Examining the Hispanic paradox in bariatric surgery

A population based study of bariatric surgery in Illinois

BACKGROUND

Utilization of metabolic and bariatric surgery has increased significantly over the last 2decades, yet barriers to access remain.

OBJECTIVES

This study aimed to 1) define rates of metabolic and bariatric surgery utilization for qualifying adults in Illinois and 2) describe patient characteristics associated with undergoing surgery at Illinois hospitals with low metabolic and bariatric surgery volume.

SETTING

Metabolic and bariatric surgery at all nonfederal Illinois hospitals was included.

METHODS

Illinois hospital administrative data for 2016-2022 metabolic and bariatric surgery procedures (numerators) and Illinois Behavioral Risk Factor Surveillance System population estimates (denominators) were used to compute metabolic and bariatric surgery rates per estimated 100,000 Illinois residents ages 18-69 who qualified for metabolic and bariatric surgery based on National Institutes of Health Guidelines. Zip code median income was obtained from census data. Multivariable logistic regression was used to identify patient characteristics associated with receiving metabolic and bariatric surgery at low volume hospitals (LVHs), defined as less than 50 annual bariatric procedures.

RESULTS

The average annual metabolic and bariatric surgery rate was 702 per 100,000 qualifying Illinois adults. Rates were highest among non-Hispanic Black patients (890/100,000) and lowest for Hispanic patients (396/100,000) and patients from zip codes with median household income <$75,000. Lower median household income was the only characteristic associated with use of LVHs.

CONCLUSIONS

Metabolic and bariatric surgery procedures almost doubled over the study period in Illinois, increasing the most for non-Hispanic Black and Medicaid patients. However, Hispanic and low-income patients still have rates well below the state average.

Patient and operative characteristics of readmission and poly-readmission following metabolic surgery: an MBSAQIP analysis (2015-2021)

BACKGROUND

Recently, same-day Metabolic Surgery (MS) has gained traction, especially to reduce costs and hospital resource utilization. While shorter hospital stays are desirable, accelerated discharge could increase postoperative burden for those patients at risk. This study evaluated whether specific patient characteristics are associated with increased 30-day readmission rates and number of readmissions as a potentially identifying those less suited for same-day discharge.

METHODS

Using the MBSAQIP (2015-2021), 960,757 cases of primary minimally invasive sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch (DS) were included. Readmission characteristics were extracted from ancillary Participant Use Files (PUF) and linked to the main MBSAQIP data. Zero-inflated Poisson (ZIP) models assessed associations between preoperative patient characteristics and readmission risk. The two-stage models analyzed odds of any 30-day readmission and calculated the relative risk (RR) of multiple readmissions.

RESULTS

Several key predictors of single as well as multiple readmissions in the first 30 days following intervention were noted. Black or Hispanic race, BMI, diabetes, COPD, GERD, and therapeutic anticoagulation were associated with increased odds of readmission likelihood after MS. Black race and GERD predicted increased readmission frequency (multiple readmissions) among all readmission cases, while those aged ≥ 40 years and Hispanic race were less likely to require multiple readmissions.

CONCLUSION

This large-scale MS analysis highlights patient characteristics that should be carefully considered by MS providers during patient counseling and consideration of same-day discharge. Readmission poses significant financial, physiological, and psychological burdens emphasizing the need for careful patient evaluation and counseling, particularly for those at higher risk, to optimize patient outcomes in the context of accelerated discharge protocols.

Demographic Factors Associated with Postoperative Complications in Primary Bariatric Surgery: A Rapid Review

BACKGROUND

Bariatric surgery is highly effective for the management of severe obesity, but its safety profile is not completely understood. This review aimed to synthesise evidence linking demographic factors to postoperative complications and mortality following primary bariatric surgery.

METHODS

We searched Medline for observational studies of adult patients linking demographic factors to postoperative complications of primary bariatric surgery published from 2017 to 2022. Risk ratios (RR) with 95% confidence intervals (95% CI) were calculated and pooled using random effect meta-analysis. Heterogeneity was quantified using the I2 statistic and tested for statistical significance using the Q-statistic. Sensitivity analyses were used to explore potential sources of heterogeneity.

