Bariatric Surgery Follow-up Research Articles

The impact of bariatric and metabolic surgery on the morbidity and mortality of patients infected during the COVID-19 pandemic: a retrospective cohort study.

Since the impact of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, several studies have shown a strong relationship between obesity and severe cases of COVID-19. It is imperative to assess whether bariatric surgery exerts a protective effect in such cases. This study aimed to assess the impact of bariatric surgery on the morbidity and mortality in obese patients during the COVID-19 pandemic. A comprehensive search was performed using the PubMed and Cochrane Library databases. Retrospective cohort studies conducted in the Faculdade de Medicina da Universidade Cidade de São Paulo, São Paulo (SP), Brazil. The search comprised the following descriptors: "bariatric, surgery, COVID-19". Current retrospective cohort studies that examined the influence of bariatric surgery on the morbidity and mortality of obese patients during the COVID-19 pandemic were considered eligible. After removing duplicates, 184 studies were obtained from the databases. Of these, 181 were excluded from the analysis as they did not meet the eligibility criteria. Patients undergoing postoperative follow-up of bariatric surgery had a similar probability of SARS-CoV-2 infection compared to the general population, and persistent comorbidities were associated with an increased risk and severity of infection. Bariatric surgery has a protective effect against severe COVID-19 in the obese population, bringing the prevalence of severe disease cases to levels equivalent to those of the nonobese general population, with a positive impact on morbidity and mortality.

A257 Evaluation of Telehealth Services to Improve Post Bariatric Surgery Follow-up Rates and Patient Experience

A257 Evaluation of Telehealth Services to Improve Post Bariatric Surgery Follow-up Rates and Patient Experience

OpenEHR based bariatric surgery follow-up

According to the World Health Organization (WHO), more than one billion people in the world are obese, and this number is still increasing. When this disease becomes a high risk to the individual's health and the non-invasive approach does not result in weight loss, it is usual to resort to an invasive intervention, bariatric surgery. Due to all the specifications, as well as the multidisciplinary treatment inherent to this procedure, the need for a specialized environment emerges. In this context, the main objective of this topic focuses on the development of a platform for registration and monitoring of bariatric surgery. For this purpose, a web platform was created, which integrates openEHR forms for the registration of appointments regarding this intervention, and uses openEHR modeling to build the interoperable template. The development of this project aims to provide greater ease and speed in patient care, assisting health professionals in their daily lives.

Does Bariatric Surgery Improve Kidney Function in obese Patients? A Cohort Study

Introduction: Obesity is a global epidemic that may cause renal dysfunction. Weight loss in the postoperative follow-up of bariatric surgery may improve renal function in these patients. Thus, the purpose of this study was to give insight on the subject using a sensible biomarker: cystatin C. Materials and methods: This cohort was performed in the Obesity Department from Campina Grande – Paraiba, Brazil. It was recruited 35 obese (25 women and 10 men) who underwent bariatric surgery with follow-up of at least one year. The ages ranged from 24 and 57 years. Those with thyroid disease and with microalbuminuria ≥ 30mg/g were excluded. Serum levels of creatinine and cystatin C were measured, and the glomerular filtration rate (GFR) was estimated using the CKD Epi (Chronic Kidney Disease Epidemiology Collaboration) equation creatinine- cystatin C. The investigation was approved by the Ethics Committee. The sample was of convenience. Quantitative variables were expressed by the mean and standard deviation. Paired tests were used for assessing difference between means. Chi square test and exact Fisher were used for difference among frequencies. p ≤ 0.05 was used for rejecting the null hypothesis. Results:The most frequent associated morbidities were: sexual dysfunction (n = 17 – 48.5%); hypertension (n =15 – 42.8%); type II diabetes (n =13 – 37.1%); anxiety (n = 14 – 40.0%); and depression (n = 12 – 34.2%). Twenty-three (65.7%) patients underwent sleeve technique and 12 (34.2%) bypass surgery. It was observed a significant reduction in the mean of body mass index (BMI) in the post-operative follow-up – p < 0.0001. The mean concentrations of cystatin C were similar, regarding to pre- and post-operative periods – p = 0.1614. There was a significant improvement of glomerular filtration rates - p= 0.0091. The improvement of renal function was more significant among those who underwent sleeve surgery as compared to bypass - p = 0.0008. Conclusion: It was observed improvement of the majority of morbidities after bariatric surgery, as well as renal function, in obese individuals. Despite these results, larger and longer-term outcome cohorts are required for better answer of the main purpose of this health issue.

