Bariatric Surgery Center Research Articles

A Framework for Bariatric Surgery Patient Care: Patient and Professional Perceptions

Abstract Introduction A multidisciplinary health team for perioperative care of the bariatric patient, sustained in a viable framework to support a long-term follow-up service, may decrease rates of complications, help the recognition of the complexity of this chronic disease, and provide a comprehensive bariatric surgery process analysis. This study aimed to analyze patients’ and professionals’ experiences with the perioperative care process and identify their perceptions of the bariatric surgery process to support the long-term management of obesity surgical treatment. Methods This qualitative study was conducted in a bariatric surgery center in south Portugal. Seven health professionals participated in one focus group, and sixteen patients participated in one of the three focus groups. Patients’ focus group script had eleven open main questions with follow-up questions to probe for more information, addressing motivations, experiences with the pre-surgery and post-surgery process, and perceptions of lifestyle changes. Results Participants reported the need for a reference professional in the hospital to contact, the importance of psychological support to help patients deal with the ‘ups and downs’ of post-surgery life, and the financial support for physical activity programs. Conclusions This research helped identify a need for a framework for long-term follow-up and showed priorities to tailor health services for managing bariatric surgery patients. New bariatric surgery programs should incorporate a diverse health team, focusing on patient support in the long-term follow-up. This team should be led by a dedicated case manager and include physical activity specialists. Key messages • The positive effects of bariatric surgery go beyond weight loss, reinforcing the importance of developing a new conceptual framework based on a patient-centered care model. • A case manager specialist on the bariatric surgery process may be the key to improving the long-term benefits of bariatric surgery.

The Role of Informal Social Support for Patients Undergoing Bariatric Surgery.

Bariatric surgery is underutilized as a treatment for metabolic disease and its associated comorbidities. While social support is known to play a crucial role in outcomes following bariatric surgery, little is known about the role of social support prior to surgery, which may impact preparedness for and willingness to undergo surgery. The study's objective was to examine the role of informal social support prior to bariatric surgery, the types of support received, and patient attitudes toward different demonstrations of support. We conducted semi-structured interviews with patients who had previously undergone bariatric surgery (n = 20) from two high-volume bariatric surgery centers. Interviews focused on patient engagement with and attitudes about social support during the preoperative process. Transcripts from each interview were iteratively analyzed through steps informed by deductive and inductive thematic analysis. Four major themes emerged characterizing social support among patients undergoing bariatric surgery: (1) emotional support, (2) instrumental support, (3) informational support, and (4) self-support. Examples of meaningful support participants received included "cheerleading" (i.e., unconditional encouragement), advice from role models who had previously undergone surgery (e.g., receiving information on the process), shared experiences with loved ones regarding dietary and activity modifications (e.g., exercising with friends), and self-support measures (e.g., seeking therapy). A comprehensive understanding of how patients receive informal social support can offer valuable insights for individuals considering surgery. Further, such knowledge may enable providers to effectively counsel patients through the decision-making process and to ensure the establishment of support systems both pre- and post-surgery.

Bariatric surgery decreases prescription drug costs for metabolic syndrome: a Canadian population-based cohort study.

