Patient Selection For Bariatric Surgery Research Articles

Analysis of psychometric questionnaires used in patient selection for bariatric surgery

IntroductionIn severe forms of obesity there is a high prevalence of psychopathological comorbidity. Psychiatric evaluation is an important component of comprehensive obesity care and contributes to optimizing therapeutic results after bariatric surgery. ObjectiveTo assess the effectiveness of psychometric tests used in the protocol for selecting patients for bariatric surgery. Material and methodsRetrospective naturalistic observational study of 100 patients who were candidates for bariatric surgery. Patients who complete the psychometric protocol and the psychiatric interview between January 2019 and June 2021 are included. Two groups are formed: those considered unfit for any psychopathological reason and those considered fit. To evaluate the effectiveness of the tests used, ROC curves will be used. The sensitivity and specificity values of each test used will be obtained. Results97 patients included, aged between 20 and 61 years, 64.9% women. 51.5% had a family history and 38.1% a personal history of any psychiatric disorder. Regarding the area under the curve, the scales that presented a value greater than 0.7 were the YFAS total score (0.771), HADS-D (0.757), the Edinburgh Bulimia total score (0.747), the severity score of YFAS (0.722) and Edinburgh Bulimia Severity Score (0.705). The most frequent diagnoses as a cause of exclusion were Food Addiction 8 (20.5%) and Generalized Anxiety Disorder (GAD) 6 (15.5%). ConclusionsThe YFAS, BITE and HADS-A scales were useful to discriminate those patients considered unsuitable for bariatric surgery for any psychopathological cause.

Patient selection for bariatric surgery: a review of health outcomes, safety and the role of the MDT

The pandemic of Obesity with its rapidly rising prevalence and burden on the health system, has become a major health concern. A variety of modifications including dietary, physical activity changes, behavioural in addition to pharmacotherapy interventions have been recommended for obesity management. Bariatric surgery has also been recommended for individuals with a Body Mass Index (BMI) exceeding or equal to 40 kg/m2 or in the range between 35 kg/m2 and 40 kg/m2 with a simultaneous significant comorbidity. Health practitioners often face the dilemma of patient selection when making a decision on bariatric surgical procedure suitability. This selection process is key to attaining good surgical outcome. Therefore, the input of a profecient multi- disciplinary team is crucial to the process. The following brief review is to point out the factors that influence the selection process. It describes the diverse bariatric surgical procedures available, discusses their efficacy, safety and complications rate, and emphasizes on the role of the MDT team in procedure selection according to patient characteristics

Sex disparity in laparoscopic bariatric surgery outcomes: a matched-pair cohort analysis

Men have been historically considered to be higher-risk patients for bariatric surgery compared to women, the perception of which is suggested to be a barrier to bariatric surgery in men. The purpose of this study is to conduct a matched-pair analysis to evaluate sex disparities in laparoscopic bariatric surgery outcomes. Data on patients who underwent laparoscopic bariatric surgery from March 2013 to 2017 was collected prospectively. Then, 707 men and 707 women pair-matched for age, preoperative body mass index (BMI) and the procedure type (i.e., sleeve gastrectomy, Roux-en-Y, or one-anastomosis gastric bypass) were compared in terms of weight loss, remission of obesity-related comorbidities, and postoperative complications classified according to the Clavien–Dindo classification. There was no difference between the two sexes regarding the operation time, bleeding during surgery and length of postoperative hospital stay. We observed similar total weight loss, BMI loss, and percentage of excess BMI loss at 12, 24, and 36 months postoperatively between men and women, with no difference in remission of diabetes mellitus, hypertension and dyslipidemia at 12 months. The rate of in-hospital, 30-day and late complications according to Clavien–Dindo classification grades was similar between men and women. Our matched-pair cohort analysis demonstrated that bariatric surgery results in comparable short- and mid-term efficacy in men and women, and is associated with similar rate and severity of postoperative complications between sexes. These findings suggest bariatric surgeons not to consider sex for patient selection in bariatric surgery.

Bariatric surgery in the treatment of morbid obesity in adolescents (literature review)

Morbid obesity in children is associated with various metabolic complications, often persisting into adulthood and leading to reduced quality and duration of life. Conservative treatment of morbid obesity, often ineffective, and therefore, bariatric surgery in adolescents is becoming more common throughout the world. This review presents an analysis of international clinical guidelines for patient selection for bariatric surgery, assessed the efficiency and safety of different types of bariatric operations and identified the main problems of the widespread use of metabolic surgery as a method of treatment of morbid obesity in adolescents.

Systematic review of psychological and social outcomes of adolescents undergoing bariatric surgery, and predictors of success.

