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Chao GF, Canner J, Hamid S, Ying LD, Ghiassi S, Schwartz JS, Gibbs KE. Outcomes of SADI and OAGB Compared to RYGB from the Metabolic and Bariatric Surgery Quality Improvement Program: The North American Experience. Obes Surg 2024; 34:337-346. [PMID: 38170422 DOI: 10.1007/s11695-023-07019-x] [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: 10/02/2023] [Revised: 12/16/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Rapid adoption of sleeve gastrectomy (SG) in the last decade aptly reflects the desire of patients and surgeons for alternatives to RYGB and DS. While SG provides good outcomes, other options that address specific patient needs are warranted. Recently approved by ASMBS, SADI, and OAGB have garnered increasing interest due to their single anastomosis technique. METHODS Using the Metabolic and Bariatric Surgery Quality Improvement Program database, we examined laparoscopic and robotic cases from 2018 to 2021 to understand the percentage of primary bariatric surgery cases that are SADI and OAGB. We used coarsened exact matching to match patients who underwent SADI or OAGB to patients who underwent Roux-en-Y gastric bypass (RYGB). We examined outcomes of matched patients using logistic regression. RESULTS Of the 667,979 patients that underwent bariatric-metabolic surgery, 1326 (0.2%) underwent SADI, and 2541 (0.4%) underwent OAGB. SADI was not identified in the database until 2020. In 2020, there were 487 SADI procedures compared to 839 in 2021. From 2018 to 2021, OAGBs went from 149 to 940. Compared with RYGB, SADI was associated with higher rates of anastomotic or staple line leak (OR 2.21 (95% CI 1.08-4.53)) and sepsis (OR 3.62 (95% CI 1.62-8.12)). Compared with RYGB, OAGB was associated with lower rates of gastrointestinal bleeding (OR 0.29 (95% CI 0.12-0.71)) and bowel obstruction (OR 0.10 (95% CI 0.02-0.39)). Of note, there were no differences between these procedures and RYGB for 30-day mortality. CONCLUSION More SADIs and OAGBs are being performed. However, there were higher complication rates associated with the SADI procedure. Further studies will be needed to better understand the key drivers for these outcomes.
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Affiliation(s)
- Grace F Chao
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA.
| | - Joseph Canner
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Safraz Hamid
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Lee D Ying
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Saber Ghiassi
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA
| | | | - Karen E Gibbs
- Department of Surgery, Yale School of Medicine, New Haven, CT, 06510, USA
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Pratt KJ, Stroup HJ, Breslin L, Kiser H, Noria S, Brethauer S, Needleman B. Social History of Bariatric Surgery: Relationship to Patient and Associations with Postoperative Outcomes. Obes Surg 2023; 33:2762-2769. [PMID: 37466828 DOI: 10.1007/s11695-023-06738-5] [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: 05/05/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE There is limited research about the prevalence of patients initiating metabolic and bariatric surgery (MBS) who also know someone who had MBS, referred to as having a social history of MBS. Evidence about the specific relationship of these individuals to the patient, how having a social history of MBS is associated with patients' choice of surgical procedure, and how having a social history of MBS is associated with patients' postoperative outcomes can be used to inform future preoperative assessments. The objective was to (a) define the number of people patients knew who had MBS and relationship to patient, (b) assess congruence between those who had MBS with patients' procedure selection, and (c) explore associations between social history of MBS and postoperative outcomes. MATERIALS AND METHODS The sample included 123 patients who had MBS in 2021 (83.7% female; 44.7% Sleeve Gastrectomy, 55.3% Gastric Bypass). For up to 5 people, patients provided their relationship and surgical procedure, and completed the Family Assessment Device (FAD). Bivariate analyses assessed congruence in type of procedure, and social history of MBS with complications, readmissions, and %TWL. Three mixed multilevel models were conducted with (1) close friend, (2) coworker, and (3) close family history of MBS including the FAD on change in %TWL over 12 months with surgical procedure as a covariate. RESULTS Ninety-one percent of patients knew someone who had MBS, average 2.66±1.45. Patients reported a close friend (56.1%), close family member (43.9%), and coworker (19.5%) who had MBS. Patients with a close family member who had MBS and reported healthy vs impaired family functioning had greater %TWL over 12 months (p=0.016). Patients with a close friend who had MBS had less %TWL (p=0.015), and patients with a coworker who had MBS had greater %TWL (p=0.012), which did not change over time. CONCLUSION Patients with coworkers or close family members with healthy family functioning with a history of MBS had more weight loss, whereas those with close friends with a history of MBS had less weight loss.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave., Columbus, OH, 43210, USA.
