Ocular complications in a patient with history of bariatric surgery

Pregnancy after bariatric surgery in women with rheumatic diseases and association with adverse birth outcomes.

Effective colon cancer screening requires adequate bowel preparation. Anecdotal evidence has suggested that patients with a history of bariatric surgery are more likely to have inadequate preparation. This study aims to evaluate the role of bariatric surgery as a predictive risk factor for inadequate bowel preparation. Data were collected retrospectively for consecutive colonoscopies between March 1, 2013, and November 15, 2017. Only the index colonoscopy for each patient within the review period, and those scored using the Boston Bowel Preparation Scale (BBPS) were included. Inadequate preparation was defined as any one or more colon segments with a BBPS score of less than two, and patients with a history of bariatric surgery were identified using ICD 9/10 codes. Multivariate logistic regression and propensity score matching was used to assess for independent factors predictive of inadequate bowel preparation. A total of 25,318 colonoscopies were included in the analysis. Two hundred 278 (1.1%) patients had a history of bariatric surgery, among which 171 (61.5%) had a history of bypass surgery and 107 (38.5%) had a history of restrictive surgical procedure. A history of bariatric surgery was predictive of inadequate bowel preparation in both univariate (OR: 2.87, 95% CI: 1.92-4.29, P = 0.0003) and multivariate analysis (OR: 2.16, 95% CI: 1.43-3.27, P = 0.0003) after controlling for differences in baseline characteristics. When evaluated separately, a history of bypass surgery was associated with inadequate bowel preparation (aOR: 2.96, 95% CI: 1.86-4.72, P < 0.0001), whereas a history of a restrictive bariatric surgery was not associated with inadequate bowel preparation in multivariate analysis (aOR: 0.98, 95% CI: 0.4-2.45, P = 0.971). A history of bariatric surgery is an independent risk factor for inadequate bowel preparation. Furthermore, bypass bariatric surgeries had higher rates of inadequate preparation when compared to restrictive bariatric surgeries. Further quality improvement initiatives should be directed at identifying the appropriate bowel preparation regimen in this population.

Objective To compare perinatal outcomes in births of women with versus without a history of bariatric surgery.Design Population based matched cohort study.Setting Swedish national health service.Participants 1 742 702 singleton...

Bariatric surgery decreases the risk of uterine malignancy

The Effect of Bariatric Surgery on Perioperative Complications after Hysterectomy

Non-variceal upper gastrointestinal bleeding (NVUGIB) is a common cause of hospitalization and associated morbidity and mortality. Bariatric surgery is a widely performed category of gastrointestinal (GI) surgery that attempts to induce weight loss by reconstructing the upper GI tract. Bleeding is a common complication of bariatric surgery; however, limited research exists on outcomes for these patients when admitted for NVUGIB compared to those without a history of bariatric surgery. Our study aims to evaluate the outcomes of post-bariatric surgery patients (PBSPs) admitted with NVUGIB over a 13-year span. The National Inpatient Sample (NIS) from 2008 to 2020 was used to identify patients over 18 years old admitted for NVUGIB using the International Classification of Disease (ICD), 9th revision (ICD-9) and 10th revision (ICD-10) codes. Records were weighted using the algorithms provided by the NIS. Primary outcomes of interest were all-cause hospital mortality, shock, acute myocardial infarction (AMI), acute kidney injury (AKI), and a composite of these. Groups were defined based on the history of bariatric surgery, and demographics and incidence of comorbidities were compared. Outcomes were compared between the two groups, and odds ratios (ORs) were calculated using two-stage weighted logistic regression. ORs were adjusted for common co-founders such as age, gender, race, Charlson comorbidity index (CCI), region, hospital size, hospital teaching status, elective vs. emergency admission, and income quartile. A total of 2,231,826 patients admitted for NVUGIB were included in this study. Of these, 28,167 had a history of bariatric surgery. Overall, bariatric surgery patients were younger, less complicated (CCI: 2.71 vs. 4.76), had a shorter length of stay (LOS), and were less likely to be on Medicare/Medicaid than those without a history of bariatric surgery (P<0.05). Several comorbidities were more common in patients without a history of bariatric surgery, including coronary artery disease, hyperlipidemia (HLD), congestive heart failure (CHF), type 2 diabetes mellitus (T2DM), end-stage renal disease (ESRD), and liver cirrhosis (P<0.05). Other comorbidities were more common in the post-bariatric surgery group, including gastroesophageal reflux disease and anemia (P<0.05). We found that patients admitted for NVUGIB with a history of bariatric surgery had significantly lower odds of all outcomes, including all-cause mortality (OR =0.48; P<0.001), AKI (OR =0.71; P<0.001), AMI (OR =0.62; P<0.05), shock (OR =0.88; P<0.05), and a composite of these four (OR =0.77; P<0.001). Our study found that patients with NVUGIB and a history of bariatric surgery had substantially decreased odds of mortality, AMI, shock, and AKI compared to patients without a history of bariatric surgery. This suggests that patients with a history of bariatric surgery experienced more minor bleeds than other patients. Further studies are therefore warranted to understand the postoperative risk of bariatric surgery.