Obesity is a chronic disease that is significantly linked to metabolic syndrome. Bariatric surgery is considered the most effective treatment for obesity resulting in long-term weight loss and comorbidity resolution. Prior studies have demonstrated the overall cost effectiveness of bariatric surgery; however, there is little data regarding direct pharmaceutical costs. The objective of this population-based study is to compare the cost of dispensed common prescription medications for metabolic syndrome before and after bariatric surgery. All patients that were enrolled in the Center for Metabolic and Bariatric Surgery who underwent gastric bypass or sleeve gastrectomy between 2013 and 2019 in Manitoba were included. Basic demographic information and outpatient prescription dispensation data were obtained from the Manitoba Population Research Data Repository, which is housed at the Manitoba Centre for Health Policy. Specific drug categories that were reviewed for costs 5years before and after surgery included Antihypertensives, Lipid Lowering Agents, Insulin and Non-insulin Diabetic Drugs. One thousand one hundred and eighty four patients were included in this review. Comparing the 5-yearpre- and post-surgery, there was a decrease in the overall amount of drug dispensed and the overall cost for all drug categories in the 5years following surgery. These categories included Antihypertensives ($506,268.8), Lipid Lowering Agents ($173,866.48), Insulin ($549,305.92), and Other Diabetes Drugs ($513,371.1). Additionally, older patients experienced a larger proportion of cost savings compared to younger patients, with the exception of non-insulin diabetic medications which trended to have more cost savings in the 30-49year old grouping. This is the first Canadian study to use accurate dispensing data from a provincial administrative prescription database to capture long-term cost savings for metabolic prescriptions after bariatric surgery. The results are consistent with the existing literature for prescriptions post-bariatric surgery. Future study will include subgroup analysis by patient age, gender, income quintile, and geography.

Shanghai consensus on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy(2024 edition)

Morbid obesity and its accompanying diseases have become one of the most serious public health problems warranting global effort and bariatric and metabolic surgery is still the most effective method for long-term weight control. Among all bariatric and metabolic procedures, sleeve gastrectomy is currently the most widely used, but it is not a perfect procedure. One of the most serious issues that this surgical procedure faces is the possibility of worsening existing or developing de novo gastroesophageal reflux disease after surgery. Moreover, there is currently a lack of high-level clinical trial evidence on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy. Therefore, initiated by four domestic bariatric and metabolic surgery centers, 41 experts with rich experience in bariatric and metabolic surgery and diagnosis and treatment of gastroesophageal reflux disease from China, Japan, and South Korea reached a consensus on the diagnosis and treatment of gastroesophageal reflux disease in sleeve gastrectomy patients using the Delphi method. There are a total of 59 consultation questions in this consensus, of which 44 have reached a consensus. We hope that this consensus can not only serve as a reference for clinical diagnosis and treatment, but also provide more possible directions for future high-quality clinical research.

Primary care practitioner and patient perspectives on care following bariatric surgery: A meta-synthesis of qualitative research.

Primary care is central to ongoing health care following bariatric surgery and patients indicate a preference for receiving follow-up support by their primary care practitioner (PCP). This meta-synthesis investigates the perspectives of both PCPs and patients in post-bariatric surgery care provided by PCPs. The aim was to synthesize themes from qualitative research to recommend improvements in post-bariatric surgery clinical care in primary care settings. Systematic searches of Scopus, Medline, EMBASE, PsycINFO, the Cochrane Library, and Google Scholar resulted in the inclusion of eight papers in the meta-synthesis. Papers were critiqued using the Critical Appraisal Skills Program (CASP) and thematically coded in Quirkos Cloud. Seven themes were reached by author consensus including stigma and judgment; clinician barriers and facilitators; patient-related support needs; communication considerations; patient context or determinants; health care setting; and adapting to life after surgery. PCPs reported barriers including poor communication and guidance from bariatric surgery centers, limited knowledge and training in bariatric patient care, and patients who may have unrealistic outcomes and poor health literacy. Patients seek comprehensive care from their PCP, however, barriers hindering the provision of this care include adverse surgical outcomes, a poor relationship with their PCP, and limited and short-term follow-up care from the PCP. Insights from this meta-synthesis offer actionable recommendations for PCPs and bariatric surgery centers to enhance patient care immediately.