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Hailey J Stroup
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave., Columbus, OH, 43210, USA
| | - Lindsay Breslin
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Haley Kiser
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave., Columbus, OH, 43210, USA
| | - Sabrena Noria
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Stacy Brethauer
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Bradley Needleman
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
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Sumithran P, Roberts L, Caterson ID, Brown RM, Spittal MJ, Brown WA. Incidence of adverse mental health outcomes after sleeve gastrectomy compared with gastric bypass and restrictive bariatric procedures: a retrospective cohort study. Obesity (Silver Spring) 2023; 31:1913-1923. [PMID: 37368518 PMCID: PMC10946809 DOI: 10.1002/oby.23757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE This study examined rates of suicide and hospitalization with psychiatric diagnoses after sleeve gastrectomy compared with gastric bypass and restrictive procedures (gastric banding/gastroplasty). METHODS This was a longitudinal retrospective cohort study comprising all patients who underwent primary bariatric surgery in New South Wales or Queensland, Australia, between July 2001 and December 2020. Hospital admission records, death registration, and cause of death records (if applicable) within these dates were extracted and linked. Primary outcome was death by suicide. Secondary outcomes were admissions with self-harm; substance-use disorder, schizophrenia, mood, anxiety, behavioral, and personality disorders; any of these; and psychiatric inpatient admission. RESULTS A total of 121,203 patients were included, with median follow-up of 4.5 years per patient. There were 77 suicides, with no evidence of difference in rates by surgery type (rates [95% CI] per 100,000 person years: 9.6 [5.0-18.4] restrictive, 10.8 [8.4-13.9] sleeve gastrectomy, 20.4 [9.7-42.8] gastric bypass; p = 0.18). Rates of admission with self-harm declined after restrictive and sleeve procedures. Admission with anxiety disorders, any psychiatric diagnosis, and as a psychiatric inpatient increased after sleeve gastrectomy and gastric bypass, but not restrictive procedures. Admissions with substance-use disorder increased after all surgery types. CONCLUSIONS Variable associations between bariatric surgeries and hospitalization with psychiatric diagnoses might indicate distinct vulnerabilities among patient cohorts or that differing anatomical and/or functional changes may contribute to effects on mental health.
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Affiliation(s)
- Priya Sumithran
- Department of Medicine (St Vincent's)University of MelbourneFitzroyVictoriaAustralia
- Department of EndocrinologyAustin HealthHeidelbergVictoriaAustralia
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
| | - Leo Roberts
- Centre for Mental Health, Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Ian D. Caterson
- Boden Initiative, Charles Perkins Centre, University of SydneyNew South WalesAustralia
| | - Robyn M. Brown
- Department of Biochemistry and PharmacologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Wendy A. Brown
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
- Department of SurgeryAlfred HospitalMelbourneVictoriaAustralia
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A Shared Decision-making Process may Affect Bariatric Procedure Selection and Alter Surgical Outcomes: a Single-unit Retrospective Study. Obes Surg 2023; 33:195-203. [PMID: 36318398 DOI: 10.1007/s11695-022-06351-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE A shared decision-making (SDM) process centered on the patient perspective may increase understanding and treatment satisfaction. This study aimed to investigate whether SDM would increase the acceptance of bariatric/metabolic surgeries, change treatment decisions, and affect 1-year results. MATERIALS AND METHODS This retrospective analysis enrolled 315 consecutive patients with a body mass index between 32.5 and 50 kg/m2 and aged 20-65 years who underwent consultation for a primary bariatric/metabolic procedure within 2 years before (pre-SDM) or after (post-SDM) SDM program implementation to assist in the decision to undergo Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery. Consent rate, procedure choice, weight loss, comorbidity remission, etc., were compared between periods and procedures. Statistical tests were two-sided, with p < 0.05 considered significant. RESULTS More eligible patients underwent metabolic/bariatric procedures post-SDM than pre-SDM (115/159 [72%] vs. 106/156 [68%]; p = 0.395), and a stronger preference for RYGB post-SDM was observed (71% vs. 62%; p = 0.153). Significantly more patients with diabetes (28 [34.1%] vs. 5 [15.2%]; p = 0.041) chose RYGB over SG post-SDM. Patients who underwent RYGB had a higher diabetes remission rate both pre-SDM (70.0% vs. 58.3%; p = 0.571) and post-SDM (76.2% vs. 66.7%; p = 0.712) than those who underwent SG. While 1-year weight loss was similar between procedures, adherence to nutritional supplementation did not appear to be broadly enhanced post-SDM. CONCLUSION SDM influenced procedure selection toward RYGB, which was more popular than SG among patients with diabetes. Higher diabetes remission was achieved with RYGB, although the results of other effects deserve further study.
