Obes Surg 2020; 29:2700-2703. [PMID: 31147822 DOI: 10.1007/s11695-019-03915-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Reductions in addiction-like food behaviors and increases in alcohol intake have been reported after weight loss surgery. However, no studies have tracked these measures in combination and prospectively. In this preliminary study, 27 participants underwent bariatric surgery (Roux-en-Y gastric bypass (RYGB) (n = 10) and sleeve gastrectomy (SG) (n = 6)), dietary weight loss (n = 6), or no treatment (n = 5). Participants were weighed, completed the Yale Food Addiction Scale (YFAS), and reported alcohol intake frequency before intervention and at 4 and 24 months after baseline. At 24 months, only the surgery group showed significant reductions in BMI. Between baseline and 24 months, YFAS scores decreased (p = .006) and alcohol intake increased in the surgery group (p = .005). Significant changes were not observed in the diet or no treatment groups.
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Affiliation(s)
- Susan M Murray
- Department of Psychology, Temple University, Philadelphia, PA, USA.
| | - S Tweardy
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allan Geliebter
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicole M Avena
- Pharmacology and Systems Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract
INTRODUCTION Health behaviors are critical for weight loss maintenance after weight loss surgery (WLS), and emotional factors often play a role in adherence. Positive psychological constructs (e.g., optimism, positive affect) have predicted health outcomes in other medical populations but have been infrequently examined in post-WLS patients. METHODS This study measured optimism and positive affect in post-WLS patients recruited from online support groups. A hierarchical linear regression analysis tested their association with health behavior adherence, physical activity, and weight loss, controlling for demographic and weight-related covariates. It also tested depression and anxiety symptoms as moderators. RESULTS In 95 participants, positive affect was associated with better adherence (b = 0.41, p < 0.01) and greater moderate-to-vigorous physical activity (b = 0.20, p < 0.001) controlling for demographic/weight-related covariates, and independently with more weight loss (b = 0.24, p < 0.05). Optimism was independently associated with better adherence (b = 0.32, p < 0.05) and with greater moderate-to-vigorous physical activity controlling for demographic/weight-related covariates (b = 0.16, p < 0.05). These associations no longer reached statistical significance controlling for depression and anxiety symptoms. Anxiety symptoms moderated the relationship between positive affect and adherence (b = 0.06, p < 0.01), and depression (b = 0.15, p < 0.01) and anxiety (b = 0.02, p < 0.05) symptoms each moderated the relationship between optimism and walking, such that there was a stronger relationship between positive psychological constructs and health behaviors for those with higher anxiety or depression scores. CONCLUSIONS Positive psychological states should be included when assessing emotional factors related to health behaviors in post-WLS patients. Interventions targeting health behaviors may be improved with inclusion of skills to boost positive psychological states.
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Affiliation(s)
- Emily H Feig
- Massachusetts General Hospital Department of Psychiatry, 55 Fruit St., Boston, MA, 02114, USA.
- Harvard Medical School Department of Psychiatry, 25 Shattuck St., Boston, MA, 02115, USA.
| | - Julia Golden
- Massachusetts General Hospital Department of Psychiatry, 55 Fruit St., Boston, MA, 02114, USA
| | - Jeff C Huffman
- Massachusetts General Hospital Department of Psychiatry, 55 Fruit St., Boston, MA, 02114, USA
- Harvard Medical School Department of Psychiatry, 25 Shattuck St., Boston, MA, 02115, USA
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Bartosiak K, Różańska-Walędziak A, Walędziak M, Kowalewski P, Paśnik K, Janik MR. The Safety and Benefits of Laparoscopic Sleeve Gastrectomy in Elderly Patients: a Case-Control Study. Obes Surg 2020; 29:2233-2237. [PMID: 31020498 DOI: 10.1007/s11695-019-03830-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/13/2022]
Abstract
INTRODUCTION The advancement of minimal invasive techniques pushed the age limit for patients qualified for bariatric surgery. AIM The aim of the study was to evaluate the safety and effectiveness of laparoscopic sleeve gastrectomy (LSG) in a cohort of patients aged 60 years or more, compared with a group of matched controls below 40 years old. METHODS The medical records of 856 patients were analyzed. Patients aged 60 years or older were identified as cases. Those below 40 years were identified as the controls. Cases were closely matched (1:1) with the controls by body mass index (BMI) (± 1 kg/m2) and presence or absence of hypertension and diabetes mellitus. RESULTS A 34 matched pairs were included in the study. There was no significant difference in the median operation length. No conversion from laparoscopic to open surgery was needed. The hospital length of stay was significantly longer in the study group (4.5 ± 1.9 vs 3.9 ± 1.5 days, p = 0.047). The complication, 30-day reoperation, and 30-day reoperation rates were comparable in both groups. There were no 30-day readmissions nor 30-day mortality. ΔBMI after 12 months was significantly lower in the study group (13.56 ± 6.05 vs 10.3 ± 4.89, p = 0.008) as well as %EBMIL (50.71 ± 25.94 vs 64.20 ± 23.29, p = 0.015). CONCLUSIONS The study suggests that LSG is a safe method of bariatric treatment in patients aged above 60 years. Even though weight loss may be lesser than in younger patients, it can still be considered satisfactory.