Five-Year Outcomes of Bariatric Surgery vs. Conservative Weight Management in People with HIV: A Single-Center Tertiary Care Experience

IntroductionIndividuals with human immunodeficiency virus (HIV) infection now have life expectancies similar to non-infected people but face increased obesity prevalence. The long-term effects of bariatric surgery (BS) and conservative weight therapy (CWT) in patients living with HIV (PLWH) remain unexplored.MethodsA retrospective review (2012–2018) at a Tertiary Centre for Bariatric Surgery and National Centre for HIV care examined the outcomes of BS and CWT. Parameters evaluated included weight loss and HIV metrics such as viral load and CD4 count.ResultsThe study included 24 chronic HIV patients, with 10 undergoing BS (5 laparoscopic adjustable gastric banding (LAGB), 3 laparoscopic sleeve gastrectomy (LSG), 2 Roux-en-Y gastric bypass (LRYGB) and 14 in CWT. The BS group showed significant BMI reduction (− 7.07, − 6.55, − 7.81 kg/m2 at 1, 3, and 5 years). The CWT group’s BMI reduction was non-significant. The BS group’s %TWL was 16%, 17.8%, and 15% at 1, 3, and 5 years, respectively; however, stapled procedures were more effective, at 1 year, %TWL was 17% LSG and 25% RYGB, at 3 years, 23% LSG, 30% RYGB and at 5 years 21% with LSG and 28% with RYGB. HIV outcomes remained stable with undetectable viral loads in the BS group.DiscussionBS appears to be a safe and effective medium-term treatment for obesity in PLWH, providing significant weight loss whilst maintaining the efficacy of HIV treatments. Although CWT has shown modest benefits, the outcomes from BS indicate that it could be a preferable option for managing obesity in PLWH based on this limited dataset.Graphical

Gender-specific differences in bariatric surgery: epidemiology, treatment and results

This study investigates gender-specific differences in obesity and the treatment by metabolic bariatric surgery (MBS). The database includes 2393 patients (1725 women, 668 men) from for ahigh-volume center for bariatric surgery. Demographic, perioperative and follow-up data were retrospectively analyzed. Men had a significantly higher body mass index (BMI) and more frequent obesity-associated diseases. Despite the higher prevalence of obesity in men, women accounted for 80% of the surgical patients. On average men had longer operation times but with the same complication rates. Postoperatively, both sexes experienced asignificant reduction in excess body weight, which was slightly more pronounced in women. The study particularly emphasizes the need to better motivate men to undergo obesity treatment in order to reduce the health consequences of morbid obesity in this population group.

Thrombosis of the superior mesenteric vein after laparoscopic sleeve gastrectomy – Case report and review of the literature

IntroductionBariatric surgery is the most effective treatment for patients with obesity. Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide. Although complication rate is low, thrombosis of the superior mesenteric vein (SMV) may be a rare but life-threatening complication after bariatric surgery. Presentation of the caseA 33-year-old female patient, BMI 51.8 kg/m², underwent an uneventful LSG at our center for bariatric and metabolic surgery in Hannover, Germany. 70 mg enoxaparin once daily was given as prophylactic anticoagulation until discharge.After an uneventful postoperative course and discharge at postoperative day 3, the patient presented 9 days later with epigastric and back pain in the emergency room. The CT scan showed thrombosis of the SMV.After thrombectomy of the SMV, several abdominal washouts, creation of a laparostoma and highly complex treatment at the intensive care unit the patient was discharged 8 weeks after revisional surgery. DiscussionThe incidence of thrombosis of the SMV after bariatric surgery is low, but mortality is high (up to 50 %). In the literature, only case reports and small series are reported. Possible causes and the management of the disease are variable and depend on the patients´ situation.Although thrombosis of the SMV is a rare complication after bariatric surgery, it should be considered or ruled out, if a patient presents with abdominal pain after a recently performed bariatric procedure. Treatment should be initiated immediately and may include therapeutic anticoagulation, interventional or surgical procedure. ConclusionEven if risk factors for thromboembolic events are unknown, every bariatric surgeon should be aware that patients with obesity are at risk.

Multimodal approach utilising a weight management programme prior to bariatric surgery in patients with BMI ≥50 kg/m2: A propensity score matching retrospective cohort study.