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Comparison of Weight Loss Outcomes between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in a Racially Mixed Urban Patient Population. Surg Obes Relat Dis 2022; 18:1218-1227. [DOI: 10.1016/j.soard.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/19/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022]
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Comparative Safety of Sleeve Gastrectomy and Gastric Bypass: An Instrumental Variables Approach. Ann Surg 2020; 275:539-545. [PMID: 33201113 DOI: 10.1097/sla.0000000000004297] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the safety of sleeve gastrectomy and gastric bypass in a large cohort of commercially insured bariatric surgery patients from the IBM MarketScan claims database, while accounting for measurable and unmeasurable sources of selection bias in who is chosen for each operation. SUMMARY OF BACKGROUND DATA Sleeve gastrectomy has rapidly become the most common bariatric operation performed in the United States, but its longer-term safety is poorly described, and the risk of worsening gastroesophageal reflux requiring revision may be higher than previously thought. Prior studies comparing sleeve gastrectomy to gastric bypass are limited by low sample size (in randomized trials) and selection bias (in observational studies). METHODS Instrumental variables analysis of commercially insured patients in the IBM MarketScan claims database from 2011 to 2018. We studied patients undergoing bariatric surgery from 2012 to 2016. We identified re-interventions and complications at 30 days and 2 years from surgery using Comprehensive Procedural Terminology and International Classification of Disease (ICD)-9/10 codes. To overcome unmeasured confounding, we use the prior year's sleeve gastrectomy utilization within each state as an instrumental variable-exploiting variation in the timing of payers' decisions to cover sleeve gastrectomy as a natural experiment. RESULTS Among 38,153 patients who underwent bariatric surgery between 2012 and 2016, the share of sleeve gastrectomy rose from 52.6% (2012) to 75% (2016). At 2 years from surgery, patients undergoing sleeve gastrectomy had fewer re-interventions (sleeve 9.9%, bypass 15.6%, P < 0.001) and complications (sleeve 6.6%, bypass 9.6%, P = 0.001), and lower overall healthcare spending ($47,891 vs $55,213, P = 0.003), than patients undergoing gastric bypass. However, at the 2-year mark, revisions were slightly more common in sleeve gastrectomy than in gastric bypass (sleeve 0.6%, bypass 0.4%, P = 0.009). CONCLUSIONS AND RELEVANCE In a large cohort of commercially insured patients, sleeve gastrectomy had a superior safety profile to gastric bypass up to 2 years from surgery, even when accounting for selection bias. However, the higher risk of revisions in sleeve gastrectomy merits further exploration.
