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Çalık Başaran N, Marcoviciu D, Dicker D. Metabolic Bariatric surgery in People with Obesity aged ≥65 Years. Eur J Intern Med 2024:S0953-6205(24)00134-1. [PMID: 38556416 DOI: 10.1016/j.ejim.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/02/2024]
Abstract
Obesity management guidelines recommend metabolic bariatric surgery for individuals with body mass index (BMI) ≥35 kg/m2, regardless of the presence of any obesity-related comorbidity; and for individuals with BMI 30-34.9 kg/m2 with metabolic diseases. Older age is not in itself a contraindication for bariatric surgeries, which can be performed after careful selection and assessment, to decrease the risks of postoperative complications. An essential amount of data has accumulated about bariatric surgery results for persons aged ≥60 years; but data are limited though increasingly accumulating for the ≥65-year-old population. Laparoscopic Roux-en-Y-gastric bypass and sleeve gastrectomy have been the preferred bariatric procedures for older adults with obesity, as for younger patients. This review summarizes the safety and efficacy of bariatric surgery for individuals aged ≥65 years with obesity, and the efforts that have been invested to improve the perioperative and long-term consequences.
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Affiliation(s)
- Nursel Çalık Başaran
- Hacettepe University, Faculty of Medicine, Department of Internal Medicine, General Internal Medicine, Ankara, Türkiye.
| | - Dana Marcoviciu
- Rabin Medical Center, Hasharon Hospital, Department of Internal Medicine D and Obesity Clinic, Petah Tikva, Israel
| | - Dror Dicker
- Rabin Medical Center, Hasharon Hospital, Department of Internal Medicine D and Obesity Clinic, Petah Tikva, Israel; Tel Aviv University, School of Medicine, Tel Aviv, Israel
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2
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Wallén S, Szabo E, Palmetun-Ekbäck M, Näslund I, Ottosson J, Näslund E, Stenberg E. Impact of socioeconomic status on new chronic opioid use after gastric bypass surgery. Surg Obes Relat Dis 2023; 19:1375-1381. [PMID: 37532668 DOI: 10.1016/j.soard.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/02/2023] [Accepted: 06/17/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Socioeconomic status may influence weight loss, postoperative complications, and health-related quality of life after bariatric surgery. Chronic use of opioid analgesics is a known risk after bariatric surgery, but whether socioeconomic factors are associated with new chronic use of opioid analgesics has not been investigated in depth. OBJECTIVES The aim of this study was to identify socioeconomic factors associated with the development of new chronic use of opioid analgesics after gastric bypass surgery. SETTING All hospitals performing bariatric surgery in Sweden. METHODS This was a retrospective cohort study with prospectively collected data including all primary gastric bypass procedures in Sweden between 2007 and 2015. Data were collected from the Scandinavian Obesity Surgery Registry, the Swedish Prescribed Drug Register, and Statistics Sweden. The primary outcome was new chronic opioid use. RESULTS Of the 44,671 participants, 1438 patients became new chronic opioid users. Longer education (secondary education; odds ratio [OR] = .71; 95% CI, .62-.81) or higher education (OR = .45; 95% CI, .38-.53), higher disposable income (20th-50th percentile: OR = .75; 95% CI, .66-.85; 50th-80th percentile: OR = .50; 95% CI, .43-.58; and the highest 80th percentile: OR = .40; 95% CI, .32-.51) were significantly associated with lower risk for new chronic opioid use. Being a second-generation immigrant (OR = 1.54; 95% CI, 1.24-1.90), being on a disability pension or early retirement (OR = 3.04; 95% CI, 2.67-3.45), receiving social benefits (OR = 1.88; 95% CI, 1.59-2.22), being unemployed for <100 days (OR = 1.25; 95% CI, 1.08-1.45), being unemployed for >100 days (OR = 1.41; 95% CI, 1.16-1.71), and being divorced or a widow or widower (OR = 1.35; 95% CI, 1.17-1.55) were significantly associated with a higher risk for chronic opioid use. CONCLUSION Given that long-term opioid use has detrimental effects after bariatric surgery, it is important that information and follow-up are optimized for patients with shorter education, lower income, and disability pension or early retirement because they are at an increased risk of new chronic opioid analgesics use.
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Affiliation(s)
- Stefan Wallén
- Pharmacology and Therapeutic Department, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Maria Palmetun-Ekbäck
- Pharmacology and Therapeutic Department, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Randell E, Katsogiannos P, Leksell J, Eriksson JW, Sundbom M, Engström MS. Complementary elements of support after gastric-bypass surgery perceived by adults with previous type 2 diabetes: A qualitative study 2 years after bariatric surgery. Clin Obes 2023; 13:e12610. [PMID: 37431181 DOI: 10.1111/cob.12610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/18/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
Bariatric surgery is the most medically and cost-effective treatment for adults with obesity and type 2 diabetes mellitus (T2DM). Our findings suggest initial improvements in health-related quality of life that may decline as support from follow-up care ends. How patients experience long-term support is not well described. This study therefore aimed to investigate how adults with previous T2DM perceived different sources of support 2 years after bariatric surgery. In this qualitative study, individual interviews were conducted with 13 adults (10 women) 2 years after surgery. Using thematic analysis, one overarching theme (compiling complementary elements of support after gastric-bypass surgery), four themes and nine subthemes emerged. The results show that support was given and received from various sources, support needs varied over time depending on where the patient was in the process and that the sources of support were complementary. To conclude, our results show that support needs change in adults who have undergone bariatric surgery. Long-term professional and day-to-day support from family and other networks are essential and complementary elements of support. Healthcare staff should consider these findings, especially during the early follow-up period.
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Affiliation(s)
- Eva Randell
- Department of Social Work, Uppsala University, Uppsala, Sweden
| | - Petros Katsogiannos
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Janeth Leksell
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Jan W Eriksson
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Svedbo Engström
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
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Wallhuss A, Ottosson J, Cao Y, Andersson E, Bergemalm D, Eriksson C, Olén O, Szabo E, Stenberg E. Outcomes of bariatric surgery for patients with prevalent inflammatory bowel disease: A nationwide registry-based cohort study. Surgery 2023; 174:144-151. [PMID: 37263879 DOI: 10.1016/j.surg.2023.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/11/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Obesity is becoming more prevalent in patients with inflammatory bowel disease. Although bariatric surgery is an effective treatment for obesity, questions remain regarding its safety and effectiveness for patients with inflammatory bowel disease. The aim of this study was to evaluate the safety and effectiveness of bariatric surgery in patients with inflammatory bowel disease. METHOD This registry-based, propensity-matched cohort study included all patients who had primary Roux-en-Y gastric bypass or sleeve gastrectomy in Sweden from January 2007 to June 2020 who had an inflammatory bowel disease diagnosis and matched control patients without an inflammatory bowel disease diagnosis. The study included data from the Scandinavian Obesity Surgery Registry, the National Patient Register, the Swedish Prescribed Drugs Register, the Total Population Register, and the Education Register from Statistics Sweden. RESULTS In total, 71,093 patients who underwent bariatric surgery, including 194 with Crohn's disease and 306 with ulcerative colitis, were 1:5 matched to non-inflammatory bowel disease control patients. The patients with Crohn's disease had a higher readmission rate within 30 days (10.7% vs 6.1%, odds ratio = 1.84, 95% confidence interval 1.02-3.31) than the control patients, with no significant difference between the surgical methods. The patients with ulcerative colitis had a higher risk for serious postoperative complications after Roux-en-Y gastric bypass (8.0% vs 3.7%, odds ratio = 2.64, 95% confidence interval 1.15-6.05) but not after sleeve gastrectomy compared to control patients (0.8% vs 2.3%). No difference was observed in postoperative weight loss or postoperative health-related quality of life. CONCLUSION Sleeve gastrectomy appears to be a safe and effective treatment for obesity in patients with inflammatory bowel disease, whereas Roux-en-Y gastric bypass was associated with a higher risk for postoperative complications in patients with ulcerative colitis.
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Affiliation(s)
- Andreas Wallhuss
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Sweden
| | - Ellen Andersson
- Department of Biomedical and Clinical Sciences, Linköping University and Department of Surgery, Vrinnevi, Norrköping, Sweden
| | - Daniel Bergemalm
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Sweden
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Sweden; Clinical Epidemiology Department, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ola Olén
- Clinical Epidemiology Department, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm South General Hospital, Sweden
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden.
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Wallén S, Bruze G, Ottosson J, Marcus C, Sundström J, Szabo E, Olbers T, Palmetun-Ekbäck M, Näslund I, Neovius M. Opioid Use After Gastric Bypass, Sleeve Gastrectomy or Intensive Lifestyle Intervention. Ann Surg 2023; 277:e552-e560. [PMID: 36700782 PMCID: PMC9905206 DOI: 10.1097/sla.0000000000005192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare opioid use in patients with obesity treated with bariatric surgery versus adults with obesity who underwent intensive lifestyle modification. SUMMARY OF BACKGROUND DATA Previous studies of opioid use after bariatric surgery have been limited by small sample sizes, short follow-up, and lack of control groups. METHODS Nationwide matched cohort study including individuals from the Scandinavian Obesity Surgery Registry and the Itrim health database with individuals undergoing structured intensive lifestyle modification, between August 1, 2007 and September 30, 2015. Participants were matched on Body Mass Index, age, sex, education, previous opioid use, diabetes, cardiovascular disease, and psychiatric status (n = 30,359:21,356). Dispensed opioids were retrieved from the Swedish Prescribed Drug Register from 2 years before to up to 8 years after intervention. RESULTS During the 2-year period before treatment, prevalence of individuals receiving ≥1 opioid prescription was identical in the surgery and lifestyle group. At 3 years, the prevalence of opioid prescriptions was 14.7% versus 8.9% in the surgery and lifestyle groups (mean difference 5.9%, 95% confidence interval 5.3-6.4) and at 8 years 16.9% versus 9.0% (7.9%, 6.8-9.0). The difference in mean daily dose also increased over time and was 3.55 mg in the surgery group versus 1.17 mg in the lifestyle group at 8 years (mean difference [adjusted for baseline dose] 2.30 mg, 95% confidence interval 1.61-2.98). CONCLUSIONS Bariatric surgery was associated with a higher proportion of opioid users and larger total opioid dose, compared to actively treated obese individuals. These trends were especially evident in patients who received additional surgery during follow-up.