We evaluated preoperative weight loss and days from initial consult to surgery in patients with BMI ≥50 kg/m2 who were and were not enrolled in medical weight management (MWM) prior to laparoscopic sleeve gastrectomy. We retrospectively identified patients with BMI ≥50 kg/m2 who had primary sleeve gastrectomy between 2014 and 2019 at two bariatric surgery centres in our healthcare system. Patients presenting after 2017 that received preoperative MWM (n = 28) were compared to a historical cohort of non-MWM patients (n = 118) presenting prior to programme initiation in 2017 on preoperative percent total body weight loss (%TBWL) and days from initial consult to surgery. A total of 151 patients (MWM, 33; non-MWM, 118) met inclusion criteria. BMI was significantly greater in MWM versus non-MWM (p = .018). After propensity score matching, median BMI at initial consult in non-MWM versus MWM no longer differed (p = .922) neither were differences observed on the basis of weight, age, sex, race or ethnicity. After PSM, MWM had significantly lower BMI at surgery (p = .018), lost significantly more weight from consult to surgery (p < .001) and achieved significantly greater median %TBWL from consult to surgery (p < .001). We noted no difference between groups on 6-month weight loss (p = .533). Days from initial consult to surgery did not differ between groups (p < .863). A preoperative MWM programme integrated into multimodal treatment for obesity in patients with a BMI ≥50 kg/m2 resulted in clinically significant weight loss without prolonging time to surgery.

Presentations, management and outcomes of postoperative bariatric patients seen in the emergency department

BackgroundBariatric surgery is becoming increasingly common and postoperative patients often present to the emergency department (ED) with complications. We sought to describe the presenting complaints, management, and outcomes of postoperative bariatric surgery patients seen in the ED. MethodsWe conducted a health records review of 300 consecutive postoperative Roux-en-Y bypass surgery patients who presented to two tertiary care EDs of a major bariatric surgery center within one year of surgery. Cases were identified using a data analytic tool, and two evaluators abstracted clinical variables, imaging, treatments, and outcomes using the electronic health record. Attending emergency physicians verified the data and an experienced bariatric surgeon interpreted the computed tomography (CT) results and surgical procedures. ResultsWe included 300 patients with mean age 43.0 years, 89.7% female. Of these, 70.0% presented within 30 days of surgery and 41.7% were admitted to hospital. ED treatments included intravenous fluids (67.0%), antiemetics (53.3%), and analgesia (61.9%). Patients presenting within 30 days of surgery were more likely to undergo a CT (74.3% vs 63.3%; p = 0.06) and to have clinically important CT findings (31.9% vs 6.6%; p ≤0.001). More of the ≤30-day patients were admitted to hospital (46.2% vs 31.1%; p = 0.02). While a higher proportion of patients presenting after 30 days underwent a procedure, a large number of those were not directly related to bariatric surgery, such as appendectomy and cholecystectomy. Of the 34 patients undergoing a procedure, the majority presented with abdominal pain (76.5%). ConclusionThis is the first detailed health records review of postoperative bariatric patients seen in the ED in the emergency medicine literature. Those presenting with abdominal pain were more likely to undergo CT abdomen and a surgical procedure. Similarly, those presenting within 30 days of surgery were more likely to have significant CT findings and require hospital admission. Others presenting with primarily nausea and vomiting may improve with ED symptom management and be discharged home with bariatric team follow-up.

Novice Chinese Bariatric Nurses' Perceptions of Their Role as Bariatric Case Managers: A Qualitative Study.

Bariatric case managers (BCM) are integral healthcare team members for patients undergoing bariatric surgery in China. As the demand for bariatric surgery increases in China, the number of BCMs has also risen. However, more is needed to know about the perceptions of novice bariatric nurses toward their role as case managers. This study aims to investigate the perceptions of novice Chinese bariatric nurses toward their roles during the early stages of their careers. This qualitative study employed semi-structured individual interviews with 15 novice bariatric nurses who received training as BCMs. The interviews were audio-recorded, transcribed line-by-line, and analyzed thematically. The study was conducted in a bariatric surgery center of a public tertiary hospital in Southern China. Three themes emerged from the data related to the perceptions of being a BCM: "negotiating the ambiguity of the BCM role," "establishing a core set of behaviors for the BCM role," and "identifying areas of competence to develop a BCM role framework." The novice bariatric nurses expressed both positive and negative feelings toward their role. They highlighted the need for further training to improve their qualifications and the importance of support from colleagues, and hospital management. The findings illuminate the role of the BCM in China. Future research should investigate effective and acceptable job descriptions and cooperation modes between BCMs, colleagues and hospital management. We recommend using these findings to develop training programs for novice BCMs and improve their capacity to provide quality care to patients undergoing bariatric surgery.