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Affiliation(s)
- Katarzyna Bartosiak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141, Warsaw, Poland
| | - Anna Różańska-Walędziak
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, 2 Karowa St, 00-315, Warsaw, Poland
| | - Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141, Warsaw, Poland
| | - Piotr Kowalewski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141, Warsaw, Poland
| | - Krzysztof Paśnik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141, Warsaw, Poland
| | - Michał R Janik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, 128 Szaserów St, 04-141, Warsaw, Poland.
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Khalifa IG, Tobar WL, Hegazy TO, Balamoun HA, Mikhail S, Salman MA, Elsayed EA. Food Tolerance After Laparoscopic Sleeve Gastrectomy with Total Antral Resection. Obes Surg 2020; 29:2263-2269. [PMID: 30895506 DOI: 10.1007/s11695-019-03840-5] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Among the controversial points in laparoscopic sleeve gastrectomy (LSG) is how much of the antrum to be resected. This study aimed to evaluate food tolerance after preservation or resection of the antrum during LSG. METHODS Prospective randomized study included 50 patients scheduled for LSG. Participants were randomly allocated into one of two groups. In antral resection (AR-LSG) group (n = 25), resection started 2 cm from the pylorus. In antral sparing (AS-LSG) group (n = 25), it started 6 cm from the pylorus. Percentage of excess weight loss (%EWL) and percentage of excess BMI loss (%EBL) were evaluated after 3 and 6 months. Quality of life (QOL) was evaluated by using the Bariatric Analysis and Reporting Outcome System (BAROS). Food tolerance was assessed using the Quality of Alimentation questionnaire. Primary outcome measure was food tolerance and %EWL. RESULTS Food tolerance was significantly better in the antral sparing group compared to the antral resection group after 3 and 6 months. The two groups were comparable in %EWL and BMI change after 3 and 6 months. Six months after surgery, the majority of patients had a very good quality of life, with no significant difference between the two groups (p = 0.877). There was no significant difference between the two groups in operative time, intraoperative blood loss, and hospital stay. CONCLUSIONS Preservation of the pyloric antrum during LSG is associated with significantly better food tolerance and comparable effect of weight loss up to 6 months postoperatively when compared with total antral resection.
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Affiliation(s)
- Ibrahim G Khalifa
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Wael L Tobar
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Tarek O Hegazy
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Hany A Balamoun
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.
