1
|
Chao GF, Yang J, Thumma JR, Chhabra KR, Arterburn DE, Ryan AM, Telem DA, Dimick JB. Out-of-pocket Costs for Commercially-insured Patients in the Years Following Bariatric Surgery: Sleeve Gastrectomy Versus Roux-en-Y Gastric Bypass. Ann Surg 2023; 277:e332-e338. [PMID: 35129487 PMCID: PMC9091055 DOI: 10.1097/sla.0000000000005291] [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: 12/31/2022]
Abstract
OBJECTIVE To compare out-of-pocket (OOP) costs for patients up to 3 years after bariatric surgery in a large, commercially-insured population. SUMMARY OF BACKGROUND DATA More information on OOP costs following bariatric surgery may affect patients' procedure choice. METHODS Retrospective study using the IBM MarketScan commercial claims database, representing patients nationally who underwent laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) January 1, 2011 to December 31, 2017. We compared total OOP costs after the surgical episode between the 2 procedures using difference-in-differences analysis adjusting for demographics, comorbidities, operative year, and insurance type. RESULTS Of 63,674 patients, 64% underwent SG and 36% underwent RYGB. Adjusted OOP costs after SG were $1083, $1236, and $1266 postoperative years 1, 2, and 3. For RYGB, adjusted OOP costs were $1228, $1377, and $1369. In our primary analysis, SG OOP costs were $122 (95% confidence interval [CI]: -$155 to -$90) less than RYGB year 1. This difference remained consistent at -$119 (95%CI: -$158 to -$79) year 2 and -$80 (95%CI: -$127 to -$35) year 3. These amounts were equivalent to relative differences of -7%, -7%, and -5% years 1, 2, and 3. Plan features contributing the most to differences were co-insurance years 1, 2, and 3.The largest clinical contributors to differences were endoscopy and outpatient care year 1, outpatient care year 2, and emergency department use year 3. CONCLUSIONS Our study is the first to examine the association between bariatric surgery procedure and OOP costs. Differences between procedures were approximately $100 per year which may be an important factor for some patients deciding whether to pursue SG or gastric bypass.
Collapse
Affiliation(s)
- Grace F. Chao
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Veterans Affairs Ann Arbor, Ann Arbor, MI
- Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Jie Yang
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Jyothi R. Thumma
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
| | - Karan R. Chhabra
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA
| | - David E. Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Andrew M. Ryan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Center for Evaluating Health Reform, University of Michigan, Ann Arbor, MI
- School of Public Health, University of Michigan, Ann Arbor, MI
| | - Dana A. Telem
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Justin B. Dimick
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
- Department of Surgery, University of Michigan, Ann Arbor, MI
| |
Collapse
|
2
|
Use of primary bariatric surgery among patients with obesity and diabetes. Insights from the Diabetes Collaborative Registry. Int J Obes (Lond) 2022; 46:2163-2167. [PMID: 36008680 DOI: 10.1038/s41366-022-01217-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/09/2022]
Abstract
Despite its cardiometabolic benefits, bariatric surgery has historically been underused in patients with obesity and diabetes, but contemporary data are lacking. Among 1,520,182 patients evaluated from 2013 to 2019 within a multicenter, longitudinal, US registry of outpatients with diabetes, we found that 462,033 (30%) met eligibility for bariatric surgery. After a median follow-up of 854 days, 6310/384,859 patients (1.6%) underwent primary bariatric surgery, with a slight increase over time (0.38% per year [2013] to 0.68% per year [2018]). Patients who underwent bariatric surgery were more likely to be female (63% vs. 56%), white (87% vs. 82%), have higher body mass indices (42.1 ± 6.9 vs. 40.6 ± 5.9 kg/m2), and depression (23% vs. 14%; p < 0.001 for all). Over a median (IQR) follow-up after surgery of 722 days (364-993), patients who underwent bariatric surgery had lost an average of 11.8 ± 18.5 kg (23% of excess body weight), 10.2% were on fewer glucose-lowering medications, and 8.4% were on fewer antihypertensives. Despite bariatric surgery being safer and more accessible over the past two decades, less than one in fifty eligible patients with diabetes receive this therapy.
Collapse
|
3
|
Samaan JS, Zhao J, Qian E, Hernandez A, Toubat O, Alicuben ET, Malik Y, Sandhu K, Dobrowolsky A, Samakar K. Preoperative Weight Loss as a Predictor of Bariatric Surgery Postoperative Weight Loss and Complications. J Gastrointest Surg 2022; 26:86-93. [PMID: 34145492 DOI: 10.1007/s11605-021-05055-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/22/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The association between preoperative weight loss and bariatric surgery outcomes remains unclear. We explored the utility of preoperative weight loss as a predictor of postoperative weight loss success. Additionally, we examined the association of preoperative weight loss with perioperative complication rates. METHODS Retrospective chart review of patients who underwent primary sleeve gastrectomy or primary Roux-en-Y gastric bypass for weight loss at a single institution between January 2003 and November 2017. Additional follow-up was obtained by a postoperative standardized patient questionnaire. Statistical analysis consisted of bivariate and multivariate logistic regression analysis. RESULTS Our study included 427 patients. Majority were female (n = 313, 73.3%) and underwent sleeve gastrectomy (n = 261, 61.1%). Average age was 45.6 years, and average follow-up was 6.3 years. Greater preoperative weight loss was associated with decreased length of stay (1.8 vs 1.3 days) in patients who underwent sleeve gastrectomy. Multivariable regression analysis revealed that preoperative weight loss was not associated with postoperative weight loss. CONCLUSIONS Preoperative weight loss is not predictive of postoperative weight loss success after bariatric surgery. Greater preoperative weight loss was associated with a mild decreased in length of stay but was not associated with a reduction in operative time, overall complication rates, ICU admissions, or intraoperative complications. The inconclusive literature and our findings do not support the medical necessity of weight loss prior to bariatric surgery for the purpose of reducing surgical complications or predicting successful postoperative weight loss success.
Collapse
Affiliation(s)
- Jamil S Samaan
- Department of Medicine, Cedars Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA, 90048, USA
| | - Jasmine Zhao
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Elaine Qian
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Angelica Hernandez
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Omar Toubat
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Evan T Alicuben
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Yousaf Malik
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Kulmeet Sandhu
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Adrian Dobrowolsky
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA
| | - Kamran Samakar
- Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, 1510 San Pablo St, Suite 51, Los Angeles, CA, 90033, USA.
| |
Collapse
|
4
|
Pardhan S, Smith L, Davis A, Bourne R, Barnett Y, Jacob L, Koyanagi A, Radzimiński Ł, Skalska M, Jastrzębska J, Jastrzębski Z, López-Sánchez GF. Gender differences in the association between physical activity and obesity in adults with vision and hearing losses. Eur J Public Health 2021; 31:835-840. [PMID: 33970269 DOI: 10.1093/eurpub/ckab077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Physical inactivity is strongly associated with obesity, which in turn is a major risk factor for many non-communicable diseases. We examined associations between physical inactivity and obesity in Spanish adults with vision and hearing difficulties and explored differences between men and women. METHODS Data from the Spanish National Health Survey 2017 were analyzed [n = 23 089 adults (15-103 years, mean age 53.4 ± 18.9 years, 45.9% men)]. Participants self-reported difficulties in seeing and hearing. Physical inactivity (exposure) was evaluated with the International Physical Activity Questionnaire Short Form. Obesity (outcome) was defined as body mass index ≥30 kg m-2 based on self-reported weight and height. The association between physical inactivity and obesity was assessed with multivariable logistic regression in people with difficulties seeing and hearing, adjusting for significant covariates. RESULTS Multivariable logistic regression analyses showed that the association between physical inactivity and obesity was stronger in those with difficulty hearing (OR 1.778, 95% CI 1.215-2.602) compared with difficulty seeing (OR 1.375, 95% CI 1.076-1.756). Gender-stratified analyses showed significant association between physical inactivity and obesity in men who reported difficulty hearing (OR 2.319, 95% CI 1.441-3.735) and difficulty seeing (OR 1.556, 95% CI 1.079-2.244), but not in women. CONCLUSIONS A significant association between physical inactivity and obesity was observed in Spanish men with vision and hearing difficulties. Physical activity has an important role in the prevention of obesity in men with seeing and hearing difficulties. Active steps should be taken to encourage physical activity to reduce the risk of obesity in people with sensory impairments.
Collapse
Affiliation(s)
- Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Adrian Davis
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK.,ENT and Audiology, Imperial College London, London, UK
| | - Rupert Bourne
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| | - Yvonne Barnett
- School of Life Sciences, Faculty of Science and Engineering, Anglia Ruskin University, Cambridge, UK
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain.,ICREA, Lluis Companys, Barcelona 08010, Spain
| | - Łukasz Radzimiński
- Department of Health and Life Sciences, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Maria Skalska
- Department of Pediatrics, Diabetology and Endocrinology, Gdansk Medical University, Gdansk, Poland
| | - Joanna Jastrzębska
- Department of Pediatrics, Diabetology and Endocrinology, Gdansk Medical University, Gdansk, Poland
| | - Zbigniew Jastrzębski
- Department of Health and Life Sciences, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Guillermo F López-Sánchez
- Vision and Eye Research Institute, School of Medicine, Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK
| |
Collapse
|
5
|
Tsigalou C, Paraschaki A, Karvelas A, Kantartzi K, Gagali K, Tsairidis D, Bezirtzoglou E. Gut microbiome and Mediterranean diet in the context of obesity. Current knowledge, perspectives and potential therapeutic targets. Metabol Open 2021; 9:100081. [PMID: 33644741 PMCID: PMC7892986 DOI: 10.1016/j.metop.2021.100081] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023] Open
Abstract
Mediterranean Diet has been recognized as one of the healthiest and sustainable dietary patterns worldwide, based on the food habits of people living in the Mediterranean region. It is focused on a plant-based cuisine combining local agricultural products and moderate intake of fish. As eating habits seem to exert a major impact on the composition of gut microbiota, numerous studies show that an adherence to the Mediterranean diet positively influences the microbiome ecosystem network. This has a profound effect on multiple host metabolic pathways and plays a major role in immune and metabolic homeostasis. Among metabolic disorders, obesity represents a major health issue where Mediterranean Dietary regime could possibly slowdown its spread. The aim of this review is to emphasize the interaction between diet and gut microbiota and the potential beneficial effects of Mediterranean diet on metabolic disorders like obesity, which is responsible for the development of many noncommunicable diseases.