Preliminary experience with 18 months result of endoscopic sleeve gastroplasty from an Asian population: Learning curve of one bariatric surgeon

Abstract Background Endoscopic sleeve gastroplasty (ESG) is emerging as an innovative approach to treating obesity. It provides a bridge between surgical and medical treatments for obesity. Nevertheless, the majority of reports on ESG originate from Western countries, and there is a lack of data from Asian nations. This study aims to share our pioneering experience with this novel technique in Asia. Materials and Methods We enrolled obese patients with a body mass index greater than 27 kg/m2 who were at least 20 years old. ESG was conducted following a comprehensive preoperative assessment. Following the procedure, patients were scheduled for regular outpatient department follow-up appointments at 7 days, 1 month, 2 months, 3 months, and then every 3 months up to 18 months postoperation. Body weight and any adverse events were documented during each follow-up visit. Results A total of 49 obese patients were enrolled in this study. Our findings demonstrate that ESG can be safely integrated into a conventional bariatric surgery center, with a learning curve observed after 10 cases in this study. In our series, the results showed that total body weight loss (TBWL) reached 7% at 1 month, 9% at 3 months, 14% at 6 months, 16% at 12 months, and 18.6% at 18 months. No adverse events or complications were reported in the study; however, five patients experienced procedure failures. Four of these patients underwent a repeat ESG, whereas one patient opted for surgical intervention. Conclusions ESG can be used in Asian countries, and the effectiveness of weight loss has proven to be satisfactory.

Management of Malnutrition and Hepatic Impairment After Duodenal Switch.

Malnutrition and liver impairment after duodenal switch (DS) are possible and undesired complications, often conservatively treated. However, in specific cases, surgical revision may be necessary. This study aims to describe outcomes achieved by two bariatric surgery centers and address effectiveness and safety of revisional surgical procedures to resolve these complications. A retrospective chart review was performed in two bariatric surgery centers from 2008 to 2022. Patients who required revisional surgery to treat malnutrition and/or liver impairment refractory to nutritional and total parenteral nutrition intervention (TPN) after duodenal switch were included. No comparisons were performed due to the descriptive nature of this study. Thirteen patients underwent revisional surgery, the mean age was 44.7, the 53.8% were females, and the mean preoperative BMI was 54.7kg/m2; the mean time between DS and revisional procedure was 26.5months, and 69.1% of patients were placed on TPN. One patient developed hepatic encephalopathy; one patient presented with ascites, pleural effusion, and renal insufficiency, undergoing reoperation after revisional procedure due to a perforated ileal loop. Mortality rate was 0%; all patients regained weight after the revisional procedure, and the mean total protein and albumin blood levels 12months after surgery were 6.3 and 3.6g/dl, respectively. While refractory malnutrition and/or liver failure are rare among patients post-DS, if underdiagnosed and untreated, this can lead to irreversible outcomes and death. All revisional procedures included in this study resulted in improvement of the nutritional status and reversal of liver impairment, with low complication rates.

Endoscopic sleeve gastroplasty safety profile - retrospective, single-center analysis of 222 consecutive patients including the learning curve period.