| | - Sameh Mikhail
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | | | - Elsayed A Elsayed
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
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Aminian A, Zajichek A, Arterburn DE, Wolski KE, Brethauer SA, Schauer PR, Nissen SE, Kattan MW. Predicting 10-Year Risk of End-Organ Complications of Type 2 Diabetes With and Without Metabolic Surgery: A Machine Learning Approach. Diabetes Care 2020; 43:852-859. [PMID: 32029638 PMCID: PMC7646205 DOI: 10.2337/dc19-2057] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/16/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To construct and internally validate prediction models to estimate the risk of long-term end-organ complications and mortality in patients with type 2 diabetes and obesity that can be used to inform treatment decisions for patients and practitioners who are considering metabolic surgery. RESEARCH DESIGN AND METHODS A total of 2,287 patients with type 2 diabetes who underwent metabolic surgery between 1998 and 2017 in the Cleveland Clinic Health System were propensity-matched 1:5 to 11,435 nonsurgical patients with BMI ≥30 kg/m2 and type 2 diabetes who received usual care with follow-up through December 2018. Multivariable time-to-event regression and random forest machine learning models were built and internally validated using fivefold cross-validation to predict the 10-year risk for four outcomes of interest. The prediction models were programmed to construct user-friendly web-based and smartphone applications of Individualized Diabetes Complications (IDC) Risk Scores for clinical use. RESULTS The prediction tools demonstrated the following discrimination ability based on the area under the receiver operating characteristic curve (1 = perfect discrimination and 0.5 = chance) at 10 years in the surgical and nonsurgical groups, respectively: all-cause mortality (0.79 and 0.81), coronary artery events (0.66 and 0.67), heart failure (0.73 and 0.75), and nephropathy (0.73 and 0.76). When a patient's data are entered into the IDC application, it estimates the individualized 10-year morbidity and mortality risks with and without undergoing metabolic surgery. CONCLUSIONS The IDC Risk Scores can provide personalized evidence-based risk information for patients with type 2 diabetes and obesity about future cardiovascular outcomes and mortality with and without metabolic surgery based on their current status of obesity, diabetes, and related cardiometabolic conditions.
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Affiliation(s)
- Ali Aminian
- Department of General Surgery, Bariatric & Metabolic Institute, Cleveland Clinic, Cleveland, OH
| | - Alexander Zajichek
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - Kathy E Wolski
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, OH
| | - Stacy A Brethauer
- Department of General Surgery, Bariatric & Metabolic Institute, Cleveland Clinic, Cleveland, OH
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Philip R Schauer
- Department of General Surgery, Bariatric & Metabolic Institute, Cleveland Clinic, Cleveland, OH
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, OH
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
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Wiggins T, Antonowicz SS, Markar SR. Cancer Risk Following Bariatric Surgery-Systematic Review and Meta-analysis of National Population-Based Cohort Studies. Obes Surg 2020; 29:1031-1039. [PMID: 30591985 DOI: 10.1007/s11695-018-3501-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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: 12/15/2022]
Abstract
This study has analyzed results from registry-based population studies to assess the effect of bariatric surgery upon cancer incidence at a population level. Relevant studies were identified and meta-analysis was used to calculate pooled odds ratios (POR) for the incidence of cancer after bariatric surgery compared to controls. Eight population-based studies were included with 635,642 total patients. Bariatric surgery was associated with a significant reduction in overall cancer incidence (POR = 0.72; 95% CI 0.59 to 0.87; p = 0.0007) and incidence of obesity-related cancer (POR = 0.55; 95% CI 0.31 to 0.96; p = 0.04). Bariatric surgery was also protective for breast cancer development (POR = 0.50; 95% CI 0.25 to 0.99; p = 0.045). Bariatric surgery appears to be associated with a reduction in cancer incidence at a population-based level.
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Affiliation(s)
- Tom Wiggins
- Department of Surgery & Cancer, Academic Surgical Unit, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Stefan S Antonowicz
- Department of Surgery & Cancer, Academic Surgical Unit, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Sheraz R Markar
- Department of Surgery & Cancer, Academic Surgical Unit, Imperial College London, 10th Floor, QEQM Building, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
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Han ML, Lee WJ, Chen JC, Ser KH, Chen SC, Lee YC. Clinical Characteristics and Outcome of Morbidly Obese Bariatric Patients with Concurrent Hepatitis C Viral Infection. Obes Surg 2020; 29:828-834. [PMID: 30536020 DOI: 10.1007/s11695-018-3615-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/26/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) is an important cause of liver cirrhosis and its complications. The safety and efficacy of bariatric surgery in patients with HCV infection is not clear. METHODS Charts were reviewed to identify patients with HCV infection before bariatric surgery. Bariatric surgical patients with non-alcoholic steatohepatitis (NASH) and without NASH (non-NASH) were recruited as comparative groups. Demographic variables, perioperative data, follow-up, and HCV-related parameters were extracted and compared. RESULTS Forty-seven bariatric patients between 2000 and 2016 that suffered from HCV infection were identified. The mean age and body mass index (BMI) at baseline were 34.5 ± 9.9 years and 40.4 ± 7.7 kg/m2, respectively. The HCV(+) group was associated with female sex, older age, lower BMI, and waist circumference than both NASH and non-NASH groups. Both HCV(+) and NASH groups had higher liver function tests and incidence of metabolic syndrome than non-NASH group. The HCV(+) group had lower uric acid and albumin level than the NASH group. Early major postoperative complication occurred in 1 (2.1%) patient of the HCV(+) group. At follow-up, the mean BMI decreased to 29.1 ± 7.1 kg/m2 and total weight loss was 25% for the HCV(+) group at 5 years after surgery. The weight loss curves were similar between the HCV(+) group and NASH group. During follow-up, no patients died but one patient with HCV(+) developed flare up of hepatitis after gastric bypass. The mean liver transaminase level remained in normal range for the HCV(+) group. CONCLUSION Co-existence of HCV infection does not influence the outcome of bariatric surgery but continued monitoring of the liver function is indicated.