Collapse
Affiliation(s)
- Christina Tsigalou
- Laboratory of Microbiology, School of Medicine, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana Campus, Alexandroupolis, 68100, Greece
| | - Afroditi Paraschaki
- Laboratory of Microbiology, School of Medicine, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana Campus, Alexandroupolis, 68100, Greece
| | - Alexandros Karvelas
- Laboratory of Microbiology, School of Medicine, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana Campus, Alexandroupolis, 68100, Greece
| | - Konstantina Kantartzi
- Department of Nephrology, Democritus University of Thrace, University General Hospital of Alexandroupolis Dragana Campus, Alexandroupolis, 68100, Greece
| | - Kenan Gagali
- University General Hospital of Alexandroupolis, Dragana Campus, Alexandroupolis, 68100, Greece
| | - Dimitrios Tsairidis
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Dragana, Alexandroupolis, 68100, Greece
| | - Eugenia Bezirtzoglou
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Dragana, Alexandroupolis, 68100, Greece
| |
Collapse
|
6
|
Bezzini DR, Washington GN, Abiodun O, Olufajo OA, Jones I, Butts DM, Ortega G, Paul H. The Potential Impact of Plastic Surgery Expertise on Body Contouring Procedure Outcomes. Aesthet Surg J 2021; 41:47-55. [PMID: 32133491 DOI: 10.1093/asj/sjaa056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With the increasing demand for body contouring procedures in the United States over the past 2 decades, more surgeons with diverse specialty training are performing these procedures. However, little is known regarding the comparative outcomes of these patients. OBJECTIVES The purpose of this study was to compare outcomes of body contouring procedures based on the specialty training of the surgeon. METHODS Data from the American College of Surgeons National Surgical Quality Improvement Program (2005-2015) were reviewed for all body contouring procedures. Patients were stratified by surgeon training (plastic surgery [PS] vs general surgery [GS]). Descriptive statistics and regression analyses were used to evaluate differences in outcomes. RESULTS A total of 11,658 patients were included; 9502 PS cases and 2156 GS cases. Most were women (90.4%), aged 40 to 59 (52.7%) and white (79.5%). Compared with PS patients, GS patients were more likely to be obese (61.4% vs 40.6%), smokers (13.6% vs 9.8%), and with ASA classification ≥3 (35.3% vs 18.6%) (all P < 0.001). Abdominal contouring procedures were the most common (76%) cases. Multivariate regression revealed that compared with PS cases, those performed by GS practitioners were associated with increased wound and infectious complications (adjusted odds ratio [aOR], 1.81; 95% confidence interval [CI], 1.44-2.27), reoperation (aOR, 1.85; 95% CI, 1.31-2.62), and predicted mean length of stay (1.12 days; 95% CI, 0.64-1.60 days). CONCLUSIONS The variable outcomes in body contouring procedures performed by PS compared with GS practitioners may imply procedural-algorithmic differences between the subspecialties, leading to the noted outcome differential. LEVEL OF EVIDENCE: 2
Collapse
Affiliation(s)
- Dylan R Bezzini
- Department of Surgery, Howard University College of Medicine, Washington, DC
| | - George N Washington
- Department of Surgery, Division of Plastic and Reconstructive Surgery, The University of Texas Health Science Center, Houston, TX
| | - Olumayowa Abiodun
- Department of Surgery, Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Olubode A Olufajo
- Callender Howard-Harvard Health Sciences Outcomes Research Center, Howard University, Washington, DC
| | - India Jones
- Callender Howard-Harvard Health Sciences Outcomes Research Center, Howard University, Washington, DC
| | - DeMario Montez Butts
- Callender Howard-Harvard Health Sciences Outcomes Research Center, Howard University, Washington, DC
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Henry Paul
- Department of Surgery, Howard University College of Medicine, Washington, DC
| |
Collapse
|
7
|
Premkumar A, Lebrun DG, Sidharthan S, Penny CL, Dodwell ER, McLawhorn AS, Nwachukwu BU. Bariatric Surgery Prior to Total Hip Arthroplasty Is Cost-Effective in Morbidly Obese Patients. J Arthroplasty 2020; 35:1766-1775.e3. [PMID: 32278487 DOI: 10.1016/j.arth.2020.02.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/09/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The cost-effectiveness of bariatric surgery to achieve weight loss prior to total hip arthroplasty (THA), and decrease the complications and costs associated with THA in the morbidly obese, is unknown. This study evaluated the cost-effectiveness of bariatric surgery prior to THA for morbidly obese patients with end-stage hip osteoarthritis (OA). METHODS A state-transition Markov model was constructed to compare the cost-utility of 2 treatment protocols for patients with morbid obesity and end-stage hip OA: (1) immediate THA and (2) bariatric surgery 2 years prior to THA (combined protocol). The analysis was performed from both a payer and a societal perspective using direct and indirect costs over a 40-year time horizon. Utilities, associated costs, and probabilities for health state transitions were derived from the literature. One-way, 2-way and probabilistic sensitivity analyses were performed to validate the robustness of the base case results, using the standard willingness-to-pay threshold of $100,000/quality-adjusted life years. RESULTS From the societal perspective, the combined protocol was more effective (13.16 vs 12.26) with less cost ($91,717 vs $92,684) and thus was the dominant strategy over immediate THA. These results were stable across broad ranges for independent model variables. Monte Carlo simulation with 100,000 samples demonstrated that bariatric surgery prior to THA was the preferred cost-effective strategy over 95% of the time from both a societal and payer perspective. CONCLUSION In the morbidly obese patient with end-stage hip OA, bariatric surgery prior to THA is a cost-effective strategy for improving quality of life and decreasing societal and payer costs. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Drake G Lebrun
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Sreetha Sidharthan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Caitlin L Penny
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Emily R Dodwell
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | | | | |
Collapse
|
8
|
Chinaka U, Fultang J, Ali A. Does Preoperative Weight Loss Predict Significant Postoperative Weight Loss Among Patients who Underwent Laparoscopic Sleeve Gastrectomy? Cureus 2019; 11:e5870. [PMID: 31763093 PMCID: PMC6834096 DOI: 10.7759/cureus.5870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 10/09/2019] [Indexed: 12/28/2022] Open
Abstract
Background Some bariatric practices, mainly those conducted under public-funded services, have adopted achieving a target preoperative weight loss (PrWL) before offering surgery. There are varied opinions on the correlation between preoperative and postoperative weight loss (PoWL) for the different surgical options. This study investigated the impact of target PrWL on PoWL for patients who underwent laparoscopic sleeve gastrectomy (LSG). Materials and methods A longitudinal retrospective cohort study was carried out on patients who had documented preoperative weight before LSG (n=155) from the authors' institution between February 2008 to October 2017. Patients were grouped into two cohorts based on meeting the 5% target PrWL or not. The endpoint included percent postoperative weight loss (% PoWL) at one year and two to three years. Results A total of 155 individuals were identified and analysed. Of these patients, 78.7% of them (n=122) achieved the 5% target PrWL (target group) while 21.3% (n= 33) did not (non-target group). At one year, there was no statistical significant difference in the mean % PoWL between the non-target and target groups (22.3 ± 8.1% versus 19.4 ± 11.8% p value= 0.08). A similar observation was made at two-three years, where the mean % PoWL in the non-target group was 14.7 ± 10.7% versus 16.3 ± 14.4% in the target group (p value= 0.07). Our further analysis highlighted a statistically significant weak inversely proportional correlation between % PrWL and % PoWL at one year and two to three years. Conclusion Meeting target PrWL does not significantly impact on PoWL after LSG. Therefore, it should not serve as exclusion criteria for eligible patients who are in need of surgery.
Collapse
Affiliation(s)
- Ugochukwu Chinaka
- General Surgery, University Hospital Ayr/University of West of Scotland, Ayr, GBR
| | - Joshua Fultang
- General Surgery, University Hospital Ayr/University of West of Scotland, Ayr, GBR
| | - Abdulmajid Ali
- General Surgery, University Hospital Ayr/University of West of Scotland, Ayr, GBR
| |
Collapse
|
9
|
Holderbaum M, Casagrande DS, Sussenbach S, Buss C. Effects of very low calorie diets on liver size and weight loss in the preoperative period of bariatric surgery: a systematic review. Surg Obes Relat Dis 2017; 14:237-244. [PMID: 29239795 DOI: 10.1016/j.soard.2017.09.531] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 12/21/2022]
Abstract
Restrictive diet implementation in bariatric surgery (BS) preoperative period is common, although its benefits are not well established. This study aimed to assess the effects of very low calorie diets (VLCD) on liver size and weight loss during BS preoperative period. Surgery-related complications were also assessed. A systematic review of the literature was performed. Terms such as "bariatric surgery" and "very low energy diet" were included in the search strategy. Inclusion criteria were adult patients (aged>18 yr); VLCD treatment in BS preoperative period (10 d to 12 wk); and assessment of 1 the following outcomes: weight loss, liver volume reduction, and surgical complications. There were 9 studies included (849 patients including 250 controls, 196 controls without VLCD). Of the studies, 3 were randomized clinical trials and 6 were observational studies. VLCD treatment led to weight loss (-2.8 to -14.8 kg) and to liver size reduction by 5% to 20% of the initial volume. VLCD treatment did not significantly reduce perioperative complications. However, 1 study (n = 273) reported a protective effect 30 days after surgery. This systematic review found VLCD treatment led to significant weight loss and liver volume reduction when applied to patients with obesity in BS preoperative period. The effect of VLCD on surgical risks is not clear. Standardization of dietary characteristics is needed, because weight loss and decrease in liver size were not connected to higher caloric restriction. This is an important matter in clinical practice as to avoid unnecessary prolonged and/or excessive dietary restriction.