RESULTS

A total of 71 observational studies (69 cohort, 2 case-control) were reviewed and appraised. Older age was consistently associated with increased risks of postoperative mortality (RR = 2.62, 95% CI 1.63-4.23, I2 = 42.04%), serious complications (RR = 1.76, 95% CI 1.09-2.82, I2 = 93.24%), anastomotic leak (RR = 1.64, 95% CI 1.04-2.58, I2 = 61.09%), and haemorrhage (RR = 1.44, 95% CI 1.07-1.94, I2 = 45.25%). Male sex was associated with increased anastomotic leak (RR = 1.39, 95% CI 1.04-1.87, I2 = 72.36%). Sensitivity analyses did not identify sources of bias. Socioeconomic factors, including Black/African American race, low financial status, and marital status (mixed results), were linked to higher complication risks in some studies.

CONCLUSIONS

Older age and certain demographic factors (male sex, Black/African American race, low financial status, marital status) were associated with increased risks of postoperative complications following primary bariatric surgery.

Influence of referral type and sociodemographic factors on completion of bariatric surgery

BACKGROUND

The impact of referral type and socioeconomic status on completion of the bariatric surgery process is not well understood.

OBJECTIVES

This study aims to 1) describe how sociodemographic characteristics influence referral type and 2) identify predictors of completion of surgery.

SETTING

Large multihospital health care system, including a large academic medical center.

METHODS

A retrospective study was performed using data from 2017 to 2022. Patients with a primary care physician within the hospital system who met criteria for bariatric surgery were included. The primary outcome was completion of bariatric surgery; the predictor was referral type (i.e., physician referral versus patient self-referral). Bivariate analysis and multivariable logistic regression were performed.

RESULTS

Of 133,882 overall patients who met criteria for bariatric surgery, 41,387 had physician referrals for bariatric surgery or obesity medicine, 4702 self-referred, and 2740 underwent surgery. Patients who were Black, Hispanic, Medicaid insured, or in the most socially vulnerable zip codes were more likely to be self-referred (all P < .01). In a multivariable logistic regression, self-referred patients were more likely to undergo surgery (2.22 [1.82, 2.73]). Hispanic patients, while less likely to be referred overall, were more likely to undergo surgery if they were referred (1.29 [1.13, 1.47]). Patients with Medicare, Medicaid, and who were more socially vulnerable had lower odds of undergoing surgery.

CONCLUSIONS

Underserved groups are less likely to be referred by physicians for bariatric surgery. However, those patients who do self-refer are more likely to proceed to surgery, demonstrating the barrier is one of access not motivation.

Identifying At-Risk Populations for Reoperations, Readmissions, and Interventions in MBSAQIP Using a Novel Inpatient Postoperative Care Metric

INTRODUCTION

Metabolic and bariatric surgery (MBS) is increasingly used for obesity and metabolic disease, with safety profiles showing it is among the safest major operations. The last 20 + years have noted significantly improved safety that has been accompanied by decreasing length of stay and select populations electing for outpatient surgery, leading to continued decreases in cost. Regardless, readmissions and complications still occur, requiring inpatient postoperative care (IP-POC). The current study aimed to identify and characterize at-risk populations for MBS-related IP-POC.

STUDY DESIGN

The 2015-2021 MBSAQIP (n = 1,346,468 records) was used to extract 973,520 primary cases of laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, duodenal switch, and associated IP-POC. Conversions, pediatric cases, and < 30-day follow-up were excluded. IP-POC severity scores were calculated by summing readmissions (1 point), interventions (5 points), and reoperations (15 points). Risk factors associated with IP-POC were identified using zero-inflated Poisson models.

RESULTS

GERD, COPD, smoking, and type of MBS procedure were significantly associated with increased IP-POC incidence and severity. Male sex was associated with increased severity but a lower likelihood of IP-POC, while Black and Hispanic race predicted increased IP-POC likelihood but not severity. ROC curve analysis identified IP-POC score thresholds of ≥ 6 and ≥ 10 as significantly associated with MACE (OR 2.4) and 30-day mortality (OR 4.7).

CONCLUSION

The weighted IP-POC model demonstrated associations between preoperative characteristics and increased IP-POC likelihood and severity. These findings add to the current understanding of MBS patient care dynamics, and can be used to improve patient counseling, refine postoperative protocols, and optimize resource allocation.

Outcomes for Hispanic patients undergoing open bypass in BEST-CLI

OBJECTIVES

Hispanic patients have a higher prevalence of peripheral artery disease (PAD) risk factors, undergo revascularization at lower rates, and have higher rates of major amputation. This study compares outcomes after open surgical revascularization within the Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI) Trial between Hispanic and non-Hispanic White patients.

