Bariatric Population Research Articles

The association between biomarkerangiopoietin-like protein fiveand obstructive sleep apnea in patients undergoing bariatric surgery.

Obstructive sleep apnea (OSA) is prevalent in the bariatric population. OSA should be recognized in patients undergoing bariatric surgery preoperatively to prevent peri- and post-operative complications. Lipid metabolism-related biomarkers are associated with OSA. Triglyceride metabolism is, among others, regulated by angiopoietin-like protein five (ANGPTL5). We aimed to evaluate the level of ANGPTL5 in patients with OSA of different severity levels before and after bariatric surgery. We performed a single-center prospective cohort study including a consecutive series of patients who underwent bariatric surgery. We collected the clinical data, polysomnography (PSG) or polygraphy (PG) parameters, and plasma derived via venipuncture before and 6 to 12months after surgery. Lipid profile, glucose levels, and ANGPTL5 levels were assessed. ANGPTL5 levels were measured using an enzyme-linked immunosorbent assay (ELISA). The study included 88 patients for analysis. The patients were divided into two subgroups: no or mild OSA (apnea-hypopnea index (AHI) < 15 events/hour, n = 57) and moderate-to-severe OSA (AHI ≥ 15 events/hour, n = 31). The ANGPTL5 level was higher in the moderate-to-severe OSA group (20.5 [15.6, 26.5] ng/mL) compared to the no or mild OSA group (16.3 [12.5, 19.4] ng/mL) (p = 0.008). A significant positive correlation was observed between ANGPTL5 and AHI (ρ = 0.256, p = 0.017), apnea index (AI) (ρ = 0.318, p = 0.003), and triglyceride levels (ρ = 0.240, p = 0.025). ANGPTL5 levels were reduced significantly after bariatric surgery in both moderate-to-severe OSA (15.6 [10.3, 18.7] ng/mL) and no or mild OSA (13.4 [9.2, 15.8] ng/mL) groups, though to a lower level in the group without or mild OSA. Post-surgery, the significant positive correlation between ANGPTL5 and AHI (ρ = 0.210, p = 0.047), AI (ρ = 0.230, p = 0.034), and triglyceride (ρ = 0.397, p < 0.001) remained. The data showed increased levels of ANGPTL5 in patients with moderate-to-severe OSA. Both AHI and ANGPTL5 levels decreased significantly after bariatric surgery. We alsoreport an association between ANGPTL5 levels and OSA severity.

Dimensional Solution of Wooden Chairs for the Adult Bariatric Population of Slovakia: Observational Study

Chairs are furniture that are intended for direct contact with people, they are heavily loaded by forces, and they must meet a number of criteria, such as ergonomics, safety, economic sustainability, feasibility, and aesthetic requirements. This study aimed to define the dimensional solution of wooden chairs for the adult bariatric subpopulation of Slovakia. Long-term observations of the changes in the anthropometric dimensions of the population (secular trend) allowed the determination of the body height of 95% of the adult male population. Based on the analysis of the bariatric population of Slovakia, regardless of gender, the values of weight, waist and hip circumference, and seat width were defined in the years 2020 to 2022. The increased population’s average body mass makes the researched topic highly relevant and necessary. Based on the obtained data, new dimensions of wooden chairs for bariatric respondents were designed: seat height 49 cm, seat width 67 cm, and seat depth 47 cm. Adjusting the dimensions of wooden chairs makes it possible to ensure comfortable sitting and standing for bariatric respondents and prevents many health problems. For furniture manufacturers, the introduction of the production of wooden furniture for bariatric respondents can be a competitive market advantage.

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.