The psychological and social outcomes of bariatric surgery in adolescents, together with psychological and social predictors of success, were systematically reviewed. PubMed, EMBASE, ISI Web of Science and PsychInfo were searched on July 2014. Existing data were sparse; 15 were suitable for qualitative review and six for meta-analysis (four quality of life [QOL], two depression). One study was a randomized controlled trial. A total of 139 subjects underwent Roux-en-Y gastric bypass, 202 underwent adjustable gastric band and 64 underwent sleeve gastrectomy. Overall QOL improved after bariatric surgery, regardless of surgical type with peak improvement at 6-12 months. Meta-analysis of four studies showed changed in overall QOL at latest follow-up of 2.80 standard deviation (SD) (95% confidence interval [CI] 1.23-4.37). Depression improved across all studies, regardless of procedure (effect size -0.47 SD [95% CI -0.76, -0.18] at 4-6 months). Two cohorts reported changes in both overall QOL and depression following a quadratic trajectory, with overall improvement over 2 years and deterioration in the second post-operative year. There were limited data on other psychological and social outcomes. There were insufficient data on psychosocial predictors of outcome to form evidence-based recommendations for patient selection for bariatric surgery at this time.

A retrospective audit of patient selection for bariatric surgery

A retrospective audit of patient selection for bariatric surgery

Does Age Influence Bariatric Surgery Outcomes?

Aim: The purpose of this study was to evaluate presurgical comorbidities, perioperative and postoperative complications, and postsurgical outcomes of minimally invasive bariatric surgery in patients aged 55 years and older to determine if age should be used as a selection criteria for bariatric surgery. Methods: A total of 750 patients underwent sleeve gastrectomy or robotic-assisted Roux-en-Y gastric bypass from January 2008 to June 2014. Patients were divided into three groups according to age: <55 years old; ≥55 to <65 years old; and ≥65 years old. Demographics, presurgical comorbidities, perioperative and postoperative complications (leaks or conversions to open surgery), and postsurgical outcomes were compared across the different groups. Results: Significant differences in presurgical comorbidities were found across age groups (p<0.001). Results from descriptive statistics revealed that patients younger than 55 years of age had a greater number of complications-defined as leaks (n=1) or conversions to open surgery (n=2)-than did patients older than 55 years of age. There were no significant differences across age groups regarding length of stay. Linear regression analysis failed to reveal significant associations between age and percentage excess weight loss at 6, 12, and 24 months follow-up. Conclusions: These initial results suggest that patient selection for bariatric surgery should not be based on age alone.

Obesity in the Elderly and Bariatric Surgery

The prevalence of morbid obesity is rising progressively among elderly patients in the world. The incidence of obesity in Koreans, 60 years and older was 34.2% in 2012. Although there was no consensus on criteria for weight loss management in aged persons, it is clear that weight loss therapy improves metabolic syndrome, physical function and health-related quality of life in obese older persons. The current therapeutic tools available for weight management in older persons do not differ from those for weight management in general; 1) lifestyle intervention involving diet, physical activity, and behavior modification; 2) pharmacotherapy; and 3) surgery. Currently, bariatric surgery can be safely performed with low morbidity and mortality rates in obese older people. In addition, the elderly can lose clinically significant amounts of weight after bariatric surgery and significant weight reduction is associated with an improvement in obesity-related co-morbidities and an overall reduction in medication requirements. Patient selection for bariatric surgery should not be based on age alone.

The Potential Role of the Edmonton Obesity Staging System in Determining Indications for Bariatric Surgery

The prevalence of obesity has continued to increase worldwide over the last two decades [1]. Presently, over 20% of the global population is overweight (BMI≥25 kg/ m), and 10% is considered clinically obese (BMI≥30 kg/ m) [2]. This equates to approximately 1.5 billion individuals being overweight and 500 million being obese worldwide [3]. These estimates are expected to continue to increase by 2030 to 2.16 billion overweight individuals and 1.12 obese individuals [2]. Similarly, in Canada, approximately 60% of Canadians are overweight and 24% are clinically obese [4]. Despite modest weight loss following lifestyle modifications, bariatric surgery is the only evidence-based approach to producing marked and sustainable weight loss in severely obese individuals. Body mass index (BMI) remains the most common measure to estimate adiposity in these individuals, and current guidelines to select appropriateness for bariatric surgery are based on BMI, with Canadian bariatric centers typically offering bariatric surgical management to individuals with BMI ≥35 kg/m with obesity-related comorbidities (e.g., type 2 diabetes mellitus) or to any patient with a BMI ≥40 kg/m. However, BMI alone may not be the optimal measure to guide patient selection for bariatric surgery. Thus, previous studies have suggested that BMI may be a poor prognostic predictor of mortality [5]. Recently, Sharma and Kushner proposed the Edmonton obesity staging system (EOSS) as a more comprehensive measure of obesity-related disease burden and predictor of mortality [6]. In this review, we explore the current evidence in support of EOSS and discuss its potential role to determine indications for bariatric surgery.

