Post-bariatric Surgery Patients Research Articles

Evaluating Night-Eating Syndrome in bariatric surgery patients: A cross-sectional study

BackgroundNight-Eating Syndrome (NES) is a complex eating disorder that has gained recognition in the context of bariatric surgery. However, its prevalence and associated factors in this specific patient population remain understudied, particularly in the Saudi Arabian context.MethodsThis cross-sectional study was conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, from June to November 2022. Adult patients who had undergone bariatric surgery with a postoperative follow-up of 6 months were included. NES was assessed using the Night Eating Questionnaire (NEQ).ResultsA total of 154 patients were enrolled in the study, with a mean age of 38.8 ± 11.4 years. The mean BMI before surgery was 44.8 ± 8.2 kg/m2, which reduced to 28.9 ± 5.8 kg/m2 post-surgery. Of these, 52 patients (33.8%) met the criteria for NES based on NEQ scores. The prevalence of NES was significantly higher among female patients, with 35 out of 83 females (42.2%) compared to 17 out of 71 males (23.9%) experiencing NES. While NES was not significantly associated with age, nationality, diet adherence, BMI, or surgery type, chronic diseases—particularly diabetes—emerged as significant risk factors for NES in post-bariatric surgery patients.ConclusionNES is a prevalent concern among post-bariatric surgery patients, with distinct associations with gender and chronic diseases, particularly diabetes. This study provides valuable insights into NES prevalence and its risk factors in the Saudi Arabian context, highlighting the importance of addressing eating disorders within the framework of bariatric surgery care.

A Dutch Survey on Medication Adjustments after Metabolic and Bariatric Surgery: Experiences of Bariatric Surgeons, Internists, Pharmacists, and General Practitioners

BackgroundAs metabolic and bariatric surgery (MBS) can alter the pharmacokinetics of drugs, post-bariatric surgery patients may require medication adjustments and monitoring. To improve pharmacotherapy in these patients, we aimed to understand the beliefs, attitudes, knowledge, and concerns of healthcare professionals who treat these patients.MethodsA survey by means of an online questionnaire was divided into six sections. It was sent to bariatric surgeons, internists, pharmacists, and general practitioners in the Netherlands.ResultsOut of 229 returned surveys, 222 were included. Virtually all respondents (98%) expected MBS to influence the effect of medication. Both reduced efficacy (23%) and more adverse events or medication-related complications (21%) were recognized. Two-thirds of the respondents felt competent to prescribe or to provide advice regarding medication in post-bariatric surgery patients.Most of the respondents (95%) believed that other healthcare professionals should be aware of the contraindication “bariatric surgery”. Of the respondents, 37% indicated that they were not aware of the medication advice incorporated in the electronic health record systems. Almost half of the respondents (48%) indicated that they documented changes in drug effects. Most respondents answered that these ought to be registered in the pharmacovigilance database or national registry.ConclusionsThe majority of prescribers and pharmacists believe that patients will receive better pharmacotherapy if healthcare professionals take MBS into account. However, not all prescribers think they are competent to act adequately. To improve this, information on changed drug effects after MBS should be more widely shared among healthcare professionals via resources that are easily accessible.Graphical

Glucagon-Like Peptide-1 Receptor Agonists in Post-bariatric Surgery Patients: A Systematic Review and Meta-analysis.