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Arterburn DE, Toh S, Williams N, Anau J, Courcoulas A, Tavakkoli A, Stilwell D, Tuzzio L, Lewis CC, Wilcox MN, McTigue KM. Translating stakeholder-driven comparative effectiveness research into practice: the PCORnet Bariatric Study. J Comp Eff Res 2020; 9:1035-1041. [PMID: 33000638 DOI: 10.2217/cer-2020-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Anita Courcoulas
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Ali Tavakkoli
- Laboratory for Surgical and Metabolic Research, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Diana Stilwell
- Shared Decision Making Solutions Consultants, Boston, MA, USA
| | - Leah Tuzzio
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Margie N Wilcox
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kathleen M McTigue
- Departments of Medicine & Epidemiology, University of Pittsburgh, Pittsburgh, PA 15261, USA
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8
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Factors influencing the choice between laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Surg Endosc 2020; 35:4691-4699. [PMID: 32909206 DOI: 10.1007/s00464-020-07933-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND While laparoscopic sleeve gastrectomy (LSG) continues to be the most commonly performed bariatric operation, several variables influence surgeons' practice patterns and patients' decision-making in the type of bariatric procedure to perform. The aim of this study was to evaluate patient factors that influence the decision between laparoscopic Roux-en-Y gastric bypass (LRYGB) versus LSG. METHODS The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was queried for patients undergoing LSG and LRYGB between 2015 and 2017. Univariate analysis and multivariate logistic regression were used to evaluate factors associated with performing LRYGB compared to LSG. RESULTS A total of 252,117 (72.3%) LSG and 96,677 (27.7%) LRYGB cases were identified. Patients undergoing LSG were younger (44.3 ± 12.0 vs 45.2 ± 11.8 years; p < 0.01) and had a lower body mass index (BMI; 45.1 ± 7.8 vs 46.2 ± 8.1 kg/m2; p < 0.01). Most of the patients were females (79.4%), white (73.0%), with an American Society of Anesthesiology (ASA) class ≤ 3 (96.4%). The factors associated with undergoing LRYGB compared to LSG were diabetes mellitus, gastroesophageal reflux disease, BMI ≥ 50 kg/m2, ASA class > 3, obstructive sleep apnea, hypertension, and hyperlipidemia. However, patients with kidney disease, black race, chronic steroid use, age ≥ 60 years, recent smoking history, chronic obstructive pulmonary disease, and coronary artery disease were more likely to undergo LSG. CONCLUSIONS The decision to perform LRYGB is primarily driven by obesity-associated comorbidities and higher BMI, whereas LSG is more likely to be performed in higher risk patients.
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Preferences for bariatric surgery: comparing surgeons and patients using a discrete choice experiment. Surg Obes Relat Dis 2020; 16:738-744. [PMID: 32205098 DOI: 10.1016/j.soard.2020.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/27/2019] [Accepted: 02/13/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Increased attention to shared decision-making is particularly important in bariatric surgery. It is unclear whether the large shift toward sleeve gastrectomy is evidence of good alignment between patient and surgeon preferences. OBJECTIVE To identify surgeon preferences for risks, benefits, and other attributes of treatment options available for bariatric surgery and to compare results with patient preferences. SETTING Online survey. METHODS A discrete choice experiment of weight loss procedures. Each procedure was described by the following set of attributes: (1) treatment method, (2) recovery and reversibility, (3) years treatment has been available, (4) expected weight loss, (5) effect on other medical conditions, (6) risk of complication, (7) side effects, (8) changes to diet, (9) out-of-pocket costs. Participants chose between surgical profiles by comparing attributes. A convenience sample of providers for the online survey was recruited via LISTSERVs of professional associations. RESULTS Respondents (n = 121) were most likely to select profiles of hypothetical procedures based on the resolution of existing medical conditions and higher expected weight loss. These results align with patient preferences. However, surgeons selected profiles based on lower risk of complications than did patients and surgeons were less sensitive to out-of-pocket costs than patients. CONCLUSIONS Results show strong alignment between the preferences of patients and the preferences of surgeons when they are asked to stand in the place of their patients. Some differences, especially those related to sensitivity to risk of complications and out-of-pocket costs indicate that shared decision-making would benefit from providers explaining their concerns about surgical risk and from appreciating the concern many patients have about financial costs.
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Ames GE, Maynard JR, Collazo-Clavell ML, Clark MM, Grothe KB, Elli EF. Rethinking Patient and Medical Professional Perspectives on Bariatric Surgery as a Medically Necessary Treatment. Mayo Clin Proc 2020; 95:527-540. [PMID: 32138881 DOI: 10.1016/j.mayocp.2019.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/12/2019] [Accepted: 09/25/2019] [Indexed: 12/31/2022]
Abstract
The prevalence of class 3 obesity (body mass index ≥40 kg/m2) is 7.7% of the United States adult population; thus, more than 25 million people may be medically appropriate for consideration of bariatric surgery as therapy for severe obesity. Although bariatric surgery is the most effective therapy for patients with severe obesity, the surgery is performed in less than 1% of patients annually for whom it may be appropriate. Patients' and medical professionals' misperceptions about obesity and bariatric surgery create barriers to accessing bariatric surgery that are not given adequate attention and clinical consideration. Commonly cited patient barriers are lack of knowledge about the severity of obesity, the perception that obesity is a lifestyle problem rather than a chronic disease, and fear that bariatric surgery is dangerous. Medical professional barriers include failing to recognize causes of obesity and weight gain, providing recommendations that are inconsistent with current obesity treatment guidelines, and being uncomfortable counseling patients about treatment options for severe obesity. Previous research has revealed that medical professional counseling and accurate perception of the health risks associated with severe obesity are strong predictors of patients' willingness to consider bariatric surgery. This article reviews patient and medical professional barriers to acceptance of bariatric surgery as a treatment of medical necessity and offers practical advice for medical professionals to rethink perspectives about bariatric surgery when it is medically and psychologically appropriate.