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Affiliation(s)
- Ming-Lun Han
- Department of Internal Medicine, Ming-Sheng General Hospital, National Taiwan University, Taipei, Taiwan
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Jei Lee
- Department of Surgery, Ming-Sheng General Hospital, National Taiwan University, Taipei, Taiwan
- , Tauoyan, Republic of China
| | - Jung-Chien Chen
- Department of Surgery, Ming-Sheng General Hospital, National Taiwan University, Taipei, Taiwan
| | - Kong-Han Ser
- Department of Surgery, Ming-Sheng General Hospital, National Taiwan University, Taipei, Taiwan
| | - Shu-Chun Chen
- Department of Surgery, Ming-Sheng General Hospital, National Taiwan University, Taipei, Taiwan
| | - Yi-Chih Lee
- Department of International Business, Chien Hsin University of Science and Technology, Taoyuan, Taiwan
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Doble B, Welbourn R, Carter N, Byrne J, Rogers CA, Blazeby JM, Wordsworth S. Multi-Centre Micro-Costing of Roux-En-Y Gastric Bypass, Sleeve Gastrectomy and Adjustable Gastric Banding Procedures for the Treatment of Severe, Complex Obesity. Obes Surg 2020; 29:474-484. [PMID: 30368646 DOI: 10.1007/s11695-018-3553-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is a growing interest in comparing the effectiveness and costs of alternative forms of bariatric surgery. We aimed to examine the per-patient, procedural costs of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and adjustable gastric banding (AGB) in the United Kingdom. METHODS Multi-centre (two National Health Service; NHS and one private hospital) micro-costing, using a time-and-motion study. Prospective collection of surgery times, staff quantities, equipment, instruments and consumables for 12 patients (four RYGB, five SG, three AGB) from patients' first surgeon interaction on the day of surgery to departure from the theatre recovery area. Costs were attached to quantities and mean costs compared. Sensitivity and scenario analyses assessed the impact of varying surgery inputs and consideration of additional plausible factors respectively on total costs. RESULTS Mean procedural costs were £5002 for RYGB, £4306 for SG and £2527 for AGB. Varying staff seniority or altering procedure times had small impacts on costs (± 4-6%). Reducing prices of consumables by 20% reduced costs by 10-13%. Accounting for differences in surgical technique by altering the number of staple reloads used impacted costs by ± 7-10%. Adjusted total costs from scenario analyses were similar to NHS tariffs for RYGB and SG (difference of £51 and -£119 respectively) but were much lower for AGB (difference of £1982). CONCLUSIONS These detailed costs will allow for more precise reimbursement of bariatric surgery and support comprehensive assessments of cost-effectiveness. Additional work to investigate costs of post-surgical care, re-operations and life-long support received by patients following surgery is required.