Case series suggest a possible association between bariatric surgery and incident IBD. The aim of this study was to evaluate the association between bariatric surgery and new-onset IBD. We first conducted a multi-institutional case series of patients with a history of IBD and bariatric surgery. We next conducted a matched case-control study using medical and pharmacy claims from 2008 to 2012 in a US national database from Source Healthcare Analytics LLC. Bariatric surgery was defined by ICD-9 or CPT code. Bariatric surgery was evaluated as recent (code in database timeframe), past (past history V code) or no history. Conditional logistic regression was used to estimate odds ratios (OR) and 95% CI for new-onset IBD, CD and UC. A total of 15 cases of IBD (10 CD, 4 UC, 1 IBD, type unclassified) with a prior history of bariatric surgery were identified. Most cases were women, had Roux-en-Y surgery years prior to diagnosis and few IBD-related complications. A total of 8980 cases and 43059 controls were included in our database analysis. Adjusting for confounders, a past history of bariatric surgery was associated with an increased risk of new-onset IBD (OR 1.93, 95% CI 1.34-2.79). However, patients who had recent bariatric surgery did not appear to be at shorter term risk of IBD (OR 0.94, 95% CI 0.58-1.52). New-onset IBD was significantly associated with a past history of bariatric surgery. This potential association needs to be confirmed in future prospective studies.

To assess the potential protective effect of bariatric surgery on mortality after myocardial infarction (MI) or cerebrovascular accident (CVA). Using the National Inpatient Sample (2007-2014), 2218 patients with a principal discharge diagnosis of acute MI and 2168 patients with ischaemic CVA who also had history of prior bariatric surgery were identified. Utilizing propensity scores, these patients were matched 1:5 with patients who had similar principal diagnoses but no history of bariatric surgery (controls). Control group-1 included participants with obesity (BMI ≥ 35 kg/m2 ) only and participants in control group-2 were matched according to post-surgery BMI with the bariatric surgery group. The primary and secondary endpoints were in-hospital all-cause mortality and length of hospital stay, respectively. Outcomes after MI and CVA were separately compared among groups in multivariate regression models. A total of 48 300 (weighted) participants were included in the analysis. The distribution of covariates was well balanced after propensity matching. Mortality rates after MI were significantly lower in patients with a history of bariatric surgery compared with control group-1 (1.85% vs 3.03%; odds ratio (OR), 0.61; 95% confidence interval (CI), 0.44-0.86; P = 0.004) and with control group-2 (2.00% vs 3.26%; OR, 0.62; 95% CI, 0.44-0.88; P = 0.008). Similarly, in-hospital mortality rates after CVA were significantly lower in patients with a history of bariatric surgery compared with control group-1 (1.43% vs 2.74%; OR, 0.54; 95% CI, 0.37-0.79; P = 0.001) and with control group-2 (1.54% vs 2.59%; OR, 0.61; 95% CI, 0.41-0.91; P = 0.015). Furthermore, length of stay was significantly shorter in the bariatric surgery group for all comparisons (P < 0.001). Prior bariatric surgery is associated with significant protective effect on survival after MI and CVA.