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Affiliation(s)
- Gretchen E Ames
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL.
| | | | | | - Matthew M Clark
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Karen B Grothe
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Enrique F Elli
- Division of General Surgery, Mayo Clinic, Jacksonville, FL
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Roh SY, Park YH, Lee WK, Kim SM. Patient preferences regarding bariatric/metabolic procedures: a survey of Korean obese candidates for surgery. Ann Surg Treat Res 2020; 98:82-88. [PMID: 32051816 PMCID: PMC7002879 DOI: 10.4174/astr.2020.98.2.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose The objective of this study was to survey potential candidates for bariatric/metabolic surgery for procedure preferences. Methods Questions asked were divided into 5 categories: (1) demographic and anthropometric data, comorbidities, and favored surgery; (2) awareness of safety, effectiveness, and complications of each type of surgery; (3) discordances in opinion between self-selected and medically recommended procedures; and (4, 5) reasons for/against particular surgery. Results From 1 October to 15 November 2018, 104 respondents adequately responded and were included in the analysis. The number (%) of female respondents was 79 (76.0%). The number (%) of respondents by decade was 17 (16.3%) in their 20s, 65 (62.5%) in their 30s, 19 (18.3%) in their 40s, and 3 (2.9%) in their 60s, respectively. Mean body mass index was 37.1 ± 6.3 kg/m2. Comorbidities were type 2 diabetes in 34 (32.7%) and hypertension in 35 (33.7%). The most favored procedure was sleeve gastrectomy (SG) in 78 (75.0%), adjustable gastric band (AGB) surgery in 12 (11.5%), Roux-en-Y gastric bypass (RYGB) in 6 (5.8%), and gastric plication (GP) in 8 (7.7%). Major reasons for choosing procedures were; “adjustable” for AGB, “stomach sparing” for GP, “excellent weight loss” for SG, and “comorbidity resolution” in RYGB. Conclusion Candidates for bariatric/metabolic surgery favored SG followed by AGB, GP, and RYGB, and their choices were compatible with current evidence-based clinical practice.
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Affiliation(s)
- Su Yeon Roh
- Department of Exercise Rehabilitation and Welfare, Gachon University, Incheon, Korea
| | - Yeon Ho Park
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Woon Ki Lee
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seong Min Kim
- Department of Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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A pilot study of laparoscopic gastric plication in adolescent patients with severe obesity. J Pediatr Surg 2019; 54:1696-1701. [PMID: 30765155 DOI: 10.1016/j.jpedsurg.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 12/21/2018] [Accepted: 01/01/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Metabolic and bariatric surgery in adolescents with severe obesity has been demonstrated to be safe and have long-term treatment efficacy. However, less than 0.1% of adolescents meeting criteria undergo surgery. METHODS A prospective pilot study of adolescents who underwent laparoscopic gastric plication (LGP) was conducted to evaluate safety and effects on anthropometrics and weight-related medical and psychological comorbidities. RESULTS Four adolescents enrolled and underwent LGP; two withdrew 90 days postoperatively and two were followed through 36 months. Preprocedure body mass index was 41.7-53.7 kg/m2 with decreases in % change of BMI of 17.5% and 39.7% at 36 months after surgery. Patients reported early satiety, good hunger control, and limited nausea at all time points. There were no major complications. Mild gastroesophageal reflux and abdominal pain occurred; both resolved without surgical intervention. Minor improvements in psychological comorbidities were also reported. CONCLUSIONS LGP can be safely performed in adolescents with severe obesity and achieves modest weight loss. Although limited by its small sample size, this study provides preliminary support for LGP as an appropriate surgical option for adolescents. A larger, multidisciplinary study is planned. TYPE OF STUDY Prospective case series review. LEVEL OF EVIDENCE Level IV evidence: case series without comparison.