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Affiliation(s)
- Stefan Wallén
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Pharmacology and Therapeutic Department, Region Örebro County, University Hospital of Örebro, Sweden
| | - Gustaf Bruze
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Torsten Olbers
- Institute of Clinical and Experimental Medicine and Wallenberg Centre for Molecular Medicine, University of Linköping and Department of Surgery, Vrinnevi, Norrköping, Sweden
| | - Maria Palmetun-Ekbäck
- Pharmacology and Therapeutic Department, Region Örebro County, University Hospital of Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Martin Neovius
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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Ighani Arani P, Wretenberg P, W-Dahl A. Information and BMI limits for patients with obesity eligible for knee arthroplasty: the Swedish surgeons' perspective from a nationwide cross-sectional study. J Orthop Surg Res 2022; 17:550. [PMID: 36536418 PMCID: PMC9762022 DOI: 10.1186/s13018-022-03442-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In the past decades, the incidence of obesity has increased worldwide. This disease is often accompanied with several comorbidities and therefore, surgeons and anesthesiologists should be prepared to provide optimal management for these patients. The aim of this descriptive cross-sectional study was to map the criteria and routines that are used by Swedish knee arthroplasty surgeons today when considering patients with obesity for knee arthroplasty. METHODS A survey including 21 items was created and sent to all the Swedish centers performing knee arthroplasty. The survey included questions about the surgeons' experience, hospital routines of preoperative information given and the surgeons' individual assessment of patients with obesity that candidates for knee arthroplasty. Descriptive statistics were used to present the data. RESULTS A total of 203 (64%) knee surgeons responded to the questionnaire. Almost 90% of the surgeons claimed to inform their patients with obesity that obesity has been associated with an increased risk of complications after knee arthroplasty. Seventy-nine percent reported that they had an upper BMI limit to perform knee arthroplasty, a larger proportion of the private centers had a BMI limit compared to public centers. The majority of the centers had an upper BMI limit of 35. CONCLUSION The majority of the knee arthroplasty surgeons in Sweden inform their patients with obesity regarding risks associated with knee arthroplasty. Most centers that perform knee arthroplasties in Sweden have an upper BMI limit.
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Affiliation(s)
- Perna Ighani Arani
- grid.412367.50000 0001 0123 6208Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden ,grid.15895.300000 0001 0738 8966Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81 Örebro, Sweden
| | - Per Wretenberg
- grid.412367.50000 0001 0123 6208Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden ,grid.15895.300000 0001 0738 8966Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81 Örebro, Sweden
| | - Annette W-Dahl
- grid.4514.40000 0001 0930 2361Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University, 221 00 Lund, Sweden ,The Swedish Arthroplasty Register, Göteborg, Sweden
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Impact of age on Quality of Life after Gastric Bypass. Data from the Scandinavian Obesity Surgery Registry (SOReg). Surg Obes Relat Dis 2022; 18:1313-1322. [DOI: 10.1016/j.soard.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/26/2022] [Accepted: 06/11/2022] [Indexed: 11/22/2022]
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Kvalem IL, Gabrielsen L, Eribe I, Kristinsson JA, Mala T. Predicting satisfaction with outcome and follow‐up care five years after bariatric surgery: a prospective evaluation. Obes Sci Pract 2022; 8:595-602. [PMID: 36238221 PMCID: PMC9535663 DOI: 10.1002/osp4.594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Patient satisfaction is viewed as essential for a successful outcome of bariatric surgery. Few studies have explored long‐term satisfaction prospectively. This study aimed to examine pre‐ and post‐surgery predictors for satisfaction with follow‐up care, and change in outcome satisfaction from one to 5 years after bariatric surgery. Methods A sample of 210 participants was recruited from a single treatment center. Self‐reported and medical record data regarding mental and somatic health, body image, follow‐up attendance, and weight loss were obtained before, 1 year, and 5 years after surgery. Results Over 90% of the participants were satisfied with the results and treatment 1 year after surgery, while 69% had their outcome expectations fulfilled and 62% were satisfied with the follow‐up 5 years after surgery. A shift from initial satisfaction to unfulfillment of expectations was predicted by baseline body dissatisfaction, greater percentage of weight regain after initial weight loss, and more discomfort from somatic symptoms 5 years after surgery. In addition to symptom discomfort, worry about surgery predicted satisfaction with follow‐up care. Conclusion At 5 years, one‐fifth of those initially satisfied reported that bariatric surgery had failed to meet their expectations. This suggests that outcome expectations related to weight loss, somatic symptoms, and body image need to be addressed both before and after bariatric surgery.
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Affiliation(s)
| | | | - Inger Eribe
- Department of EndocrinologyMorbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
| | - Jon A. Kristinsson
- Department of EndocrinologyMorbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Department of Gastrointestinal and Paediatric SurgeryUniversity of OsloOsloNorway
| | - Tom Mala
- Department of EndocrinologyMorbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Department of Gastrointestinal and Paediatric SurgeryUniversity of OsloOsloNorway
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Yu Y, Ma Q, Johnson JA, O'Malley WE, Sabbota A, Groth SW. Predictors of 30-day follow-up visit completion after primary bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Surg Obes Relat Dis 2021; 18:384-393. [PMID: 34974998 DOI: 10.1016/j.soard.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/01/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adherence to follow-up visits is often unsatisfactory after bariatric surgery. OBJECTIVES To identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015-2018). METHODS Patients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy were included in this analysis. Data were analyzed using weighted logistic regression. Subanalyses included stratification of the sample by sex and age (<45, 45-60, and >60 years). RESULTS Patients (n = 566,774) were predominantly female (79.6%), White (72.4%), non-Hispanic (77.9%), and middle-aged (44.5 ± 11.9 years), with a mean BMI of 45.3 ± 7.8 kg/m2. More than 95% of patients completed the 30-day visits. In the whole-sample analysis, older age (odds ratio [OR], 1.02) and the presence of non-insulin-dependent diabetes (OR, 1.04), hypertension (OR, 1.03), hyperlipidemia (OR, 1.10), obstructive sleep apnea (OR, 1.15), and gastroesophageal reflux disease (OR, 1.16) were positive predictors of the 30-day visit completion (Ps < .01). Conversely, sleeve gastrectomy procedure (OR, .86), Black race (OR, .87), Hispanic ethnicity (OR, .94), and the presence of insulin-dependent diabetes (OR, .96) and smoking (OR, .83) were negative predictors (Ps < .01). Several differences emerged in subanalyses. For example, in sex stratification, Hispanic ethnicity lost its significance in men. In age stratification, BMI and male sex emerged as positive predictors in the age groups of <45 and 45-60 years, respectively. CONCLUSION Although challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York.
| | - Qianheng Ma
- School of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Joseph A Johnson
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - William E O'Malley
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Aaron Sabbota
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Susan W Groth
- School of Nursing, University of Rochester, Rochester, New York
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YILMAZ EKER P, YILMAZ M, TOPAL HANÇER A. Determination of quality of life of individuals before and after bariatric surgery: Prospective study with 1 year follow-up. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.862544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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11
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Gastrointestinal quality of life before and short- and long-term after Roux-en-Y gastric bypass for severe obesity. Surg Obes Relat Dis 2021; 17:1583-1590. [PMID: 34099420 DOI: 10.1016/j.soard.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/26/2021] [Accepted: 05/11/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Overall quality of life (QoL) is generally improved after bariatric surgery. Gastrointestinal (GI) symptoms including abdominal pain have been reported in up to >30% of patients after Roux-en-Y gastric bypass (RYGB), and may negatively influence QoL, especially GI-QoL. OBJECTIVES To evaluate the evolution of GI symptoms and GI-QoL short- and long-term after RYGB. SETTING Two public hospitals METHODS: Candidates for bariatric surgery (n = 128, BMI = 44.2 ± 7.4) or patients who had undergone RYGB 2-4 years (n = 161, BMI = 29.3 ± 15.9) and 5-10 years (n = 121, BMI = 31.3 ± 6.5) before were invited to complete a questionnaire combining 3 validated questionnaires (GIQLI, GSRS, and PCS) specifically designed to evaluate GI-QoL. Scores were compared between the preoperative, early, and late postoperative periods. RESULTS The GIQLI score improved from 88.1 before surgery to 118.6 (P < .0001) and 109.7 (P < .0001) in the early and late postoperative periods respectively. GSRS score improved from 15.6 to 10.1 (P = .0001) and 12.8 (P = .012), and PCS-score improved from 19 to 4.5 (P = .0001) and 8.3 (P = .0001), respectively. The GI subscore of the GIQLI improved from 57.4 to 62.1 (P = .007) in the early period but was not significantly different in the late period (59.3 versus 57.4, P = .3). The psychological impact of GI symptoms decreased at both postoperative time points. CONCLUSION GI-QoL is markedly improved after RYGB, and this improvement persists up to 10 years. GI symptoms decrease early after surgery and do not worsen in the longer term. Their psychological impact is markedly reduced.
