Outcomes Of Bariatric Surgery In Patients Research Articles

136 – Bariatric Surgery Outcomes in Patients Requiring Anticoagulation: An Analysis of the Mbsaqip

136 – Bariatric Surgery Outcomes in Patients Requiring Anticoagulation: An Analysis of the Mbsaqip

Mo2040 – Bariatric Surgery Outcomes in Patients with Previous Organ Tranplants: An Analysis of the Mbsaqip

Mo2040 – Bariatric Surgery Outcomes in Patients with Previous Organ Tranplants: An Analysis of the Mbsaqip

National Postoperative Bariatric Surgery Outcomes in Patients with Chronic Kidney Disease and End-Stage Kidney Disease.

Obesity is a major risk factor for end-stage kidney disease (ESKD) and is often a barrier to kidney transplantation. However, limited evidence exists evaluating postoperative bariatric surgery outcomes in patients with chronic kidney disease (CKD) and ESKD. We performed a retrospective cohort study of patients who underwent bariatric surgery in 2015-2016 using the national Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program dataset. Propensity score matching was used to balance characteristics across patients with CKD and ESKD vs. those without CKD. There were 323,034 patients without CKD, 1694 patients with CKD, and 925 patients with ESKD who underwent bariatric surgery. Patients with CKD and ESKD had a significantly increased risk of 30-day reoperation (CKD odds ratio [OR] 2.25 95% confidence interval [CI] 1.45-3.51; ESKD OR 3.10, 95% CI 1.72-5.61) and readmission (CKD OR 1.98, 95% CI 1.53-2.56; ESKD OR 2.97, 95% CI 2.05-4.31) compared to patients without CKD; mortality risk was elevated in patients with ESKD (OR 11.59, 95% CI 6.71-20.04) but not in those with CKD (OR 1.00, 95% CI 0.32-3.11). Rates of adverse outcomes were < 15% across all groups. There were 12, 50, and 172 deaths per 1000 person-years among patients without CKD, with CKD, and with ESKD, respectively. Patients with CKD and ESKD experienced higher risk of postbariatric surgery complications compared to those without kidney disease, although absolute complication rates were low across all groups. CKD and ESKD should not be perceived as contraindications to bariatric surgery.

Proteomic Identification of Biomarkers Associated with Eating Control and Bariatric Surgery Outcomes in Patients with Morbid Obesity.

The current therapeutics of morbid obesity could be significantly improved after the identification of novel biomarkers associated with the food addiction endophenotype of obesity and with bariatric surgery outcomes. We applied differential expression proteomics and enzyme-linked immunosorbent confirmatory assays to identify (a) proteins that varied according to loss of control over eating in morbidly obese patients and (b) proteins that varied between normoweight controls and patients before and 1year after bariatric surgery. Clusterin was the only protein that consistently varied according to eating control in patients. Patients showed increased levels of serum amyloid P protein, apolipoprotein A4, serotransferrin, complement factors B and C3 and haptoglobin with respect to controls; the levels of all these proteins tended to return to control values 1year after surgery. In contrast, apolipoprotein A1 and transthyretin were initially downregulated in patients and were scarcely changed by surgery. Leucine-rich alpha-2-glycoprotein was markedly increased in patients only after surgery. Clusterin could be of interest as a putative biomarker for food addiction diagnosis in people with morbid obesity. In addition, postsurgical normalization of the proteins initially dysregulated in obese subjects might help monitor clinical improvements after surgery, while lasting or newly detected alterations (i.e., those affecting transthyretin and leucine-rich alpha-2-glycoprotein) could reflect partial refractoriness and/or contribute to the early prediction of clinical problems.

A134 - Bariatric Surgery Outcomes in Patients with BMI≥50

A134 - Bariatric Surgery Outcomes in Patients with BMI≥50

Bariatric Surgery in Patients with Type 1 Diabetes and Obesity—A Three-Year Observational Matched Cohort Study

Recent data show that ∼50% of patients with type 1 diabetes (T1D) are overweight or obese. Few patients with T1D and obesity resort to bariatric surgery (BS) for weight reduction and possible improvement in glycemic control. However, previous studies reported conflicting long-term effects of BS on glycemic control and other cardiovascular risk factors in this population. Meanwhile, no previous study compared BS outcomes in patients with T1D to a matched cohort receiving standard care. In our electronic health records, we identified 20 patients with T1D and obesity who underwent BS and received diabetes care at our center (baseline mean age 41±10 years, T1D duration 24±12 years, all female, HbA1c 8.4±1.3%, BMI 43.6±6.3 kg/m2, weight 119.2±18.0 kg, systolic BP 128±11 mmHg, diastolic BP 75±8 mmHg, LDL-C 104±34 mg/dL, HDL-C 59±18 mg/dL, triglycerides 121±61mg/dL). We matched them in a 1:1 ratio with a similar cohort of patients who received standard diabetes care at the same center (baseline mean age 43±12 years, T1D duration 22±11 years, HbA1c 8.4±1.0%, BMI 43.9±6.3 kg/m2, weight 116.1±19.3 kg, systolic BP 123±17 mmHg, diastolic BP 71±9 mmHg, LDL-C 81±22 mg/dL, HDL-C 57±20 mg/dL, triglycerides 103±62mg/dL). T1D was confirmed based on the presence of antibodies, history of DKA and clinical criteria. There were no differences between cohorts at baseline, except that more patients used insulin pump therapy in the BS cohort (55% vs. 35%, p&amp;lt;0.05). At 3 years, body weight changed by -33.5±2.6 kg (-28.1±2.2%) in the BS cohort and by +2.6±2.8 kg (+2.2±2.4%) in the matched cohort (p&amp;lt;0.0001). However, HbA1c, BP and LDL-C did not change from baseline in both cohorts. HDL-C increased and triglycerides decreased in the BS cohort in comparison to the matched cohort (p&amp;lt;0.for both). These results show that despite significant reduction in body weight and improvements in HDL-C and triglyceride levels, bariatric surgery has no long-term impact on glycemic control, BP and LDL-C in patients with T1D and obesity. Disclosure A. Mottalib: None. K. Alsibai: None. S. Tomah: None. T. Elseaidy: None. J.R. Holley-Cuthrell: None. R. Middelbeek: None. N. Mahmoud: None. S. Ashrafzadeh: None. F.M. Brown: None. O. Hamdy: Research Support; Self; Abbott. Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck &amp; Co., Inc.. Research Support; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Healthimation, LLC.. Consultant; Self; Sanofi-Aventis.