The global obesity epidemic affects over 1.9 billion adults, with an additional 650 million classified as obese. Endoscopic sleeve gastroplasty (ESG) is a type of minimally invasive endobariatric procedure. It is a less invasive alternative to laparoscopic sleeve gastrectomy (LSG). Although the effectiveness of ESG is lower, it might have a better safety profile. To assess the safety profile of ESG and describe complications classified as grade II or higher, using the Clavien-Dindo classification, with an overview of the learning curve. We included 222 patients who underwent ESG at the Endoscopic and Bariatric Surgery Center of the hospital in Brzeziny from January 2021 to October 2023. The severity of complications was evaluated based on the Clavien-Dindo classification, considering complications of grade II or higher. Among the studied group of patients, a total of 4 (1.8%) cases of perioperative bleeding into the gastrointestinal tract were recorded. One (0.5%) patient had the most severe grade IVb complication that required treatment in the Intensive Care Unit. All patients with serious adverse events (SAE) fully recovered. We did not observe an association between the learning curve, procedure duration, and the frequency or severity of postoperative complications. The presented results confirm the high safety of ESG in the treatment of obesity.

IBC-Oxford University2023_BJSOral_27Trends and Safety of Bariatric Revisional Surgery in Italy: multi-centre, prospective, observational study

Abstract Introduction Revisional bariatric surgery (RBS) represents a further solution for patients who experience inadequate weight loss (IWL) following primary bariatric surgery (BS) or significant weight regain (WR) following initial satisfactory response. RBS guidelines are lacking, however, an increased trend in further BS offering has been reported lately. Objectives Analysing trend, mortality, complication, readmission, and reoperation rates for any reason at 30 days after RBS in Italy. Setting: 10 Italian high-volume bariatric surgery centres (University hospitals and Private centres). Methods Prospective, observational, multi-centre study enrolling patients undergoing RBS between 01.10.2021-31.03.2022, registering reasons for RBS, technique, mortality, intraoperative and perioperative complications, readmissions, and reinterventions for any reason. Patients undergoing RBS during same calendar interval of 2016-2020 were considered control-group. Results 220 patients were enrolled and compared with 560 control-group patients. Mortality was 0.45% vs 0.35% (not significant), with an overall of 0.25%, while open surgery or conversion to open surgery registered in 1%. No difference was found for mortality, morbidity, complications, readmission (1.3%) and reoperation rates (2.2%). IWL/WR was the most frequent cause, followed by GERD; Roux-en-Y gastric bypass (RYGB) was the most used revisional procedure (56%). Sleeve gastrectomy (SG) was the most revised procedure in the study-group, while gastric banding in the control-group. RBS represents up to 9% of the total BS in the Italian participating centres. Conclusions Laparoscopy represents the standard approach for RBS, which appears safe. Current Italian trends show a shift towards SG being the most revised procedure and RYGB the most used as revisional procedure.

BS O08 The burden of bariatric health tourism on publicly funded health services in the UK

Abstract Background Bariatric surgery is a safe and effective treatment for obesity and it's associated co-morbidities. Limited access to surgery in the NHS and a combination of cheaper costs and aggressive advertising by international clinics has led to a surge in people seeking surgery abroad. There is a perception that an indeterminate volume of bariatric health tourism has resulted in increased rate of serious complications in UK. This study aimed to objectively quantify this perceived burden by describing the presentation, management and outcomes of bariatric emergencies in cases undertaken abroad and comparing them to emergency cases originating in the UK. Methods This was a retrospective review of all consecutive non-elective attendances and admissions between January 2018 and April 2023. The setting was a regional bariatric and metabolic surgery centre with a dedicated bariatric on-call service serving Greater Manchester and the North-West of England. Patient demographics, data on index procedures, diagnostic and therapeutic interventions as well as length of hospital and ITU stay was collected. Changes in trends in patients undergoing their index procedure abroad (bariatric health tourist BHT group) were explored and compared to those undergoing surgery in the UK (UK group). Results 373 non-elective episodes were included; 28% related to index procedures abroad. The proportion of admissions related to BHT was 35.5% (17/48), 21% (10/48), 16.5% (9/54), 17% (6/35) and 36.5% (47/128) in years 1 to 5 respectively. BHT patients presented were most likely to present with sleeve complications (33% vs UK 20%) whilst UK patients were most likely to present with band-related problems (46% vs BHT 20%). BHT patients underwent 124 fluoroscopies, 115 CT-scans and 60% required surgical interventions. BHT patients accounted for 37% of total bed days (1610/4311) and had longer median ITU stays (8 v 3 days). Conclusions The total number of emergency episodes related to bariatric surgery undertaken abroad increased eight-fold in the last 12 months compared to the preceding year, and was higher than the total number of episodes in the preceding 4 years. This reflects the ongoing challenges with patient access to publicly funded and affordable bariatric surgery in the UK. Complications arising in this patient group result in longer stays and greater resource burden compared to those patients who have undergone surgery in the UK. This trend has enormous resource implications for service design and an urgent response is needed.

