Bariatric Patients Research Articles

Characterization of Pre- and Postpandemic 30-Day Follow-Up After Elective Bariatric Surgery: a Retrospective MBSAQIP Analysis of 834,646 Patients.

Effects of the COVID-19 pandemic on rates of early postoperative follow-up after bariatric surgery are poorly understood. Our study characterizes 30-day follow-up after bariatric surgery prior to COVID-19 (years 2015-2019) and during the pandemic of COVID-19 (year 2020) and evaluates general predictive factors of short-term follow-up. Data was extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015 to 2020. Cohorts were divided into pre-pandemic and pandemic years and patients with and without 30-day follow-up. Multivariable logistic regression analysis was used to identify general factors independently predictive of 30-day follow-up. The primary aim was to evaluate the impact of the COVID-19 pandemic on short-term 30-day follow-up adherence. A secondary outcome was to characterize general short-term postoperative 30-day follow-up associated with elective bariatric surgery and identify independent predictors of 30-day follow-up among bariatric surgery patients using multivariable logistic regression analysis. A total of 834,646 patients were identified. Follow-up rates significantly increased in the COVID era in 2020 (p < 0.0001). Patients who achieved 30-day follow-up were older and had an increased burden of medical comorbidities, including non-insulin and insulin-dependent diabetes mellitus, hypertension, dyslipidemia, as well as increased BMI compared to patients lacking follow-up. The cohort with successful 30-day follow-up was more likely to receive gastric bypass and had increased rates of metabolic comorbidities. After adjusting for comorbidities, the greatest independent predictors of follow-up were the 2020 COVID-19 era year, Asian race, black race, and gastroesophageal reflux disease. After adjusting for comorbidities, the 2020 COVID-19 era year was one of the greatest predictors of follow-up after bariatric surgery. Postoperative follow-up rates after elective bariatric surgery are excellent at > 95% and increased during the 2020 COVID-19 era year. Several independent predictors of follow-up were identified which may help in development of strategies aimed to mitigate lack of postoperative follow-up.

Foregut Malignancy After Metabolic Surgery: a Literature Review.

Obesity is known to be epidemiologically associated with malignancy. Although there is an increasing global number of bariatric surgeries, the relationship between bariatric surgery and esophagogastric cancers is not well understood. Diagnosis of esophagogastric cancers following bariatric surgery is challenging because the presentation tends to be nonspecific and may be perceived as usual postoperative symptoms in bariatric patients. Therefore, the early diagnosis requires a high index of suspicion. In addition, endoscopic investigation of the excluded stomach after a Roux-en-Y gastric bypass or a one-anastomosis gastric bypass is technically challenging, which further complicates the diagnosis. The aim of this study is to review the current evidence in the literature on esophagogastric cancers following bariatric surgery.

Environmental Factors Determining Body Mass Index (BMI) within 9 Months of Therapy Post Bariatric Surgery-Sleeve Gastrectomy (SG).

Treatment of obesity should be multidirectional and include, in addition to bariatric surgery, changing the key factors of lifestyle and eating habits. The study aimed to assess the impact of bariatric surgery and dietary care on anthropometric measurements, blood pressure, changes in lifestyle, and eating habits of patients within 9 months after the procedure, with the selection of environmental factors determining BMI variation. The study included 30 SG patients before surgery (month zero) and at 1, 3, 6, and 9 months after SG. Patients completed a questionnaire regarding age, sex, place of residence, education, professional activity, number of family members, financial situation, family history of obesity, previous forms of therapy, self-assessment of nutritional knowledge, receiving and following nutritional recommendations, eating habits, frequency of body weight control, leisure time. Body weight, height, waist and hip circumference, and systolic and diastolic pressure were measured, and BMI and WHR (Waist to Hip Ratio) were calculated. Within 9 months after the procedure, the patients' body weight and BMI decreased on average by 26%. Post bariatric surgery, patients changed their eating habits. The influence of bariatric SG surgery and time after surgery was decisive for the normalization of BMI and explained the 33% variation in BMI up to 9 months after the procedure. Other factors important for the normalization of BMI after surgery were: male gender, older age of patients, family obesity (non-modifiable factors), as well as previous forms of therapy related to weight loss before surgery, shortening the intervals between meals and stopping eating at night (modifiable factors). The tested model explained 68% of the BMI variation after SG surgery for all assessed factors. Changes in lifestyle and eating habits in bariatric patients are crucial to maintaining the effect of bariatric surgery.