Behavior of Iron and Ferritin After Bariatric Surgery in Patients With and Without Hepatic Steatosis.

Iron deficiency and hepatic steatosis are common in bariatric surgery patients. Steatosis can falsely elevate ferritin values even in presence of iron deficiency. This study aims to assess the influence of hepatic steatosis on iron deficiency and replacement therapy after bariatric surgery. Seventy-nine individuals undergoing gastric bypass have been studied at 4 time points (preoperative and 1, 3, and 6months after surgery). Weight, body mass index (BMI), iron, ferritin, vitamin B12, folate, hemoglobin, gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and use of iron replacement were recorded. Forty-two individuals (53%) had moderate/severe steatosis assessed by ultrasound. No differences were seen in iron profile and replacement therapy features compared to individuals with no/mild steatosis both in the preoperative and postoperative periods. Mixed model analysis showed ferritin levels to be higher in the moderate/severe steatosis group than in no/mild steatosis at the 6th month (139 ± 131 vs. 60.9 ± 49.8, p < 0.05). Values in both groups were lower than baseline, with p < 0.0001. The same was observed with serum iron (92.1 ± 39.6 moderate/severe steatosis vs. 68.6 ± 33.4 no/mild steatosis, p < 0.001; p from baseline < 0.01 for both). GGT was higher in moderate/severe steatosis in the 3rd month (38.8 ± 40.5 vs. 28.8 ± 20.8, p < 0.05; p from baseline < 0.0001 for both). Ferritin levels were consistently higher in individuals with steatosis in the follow-up of bariatric surgery, but no apparent implication on the diagnosis of iron deficiency and in the prescription of replacement therapy was demonstrated at 6months of follow-up. Longer studies are probably necessary to investigate this matter.

SurgiCal Obesity Treatment Study (SCOTS): a prospective, observational cohort study on health and socioeconomic burden in treatment-seeking individuals with severe obesity in Scotland, UK

ObjectivesThere is a lack of evidence to inform the delivery and follow-up of bariatric surgery for people with severe obesity. The SurgiCal Obesity Treatment Study (SCOTS) is a national longitudinal...

Bariatric surgery and perioperative education: The look of patients who are waiting for surgery

Objective: To know the perception of patients who expect the performance of bariatric surgery on perioperative education.Methods: Exploratory study performed with patients from the preoperative period of bariatric surgery in a reference institution in the realization of the surgical procedure by the Sistema Único de Saúde (SUS) in the State of Ceará, Brazil, in January 2019, through a focal group.Results: Five categories related to the perception of the subjects about the perioperative education were identified: “Imagining what life will be like after the bariatric surgery”; “Fear and anxiety with the performance of bariatric surgery”; “Preoperative preparation and follow-up in the health service”; “Resolution of doubts during the preoperative preparation” and “Main doubts of those who are still in the preoperative”.Conclusions: It was evident that the participants recognized the importance of the preoperative follow-up of bariatric surgery, highlighted as beneficial the occurrence of educational strategies in this period for the acquisition of knowledge and resolution of doubts, especially about the surgical procedure and postoperative care.