A significant number of patients face the issue of weight gain (WG) or inadequate weight loss (IWL) post-bariatric surgery for obesity. Several studies have been published evaluating the role of glucagon-like peptide-1 receptor agonists (GLP1RA) for weight loss post-bariatric surgery. However, no systematic review and meta-analysis (SRM) till date has evaluated the efficacy, safety and tolerability of GLP1RA in this clinical scenario. Hence, this SRM aimed to address this knowledge gap. Databases were searched for randomized controlled trials (RCTs), case-control, cohort and observational studies involving use of GLP1RA in the intervention arm post-bariatric surgery. Primary outcome was weight loss post at least 3months of therapy. Secondary outcomes were evaluation of body composition parameters, total adverse events (TAEs) and severe adverse events (SAEs). From initially screened 1759 articles, 8 studies (557 individuals) were analysed. Compared to placebo, patients receiving liraglutide had significantly greater weight loss after 6-month therapy [MD - 6.0kg (95% CI, - 8.66 to - 3.33); P < 0.001; I2 = 79%]. Compared to liraglutide, semaglutide had significantly greater percent reduction in body weight after 6-month [MD - 2.57% (95% CI, - 3.91 to - 1.23); P < 0.001; I2 = 0%] and 12-month [MD - 4.15% (95% CI, - 6.96 to - 1.34); P = 0.004] therapy. In study by Murvelashvili et al. (2023), after 12-month therapy, semaglutide had significantly higher rates of achieving > 15% [OR 2.15 (95% CI, 1.07-4.33); P = 0.03; n = 207] and > 10% [OR 2.10 (95% CI, 1.19-3.71); P = 0.01; n = 207] weight loss. A significant decrease in fat mass [MD - 4.78kg (95% CI, - 7.11 to - 2.45); P < 0.001], lean mass [MD - 3.01kg (95% CI, - 4.80 to - 1.22); P = 0.001] and whole-body bone mineral density [MD - 0.02kg/m2 (95% CI, - 0.04 to - 0.00); P = 0.03] was noted with liraglutide. Current data is encouraging regarding use of GLP1RAs for managing WG or IWL post-bariatric surgery. Deterioration of bone health and muscle mass remains a concern needing further evaluation. The predefined protocol has been registered in PROSPERO having registration number of CRD42023473991.

Low Mass Low Beat: The Effect of Bariatric Surgery on Cardiac Rhythm

Obesity is a global health problem, associated with significant morbidity and mortality. It is a multifactorial disorder associated with serious complications including diabetes mellitus, dyslipidemia and Cardiovascular Disease (CVD). Its prevalence has been increasing over the last few decades and has become a modern-day epidemic. The management and the treatment of obesity include lifestyle modifications and increased physical activity. Patients with a BMI of greater than 35 kg/m2 with other comorbidities such as type two diabetes are considered eligible for bariatric surgery. There is a plethora of evidence about the effect of bariatric surgery on medical outcomes including reversal of metabolic disease and reduction of negative cardiovascular outcome. Based on the few reported cases in the medical literature, increased cholinergic tone manifesting as bradycardia and delayed chronotropic response on stress test have been reported in post-bariatric surgery patients with significant weight loss. We reported three cases of patients that underwent bariatric surgery and present with brady-arrythmias. While considering other complications of bariatric surgery, it is important to consider cardiac related sequalae such as bradyarrhythmias like sinus bradycardia, atrioventricular block, sick sinus syndrome due to delayed chronotropic response and irreversible atrioventricular defect could be helpful in clinical decision making. We recommend that an EKG and echocardiogram should be a performed as part as of a routine analysis in patients who had a bariatric surgery.

Collaborative Prescribing Practice in Managing Patients Post-Bariatric Surgery in a Tertiary Centre in Singapore.

Background: A collaborative prescribing (CP) practice model, established by the endocrinologists, pharmacists, and advanced practice nurses, aims to provide for the postoperative monitoring and medical and nutritional management of stable patients after bariatric surgery. Method: Under the CP agreement, endocrinologists refer patients who have undergone bariatric surgery with stable medical conditions to CP practitioners, comprising senior pharmacists and advanced practice nurses. CP practitioners review the patient's weight loss progress, blood test results and vitals, the sufficiency of micronutrient repletion, adherence to supplements and medications, and chronic disease control. CP practitioners can prescribe and adjust the medications and supplements, in accordance with a clinical evaluation and standard guidance. Patients who require immediate attention due to complications or red flags are referred to the primary endocrinologist for further management. Results: From 5 May 2020 to 30 September 2023, CP practitioners provided 672 consultations. At least 68% and 80% of patients achieved appropriate weight loss post-surgery during the acute and maintenance phases, respectively. Less than 10% of the patients presented with anaemia and iron deficiency, and vitamin B12, folate and vitamin D deficiency. More than 80% of patients achieved a HbA1c of less than 7%. Conclusions: The CP practice framework provides a sustainable and viable model to facilitate optimal outcomes after bariatric surgery.