Safety and Efficacy of Revisional Surgery as a Treatment for Malnutrition after Bariatric Surgery.

Malnutrition after bariatric operation is a rare but potentially life-threatening complication. The safety and efficacy of revisional bariatric operation in malnourished patients are not well elucidated. We performed a retrospective chart review of patients who underwent revisional bariatric operation for severe malnutrition at our institution between 2008 and 2020. Associations of demographic and clinical characteristics with dichotomous outcomes of interest were examined using Fisher's exact tests, Cochran-Armitage tests for trend, and two-sample t -tests when appropriate. Fifty-three patients underwent revisional bariatric operation for malnutrition from 2008 and 2020. The median follow-up was 24 months. The anatomy before revision was Roux-en-Y gastric bypass (n = 40, 75%), biliopancreatic diversion with duodenal switch (n = 6, 11%), sleeve gastrectomy (n = 4, 8%), and mini gastric bypass (n = 3, 6%). The percentage of patients requiring supplemental or total nutritional support decreased from 89% preoperatively (47% on enteral feedings and 42% on total parenteral nutrition (TPN) with or without tube feeding) to 13.2% at the last encounter after revision (7.5% still requiring enteral feedings and 5.7% on TPN). There was an association between the number of prior abdominal operations and postoperative pneumonia (p 0.03) and need for blood transfusion (p 0.01). There were no associations between major complications or last encounter nutrition and any preoperative variables other than age at the time of operation. There were 2 mortalities during a median follow-up of 24 months, and both occurred more than 1 year postoperatively. Revisional operation for severely malnourished bariatric operation patients is effective in the discontinuation of supportive nutrition. Postoperative complications are increased but not prohibitive.

Analysis of Body Contouring and Sustained Weight Loss in a Diverse, Urban Population: A 7-Year Retrospective Review.

Studies demonstrating the positive impact of body contouring on sustained weight loss in bariatric patients describe a narrow cohort. The authors sought to evaluate the impact of postbariatric body contouring procedures on sustained weight loss in minority race patients. A retrospective review of bariatric surgery patients at a single institution was performed. Patients were grouped as follows: (1) those who underwent body contouring, (2) those who had consultation but did not undergo body contouring, and (3) those without consultation. Body mass index (BMI) and excess body weight loss (EBWL) over 7 years were the primary outcomes. 2531 patients were analyzed: 350 in group 1, 364 in group 2, and 1817 in group 3. At postoperative year 7, groups 1 and 2 had average BMIs 4.71 and 2.31 kg/m 2 lower than group 3, respectively, while adjusting for covariates. After exclusion of 105 patients in group 2 who were not offered body contouring because of inadequate weight loss, however, group 2 had an average BMI 4.07 kg/m 2 lower than group 3 at postoperative year 7. During postoperative year 1, group 1 had an average EBWL of 74.38%, which declined 1.51% yearly, and group 2 had an average EBWL of 70.12%, which declined 1.86% yearly. After exclusion of the aforementioned patients, group 2 had an average EBWL of 74.9% at postoperative year 1, which declined 1.88% yearly. Body contouring after bariatric surgery did not impart a clinically significant, long-term sustained weight loss benefit in the authors' cohort. In the authors' study population, patients identifying as black had significantly worse sustained weight loss. Therapeutic, III.

The Prevalence of Depression and Anxiety in Post-bariatric Surgery Patients at King Khalid University Hospital, Riyadh.

Background Obesity negatively impacts mental and physical health and is a leading cause of disease worldwide. Obesity affects 33% of Saudi adults, with 10% being morbidly obese (body mass index, BMI >40 kg/m2). This study explored the association between bariatric surgery (BS) and a predisposition or exacerbation of depressive and anxiety symptoms. Material and methods A cross-sectional study of patients who underwent bariatric surgery at the King Khalid University Hospital in Riyadh, Saudi Arabia, was conducted between February 2016 and December 2021. The patients were contacted by phone to complete a self-administered questionnaire on demographic information, chronic medical diseases, psychiatric diseases, body mass index, and type of bariatric surgery. In addition, they completed the patient health questionnaire-9 (PHQ-9) and general anxiety disorder-7 (GAD-7) questionnaire to screen for patients' depression and anxiety symptoms. Results The findings of the 367 BS patients showed that 20.7% of the patients were considered to have mild anxiety, 11.2% had moderate anxiety, and 8.7% had high anxiety levels. However, regarding depression, 46.9% had extremely low levels of depression, followed by mild depression in 29.4% and moderate depression in 11.2%. Furthermore, another 8.2% of BS patients had moderately high depression levels, and 4.4% had severe depression. The anxiety and depression levels of the patients in this study did not show any statistically significant changes postoperatively in the short, medium, or long term. On the other hand, almost all of the patients 97% who underwent bariatric surgery were satisfied with the outcome of their surgery. Conclusion Few BS patients had high symptoms of depression and anxiety. We recommend pre- and postoperative psychiatric assessment for all bariatric surgery patients as surgical protocol.