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Rozier MD, Ghaferi AA, Rose A, Simon NJ, Birkmeyer N, Prosser LA. Patient Preferences for Bariatric Surgery: Findings From a Survey Using Discrete Choice Experiment Methodology. JAMA Surg 2019; 154:e184375. [PMID: 30484820 DOI: 10.1001/jamasurg.2018.4375] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance Surgical options for weight loss vary considerably in risks and benefits, but the relative importance of procedure-associated characteristics in patient decision making is largely unknown. Objective To identify patient preferences for risks, benefits, and other attributes of treatment options available to individuals who are candidates for bariatric surgery. Design, Setting, and Participants This discrete choice experiment of weight loss procedures was performed as an internet-based survey administered to patients recruited from bariatric surgery information sessions in the State of Michigan. Each procedure was described by the following set of attributes: (1) treatment method, (2) recovery and reversibility, (3) time that treatment has been available, (4) expected weight loss, (5) effect on other medical conditions, (6) risk of complication, (7) adverse effects, (8) changes to diet, and (9) out-of-pocket costs. Participants chose between surgical profiles by comparing attributes. Survey data were collected from May 1, 2015, through January 30, 2016, and analyzed from February 1 to June 30, 2016. Main Outcomes and Measures Estimated relative value of risks and benefits for leading weight-loss surgical options and marginal willingness to pay for procedure attributes. A latent class analysis identified respondent subgroups. Results Among the 815 respondents (79.9% women; mean [SD] age, 44.5 [12.0] years), profiles of hypothetical procedures that included resolution of medical conditions (coefficient for full resolution, 0.229 [95% CI, 0.177 to 0.280; P < .001]; coefficient for no resolution, -0.207 [95% CI, -0.254 to -0.159; P < .001]), higher total weight loss (coefficient for each additional 20% loss, 0.185 [95% CI, 0.166 to 0.205; P < .001]), and lower out-of-pocket costs (coefficient for each additional $1000, -0.034 [95% CI, -0.042 to -0.025; P < .001]) were most likely to be selected. Younger respondents were more likely than older respondents to choose treatments with higher weight loss (coefficient for loss of 80% excess weight 0.543 [95% CI, 0.435-0.651] vs 0.397 [95% CI, 0.315-0.482]) and were more sensitive to out-of-pocket costs (coefficient for $100 out-of-pocket costs, 0.346 [95% CI, 0.221-0.470] vs 0.262 [95% CI, 0.174 to 0.350]; coefficient for $15 000 in out-of-pocket costs, -0.768 [95% CI, -0.938 to -0.598] vs -0.384 [95% CI, -0.500 to -0.268]). Marginal willingness to pay indicated respondents would pay $5470 for losing each additional 20% of excess body weight and $12 843 for resolution of existing medical conditions, the most desired procedure attributes. Latent class analysis identified the following 3 unobserved subgroups: cost-sensitive (most concerned with costs); benefit-focused (most concerned with excess weight loss and resolution of medical conditions); and procedure-focused (most concerned with how the treatment itself worked, including recovery and reversibility). Conclusions and Relevance Candidates for bariatric surgery identified costs, expected weight loss, and resolution of medical conditions as the most important characteristics of weight loss surgery decisions. Other information, such as risk of complications and adverse effects, were important to patients but less so.