The role of speech therapist in the patient care team for bariatric surgery

The work of the speech therapist with patients undergoing Bariatric Surgery (BS) is still little explored, although essential for the adequate preparation of the subject for surgery, as well as for his short and long term recovery. Given its importance and it’s still limited performance in this scenario, the objective of this study was to verify the perception of patients about the importance and effectiveness of speech therapy both in the pre and postoperative period of BS. Questionnaires were carried out with 44 patients divided into 4 groups, according to the moment of bariatric surgery follow-up. Most of the subjects were unaware of the role of the speech therapist at the beginning of the treatment, but they considered their guidance and their presence in the team relevant during the process. The ignorance of the role of the SpeechLanguage Pathologist in the care of bariatric patients is related to the incipient participation of Speech-Language Pathologists in this scenario. The positive impact of speech therapy guidelines in the preoperative period improves quality of life, provides information and clarifies subjects’ doubts and fears, enhancing results and minimizing postoperative problems. The professional’s guidance in relation to the aspects experienced in the patients’ daily lives implies a consensus on the importance of the participation of the Speech Therapist during the process of monitoring the BS. Patients’ perception of the importance of the guidelines received by the Speech-Language Pathologist was well-known, as well as their necessary participation in the multidisciplinary team. The results demonstrated the effectiveness of speech therapy both in the pre and in the short and long term postoperative period.

COVID-19: A Lever for the Recognition of Obesity as a Disease? The French Experience.

Despite repeated efforts by the international scientific community, academic societies and the combined actions of patient associations, public authorities have difficulties in admitting that obesity is not just a risk factor but a disease. Could our current experience with the COVID-19 pandemic be a lever to advance the cause of people with obesity? In this crisis, it seems pertinent to report on the French experience with the actions of stakeholders that were able to challenge the status quo in this field.

Relapse of Diabetes After Roux-en-Y Gastric Bypass for Patients With Obesity: 12Years Follow-up Study.

Roux-en-Y gastric bypass (RYGB) is a recommended treatment for type 2 diabetes mellitus (T2DM) in patients with obesity, with superiority over medical therapy. While diabetes remission is achieved initially in 60-90% of patients following surgery, many may experience relapse of diabetes on the long-term. Data on long-term follow-up of bariatric surgery is scarce. We report this 12-year follow-up study of glycaemic control following RYGB. Two hundred seventeen patients with obesity (109 diabetic, 108 matched nondiabetic) who underwent RYGB between 2000 and 2008 were identified. Data was recorded prospectively for these patients at baseline and 2years postoperatively. The long-term data was obtained via direct contact with the patients cross-checked with our hospital/national patients' electronic databases. The follow-up rate was 88% (initial age 44 ± 9years, female 79%). The mean (± SD) percentage total weight loss was 28% (± 15%) and 27% (± 17%) at 2years and 12years, respectively. Diabetes remission rate was 69% at 2years, but decreased to 36% at 12years following surgery. The 12-year incidence of new-onset T2DM in the control group was 4.3%. On univariate analysis, age, preoperative duration of diabetes and use of insulin were associated with less chance of diabetes remission at long-term (p value 0.06, 0.01 and 0.03, respectively). However, on multivariate regression analysis, only the duration of diabetes preoperatively remained significant (p = 0.025). This study shows a high relapse of diabetes 12-year post-RYGB despite the durability of weight loss. This affects preoperative counselling and indicates a need for a longer follow-up to detect relapse.

Eating Behavior after Bariatric Surgery (EBBS) Questionnaire: a New Validated Tool to Quantify the Patients' Compliance to Post-Bariatric Dietary and Lifestyle Suggestions.

In the management of bariatric surgery follow-up, a multidisciplinary approach allows to evaluate the weight loss maintenance and the dietary and lifestyle changes adherence. The main aim of this study is to create and to validate a questionnaire (eating behavior after bariatric surgery (EBBS)) to objectivize the compliance to dietary/lifestyle suggestions after bariatric surgery. An observational retrospective monocentric clinical trial was carried out at the Bariatric Surgery Unit of Modena, Italy. All weight-related data of bariatric surgery patients collected during the multidisciplinary post-surgical path were recorded. EBBS questionnaire and three validated psychological tests were administered. EBBS includes 11 questions concerning food (domain A), drinks (B), behaviors (C), and lifestyle (S). All data analyzed in the study were collected during the same visit. In 41 enrolled patients (52.2+11.9years), the total weight loss after surgery was 44.87+18.37kg (- 35.40+11.60%), with a weight loss maintenance of 86.92+14.30%. The EBBS questionnaire showed a good internal validity (Cronbach's alpha 0.743, Hotelling's T-square test p < 0.001). The S domain was directly related with the percentage of weight loss maintained (p = 0.048), suggesting that the frequent physical activity and the periodic weight self-check are the most predictive behaviors to obtain weight control. None of the psychological questionnaires appeared related to the weight trend. We validated for the first time a 11-item self-filling questionnaire allowing to quantify the adaption to dietary/lifestyle suggestions provided after bariatric surgery. EBBS questionnaire could be a useful tool both in clinical and research setting to monitor the patient's adherence to post-surgical indications and to identify predictive factors for bariatric surgery efficacy.