Hypovitaminosis D in patients after bariatric surgery by Y-Roux and Sleeve

Introduction: Obesity is a multifactorial chronic disease, resulting from complex interactions between genetic, psychological, environments, lifestyles and emotional facts. Bariatric surgery is the most effective tool in the control and treatment of severe obesity. However, individuals submitted to this surgery may present malabsorption, some degrees of protein-energy malnutrition and hypovitaminosis. Objectives:To evaluate the prevalence of hypovitaminosis D in bariatric patients submitted to BPGYR and to the Sleeve using conventional multivitamin (group with supplementation) or (without supplementation). Methodology: A cross-sectional, retrospective, on the analysis of the medical records of female and male patients submitted to BPGYR and Sleeve in the late postoperative period. Data regarding the time after surgery, pre and post-surgery weight, percentage loss of excess weight and serious levels of vitamin D, PTH and calcium were analyzed. A total of 93 patients were analyzed, with a mean age of 41.4 ± 7.1 in the SS group and 43.7 ± 10.4 in the CS group. The mean time after bariatric was 52.4 ± 46.4 months in the SS and 46.2 ± 37.1 in the CS, with no difference between groups. Results:Surgery was effective in the loss of weight of the patients studied (SS - 70.3%±22.6; CS -79.3% ± 26.8; p= 0.19); however, hypovitaminosis D was found (SS-26.4 ± 10.0, CS-24.9 ± 10, p = 0.91) even in the group supplemented with conventional multivitamins. Conclusion: BPGYR and Sleeve are effective procedures in weight loss;these patients, however, are deficient in vitamin D. A supplementation with multivitamins is not sufficient to avoid hypovitaminosis, requiring vitamin D supplementation.

BS O09 Enhanced recovery and fast track surgery is applicable with good outcomes in patients undergoing bariatric surgery

Abstract Background Fast track surgery is well established in major centres undertaking bariatric surgery Methods All patients who underwent bariatric surgery in a high volume centre were included. Patient outcomes in terms of complication rates, length of stay, one day discharge rate and 30 day readmission rate were analysed. Results 1009 patients (105 gastric band removal, 756 gastric bypass, 104 sleeve gastrectomy and 44 revision surgery) were included in the study. Demographics include: Age 46(20–77), M:F = 190–819; BMI – 44.3 (20.6–62); Wt. – 120.3 Kg (57.4–190.7). Median length of stay was 1.7 (1–23) with 79% 1 day discharge. 19 patients had complications (1.8%) with no mortality. Logistic regression analysis revealed that presence of co-morbidities (OR = 1.92; 95% CI: 1.26–2.94; p=0.002) and history of previous abdominal surgery (OR = 2.22; 95% CI: 1.27–3.89; p = 0.005) increases risk of delayed discharge. The 30 day readmission rate was significantly higher in patients who had concomitant surgery in addition to primary bariatric surgery (Chi squared test p=0.032) and patients who failed the fast track protocol (p-0.000; chi squared = 13.2) Conclusions Increased understanding of factors which can be optimised may result in even better outcomes in fast track bariatric surgery.

Incidence of Substance Use Disorder Following Bariatric Surgery: A Retrospective Cohort Study.