METHODS

In a secondary analysis of BEST-CLI, open surgical cohorts were combined (cohort 1, suitable single segment greater saphenous vein [n = 484]; cohort 2, lack of suitable single segment greater saphenous vein [n = 150]) and examined, by ethnicity, for the following 1-year outcomes: (1) above-ankle amputation, (2) major reintervention, (3) major adverse limb event (a composite of major amputation and major reintervention), and (4) survival. Cox regression models were constructed to determine the association between Hispanic ethnicity and selected endpoints after surgical bypass for patients enrolled in BEST-CLI.

RESULTS

Of the 634 patients who underwent open surgical bypass, 528 (83.3%) were non-Hispanic White (White) and 106 (16.7%) were Hispanic. Compared with White patients, Hispanic patients were younger (64.6 ± 8.6 years vs 68.5 ± 9.6 years; P < .001), had a higher proportion of diabetes (91.5% vs 66.3%; P < .001), end-stage renal disease (15.1% vs 6.8%; P = .005), and were more often never smokers (44.3% vs 16.2%; P < .001). Preoperative ankle-brachial index was higher among Hispanic patients (0.7 ± 0.4 vs 0.5 ± 0.3; P < .001). After controlling for age, sex, diabetes, end-stage renal disease, smoking history, infrapopliteal disease, Wound Ischemia foot Infection stage, and previous lower extremity revascularization, Hispanic ethnicity was not significantly associated with major amputation (adjusted hazard ratio [aHR], 0.67; 95% confidence interval [CI], 0.30-1.48), major reintervention (aHR, 0.81; 95% CI, 0.35-1.87), major adverse limb event (aHR, 0.64; 95% CI, 0.34-1.21), or survival (aHR, 0.69; 95% CI, 0.42-1.13) 1 year after surgical bypass.

CONCLUSIONS

Disparities in limb-related outcomes were not observed for Hispanic patients undergoing open revascularization in BEST-CLI. Future PAD clinical trials should capture metrics of access to care, and timeliness of care for assessing risk of disparate outcomes among PAD populations thought to be at higher risk based on epidemiological and retrospective studies.

Cognitive function 10 years after adolescent bariatric surgery

BACKGROUND

Adolescent bariatric surgery produces substantial weight loss and reduction of medical co-morbidities. Research in adult samples shows improved cognitive function postoperatively, although much less is known about the potential cognitive benefits of bariatric surgery in adolescents-especially at extended follow-up.

OBJECTIVE

Examine cognitive function 10 years after adolescent bariatric surgery.

SETTING

University hospital.

METHODS

A total of 99 young adults who underwent bariatric surgery as adolescents completed a computerized cognitive test battery as part of a larger 10-year postoperative assessment. All had been long-term participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study.

RESULTS

Cognitive dysfunction was prevalent on tests of attention and executive function (e.g., Continuous Performance Test - Reaction Time 30%; Maze Errors - Overrun 30%), and 53.5% met research criteria for mild cognitive impairment (MCI). Modified Poisson regression with robust error variance revealed participants with preoperative hypertension and those completing Roux-en-Y gastric bypass were more likely to meet criteria for MCI at 10-year follow-up.

CONCLUSIONS

The current findings indicate that cognitive deficits are common 10 years after bariatric surgery. Additional studies are needed to clarify possible cohort effects, determine whether these cognitive deficits persist to even later follow-up (e.g., 20 yr after surgery), and identify underlying mechanisms and mitigation strategies.

ASMBS statement on metabolic and bariatric surgery for beneficiaries of Centers for Medicare and Medicaid Services with a review of the literature

This position statement is issued by the American Society for Metabolic and Bariatric. Surgery in response to inquiries made to the Society by patients, physicians, Society members, hospitals, health insurance payors, the media, and others regarding the access and outcomes of metabolic and bariatric surgery for beneficiaries of Centers for Medicare and Medicaid Services. This position statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement is not intended to be and should not be construed as stating or establishing a local, regional, or national standard of care. This statement will be revised in the future as additional evidence becomes available.