Collapse
Affiliation(s)
- Mariana Holderbaum
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil; Centro de Obesidade e Síndrome Metabólica (Center for Morbid Obesity and Metabolic Syndorme) Hospital São Lucas Hospital, PontifíciaUniversidadeCatólica do Rio Grande Sul (C.O.M. PUCRS), Porto Alegre, Brazil
| | - Daniela Schaan Casagrande
- Centro de Obesidade e Síndrome Metabólica (Center for Morbid Obesity and Metabolic Syndorme) Hospital São Lucas Hospital, PontifíciaUniversidadeCatólica do Rio Grande Sul (C.O.M. PUCRS), Porto Alegre, Brazil
| | - Samanta Sussenbach
- Centro de Obesidade e Síndrome Metabólica (Center for Morbid Obesity and Metabolic Syndorme) Hospital São Lucas Hospital, PontifíciaUniversidadeCatólica do Rio Grande Sul (C.O.M. PUCRS), Porto Alegre, Brazil
| | - Caroline Buss
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Rio Grande do Sul, Brazil; Departamento de Nutrição (Department of Nutrition) - UFSCPA, Rio Grande do Sul, Brazil.
| |
Collapse
|
10
|
Frechette DM, Krishnamoorthy D, Pamon T, Chan ME, Patel V, Rubin CT. Mechanical signals protect stem cell lineage selection, preserving the bone and muscle phenotypes in obesity. Ann N Y Acad Sci 2017; 1409:33-50. [PMID: 28891202 DOI: 10.1111/nyas.13442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/19/2017] [Accepted: 06/28/2017] [Indexed: 12/18/2022]
Abstract
The incidence of obesity is rapidly rising, increasing morbidity and mortality rates worldwide. Associated comorbidities include type 2 diabetes, heart disease, fatty liver disease, and cancer. The impact of excess fat on musculoskeletal health is still unclear, although it is associated with increased fracture risk and a decline in muscular function. The complexity of obesity makes understanding the etiology of bone and muscle abnormalities difficult. Exercise is an effective and commonly prescribed nonpharmacological treatment option, but it can be difficult or unsafe for the frail, elderly, and morbidly obese. Exercise alternatives, such as low-intensity vibration (LIV), have potential for improving musculoskeletal health, particularly in conditions with excess fat. LIV has been shown to influence bone marrow mesenchymal stem cell differentiation toward higher-order tissues (i.e., bone) and away from fat. While the exact mechanisms are not fully understood, recent studies utilizing LIV both at the bench and in the clinic have demonstrated some efficacy. Here, we discuss the current literature investigating the effects of obesity on bone, muscle, and bone marrow and how exercise and LIV can be used as effective treatments for combating the negative effects in the presence of excess fat.
Collapse
Affiliation(s)
- Danielle M Frechette
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Divya Krishnamoorthy
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Tee Pamon
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - M Ete Chan
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Vihitaben Patel
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Clinton T Rubin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| |
Collapse
|
11
|
Solbrig L, Jones R, Kavanagh D, May J, Parkin T, Andrade J. People trying to lose weight dislike calorie counting apps and want motivational support to help them achieve their goals. Internet Interv 2017; 7:23-31. [PMID: 28286739 PMCID: PMC5332530 DOI: 10.1016/j.invent.2016.12.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Two thirds of UK adults are overweight or obese and at increased risk of chronic conditions such as heart disease, diabetes and certain cancers. Basic public health support for weight loss comprises information about healthy eating and lifestyle, but internet and mobile applications (apps) create possibilities for providing long-term motivational support. AIMS To explore among people currently trying to lose weight, or maintaining weight loss, (i) problems, experiences and wishes in regards to weight management and weight loss support including e-health support; (ii) reactions to Functional Imagery Training (FIT) as a possible intervention. METHOD Six focus groups (N = 24 in total) were recruited from a public pool of people who had expressed an interest in helping with research. The topics considered were barriers to weight loss, desired support for weight loss and acceptability of FIT including the FIT app. The focus group discussions were transcribed and thematically analysed. RESULTS All groups spontaneously raised the issue of waning motivation and expressed the desire for motivational app support for losing weight and increasing physical activity. They disliked calorie counting apps and those that required lots of user input. All groups wanted behavioural elements such as setting and reviewing goals to be included, with the ability to personalise the app by adding picture reminders and choosing times for goal reminders. Participants were positive about FIT and FIT support materials. CONCLUSION There is a mismatch between the help provided via public health information campaigns and commercially available weight-loss self-help (lifestyle information, self-monitoring), and the help that individuals actually desire (motivational and autonomous e-support), posing an opportunity to develop more effective electronic, theory-driven, motivational, self-help interventions.
Collapse
Affiliation(s)
- Linda Solbrig
- School of Psychology, Plymouth University & NIHR CLAHRC South-West Peninsula, UK
| | - Ray Jones
- School of Psychology, Cognition Institute, Plymouth University, UK
| | - David Kavanagh
- School of Health Professions (Dietetics), Plymouth University, UK
| | - Jon May
- School of Nursing & Midwifery, Plymouth University, UK
| | - Tracey Parkin
- Institute for Health & Biomedical Innovation and School of Psychology & Counselling, Queensland University of Technology, Australia
| | | |
Collapse
|
12
|
Telem DA, Yang J, Altieri M, Talamini M, Zhang Q, Pryor AD. Hospital Charge and Health-Care Quality in Bariatric Surgery. Am Surg 2017. [DOI: 10.1177/000313481708300217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To determine if hospital charges correlate with patient outcomes after bariatric surgery. A retrospective review of 46,180 patients who underwent bariatric surgery from 2004-2010 was performed. Patients were identified using the New York Statewide Planning and Research Cooperative System database. Hospitals were categorized on estimates from a multiple linear regression model for charge: low (<$25,027.00), medium ($25,027.00–$35,449.00), and high (≥$35,449.01). Patient outcomes were compared among the charge classification. Of the 46,180 patients, 24 per cent underwent operations in low-, 26 per cent in medium-, and 23,082 (50%) in high-charge hospitals. Controlling for patient demographics, comorbidity, insurance, and operative procedure, multivariable logistic regression demonstrated no significant difference in major complication or mortality among charges. Hospital charge does not correlate with improved outcomes. This is significant given the adverse association between price inflation and rising insurance premiums. Inflated hospital charges may also discriminate against certain patient populations including the uninsured and those with high-deductible insurance plans.
Collapse
Affiliation(s)
- Dana A. Telem
- Division of Minimally Invasive Surgery, University of Michigan, Ann Arbor, Michigan
| | - Jie Yang
- Departments of Preventative Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Maria Altieri
- Bariatric, Foregut, and Advanced Gastrointestinal Surgery Division, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Mark Talamini
- Bariatric, Foregut, and Advanced Gastrointestinal Surgery Division, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| | - Qiao Zhang
- Departments of Applied Mathematics and Statistics, Stony Brook University Medical Center, Stony Brook, New York
| | - Aurora D. Pryor
- Bariatric, Foregut, and Advanced Gastrointestinal Surgery Division, Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York
| |
Collapse
|
13
|
Campbell JA, Venn A, Neil A, Hensher M, Sharman M, Palmer AJ. Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review. Obes Rev 2016; 17:850-94. [PMID: 27383557 DOI: 10.1111/obr.12424] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/29/2016] [Accepted: 04/08/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Health economic evaluations inform healthcare resource allocation decisions for treatment options for obesity including bariatric/metabolic surgery. As an important advance on existing systematic reviews, we aimed to capture, summarize and synthesize a diverse range of economic evaluations on bariatric surgery. METHODS Studies were identified by electronic screening of all major biomedical/economic databases. Studies included if they reported any quantified health economic cost and/or consequence with a measure of effect for any type of bariatric surgery from 1995 to September 2015. Study screening, data extraction and synthesis followed international guidelines for systematic reviews. RESULTS Six thousand one hundred eighty-seven studies were initially identified. After two levels of screening, 77 studies representing 17 countries (56% USA) were included. Despite study heterogeneity, common themes emerged, and important gaps were identified. Most studies adopted the healthcare system/third-party payer perspective; reported costs were generally healthcare resource use (inpatient/shorter-term outpatient). Out-of-pocket costs to individuals, family members (travel time, caregiving) and indirect costs due to lost productivity were largely ignored. Costs due to reoperations/complications were not included in one-third of studies. Body-contouring surgery included in only 14%. One study evaluated long-term waitlisted patients. Surgery was cost-effective/cost-saving for severely obese with type 2 diabetes mellitus. Study quality was inconsistent. DISCUSSION There is a need for studies that assume a broader societal perspective (including out-of-pocket costs, costs to family and productivity losses) and longer-term costs (capture reoperations/complications, waiting, body contouring), and consequences (health-related quality-of-life). Full economic evaluation underpinned by reporting standards should inform prioritization of patients (e.g. type 2 diabetes mellitus with body mass index 30 to 34.9 kg/m(2) or long-term waitlisted) for surgery. © 2016 World Obesity.
Collapse
Affiliation(s)
- J A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - A Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - A Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - M Hensher
- Department of Health and Human Services, Hobart, Tasmania, Australia
| | - M Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - A J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
14
|
Kunze KN, Hanlon EC, Prachand VN, Brady MJ. Peripheral circadian misalignment: contributor to systemic insulin resistance and potential intervention to improve bariatric surgical outcomes. Am J Physiol Regul Integr Comp Physiol 2016; 311:R558-63. [PMID: 27465735 PMCID: PMC5142221 DOI: 10.1152/ajpregu.00175.2016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/26/2016] [Indexed: 11/22/2022]
Abstract
Thirteen percent of the world's population suffers from obesity and 39% from being overweight, which correlates with an increase in numerous secondary metabolic complications, such as Type 2 diabetes mellitus. Bariatric surgery is the most effective treatment for severe obesity and results in significant weight loss and the amelioration of obesity-related comorbidities through changes in enteroendocrine activity, caloric intake, and alterations in gut microbiota composition. The circadian system has recently been found to be a critical regulatory component in the control of metabolism and, thus, may potentially play an important role in inappropriate weight gain. Indeed, some behaviors and lifestyle factors associated with an increased risk of obesity are also risk factors for misalignment in the circadian clock system and for the metabolic syndrome. It is thus possible that alterations in peripheral circadian clocks in metabolically relevant tissues are a contributor to the current obesity epidemic. As such, it is plausible that postsurgical alterations in central circadian alignment, as well as peripheral gene expression in metabolic tissues may represent another mechanism for the beneficial effects of bariatric surgery. Bariatric surgery may represent an opportunity to identify changes in the circadian expression of clock genes that have been altered by environmental factors, allowing for a better understanding of the mechanism of action of surgery. These studies could also reveal an overlooked target for behavioral intervention to improve metabolic outcomes following bariatric surgery.