New-onset substance use disorder (SUD) following bariatric surgery is a significant concern that is likely multi-factorial, although the etiologies are unclear. Previous studies have identified variable rates of SUD along with utilizing different methods and measures. The objective of this study is to evaluate new-onset SUD diagnoses among adults following bariatric surgery and compare these rates to those in the general population as well as those diagnosed with overweight or obesity. Data was extracted from TriNetX Research Platform and used to build three cohorts of adults: those who had bariatric surgery (bariatric surgery cohort), those diagnosed with obesity or overweight, and a general population cohort. Rates of incident SUD were compared among these three groups. Initial encounters for all individuals were from January 1, 2018, to June 30, 2019. The incidence rate of SUD in patients with a history of bariatric surgery was 6.55% (n = 2523). When compared to the general population, persons who had any type of bariatric procedure had a decreased risk of new-onset SUD with an overall odds ratio (OR) [95% confidence limits (CL)] of 0.89 [0.86, 0.93]. When compared to persons with overweight orobesity, bariatric patients were less likely to develop any form of SUD (OR: 0.65 [0.62, 0.67]). While overall rates of new-onset SUD are lower among those who had bariatric surgery, they also vary by surgery and substance type. Efforts should still be made to address new-onset SUD in order to optimize the post-surgical care of patients.

BS O06 The burden of bariatric-related emergency interventions at a tertiary bariatric centre: The Luton and Anglian Experience

Abstract Background Bariatric surgery is becoming more prevalent worldwide due to increasing rates of obesity. British patients can access bariatric surgical services through established NHS services, or privately via British hospitals or abroad. Post-operatively, patients might require urgent surgical admission for analgesia, nutritional evaluation and even emergency surgery. Few publications have addressed the rates of late endoscopic or surgical re-intervention in British bariatric patients. This study investigated the burden of emergency bariatric-related surgery at an established high volume bariatric centre. Methods All bariatric-related procedures were selected from a prospectively maintained emergency surgery database. Patients who underwent unplanned, endoscopic or surgical procedures between September 2018 and September 2021 were included. Patients who had bariatric surgery at our institution and returned to theatre within their inpatient stay were excluded. Primary outcomes were the location of the index procedure (local, other institutions within the UK, or abroad), type of the index bariatric procedure, length of stay (LOS), admission to intensive care, and mortality. Results During the study period, 87 patients underwent 102procedures. Index procedures were roux-en-Y gastric bypass 32 (37%), gastric banding 28 (32%), balloon insertion 12 (14%), sleeve gastrectomy 7 (8%), one-anastomosis gastric bypass 4 (5%) and band-to-sleeve gastrectomy revision 3 (3%). 34 (39%) patients had their initial procedure at our unit, 36 (41%) at another British centre and 17 (20%) abroad. The commonest index procedure to require emergency reintervention of those who had surgery at our hospital was the roux-en-Ygastric bypass (26%). Amongst those who had surgery at another UK hospital, it was the gastric band (28%), and intragastric balloons (6%) in the abroad group. The most common emergency procedures performed for patients from our centre were OGD 11 (11%) and redo jejuno-jejunostomy 7 (7%). Patients from other UK centres required removal of gastric bands 25 (25%) and removal of intragastric balloons 4 (4%). Patients who underwent surgery abroad required OGD 5 (5%), removal of gastric balloons 5 (5%) or gastric bandremoval 4 (4%). Median length of stay was 4 days (IQR 3.9–12.7). There were 9 (9%) admissions to ITU. There were two mortalities (2%), one patient from our hospital and onepatient from another British centre. Conclusions Our centre experiences a high volume of bariatric surgical emergencies that are promptly managed surgically and endoscopically with increased demand from patients who underwent bariatric surgery abroad. More than a third of patients are from other British centres reflecting the importance of established regional networks for the specialised care of these patients, while a fifth underwent surgery abroad. Further work should involve exploring factors affecting patients decision to seek private bariatric surgery, within the UK or abroad, and a consideration of the cost-burden to the NHS.

The impact of exercise on prevention of sarcopenia after bariatric surgery: The study protocol of the EXPOBAR randomized controlled trial