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12
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Antonsson T, Wennersten A, Sörensen K, Regnér S, Ekelund M. Differences in Health-Related Quality of Life After Gastric Bypass Surgery: a Cross-Sectional Study. Obes Surg 2021; 31:3194-3202. [PMID: 33928524 PMCID: PMC8175313 DOI: 10.1007/s11695-021-05416-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gastric bypass (GBP) is a surgical method with good evidence of sustainable weight loss, reduced obesity-related comorbidities, and improved health-related quality of life (HRQoL). However, long-term data post-GBP is scarce on HRQoL related to other factors than weight loss, such as impact of socio-economic, age, and gender. AIM To investigate long-term HRQoL in GBP patients. METHODS The study was conducted as a cross-sectional study covering 3 to 9 years post-GBP measuring HRQoL using RAND-36. Association to weight loss, time since surgery, gender, educational level, occupation, and age was analyzed. The participants were included on the basis that they had received a GBP that was performed by Region Skåne, the southernmost administrative healthcare region in Sweden. Recruitment to the study was by mail invitation for an online survey. RESULTS Of the total population of 5310 persons receiving the questionnaire, 1339 of the 1372 responders fulfilled the inclusion criteria. Those with low educational level, unemployed, persons on sick leave or disability support, and those with less weight loss reported the lowest HRQoL. The longer time since surgery, the lower the HRQoL. CONCLUSION Less weight loss, longer time since GBP, lower educational level, and lower degree of employment all affect HRQoL negatively after GBP surgery.
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Affiliation(s)
- Tobias Antonsson
- Department of Clinical Sciences Malmö, Section for Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
| | - André Wennersten
- Clinical Studies Sweden - Forum South, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Family Medicine and Community Medicine, Malmö, Sweden
| | - Kaisa Sörensen
- Department of Surgery, Skane University Hospital, Lund, Malmo, Sweden
| | - Sara Regnér
- Department of Clinical Sciences Malmö, Section for Surgery, Skåne University Hospital, Lund University, Lund, Sweden.,Department of Surgery, Skane University Hospital, Lund, Malmo, Sweden
| | - Mikael Ekelund
- Department of Clinical Sciences Malmö, Section for Surgery, Skåne University Hospital, Lund University, Lund, Sweden.,Department of Surgery, Skane University Hospital, Lund, Malmo, Sweden
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Hatchimonji JS, Bader AL, Ma LW, Chreiman K, Byrne JP, Reilly PM, Braslow BM, Seamon MJ, Holena DN. Pain Interference and Decreased Physical Function After Emergency General Surgery: Measuring Patient-Reported Outcomes. World J Surg 2021; 45:1725-1733. [PMID: 33683414 PMCID: PMC7938883 DOI: 10.1007/s00268-021-06011-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 10/27/2022]
Abstract
INTRODUCTION There is increasing emphasis on patient-reported outcomes (PROs) measures in healthcare, but this area remains largely unexplored in emergency general surgery (EGS) conditions. We hypothesized that postoperative patients in our EGS clinic would report detrimental changes in several domains of health-related quality of life (HRQoL). METHODS We administered the PROMIS-29, a HRQoL measurement tool, to postoperative patients in our EGS clinic (11/2019-4/2020). Patients responded to measures of 7 domains. Domain scores were converted to t-scores, allowing comparison to average values within the general US population (set to 50 by definition). We report the mean scores within each domain. Higher scores in negatively worded domains (e.g., "Depression") are worse; vice versa for positively worded domains (e.g., "Physical Function"). Changes in scores at subsequent clinic visits were analyzed using the paired t-test. RESULTS There were 97 patients who completed the PROMIS-29 at the first postoperative visit. Mean (SD) age was 54.1 (16.2) years; 51% were male. There was no difference in our patients from the average US population in the domains of Ability to Participate in Social Roles and Activities, Anxiety, Fatigue, and Sleep Disturbance. However, EGS patients experienced significantly greater Pain Interference (56.1 [54.1, 58.1]) and worse Physical Function (40.6 [38.4, 42.7]) than average. For patients seen in follow-up twice (13 patients, median interval between clinic visits 21 days), there were improvements in the domains of Physical Function (42.9 vs 37.3; p = 0.04) and Fatigue. CONCLUSION We demonstrate room for improvement in the domains of pain interference and physical function. While positive changes over a relatively short period of time are encouraging, consideration should be given to patient perceptions of illness and lifestyle impact when managing EGS patients.
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Affiliation(s)
- Justin S Hatchimonji
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, 4 Maloney, Philadelphia, PA, USA.
| | - Amanda L Bader
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, 4 Maloney, Philadelphia, PA, USA
| | - Lucy W Ma
- School of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristen Chreiman
- Division of Traumatology, Emergency Surgery, and Surgical Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - James P Byrne
- Division of Traumatology, Emergency Surgery, and Surgical Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Patrick M Reilly
- Division of Traumatology, Emergency Surgery, and Surgical Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin M Braslow
- Division of Traumatology, Emergency Surgery, and Surgical Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J Seamon
- Division of Traumatology, Emergency Surgery, and Surgical Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel N Holena
- Division of Traumatology, Emergency Surgery, and Surgical Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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14
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Ighani Arani P, Wretenberg P, Ottosson J, Robertsson O, W-Dahl A. Bariatric surgery prior to total knee arthroplasty is not associated with lower risk of revision: a register-based study of 441 patients. Acta Orthop 2021; 92:97-101. [PMID: 33143505 PMCID: PMC7919889 DOI: 10.1080/17453674.2020.1840829] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Obesity is a considerable medical challenge in society. We investigated the risk of revision for any reasons and for infection in patients having total knee arthroplasty (TKA) for osteoarthritis (OA) within 2 years after bariatric surgery (BS) and compared them with TKAs without BS.Patients and methods - We used the Scandinavian Obesity Surgery Registry (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) to identify patients operated on in 2009-2019 with BS who had had primary TKA for OA within 2 years after the BS (BS group) and compared them with TKAs without prior BS (noBS group). We determined adjusted hazard ratio (HR) for the BS group and noBS group using Cox proportional hazard regression for revision due to any reasons and for infection. Adjustments were made for sex, age groups, and BMI categories preoperatively.Results - 441 patients were included in the BS group. The risk of revision for infection was higher for the BS group with HR 2.2 (95% CI 1.1-4.7) adjusting for BMI before the TKA, while the risk of revision for any reasons was not statistically significant different for the BS group with HR 1.3 (CI 0.9-2.1). Corresponding figures when adjusting for BMI before the BS were HR 0.9 (CI 0.4-2) and HR 1.2 (CI 0.7-2).Interpretation - Our findings did not indicate that BS prior to TKA was associated with lower risk of revision.
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Affiliation(s)
- Perna Ighani Arani
- Department of Orthopedics, Orebro University Hospital; ,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro; ,Correspondence:
| | - Per Wretenberg
- Department of Orthopedics, Orebro University Hospital; ,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro;
| | - Johan Ottosson
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro; ,Department of Surgery, Örebro University Hospital; ,Scandinavian Obesity Surgery Registry, Örebro;
| | - Otto Robertsson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund; ,The Swedish Knee Arthroplasty Register, Lund, Sweden
| | - Annette W-Dahl
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Lund; ,The Swedish Knee Arthroplasty Register, Lund, Sweden
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Atwood ME, Cassin SE, Rajaratnam T, Hawa R, Sockalingam S. The Bariatric Interprofessional Psychosocial Assessment of Suitability Scale predicts binge eating, quality of life and weight regain following bariatric surgery. Clin Obes 2021; 11:e12421. [PMID: 33200534 DOI: 10.1111/cob.12421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022]
Abstract
Presurgical psychosocial evaluations are an important component of bariatric care; yet, bariatric programs vary widely in their assessment and interpretation of psychosocial risk. There is a need for validated clinical tools that help to standardize and streamline the assessment of variables relevant to surgical outcomes. The present study contributes to the validation of the Bariatric Interprofessional Psychosocial Assessment of Suitability Scale (BIPASS), a novel presurgical psychosocial evaluation tool, by: (a) examining the psychometric properties and optimal cutoff score, and; (b) examining the ability of the BIPASS tool to predict outcomes 1 and 2 years postsurgery, including weight regain, quality of life, psychiatric symptoms and adherence to postsurgical follow-up appointments. The BIPASS was applied retrospectively to the charts of 179 consecutively referred patients to a metropolitan bariatric surgery programme. Internal consistency for the BIPASS was acceptable, and interrater reliability was excellent. Higher BIPASS scores predicted higher binge eating symptomatology and lower mental health-related quality of life at 1 year postsurgery, and weight regain at 2 years (all P < .01). The BIPASS did not predict adherence to postsurgical follow-up appointments. Findings suggest that the BIPASS can be used to identify patients at increased risk of disordered eating, poor quality of life and weight regain early in the postsurgical course, thereby facilitating patient education and appropriate interventions.