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Affiliation(s)
- Michael D Rozier
- Department of Health Management and Policy, Saint Louis University College for Public Health and Social Justice, St Louis, Missouri
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan.,Department of Management and Organizations, University of Michigan Ross School of Business, Ann Arbor, Michigan
| | - Angela Rose
- Child Health Evaluation and Research Center, University of Michigan School of Medicine, Ann Arbor
| | | | - Nancy Birkmeyer
- Department of Surgery, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Lisa A Prosser
- Department of Pediatrics and Communicable Diseases, University of Michigan School of Medicine, Ann Arbor.,Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
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Kallies KJ, Ramirez LD, Grover BT, Kothari SN. Roux-en-Y gastric bypass versus sleeve gastrectomy: what factors influence patient preference? Surg Obes Relat Dis 2018; 14:1843-1849. [PMID: 30290991 DOI: 10.1016/j.soard.2018.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/25/2018] [Accepted: 08/22/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed bariatric procedures. RYGB involves altered gastrointestinal anatomy and 2 anastomoses, while SG involves gastric resection. When potential patients view images of the procedures, they may perceive RYGB to involve significant risk compared with SG, in which no significant gastrointestinal alterations are depicted. OBJECTIVE To evaluate preferences for RYGB versus SG. SETTING Survey of U.S. adults. METHODS An electronic survey was distributed to 1000 U.S. adults. Respondents selected either RYGB or SG based on (1) procedural pictures alone, (2) only data on risks and benefits of each procedure, (3) pictures with corresponding risk/benefit profile, and (4) pictures with mismatched information. RESULTS Overall, 999 individuals met inclusion criteria; 66 (7%) had undergone bariatric surgery and were excluded. Mean age and body mass index of respondents was 44.8 ± 14.6 years (n = 922) and 28.7 ± 8.0 kg/m2 (n = 915). A higher proportion of patients preferred RYGB to SG when images only were provided (54% versus 46%), when information only was provided (63% versus 37%), and when correct information with the procedure image was provided (57% versus 43%). When presented with mismatched information and images, 56% preferred RYGB information + SG image versus SG information + RYGB image (44%). CONCLUSIONS Based on this survey, providing evidence-based risks and benefits of a procedure resulted in the majority of respondents choosing RYGB over SG. When procedure images were provided alone, preference for RYGB and SG were similar. There are likely other factors contributing to increasing SG volume aside from patient preference.
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Affiliation(s)
- Kara J Kallies
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Luis D Ramirez
- Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin
| | - Brandon T Grover
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Shanu N Kothari
- Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin.
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15
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Opozda M, Wittert G, Chur-Hansen A. Patients' expectations and experiences of eating behaviour change after bariatric procedures. Clin Obes 2018; 8:355-365. [PMID: 30117282 DOI: 10.1111/cob.12273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 05/29/2018] [Accepted: 06/09/2018] [Indexed: 12/14/2022]
Abstract
Patients' pre-surgical expectations and post-surgical experiences of eating-related behaviour change after bariatric surgery may vary by procedure and time since surgery. To investigate this, data were coded from 206 Australian adults ≥2 months post-Roux-en-Y gastric bypass (RYGB; 17%), adjustable gastric band (AGB; 23%) or vertical sleeve gastrectomy (VSG; 60%) who completed an online questionnaire including open-ended questions about pre-surgical eating-related expectations and post-surgical experiences. Participants were 94% female, and mean age was 45.9 (SD = 10.0). Average time since surgery varied (AGB: 69.6 months; RYGB: 22.8; and VSG: 17.8). The proportions reporting any one or more 'positive' (healthy, helpful or desired; RYGB 82%; AGB 76%; and VSG 84%) or any one or more 'negative' (unhealthy, unhelpful or unwanted; RYGB 46%; AGB 46%; and VSG 42%) post-surgical eating-related experience did not differ by procedure. Negative experiences were more often reported at ≥18 months than 2 to <18 months (P = 0.035). After both VSG and AGB, but not RYGB, reporting any one or more positive eating-related experience was related to better outcomes (VSG: in mental health; AGB: in weight loss, physical health, satisfaction) and negative experiences were linked to poorer outcomes (VSG: in mental health, satisfaction; AGB: in mental and physical health, satisfaction). Reporting any one or more positive experience was related to better mental health improvement at 2 to <18 months and greater satisfaction at 18+ months post-surgery. The findings highlight the necessity of long-term, multidisciplinary patient care and further investigation into impacts of eating-related experiences on outcomes, with attention to procedure-based and temporal effects.
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Affiliation(s)
- M Opozda
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
- Discipline of Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Freemasons Foundation Centre for Men's Health, Adelaide, South Australia, Australia
- Centre for Nutrition and Gastrointestinal Diseases, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - G Wittert
- Adelaide Medical School, The University of Adelaide, Freemasons Foundation Centre for Men's Health, Adelaide, South Australia, Australia
- Centre for Nutrition and Gastrointestinal Diseases, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - A Chur-Hansen
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
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