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Affiliation(s)
- Brett Doble
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
| | - Richard Welbourn
- Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - Nicholas Carter
- Bariatric and Metabolic Surgery Department, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, PO6 3LY, UK
| | - James Byrne
- Southampton University Hospitals NHS Trust, Southampton, SO16 6YD, UK
| | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Bristol Medical School, University of Bristol, Bristol, BS2 8HW, UK
| | - Jane M Blazeby
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
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Koliaki C, Tzeravini E, Papachristoforou E, Severi I, El Deik E, Karaolia M, Noutsou M, Thanopoulou A, Kountouri A, Balampanis K, Lambadiari V, Tentolouris N, Kokkinos A. Eligibility and Awareness Regarding Metabolic Surgery in Patients With Type 2 Diabetes Mellitus in the Real-World Clinical Setting; Estimate of Possible Diabetes Remission. Front Endocrinol (Lausanne) 2020; 11:383. [PMID: 32582036 PMCID: PMC7292012 DOI: 10.3389/fendo.2020.00383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/14/2020] [Indexed: 01/06/2023] Open
Abstract
Despite high-quality evidence highlighting metabolic surgery as an effective treatment option for type 2 diabetes mellitus (T2DM), the number of patients receiving bariatric surgery (BS) remains low. Since the introduction of the Diabetes Surgery Summit II (DSS-II) eligibility criteria, data on eligibility rates for BS in T2DM cohorts remain scarce. The aims of the present study were to examine in a real-world clinical setting: (i) what is the percentage of T2DM patients visiting diabetes outpatient clinics who meet the DSS-II eligibility criteria, (ii) how many of these have been informed about the option of BS, and (iii) what are the characteristics associated with eligibility and awareness of BS. Demographic, anthropometric, clinical and socioeconomic data were obtained for all patients with T2DM who were consecutively examined in the outpatient clinics of three large-volume university hospitals (n = 1167). A medical registry form was completed to screen for BS eligibility. Patients were considered eligible if the recommendation by DSS-II criteria was either to "consider" or "recommend" BS. Eligible patients were further inquired whether they had ever been informed about the option of BS by their physicians. The advanced DiaRem score (ADRS) was applied to eligible patients to assess their probability of achieving postoperative T2DM remission. A significant percentage of T2DM patients who are routinely assessed in outpatient clinics meet the DSS-II eligibility criteria (15.3%). Eligible patients are younger and more obese, have a shorter T2DM duration, worse glycaemic control and better renal function, compared to non-eligible ones. Among eligible patients, only 39.3% have been medically informed about the option of BS. Informed patients are younger and more severely obese than non-informed ones. A significant percentage of non-informed patients (35%) have an ADRS ≤10, indicating a considerable probability for T2DM remission after BS, and are thus deprived of this opportunity due to lack of appropriate medical counseling. Screening and awareness of BS remain an unmet need in current T2DM management. Future research should focus on intensifying screening for BS eligibility at every medical visit and promoting evidence-based clinical recommendations for patients expected to benefit the most.
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Affiliation(s)
- Chrysi Koliaki
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Evangelia Tzeravini
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Eleftheria Papachristoforou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Ioanna Severi
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Elina El Deik
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Melina Karaolia
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Marina Noutsou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Thanopoulou
- Diabetes Center, Second Department of Internal Medicine, Medical School, Hippokratio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Kountouri
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Konstantinos Balampanis
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Vaia Lambadiari
- Second Department of Internal Medicine and Research Institute, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - Nicholas Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
- *Correspondence: Alexander Kokkinos
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Köhler H, Dorozhkina R, Gruner-Labitzke K, de Zwaan M. Specific Health Knowledge and Health Literacy of Patients before and after Bariatric Surgery: A Cross-Sectional Study. Obes Facts 2020; 13:166-178. [PMID: 32208386 PMCID: PMC7250322 DOI: 10.1159/000505837] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/08/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It is an important condition for adequate weight loss and prevention of adverse events that bariatric surgery (BS) candidates possess good specific health knowledge. There is a paucity of standardized instruments to evaluate the specific health knowledge of patients before and after BS. Therefore, we developed a 32-item multiple-choice test covering the main aspects of life which are important after BS, and investigated the correlation of specific health knowledge with health literacy, level of depression and anxiety, percentage of excess weight loss, and specific complications of BS in postoperative patients. METHODS Two groups participated in the cross-sectional study: the preoperative group (n = 109) was recruited from candidates for BS (gastric bypass or sleeve gastrectomy), the postoperative group (n = 110) was recruited from patients 12-74 months after BS (average 33 months, SD = 16.5). Both groups had completed a preoperative multimodal training program. Specific health knowledge was assessed with a newly developed knowledge questionnaire. Health literacy was evaluated with the short version of the European Health Literacy Survey (HLS-EU-Q16). The 9-item Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Scale (GAD-7) were used to assess the levels of depression and anxiety. RESULTS The pre- and postoperative group did not differ with regard to the number of correctly answered questions on the knowledge questionnaire, with 75% correct answers in both groups (p = 0.059). No correlations were found with health literacy (p = 0.498) and levels of depression (preoperative group: p = 0.279; postoperative group: p = 0.242) and anxiety (preoperative group: p = 0.866; postoperative group: p = 0.119). In postoperative patients specific health knowledge was not associated with the weight loss achieved (p = 0.437). CONCLUSION The newly designed knowledge questionnaire can be useful for screening specific knowledge of BS patients at different time points.