Levothyroxine dose adjustment in hypothyroid patients following gastric sleeve surgery

IntroductionEuthyroid patients show decreased TSH level following sleeve gastrectomy. However, studies of levothyroxine absorption after bariatric surgery reported contradictory results and data on levothyroxine dose adjustment according to weight are sparse. The aim of this study was to evaluate levothyroxine dose adjustment during weight loss following sleeve surgery. MethodThis retrospective study assessed change in levothyroxine dose in patients undergoing sleeve gastrectomy at the university hospital center of Nîmes (France) between January 2010 and March 2016. Patients were receiving standard bariatric surgery follow-up with levothyroxine therapy for hypothyroidism. ResultsFifty-two of the 271 patients who underwent sleeve gastrectomy (19.2%) were being treated with levothyroxine. Among these patients, 31 were followed up for 12 months, including 12 who were followed up for 24 months. Mean weight loss was 35±11kg at 12 months and 41.8±10.2 kg at 24 months. Daily levothyroxine dose decreased from 108 [88–144] μg/day to 94 [63–125] μg/day at 12 months and 69 [44–134] μg/day at 24 months, with positive correlation between dose and weight loss at 12 months (P=0.03). Weight-adjusted dose was 1.04 [0.81–1.24] μg/kg/day at baseline, 1.14 [0.85–1.66] μg/kg/day at 12 months, and 0.85 [0.53–2.10] μg/kg/day at 24 months, showing no correlation with weight loss. Median TSH level dropped to 1.30 [0.63–2.27] mIU/l at 12 months and 1.48 [1.08–2.42] mIU/l at 24 months. ConclusionDespite a decrease in daily levothyroxine dose correlating with weight loss at 12 months, the absence of correlation with weight-adjusted dose suggests the involvement of confounding factors such as poor levothyroxine absorption or altered thyroid function. Further studies are required to elucidate the absorption of levothyroxine.

Long-term outcomes of macrovascular diseases and metabolic indicators of bariatric surgery for severe obesity type 2 diabetes patients with a meta-analysis.

There is currently no detailed evidence for the long-term effects of bariatric surgery on severely obese with type 2 diabetes, such as the risk of myocardial infarction and stroke. In order to provide evidence on the risks of macrovascular diseases and metabolic indicators of bariatric surgery follow-up for more than five years, we searched in the Cochrane library, Pubmed, and EMBASE databases from the earliest studies to January 31, 2019. Randomized clinical trials or cohort studies compared bariatric surgery and conventional medical therapy for long-term incidence of macrovascular events and metabolic outcomes in severely obese patients with T2DM. Fixed-effects and random-effects meta-analyses were performed to pool the relative risks (RRs), hazard ratios (HRs) and weighted mean difference (WMD). Publication bias and heterogeneity were examined. Four RCTs and six cohort studies were finally involved in this review. Patients in the bariatric surgery group as compared to the conventional treatment group had lower incidence of macrovascular complications (RR = 0.43, 95%CI = 0.27~0.70), cardiovascular events (CVEs) (HR = 0.52, 95%CI = 0.39~0.71), and myocardial infarction (MI) (RR = 0.40, 95%CI = 0.26~0.61). At the same time, the results demonstrate that bariatric surgery is associated with better weight and better glycemic control over the long-term than non-surgical therapies, and reveal that different surgical methods have different effects on various metabolic indicators. Bariatric surgery significantly decreases macrovascular complications over the long term and is associated with greater weight loss and better intermediate glucose outcomes among T2DM patients with severe obesity as compared to patients receiving only conservative medical measures.