Dimensional solution for beds from wood composites for the bariatric population

The aim of the work was to define a suitable dimensional solution for a single-occupancy bed from wood composites for the adult bariatric population of Slovakia. Current bed dimensions are designed for the adult population for standard human dimensions and weight up to 150 kg. Based on the long-term observation of the development of anthropometric dimensions of the population (secular trend), the height of 95% of the adult male population was defined. Based on the analysis of the bariatric population of Slovakia, regardless of gender, the values of weight, waistline and hipline, and seat width were defined in the years 2020 to 2022. Based on the results, the weight of the bariatric population can be up to 250 kg. New bed dimensions for bariatric respondents were proposed, including bed length according to room dimensions from 220 cm to 240 cm, bed width of 141 cm, and bed height of 55 cm. By adjusting the dimensions of the beds for bariatric respondents, they will be able to move comfortably during rest and sleep. This can prevent many health problems.

Examining weight bias before and/or after bariatric surgery: A systematic review

Research examining weight bias in the bariatric population, who may be at greater risk of weight stigma, is scarce. The present study aimed to systematically review the literature for quantitative evidence that explores the medical, psychosocial, and behavioral sequelae associated with experienced, internalized, and/or externalized weight bias in patients seeking or who have undergone bariatric surgery. Five databases were systematically searched for English peer-reviewed quantitative studies, which examined weight bias in a sample of individuals seeking or who had undergone bariatric surgery. Risk of bias was assessed. Twenty-nine studies were included, of which 13 examined internalized weight bias, 12 examined experienced weight bias, 4 examined both, and 0 examined externalized weight bias. Most studies were cross-sectional, and the results showed high risk of bias. The results suggested that both experienced and internalized weight bias were associated with a host of negative psychosocial, behavioral, and medical sequelae. The findings of this review underscore the need for more rigorous research to better understand the relationship between weight bias and bariatric surgery, particularly longitudinally. Future patients may benefit from research developing interventions for reducing weight bias prior to and following bariatric surgery in order to reduce the associated negative correlates and improve outcomes.

Bariatric Center Designation and Outcomes Following Repeat Abdominal Surgery in Bariatric Patients

IntroductionRepeat abdominal surgery in the bariatric surgery patient population may be challenging for non–bariatric-accredited institutions. The impact of regionalized bariatric care on clinical outcomes for bariatric surgery patients requiring repeat abdominal surgery is currently unknown. This study aims to investigate the association between bariatric center designation and clinical outcomes following hepatobiliary, hernia, and upper and lower gastrointestinal operations among patients with prior bariatric surgery. MethodsThis is a cohort study of a large sample of Ontario residents who underwent primary bariatric surgery between 2010 and 2017. A comprehensive list of eligible abdominal operations was captured using administrative data. The primary outcome was 30-d complications. Secondary outcomes included 30-d mortality, readmission, and length of stay. ResultsAmong the 3301 study patients, 1305 (40%) received their first abdominal reoperation following bariatric surgery at a designated bariatric center. Nonbariatric center designation was not associated with significantly higher rates of 30-d complications (5.73% versus 5.72%), mortality (0.80% versus 0.77%), readmissions (1.11% versus 1.85%), or median postoperative length of stay (4 versus 4 d). After grouping the category of reoperations, upper gastrointestinal (odds ratio [OR] 0.66, confidence interval [CI] 0.39-1.11) and abdominal wall hernia surgery (OR 0.52, CI 0.27-0.99) showed a lower adjusted OR for complications among bariatric centers. ConclusionsOur study demonstrates that after adjustment for case-mix and patient characteristics, bariatric surgery patients undergoing repeat abdominal surgery at nonbariatric centers is not associated with higher proportion of complications or mortality. Complex hernia surgery may be considered the most appropriate for referral.