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Affiliation(s)
- Hinrich Köhler
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany,
| | - Renata Dorozhkina
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
| | - Kerstin Gruner-Labitzke
- Department of General, Abdominal, and Bariatric Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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Abstract
BACKGROUND In response to concerns about inadequate insurance coverage, bariatric surgery was included in the Affordable Care Act's essential health benefits program-requiring individual and small-group insurance plans in 23 states to cover bariatric surgery. We evaluated the impact of this policy on bariatric surgery utilization. METHODS Multiple-group interrupted time series analyses of IBM MarketScan commercial claims data from 2009 to 2016. RESULTS Bariatric surgery utilization increased in all states after ACA implementation, but this increase was no greater in states with a bariatric surgery essential health benefit. CONCLUSIONS Our findings suggest that the essential health benefits program may have been too narrow in scope to meaningfully increase bariatric surgery utilization at the population level.
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Affiliation(s)
- Karan R Chhabra
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Building 14, Room G100, Ann Arbor, MI, 48109, USA.
- Center for Healthcare Outcomes and Policy, University of Michigan, 2800 Plymouth Road, Building 16, 016-100N-28, Ann Arbor, MI, 48109, USA.
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - Zhaohui Fan
- Center for Healthcare Outcomes and Policy, University of Michigan, 2800 Plymouth Road, Building 16, 016-100N-28, Ann Arbor, MI, 48109, USA
| | - Grace F Chao
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Road, Building 14, Room G100, Ann Arbor, MI, 48109, USA
- Center for Healthcare Outcomes and Policy, University of Michigan, 2800 Plymouth Road, Building 16, 016-100N-28, Ann Arbor, MI, 48109, USA
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Justin B Dimick
- Center for Healthcare Outcomes and Policy, University of Michigan, 2800 Plymouth Road, Building 16, 016-100N-28, Ann Arbor, MI, 48109, USA
- Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, 016-100N-28, Ann Arbor, MI, 48109, USA
| | - Dana A Telem
- Center for Healthcare Outcomes and Policy, University of Michigan, 2800 Plymouth Road, Building 16, 016-100N-28, Ann Arbor, MI, 48109, USA
- Department of Surgery, University of Michigan, 2800 Plymouth Road, Building 16, 016-100N-28, Ann Arbor, MI, 48109, USA
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Abstract
BACKGROUND Opioid use after bariatric surgery is not clearly understood. Few guidelines exist to inform opioid-prescribing practices after bariatric surgery. OBJECTIVE To understand opioid use following bariatric surgery. SETTING University hospital. METHODS Bariatric surgery patients at a single center were prospectively surveyed at the time of their post-operative visit (January-May 2018). Patients were asked about their opioid use following surgery, whether they received education about opioid use and what they did with leftover medications. Demographic and operative details were obtained from the medical record. RESULTS Among 33 patients, the majority (n = 29, 88%) were female with a median age of 40 (20-68) and body mass index of 44.8 (33-78.5). Most patients had leftover narcotics (n = 25, 73%). The median number of pills used was 15 (0-48). Only 12 patients (36%) thought that they had been prescribed "too much" pain medication. Most patients reported receiving education about expectations for post-operative pain (n = 22, 69%); few recalled education about reducing or stopping opioids (n = 13, 40%). More than half of patients (n = 17, 53%) kept their leftover opioids rather than disposing of them or bringing them to an approved turn in location. CONCLUSIONS Despite most patients having leftover opioids following surgery, few patients recognized possible overprescription. Education regarding opioid use following surgery is inconsistent, potentially contributing to the amount of retained opioids currently available. Future guidelines should focus on determining the appropriate amount of opioids to be prescribed following surgery and standardizing and improving education given to patients.