Collapse
Affiliation(s)
- Kyle N Kunze
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago Illinois
| | - Erin C Hanlon
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago Illinois
| | - Vivek N Prachand
- Department of Surgery, Section of General Surgery, University of Chicago, Chicago Illinois; and Committee on Molecular Metabolism and Nutrition, University of Chicago, Chicago Illinois
| | - Matthew J Brady
- Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Chicago, Chicago Illinois; Committee on Molecular Metabolism and Nutrition, University of Chicago, Chicago Illinois
| |
Collapse
|
15
|
Lam S, Lin Y, Curry DJ, Reddy GD, Warnke PC. Revision surgeries following vagus nerve stimulator implantation. J Clin Neurosci 2016; 30:83-87. [DOI: 10.1016/j.jocn.2016.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
|
16
|
Gupta S, Wang Z. Treatment satisfaction with different weight loss methods among respondents with obesity. Clin Obes 2016; 6:161-70. [PMID: 27008069 DOI: 10.1111/cob.12140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 01/18/2023]
Abstract
Satisfaction with weight loss (WL) methods has been correlated with the effectiveness, long-term compliance and commitment to weight management. This study explored treatment satisfaction associated with different WL methods among patients with obesity. Cross-sectional data were analysed from the 2012 US National Health and Wellness Survey. Respondents with obesity were categorized as having a WL procedure (e.g., gastric bypass and gastric banding) or using a prescription medication for WL (Sur/Rx), vs. using self-modification WL techniques (e.g., diet, exercise and WL supplements). Overall satisfaction with current WL methods was assessed among the obese and the overweight/obese with type 2 diabetes mellitus (T2DM). Of the 22 927 respondents with obesity, 58.4% took no current action to lose weight, 2.3% were identified as Sur/Rx and 39.3% were identified as self-modification. The Sur/Rx group reported being very/extremely satisfied more frequently than the self-modification group (39.3% vs. 20.2%, P < 0.001). Similarly, respondents with T2DM that were overweight/obese reported higher satisfaction in the Sur/Rx vs. the self-modification group (46.6% vs. 22.7%, P < 0.001). Satisfaction with WL methods was greater for the Sur/Rx vs. the self-modification group. Data suggest the importance of including bariatric surgery and pharmacotherapy as an integral part in comprehensive WL management.
Collapse
Affiliation(s)
- S Gupta
- Health Outcomes Practice, Kantar Health, Princeton, NJ, USA
| | - Z Wang
- Health Economics & Outcomes Research, Eisai, Inc., Woodcliff Lake, NJ, USA
| |
Collapse
|
17
|
Montanera D. The importance of negative defensive medicine in the effects of malpractice reform. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:355-369. [PMID: 25855557 DOI: 10.1007/s10198-015-0687-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 03/18/2015] [Indexed: 06/04/2023]
Abstract
This article presents a model of physician and insurer behavior in which the practice of defensive medicine, both positive and negative, can arise. Accounting for negative defensive medicine, and insurers' reaction to it, leads to different predictions of the effects of changing malpractice pressure compared to past models. Rising malpractice pressure causes both health care spending and quality to increase up to a threshold, and decrease thereafter. This non-monotonicity implies that malpractice reform is not a "silver bullet" capable of achieving both cost reductions and quality improvements for all consumers. The results can further explain inconsistent findings in the empirical literature and suggest alternative specifications for estimating the effects of malpractice reform.
Collapse
Affiliation(s)
- Daniel Montanera
- Institute of Health Administration, Georgia State University, 35 Broad Street NW, Suite 805, P.O. Box 3988, Atlanta, GA, 30302, USA.
| |
Collapse
|
18
|
Jayasinghe TN, Chiavaroli V, Holland DJ, Cutfield WS, O'Sullivan JM. The New Era of Treatment for Obesity and Metabolic Disorders: Evidence and Expectations for Gut Microbiome Transplantation. Front Cell Infect Microbiol 2016; 6:15. [PMID: 26925392 PMCID: PMC4759265 DOI: 10.3389/fcimb.2016.00015] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/25/2016] [Indexed: 12/15/2022] Open
Abstract
Key Points: The microbiome has been implicated in the development of obesity. Conventional therapeutic methods have limited effectiveness for the treatment of obesity and prevention of related complications. Gut microbiome transplantation may represent an alternative and effective therapy for the treatment of obesity. Obesity has reached epidemic proportions. Despite a better understanding of the underlying pathophysiology and growing treatment options, a significant proportion of obese patients do not respond to treatment. Recently, microbes residing in the human gastrointestinal tract have been found to act as an "endocrine" organ, whose composition and functionality may contribute to the development of obesity. Therefore, fecal/gut microbiome transplantation (GMT), which involves the transfer of feces from a healthy donor to a recipient, is increasingly drawing attention as a potential treatment for obesity. Currently the evidence for GMT effectiveness in the treatment of obesity is preliminary. Here, we summarize benefits, procedures, and issues associated with GMT, with a special focus on obesity.
Collapse
Affiliation(s)
| | | | - David J Holland
- Department of Infectious Diseases, Counties Manukau Health Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, The University of AucklandAuckland, New Zealand; Gravida: National Centre for Growth and DevelopmentAuckland, New Zealand
| | - Justin M O'Sullivan
- Liggins Institute, The University of AucklandAuckland, New Zealand; Gravida: National Centre for Growth and DevelopmentAuckland, New Zealand
| |
Collapse
|
19
|
McLawhorn AS, Southren D, Wang YC, Marx RG, Dodwell ER. Cost-Effectiveness of Bariatric Surgery Prior to Total Knee Arthroplasty in the Morbidly Obese: A Computer Model-Based Evaluation. J Bone Joint Surg Am 2016; 98:e6. [PMID: 26791039 DOI: 10.2106/jbjs.n.00416] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Obesity is associated with adverse outcomes and increased costs after total knee arthroplasty. Bariatric surgery is an effective treatment for morbid obesity, but its cost-effectiveness for weight loss prior to total knee arthroplasty is unknown. The purpose of this study was to evaluate the cost-effectiveness of bariatric surgery prior to total knee arthroplasty for patients in whom medical treatment of obesity and knee osteoarthritis had failed. METHODS A state-transition Markov model was constructed to compare the cost-utility of two treatment protocols for patients with morbid obesity and end-stage knee osteoarthritis: (1) immediate total knee arthroplasty and (2) bariatric surgery two years prior to the total knee arthroplasty. The probability of transition for each health state and its utility were derived from the literature. Costs, expressed in 2012 United States dollars, were estimated with use of administrative and claims data. Costs and utilities were discounted at 3% annually, and effectiveness was expressed in quality-adjusted life-years (QALYs). The principal outcome measure was the incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were performed, using $100,000 per QALY as the threshold willingness to pay. RESULTS Morbidly obese patients undergoing total knee arthroplasty alone had lower QALYs gained than patients who underwent bariatric surgery two years prior to the total knee arthroplasty. The ICER between these two procedures was approximately $13,910 per QALY, well below the threshold willingness to pay. Results were stable across broad value ranges for independent variables. Probabilistic sensitivity analysis found that the median ICER was $14,023 per QALY (95% confidence interval, $4875 to $51,210 per QALY). CONCLUSIONS This model supports bariatric surgery prior to total knee arthroplasty as a cost-effective option for improving outcomes in morbidly obese patients with end-stage knee osteoarthritis who are indicated for total knee arthroplasty. LEVEL OF EVIDENCE Economic and Decision Analysis Level II. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Alexander S McLawhorn
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for A.S. McLawhorn:
| | - Daniel Southren
- Columbia University College of Physicians & Surgeons, 630 West 168th Street, New York, NY 10032
| | - Y Claire Wang
- Department of Health Policy and Management, Columbia Mailman School of Public Health, 600 West 168th Street, 6th Floor, New York, NY 10032
| | - Robert G Marx
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for A.S. McLawhorn:
| | - Emily R Dodwell
- Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for A.S. McLawhorn:
| |
Collapse
|
20
|
Jonas WB, Crawford C, Colloca L, Kaptchuk TJ, Moseley B, Miller FG, Kriston L, Linde K, Meissner K. To what extent are surgery and invasive procedures effective beyond a placebo response? A systematic review with meta-analysis of randomised, sham controlled trials. BMJ Open 2015; 5:e009655. [PMID: 26656986 PMCID: PMC4679929 DOI: 10.1136/bmjopen-2015-009655] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To assess the quantity and quality of randomised, sham-controlled studies of surgery and invasive procedures and estimate the treatment-specific and non-specific effects of those procedures. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched PubMed, EMBASE, CINAHL, CENTRAL (Cochrane Library), PILOTS, PsycInfo, DoD Biomedical Research, clinicaltrials.gov, NLM catalog and NIH Grantee Publications Database from their inception through January 2015. STUDY SELECTION We included randomised controlled trials of surgery and invasive procedures that penetrated the skin or an orifice and had a parallel sham procedure for comparison. DATA EXTRACTION AND ANALYSIS Three authors independently extracted data and assessed risk of bias. Studies reporting continuous outcomes were pooled and the standardised mean difference (SMD) with 95% CIs was calculated using a random effects model for difference between true and sham groups. RESULTS 55 studies (3574 patients) were identified meeting inclusion criteria; 39 provided sufficient data for inclusion in the main analysis (2902 patients). The overall SMD of the continuous primary outcome between treatment/sham-control groups was 0.34 (95% CI 0.20 to 0.49; p<0.00001; I(2)=67%). The SMD for surgery versus sham surgery was non-significant for pain-related conditions (n=15, SMD=0.13, p=0.08), marginally significant for studies on weight loss (n=10, SMD=0.52, p=0.05) and significant for gastroesophageal reflux disorder (GERD) studies (n=5, SMD=0.65, p<0.001) and for other conditions (n=8, SMD=0.44, p=0.004). Mean improvement in sham groups relative to active treatment was larger in pain-related conditions (78%) and obesity (71%) than in GERD (57%) and other conditions (57%), and was smaller in classical-surgery trials (21%) than in endoscopic trials (73%) and those using percutaneous procedures (64%). CONCLUSIONS The non-specific effects of surgery and other invasive procedures are generally large. Particularly in the field of pain-related conditions, more evidence from randomised placebo-controlled trials is needed to avoid continuation of ineffective treatments.