IntroductionBariatric surgery is one of the treatments for severe obesity, with proven efficacy in reducing weight and diseases associated with obesity. Weight loss associated with bariatric surgery is greatly associated with a significant reduction of skeletal muscle and bone mineral mass, which leads us to induce that after bariatric surgery, patients incur an increased risk of sarcopenia. The need for prophylactic programs that prevent sarcopenia in bariatric surgery patients seems to be one of the crucial points for the long-term surgical success of bariatric and metabolic surgery. The aim of this randomized clinical trial will be to study the effects of a 16-week supervised exercise intervention program on the prevention of sarcopenia, in patients undergoing bariatric surgery. As a secondary purpose, it is also intended to characterize metabolic risk factors, physical fitness, and quality of life in post-bariatric surgery patients. MethodA total of 45 patients on the waiting list for bariatric surgery and who have subsequently perfurgery, will be include on EXPOBAR (EXercise POst BARiatric) and randomized into 2 groups, experimental and control. The intervention starts one month after surgery, for a total of 16 weeks. Parameters of body composition, metabolic risk, quality of life, physical activity, physical fitness, and sedentary behavior will be determined. For each participant, outcomes are measured at five different time points: before the surgery, before the exercise program, after the exercise program, six and twelve months after de exercise program. ResultsThis study will provide the effects of a physical exercise on sarcopenia, in patients after bariatric surgery. Trial registrationThe trial was registered at Clinicaltrials.gov NCT03497546.

Chronic abdominal pain after bariatric surgery: a narrative review

Objective: This paper reviews the prevalence, etiology, risk factors, diagnosis and prevention of chronic abdominal pain after bariatric surgery. Introduction: Chronic pain is a very common and complex problem that has serious consequences on individuals and society. It frequently presents as a result of a disease or an injury. Obesity and obesity-related comorbidities are a major health problem and are dramatically increasing year after year. Dieting and physical exercise show disappointing results in the treatment of obesity. Therefore, bariatric surgery is increasingly widely offered as a weight reducing strategy. In our pain clinic we see a lot of patients who suffer from chronic abdominal pain after bariatric surgery. This review aims to explore the link between chronic abdominal pain and bariatric surgery in this specific type of patients. Method: The review is based on searches in PubMed, Embase and Cochrane databases. Keywords are used in different combinations. We did a cross-reference of the articles included. Results: Chronic abdominal pain after bariatric surgery is very common. Around 30% of the bariatric patients experience persistent abdominal pain. An explanation for the abdominal pain is found in 2/3 of these patients. There is a wide variety of causes including behavioral and nutritional disorders, functional motility disorders, biliary disorders, marginal ulceration and internal hernia. Another, frequently overlooked, cause is abdominal wall pain. Unexplained abdominal pain after bariatric surgery is present in 1/3 of the patients with persistent abdominal pain. More studies are needed on the risk factors and prevention of unexplained abdominal pain in bariatric patients.

Association between neighborhood food environments and bariatric surgery outcomes.

Individual characteristics associated with weight loss after bariatric surgery are well established, but the neighborhood characteristics that influence outcomes are unknown. The objective of this study was to determine if neighborhood characteristics, including social determinants and lifestyle characteristics, were associated with weight loss after bariatric surgery. Single university healthcare system, United States. In this retrospective cohort study, all patients who underwent primary bariatric surgery from 2008 to 2017 and had at least 1 year of follow-up data were included. Patient-level demographics and neighborhood-level social determinants (area deprivation index, urbanicity, and walkability) and lifestyle factors (organic food use, fresh fruit/vegetable consumption, diet to maintain weight, soda consumption, and exercise) were analyzed. Median regression with percent total body weight (%TBW) loss as the outcome was applied to examine factors associated with weight loss after surgery. Of the 647 patients who met inclusion criteria, the average follow-up period was 3.1 years, and the mean %TBW loss at the follow-up was 22%. In adjusted median regression analyses, Roux-en-Y gastric bypass was associated with greater %TBW loss (11.22%, 95% confidence interval [8.96, 13.48]) compared to sleeve, while longer follow-up time (-2.42% TBW loss per year, 95% confidence interval [-4.63, -0.20]) and a preoperative diagnosis of diabetes (-1.00% TBW loss, 95% confidence interval [-1.55, -0.44]) were associated with less. None of the 8 neighborhood level characteristics was associated with weight loss. Patient characteristics rather than neighborhood-level social determinants and lifestyle factors were associated with weight loss after bariatric surgery in our cohort of bariatric surgery patients. Patients from socioeconomically deprived neighborhoods can achieve excellent weight loss after bariatric surgery.

Inflammatory type 2 conventional dendritic cells contribute to murine and human cholangitis.