A-226 The reliability of the Millon Behavioral Medicine Diagnostic for Presurgical Bariatric Weight Loss Evaluations

Abstract Objective: The Millon Behavioral Medicine Diagnostic (MBMD) is routinely used in presurgical bariatric evaluations to evaluate individuals’ experience of their health, response to medical concerns in relation to treatment recommendations, history of adherence to treatment plans, and typical coping skills. Researchers (Walfish, Wise, &amp; Streiner, 2008) raised concern that 16 of the 32 scales did not meet minimal standards of use (as defined by a Cronbach’s Alpha of &amp;gt;.69) within bariatric populations, and 13 of the remaining scales lacked strong evidence of reliability. The present study aimed to assess MBMD scale consistency examining a bariatric population independent of the original sample. Method: Archival data from an independent sample of adult bariatric surgery candidates included 759 patients (Age: 46.1 [SD=12.0]; 84% female; 87% White, Non-Hispanic). We estimated internal consistency for each of the 32 scales of the MBMD. Our study sample size was adequately powered (80%) at an alpha of 0.05 for scale sizes ranging from 5 to 25 items to test a null hypothesis. Results: Of the 32 scales, 19 (59%) had a Cronbach’s Alpha value ≥0.70, primarily including bariatric patients’ psychiatric indications (e.g., depression, anxiety) and stress moderation (e.g., social isolation, future pessimism). Conclusion: These findings suggest 13 of the 32 scales in the MBMD are not consistently measuring unified concepts. Immediate future steps include further examination of internal consistency on the scale and item level. Additionally, examining internal consistency at the item level would be helpful in the development of a reliability index for individual response styles.

The utility of endoscopy prior to bariatric surgery: an 11-year retrospective analysis of 885 patients.

Our aim was to evaluate the diagnostic yield of routine preoperative esophagogastroduodenoscopy (p-EGD) in patients undergoing bariatric surgery. Many medical problems that are common in patients with obesity, including gastroesophageal reflux disease (GERD) and hiatal hernias, have important implications for patients undergoing bariatric surgery. While p-EGD is considered standard of care prior to antireflux surgery, the role of p-EGD in bariatric surgery patients remains controversial. We performed a retrospective chart review of 885 patients who underwent primary bariatric surgery at a university hospital-based bariatric surgery program between March 2011 and February 2022. Clinical history, demographics, and preoperative EGD reports were reviewed for abnormal findings. Of the 885 patients evaluated in this study, one or more abnormal EGD findings were observed in 83.2% of patients. More than half of our patients (54.7%) presented with history of heartburn, reflux, or GERD. EGD findings demonstrated a hernia in 43.1% of patients [(Type I: 40.6%; Type II: 0.5%; Type III: 2.1%)]. 68.0% of patients were biopsied. Among patients who were biopsied, other findings included gastritis (32.4%), esophagitis (8.0%), eosinophilic esophagitis (4.7%), or duodenitis (2.7%). We found ulcers in 6.7% of patients. Pathology was consistent with H. pylori in 9.8% of biopsies taken and consistent with BE in 2.7%. Following routine p-EGD, 11.2% of patients were placed on PPI and 8.3% were recommended to stop NSAIDs. Gastroesophageal reflux disease and associated pathology are common in the bariatric population. Preoperative EGD in patients undergoing bariatric surgery frequently identifies clinically significant UGI pathology. This may have important implications for medical and surgical management. Given the rate of abnormal preoperative endoscopic findings in obese patients, the work-up for bariatric surgery should align with the current recommendations for foregut surgery.

Physical Exercise to Improve Functional Capacity: Randomized Clinical Trial in Bariatric Surgery Population.

Background: Bariatric surgery is a safe and effective method to lose weight over time. However, some patients fail to achieve healthy weight losses. We aimed to determine if a moderate-intensity physical exercise intervention in patients who underwent bariatric surgery increases their functional capacity thus improving bariatric surgery results. Methods: We conducted a parallel-group non-blinded randomized controlled trial at a surgery clinic in Talca, Chile. A total of 43 participants with obesity and scheduled bariatric surgery completed the six months follow-up. A physical exercise program was conducted in exercise group participants one month after bariatric surgery. Walked distance in the six-minute walk test, BMI, Borg scale of perceptive exertion results and cardiovascular variables were evaluated. Results: Patients’ weight significantly decreased after bariatric surgery but there was no difference between the groups of study. The exercise group progressed from a base value of 550 ± 75 m walked in the six-minute walk test to a sixth-month value of 649.6 ± 68.5 m (p < 0.05), whilst the control group yielded base values of 554.4 ± 35.1 and a sixth-month walked distance of 591.1 ± 75.34 (p > 0.05). Conclusions: Physical exercise in obese patients undergoing bariatric surgery increased functional capacity independently of weight losses resulting from bariatric surgery.