Chirurgie bariatrique et médicaments : revue de la littérature et analyse des effets indésirables dans la banque nationale de pharmacovigilance

Bariatric surgery is the only treatment for severe obesity (BMI>35kg/m2) currently recognized as effective both in achieving tangible and lasting weight loss, and in improving obesity-related comorbidities such as type 2 diabetes, hypertension, and cardiovascular complications. Bariatric surgery, like any other surgery of the digestive tract, can have an impact on nutrient absorption, as well as on drug absorption. The literature on drug management in bariatric surgery patients concerned mainly of case reports and retrospective studies involving a small number of patients. No official guidelines are available. We conducted a literature search on the consequences of bariatric surgery in terms of drug bioavailability and/or effect. The Medline® (PubMed) database was searched using the following keywords: "bariatric surgery", "bioavailability", "gastric bypass", and "obesity". We completed this review with an analysis of reports of adverse drug reactions (ADRs) in post-bariatric surgery patients for obesity registered in the National pharmacovigilance database (PVDB). We selected all cases with the mention of "bariatric surgery and/or gastrectomy" as "medical history". After reading the cases, we excluded those in which the patient had undergone surgery for an indication other than obesity, where the route of administration was other than oral, and cases in which ADRs resulted from voluntary overdose, attempted suicide, allergy, switch to Levothyrox® new formulation, meningioma under progestative drugs, inefficacy related to generic substitution and medication error. The literature search identified mainly "case report" about the impact of bariatric surgery on so-called "narrow therapeutic window" drugs. We identified 66 informative cases out of a total of 565 cases selected (11%) in the PVDB. Nevertheless, the information does not allow a clear relationship between the occurrence of the ADR and the influence of bariatric surgery. There is a lack of official information and/or recommendations on medication use in subjects who have undergone bariatric surgery. Apart from under-reporting, ADRs reports remain largely uninformative. Health professional and patients would be awareness for improving, quantitatively and qualitatively the reporting of ADRs in this population.

The financial toxicity of postbariatric body contouring surgery: a survey study of an urban tertiary care center’s patients

BackgroundPatients with obesity who undergo bariatric surgery achieve sustained weight loss but are often left with excess skin folds that cause functional and psychological deficits. To remove excess skin, patients can undergo postbariatric BCS; however, cost and lack of insurance coverage present a significant barrier for many patients. ObjectivesThis study aimed to characterize the financial impact of treatment on all patients who received bariatric surgery and to compare between those receiving only bariatric surgery and those with postbariatric BCS. SettingEmail-based survey study at an urban tertiary care center. MethodsSurveys that included the COST-FACIT were sent to patients with a history of bariatric surgery and/or post-bariatric BCS. ResultsOne hundred and five respondents completed the survey, of which 19 reported having postbariatric BCS. Patients with postbariatric BCS had slightly higher COST scores than those receiving bariatric surgery only, but this difference was not significant (15.6 versus 17.8, P = .23). Most patients (76%) did not have an awareness of BCS or BCS cost prior to bariatric surgery, and many (68%) had more loose skin than anticipated. ConclusionsFinancial toxicity was similar across all postbariatric surgery patients surveyed regardless of history of BCS. However, survey respondents noted a gap between patient education and expectations around loose skin and body contouring that can be addressed through improved presurgical counseling.

Top tips on endoscopy in post–bariatric surgery patients

Top tips on endoscopy in post–bariatric surgery patients

Post-bariatric Surgery Changes in Secondary Esophageal Motility and Distensibility Parameters.

Despite the increasing number of bariatric procedures over the recent years, the physiological changes in secondary esophageal motility and distensibility parameters after surgery remain unknown. This is a retrospective, single-center cohort study comparing esophageal planimetry and gastroesophageal junction (GEJ) distensibility in post-bariatric surgery patients (Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and conversion/revisional patients (DH)) and native-anatomy patients with obesity (NAC). Distensibility refers to the area achieved with a certain amount of pressure, and secondary peristalsis represents the esophageal response to an intended obstruction. Patients with pre-surgical dysmotility symptoms were excluded from the study. From November 2018 to January 2023, 167 patients were evaluated and eligible for this study (RYGB = 87, SG = 33, NAC = 22, DH = 25). In NAC cohort, 17/22 (77%) patients presented normal motility patterns compared to 35/87 (40%) RYGB, 12/33 (36%) SG, and 5/25 (20%) DH (p < 0.05 for all comparisons). The most common abnormal motility pattern for all three bariatric cohorts was absent contractions. DH patients generally had the highest mean maximum distensibility index averages, followed by SG, RYGB, and NAC. Bariatric surgery affects esophageal and GEJ physiology, and it is associated with higher rates of secondary dysmotility. DH patients have even higher rates of dysmotility. Further studies assessing clinical data and their correlation with manometric and pH-metric findings are needed.