Primary sclerosing cholangitis (PSC) is a progressive cholangiopathy characterised by fibrotic stricturing and inflammation of bile ducts, which seems to be driven by a maladaptive immune response to bile duct injury. The histological finding of dendritic cell expansion in portal fields of patients with PSC prompted us to investigate the role of dendritic cells in orchestrating the immune response to bile duct injury. Dendritic cell numbers and subtypes were determined in different mouse models of cholangitis by flow cytometry based on lineage-imprinted markers. Findings were confirmed by immunofluorescence microscopy of murine livers, and liver samples from patients with PSC were compared to control samples from bariatric surgery patients. Using genetic tools, selected dendritic cell subsets were depleted in murine cholangitis. The dendritic cell response to bile duct injury was determined by single-cell transcriptomics. Cholangitis mouse models were characterised by selective intrahepatic expansion of type 2 conventional dendritic cells, whereas plasmacytoid and type 1 conventional dendritic cells were not expanded. Expansion of type 2 conventional dendritic cells in human PSC lesions was confirmed by histology. Depletion studies revealed a proinflammatory role of type 2 conventional dendritic cells. Single-cell transcriptomics confirmed inflammatory maturation of the intrahepatic type 2 conventional dendritic cells and identified dendritic cell-derived inflammatory mediators. Cholangitis is characterised by intrahepatic expansion and inflammatory maturation of type 2 conventional dendritic cells in response to biliary injury. Therefore, type 2 conventional dendritic cells and their inflammatory mediators might be potential therapeutic targets for the treatment of PSC. Primary sclerosing cholangitis (PSC) is an inflammatory liver disease of the bile ducts for which there is no effective treatment. Herein, we show that the inflammatory immune response to bile duct injury is organised by a specific subtype of immune cell called conventional type 2 dendritic cells. Our findings suggest that this cell subtype and the inflammatory molecules it produces are potential therapeutic targets for PSC.

IBC-Ox32 Streamlining preoperative risk assessment: counterintuitive results in the Bariatric patient

Abstract Background Bariatric surgical operations continue to be performed in high numbers nationally, thus it is important to identify factors associated with post-surgical complications. This study aims to identify preoperative risk factors associated with bariatric surgery mortality. Methods A retrospective analysis was conducted on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database to determine the strength of association between pre-operative exposures and 30-day mortality following bariatric surgery. A total of 701,265 primary bariatric operations were registered between the years of 2015 and 2017, consisting of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), adjustable gastric band (AGB), and duodenal switch (DS) Results From the 701,265 surgeries registered in the database, 636,286 had complete data points for the variables of interest and therefore were included in this analysis. The mean age of the cohort was 45.01 (SD= 11.96) years, mean BMI was 45.54 kg/m2 (SD=7.72), and 80.07% were female. Overall 30-day mortality was 0.10% (n=629). The association between the following preoperative variables and mortality within 30 days of bariatric surgery was not statistically significant: hyperlipidemia, history of pulmonary embolism, oxygen dependence, obstructive sleep apnea and history of venous stasis. Smoking status (AOR=1.38), insulin dependent diabetes (AOR=1.37) and the use of more than 3 hypertensive medications (AOR=1.30) were weakly associated with postoperative mortality (p&amp;lt;0.05; CI=95%). History of chronic obstructive pulmonary disease (COPD; AOR=2.00), partial functional dependency (AOR=2.09), renal insufficiency (AOR=1.63), dialysis (AOR=3.15), history of deep venous thrombosis (AOR=1.78), history of myocardial infarction (AOR=1.65) and history of cardiac surgery (AOR=1.87) were strongly associated with mortality (P&amp;lt;0.05; c.i. = 95%) Conclusion Bariatric surgery continues to be safe. Many factors that have traditionally been thought to contribute to mortality, such as diabetes, hypertension, smoking, and oxygen dependence may have little impact. Other variables such as previous heart surgery, functional dependency status and COPD may play a bigger role in adverse outcomes. While these associations do not determine causality, understanding the strength of them can guide physicians on preoperative risk assessment and care.

Trending Weight Loss Between Usual Care and Bariatric Surgery Among Higher Weight Persons With Obstructive Sleep Apnea.