Interrater reliability and internal consistency of the eating disorder examination in the longitudinal assessment of bariatric surgery study.

Psychometric studies of eating disorder measures within bariatric surgery populations are limited. To examine the interrater reliability and internal consistency of the Eating Disorder Examination (EDE) among patients before and after bariatric surgery. Three clinical centers of the Longitudinal Assessment of Bariatric Surgery Research Consortium. The EDE-Bariatric Surgery Version was administered and audio-recorded by trained interviewers before and at annual assessments after bariatric surgery. Approximately 20% of interviews were randomly selected for rating by a second interviewer. Reliability of the original and brief EDE subscales was examined. Interrater reliability of the EDE subscales ranged from .86-.97 for the original subscales and .83-.95 for brief subscales before surgery, and .90-.98 for the original subscales and .92-.97 for brief subscales after bariatric surgery. Interrater agreement (based on kappa) was almost perfect for overeating and binge-eating behaviors and substantial for loss-of-control eating before surgery. Similar interrater agreements (based on kappa) were observed after surgery for subjective overeating and binge-eating episodes. Internal consistency of the subscale and global scores was variable, ranging from .41-.97. Findings provide support of the interrater reliability of the EDE, albeit with variable internal consistency, before and after bariatric surgery. Despite support for trained raters to reliably assess EDE constructs, variability in internal consistency suggests that further psychometric testing and rigorous scale development of disordered eating may be needed for the bariatric surgery population.

Involvement of Helicobacter pylori in Preoperative Gastric Findings on a Bariatric Population.

The prevalence of Helicobacter pylori (Hp) in bariatric patients is common and related to gastric pathology. With preoperative upper gastrointestinal endoscopy (UGE), these pathologies and the presence of Hp are diagnosed. The histopathological study of the UGE biopsies is classified based on the Sydney System, a scoring system that stages chronic gastritis (CG) and precancerous gastric lesions. The objective is to assess the histological findings of gastric biopsies during routine UGE and to determine the involvement of Hp in gastric disorders in patients undergoing bariatric surgery. A multicenter retrospective review of prospectively collected databases was performed. The presence of CG, gastric atrophy (GA), and gastric intestinal metaplasia (GIM) in the study of the biopsies was assessed and correlated with Hp infection. The incidence of Hp among our bariatric population was 36.1%, and it increases with age. The percentage of patients with severe Hp infection is higher in patients with GA or GIM. The Hp eradication rate is also reduced when GA and GIM are present. A histological examination of all the biopsies did not show features of malignancy in any of the cases. Hp is not the only factor involved in the development of gastric pathology in bariatric patients.

The impact of bariatric surgery on disease activity and progression of multiple sclerosis: A nationwide matched cohort study

Background: Surgical outcomes in patients with multiple sclerosis (MS) following metabolic surgery appear to be similar compared to those of the general bariatric population. Objective: To study the impact of metabolic surgery on the clinical course of MS. Methods: Using data from the Scandinavian Obesity Surgery Registry and the Swedish Multiple Sclerosis register, we compared disease outcomes in 122 cases of MS who had undergone metabolic surgery with those of 122 cases of MS without surgery, matched by a two-staged Propensity score match, including age at disease onset, sex, MS phenotype, body mass index, and preoperative severity of MS as measured by the Expanded Disability Status Scale. Results: The time to 6-month confirmed disability progression during the first five years postbaseline was shorter among the surgical patients (hazard ratio (HR) = 2.31, 95% confidence interval (CI) = 1.09–4.90; p = 0.03). No differences were observed regarding postoperative annual relapse rate (p = 0.24) or time to first postoperative relapse (p = 0.52). Conclusion: Although metabolic surgery appears to be a safe and efficient treatment of obesity in patients with MS, the clinical course of the disease might be negatively affected. Long-term nutritional follow-up after surgery and supplementation maintenance are crucial, particularly among those with preoperative deficits.