Introduction: Previous data has pointed towards worse outcomes with COVID-19 disease in the presence of obesity. Through sustained weight loss and improvement in metabolic co-morbids, a history of bariatric surgery may be hypothesized to reduce the risk of severe COVID-19 disease. However, the outcomes of COVID-19 disease in patients with obesity have not been explored. Methods: We conducted a retrospective cohort study on the multi-institutional research network TriNETX. Patients with COVID-19 were identified and divided into cohorts based on history of bariatric surgery (BS cohort and non-BS cohort). Clinical outcomes were compared in unmatched and propensity score matched analyses with patients matched 1:1 based on known risk factors of severe COVID-19 disease. Patients with no history of bariatric surgery but with clinical attributes qualifying for these procedures were identified and included in a ‘bariatric procedure qualifying’ group for sensitivity analysis. Results: Unmatched analysis revealed lower risk of mechanical ventilation or mortality at 30 days after COVID-19 diagnosis in the BS cohort compared to the non-BS cohort (1.07% vs 2.58%, Risk Ratio 0.41, 95% CI: 0.26 – 0.65). Lower risk of need for mechanical ventilation and lower mortality was noted in the bariatric surgery cohort. In the propensity score matched analysis, there was lower risk of reaching primary endpoint of mechanical ventilation or mortality in the BS cohort compared to the non-BS cohort (1.07% vs 3.09%, RR 0.35, 95% CI: 0.21 – 0.58). Mortality rate was lower in the BS cohort, and patients in the BS group were less likely to require critical care, mechanical ventilation, or develop acute kidney injury after COVID-19 diagnosis Log Rank tests revealed worse survival in both matched and unmatched analysis in the non-BS cohort when compared to the BS group (Log rank p values < 0.01 for all analyses). Subgroup analysis was performed comparing the RYGB and sleeve gastrectomy subgroups. No difference was noted in any clinical outcome on unmatched or matched analysis. On sensitivity analysis comparing BS group with BS qualifying cohort, lower rate of mortality, mechanical ventilation, need for critical care was noted in BS cohort (Table 1). Conclusion: In CONCLUSION:, our propensity matched analysis of a large cohort, we have found that a history of bariatric surgery is associated with a reduced risk of poor outcomes of COVID-19 disease compared to a cohort of obese patients as well as the general population.Figure 1.: (a-d) showing Kaplan Maier curves for Mortality (a and b) and compositive outcome (c and d) before (a and c) and after (b and d) propensity score matching for the bariatric surgery (purple) and the non-bariatric surgery (blue) cohorts.Table 1.: Outcomes in the two cohorts of COVID-19 patients with history of bariatric surgery and without bariatric surgery before and after propensity score matching.