Collapse
Affiliation(s)
| | | | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, Maryland, USA
- Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School Boston, Massachusetts, USA
| | | | - Franklin G Miller
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Hamburg, Germany
| | - Klaus Linde
- Institute of General Practice, Technische Universitat Munchen, Munich, Germany
| | - Karin Meissner
- Institute of Medical Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
21
|
Shuang J, Zhang Y, Ma L, Tan X, Huang J, Wang X, Xiong G, Jiang Z, Zhang X, DU S, Gu Y, Shi X, Fan Z. Relief of diabetes by duodenal-jejunal bypass sleeve implantation in the high-fat diet and streptozotocin-induced diabetic rat model is associated with an increase in GLP-1 levels and the number of GLP-1-positive cells. Exp Ther Med 2015; 10:1355-1363. [PMID: 26622491 PMCID: PMC4578072 DOI: 10.3892/etm.2015.2669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 06/29/2015] [Indexed: 12/22/2022] Open
Abstract
A recently invented duodenal-jejunal bypass sleeve (DJBS) implanted in the duodenum and proximal jejunum has exhibited good glycemic control in diabetes mellitus. However, the specific mechanism by which DJBS placement induces the remission of diabetes is not well known. Previous studies have indicated that changes in the pattern of gut hormone secretion may play a role. The aim of the present study was to explore the role of intestinal L cells and the production of glucagon-like peptide-1 (GLP-1) by these cells in DJBS implantation-induced glycemic control in diabetic rats. A DJBS was placed in the proximal small intestine of rats with diabetes induced by a high-fat diet and low-dose streptozotocin (STZ), and the effects of the DJBS on the remission of diabetes and the GLP-1 levels of plasma and intestinal tissues were investigated 12 weeks after DJBS placement. The number of intestinal GLP-1 positive cells was also counted. When the DJBS had been in place for 12 weeks, the plasma glucose level of the DJBS-implanted rats decreased significantly from 23.33±1.56 mmol/l prior to surgery to 7.70±0.84 mmol/l and the diabetes mellitus was relieved completely; however, diabetic control rats and diabetic rats subjected to sham surgery did not show any improvement. Parallel with the remission of diabetes, the plasma and distal ileum GLP-1 levels of rats in the DJBS implantation group were also higher than those of rats in the diabetic control and sham surgery groups. The number of GLP-1-positive cells in the distal ileum was also higher in the DJBS implantation group than in the diabetic control and sham surgery groups (31.0±2.6 vs. 23.5±4.4 vs. 23.0±3.2 respectively; P<0.01). DJBS implantation effectively led to the remission of diabetes in rats with diabetes induced by a high-fat diet and low-dose STZ when implanted for 12 weeks. The remission of diabetes may be associated with the increase in the number of L cells and elevation of GLP-1 levels induced by DJBS implantation.
Collapse
Affiliation(s)
- Jinquan Shuang
- Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China ; Department of Gastroenterology, People's Hospital of Chizhou, Chizhou, Anhui 247100, P.R. China
| | - Ying Zhang
- Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Limei Ma
- Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Xueming Tan
- Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Jing Huang
- Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Xiang Wang
- Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Guanyin Xiong
- Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Zhonghua Jiang
- Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Xiuhua Zhang
- Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| | - Shiqing DU
- Department of Gastroenterology, People's Hospital of Chizhou, Chizhou, Anhui 247100, P.R. China
| | - Yongsong Gu
- Department of Gastroenterology, People's Hospital of Chizhou, Chizhou, Anhui 247100, P.R. China
| | - Xiangyang Shi
- Department of Gastroenterology, People's Hospital of Chizhou, Chizhou, Anhui 247100, P.R. China
| | - Zhining Fan
- Department of Digestive Endoscopy and Medical Center for Digestive Diseases, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210011, P.R. China
| |
Collapse
|
22
|
Hamdi A, Julien C, Brown P, Woods I, Hamdi A, Ortega G, Fullum T, Tran D. Midterm outcomes of revisional surgery for gastric pouch and gastrojejunal anastomotic enlargement in patients with weight regain after gastric bypass for morbid obesity. Obes Surg 2015; 24:1386-90. [PMID: 24634099 DOI: 10.1007/s11695-014-1216-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Reoperative surgery for the morbidly obese has become increasingly common due to postoperative weight regain. There are limited studies evaluating the effectiveness of revisional surgery. This study evaluates the weight loss outcomes of revisional surgery over a 2-year period at our University Hospital, USA. Of the 412 patients who underwent laparoscopic bariatric surgery between June 2009 and June 2011, we identified 25 patients who had Roux-en-Y gastric bypass (RYGB) originally, who underwent laparoscopic revisional surgery for weight regain. Preoperative and postoperative data were reviewed. Statistical analysis was performed using paired t test. This study includes 0 male and 25 female patients with an average age of 42 (range min to max: 28-58), mean original body mass index (BMI) of 54.6 kg/m(2) (r = 37.3-80.7), average lowest BMI achieved of 32.2 (r = 20.1-50.9), and average BMI at the time of revision of 41.0 kg/m(2) (r = 29.5-60.7, standard deviation (SD) = 8.5). All laparoscopic revisions consisted of resizing the gastric pouch by resection and recreating the gastrojejunostomy. Average hospital length of stay was 1.28 days (r = 1-4). Perioperative morbidity was 8 %; one patient developed a trocar site hernia which required repair, and another suffered postoperative bleeding requiring transfusion. There was no mortality. Postoperative BMI averages at 3, 6, 9, 12, and 24 months were 35.0 (SD = 7.15), 34.7 (SD = 4.26), 36.2 (SD = 7.63), 33.0 (SD = 6.58), and 44.2 (SD = 12.87), respectively. Statistically significant weight loss was achieved at 3 [t (10) = 6.74, p < 0.05], 6 [t (7) = 4.69, p < 0.05], 9 [t (9) = 2.94, p < 0.05], and 12 [t (6) = 3.78, p < 0.05] months. However, there was no statistically significant weight loss at 24 months postoperatively [t (4) = -0.16, p > 0.05]. Laparoscopic revisional bariatric surgery can be performed with significant weight loss up to 1 year postoperatively. However, additional studies are required to evaluate longer-term success.
Collapse
|
23
|
Chen SY, Stem M, Schweitzer MA, Magnuson TH, Lidor AO. Assessment of postdischarge complications after bariatric surgery: A National Surgical Quality Improvement Program analysis. Surgery 2015; 158:777-86. [PMID: 26096563 DOI: 10.1016/j.surg.2015.04.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Little is reported about postdischarge complications after bariatric surgery. We sought to identify the rates of postdischarge complications, associated risk factors, and their influence on early hospital readmission. METHODS Using the database of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) (2005-2013), we identified patients ≥18 years of age who underwent a bariatric operation with a primary diagnosis of morbid/severe obesity and a body mass index ≥35. The incidence of postdischarge complication was the primary outcome, and hospital readmission was the secondary outcome. The association between postdischarge complications and various patient factors was explored by the use of multivariable logistic regression. RESULTS A total of 113,898 patients were identified with an overall postdischarge complication rate of 3.2% within 30 days of operation. The rates decreased from 2005 to 2006 (4.6%) to 2013 (3.0%) (P < .001). On average, postdischarge complications occurred 10 days postoperatively, with wound infection (49.4%), reoperation (30.7%), urinary tract infection (16.9%), shock/sepsis (12.4%), and organ space surgical-site infection (11.0%) being the most common. Patients undergoing open gastric bypass had the greatest postdischarge complication rate of 8.5%. Of those patients experiencing postdischarge complications, 51.6% were readmitted. The overall readmission rate was 4.9%. The factors associated most strongly with increased odds of postdischarge complications were body mass index ≥ 50, use of steroids, procedure type, predischarge complication, prolonged duration of stay, and prolonged operative time. CONCLUSION Postdischarge complications after bariatric surgery represent a substantial source of patient morbidity and hospital readmissions. The majority of postdischarge complications are infection-related, including surgical-site infections and catheter-associated urinary tract infections. Adopting and implementing standardized pre- and postoperative strategies to decrease perioperative infection may help to decrease the rate of postdischarge complications and associated readmissions and enhance overall quality of care.
Collapse
Affiliation(s)
- Sophia Y Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Miloslawa Stem
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael A Schweitzer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas H Magnuson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anne O Lidor
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| |
Collapse
|
24
|
Piché MÈ, Auclair A, Harvey J, Marceau S, Poirier P. How to choose and use bariatric surgery in 2015. Can J Cardiol 2014; 31:153-66. [PMID: 25661550 DOI: 10.1016/j.cjca.2014.12.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/03/2014] [Accepted: 12/03/2014] [Indexed: 01/01/2023] Open
Abstract
Severe obesity is associated with increased morbidity and mortality and represents a major health care problem with increasing incidence worldwide. Bariatric surgery, through its efficacy and improved safety, is emerging as an important available treatment for patients with severe obesity. Classically, bariatric surgery has been described as either a restrictive or a hybrid surgery, which is a combination of restriction and malabsorption. For most severely obese patients, bariatric surgery results in the remission of major obesity-related comorbidities including type 2 diabetes mellitus, sleep apnea, hypertension, and dyslipidemia. Thus, bariatric surgery reduces cardiovascular risk burden, and overall mortality risk. Early complications (< 30 days) after bariatric surgery were reported to be < 10% and tend to be lower in restrictive surgeries compared with hybrid surgeries. Most common early complications reported are gastric and anastomosis leak (1.6%-5.1%), bleeding (0.5%-3.5%), and pulmonary embolism (0.2%-1%). Long-term complications (> 30 days) might differ depending on the type of bariatric surgery. According to the type of surgery and the type of study, the 30-day operative mortality rates differ from 0.1% to 1.2%. Studies on postoperative outcomes, investigations on weight loss physiology, and mechanism of action after bariatric surgery provide a better understanding of the bariatric surgery metabolic benefits. In this article, we present an overview of bariatric procedures with their effects, including risks and benefits, on the severely obese patients' health. It provides evidence to support surgical treatment of severe obesity to achieve cardiovascular disease risk reduction in severely obese patients.
Collapse
Affiliation(s)
- Marie-Ève Piché
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Audrey Auclair
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Jany Harvey
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada
| | - Simon Marceau
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Medicine, Laval University, Québec, Québec, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada; Faculty of Pharmacy, Laval University, Québec, Québec, Canada.
| |
Collapse
|
25
|
Abstract
Several techniques for the surgical management of obesity are available to bariatric surgeons. These interventions are performed more frequently with worsening of the obesity epidemic. Radiologists should be familiar with the surgical techniques, normal postoperative appearances, and potential complications for which imaging may be employed to establish a diagnosis to optimize patient care.