A Call to Reconceptualize Obesity Treatment in Service of Health Equity: Review of Evidence and Future Directions

PURPOSE OF REVIEW

Rates of obesity and associated comorbidities are higher among Black and Latino adults compared to white adults. We sought to provide an overview of both structural and individual factors contributing to obesity inequities and synthesize available evidence regarding treatment outcomes in Black and Latino adults, with an eye towards informing future directions.

RECENT FINDINGS

Obesity disparities are influenced by myriad systemic issues, yet the vast majority of interventions target individual-level factors only, and most behavioral treatments fail to target drivers beyond eating and physical activity. Extant treatments are not equally accessible, affordable, or effective among Black and Latino adults compared with white counterparts. Asset-based, culturally relevant interventions that target the root causes of obesity and address intersectional stress-designed in partnership with intended beneficiaries-are urgently needed. Treatment trials must improve enrollment of Black and Latino adults and report treatment outcomes by race and ethnicity.

African American Patients Experience Worse Outcomes than Hispanic Patients Following Bariatric Surgery: an Analysis Using the MBSAQIP Data Registry

BACKGROUND

Obesity rates in Hispanics and African Americans (AAs) are higher than in Caucasians in the USA, yet the rate of metabolic and bariatric surgery (MBS) for weight loss remains lower for both Hispanics and AAs.

METHODS

Patient demographics and outcomes of adult AA and Hispanic patients undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) procedures were analyzed using the MBSAQIP dataset [2015-2018] using unmatched and propensity-matched data.

RESULTS

In total, 173,157 patients were included, of whom 98,185 were AA [56.7%] [21,163-RYGB; 77,022-SG] and 74,972 were Hispanic [43.3%] [20,282-RYGB; 54,690-SG]). Preoperatively, the AA cohort was older, had more females, and higher BMIs with higher rates of all tracked obesity-related medical conditions except for diabetes, venous stasis, and prior foregut surgery. Intra- and postoperatively, AAs were more likely to experience major complications including unplanned ICU admission, 30-day readmission/reintervention, and mortality. After propensity matching, the differences in ED visits, treatment for dehydration, 30-day readmission, 30-day intervention, and pulmonary embolism remained for both SG and RYGB cohorts. Progressive renal insufficiency and ventilator use lost statistical significance in both cohorts. Conversely, 30-day reoperation, postoperative ventilator requirement, unplanned intubation, unplanned ICU admission, and mortality lost significance in the RYGB cohort, but not SG patients.

CONCLUSION

Outcomes for AA patients were worse than for Hispanic patients, even after propensity matching. After matching, differences in major complications and mortality lost significance for RYGB, but not SG. These data suggest that outcomes for RYGB may be driven by the presence and severity of pre-existing patient-related factors.

Pre-operative cardiopulmonary, metabolic, abdominal, and somatic variations by race in men with obesity resolve after Laparoscopic Roux-en-Y gastric bypass (LRYGB): Dyslipidemia and psychologicals by race persist

BACKGROUND

Whether/how LRYGB men vary by race in clinical characteristics/post-operative outcomes is unknown.

OBJECTIVE

Identify male pre-/post LRYGB clinical/outcomes variations by race.

METHODS

Data from 17,734 LYRGB BOLD database men were analyzed in five groups: African American (AA, n = 1310), Caucasian (C, n = 14,168), Asian (A, n = 53), Hispanic (H, n = 1519), and Other (O, Pacific Islander, Native American, or more than one race, n = 684).

DATA

demographics, BMI, and 28 weight-related conditions.

RESULTS

Pre-LRYGB age, health insurance, unemployment, BMI, and 24/28 obesity related comorbidities varied by race (p < 0.01). Highest pre-LRYGB: AA 4, C 14, A 5, H none, O 1 comorbidity. 12 month BMI and 14 comorbidities varied by race (p < 0.05). 24 months only dyslipidemia, depression, and psychological impairment varied by race (p < 0.05).

CONCLUSION

Demographics, BMI and 24 obesity comorbidities vary by race in LRYGB men, but only 3 at 24 months. Caucasians have the greatest cardiopulmonary related comorbidities. This advanced knowledge may facilitate peri-operative management.

National Trends and Outcomes in Adolescents Undergoing Bariatric Surgery

BACKGROUND

In the US, obesity continues to be a severe health issue now affecting adolescents. Bariatric surgery remains the most effective treatment for obesity, but use among adolescents remains low. The objective of this study was to identify current national trends in bariatric surgery among adolescents.