Introduction: Effective colon cancer screening requires adequate bowel preparation. In the setting of prior bariatric surgery, low-volume preparations or extended time delivery for high-volume preparations is recommended, although this recommendation is based on weak evidence. This study aims to evaluate bariatric surgery as a predictive risk factor for inadequate bowel preparation. Methods: Data were collected retrospectively for consecutive colonoscopies between March 1, 2013 and November 15, 2017. Only the index colonoscopy for each patient within the review period, and those scored using the Boston Bowel Preparation Scale (BBPS) were included. Incomplete data sets and patients with inflammatory bowel disease (IBD) were excluded. Inadequate preparation was defined as any one or more colon segments with a BBPS score of less than two. Patients with bariatric surgery occurring before the date of the colonoscopy were identified using ICD 9/10 codes. Data were analyzed using Wilcoxon rank-sum test for continuous variables and Fischer’s exact test for dichotomous variables. Multivariate logistic regression was performed to identify independent factors predictive of inadequate bowel preparation. Results: 70,714 colonoscopies occurred within the designated review period. 58,853 were excluded from analysis as shown in Figure 1. Of the remaining 11,861 colonoscopies, 363 (3.1%) had inadequate preparation. Factors associated with inadequate preparation on univariate analysis included: age, male sex, non-white race, body mass index (BMI), hypertension (HTN), diabetes mellitus (DM), and history of bariatric surgery (Table 1). After controlling for confounding risk factors, a history of bariatric surgery (OR = 2.98; 95% CI: 1.93-4.61) was found to be predictive of inadequate preparation (Table 1). In a subanalysis of malabsorptive vs. restrictive bariatric surgery patients, malabsorptive bariatric surgery was associated with a higher rate of inadequate preparation (12.79% vs. 4.58%, P = 0.023).515_A Figure 1 No Caption available.Conclusion: A history of bariatric surgery is an independent risk factor for inadequate bowel preparation. Furthermore, malabsorptive bariatric surgeries had higher rates of inadequate preparation when compared to restrictive bariatric surgeries. Further quality improvement initiatives should be directed at identifying the appropriate bowel preparation regimen in this population.515_B Figure 2. Risk factors for Inadequate Bowel Preparation.

Hypocalcemia following thyroidectomy is a common and potentially life-threatening complication. It is caused by intraoperative injury to the parathyroid glands or their blood supply. Although several studies have shown that patients with a prior history of bariatric surgery may be at an increased risk for hypocalcemia after thyroidectomy, no clear recommendations exist for preventing and managing this condition in this population. This paper highlights the significance of understanding this risk and of obtaining a history of prior bariatric surgery before thyroidectomy. We propose concise recommendations for preventing and managing hypocalcemia following thyroidectomy in patients with a history of bariatric surgery.

Hypocalcaemia is a common complication after thyroidectomy. Bariatric surgery is associated with significant changes in calcium metabolism. Some studies have identified bariatric surgery as a risk factor for hypocalcaemia after thyroidectomy. This systematic review and meta-analysis assessed whether a history of bariatric surgery was associated with an increased risk of hypocalcaemia after thyroidectomy. This prospectively registered systematic review (PROSPERO; CRD42021295423) was performed in accordance with PRISMA guidelines. Meta-analysis was undertaken using the Mantel-Haenszel method, with outcomes reported as ORs with 95 per cent confidence intervals. Twenty studies were included in the qualitative synthesis. Five studies incorporating 19 547 patients met the inclusion criteria for meta-analysis, of whom 196 (1.0 per cent) had a history of bariatric surgery. Patients with a history of bariatric surgery were more likely to develop hypocalcaemia after thyroidectomy (30.6 versus 13.0 per cent; OR 3.90, 95 per cent c.i. 1.50 to 10.12; P = 0.005). Among those with a history of bariatric surgery, patients who underwent a bypass procedure were more likely to develop hypocalcaemia after thyroidectomy than those who had a restrictive procedure (38 versus 23 per cent; OR 2.12, 1.14 to 3.97; P = 0.020). Patients with a history of bariatric surgery have a significantly greater risk of hypocalcaemia after thyroidectomy, with a heightened risk among those who have had a bypass procedure. Surgeons performing thyroid surgery should be aware of the increased risk of hypocalcaemia after thyroidectomy among these patients.

