Evaluation of quality of life, weight loss and evolution of comorbidities at 6 years after bariatric surgery

INTRODUCTION

Morbid obesity is a disease with multiple comorbidities and considerably limits the quality of life and life expectancy. Bariatric surgery is an effective therapeutic alternative in these patients; it acts on the decrease and / or absorption of nutrients, achieving a significant weight loss which is maintained over time. The objective of the study is to determine the long-term results, in terms of efficacy, regarding weight loss, the resolution of comorbidities and improvement in the quality of life of our patients.

MATERIAL AND METHODS

This was a retrospective study that comprised all patients consecutively undergoing laparoscopic bariatric surgery at our center over a 10 year period. In all patients, the anthropometric and clinical data were collected prior to surgery and in subsequent protocolized visits after surgery. At the end of the follow-up, a BAROS questionnaire was used that recorded weight loss, the resolution of comorbidities, complications and the quality of life test completed by the patients.

RESULTS

353 patients (303 GBPRY and 50 GV), 105 men and 248 women, with a mean age of 42.14 ± 10.16 years, BMI 48.63 kg / m2 and 68.5% had some comorbidity. The mean follow-up was 5.7 ± 2.6 years for 96.7% of the total number operated on. At the end of the follow-up the %EWL was 59.00 ± 19.50, %EBMIL 68.15 ± 22.94, the final BMI 32.65 ± 5.98 and 31.3% of the patients had %EWL ≤ 50. The resolution of comorbidities was as follows: 48.7% hypertension, 70.3% Type 2 Diabetes, 82.6% DLP and 71.6% SAHS. The result of the quality of life test was 1.51 ± 0.93, with 67.2% of patients reporting good or very good quality, with the highest score being for self-esteem, followed by physical condition, work and social activity, and the lowest being for sexual quality of life in that only 40.3% reported an improvement. The BAROS score was 4.35 ± 2.06 with 84.7% of the patients in the good to excellent range, while 91.2% of all patients would undergo surgery again.

CONCLUSIONS

Bariatric surgery is an effective technique for reducing weight, resolving comorbidities and improving the quality of life of patients with morbid obesity, mainly in its physical aspect. In our series, the percentage of follow-up and average time was within the range of established quality standards.

Enhanced recovery after bariatric surgery: Implementation of program and clinical outcomes from a bariatric surgery and metabolic diseases reference center

Background

Enhanced recovery after bariatric surgery (ERABS) protocols involve a series of multimodal perioperative procedures based on evidence designed to reduce physiological stress, improve recovery, and reduce costs on medical attention by decreasing length of hospital stay (length of stay [LOS]).

Objective

The objective of the study was to report the viability and results of the ERABS application in a reference bariatric center.

Materials and methods

A prospective, observational, and descriptive study on bariatric procedures conducted over 12 months in the ERABS context which includes pre-procedure, intraprocedure, and post-procedure measures. The collected data include demographic data, comorbidity, morbimortality, LOS, and readmission to hospital.

Results

Sixty-four patients within a median of 38.8 ± 9.5 years and 44.1 ± 6.20 kg/m² BMI underwent surgery. Fifty-five (85.93%) were Roux-en-Y gastric bypass (RYGB) cases and 9 (14.06%) were sleeve gastrectomy (SG). Related comorbidities were hypertension 37%, diabetes 34%, dyslipidemia 23%, and obstructive sleep apnea 21%. Two (3.12%) patients developed post-operative morbidity (respiratory and thromboembolic complications). LOS for RYGB was 1.16 ± 0.97 and 1 ± 0 days for SG. The successful discharge rate on the 1^st day after procedure was 96% and 100%, respectively. Readmission to hospital within a 30-day period presented itself on 4 patients (6.25%).

Conclusion

Applying ERABS protocols is feasible, safe, morbidity low, LOS acceptable, and a low readmission rate within 30 days.