Role of Ursodeoxycholic Acid in the Prevention of Gallstones Formation in Bariatric Patients-a Systematic Review and Meta-Analysis of Randomised Trials.

The aim of this meta-analysis was to assess whether treatment with ursodeoxycholic acid (UDCA) in patients who have undergone bariatric surgery reduces gallstone formation. A systematic literature search was performed using electronic databases (MEDLINE, Embase, CENTRAL, Web of Science, PROSPERO, Google Scholar and the WHO International Clinical Trials Registry platform). RCTs without restrictions on study language, year, status of publication and patient's age were used. Pooled risk ratios were calculated using a random-effects model. Subgroup analyses for drug dose, duration and procedure types were performed. Sensitivity analyses and a summary of findings table were generated to assess the robustness and the level of evidence provided, respectively. Fourteen trials were included (3619 patients, 2292 in UDCA vs 1327 in control group). Procedures included SG, RYGB, OAGB, AGB and Gastroplasty. UDCA dose ranged from 300 to 1200mg per day. Gallstone formation occurred in 19.3% (8.3% in UDCA vs 38.1% in the control group). UDCA significantly reduced the risk of gallstone formation (14 trials, 3619 patients; RR 0.27, 95% CI 0.18-0.41; P < 0.001). UDCA significantly reduced the risk of symptomatic gallstone disease (6 trials, 2458 patients; RR 0.30, 95% CI 0.21-0.43; P < 0.001). No subgroup difference was found for different doses, duration and type of procedure performed. Oral UDCA treatment significantly reduces the risks of developing gallstones in postoperative bariatric patients from 38 to 8%. The use of 500 to 600mg UDCA for 6months is effective and should be implemented in all patients post-bariatric surgery.

B-177 Quantitative Measurement of Vitamin B1 in Whole Blood using a Multiplex ESI-LC-MS/MS System

Abstract Background Vitamin B1 is a water-soluble vitamin required for human health. Thiamine diphosphate (TDP), the active form of vitamin B1, plays an essential role in biochemical pathways required for energy metabolism. TDP is analyzed routinely in the laboratory to assess the nutritional status of post-bariatric surgery patients and other individuals who are at risk of vitamin deficiency. In recent years, demand for vitamin B1 testing has increased dramatically, prompting development of a high throughput assay. Here, we present a method using protein precipitation and multiplex LC-ESI-MS/MS analysis at low pH with reversed-phase parameters that optimize chromatographic separation. The new method was validated for linearity, sensitivity, accuracy, imprecision, specificity, reproducibility, carryover, and stability. Method Whole blood samples were deproteinized using trichloroacetic acid (TCA) after the addition of stable-isotope-labeled TDP (d3-TDP) as an internal standard (IS). TDP was separated by reversed-phase chromatography on Waters XBridge™ Premier BEH C18 columns (2.1 × 100 mm, 2.5 µm) and analyzed on an Agilent StreamSelect™ LC-ESI-MS/MS platform. The StreamSelect™ system consists of four parallel Agilent Infinity Lab LC Series II instruments coupled to a single triple quadrupole mass spectrometer (6470B). TDP was found to interact with metal surfaces in the LC system, so the flow path was passivated using a deactivator solution which improved overall sensitivity and peak quality. TDP eluted in 3.15 ± 0.08 minutes; run times per column for a single stream and four streams were 9 min and 2.25 min, respectively. TDP was analyzed using positive electrospray ionization and multiple reaction monitoring mode with mass transitions of m/z 425.05 &amp;gt; 121.1 (quantifier) and m/z 425.05 &amp;gt; 304.00 (qualifier). Results The method was linear from 20 to 1000 nmol/L with an R2 &amp;gt; 0.99. Replicate analysis of low calibrators to evaluate assay sensitivity demonstrated accuracy within 10% and imprecision of ≤5%. Spike-recovery experiments showed an accuracy of ±15%. TDP measured in purchased, matrix-matched quality control (QC) and expired proficiency testing materials met the specified range for all samples. The intra- and inter-day assay imprecision was ≤3%. The cross-analyte interference study showed the analyte response in the IS-only blank was less than 10% of the LLOQ area. Also, the IS response at the ULOQ was ≤5% of the analyte area. Repeated injections of calibrators and QC materials across the four LC streams showed excellent parity (&amp;lt;2% imprecision). Re-injection reproducibility of extracted samples at 24 and 48 h was within ±2% of time zero concentration. Batch size tests indicated a high degree of robustness required to support the anticipated high testing volumes. Conclusions An accurate, specific, and high-throughput LC-ESI-MS/MS method was developed and validated to measure TDP in whole blood. Simple, quick sample preparation was employed for adaption to a high-throughput platform. StreamSelect™ using four parallel LCs reduced injection times to 2.25 min per sample and significantly minimized mass spectrometer idle time. The assay performance evaluations met our laboratory-developed test acceptance criteria for use in routine clinical laboratory analysis.