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Affiliation(s)
- Anne P Ehlers
- Department of Surgery, University of Michigan, VA Ann Arbor Healthcare System 2210 Taubman Center, SPC 5343, Ann Arbor, MI, USA.
| | - Kevin M Sullivan
- Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - John I Monu
- Department of Surgery, University of Washington, Seattle, WA, USA
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Taylor T, Wrapson W, Dewes O, Taufa N, Siegert RJ. Preoperative bariatric surgery programme barriers facing Pacific patients in Auckland, New Zealand as perceived by health sector professionals: a qualitative study. BMJ Open 2019; 9:e029525. [PMID: 31678938 PMCID: PMC6830665 DOI: 10.1136/bmjopen-2019-029525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED Minority ethnic patient groups typically have the highest bariatric surgery preoperative attrition rates and lowest surgery utilisation worldwide. Eligible patients of Pacific Island ethnicity (Pacific patients) in New Zealand (NZ) follow this wider trend. OBJECTIVES The present study explored structural barriers contributing to Pacific patients' disproportionately high preoperative attrition rates from publicly-funded bariatric surgery in Auckland, NZ. SETTING Publicly-funded bariatric surgery programmes based in the wider Auckland area, NZ. DESIGN Semi-structured interviews with health sector professionals (n=21) were conducted.Data were analysed using an inductive thematic approach. RESULTS Two primary themes were identified: (1) Confidence negotiating the medical system, which included Emotional safety in clinical settings and Relating to non-Pacific health professionals and (2) Appropriate support to achieve preoperative goals, which included Cultural considerations, Practical support and Relating health information. Clinical environments and an under-representation of Pacific staff were considered to be barriers to developing emotional safety, trust and acceptance of the surgery process with patients and their families. Additionally, economic deprivation and lower health literacy impacted preoperative goals. CONCLUSIONS Health professionals' accounts indicated that Pacific patients face substantial levels of disconnection in bariatric surgery programmes. Increasing representation of Pacific ethnicity by employing more Pacific health professionals in bariatric teams and finding novel solutions to implement preoperative programme components have the potential to reduce this disconnect. Addressing cultural competency of staff, increasing consultancy times and working in community settings may enable staff to better support Pacific patients and their families. Programme structures could be more accommodating to practical barriers of attending appointments, managing patients' preoperative health goals and improving patients' health literacy. Given that Pacific populations, and other patients from minority ethnic backgrounds living globally, also face high rates of obesity and barriers accessing bariatric surgery, our findings are likely to have broader applicability.
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Affiliation(s)
- Tamasin Taylor
- Faculty of Heath and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Wendy Wrapson
- Faculty of Heath and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Ofa Dewes
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Nalei Taufa
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Richard J Siegert
- Faculty of Heath and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Walker E, Elman M, Takemoto EE, Fennern E, Mitchell JE, Pories WJ, Ahmed B, Pomp A, Wolfe BM. Bariatric Surgery Among Medicare Subgroups: Short- and Long-Term Outcomes. Obesity (Silver Spring) 2019; 27:1820-1827. [PMID: 31562705 PMCID: PMC6832742 DOI: 10.1002/oby.22613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/15/2019] [Accepted: 07/15/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study sought to examine weight change, postoperative adverse events, and related outcomes of interest among age-qualified (AQ) and disability-qualified (DQ) Medicare recipients compared with non-Medicare (NM) patients undergoing an initial bariatric procedure. METHODS The Longitudinal Assessment of Bariatric Surgery (LABS-2) is an observational cohort study of 2,458 adults who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) bariatric surgery. Weight, percentage body fat, functional status, and comorbidities, as well as postoperative adverse events, were assessed at baseline and annually for 5 years. The 1,943 participants who reported insurance type were categorized into the following groups: AQ, DQ, or NM. RESULTS The median preoperative BMI ranged from 45 to 48 kg/m2 across groups. For RYGB, 5-year BMI loss was approximately 30% for all groups, and for LAGB, BMI loss was 12% to 15%. Diabetes remission after 5 years was also similar across groups within procedure types (RYGB: 33%-40%; LAGB: 13%-19%). The frequency of adverse events after RYGB ranged from 4.1% for NM participants to 6.7% for DQ participants. After LAGB, there were no adverse events for the AQ group, whereas 3% of DQ participants and 1.8% of NM participants had at least one adverse event. CONCLUSIONS Medicare participants experienced substantial BMI loss and diabetes remission, with a frequency of adverse events similar to that of NM participants.