Objectives: The objective of this study was to compare failure rates and patient reported outcomes after rotator cuff repair (RCR) between patients with and without a previous history of bariatric surgery (BS). Our hypothesis was that patients with a history of BS would have greater failure rates and inferior outcome measures after RCR. Methods: Patients with a history of BS who underwent arthroscopic RCR for full-thickness tears of the supraspinatus tendon between March 2013 and March 2023 were identified. Phone call surveys were completed to collect postoperative outcome data. These patients were matched in a 1:3 ratio by age, sex, and body mass index (BMI) to patients without a history of BS who underwent RCR. Revision procedures were excluded. The minimum follow-up was 24 months. Primary outcome was surgical failure, defined as symptomatic retear confirmed on magnetic resonance imaging (MRI) and/or need for revision surgery. Secondary outcome assessed included range of motion (ROM) in forward flexion (FF) and external rotation (ER), visual analog scale (VAS) for pain, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons Shoulder Score (ASES), need for manipulation under anesthesia (MUA), and conversion to reverse total shoulder arthroplasty (rTSA). Results: A total of 34 RCR patients with a history of BS (24 female, 10 male; age 56.4 ± 8.5 years; BMI 33.5 ± 7.2) were matched to 102 RCR patients without BS (72 female, 30 male; age 57.0 ± 8.1 years; BMI 32.9 ± 7.0). Average follow-up was significantly different (52.7 months in BS group, 72.3 months without BS group; p = 0.01). The BS group had significantly higher overall failure rates (20.6% vs. 6.9%; p =0.04) than patients without history of BS. The BS group had significantly higher post-operative VAS pain scores (3.9 vs 1.3; p = 0.00), lower SSV (77.7 vs. 87.7, p =0.04), lower ASES (72.6 vs. 90.4, p = 0.00), worse FF ROM (149 vs 159 degrees; p = 0.03), and worse ER ROM (47.9 vs. 52.8, p = 0.02). Need for Revision RCR, MUA, and conversion to rTSA rates did not reach significance. Conclusions: Previous BS resulted in significantly increased surgical failure rates, as well as inferior subjective outcome scores and inferior ROM, after arthroscopic RCR. Prior bariatric surgery or other nutritional deficiencies may represent an under-appreciated, yet modifiable, risk factor for RCR failure. A prior history of bariatric surgery should be noted preoperatively when indicating patients for RCR, and these patients should be counseled regarding the risks for inferior outcomes after surgery. These patients may also benefit from nutritional supplementation or operative biologic adjuvants to improve their healing potential after surgery.

Impact of bariatric surgery on heart failure mortality

Clinical trials comparing direct oral anticoagulants (DOAC) to warfarin excluded patients with a history of bariatric surgery. The anatomic changes from bariatric procedures have several effects on drug absorption which can have serious consequences for these patients. We sought to describe real-world use of DOACs among adults that had a history of bariatric surgery or underwent a bariatric surgery while receiving a DOAC. We conducted a retrospective case series of adult patients, at a large academic medical center, who initiated any DOAC in 2016 thru 2019 and had a history of bariatric surgery or underwent a bariatric surgery while receiving a DOAC. Thrombotic and bleeding events were described using summary statistics and bleeding severity was described using the International Society on Thrombosis and Haemostasis criteria. Twenty-eight patients met the inclusion criteria of having bariatric surgery (Roux-en-Y gastric bypass, sleeve gastrectomy or gastric band) and receiving a DOAC. Twenty (71.4%) were prescribed apixaban and eight (28.6%) were prescribed rivaroxaban. Seven patients (25%) experienced at least one clinically relevant non-major bleeding event, including one patient (3.6%) that had a major bleeding event. Two patients (7.1%) had a thromboembolic event. Coagulation laboratory studies were infrequently performed at the time of the bleeding or clotting events. Among patients with a history of bariatric surgery, use of DOACs were commonly associated with clinically relevant non-major bleeding events and less commonly associated with major bleeding and thromboembolic events. Larger studies may offer further insight into the overall safety and efficacy of DOAC therapy in patients that have undergone bariatric surgery. The specific role of coagulation laboratory studies warrants further evaluation.