Collapse
|
26
|
Sussenbach SP, Silva EN, Pufal MA, Casagrande DS, Padoin AV, Mottin CC. Systematic review of economic evaluation of laparotomy versus laparoscopy for patients submitted to Roux-en-Y gastric bypass. PLoS One 2014; 9:e99976. [PMID: 24945704 PMCID: PMC4063755 DOI: 10.1371/journal.pone.0099976] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/20/2014] [Indexed: 12/13/2022] Open
Abstract
Background Because of the high prevalence of obesity, there is a growing demand for bariatric surgery worldwide. The objective of this systematic review was to analyze the difference in relation to cost-effectiveness of access route by laparoscopy versus laparotomy of Roux en-Y gastric bypass (RYGB). Methods A systematic review was conducted in the electronic databases MEDLINE, Embase, Scopus, Cochrane and Lilacs in order to identify economic evaluation studies that compare the cost-effectiveness of laparoscopic and laparotomic routes in RYGB. Results In a total of 494 articles, only 6 fulfilled the eligibility criteria. All studies were published between 2001 and 2008 in the United States (USA). Three studies fulfilled less than half of the items that evaluated the results quality; two satisfied 5 of the required items, and only 1 study fulfilled 7 of 10 items. The economic evaluation of studies alternated between cost-effectiveness and cost-consequence. Five studies considered the surgery by laparoscopy the dominant strategy, because it showed greater clinical benefit (less probability of post-surgical complications, less hospitalization time) and lower total cost. Conclusion This review indicates that laparoscopy is a safe and well-tolerated technique, despite the costs of surgery being higher when compared with laparotomy. However, the additional costs are compensated by the lower probability of complications after surgery and, consequently, avoiding their costs.
Collapse
Affiliation(s)
- Samanta Pereira Sussenbach
- Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil
- Pós-Graduação em Medicina e Ciências da Saúde da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Milene Amarante Pufal
- Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil
- Pós-Graduação em Medicina e Ciências da Saúde da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Daniela Shan Casagrande
- Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil
- Postgraduate Program in Medical Sciences: Endocrinology and Metabolism, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Port Alegre, Porto Alegre, Brazil
| | - Alexandre Vontobel Padoin
- Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil
- Pós-Graduação em Medicina e Ciências da Saúde da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Cláudio Corá Mottin
- Centro da Obesidade e Síndrome Metabólica do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (COM HSL-PUCRS), Porto Alegre, Brasil
- Pós-Graduação em Medicina e Ciências da Saúde da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
- * E-mail:
| |
Collapse
|
27
|
Block JP, Choudhry NK, Carpenter DP, Fischer MA, Brennan TA, Tong AY, Matlin OS, Shrank WH. Time series analyses of the effect of FDA communications on use of prescription weight loss medications. Obesity (Silver Spring) 2014; 22:943-9. [PMID: 23929685 DOI: 10.1002/oby.20596] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/03/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the impact of FDA safety communications regarding the weight loss medications sibutramine and orlistat. METHODS The 2008 to 2011 pharmacy claims data from CVS Caremark were used to determine the effect of the relevant FDA warnings on (1) use of sibutramine and orlistat, (2) their rates of discontinuation, and (3) substitution to an alternate weight loss medication in the 3-month period following discontinuation. RESULTS The use of sibutramine, orlistat, or phentermine declined from 45 users per 100,000 Caremark enrollees in May 2008 to 24 users per 100,000 enrollees in December 2010. In the time series analyses of overall use of medications, a very small decline in the trend of use of sibutramine after the FDA communication (0.000002% per month decline after the communication; P < 0.001) was found. However, rates of discontinuation of sibutramine and orlistat were similar before and after relevant FDA communications (all P values >0.1 for both level and trend changes post-warning). Patients discontinuing sibutramine post-communication increased use of phentermine at a rate of 0.004% per month after discontinuation (P = 0.01). CONCLUSION From 2008 to 2010, use of prescription weight loss medications was low and declined over time. FDA communications regarding the safety of these medications had limited effect on use.
Collapse
Affiliation(s)
- Jason P Block
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
SUSSENBACH S, SILVA EN, PUFAL MA, ROSSONI C, CASAGRANDE DS, PADOIN AV, MOTTIN CC. Implementing laparoscopy in Brazil's National Public Health System: the bariatric surgeons' point of view. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2014; 27 Suppl 1:39-42. [PMID: 25409964 PMCID: PMC4743517 DOI: 10.1590/s0102-6720201400s100010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/08/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy. AIM 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures. METHODS A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed. RESULTS From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy. CONCLUSION 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy.
Collapse
Affiliation(s)
- Samanta SUSSENBACH
- From the Centro da Obesidade e Síndrome
Metabólica do Hospital São Lucas, Pontifícia Universidade
Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Pós-Graduação em Medicina e
Ciências da Saúde da Pontifícia Universidade Católica do Rio
Grande do Sul, Porto Alegre, RS, Brazil
| | - Everton N SILVA
- Faculdade de Ceilândia da Universidade de
Brasília, Brasília, DF, Brazil
| | - Milene Amarante PUFAL
- From the Centro da Obesidade e Síndrome
Metabólica do Hospital São Lucas, Pontifícia Universidade
Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Pós-Graduação em Medicina e
Ciências da Saúde da Pontifícia Universidade Católica do Rio
Grande do Sul, Porto Alegre, RS, Brazil
| | - Carina ROSSONI
- Pós-Graduação em Medicina e
Ciências da Saúde da Pontifícia Universidade Católica do Rio
Grande do Sul, Porto Alegre, RS, Brazil
- Centro Integrado de Tratamento à Obesidade,
Chapecó, SC, Brazil
| | - Daniela Schaan CASAGRANDE
- From the Centro da Obesidade e Síndrome
Metabólica do Hospital São Lucas, Pontifícia Universidade
Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Alexandre Vontobel PADOIN
- From the Centro da Obesidade e Síndrome
Metabólica do Hospital São Lucas, Pontifícia Universidade
Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Pós-Graduação em Medicina e
Ciências da Saúde da Pontifícia Universidade Católica do Rio
Grande do Sul, Porto Alegre, RS, Brazil
| | - Cláudio Corá MOTTIN
- From the Centro da Obesidade e Síndrome
Metabólica do Hospital São Lucas, Pontifícia Universidade
Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Pós-Graduação em Medicina e
Ciências da Saúde da Pontifícia Universidade Católica do Rio
Grande do Sul, Porto Alegre, RS, Brazil
| |
Collapse
|
30
|
Tur JJ, Escudero AJ, Alos MM, Salinas R, Terés E, Soriano JB, Nicola G, Urgelés JR, Pagán A, Cortes B, González X, Burguera B. One year weight loss in the TRAMOMTANA study. A randomized controlled trial. Clin Endocrinol (Oxf) 2013; 79:791-9. [PMID: 23163735 DOI: 10.1111/cen.12109] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 07/27/2012] [Accepted: 11/14/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Morbid obesity is a major health problem and bariatric surgery is currently the most effective therapy available to induce weight loss in these patients. This report describes 1-year changes in weight and metabolic parameters, in a trial designed to examine the effects of a nonsurgical approach, Intensive Life style Intervention (ILI) on the therapy of morbid obesity. METHODS The primary outcome was change in body weight. Patients were randomized to ILI (n = 60) or conventional obesity therapy (COT) (n = 46). The ILI group received behavioural therapy and nutritional/physical activity counselling. The COT group received the standard medical treatment available for these patients. A third group consisted of the patients already included in our bariatric surgery waiting list (n = 37). FINDINGS We present here 1-year data showing that patients who received ILI with no restrictions in calorie intake had a greater percentage of weight loss than patients receiving COT (-11·58% vs -0·4%; P < 0·001). Importantly, 31·4% of patients included in the ILI group were not morbidly obese after 6 months of intervention. This number increased to 42·8% after 12 months of intervention. INTERPRETATION ILI was associated with significant weight loss compared with COT in a group of morbidly obese patients. The weight loss effect was already obtained after 6 months of ILI intervention. These results seriously question the efficacy of the COT approach to morbid obesity. Furthermore, they underscore the use of ILI programmes in the hospital setting to effectively treat morbidly obese patients and might help to reduce the number of candidate patients for bariatric surgery.
Collapse
Affiliation(s)
- Juan Jesús Tur
- Grupo de Obesidad y Diabetes - Instituto Universitario de Investigación en Ciencias de la Salud de les Illes Balears- (IUNICS), Hospital Universitario Son Espases, Palma de Mallorca, Spain; Unidad de Investigación-CAIBER, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
|
32
|
Kwon S, Wang B, Wong E, Alfonso-Cristancho R, Sullivan SD, Flum DR. The impact of accreditation on safety and cost of bariatric surgery. Surg Obes Relat Dis 2012; 9:617-22. [PMID: 23312757 DOI: 10.1016/j.soard.2012.11.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/23/2012] [Accepted: 11/25/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective of this study was to examine how much of the impact of the Centers for Medicare and Medicaid Services' national coverage decision (NCD) on bariatric surgery was driven by the restriction of reimbursements to Centers of Excellence (COE). We used inpatient care data of those with employer-sponsored insurance plans across United States using the MarketScan Commercial Claims and Encounter Database (2003-2009). METHODS We performed a retrospective cohort study evaluating the impact of the accreditation on subjects with a difference-in-difference approach (removing the temporal changes occurring in non-COEs) on rates of inpatient mortality, 90-day reoperations, complications, readmissions, and total payments. RESULTS A total of 30,755 patients (43.9 ± 11.0 years; 79.9% women) had bariatric surgery. A total of 17,896 patients underwent procedures at sites that became COEs (8455 pre-NCD and 9441 post-NCD, [+10.4%]) compared with 12,859 at non-COEs (6534 pre-NCD and 6325 post-NCD, [-3.3%]). Of the total number of bariatric procedures, laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable band procedures increased from 42.9% and 3.1% pre-NCD to 64.5% and 19.7% post-NCD, respectively. In the COEs, there were reductions in inpatient mortality (.3% to .1%; P = .02), 90-day reoperations (.8% to .5%; P = .006), complications (36.4% to 27.6%; P<.001), and readmissions (10.8% to 8.8%; P<.001) while payments remained similar ($24,543 ± $40,145 to $24,510 ± $37,769; P = .9). After distinguishing from temporal trends and differences occurring at non-COEs, 90-day reoperation (-.8%; P = .02) and complication rates (-2.7%; P = .01) were lower at the COEs after the NCD. CONCLUSIONS The accreditation-based NCD in bariatric surgery was associated with lower rates of reoperations and complications. Such policies may become a powerful tool to improve surgical safety and quality.