Exploring the Effects of Telemedicine on Bariatric Surgery Follow-up: a Matched Case Control Study.

Telemedicine offers a potential solution for bariatric surgery (BS) aftercare for patients living in rural areas with limited access to healthcare services. This study aimed to compare post-BS appointment adherence, psychosocial, and body mass index (BMI) outcomes in patients that did or did not use telemedicine. In total, 192 (96 telemedicine and 96 non-telemedicine) patients were matched on gender, age, time since surgery, BMI, and travel distance from program. Additional psychosocial and demographic variables including rurality index (RIO) were collected. Telemedicine users had a significantly higher RIO (p < 0.001) than non-telemedicine users. Appointment attendance, BMI, and psychosocial outcomes were not significantly different between the two groups. Therefore, our results suggest that telemedicine could help overcome geographical barriers to provide comparable quality healthcare services to more remote regions.

THE ALCOHOL CONSUMPTION IS AMENDED AFTER BARIATRIC SURGERY? AN INTEGRATIVE REVIEW.

ABSTRACT Background: Bariatric surgery has been an alternative when conservative methods of weight loss fail. Patients undergoing bariatric surgery have an increased risk of up to 6.5% of problems related to alcohol. Objetive: To review the literature about the changes on alcohol consumption in this public. Method: Database was accessed from June of 2015 to January of 2016 by searching “bariatric surgery” AND “alcoholism”, and their Portuguese equivalents. Science Direct, PubMed, Lilacs and Medline, besides manual search, were searched. To be included, the paper should have been published between 2005-2016 and related to bariatric surgery and alcoholism. Theses, dissertations, unpublished papers, case reports and theoretical studies were excluded. In 2005 there was only one review of change in alcohol metabolism in patients undergoing bariatric surgery. There were no publications in 2006. In 2007, only one study was published, and it did not meet the inclusion criteria. In 2010, there was an increase of 13% in publications and of 20% in 2012, reaching 40% in 2013. Conclusion: The prevalence and incidence of alcohol consumption in relation to the postoperative time was six months to three years with higher incidence in men. Roux-en-Y gastric bypass showed greater association with increased alcohol consumption during the postoperative period. This and other studies showed that the pattern of alcohol consumption is important to be faced as a problem in bariatric surgery follow-up.

Understanding the post-surgical bariatric experiences of patients two or more years after surgery.

In Canada, one year after bariatric surgery follow-up appointments become less frequent and surgical recipients must cope with weight management more independently. Up to 50% of patients experience weight regain by two years post-surgery. Understanding the lived experiences of those who have gone through the bariatric process may shed light on what is needed to support others moving forward. Therefore, the purpose of the study was to gain an understanding of the physical, psychological, social, and clinic-related experiences of individuals who have undergone bariatric surgery at least two years prior. The purpose of the study was to gain an understanding of the physical, psychological, social, and clinic-related experiences of individuals who have undergone bariatric surgery at least two years prior. In-depth, individual semi-structured interviews lasting approximately 60min were conducted. Interviews were transcribed verbatim and inductive content analysis was used to identify emerging themes. Methods were employed throughout to support data trustworthiness. Participants (n=28; 21 female) wereprimarily middle-aged (mean: 49.7±12.7years old), Caucasian (71%), and completed bariatric surgery more than three years. The data fell naturally into four primary themes, namely physical changes and challenges, psychological experiences, social functioning and support, and clinic-related experiences and reflections. Generally, participants described positive improvements in their physical, psychological, and social state since surgery. However, concerns pertaining to several unanticipated outcomes of the surgery were underscored and informed the recommendations for other patients to be prepared to relearn about ones' body, utilize the support services available, and be aware that social relationships may change and/or require tending. Participants' insights can be used to help others meet with long-term success post-bariatric surgery.