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Affiliation(s)
- Molly E Atwood
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Stephanie E Cassin
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Thiyake Rajaratnam
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Department of Education, Centre for Addictions and Mental Health, Toronto, Ontario, Canada
| | - Raed Hawa
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
- Department of Education, Centre for Addictions and Mental Health, Toronto, Ontario, Canada
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16
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Patel K, Askari A, Mamidanna R, Jain V, Adil T. Long-term BAROS scores and independent obesity-related co-morbidity predictors of failure after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2020; 16:1954-1960. [PMID: 32958371 DOI: 10.1016/j.soard.2020.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/05/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Long-term (>5 yr) studies assessing outcomes after laparoscopic Roux-en-Y gastric bypass (LRYGB) using the Bariatric Analysis and Reporting Outcome System (BAROS) are limited. Evidence of predictors of failure long-term after LRYGB is also lacking. OBJECTIVES To compare BAROS scores at 5 and 10 years post LRYGB and to establish whether individual obesity-related co-morbidities are associated with suboptimal outcomes at these time points. SETTING Single bariatric unit. METHODS BAROS scores were analyzed in patients who were 5 years (group A) and 10 years (group B) post LRYGB. Obesity-related co-morbidities as predictors of failure of surgery (defined by % excess weight loss [%EWL] <50% or BAROS total score ≤1) were examined. Intergroup comparative analysis of outcomes and logistic regression modeling to determine predictors of weight loss failure were conducted. RESULTS A total of 88 patients were 5 years post LRYGB (group A), and 91 patients were 10 years post LRYGB (group B). A total of 52.3% (46/88) in group A and 54.9% (50/91) in group B had failure of weight loss defined by %EWL <50%. There were no significant differences in percentage of total weight loss, %EWL, or BAROS scores between the 2 groups (21.8% versus 22.0%, P = .897; 48.5% versus 47.1%, P = .993; and 3.7 versus 3.3, P = .332, respectively). No individual obesity-related co-morbidity at time of surgery was associated with suboptimal outcomes (%EWL <50% or BAROS total score ≤1) at 5 years or 10 years after LRYGB. CONCLUSIONS Long-term outcomes assessed by the BAROS score appear sustainable between 5 and 10 years after LRYGB surgery, and weight loss achieved at 5 years is maintained at 10 years. Preoperative presence of specific obesity-related co-morbidities was not associated with failure of surgery long-term.
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Affiliation(s)
- Krashna Patel
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom.
| | - Alan Askari
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Ravikrishna Mamidanna
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Vigyan Jain
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Tanveer Adil
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital, Luton, United Kingdom
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17
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Improvements of health-related quality of life 5 years after gastric bypass. What is important besides weight loss? A study from Scandinavian Obesity Surgery Register. Surg Obes Relat Dis 2020; 16:1249-1257. [DOI: 10.1016/j.soard.2020.04.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/19/2020] [Accepted: 04/30/2020] [Indexed: 12/19/2022]
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Abstract
INTRODUCTION Up to 30 % of patients undergoing bariatric surgery are dissatisfied with treatment outcomes in the long term. The aim of this study was to examine overall satisfaction with treatment 5 years after bariatric surgery and its association with body mass index (BMI) and health-related quality of life (HRQOL). METHODS Patients were surveyed 5 years after bariatric surgery; 108 patients had duodenal switch (DS) and 153 patients had laparoscopic sleeve gastrectomy (LSG). The main outcome was overall treatment satisfaction, assessed by a single question, and analyzed by multiple logistic regression. Estimates for continuous independent variables represent the odds ratios (OR) for a 2-standard deviation difference. RESULTS Five years after surgery, 82.4 % of the patients were very satisfied or satisfied, whereas 17.6 % were unsure or dissatisfied. The following variables assessed at 5 years were associated with being dissatisfied/unsure: a higher BMI (OR = 6.1, 95 % CI = 2.7-14.0, p < 0.001), reduced obesity-specific HRQOL (OR = 3.0, 95 % CI = 1.1-7.8, p = 0.03), and reduced mental HRQOL (OR = 0.3, 95 % CI = 0.1-0.8, p = 0.02). We also found that a higher proportion of patients who underwent LSG, compared to DS, reported being dissatisfied/unsure (OR = 3.3, 95 % CI = 1.3-8.8, p = 0.01). CONCLUSION Reduced mental HRQOL and obesity-related HRQOL, as well as higher BMI, were associated with less satisfaction with overall treatment outcomes 5 years after bariatric surgery. Differences in overall treatment satisfaction by type of operation warrant further investigation.
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19
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Gryth K, Persson C, Näslund I, Sundbom M, Näslund E, Stenberg E. The Influence of Socioeconomic Factors on Quality-of-Life After Laparoscopic Gastric Bypass Surgery. Obes Surg 2020; 29:3569-3576. [PMID: 31190262 DOI: 10.1007/s11695-019-04028-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Patients with low socioeconomic status have been reported to experience poorer outcome after several types of surgery. The influence of socioeconomic factors on health-related quality-of-life (HRQoL) after bariatric surgery is unclear. MATERIALS AND METHODS Patients operated with a primary laparoscopic gastric bypass procedure in Sweden between 2007 and 2015 were identified in the Scandinavian Obesity Surgery Register. Patients with a completed assessment of health-related quality-of-life based on the Obesity-related Problem Scale (OP Scale) were included in the study. Socioeconomic status was based on data from Statistics Sweden. RESULTS A total of 13,723 patients (32% of the 43,096 operated during the same period), with complete OP scores at baseline and two years after surgery, were included in the study. Age, lower preoperative BMI, male gender, higher education, professional status and disposable income as well as not receiving social benefits (not including retirement pension), and not a first- or second-generation immigrant, were associated with a higher postoperative HRQoL. Patients aged 30-60 years, with lower BMI, higher socioeconomic status, women and those born in Sweden by Swedish parents experienced a higher degree of improvement in HRQoL. Postoperative weight-loss was associated with higher HRQoL (unadjusted B 16.3, 95%CI 14.72-17.93, p < 0.0001). CONCLUSION At 2 years, a strong association between weight loss and improvement in HRQoL was seen, though several factors influenced the degree of improvement. Age, sex, preoperative BMI and socioeconomic status all influence the postoperative HRQoL as well as the improvement in HRQoL after laparoscopic gastric bypass surgery.
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Affiliation(s)
- Karin Gryth
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, SE-701 85, Örebro, Sweden
| | - Carina Persson
- Department of Community Medicine and Public Health, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Department for Sustainable Development, Region Örebro County, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, SE-701 85, Örebro, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Näslund
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, SE-701 85, Örebro, Sweden.
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20
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Major P, Stefura T, Dziurowicz B, Radwan J, Wysocki M, Małczak P, Pędziwiatr M. Quality of Life 10 Years After Bariatric Surgery. Obes Surg 2020; 30:3675-3684. [PMID: 32535784 PMCID: PMC7467960 DOI: 10.1007/s11695-020-04726-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Improvement of the quality of life after bariatric surgery is an important outcome of the treatment. Assessing the long-term QoL results provides better insights into the effectiveness of bariatric surgery. MATERIALS AND METHODS This is a cohort study including patients who underwent bariatric surgery between June 2009 and May 2010 in one academic center. Patients underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). Overall, 34 patients underwent LSG (52.3%) and 31 patients underwent LRYGB (47.7%). Preoperatively, and after 1 and 10 years, QoL was assessed using two standardized questionnaires: SF-36 and MA-QoLII. After 10 years, 72% of patients filled out these questionnaires. RESULTS The global QoL score before surgery was 48.3 ± 20.6. At the 1-year follow-up, the global total QoL score was 79.7 ± 9.8. At the 10-year follow-up, the global total QoL score was 65.1 ± 21.4. There was a significant increase in total QoL between measurements before the operation and 10 years after surgery in the whole study group (p = 0.001) and for patients who underwent LSG (p = 0.001). There was no significant difference between total QoL prior to surgery and 10 years after for patients who underwent LRYGB (p = 0.450). CONCLUSION LSG led to significant improvement in QoL.
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Affiliation(s)
- Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Tomasz Stefura
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.
| | - Błażej Dziurowicz
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Joanna Radwan
- Students' Scientific Group at 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Jakubowskiego 2 st., 30-688, Cracow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Cracow, Poland
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de Oliveira Lima MD, da Silva TPR, de Menezes MC, Mendes LL, Pessoa MC, de Araújo LPF, Andrade RGC, D’Assunção ADM, Manzo BF, dos Reis Corrêa A, Santos FBO, Lachtim SAF, de Freitas GL, de Andrade LAV, de Sousa MA, Matozinhos FP. Environmental and individual factors associated with quality of life of adults who underwent bariatric surgery: a cohort study. Health Qual Life Outcomes 2020; 18:87. [PMID: 32228607 PMCID: PMC7106729 DOI: 10.1186/s12955-020-01331-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/18/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Obesity is a multifactorial chronic condition associated with genetic, behavioral and environmental factors. Understanding the role of the built and social environment in Quality of Life (QOL) is critical to reducing the negative impacts of the environment on health. OBJECTIVE To estimate the built and social environmental and individual factors that influence the QOL of adults who underwent bariatric surgery. METHODS A prospective cohort study conducted with adults who underwent bariatric surgery. Using longitudinal linear regression analysis, we verified the association between the domains of World Health Organization Quality of Life in version bref (WHOQOL-Bref) - General QOL and domains psychological, physical health, social relations and environment - and possible influencing factors. RESULTS The increase in Body Mass Index (BMI) reduces on average 0.47 points in physical domain assessment score. The increase of healthy establishments within the buffer increases on average 0.52 points in the physical domain score. Being female reduces, on average, 5.35 points in the psychological domain evaluation score. Adults who practiced less than 150 min a week of leisure-time physical activity had a 3.27 point average reduction in the social relations domain assessment score. The increase in the number of Supermarkets and Hypermarkets in the buffer increases on average 2.18 points from the Social Relations domain score. CONCLUSIONS Individual and contextual factors were associated with the QOL of adults who underwent bariatric surgery. Although the surgery yields positive results, the maintenance of same is strongly related to changes in lifestyle, the built environment and multi-professional guidance.