Background This study aimed to investigate the actual weight change documented as a goal of treatment after patients were newly diagnosed with obstructive sleep apnea (OSA). We hypothesized that patients with OSA and classified as overweight and obese based on BMIwould fail to achieve significant weight loss over a two- to five-year period. Methodology This retrospective review included adults aged 18 years or older who were newly diagnosed with OSA in 2015, as indicated by a full nocturnal polysomnogram and using the 4% rule for the definition of hypopnea. Data collected were between January 01, 2015, and December 31, 2020. Patients received either usual care for weight reduction or bariatric surgery to assess the overall weight loss and identify barriers. Statistical analysis included independent t-tests, Mann-Whitney U tests and related samples McNemar change statistics, Cox proportional hazards regression, and Kaplan-Meier curves to analyze age, gender, ethnicity, and weight differences between usual care and bariatric surgery groups. Results The number of participants included forusual care and bariatric surgery was 100 and 24, respectively. Over five years, 87% of the usual care patients remained in the same BMI classification, 7% lowered their classification, and 6% raised theirs. For usual care patients, the average net weight per individual of 2.19 kg gained represented a 1.96% weight change. Bariatric patients lost an average net weight of 30.40 kg (22.39%). Cox proportional hazards regression showed that the overall model fit was statistically significant (χ2 = 55.40, degrees of freedom [df] = 9, and P-value < 0.001). The significant variables were time-dependent weight change and ethnicity. The Kaplan-Meier curverevealed that weight loss reduced over time in treatment. Conclusions This study confirmed that despite the direction to lose weight, only 7% of OSA patients lowered their BMI classification. Patient instruction and provider-driven weight loss strategies seem equally ineffective to achieve sustained weight reduction amonghigh-risk groups. More research is needed to investigate optimal strategies that include interprofessional collaborative practices for sustained weight loss.

IBC-Ox22 Greater Adherence to Mediterranean Diet leads to longer term weight loss

Abstract We were able to obtain dietary data of 134 weight loss surgery patients with an average follow up of five years with annual scoring of the 9 point Mediterranean Diet. The closer adherence to the MD showed more weight loss than those who had not. Background The Mediterranean Diet has been associated with decreased all cause mortality for those who adhere strongly to it, as well as decreased risk of heart disease, and cancer. The diet is rich in polyphenols with fruits, vegetables, legumes, fish, mono-unsaturated fats, whole grains, while minimizing dairy, meat and poultry, and some moderate alcohol consumption. Methods Pre operatively all bariatric patients patients were counseled about the Mediterranean diet, how to score the diet, and adherence to the diet was reemphasized at their follow ups. Annually they were asked to fill out their scores. We looked at other diet plans that some of the patients reported (low carbohydrate, weight watchers) and the results were not significant. Results Of the 134 patients there were 65 which had scores of 5 points or more and showed an absolute reduction in weight of 54% total weight loss on average, vs those of 1-3 who had 32% total weight loss (total of 60 patients). The remaining 9 patients who escorted 4 points had a wide spread of weight loss that could not be calculated (these patients predominantly followed a self-described low-carbohydrate diet). There was no difference in weight loss regarding the type of surgery that the patient had (Lap-Band (N=74) vs Gastric Sleeve (N=50) vs Gastric bypass (N=10). Nor was there any difference in weight loss when measuring physical activity. Using the 9 point scale of the Mediterranean Diet those who had greater than 5 of the 9 points on the MD had greater weight loss over five years than those who were 0-3. Those who scored 4 points were indeterminate. Conclusions The Mediterranean Diet scale provides a quick and easy guide, providing targets for patients (example, less than 4 ounces per day of poultry or meat is a point, more is 0 points). The emphasis on a post operative diet for health, as opposed to weight loss, inadvertently provided a good model for post operative weight loss.

Data assimilation on mechanistic models of glucose metabolism predicts glycemic states in adolescents following bariatric surgery.