BS O05 Resource impacts of bariatric surgery emergencies on the NHS: a 5-year review from a regional bariatric centre

Abstract Background Bariatric surgery is a safe and highly effective treatment for obesity. Whilst the risks of surgery are generally low, emergency presentations can be extremely challenging to manage, particularly in a cohort with complex health needs. In the UK, a large proportion of cases are undertaken outside of the NHS. Little is known about the burden that an indeterminate volume of elective cases has on a publicly funded healthcare system which may need to adapt to better care for this group. This study aimed to explore this topic further by understanding the changing trends of emergency care for bariatric surgery patients. Methods This was a retrospective review of all consecutive non-elective (NE) attendances and admissions between January 2018 and April 2023. The setting was a regional bariatric and metabolic surgery centre with a dedicated bariatric on-call service serving a regional population in the North-West of England. Patient demographics, data on index procedures, diagnostic and therapeutic interventions as well as length of hospital stay (LOS) and intensive therapy unit (ITU) stay was collected. Changing trends in presentations and resource utilization were explored. Results 373 NE episodes resulted in 4311 bed day occupancy; 76% had privately funded surgery accounting for 66.5% of total bed days. Median LOS was 5 days (IQR 2-11). 29 episodes resulted in 176 ITU bed days (median 4 days). Band-related complications were the most frequent cause of episodes (167) versus gastric bypass (104) and gastric sleeve (88). Median time from index procedure was 5 years IQR (2-11). 397 fluoroscopies and 365 CT-scans were undertaken in addition to 270 interventions (186 surgical; 30 radiological; 26 bedside deflations and 28 endoscopic). There was a three-fold increase in episodes between 2021 and 2022. Conclusions Non-elective episodes related to bariatric surgery can occur many years after the index procedure and result in the use of significant diagnostic, therapeutic and system resource. Our results suggest that the landscape of emergency bariatric surgery is changing with more cases that result in greater complex management needs. Most NE episodes are a result of privately funded surgery (likely as a response to limited access in the NHS) which have contributed to this increased resource use. These changes have serious implications for service delivery and design in the NHS which needs to rapidly adapt to these needs.

Safety and feasibility of destination care for bariatric surgery: a single institution retrospective study.

Increasing emphasis on value-based healthcare has prompted both employers and healthcare organizations to develop innovative strategies to supply high quality care to patients. One such strategy is through the bundled care payment model (BCPM). Through this model, our institution partnered with employers from across the country to provide quality care for their members. Patients traveling greater than 2h driving time from the bariatric center were considered "destination" patients. To properly care for our destination patients, our institution created a "destination bariatric program." We sought to investigate comparative outcomes for the first 100 patients who completed the program. We hypothesized that there would be no difference in patient outcomes or complications between destination and local patient groups undergoing sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). A retrospective cohort analysis of patients undergoing bariatric surgery at a MBSAQIP-accredited bariatric surgery center between May 2019 and October 2021 was conducted. Patients were divided into destination or local patient groups based on participation in the established destination surgery program. Patient demographics, perioperative clinical outcomes, and complications were compared and statistically analyzed using two-sample t-tests, Chi-square tests, Fisher's exact tests, and univariate logistic regressions. This study identified 296 patients, which consisted of destination (n = 110) and local (n = 186) patient cohorts. Patients in the destination group had higher rates of diabetes mellitus (29.1% vs 24.2%, p = 0.029), but otherwise cohorts had similar basic demographics and comorbidities. Outcomes revealed no statistically significant associations between patient cohort (destination versus local) and ED admission (p = 0.305), hospital readmission (p = 0.893), surgical reintervention (p = 0.974), endoscopic-reintervention (p = 0.714), and patient complications in the postoperative period (30days). Participation in destination care programs for bariatric surgery was found to be both safe and feasible. These destination programs represent an opportunity to provide a broader patient population access to complex surgical care.