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Affiliation(s)
- Marina Dayrell de Oliveira Lima
- Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Thales Philipe Rodrigues da Silva
- Postgraduate Program in Health Sciences, Child and Adolescent Health, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Mariana Carvalho de Menezes
- Departament of Clinical and Social Nutrition, Universidade Federal de Ouro Preto, Ouro Preto, Minas Gerais Brazil
| | - Larissa Loures Mendes
- Department of Nutrition, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Milene Cristine Pessoa
- Department of Nutrition, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | | | | | | | - Bruna Figueiredo Manzo
- Department of Maternal Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Allana dos Reis Corrêa
- Basic Nursing Departament, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | | | | | - Giselle Lima de Freitas
- Department of Maternal Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | | | - Marco Aurélio de Sousa
- Postgraduate Program in Nursing, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Fernanda Penido Matozinhos
- Department of Maternal Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
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Chahal-Kummen M, Salte OBK, Hewitt S, Blom-Høgestøl IK, Risstad H, Kristinsson J, Mala T. Health benefits and risks during 10 years after Roux-en-Y gastric bypass. Surg Endosc 2020; 34:5368-5376. [PMID: 31993812 PMCID: PMC7644522 DOI: 10.1007/s00464-019-07328-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/24/2019] [Indexed: 01/19/2023]
Abstract
Background Long-term evaluations 10 years after Roux-en-Y gastric bypass (RYGB) are limited. We report the development in weight and cardiovascular risk factors during 10 years after laparoscopic RYGB, with evaluation of gastrointestinal symptoms and quality of life (QoL) at 10-year follow-up. Methods We performed a prospective longitudinal cohort study. Patients operated with laparoscopic RYGB from May 2004 to November 2006 were invited to 10-year follow-up consultations. Gastrointestinal Symptom Rating Scale (GSRS) questionnaire and two QoL questionnaires were used for analyses of gastrointestinal symptoms and QoL. Results A total of 203 patients were operated; nine (4.4%) died during follow-up. Of 194 eligible patients, 124 (63.9%) attended 10-year follow-up consultations. Percent excess weight loss (%EWL) and percent total weight loss (%TWL) at 10 years were 53.0% and 24.1%, respectively. %EWL > 50% was seen in 53.2%. Significant weight regain (≥15%) from 2 to 10 years was seen in 63.3%. Remission rates of type 2 diabetes, dyslipidemia, and hypertension were 56.8%, 46.0%, and 41.4%, respectively. Abdominal operations beyond 30 days after RYGB were reported in 33.9%. Internal hernia and ileus (13.7%) and gallstone-related disease (9.7%) were the most common causes. Vitamin D deficiency (<50nmol/L) was seen in 33.3%. At 10 years, bothersome abdominal pain and indigestion symptoms (GSRS scores ≥3) were reported in 42.9% and 54.0%, respectively, and were associated with low QoL. Conclusion We observed significant weight loss and remission of comorbidities 10 years after RYGB. Significant weight regain occurred in a substantial subset of patients. Gastrointestinal symptoms were common and negatively impacted QoL.
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Affiliation(s)
- M Chahal-Kummen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Nydalen, PO Box 4950, 0424, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - O B K Salte
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
| | - S Hewitt
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Nydalen, PO Box 4950, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - I K Blom-Høgestøl
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Nydalen, PO Box 4950, 0424, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - H Risstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Nydalen, PO Box 4950, 0424, Oslo, Norway
| | - J Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Nydalen, PO Box 4950, 0424, Oslo, Norway
| | - T Mala
- Department of Gastrointestinal Surgery, Oslo University Hospital, Oslo, Norway
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Katsogiannos P, Randell E, Sundbom M, Rosenblad A, Eriksson JW, Leksell J. Quality of life after gastric bypass surgery in patients with type 2 diabetes: patients' experiences during 2 years of follow-up. Diabetol Metab Syndr 2020; 12:90. [PMID: 33062061 PMCID: PMC7552522 DOI: 10.1186/s13098-020-00597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/01/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To examine the effects of gastric bypass surgery on health-related quality of life (HRQoL) in obese patients with type 2 diabetes, and to investigate their experiences of life adjustments using quantitative and qualitative methods. METHODS Thirteen patients with type 2 diabetes and obesity, (body mass index, BMI > 30 kg/m2), participating in a randomized clinical trial, completed this sub-study. HRQoL was evaluated before, and at 6 months and 2 years after gastric bypass surgery, using the RAND- 36-item health survey. At 2 years, interviews for in-depth analysis of HRQoL changes were performed. RESULTS Significant improvement was observed from baseline to 6 months for 2 of the eight health concepts, general health, and emotional well-being. At 2 years, improvements were also seen in physical functioning, energy/fatigue, as well as sustained improvements in general health and emotional well-being. Multiple regression analyses showed mostly non-significant associations between the magnitude of decrease in weight, BMI, and HbA1c during follow-up and improvement in HRQoL. The analyses from qualitative interviews supported a common latent theme "Finding a balance between the experience of the new body weight and self-confidence". CONCLUSIONS The improved HRQoL after gastric bypass surgery in obese patients with type 2 diabetes was not explained specifically by the magnitude of weight loss, but rather by the participants achieving a state of union between body and consciousness.Trial registration ClinicalTrials.gov Identifier NCT02729246. Date of registration 6 April 2016 - Retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02729246?term=bariglykos&draw=2&rank=1.
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Affiliation(s)
- Petros Katsogiannos
- Departments of Medical Science, Clinical Diabetes and Metabolism Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Randell
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Rosenblad
- Departments of Medical Science, Clinical Diabetes and Metabolism Sciences, Uppsala University, Uppsala, Sweden
| | - Jan W. Eriksson
- Departments of Medical Science, Clinical Diabetes and Metabolism Sciences, Uppsala University, Uppsala, Sweden
| | - Janeth Leksell
- Departments of Medical Science, Clinical Diabetes and Metabolism Sciences, Uppsala University, Uppsala, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Use of Opioid Analgesics Before and After Gastric Bypass Surgery in Sweden: a Population-Based Study. Obes Surg 2019; 28:3518-3523. [PMID: 29998381 DOI: 10.1007/s11695-018-3377-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Little is known regarding the use of opioid analgesics among patients who have undergone bariatric surgery. The Roux-en-Y gastric bypass (RYGB) procedure has been shown to significantly increase the rate of absorption of and exposure to morphine, raising concerns regarding the potentially increased risk of side-effects and the development of substance-use disorder. OBJECTIVES The aim of this study was to describe the pattern of opioid use over time following RYGB and to see if the pattern differs between patients with a high opioid consumption (HOC) prior to surgery and those with a low consumption (LOC). SETTING University Hospital of Örebro, Sweden. METHODS The study was a descriptive retrospective population-based cohort study where two registers with complete coverage were cross-matched. RESULTS The study population comprised 35,612 persons (1628 HOC, and 33,984 LOC). After surgery, the number of HOC patients increased to 2218. Mean daily opioid consumption in the total population and the LOC group increased after surgery (p < .0005). In the HOC group, there was no difference between mean daily consumption before and after surgery. CONCLUSION In this nationwide study, we have showed that there is an increase in consumption of opioid analgesics after gastric bypass surgery in Sweden. The increase in the number of individuals with high opioid consumption in the total population was mainly due to an increase in the group of patients with a low consumption prior to surgery.
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Women’s Satisfaction with and Reasons to Seek Bariatric Surgery—a Prospective Study in Sweden with 1-Year Follow-up. Obes Surg 2019; 29:2059-2070. [DOI: 10.1007/s11695-019-03834-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Generic Health-Related Quality of Life May Not Be Associated with Weight Loss 4 Years After Bariatric Surgery: a Cross-Sectional Study. Obes Surg 2018; 28:3142-3150. [DOI: 10.1007/s11695-018-3332-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Stenberg E, Szabo E, Ottosson J, Thorell A, Näslund I. Health-Related Quality-of-Life after Laparoscopic Gastric Bypass Surgery with or Without Closure of the Mesenteric Defects: a Post-hoc Analysis of Data from a Randomized Clinical Trial. Obes Surg 2018; 28:31-36. [PMID: 28676957 PMCID: PMC5735210 DOI: 10.1007/s11695-017-2798-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mesenteric defect closure in laparoscopic gastric bypass surgery has been reported to reduce the risk for small bowel obstruction. Little is known, however, about the effect of mesenteric defect closure on patient-reported outcome. The aim of the present study was to see if mesenteric defect closure affects health-related quality-of-life (HRQoL) after laparoscopic gastric bypass. METHODS Patients operated at 12 centers for bariatric surgery participated in this randomized two-arm parallel study. During the operation, patients were randomized to closure of the mesenteric defects or non-closure. This study was a post-hoc analysis comparing HRQoL of the two groups before surgery, at 1 and 2 years after the operation. HRQoL was estimated using the short form 36 (SF-36-RAND) and the obesity problems (OP) scale. RESULTS Between May 1, 2010, and November 14, 2011, 2507 patients were included in the study and randomly assigned to mesenteric defect closure (n = 1259) or non-closure (n = 1248). In total, 1619 patients (64.6%) reported on their HRQoL at the 2-year follow-up. Mesenteric defect closure was associated with slightly higher rating of social functioning (87 ± 22.1 vs. 85 ± 24.2, p = 0.047) and role emotional (85 ± 31.5 vs. 82 ± 35.0, p = 0.027). No difference was seen on the OP scale (open defects 22 ± 24.8 vs. closed defects 20 ± 23.8, p = 0.125). CONCLUSION When comparing mesenteric defect closure with non-closure, there is no clinically relevant difference in HRQoL after laparoscopic gastric bypass surgery.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-701 85, Örebro, Sweden.