STUDY DESIGN

Using the Nationwide Inpatient Sample database, adolescents aged 9 to 19 with a diagnosis of morbid obesity who underwent a laparoscopic gastric bypass (Roux-en-Y gastric bypass) or laparoscopic sleeve gastrectomy (SG) between 2015 and 2018 were identified. Demographics, comorbidities, and in-hospital complications were collected. National estimates were calculated. The trend of annual number of operations was determined by Kruskal-Wallis rank test.

RESULTS

Between 2015 and 2018, 1,203 adolescents were identified, resulting in a nationwide estimate of 4,807 bariatric cases. The number of bariatric operations increased annually from 1,360 in 2015 to 1,740 operations in 2018 (p = 0.0771). The majority of patients were female (76%), 17 to 19 years old (84.1%), and White (47.9%). Most patients underwent SG (82.0%). Black and Hispanic patients comprised 40.2% of the cohort. Significant comorbidities included diabetes, dyslipidemia, nonalcoholic fatty liver disease, hypertension, and sleep apnea. The average length of stay decreased from 2.12 days to 1.64 days. There were no in-hospital mortalities, and complications were less than 1%.

CONCLUSIONS

With the increasing prevalence of obesity among adolescents in the US, bariatric surgery increased over time but was performed less in patients younger than 16 years of age and racial minorities. Bariatric surgery among adolescents remains safe, with extremely low complication rates and zero in-hospital mortality.

Disparities in esophageal cancer care based on race: a National Cancer Database analysis

Esophageal cancer is one of the most common cancer killers in our country. The effects of racial disparities on care for esophageal cancer patients are incompletely understood. Using the National Cancer Database, we investigated racial disparities in treatment and outcome of esophageal cancer patients. The National Cancer Database was queried from 2004 to 2017. Logistic regression and survival analysis were used to determine racial differences in access, treatment and outcome. A total of 127,098 patients were included. All minority groups were more likely to be diagnosed at advanced stages versus Caucasians after adjusting for covariates (African American OR-1.64 [95% confidence interval 1.53-1.76], Hispanic OR-1.19 [1.08-1.32], Asian OR-1.78 [1.55-2.06]). After adjustment, all minorities were less likely at every stage to receive surgery. Despite these disparities, Hispanics and Asians had improved survival compared with Caucasians. African Americans had worse survival. Racial disparities for receiving surgery were present in both academic and community institutions, and at high-volume and low-volume institutions. Surgery partially mediated the survival difference between African Americans and Caucasians (HR-1.13 [1.10-1.16] and HR-1.04 [1.02-1.07], without and with adjustment of surgery).There are racial disparities in the treatment of esophageal cancer. Despite these disparities, Hispanics and Asians have improved overall survival versus Caucasians. African Americans have the worst overall survival. Racial disparities likely affect outcome in esophageal cancer. But other factors, such as epigenetics and tumor biology, may correlate more strongly with outcome for patients with esophageal cancer.

Racial disparities in complications and mortality after bariatric surgery: A systematic review

BACKGROUND

Studies have shown racial discrepancies in the rates of postoperative adverse events following bariatric surgery (BS). We aim to systematically review the literature examining racial disparities in postoperative adverse events.

METHODS

PubMed, Embase, and SCOPUS databases were searched for studies that reported race, postoperative adverse events and/or length of stay.

RESULTS

Thirty-five studies were included. Most compared Black and White patients using standardized databases. Racial/ethnic terminology varied. The majority found increased 30-day mortality and morbidity and length of stay in Black relative to White patients. Differences between White and Hipanic patients were mostly non-significant in these outcomes.

CONCLUSIONS

Black patients may experience higher rates of adverse events than White patients within 30 days following bariatric surgery. Given the limitations in the large multicenter databases, explanations for this disparity were limited. Future research would benefit from longer-term studies that include more races and ethnicities and consider socioeconomic factors.

Introducing a Bariatric Surgery Program at a Large Urban Safety Net Medical Center Serving a Primarily Hispanic Patient Population

Background

Few bariatric surgery programs exist at safety net hospitals which often serve patients of diverse racial and socioeconomic backgrounds. A bariatric surgery program was developed at a large urban safety net medical center serving a primarily Hispanic population. The purpose of this study was to evaluate safety, feasibility, and first-year outcomes to pave the way for other safety net bariatric programs.