Type 2 diabetes mellitus is a complex and under-treated disorder closely intertwined with obesity. Adolescents with severe obesity and type 2 diabetes have a more aggressive disease compared to adults, with a rapid decline in pancreatic β cell function and increased incidence of comorbidities. Given the relative paucity of pharmacotherapies, bariatric surgery has become increasingly used as a therapeutic option. However, subsets of this population have sub-optimal outcomes with either inadequate weight loss or little improvement in disease. Predicting which patients will benefit from surgery is a difficult task and detailed physiological characteristics of patients who do not respond to treatment are generally unknown. Identifying physiological predictors of surgical response therefore has the potential to reveal both novel phenotypes of disease as well as therapeutic targets. We leverage data assimilation paired with mechanistic models of glucose metabolism to estimate pre-operative physiological states of bariatric surgery patients, thereby identifying latent phenotypes of impaired glucose metabolism. Specifically, maximal insulin secretion capacity, σ, and insulin sensitivity, SI, differentiate aberrations in glucose metabolism underlying an individual's disease. Using multivariable logistic regression, we combine clinical data with data assimilation to predict post-operative glycemic outcomes at 12months. Models using data assimilation sans insulin had comparable performance to models using oral glucose tolerance test glucose and insulin. Our best performing models used data assimilation and had an area under the receiver operating characteristic curve of 0.77 (95% confidence interval 0.7665, 0.7734) and mean average precision of 0.6258 (0.6206, 0.6311). We show that data assimilation extracts knowledge from mechanistic models of glucose metabolism to infer future glycemic states from limited clinical data. This method can provide a pathway to predict long-term, post-surgical glycemic states by estimating the contributions of insulin resistance and limitations of insulin secretion to pre-operative glucose metabolism.

Risk of sarcopenia after bariatric surgery in patients with type 2 diabetes mellitus

Introduction. Despite the great popularity of Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in the treatment of morbid obesity, the problem of the development and progression of sarcopenia in patients with type 2 diabetes mellitus in the postoperative period remains insufficiently studied.Aim. To study the prevalence and dynamics of sarcopenia in patients with type 2 diabetes mellitus after Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in the long term.Materials and methods. Our prospective study included 257 bariatric patients (170 Roux-en-Y gastric bypass and 87 laparoscopic sleeve gastrectomy) with type 2 diabetes mellitus. All patients underwent a standard set of preoperative examination with obligatory determination of the skeletal muscle mass index using the bioelectrical impedance analysis. After 6, 12, 18 and 24 months, control examinations were carried out.Results. At the preoperative stage, 28 patients (16.5%) with signs of moderate sarcopenia were identified in the Roux-en-Y gastric bypass group and 15 patients (17.2%) in the laparoscopic sleeve gastrectomy group. According to the bioelectrical impedance analysis, 24 months after the operation, 37 patients (25.9%) with signs of moderate sarcopenia and 2 patients (1.4%) with severe sarcopenia were identified in the first group. 24 months after surgery in the second group there was no statistical difference in the number of patients with signs of sarcopenia in comparison with the preoperative period.Conclusion. The frequency of development and progression of signs of sarcopenia after Roux-en-Y gastric bypass is statistically higher than after laparoscopic sleeve gastrectomy. In this regard, in our opinion, when choosing a method of surgical treatment of morbid obesity with concomitant type 2 diabetes mellitus, a detailed assessment of the state of protein metabolism by the bioelectrical impedance analysis is necessary.

Efficacy and Safety of Gabapentin on Postoperative Pain Management After Bariatric Surgery: A Systematic Review and Meta-Analysis

PurposeExamine the efficacy and safety of perioperative gabapentin in bariatric surgical patients. DesignSystematic Review and Meta-analysis. MethodsAn exhaustive search was conducted using PubMed, Cochrane Library, MEDLINE, CINAHL, Google Scholar, and other gray literature. Only randomized controlled trials evaluating the use of gabapentin in bariatric surgery were included. Risk ratio (RR) and mean difference (MD) were used to estimate outcomes with suitable effect models. Quality of evidence was assessed using the Risk of Bias and GRADE system. FindingsFour trials consisting of 283 patients were analyzed. The use of gabapentin significantly lowered the cumulative pain score in the first 24 hours after surgery by an average of 1.04 (MD, –1.04; 95% CI, –1.45 to –0.63; P < .00001). Gabapentin also reduced the overall morphine equivalent consumption by 7.89 mg (MD, –7.89; 95% CI, –13.56 to –2.2; P = .006). However, gabapentin did not affect the incidence of PONV (RR, 0.61; 95% CI, 0.38-1.00; P = .05), somnolence (RR, 1.25; 95% CI, 0.57-2.73; P = .57), dizziness (RR, 1.01; 95% CI, 0.40-2.54; P = .99), and headache (RR, 0.76; 95% CI, 0.25-2.30; P = .62). Substantial heterogeneity, imprecision of the effect size, and potential publication bias were limitations of this review. ConclusionsThe use of gabapentin is effective in the management of postoperative pain in bariatric surgery. However, there is limited data regarding the opioid-sparing effect and adverse effect profiles of gabapentin in the bariatric surgical population.