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-701 85, Örebro, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-701 85, Örebro, Sweden
| | - Anders Thorell
- Department of Surgery, Ersta Hospital, Stockholm, Sweden.,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, SE-701 85, Örebro, Sweden
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Fink K, Ross CA. Adverse Childhood Experiences in a Post-bariatric Surgery Psychiatric Inpatient Sample. Obes Surg 2018; 27:3253-3257. [PMID: 28593483 DOI: 10.1007/s11695-017-2767-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sixty-three inpatients in a psychiatric hospital who had previously undergone bariatric surgery were interviewed by the hospital dietitian. The purpose of the study was to determine the frequency of adverse childhood experiences in this population. METHODS Participants completed the Adverse Childhood Experiences (ACE) Scale. RESULTS The average score on the ACE was 5.4 (3.3); 76% of participants reported childhood emotional neglect, 70% childhood verbal abuse, and 64% childhood sexual abuse; only two participants reported no adverse childhood experiences. CONCLUSIONS The participants in the study reported high levels of adverse childhood experiences compared to the general population, which is consistent with prior literature on rates of childhood trauma in post-bariatric surgery patients. The role of adverse childhood experiences in post-bariatric surgery adaptation should be investigated in future research, including in prospective studies.
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Affiliation(s)
- Kathryn Fink
- Institute for Psychological Trauma, 1701 Gateway, #349, Richardson, TX, 75080, USA
| | - Colin A Ross
- Institute for Psychological Trauma, 1701 Gateway, #349, Richardson, TX, 75080, USA.
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[Quality indicators for metabolic and bariatric surgery in Germany : Evidence-based development of an indicator panel for the quality of results, indications and structure]. Chirurg 2017; 89:4-16. [PMID: 29209749 DOI: 10.1007/s00104-017-0563-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
An expert committee was appointed by the German Society for General and Visceral Surgery to develop a panel of appropriate quality indicators to collate the quality of results, indications and structure in metabolic and bariatric surgery. This entailed assimilating the available evidence (systematic literature search), results from the national registry of the society (StuDoQ|MBE) and specific socioeconomic aspects (e. g. severely limited access to metabolic and bariatric surgery in Germany). These quality parameters were to be incorporated into the national guidelines and the rules of procedure for certification in the future. The committee concluded that mortality, MTL30 and severe complications needing intervention (Clavien-Dindo ≥ 3b) are suitable indicators to measure surgical outcome quality due to their relevance, scientific soundness and practicability. As a systematic follow-up is mandatory after bariatric surgery, a minimum follow-up quota is now required using reported quality of life data as an indicator of process quality. As intestinal bypass procedures have been shown to be superior in the treatment of type 2 diabetes, these procedures should be offered to eligible patients and also be performed. The proposed threshold values based on the results of the available literature and StuDoQ registry are to be considered as preliminary and need to be validated and adjusted if necessary in the future. The StuDoQ|MBE is considered a valuable tool to gather this information and also represents the appropriate infrastructure for the collation of relevant risk adjustors.
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Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes 2017; 7:273-289. [PMID: 28695722 PMCID: PMC5600094 DOI: 10.1111/cob.12203] [Citation(s) in RCA: 280] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/19/2017] [Accepted: 05/23/2017] [Indexed: 12/19/2022]
Abstract
This is the first systematic review of reviews to assess the effect of obesity and weight loss on health-related quality of life (HRQoL). We identified 12 meta-analyses/systematic reviews published between January 2001 and July 2016. They addressed the following themes: (i) the relationship between weight/body mass index and HRQoL (baseline/pre-intervention; n = 2). (ii) HRQoL after weight loss (varied interventions and/or study design; n = 2). (iii) HRQoL after weight loss (randomized controlled trials only; n = 2). (iv) HRQoL after bariatric surgery (n = 6). We found that in all populations, obesity was associated with significantly lower generic and obesity-specific HRQoL. The relationship between weight loss and improved HRQoL was consistently demonstrated after bariatric surgery, perhaps due to a greater than average weight loss compared with other treatments. Improved HRQoL was evident after non-surgical weight loss, but was not consistently demonstrated, even in randomized controlled trials. This inconsistency may be attributed to variation in quality of reporting, assessment measures, study populations and weight-loss interventions. We recommend longer-term studies, using both generic and obesity-specific measures, which go beyond HRQoL in isolation to exploring mediators of HRQoL changes and interactions with other variables, such as comorbidities, fitness level and body image.
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Affiliation(s)
- R. L. Kolotkin
- Quality of Life Consulting, PLLCDurhamNCUSA
- Department of Community and Family MedicineDuke University School of MedicineDurhamNCUSA
- Faculty of Health StudiesWestern Norway University of Applied SciencesFørdeNorway
- Førde Hospital TrustFørdeNorway
- Morbid Obesity CentreVestfold Hospital TrustTønsbergNorway
| | - J. R. Andersen
- Faculty of Health StudiesWestern Norway University of Applied SciencesFørdeNorway
- Førde Hospital TrustFørdeNorway
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Elias K, Bekhali Z, Hedberg J, Graf W, Sundbom M. Changes in bowel habits and patient-scored symptoms after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2017; 14:144-149. [PMID: 29108895 DOI: 10.1016/j.soard.2017.09.529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/18/2017] [Accepted: 09/21/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Bariatric procedures are increasingly being used, but data on bowel habits are scarce. OBJECTIVES To assess changes in gastrointestinal function and patient-scored symptoms after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion with duodenal switch (BPD/DS). SETTING University hospital in Sweden. METHODS We recruited 268 adult patients (mean age of 42.5 yr, body mass index 44.8, 67.9% female) listed for RYGB and BPD/DS. Patients answered validated questionnaires prospectively concerning bowel function, the Fecal Incontinence Quality of Life Scale, and the 36-Item Short Form Health Survey before and after their operation. RESULTS Postoperatively, 208 patients (78.2% of 266 eligible patients) answered the questionnaires. RYGB patients had fewer bowel motions per week (8 versus 10) and more abdominal pain postoperatively (P<.001). Postoperatively, the 35 BPD/DS patients (69% versus 23%) needed to empty their bowel twice or more than twice daily, reported more flatus and urgency, and increased need for keeping a diet (P<.001). Concerning Fecal Incontinence Quality of Life Scale, coping and behavior was slightly reduced while depression and self-perception scores were improved after RYGB. Lifestyle, coping and behavior, and embarrassment were reduced after BPD/DS (P<.05). In the 36-Item Short Form Health Survey, physical scores were markedly improved, while mental scores were largely unaffected. CONCLUSION RYGB resulted in a reduced number of bowel movements but increased problems with abdominal pain. In contrast, BPD/DS-patients reported higher frequency of bowel movements, more troubles with flatus and urgency, and increased need for keeping a diet. These symptoms affected quality of life negatively, however, general quality of life was markedly improved after both procedures. These results will be of great value for preoperative counseling.
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Affiliation(s)
- Khalid Elias
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Zakaria Bekhali
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Jakob Hedberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Wilhelm Graf
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Magnus Sundbom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Abstract
OBJECTIVE The aim of this study was to examine risk of self-harm, hospitalization for depression and death by suicide after gastric bypass surgery (GBP). SUMMARY OF BACKGROUND DATA Concerns regarding severe adverse psychiatric outcomes after GBP have been raised. METHODS This nationwide, longitudinal, self-matched cohort encompassed 22,539 patients who underwent GBP during 2008 to 2012. They were identified through the Swedish National Patient Register, the Prescribed Drug Register, and the Causes of Death Register. Follow-up time was up to 2 years. Main outcome measures were hazard ratios (HRs) for post-surgery self-harm or hospitalization for depression in patients with presurgery self-harm and/or depression compared to patients without this exposure; and standardized mortality ratio (SMR) for suicide post-surgery. RESULTS A diagnosis of self-harm in the 2 years preceding surgery was associated with an HR of 36.6 (95% confidence interval [CI] 25.5-52.4) for self-harm during the 2 years of follow up, compared to GBP patients who had no self-harm diagnosis before surgery. Patients with a diagnosis of depression preceding GBP surgery had an HR of 52.3 (95% CI 30.6-89.2) for hospitalization owing to depression after GBP, compared to GBP patients without a previous diagnosis of depression. The SMR for suicide after GBP was increased among females (n = 13), 4.50 (95% CI 2.50-7.50). The SMR among males (n = 4), was 1.71 (95% CI 0.54-4.12). CONCLUSIONS The increased risk of post-surgery self-harm and hospitalization for depression is mainly attributable to patients who have a diagnosis of self-harm or depression before surgery. Raised awareness is needed to identify vulnerable patients with history of self-harm or depression, which may be in need of psychiatric support after GBP.