A148 Is Universal Preoperative Psychosocial Evaluation Warranted in the Bariatric Population?: Analysis of a Single Center Experience

A148 Is Universal Preoperative Psychosocial Evaluation Warranted in the Bariatric Population?: Analysis of a Single Center Experience

A073 Analyzing the adequacy of BMI-tiered enoxaparin dosing for venous thromboembolism prophylaxis in the bariatric surgery population based on anti-factor Xa assay data

A073 Analyzing the adequacy of BMI-tiered enoxaparin dosing for venous thromboembolism prophylaxis in the bariatric surgery population based on anti-factor Xa assay data

A054 A Survey of Socioeconomic and Cultural Factors in a Safety Net Bariatric Population

A054 A Survey of Socioeconomic and Cultural Factors in a Safety Net Bariatric Population

Specificities of the Use of Psychotropic Drugs in Bariatric Surgery

IntroductionBariatric surgery is considered an effective treatment against obesity. Psychiatric illness is relatively common in patients who have undergone bariatric surgery. Over one-third of these patients are prescribed psychotropic drugs, particularly antidepressants. Unlike medications for diabetes, hypertension or hyperlipidemia, which are generally reduced and at times discontinued, postsurgery psychotropic use is only slightly reduced. The surgical intervention and the subsequent weight loss can affect several pharmacokinetic parameters, leading to a possible need of dosing adjustment.ObjectivesTo review the influence of bariatric surgery on the use and pharmacokinetics of psychotropic drugs.MethodsNon-systematic review of literature through search on PubMed/MEDLINE for publications from 2011 to 2021, following the terms psychotropic and bariatric surgery. Textbooks were consulted.ResultsIt is difficult to predict how psychotropics will be affected by bariatric surgery because of interindividual differences and limited data. Malabsorptive surgical procedures have a relatively greater potential to alter drug exposure. Medication disintegration, dissolution, absorption, metabolism and excretion have been found to be altered in postbariatric patients. Antidepressants are the best studied psychotropics in the bariatric population and their absorption is reduced. The risk of gastric bleeds with bariatric surgery will probably be increased by serotoninergic antidepressants. Antipsychotics and mood stabilisers are not well studied in these patients. Depot antipsychotics avoid the risk of reduced absorption after surgery. Lithium use requires particular close monitoring.Conclusions Close treatment monitoring and the ongoing monitoring of symptoms are needed after bariatric surgery. Many patients may not require significant changes to drug treatment after surgery.DisclosureNo significant relationships.

Gastrointestinal Symptomatology as a Predictor of Esophagogastroduodenoscopy Findings in the Bariatric Population: a Retrospective Cohort Study with Review of the Literature.