Guidelines for the follow-up of patients undergoing bariatric surgery.

Bariatric surgery can facilitate weight loss and improvement in medical comorbidities. It has a profound impact on nutrition, and patients need access to follow-up and aftercare. NICE CG189 Obesity emphasized the importance of a minimum of 2 years follow-up in the bariatric surgical service and recommended that following discharge from the surgical service, there should be annual monitoring as part of a shared care model of chronic disease management. NHS England Obesity Clinical Reference Group commissioned a multi-professional subgroup, which included patient representatives, to develop bariatric surgery follow-up guidelines. Terms of reference and scope were agreed upon. The group members took responsibility for different sections of the guidelines depending on their areas of expertise and experience. The quality of the evidence was rated and strength graded. Four different shared care models were proposed, taking into account the variation in access to bariatric surgical services and specialist teams across the country. The common features include annual review, ability for a GP to refer back to specialist centre, submission of follow-up data to the national data base to NBSR. Clinical commissioning groups need to ensure that a shared care model is implemented as patient safety and long-term follow-up are important.

Su1982 Compliance With Bariatric Surgery Follow-Up and Weight Loss Outcomes

Su1982 Compliance With Bariatric Surgery Follow-Up and Weight Loss Outcomes

Predictors of Post-bariatric Surgery Appointment Attendance: the Role of Relationship Style

Attendance at bariatric surgery follow-up appointments has been associated with bariatric surgery outcomes. In this prospective study, we sought to examine psychosocial predictors of attendance at post-operative follow-up appointments. Consecutive bariatric surgery patients (n = 132) were assessed pre-surgery for demographic variables, depressive symptoms, and relationship style. Patients were followed for 12 months post-surgery and, based on their attendance at follow-up appointments, were classified as post-surgery appointment attenders (attenders--attended at least one appointment after post-operative month 6) or post-surgery appointment non-attenders (non-attenders--did not attend at least one appointment after post-operative month 6). Psychosocial and demographic variables were compared between the attender and non-attender groups. Multivariate logistic regression was used to identify significant predictors of attendance at post-bariatric surgery follow-up appointments. At 12 months post-surgery, 68.2 % of patients were classified as attenders. The non-attender group was significantly older (p = 0.04) and had significantly higher avoidant relationship style scores (p = 0.02). There was a trend towards patients in the non-attender group living a greater distance from the bariatric center (p = 0.05). Avoidant relationship style was identified as the only significant predictor of post-operative appointment non-attendance in the logistic regression analysis. These findings suggest that avoidant relationship style is an important predictor of post-bariatric surgery appointment non-attendance. Recognition of patients' relationship style by bariatric surgery psychosocial team members may guide the delivery of interventions aimed at engaging this patient group post-surgery.

Internet of Things and bariatric surgery follow-up: Comparative study of standard and IoT follow-up

Introduction:Follow-up of obese patient is difficult. There is no literature related to patient follow-up that incorporates the concept of Internet of Things (IoT), use of WiFi, Internet, or portable devices for this purpose. Material and methods:This prospective observational study commenced in June 2011. Patients were prospectively offered to participate in the IoT study group, in which they received a WiFi scale (Withing®, Paris) that provides instant WiFi data to the patient and surgeon. Other patients were admitted to the standard follow-up group at the outpatient clinic. A total of 33 patients were included in our study (ten in the IoT group). Results:Twelve patients did not have WiFi at home, ten lacked of computer knowledge, and seven preferred standard for follow-up. All patients underwent different surgical procedures. There were no complications. Excess weight loss (EWL) was similar in both groups. More than 90% of patients were satisfied. In the IoT group, patients considered it valuable in saving time, and considered seeing their evolution graphics extremely motivating. Conclusion:IoT technology can monitor medical parameters remotely and collect data. A WiFi scale can facilitate preoperative and follow-up. Standard follow-up in a classical outpatient clinic setting with the surgeon was preferred globally.