Collapse
Affiliation(s)
- Steve Kwon
- Surgical Outcomes Research Center in the Department of Surgery and the Department of Health Services, University of Washington, Seattle, Washington
| | | | | | | | | | | |
Collapse
|
33
|
Modarressi A, Balagué N, Huber O, Chilcott M, Pittet-Cuénod B. Plastic Surgery After Gastric Bypass Improves Long-Term Quality of Life. Obes Surg 2012; 23:24-30. [DOI: 10.1007/s11695-012-0735-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
34
|
Nicklas JM, Huskey KW, Davis RB, Wee CC. Successful weight loss among obese U.S. adults. Am J Prev Med 2012; 42:481-5. [PMID: 22516488 PMCID: PMC3339766 DOI: 10.1016/j.amepre.2012.01.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 12/09/2011] [Accepted: 01/06/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about weight control strategies associated with successful weight loss among obese U.S. adults in the general population. PURPOSE To identify strategies associated with losing at least 5% and 10% of body weight. METHODS Multivariable analysis of data from obese adult (BMI ≥30) participants in the 2001-2006 NHANES to identify strategies associated with losing ≥5% and ≥10% of body weight (conducted in 2009-2011). RESULTS Of 4021 obese adults, 2523 (63%) reported trying to lose weight in the previous year. Among those attempting weight loss, 1026 (40%) lost ≥5% and 510 (20%) lost ≥10% weight. After adjustment for potential confounders, strategies associated with losing ≥5% weight included eating less fat (OR=1.41, 95% CI=1.14, 1.75); exercising more (OR=1.29, 95% CI=1.05, 1.60); and using prescription weight loss medications (OR=1.77, 95% CI=1.00, 3.13). Eating less fat (OR=1.37, 95% CI=1.04, 1.79); exercising more (OR=1.36, 95% CI=1.12, 1.65); and using prescription weight loss medications (OR=2.05, 95% CI=1.09, 3.86) were also associated with losing ≥10% weight, as was joining commercial weight loss programs (OR=1.72, 95% CI=1.00, 2.96). Adults eating diet products were less likely to achieve 10% weight loss (OR=0.48, 95% CI=0.31, 0.72). Liquid diets, nonprescription diet pills, and popular diets had no association with successful weight loss. CONCLUSIONS A substantial proportion of obese U.S. adults who attempted to lose weight reported weight loss, at least in the short term. Obese adults were more likely to report achieving meaningful weight loss if they ate less fat, exercised more, used prescription weight loss medications, or participated in commercial weight loss programs.
Collapse
Affiliation(s)
- Jacinda M Nicklas
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA.
| | | | | | | |
Collapse
|
35
|
Bolen SD, Chang HY, Weiner JP, Richards TM, Shore AD, Goodwin SM, Johns RA, Magnuson TH, Clark JM. Clinical outcomes after bariatric surgery: a five-year matched cohort analysis in seven US states. Obes Surg 2012; 22:749-63. [PMID: 22271357 PMCID: PMC4040221 DOI: 10.1007/s11695-012-0595-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective weight loss treatment, yet few studies have reported on short- and long-term outcomes postsurgery. METHODS Using claims data from seven Blue Cross/Blue Shield health plans serving seven states, we conducted a non-concurrent, matched cohort study. We followed 22,693 persons who underwent bariatric surgery during 2003-2007 and were enrolled at least 6 months before and after surgery. Using logistic regression, we compared serious and less serious adverse clinical outcomes, hospitalizations, planned procedures, and obesity-related co-morbidities between groups for up to 5 years. RESULTS Relative to controls, surgery patients were more likely to experience a serious [odds ratio (OR) 1.9; 95% confidence interval (CI) 1.8-2.0] or less serious (OR 2.5, CI 2.4-2.7) adverse clinical outcome or hospitalization (OR 1.3, CI 1.3-1.4) at 1 year postsurgery. The risk remained elevated until 4 years postsurgery for serious events and 5 years for less serious outcomes and hospitalizations. Some complication rates were lower for patients undergoing laparoscopic surgery. Planned procedures, such as skin reduction, peaked in postsurgery year 2 but remained elevated through year 5. Surgery patients had a 55% decreased risk of obesity-related co-morbidities, such as type 2 diabetes, in the first year postsurgery, which remained low throughout the study (year 5: OR 0.4, CI 0.4-0.5). CONCLUSIONS While bariatric surgery is associated with a higher risk of adverse clinical outcomes compared to controls, it also substantially decreased obesity-related co-morbidities during the 5-year follow-up.
Collapse
Affiliation(s)
- Shari Danielle Bolen
- Center for Health Care Research and Policy, Department of Medicine, MetroHealth Medical Center/Case Western Reserve University, 2500 MetroHealth Drive, Rammelkamp building R234A, Cleveland, OH 44109, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome. Int J Obes (Lond) 2012; 36:1380-7. [PMID: 22508337 DOI: 10.1038/ijo.2012.60] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Pre-bariatric surgery requirements vary between surgeons and surgical centers, with standards of practice not yet established. The goal of this systematic review was to summarize and evaluate the available literature on pre-bariatric surgery weight loss requirements and the relation between preoperative weight loss and postoperative outcome. Major databases, including Medline, PubMed and PsychINFO were searched for relevant articles. Case studies, studies>20 years old and studies that utilized self-reported body weight data were excluded. Data on the effect of the following was summarized: (1) preoperative requirements on preoperative weight loss; (2) insurance-mandated preoperative requirements; (3) the contingency of receipt of surgery; (4) preoperative weight loss on postoperative weight loss and (5) preoperative weight loss on perioperative and postoperative complication and comorbidity rates. The majority of studies suggest that: (1) current preoperative requirements held by the majority of third party payer organizations in the United States are ineffective in fostering preoperative weight loss; (2) making receipt of surgery contingent upon achieving preoperative weight loss, and meal-replacement diets, may be particularly effective in fostering preoperative weight loss and (3) preoperative weight loss may lead to improvements in at least some relevant postoperative outcomes. However, a preoperative weight loss mandate may lead to the denial of surgery and subsequent health benefits to individuals who are unable to achieve a prespecified amount of weight. Overall, the limited number and quality of prospective studies in this area prohibits the much-needed establishment of standards of practice for pre-bariatric requirements.
Collapse
|
37
|
Abstract
STUDY DESIGN Retrospective analysis of a population-based insurance claims data set. OBJECTIVE To determine the risk of repeat fusion and total costs associated with bone morphogenetic protein (BMP) use in single-level lumbar fusion for degenerative spinal disease. SUMMARY OF BACKGROUND DATA The use of BMP has been proposed to reduce overall costs of spinal fusion through prevention of repeat fusion procedures. Although radiographic fusion rates associated with BMP use have been examined in clinical trials, few data exist regarding outcomes associated with BMP use in the general population. METHODS Using the MarketScan claims data set, 15,862 patients that underwent single-level lumbar fusion from 2003 to 2007 for degenerative disease were identified. Propensity scores were used to match 2372 patients who underwent fusion with BMP to patients who underwent fusion without BMP. Logistic regression models, Kaplan-Meier estimates, and Cox proportional hazards models were used to examine risk of repeat fusion, length of stay, and 30-day readmission by BMP use. Cost comparisons were evaluated with linear regression models using logarithmic transformed data. RESULTS At 1 year from surgery, BMP was associated with a 1.1% absolute decrease in the risk of repeat fusion (2.3% with BMP vs. 3.4% without BMP, P = 0.03) and an odds ratio for repeat fusion of 0.66 (95% confidence interval [CI] = 0.47-0.94) after multivariate adjustment. BMP was also associated with a decreased hazard ratio for long-term repeat fusion (adjusted hazards ratio = 0.74, 95% CI = 0.58-0.93). Cost analysis indicated that BMP was associated with initial increased costs for the surgical procedure (13.9% adjusted increase, 95% CI = 9.9%-17.9%) as well as total 1-year costs (10.1% adjusted increase, 95% CI = 6.2%-14.0%). CONCLUSION At 1 year, BMP use was associated with a decreased risk of repeat fusion but also increased health care costs.
Collapse
|
38
|
Huang CY, Hsu MC, Pan KC, Huang CK, Chi SC. Early Health Status and Health-Related Quality of Life after Laparoscopic Gastric Bypass Surgery in Morbidly Obese Patients. ACTA ACUST UNITED AC 2011. [DOI: 10.1089/bar.2011.9943] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Chiung-Yu Huang
- Department of Nursing, I-Shou University, Jiaosu, Yanchao, Kaohsiung City, Taiwan
| | - Mei-Chi Hsu
- Department of Nursing, I-Shou University, Jiaosu, Yanchao, Kaohsiung City, Taiwan
| | | | | | - Shu-Ching Chi
- E-Da Hospital, Jiaosu, Yanchao, Kaohsiung City, Taiwan
| |
Collapse
|
39
|
Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surg Obes Relat Dis 2011; 7:760-7; discussion 767. [PMID: 21978748 DOI: 10.1016/j.soard.2011.08.011] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 08/06/2011] [Accepted: 08/06/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND The potential benefit of preoperative weight loss in patients undergoing bariatric surgery has led many bariatric surgeons to recommend an aggressive weight reduction regimen to their patients. Some surgeons might withhold bariatric procedures if a certain threshold of preoperative weight loss is not achieved. It is unclear whether this practice has any scientific evidence supporting it. Our study aimed to examine the current evidence surrounding this issue in a systematic review. The setting was a university hospital. METHODS A systematic search of multiple databases, including MEDLINE, Google Scholar, EMBASE, the Cochrane Library, and conference proceedings were reviewed, yielding a final total of 27 studies. Of the 27 studies, 7 were prospective studies (2 randomized controlled trials from the same patient population), 14 were retrospective studies (2 chart reviews from the same patient population), 1 was an editorial, and a number were conference presentations. RESULTS A total of 17 trials, including approximately 4611 patients, deemed preoperative weight loss beneficial, and 10 studies, including 2075 patients, deemed preoperative weight loss to be of no benefit. The operative time was 12.5 minutes shorter for the preoperative weight loss patients undergoing laparoscopic Roux-en-Y gastric bypass. With regard to the effects of preoperative weight loss on postoperative weight loss, 9 studies (39%) reported a positive correlation, and 15 (62.5%) reported no benefit. Nine studies reporting perioperative complications (852 patients) revealed no difference in the complication rates, and 2 studies (1234 patients) suggested a significant decrease was associated with preoperative weight loss. CONCLUSION This systematic review suggests little evidence is available to support or refute the routine use of preoperative weight reduction in bariatric surgery. Clearly, a large-scale, multicenter, randomized, controlled trial with sufficient power is necessary to clarify this significant aspect of preoperative care.