Common Physiological and Psychological Problems Among Post-Bariatric Surgery Patients

Common Physiological and Psychological Problems Among Post-Bariatric Surgery Patients

Collaborative Prescribing Practice in Managing Patients Post-bariatric Surgery in a Tertiary Centre in Singapore

Collaborative Prescribing Practice in Managing Patients Post-bariatric Surgery in a Tertiary Centre in Singapore

Evaluating the Compliance, Efficacy, and Cost of Formulated Vitamins Versus Separate Supplements in Post-bariatric Surgery Patients.

Micronutrient deficiencies are common complications after bariatric surgery as alterations to the gastrointestinal tract change absorption. Patients are recommended to take supplements including multivitamins, B complex, calcium, vitamin D, and iron after bariatric surgery, and can take these as specifically formulated vitamins for post-bariatric patients or separate vitamin supplements. We investigated the compliance, efficacy, and cost of specifically formulated vitamins for post-bariatric patients in comparison to separate vitamin supplements. We surveyed 126 post-bariatric adult patients between February 1, 2022, and August 31, 2022, who had undergone bariatric surgery between 2014 and 2021 to assess the type of supplements taken, compliance, and cost. Demographics, type of bariatric surgery, and serum micronutrient levels were evaluated for all patients. There were 51 patients taking formulated vitamins and 75 patients taking separate vitamins. The formulated vitamin group demonstrated greater adherence to optimal vitamin dosage (formulated vitamin group, 76.5% vs. separate supplement group, 30.7%; p < 0.001) and higher compliance (formulated vitamin group, 90.2% vs. separate supplement group, 66.7%; p = 0.002). The costs associated with both groups were comparable. No significant difference was observed in the incidence of micronutrient deficiency between the groups. Our study shows that formulated vitamins do not offer significant difference in micronutrient levels or cost compared to separate standard vitamin supplements. However, formulated bariatric vitamins have improved compliance compared to separate vitamin supplements.

Understanding food addiction in Post-Bariatric patients

This study delves into the construct validity of Food Addiction (FA) as evaluated by the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) within the context of post-bariatric surgery patients in Brazil. Understanding the prevalence, characteristics, and construct validity of FA among individuals who have undergone bariatric surgery is crucial for enhancing patient care and advancing research in this field. Our findings are based on a convenience-based sample of 100 individuals who had undergone bariatric surgery at Hospital Estadual Mário Covas (HEMC) in Brazil. Using mYFAS 2.0, we found that 51% of the participants met the criteria for FA, with 31% classified as severely affected. In our investigation of construct validity, we confirmed a one-dimensional model, in line with prior research using the YFAS and its modified versions. Item Response Theory (IRT) analyses further confirmed the appropriateness of the mYFAS 2.0 items, with all criteria contributing to the latent structure, most exhibiting discrimination values exceeding 0.5, and the majority having values greater than 2. These results provide substantial support for the construct validity of mYFAS 2.0 in our Brazilian subpopulation of post-bariatric surgery patients. Comparative analyses with previous studies revealed a notably higher prevalence of FA in our population, suggesting potential differences between pre- and post-bariatric surgery groups. This study contributes unique insights into the assessment of FA among post-surgery patients and highlights the importance of early detection and intervention in this population. While this study advances our understanding of FA in post-bariatric surgery patients, certain limitations, such as the relatively small sample size and cross-sectional design, warrant consideration. Nevertheless, our findings hold valuable implications for healthcare providers, researchers, and patients in the field of bariatric surgery and FA management. Future research can build upon these foundations to explore long-term FA effects post-surgery and potential interventions to address this issue effectively.