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Stenberg E, Szabo E, Näslund I, Ottosson J. Bleeding during laparoscopic gastric bypass surgery as a risk factor for less favorable outcome. A cohort study from the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis 2017; 13:1735-1740. [PMID: 28688860 DOI: 10.1016/j.soard.2017.05.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 05/19/2017] [Accepted: 05/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Intraoperative adverse events are known to be associated with postoperative complications; however, little is known about whether or not blood loss during laparoscopic gastric bypass surgery affects the outcome. OBJECTIVE To see if intraoperative bleeding was associated with a less favorable outcome, and to identify patient-specific risk factors for intraoperative bleeding. SETTING Nationwide, Sweden. METHODS Patients who underwent laparoscopic gastric bypass surgery between January 8, 2007, and September 15, 2015, were included in the study. The volume of intraoperative blood loss was compared with data from follow-up at day 30 and 1 and 2 years after surgery. Patient-specific factors were analyzed as potential risk factors for intraoperative bleeding. RESULTS The study included 43,157 patients. Intraoperative bleeding was associated with an increased risk for postoperative complication (100-499 mL, odds ratio [OR] 2.97, 95% confidence interval [95%CI] 2.53-3.50;>500 mL OR 3.34, 95%CI 2.05-5.44), lower weight loss (<100 mL, 82.4±24.19% excess body mass index-loss [%EBMIL]; 100-499 mL, 76.9±24.24 %EBMIL, P<.0001;>500 mL 76.9±23.89 %EBMIL, P = .063) and lower reported quality-of-life 2 years after surgery (<100 mL, Obesity-related Problem scale (OP) 21.1±24.46; 100-499 mL, OP 25.0±26.62, P = .008;>500 mL, OP 25.2±24.46, P = .272). Diabetes (OR 1.30, 95%CI 1.08-1.58), age (OR 1.02, 95%CI 1.02-1.03), and body mass index (OR 1.03, 95%CI 1.02-1.05) were patient-specific risk factors for intraoperative bleeding≥100 mL, whereas intentional preoperative weight loss was associated with a lower risk (OR .50, 95%CI .43-.57). CONCLUSION Intraoperative bleeding was associated with less favorable outcome after laparoscopic gastric bypass surgery. Age, body mass index, and diabetes were risk factors for intraoperative bleeding, while preoperative weight reduction seems to be protective.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an introduction to quality of life (QOL) outcomes after bariatric surgery and a summary of the current evidence. RECENT FINDINGS QOL has been emphasized in bariatric surgery since the NIH Consensus Conference statement in 1991. Initial studies were limited to 1- and 2-year follow-up. More recent findings have expanded the follow-up period up to 12 years, providing a better description of the impact on long-term QOL. Overall, there is little to no consensus regarding the definition of QOL or the ideal survey. Bariatric surgery has the greatest impact on physical QOL, and the impact on mental health remains unclear. There are some specific and less frequently reported threats to quality of life after bariatric surgery that are also discussed. Obesity has a definite impact on quality of life, even without other comorbidities, and surgery for obesity results in significant and lasting improvements in patient-reported quality of life outcomes. This conclusion is limited by a wide variety of survey instruments and absence of consensus on the definition of QOL after bariatric surgery.
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Affiliation(s)
- Laura M Mazer
- Division of General Surgery, Department of Surgery, Stanford University School of Medicine, Stanford University, 300 Pasteur Drive, H3591, Stanford, CA, 94305-5655, USA
| | - Dan E Azagury
- Section of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford University, 300 Pasteur Drive, H3680A, Stanford, CA, 94305-5655, USA
| | - John M Morton
- Section of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford University, 300 Pasteur Drive, H3680A, Stanford, CA, 94305-5655, USA.
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Macano CAW, Nyasavajjala SM, Brookes A, Lafaurie G, Riera M. Comparing quality of life outcomes between Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass using the RAND36 questionnaire. Int J Surg 2017; 42:138-142. [PMID: 28465258 DOI: 10.1016/j.ijsu.2017.04.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/31/2017] [Accepted: 04/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Obesity surgery is an effective treatment to improve the health of patients. There is a lack of data regarding weight loss surgery outcomes and effects on Quality of Life (QoL). This study aims to compare changes in QoL following either Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Roux-en-Y Gastric Bypass (LRYGB). METHODS SF36 questionnaires were mailed to all LSG and LRYGB patients who underwent surgery in 2013. Demographic data was obtained from hospital records. Statistical analysis was undertaken using Stats direct. RESULTS 158 patients were sent postal questionnaires. 60 were returned (38%). 41 were women, 16 LSG, 44 LRYGB, mean age 52 years, mean BMI pre-surgery 41.0. Both procedures yielded similar weight loss over 2 year follow up (p = 0.01), and similar improvements in obesity related co-morbidities. These procedures yielded significant improvements in all QoL scales and domains other than the emotional role limitations scale following sleeve gastrectomy. CONCLUSION Bariatric surgery has been shown to improve a patient's QoL. More research is needed to explain the reasons why there was a difference between Sleeve and Bypass procedures in emotional changes to patients.
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Affiliation(s)
- Christina A W Macano
- The Shrewsbury and Telford Hospital NHS Trust, Oak Rd, Shrewsbury, Shropshire, SY3 8XQ, United Kingdom.
| | - Sitaramachandra M Nyasavajjala
- Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green, Birmingham, B9 5SS, United Kingdom
| | - Alastair Brookes
- The Shrewsbury and Telford Hospital NHS Trust, Oak Rd, Shrewsbury, Shropshire, SY3 8XQ, United Kingdom
| | - Guillaume Lafaurie
- The Shrewsbury and Telford Hospital NHS Trust, Oak Rd, Shrewsbury, Shropshire, SY3 8XQ, United Kingdom
| | - Manel Riera
- The Shrewsbury and Telford Hospital NHS Trust, Oak Rd, Shrewsbury, Shropshire, SY3 8XQ, United Kingdom
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Peterhänsel C, Nagl M, Wagner B, Dietrich A, Kersting A. Predictors of Changes in Health-Related Quality of Life 6 and 12 months After a Bariatric Procedure. Obes Surg 2017; 27:2120-2128. [DOI: 10.1007/s11695-017-2617-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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King WC, Chen JY, Belle SH, Courcoulas AP, Dakin GF, Elder KA, Flum DR, Hinojosa MW, Mitchell JE, Pories WJ, Wolfe BM, Yanovski SZ. Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity. JAMA 2016; 315:1362-71. [PMID: 27046364 PMCID: PMC4856477 DOI: 10.1001/jama.2016.3010] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE The variability and durability of improvements in pain and physical function following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) are not well described. OBJECTIVES To report changes in pain and physical function in the first 3 years following bariatric surgery, and to identify factors associated with improvement. DESIGN, SETTING, AND PARTICIPANTS The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study at 10 US hospitals. Adults with severe obesity undergoing bariatric surgery were recruited between February 2005 and February 2009. Research assessments were conducted prior to surgery and annually thereafter. Three-year follow-up through October 2012 is reported. EXPOSURES Bariatric surgery as clinical care. MAIN OUTCOMES AND MEASURES Primary outcomes were clinically meaningful presurgery to postsurgery improvements in pain and function using scores from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (ie, improvement of ≥5 points on the norm-based score [range, 0-100]) and 400-meter walk time (ie, improvement of ≥24 seconds) using established thresholds. The secondary outcome was clinically meaningful improvement using the Western Ontario McMaster Osteoarthritis Index (ie, improvement of ≥9.7 pain points and ≥9.3 function points on the transformed score [range, 0-100]). RESULTS Of 2458 participants, 2221 completed baseline and follow-up assessments (1743 [78.5%] were women; median age was 47 years; median body mass index [BMI] was 45.9; 70.4% underwent RYGB; 25.0% underwent LAGB). At year 1, clinically meaningful improvements were shown in 57.6% (95% CI, 55.3%-59.9%) of participants for bodily pain, 76.5% (95% CI, 74.6%-78.5%) for physical function, and 59.5% (95% CI, 56.4%-62.7%) for walk time. Additionally, among participants with severe knee or disability (633), or hip pain or disability (500) at baseline, approximately three-fourths experienced joint-specific improvements in knee pain (77.1% [95% CI, 73.5%-80.7%]) and in hip function (79.2% [95% CI, 75.3%-83.1%]). Between year 1 and year 3, rates of improvement significantly decreased to 48.6% (95% CI, 46.0%-51.1%) for bodily pain and to 70.2% (95% CI, 67.8%-72.5%) for physical function, but improvement rates for walk time, knee and hip pain, and knee and hip function did not (P for all ≥.05). Younger age, male sex, higher income, lower BMI, and fewer depressive symptoms presurgery; no diabetes and no venous edema with ulcerations postsurgery (either no history or remission); and presurgery-to-postsurgery reductions in weight and depressive symptoms were associated with presurgery-to-postsurgery improvements in multiple outcomes at years 1, 2, and 3. CONCLUSIONS AND RELEVANCE Among a cohort of participants with severe obesity undergoing bariatric surgery, a large percentage experienced improvement, compared with baseline, in pain, physical function, and walk time over 3 years, but the percentage with improvement in pain and physical function decreased between year 1 and year 3. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00465829.
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Affiliation(s)
- Wendy C King
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Jia-Yuh Chen
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Steven H Belle
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | | | - Katherine A Elder
- Oregon Health and Science University, Portland5Now with Pacific University, Forest Grove, Oregon, and the Oregon Health and Science University, Portland
| | | | | | | | - Walter J Pories
- Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | | | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
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Driscoll S, Gregory DM, Fardy JM, Twells LK. Long-term health-related quality of life in bariatric surgery patients: A systematic review and meta-analysis. Obesity (Silver Spring) 2016; 24:60-70. [PMID: 26638116 DOI: 10.1002/oby.21322] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/11/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Bariatric surgery results in significant weight loss in the majority of patients. Improvement in health-related quality of life (HRQoL) is an equally important outcome; however, there are few studies reporting long-term (≥5 years) HRQoL outcomes. This study assesses the quality of evidence and effectiveness of surgery on HRQoL ≥ 5 years. METHODS PubMed, Cochrane Review, EmBase, CINANL, PsycInfo, obesity conference abstracts, and reference lists were searched. Keywords were bariatric surgery, obesity, and quality of life. Studies were included if (1) there was ≥5 years follow-up, (2) patients had class II or III obesity, (3) individuals completed a validated HRQoL survey, and (4) there was a nonsurgical comparison group with obesity. Two reviewers independently assessed each study. RESULTS From 1376 articles, 9 studies were included in the systematic review (SR) and 6 in the meta-analysis (MA). Inconsistent results for long-term improvements in physical and mental health emerged from the SR. In contrast, the MA found significant improvements in these domains ≥5 years after surgery. CONCLUSIONS Study findings provide evidence for a substantial and significant improvement in physical and mental health favoring the surgical group compared with controls spanning 5 to 25 years after surgery.