Esophagogastroduodenoscopy (EGD) is a useful test to diagnose significant pathologies before bariatric surgery. Controversy remains about its role in the preoperative workup of asymptomatic patients. This study aims to describe findings and changes in the management related to EGD. A secondary objective was to review the existing literature on the subject to analyze the role of patients' gastrointestinal symptomatology as an indication to undergo a preoperative EGD. A retrospective chart review of patients operated at the Centre hospitalier universitaire de Sherbrooke (CHUS) since the opening of the Clinique médico-chirurgicale du traitement de l'obésité (CMCTO) was conducted, alongside a review of the literature. Pathologic findings on EGD were classified into 4 groups (groups 0 to 3). Results of this study were combined with literature to calculate weighted averages of global sensitivity, specificity, positive/negative predictive values, and likelihood ratios of gastrointestinal symptomatology as a predictor of pathologic endoscopy findings. A total of 737 patients were included in the study. Of those, 236 (35,7%) were considered symptomatic. Significant pathologic findings on EGD (group 2 and 3) were present for 270 patients (36.6%). Changes in medical management occurred in 22.8% of cases and in surgical management in 3.5% of cases. When combining past studies with the present one, the presence of symptoms had a sensitivity of 57.4% and a specificity of 82.4% for findings on EGD. Considering that this exam is relatively safe, that it allows uncovering a great number of pathologies altering management, and that symptoms are not a good screening test to decide of its indication, the authors recommend that all bariatric surgery patients undergo an EGD in their preoperative workup.

Laparoscopic-Assisted Transversus Abdominis Plane Block Is Superior to Port Site Infiltration in Reducing Post-Operative Opioid Use in Laparoscopic Surgery.

The ultrasound-guided transversus abdominis plane (TAP) block can be time-consuming, costly, and technically challenging in the bariatric patient population. Laparoscopic-assisted TAP (L-TAP) block was developed and has been shown to be non-inferior to ultrasound-guided blocks. Postoperative pain can be significant, and pain control in the morbidly obese patients can be challenging. This study's aim was to compare L-TAP block to traditional port site infiltration in terms of postoperative opioid requirement for morbidly obese patients after laparoscopic Roux-en-Y gastric bypass (RYGB) surgery. A retrospective chart review was performed from February 2019 through February 2020. Two study groups: L-TAP block and port site infiltration. Outcomes examined the amount of opioid used at different time segments relative to the operation. All intravenous (IV) and oral opioids used were converted into IV morphine milligram equivalents (MME) for standardization. 150 patients were included. The patient characteristics were not statistically significant between the two groups. Post-operative opioid use trended lower in the L-TAP block group in all time segments. A significant difference was detected in IV opioid use during post-operative day 0 with the mean MME for the L-TAP block group being 1.1±3.8 and port site infiltration group being 2.8±4.5 (P = .02). The L-TAP block more effectively reduces postoperative opioid use in comparison to port site infiltration in laparoscopic Roux-en-Y gastric bypass (RYGB) surgery. Based on these findings, as well as the efficiency and cost-effectiveness of L-TAP blocks, its routine use in laparoscopy should be considered.

Comparing the Impact of Social Distancing and Lockdown on Surgical versus Medical Weight Management during COVID-19 Pandemic-Cross Sectional Study

Social distancing negatively impacts dietary, exercise and psychological health of the bariatric population. We aim to evaluate the impact of quarantine on post-Metabolic Surgery (MS) compared to medical weight management patients.

History of abuse and bariatric surgery outcomes: a systematic review.

Although there is evidence to support the relationship between abuse history and obesity, the association between abuse history and outcomes after bariatric surgery is not well-established. We aimed to summarize the current literature examining this relationship, as well as provide clinical recommendations to optimize postoperative outcomes. PubMed and SCOPUS databases were queried to identify relevant published studies. Overall, 20 studies were included. Rates of the various types of abuse reported in the bariatric surgery population varied widely across studies, as did the methodology used to assess it. The majority of studies found no significant associations between abuse history and postoperative weight loss outcomes. The literature examining the relationship between abuse history and postoperative psychiatric outcomes was less conclusive. Most current evidence demonstrates that abuse history is not associated with weight loss outcomes after bariatric surgery. Literature on postoperative psychiatric outcomes is mixed, and more robust studies are needed to further investigate the relationship between abuse history and postoperative psychiatric outcomes. Importantly, abuse history should not preclude patients from undergoing bariatric surgery. Of note, patients may benefit from careful monitoring for emotional distress and worsening of psychiatric comorbidities after surgery and psychiatric counseling and treatment when indicated.