A5248 - Comparing Postoperative Bariatric Surgery Outcomes in Patients with and without Chronic Kidney Disease

Bariatric surgery (BS) has been proposed as a weight loss alternative in the chronic kidney disease (CKD) population with obesity to reduce comorbidities and improve renal function. Recent studies have focused on the safety and effectiveness of BS in this population, but few data exist regarding the outcomes between CKD and non-CKD patients. The aim of this study was to compare post-operative bariatric surgical outcomes between CKD and non-CKD patients after bariatric surgery.

Bariatric surgery outcomes in patients with systemic lupus erythematosus

BackgroundObesity is common among systemic lupus erythematosus (SLE) patients. An increased perioperative risk after major surgery in SLE has been reported. The aim of this study was to describe postoperative outcomes among SLE patients undergoing bariatric surgery. MethodsCharts were reviewed to identify patients with an active diagnosis of SLE before bariatric surgery. Demographic variables, perioperative data, and SLE-related parameters were extracted. ResultsThirty-one morbidly obese patients who underwent bariatric surgery between 2005 and 2013 had a SLE diagnosis. Twenty-three patients had laparoscopic Roux-en-Y gastric bypass (RYGBP), 3 underwent laparoscopic revisional surgery for failed bariatric procedure, 3 had laparoscopic sleeve gastrectomy and 1 underwent laparoscopic adjustable gastric banding. Mean age, body mass index, and excess weight (kg) at baseline were 52.8±9.4 years, 44.3±9 kg/m2, and 52.5±25.7 kg, respectively. Of these 31 patients, 24 (77.4%) were taking immunosuppressive medications at the time of surgery. Early major postoperative complications occurred in 4 patients (12.9%), with 3 requiring reoperation (9.6%). Multivariate analysis identified immunosuppressive therapy to be significantly associated with postoperative complications (P = .05). At a mean follow-up of 3 years, 13 patients (42%) showed reduction in the number of immunosuppressive medications and 6 (19.3%) were off steroids completely. After bariatric surgery, mean body mass index decreased to 34.2±8.2 kg/m2 (P<.005) and excess weight loss was 51.2%± 33.4%. ConclusionResults suggest that weight loss after bariatric surgery is associated with decreased SLE immunosuppression medication requirements; however, the risks are higher. Bariatric surgery in this patient population should be approached with caution.

Bariatric Surgery Outcomes in Patients Aged 65 Years and Older at an American Society for Metabolic and Bariatric Surgery Center of Excellence

Although morbid obesity rates in patients >or=65 years of age are increasing, few centers have reported weight loss surgery outcomes in elderly patients, resulting in a paucity of literature on perioperative mortality and morbidity. A retrospective analysis was performed on 197 consecutive patients >or=65 years old who underwent weight loss surgery from January 2000 to December 2007. Primary data points included 30-day and 1-year mortality rates, length of stay (LOS), percent excess weight loss (EWL), change in daily medication use, and quality of life (QOL). The average patient's age was 67.3 years with 72.1% being female. Average preoperative weight and BMI were 131.9 kg and 48.1 kg/m(2), respectively. Average preoperative daily medication use was 8.04 +/- 3.67. Procedure types included Roux-en-Y gastric bypass (79.3%), adjustable gastric banding (17.2%), and vertical sleeve gastrectomy (3%). Ninety-seven percent of procedures were performed laparoscopically. Average LOS was 2.0 +/- 2.1 days. Average weight, BMI, and daily medication use were significantly reduced at 6 months and 1 year (p < 0.001), with patients achieving an average EWL of 44.5% and 55.3% at 6 months and 1 year, respectively. QOL scores improved at 6 months (p < 0.001) and 1 year (p = 0.049). In all patients, the 30-day mortality rate was 0%. The 1-year mortality rate for RYGB patients was 1.3%. Complication rates were acceptable, with 7% of RYGB patients experiencing a major postoperative complication. Weight loss surgery is effective in patients >or=65 years of age, producing significant EWL, reduction in daily medication use, and improvement in QOL. Surgery is also associated with a low mortality rate and an acceptable morbidity profile.