Predictors of Patient Selection in Bariatric Surgery

To identify sociodemographic and clinical predictors of patient selection in bariatric surgery. Population-based studies suggest that bariatric surgery patients are disproportionately privately insured, middle-aged white women. It is uncertain whether such disparities are due to surgeon decisions to operate, differences among morbidly obese individuals in access to surgery, or patients' personal preferences regarding surgical treatment. We conducted a national survey of 1343 U.S. bariatric surgeons. The questionnaire contained clinical vignettes generated using a balanced fractional factorial design. For each of 3 hypothetical patients unique in age, race, gender, body mass index (BMI), comorbidities, social support, functional status, and insurance, respondents were asked if they would operate. Logistic regression was used to determine the odds of selection for each characteristic while controlling for the other 7 characteristics. Subset analyses were also performed using combinations of BMI and comorbidities. A total of 62.5% of eligible surgeons responded (n = 820). Patient race did not influence surgeon decisions to operate. Hypothetical patient age, BMI, and social support were most influential. In the subgroup of patients who did not meet current NIH BMI and comorbidity criteria for bariatric surgery, male sex (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.14-0.76) was associated with decreased odds of selection. Overall, younger age (OR, 0.09; 95% CI, 0.07-0.11), older age (OR, 0.70; 95% CI, 0.56-0.90), limited functional status (OR, 0.66; 95% CI, 0.52-0.82), poor social support (OR, 0.37; 95% CI, 0.30-0.47), self-pay (OR, 0.72; 95% CI, 0.57-0.91), and public insurance (OR, 0.54; 95% CI, 0.43-0.67) were associated with decreased odds of selection. BMI and comorbidity criteria influenced the magnitude of these effects. Patient race did not play a role in surgeon decisions to operate. Further research should examine the roles of unequal access to bariatric surgery and differing socio-cultural perceptions of morbid obesity on racial disparities. The influence of patient age, gender, insurance status, social support, and functional status on decisions to operate was mitigated by BMI and comorbidities. Policy-makers currently debating BMI and comorbidity criteria for bariatric surgery should also consider guidelines pertaining to these sociodemographic issues that influence patient selection in bariatric surgery.

Perioperative management of the bariatric surgery patient: focus on cardiac and anesthesia considerations.

Obesity is a major public health problem in developed nations worldwide. Currently, the only treatment for severe obesity (BMI > or = 35 kg/m2 with comorbidity) that provides long-term weight loss is bariatric surgery. Restrictive, malabsorptive, and combination procedures have been developed. Each type of procedure has its merits and unique set of risks and complications. Weight loss after bariatric surgery is accompanied by predictable improvement or resolution of obesity-related comorbidities and improved quality of life and life expectancy. Candidates for bariatric surgery are often at high risk for complications because of obesity-related comorbidities. Therefore, careful patient selection for bariatric surgery, together with well-designed strategies for preventing and managing complications, are keys to success. Close monitoring for nutritional deficiencies and short- and long-term complications is required to completely assess outcomes of these procedures.

Determinants of patient selection in bariatric surgery

Determinants of patient selection in bariatric surgery

Impact of Preoperative Teaching on Surgical Option of Patients Qualifying for Bariatric Surgery

During the last 5 years, the performance of bariatric operations has doubled via our outpatient obesity clinic. Currently, 52% of the patients presenting for weight loss are interested in bariatric surgery. Gastric banding and Roux-en-Y gastric bypass are the two laparoscopic procedures proposed. The aim of this study was to evaluate the impact of preoperative teaching on the patients' surgical option. All the candidates for bariatric surgery were submitted to preoperative teaching and those between February 2001 and December 2002 are the subject of this study. The teaching consisted of 3 weekly interactive 2-hour sessions. During the first session, the patients were asked about the type of operation that they had in mind: gastric banding, gastric bypass, or not yet decided. The same questions were repeated at the end of the third session, with an additional possible answer: no surgery. 297 consecutive patients with a BMI >35 kg/m(2) with at least one severe co-morbidity, were submitted to preoperative teaching. 80% of the patients were women. Median age was 41 years. Before teaching, 68 patients (23%) were uncertain, 100 (34%) favored gastric banding, and 129 (43%) wanted a gastric bypass. After education, only 3 patients (1%) remained uncertain, 45 (15%) changed their surgical option, and 27 (9%) declined surgery. The proportion of patients opting for gastric banding decreased from 34% to 20%, whereas those electing bypass increased from 43% to 70%. Preoperative training provides an informed and better patient selection for bariatric surgery. It helps the patients understand the various surgical options, and makes their decision easier.