Methods

The bariatric surgery program was started at a safety net hospital located in a neighborhood with over twice the national poverty rate. A retrospective review was performed for patient demographics, comorbidities, preoperative diet and exercise habits, perioperative outcomes, and 1-year outcomes including percent total weight lost (%TWL) and comorbidity reduction.

Results

A total of 153 patients underwent laparoscopic sleeve gastrectomy from May 2017 through December 2019. The average preoperative BMI was 47.9kg/m², and 54% of patients had diabetes. The 1-year follow-up rate was 94%. There were no mortalities and low complication rates. The average 1-year %TWL was 22.8%. Hypertension and diabetes medications decreased in 52% and 55% of patients, respectively. The proportion of diabetic patients with postoperative HbA1c <6.0% was 49%.

Conclusion

This is one of the first reports on the outcomes of a bariatric surgery program at a safety net hospital. This analysis demonstrates feasibility and safety, with no mortalities, low complication rates, and acceptable %TWL and comorbidity improvement. More work is needed to investigate the impacts of race, culture, and socioeconomic factors on bariatric outcomes in this population.

Graphical abstract

Differences in outcomes after emergency general surgery between Hispanic subgroups in the New Jersey State Inpatient Database (2009-2014): The Hispanic population is not monolithic

BACKGROUND

Our aim was to examine differences in clinical outcomes between Hispanic subgroups who underwent emergency general surgery (EGS).

METHODS

Retrospective cohort study of the HCUP State Inpatient Database from New Jersey (2009-2014), including Hispanic and non-Hispanic White (NHW) adult patients who underwent EGS. Multivariable analyses were performed on outcomes including 7-day readmission and length of stay (LOS).

RESULTS

125,874 patients underwent EGS operations. 22,971 were Hispanic (15,488 with subgroup defined: 7,331 - Central/South American; 4,254 - Puerto Rican; 3,170 - Mexican; 733 - Cuban). On multivariable analysis, patients in the Central/South American subgroup were more likely to be readmitted compared to the Mexican subgroup (OR 2.02; p < 0.001, respectively). Puerto Rican and Central/South American subgroups had significantly shorter LOS than Mexican patients (Puerto Rico -0.58 days; p < 0.001; Central/South American -0.30 days; p = 0.016).

CONCLUSIONS

There are significant differences in EGS outcomes between Hispanic subgroups. These differences could be missed when data are aggregated at Hispanic ethnicity.

Weight loss dynamics following laparoscopic Roux-en-Y gastric bypass. An analysis of 10-year follow-up data

BACKGROUND

Laparoscopic Roux-en-Y gastric bypass (LRYGB) still remains the gold-standard bariatric procedure. Short-term weight loss and improvement of type 2 diabetes mellitus (DM2) after LRYGB are well-documented. Little data are available on long-term weight loss and continued remission of DM2 in these patients.

METHODS

This study reports on weight loss and remission of DM2 in 576 consecutive patients who underwent primary LRYGB between August 2001 and August 2009 with at least 10-year follow up. All patients were treated at a single institution by a single surgeon. All data were collected and entered into the database prospectively.

RESULTS

A total of 576 patients were included in the study. Patients' mean age was 38.2 ± 10.9 years and females represented 88.2% of patients. Patients' ethnicity was diverse, including African Americans (44.4%), Caucasians (34.0%), Hispanics (18.1%), and 3.5% from other backgrounds. On average, there were 6.9 ± 2.7 comorbidities per patient and DM2 was initially present in 150/576 patients (26.0%). Mean preoperative weight and BMI were 132.4 ± 22.0 kg and 48.3 ± 6.7 kg/m², respectively. Ten-year follow-up reporting rate was 145/576 (25.2%). Maximum weight loss occurred at 18 months (mean weight 83.4 ± 16.5 kg, mean BMI 30.5 ± kg/m²). At 10 years, mean weight was maintained at 94.8 ± 20.5 kg and mean BMI was 34.3 ± 6.8 kg/m². The average weight regain between one and ten years was 8.27 kg. Among patients with preoperative DM2, continued remission of DM2 at 10 years occurred in 19/32 (59.4%) patients.

CONCLUSIONS

LRYGB provides durable long-term weight loss, as well as successful remission of DM2 at 10 years. More long-term follow-up studies evaluating weight loss and comorbidities extending beyond the initial 10-year period are needed. Such studies are essential for projecting late outcomes of LRYGB, particularly in younger patients with life expectancy exceeding several decades.