Collapse
|
40
|
Hood MM, Corsica JA, Azarbad L. Do patients seeking laparoscopic adjustable gastric banding surgery differ from those seeking gastric bypass surgery? A comparison of psychological profiles across ethnic groups. Obes Surg 2011; 21:440-7. [PMID: 20582637 DOI: 10.1007/s11695-010-0222-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Understanding presurgical psychological functioning is important in determining whether patients may benefit from psychological support before or after undergoing bariatric surgery. However, few studies have directly explored whether presurgical psychosocial profiles differ for patients presenting for different bariatric surgeries and what, if any, impact ethnic background might have. The present study compared presurgical depressive symptomatology, binge eating symptoms, and psychopathology in Caucasian and African American laparoscopic adjustable gastric banding (LAGB) and gastric bypass (RYGB) patients. METHODS Patients (n=272) presenting for either LAGB or RYGB surgery completed self-report measures of depressive symptomatology (BDI), binge eating symptoms (BES), and psychopathology/personality (PAI) as part of the presurgical psychological evaluation. RESULTS RYGB patients endorsed more depressive symptomatology, binge eating symptoms, somatic complaints, and antisocial features than LAGB patients, though higher BMI in the RYGB patients accounted for differences in binge eating symptoms. When the sample was examined by ethnic group, LAGB-RYGB differences were found only in African American, and not Caucasian, patients. CONCLUSIONS Psychosocial profiles appear to differ for African American patients presenting for LAGB and RYGB surgeries; however, some of these differences are accounted for by differences in presurgical BMI. Gaining a better understanding of the initial psychological characteristics of bariatric surgery candidates may improve clinicians' abilities to identify and address specific areas of concern for these patients.
Collapse
Affiliation(s)
- Megan M Hood
- Department of Behavioral Sciences, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
| | | | | |
Collapse
|
41
|
De Salvo G, Maguire JI, Lotery AJ. Vitamin A deficiency-related retinopathy after bariatric surgery. Graefes Arch Clin Exp Ophthalmol 2011; 250:941-3. [DOI: 10.1007/s00417-011-1715-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022] Open
|
42
|
Chang SH, Stoll CRT, Colditz GA. Cost-effectiveness of bariatric surgery: should it be universally available? Maturitas 2011; 69:230-8. [PMID: 21570782 DOI: 10.1016/j.maturitas.2011.04.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 04/15/2011] [Indexed: 12/15/2022]
Abstract
This paper is the first to conduct cost-effectiveness analyses of bariatric surgery comparing obese patients with obesity-related diseases to obese people without comorbidities across different BMI categories, using the meta-analysis results of surgery outcomes for our effectiveness inputs. We find that surgery treatment is in general cost-effective for people whose BMI is greater than 35 kg/m(2) with or without obesity-related comorbidities, and it is even cost-saving for super obese (BMI ≥ 50 kg/m(2)) with obesity-related comorbidities. Our results also suggest that surgery can be cost-effective for the mildly obese (BMI ≥ 30 kg/m(2)). The bottom line is that bariatric surgery should be universally available to all classes of obese people.
Collapse
Affiliation(s)
- Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | | | | |
Collapse
|
43
|
Financial implications of coverage for laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2011; 7:295-303. [DOI: 10.1016/j.soard.2010.10.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 10/06/2010] [Accepted: 10/06/2010] [Indexed: 02/07/2023]
|
44
|
Hoerger TJ, Zhang P, Segel JE, Kahn HS, Barker LE, Couper S. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care 2010; 33:1933-9. [PMID: 20805271 PMCID: PMC2928336 DOI: 10.2337/dc10-0554] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze the cost-effectiveness of bariatric surgery in severely obese (BMI >or=35 kg/m(2)) adults who have diabetes, using a validated diabetes cost-effectiveness model. RESEARCH DESIGN AND METHODS We expanded the Centers for Disease Control and Prevention-RTI Diabetes Cost-Effectiveness Model to incorporate bariatric surgery. In this simulation model, bariatric surgery may lead to diabetes remission and reductions in other risk factors, which then lead to fewer diabetes complications and increased quality of life (QoL). Surgery is also associated with perioperative mortality and subsequent complications, and patients in remission may relapse to diabetes. We separately estimate the costs, quality-adjusted life-years (QALYs), and cost-effectiveness of gastric bypass surgery relative to usual diabetes care and of gastric banding surgery relative to usual diabetes care. We examine the cost-effectiveness of each type of surgery for severely obese individuals who are newly diagnosed with diabetes and for severely obese individuals with established diabetes. RESULTS In all analyses, bariatric surgery increased QALYs and increased costs. Bypass surgery had cost-effectiveness ratios of $7,000/QALY and $12,000/QALY for severely obese patients with newly diagnosed and established diabetes, respectively. Banding surgery had cost-effectiveness ratios of $11,000/QALY and $13,000/QALY for the respective groups. In sensitivity analyses, the cost-effectiveness ratios were most affected by assumptions about the direct gain in QoL from BMI loss following surgery. CONCLUSIONS Our analysis indicates that gastric bypass and gastric banding are cost-effective methods of reducing mortality and diabetes complications in severely obese adults with diabetes.
Collapse
Affiliation(s)
- Thomas J Hoerger
- RTI-UNC Center of Excellence in Health Promotion Economics, RTI International, Research Triangle Park, North Carolina, USA.
| | | | | | | | | | | |
Collapse
|
45
|
Laiteerapong N, Huang ES. The public health implications of the cost-effectiveness of bariatric surgery for diabetes. Diabetes Care 2010; 33:2126-8. [PMID: 20805285 PMCID: PMC2928378 DOI: 10.2337/dc10-1255] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Neda Laiteerapong
- From the Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Elbert S. Huang
- From the Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| |
Collapse
|
46
|
Lee JS, Sheer JLO, Lopez N, Rosenbaum S. Coverage of obesity treatment: a state-by-state analysis of Medicaid and state insurance laws. Public Health Rep 2010; 125:596-604. [PMID: 20597460 DOI: 10.1177/003335491012500415] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES We determined whether state Medicaid programs cover recommended treatments for adult and pediatric obesity and to what extent states regulate the treatment and coverage of obesity by private insurers. METHODS We conducted a state-by-state document review of Medicaid manuals and private insurance laws and regulations. RESULTS Eight state Medicaid programs appear to cover all recommended obesity treatment modalities for adults. Only 10 states appear to reimburse for obesity-related treatment in children. In the small-group insurance market, 35 states expressly allow obesity to be used for rate adjustments, while 10 states do so in the individual market. Two states expressly allow obesity to be used in eligibility decisions in the individual market. Five states provide for coverage of one or more treatments for obesity in both small-group and individual markets. CONCLUSIONS Very few states ensure coverage of recommended treatments for adult and pediatric obesity through Medicaid or private insurance. Most states allow obesity to be used to adjust rates in the small-group and individual markets and to deny coverage in the individual market.
Collapse
Affiliation(s)
- Jennifer S Lee
- Department of Emergency Medicine, The George Washington University, Washington, DC 20037, USA.
| | | | | | | |
Collapse
|
47
|
Utilization Rate of Bariatric Surgery in an Employee-Based Healthcare System Following Surgery Coverage. Obes Surg 2010; 20:1575-8. [DOI: 10.1007/s11695-010-0193-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
48
|
Estimating the costs of medicalization. Soc Sci Med 2010; 70:1943-1947. [DOI: 10.1016/j.socscimed.2010.02.019] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 02/11/2010] [Accepted: 02/15/2010] [Indexed: 11/20/2022]
|
49
|
Bolen SD, Clark JM, Richards TM, Shore AD, Goodwin SM, Weiner JP. Trends in and patterns of obesity reduction medication use in an insured cohort. Obesity (Silver Spring) 2010; 18:206-9. [PMID: 19498347 DOI: 10.1038/oby.2009.175] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Several prescription medications are approved to treat obesity, yet little is known about their use in the United States. Our objective was to describe recent trends and patterns of obesity reduction medication use in an insured US population. From among ~4.2 million persons enrolled in two Blue Cross and Blue Shield plans, we obtained all medical and pharmacy claims for 86,804 persons who took an obesity reduction medication anytime during 2002-2005. Overall, obesity reduction medication use decreased significantly over time from 1% in 2002 to 0.7% in 2005 (P for trend <0.001), which was most notable for the newer medications (orlistat and sibutramine). Few (range: 11-18%) used these medications longer than 3 months regardless of whether they were Federal Drug Administration (FDA)-approved for long-term use or not. More than half (57%) of obesity reduction medication users also took narcotics and 38% took antidepressants. Few sympathomimetic users had potential serious contraindications prior to medication initiation, including cardiovascular diseases (2.4%), schizophrenia (2.5%), and age >65 (1.2%). Despite the high prevalence of obesity, obesity reduction medication use was low and decreased significantly from 2002 through 2005. Prescribers of these agents should be aware of approved durations, potential contraindications, and consider screening for depression and substance abuse.
Collapse
Affiliation(s)
- Shari D Bolen
- Center for Health Care Research and Policy, MetroHealth/Case Western Reserve University, Cleveland, Ohio, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Hwang KO, Childs JH, Goodrick GK, Aboughali WA, Thomas EJ, Johnson CW, Yu SC, Bernstam EV. Explanations for unsuccessful weight loss among bariatric surgery candidates. Obes Surg 2009; 19:1377-83. [PMID: 18542846 PMCID: PMC3063089 DOI: 10.1007/s11695-008-9573-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 05/13/2008] [Indexed: 01/22/2023]
Abstract
BACKGROUND Our objective was to analyze subjective explanations for unsuccessful weight loss among bariatric surgery candidates. METHODS This was a retrospective analysis of 909 bariatric surgery candidates (78.2% female, average body mass index [BMI] 47.3) at a university center from 2001 to April 2007 who answered an open-ended question about why they were unable to lose weight. We generated a coding scheme for answers to the question and established inter-rater reliability of the coding process. Associations with demographic parameters and initial BMI were tested. RESULTS The most common categories of answers were nonspecific explanations related to diet (25.3%), physical activity (21.0%), or motivation (19.7%), followed by diet-related motivation (12.7%) and medical conditions or medications affecting physical activity (12.7%). Categories related to time, financial cost, social support, physical environment, and knowledge occurred in less than 4% each. Men were more likely than women to cite a medical condition or medication affecting physical activity (19.2% vs 10.8%, P = 0.002, odds ratio [OR] = 1.96, 95% confidence interval [CI] = 1.28-2.99) but less likely to cite diet-related motivation (7.1% vs 14.2%, P = 0.008, OR = 0.46, 95% CI = 0.26-0.82). CONCLUSIONS Our findings suggest that addressing diet, physical activity, and motivation in a comprehensive approach would meet the stated needs of obese patients. Raising patient awareness of under-recognized barriers to weight loss, such as the physical environment and lack of social support, should also be considered. Lastly, anticipating gender-specific attributions may facilitate tailoring of interventions.
Collapse
Affiliation(s)
- Kevin O Hwang
- Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, USA.
| | | | | | | | | | | | | | | |
Collapse
|