Bariatric surgery outcomes in patients with bipolar or schizoaffective disorders.

Obesity is associated with many co-morbidities and can cause harm to physical and mental well-being. While much has been studied in the general population about the outcomes of bariatric surgery, its implications in patients with bipolar/schizoaffective disorder (BSD) are less well understood. We aimed to describe outcomes of bariatric surgery in patients with BSD. Referral center for bariatric surgery. We conducted a retrospective chart review analysis of bariatric surgical procedures in patients with BSD between 2008 and 2021 at Mayo Clinic. Patients with BSD (cases) were matched via propensity score matching (1:2) with non-BSD controls based on surgical procedure, age, sex, body mass index, and type 2 diabetes. Hierarchical logistic regression model was performed using SAS software. We matched 71 patients with BSD with 142 controls in a 1:2 ratio. After adjusting for baseline preoperative weight, patients with BSD had a 3.4% greater total weight loss compared with controls over 24 months (P = .02 [95% CI, .65-6.08]). Remission in obesity-related diseases, such as diabetes, hypertension, dyslipidemia, and sleep apnea, was similar in both groups. Perioperative complication rates were similar other than deep venous thrombosis, which showed a higher rate in patients with BSD (P = .04). Patients with long-term BSD were at increased risk of alcohol use compared with controls. When compared with the general bariatric population, weight loss was similar to slightly improved, with a comparable risk and complication profile. Patients with BSD have increased alcohol use after bariatric surgery, highlighting the need for psychological care before and after surgery in this population.

Long-term follow-up of a cohort with post sleeve gastrectomy leaks: results of endoscopic treatment and salvage surgery.

Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide. The most challenging postoperative complication is gastric leak. The objectives of this study are to examine the efficacy and morbidity of different therapeutic strategies addressing leakage, and the long-term outcomes of a cohort of LSG leaks. A retrospective review of patients treated for LSG leaks between September 2014 and January 2023 at our high-volume bariatric surgery center was performed. The charts of 37 patients (29 women and 8 men) were reviewed, with a mean age of 43years and a median follow-up of 24months. The mean preoperative body mass index was 45.1kg/m2. Overall, 30/37 (81%) patients were successfully treated with endoscopic management, and 7/37 (19%) ultimately underwent salvage surgery. If the leak was diagnosed earlier than 6weeks, endoscopic treatment had a 97% success rate. The median number of endoscopic procedures was 2 per patient, and included internal pigtails, stents, septoplasty, endoluminal vacuum therapy and over-the-scope clips. Complications included stent-related ulcers (10), esophageal stenosis requiring endoscopic dilatations (4), stent migrations (2) and kinking requiring repositioning (1), and internal pigtail migration (3). Revisional surgery consisted of proximal gastrectomy and Roux-en-Y esophago-jejunal anastomosis, Roux-en-Y fistulo-jejunostomy or classic Roux-en-Y gastric bypass proximal to the gastric stricture. In 62% of the cases, the axis/caliber of the LSG was abnormal. Beyond 4 attempts, endoscopy was unsuccessful. The success rate of endoscopic management dropped to 25% when treatment was initiated more than 45days after the index surgery. Purely endoscopic management was successful in 81% of cases; with 97% success rate if diagnosis earlier than 6weeks. After four failed endoscopic procedures, a surgical approach should be considered. Delayed diagnosis appears to be a significant risk factor for failure of endoscopic treatment.