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Affiliation(s)
- Elizaveta Walker
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Miriam Elman
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Erin E. Takemoto
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Erin Fennern
- Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - James E. Mitchell
- Department of Psychiatry and Behavioral Science, University of North Dakota, Chaska, MN
| | - Walter J. Pories
- Department of Surgery, East Carolina University, Greenville, NC, USA
| | - Bestoun Ahmed
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Alfons Pomp
- Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - Bruce M. Wolfe
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
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Haseeb YA. A Review of Obstetrical Outcomes and Complications in Pregnant Women after Bariatric Surgery. Sultan Qaboos Univ Med J 2019; 19:e284-e290. [PMID: 31897311 PMCID: PMC6930040 DOI: 10.18295/squmj.2019.19.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/08/2019] [Accepted: 07/07/2019] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery (BS) is a novel treatment for weight reduction with longer lasting health benefits. This review aimed to summarise the available evidence regarding the fetomaternal outcomes and the most common challenges and complications in pregnancies following BS. Google Scholar (Google LLC, Mountain View, California, USA) and PubMed® (National Library of Medicine, Bethesda, Maryland, USA) databases were searched for articles published until December 2018. A total of 64 articles were included in this review and results showed that BS mitigates the risk of gestational diabetes mellitus, hypertensive disorders in pregnancy and fetal macrosomia. However, it can also have detrimental effects on fetomaternal health. There is paucity of data regarding small for gestational age intrauterine growth restriction, premature rupture of membranes and long-term effects on the children born to women who underwent BS.
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Affiliation(s)
- Yasmeen A Haseeb
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Clapp B, Lodeiro C, Dodoo C, Coleman G, Sadri B, Wicker E, Swinney IL, Cullen R, Tyroch A. Trends in Drain Utilization in Bariatric Surgery: an Analysis of the MBSAQIP Database 2015-2017. Obes Surg 2019; 30:569-579. [PMID: 31654344 PMCID: PMC7223106 DOI: 10.1007/s11695-019-04215-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (SG) are the two most common bariatric operations. With the implementation of enhanced recovery protocols, the use of drains should decrease. Methods The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was queried for the years 2015–2017. Our inclusion criteria included all patients undergoing a primary LRYGB, SG, and revisions. We examined demographics, operative characteristics, the use of drains, and postoperative complications. Continuous variables were summarized using means and standard deviations (SD). Categorical variables were summarized using frequencies and proportions. Student’s T test (Wilcoxon sum rank test in the case of skewed data) and chi-squared analysis were used to assess the baseline differences in drain utilization. Results From 2015 to 2017, there were 388,239 bariatric cases performed without drains and 100,221 performed with drains. Twenty-nine percent of LRYGB patients had a drain placed but only 16.7% of SG patients. The percentage of LRYGB that had a drain dropped from 33.1 to 24.6% during the study period and that of SG dropped from 20.3 to 13.6%. Patients that had drains placed were more likely to have a provocative test at the time of surgery (prevalence ratio (PR) 2.24) and to have a postoperative swallow study (PR 1.93). Conclusions Drains are still commonly used in bariatric patients. Over the study period, there was a decrease in the use of drains in both bypass and sleeve patients. Patients with a drain were more likely to have had a provocative test and a swallow study and have a higher rate of complications and mortality. Electronic supplementary material The online version of this article (10.1007/s11695-019-04215-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Clapp
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, 1700 N. Mesa, El Paso, TX 79902 USA
| | - Carlos Lodeiro
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, 1700 N. Mesa, El Paso, TX 79902 USA
| | - Christopher Dodoo
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, 1700 N. Mesa, El Paso, TX 79902 USA
| | - Ginger Coleman
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, 1700 N. Mesa, El Paso, TX 79902 USA
| | - Babak Sadri
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, 1700 N. Mesa, El Paso, TX 79902 USA
| | - Ellen Wicker
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, 1700 N. Mesa, El Paso, TX 79902 USA
| | - Ira L. Swinney
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, 1700 N. Mesa, El Paso, TX 79902 USA
| | - Robert Cullen
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, 1700 N. Mesa, El Paso, TX 79902 USA
| | - Alan Tyroch
- Department of Surgery, Texas Tech HSC Paul Foster School of Medicine, 1700 N. Mesa, El Paso, TX 79902 USA
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