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Affiliation(s)
- Shannon Driscoll
- Faculty of Medicine, Memorial University, Health Sciences Centre, St. John's, Newfoundland and Labrador, Canada
| | - Deborah M Gregory
- Faculty of Medicine, Memorial University, Health Sciences Centre, St. John's, Newfoundland and Labrador, Canada
| | - John M Fardy
- Faculty of Medicine, Memorial University, Health Sciences Centre, St. John's, Newfoundland and Labrador, Canada
| | - Laurie K Twells
- Faculty of Medicine, Memorial University, Health Sciences Centre, St. John's, Newfoundland and Labrador, Canada
- School of Pharmacy, Memorial University, Health Sciences Centre, St. John's, Newfoundland and Labrador, Canada
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Castro ADAE, Skare TL, Nassif PAN, Sakuma AK, Barros WH. TENDINOPATHY AND OBESITY. ACTA ACUST UNITED AC 2016; 29Suppl 1:107-110. [PMID: 27683789 PMCID: PMC5064259 DOI: 10.1590/0102-6720201600s10026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/17/2016] [Indexed: 12/14/2022]
Abstract
Introduction Tendinopathies and tendon tears account for over 30% of all musculoskeletal consultations. Obesity, which is becoming one of the world´s most prevalent public health issues, may be associated with this condition. Objective To review the literature about tendinopathies and obesity association. Methods This is a descriptive exploratory study using the portal Medline. Literature in English language from 2006 to 2014 were reviewed. Results The pathogenesis of tendinopathies includes inflammatory, regenerative and degenerative processes that happen simultaneously from early to late phases of the disease. Mechanical stress upon tendons seems to be one of the most important factors to initiate the inflammatory response, but it´s not the only one that can deflagrate it: there are other extrinsic, genetic and metabolic factors that may be involved. Therefore, tendinopathies in obese patients can be due to tendon overload because of the excess of weight, but also because of increased production of pro-inflammatory mediators related to fat tissue such as adipokines. This pro-inflammatory state that obese people can suffer is known as adiposopathy, or sick fat syndrome. Weight loss is associated with decrease in adipokines and improvement of musculoskeletal symptoms. Conclusion The relation of obesity and tendinopathies is supported by evidences of recent studies, exemplified in this review of literature.
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Affiliation(s)
- Adham do Amaral E Castro
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Thelma Larocca Skare
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Paulo Afonso Nunes Nassif
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Alexandre Kaue Sakuma
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Wagner Haese Barros
- Postgraduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
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Ribeiro EF, de Ávila RI, de Sousa Santos RR, Garrote CFD. Impact of Bariatric Surgery on Patients from Goiás, Brazil, Using the BAROS Method - A Preliminary Study. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:93-102. [PMID: 28868385 PMCID: PMC5580192 DOI: 10.1016/j.jpge.2015.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/13/2015] [Indexed: 12/25/2022]
Abstract
Introduction As obesity is currently a major public health problem, bariatric surgery has been widely indicated due to the difficulties involved in the clinical management of obese adults. Objectives Assess the quality-of-life (QOL) of patients who had undergone Roux-en-Y Gastric Bypass (RYGB) in the State of Goiás, Brazil, where as yet no studies have been published on the QOL of patients who underwent bariatric surgery. Methods A retrospective study, using the Bariatric Analysis and Reporting Outcome System (BAROS), was carried out in Goiânia and Rio Verde, Goiás, Brazil, with 50 over 18-year-old patients of both genders, who had undergone RYGB and had at least three months of postoperative time. Results Before RYGB, 48% of the individuals were classified as morbidly obese. Average weight and body mass index (BMI) of the 50 patients interviewed were 119.37 ± 18.44 kg and 43.54 ± 5.33 kg/m2, respectively. By contrast, after the RYGB these parameters decreased significantly to 78.01 ± 11.06 kg and 28.46 ± 3.61 kg/m2, respectively, mainly from the 3rd to 85th month of postoperative time (p < 0.0001). As well as that, 78% reported having presented preoperative comorbidities, especially hypertension (44%), rheumatism (34%), dyslipidemia (24%) and diabetes (20%). However, after surgery, the resolution rates were 77, 24, 100 and 100%, respectively, for these same clinical conditions. In terms of QOL, some patients reported feeling better (8%) or much better (92%) after RYGB. The outcome of the BAROS method for those patients was classified as fair (2%), good (8%), very good (24%) and excellent (66%). Conclusions Preliminary results indicated that RYGB could be a successful surgical procedure to promote satisfactory and sustained reduction in the body measurements of morbidly obese patients from Goiás, Brazil. Furthermore, the final BAROS score showed improvements in associated comorbidity and also in the QOL of these patients.
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Daigle CR, Andalib A, Corcelles R, Cetin D, Schauer PR, Brethauer SA. Bariatric and metabolic outcomes in the super-obese elderly. Surg Obes Relat Dis 2015; 12:132-7. [PMID: 26077696 DOI: 10.1016/j.soard.2015.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/29/2015] [Accepted: 04/08/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Numerous reports address bariatric outcomes in super-obese or elderly patients, but data addressing this high-risk combination is lacking. OBJECTIVE The objective of this study was to assess outcomes of bariatric surgery in the super-obese elderly. SETTING Academic institution, United States. METHODS All primary bariatric cases performed on patients aged 65 years or older with a body mass index (BMI) ≥ 50 kg/m(2) were retrospectively analyzed. Surgical approaches included laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB). RESULTS Thirty patients (26 female, 4 male) with a mean age of 67.1 ± 2.7 years and BMI of 55.9 ± 3.9 kg/m(2), who had LRYGB (n = 16), LSG (n = 6), or LAGB (n = 8), were identified. There were no deaths, conversions, or intraoperative complications. Three patients were lost to follow-up after the 3-month visit. The early (<30 d) major morbidity rate was 10.0%. At a median follow-up of 37 (range, 6-95) months, the cohort had a mean BMI of 42.3 ± 6.7 kg/m(2), which corresponded to a mean percent excess weight loss of 44.5% ± 20.5% and mean percent total weight loss of 24.4% ± 12.2%. The most percent excess weight loss was achieved after LRYGB (54.1% ± 19.4%), followed by LSG (48.3% ± 10.2%) and then LAGB (26.2% ± 14.4%). Diabetic medication reduction in number and/or dosage was observed in 40% (6/15) patients, and 33% (5/15) of patients were completely off antidiabetic agents. CONCLUSIONS Although further research is needed, the present data suggest that successful weight loss and metabolic improvement can be achieved safely in the high-risk population of super-obese elderly.
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Affiliation(s)
| | - Amin Andalib
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ricard Corcelles
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Derrick Cetin
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
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Khoraki J, Katz MG, Funk LM, Greenberg JA, Fernandez LA, Campos GM. Feasibility and outcomes of laparoscopic sleeve gastrectomy after solid organ transplantation. Surg Obes Relat Dis 2015; 12:75-83. [PMID: 26048513 DOI: 10.1016/j.soard.2015.04.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/01/2015] [Accepted: 04/04/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Obesity is common after solid organ transplantation and is associated with worse transplantation-related outcomes. Laparoscopic sleeve gastrectomy (LSG) may be the preferred bariatric operation in transplantation patients over other techniques, such as gastric bypass, given the concerns about medication absorption. However, little is known about LSG outcomes in post-transplantation patients. OBJECTIVES We report the outcomes in 10 consecutive patients who underwent solid organ transplantation followed by LSG. SETTING An academic medical center. METHODS Primary outcomes studied were weight loss, perioperative complications, resolution or improvement of obesity-related co-morbidities, and markers of graft function following LSG. RESULTS The types of transplantation before LSG were as follows: liver = 5, kidney = 4, and heart = 1. Mean body mass index (BMI) at LSG was 44.7 ± 1.7 kg/m(2). All patients had hypertension, and 6 had type 2 diabetes. Perioperative complications occurred in 2 patients, and there were no deaths. Excess weight loss at 12 and 24 months after LSG was 45.7% and 42.5%, respectively. At 1 year after LSG, there was a significant reduction in the number of antihypertensive medications (2.4 to 1.5; P = .02). Three patients achieved complete remission of type 2 diabetes, and the other 3 significantly reduced their dosages of insulin. Graft function remained preserved in liver transplantation patients; left ventricular ejection fraction (LVEF) increased by 10% in the heart transplantation subject, and the estimated glomerular filtration rate (eGFR) increased significantly in kidney transplantation patients (53 ± 3 to 82 ± 3 mL/min; P = .03). CONCLUSIONS We concluded that LSG, in selected patients with severe obesity after solid organ transplantation, results in significant weight loss, improvement or resolution of obesity-related conditions, and preservation or improvement of graft function. Larger studies are needed to determine tolerability standards.
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Affiliation(s)
- Jad Khoraki
- Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Micah G Katz
- Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Luke M Funk
- Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jacob A Greenberg
- Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Luis A Fernandez
- Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Guilherme M Campos
- Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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