Abstract
SummaryAimsEvery year, over 200 000 individuals undergo bariatric surgery for the treatment of extreme obesity in the United States. Several retrospective studies describe the occurrence of orthostatic intolerance (OI) syndrome after bariatric surgery. However, the incidence of this syndrome remains unknown.Materials and methodsWe used a prospective, de‐identified registry of 4547 patients who have undergone bariatric surgery at Vanderbilt to identify cases of new‐onset OI. Structured chart reviews were conducted for all subjects who reported new‐onset OI post surgery. Cases of OI were confirmed using an operational case definition developed by the Vanderbilt Autonomic Dysfunction Center, and autonomic function tests results were examined for evidence of impaired autonomic function. The cumulative incidence of post‐bariatric surgery OI syndrome was estimated using a life table.ResultsSeven hundred forty‐one of 4547 (16.3%) patients included in our cohort reported new OI symptoms after surgery. After the chart review, we confirmed the presence of post–bariatric surgery OI syndrome in 85 patients, 14 with severe OI requiring pressor agents. At 5 years post surgery, follow‐up is reduced to 15%; the unadjusted 5‐year prevalence of OI was 1.9%. The cumulative incidence of OI syndrome adjusted for loss of follow‐up was 4.2%. Most OI cases developed during weight‐stable months (±5 kg). At the time of identification, 13% of OI cases showed evidence of impaired sympathetic vasoconstrictor activity.ConclusionOI is frequent in the bariatric population, affecting 4.2% of patients within the first 5 years postoperatively. In 13% of post–bariatric surgery OI patients, there was evidence of impaired sympathetic vasoconstriction activity.
Highlights
Obesity afflicts over 117 million American adults, and the cost of its care amounts to over $340 billion annually.[1]
Autonomic function test (AFT) data were extracted from the Synthetic Derivative (SD), but such data were only available from patients who had been referred to the Vanderbilt Autonomic Dysfunction Center (VADC)
The AFTs informed about the integrity of autonomic reflex arcs by evaluating blood pressure and heart rate (HR) changes in response to orthostatic stress after a 70° head‐up tilt and Valsalva manoeuvre.[13]
Summary
Obesity afflicts over 117 million American adults, and the cost of its care amounts to over $340 billion annually.[1]. It is estimated that over 200 000 patients in the United States undergo bariatric surgery every year,[4] and it becomes increasingly important to understand the long‐term consequences of this operation. In this context, small case series studies[5-7] have documented the presence of new‐onset orthostatic intolerance (OI) in postoperative bariatric surgery patients. OI is a rare and chronic disabling condition characterized by dizziness, lightheadedness, and syncope on standing that improve after sitting or lying down.[8] This disorder significantly reduces the quality of life,[9] and in severe cases, it requires the use of pressor agents to control the presyncopal symptoms
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