Prevalence of elevated alkaline phosphatase levels among post-bariatric surgery patients.

Little is known about the prevalence of elevated alkaline phosphatase in post-bariatric surgery patients due to under-utilization of this test after surgery. Elevated alkaline phosphatase levels are caused by hepatobiliary disease or bone resorption, which can lead to gallstones and osteoporosis. Early, post-operative measurement of alkaline phosphatase can prevent complications, thus reducing morbidity and overall healthcare costs. The purpose of this study was to determine the prevalence of elevated alkaline phosphatase levels among post-operative bariatric surgery patients. This was a retrospective study of patients 18years or older, who underwent laparoscopic sleeve gastrectomy (LSG) at a Midwestern Weight Management Clinic between January 1, 2002 and December 31, 2020. Alkaline phosphatase levels, weight, body mass index (BMI), gamma-glutamyl transferase (GGT), parathyroid hormone (PTH), calcitriol, and calcitonin, vitamin D and multivitamin supplementation were measured at baseline, 3, 6, and 12months post-surgery. Two hundred thirty patients with mean age of 47years and BMI of 44.6 were included with 80.9% (n = 186) female. Alkaline phosphatase was elevated relative to baseline for 36.1% of patients (n = 52) at 3months post-surgery, 42.4% of patients (n = 56) at 6months, and 43.3% of patients (n = 45) at 12months (p < 0.001). There were six cases of documented cholelithiasis post-surgery. A significant proportion of participants experienced elevations in alkaline phosphatase following surgery, indicating that the prevalence of gallbladder pathology and bone resorption may be higher than previously thought. This merits additional investigation into these complications post-operatively to determine prevalence and avoid excess morbidity.

Use of Continuous Glucose Monitoring in Patients Following Bariatric Surgery: A Scoping Review.

The objective of this scoping review was to summarize the emerging literature on the use of continuous glucose monitoring (CGM) in post-bariatric surgery patients, with a focus on its features (e.g., device, mode, and accuracy), as well as purposes and outcomes of utilization. Three databases (PubMed, EMBASE, and Web of Science) were searched to obtain relevant studies. Results suggested that most studies used CGM for 3-7 days under blinded mode. Accuracy data were available in only one study, which reported a mean absolute relative difference of 21.7% for Freestyle Libre. The primary applications of CGM were for elucidating glucose patterns and assessing glycemic treatment outcomes. No study has tested the effect of CGM as an intervention strategy to enhance glucose control.

Nutrition, Physical Activity, and Prescription of Supplements in Pre- and Post-bariatric Surgery Patients: An Updated Comprehensive Practical Guideline.

Only in the USA, 315 billion dollars are spent annually on the medical cost of obesity in adult patients. Till now, bariatric surgery is the most effective method for treating obesity and can play an essential role in reducing the direct and indirect costs of obesity treatment. Nonetheless, there are few comprehensive guidelines which include nutrition, physical activity, and supplements, before and after surgery. The purpose of the present narrative review is to provide an updated and comprehensive practical guideline to help multidisciplinary teams. The core keywords include nutrition, diet, physical activity, exercise, supplements, macronutrients, micronutrients, weight reduction, bariatric surgery, Roux-en-Y Gastric Bypass, Sleeve Gastrostomy, Laparoscopic Adjustable Gastric Banding, and Biliopancreatic diversion with duodenal switch which were searched in databases including PubMed/Medline, Cochrane, and some other sources such as Google Scholar. We answered questions in five important areas: (a) nutritional strategies before bariatric surgery, (b) nutrition after bariatric surgery, (c) physical activity before and after bariatric surgery, (d) weight regain after bariatric surgery, and (e) micronutrient assessments and recommendations before and after bariatric surgery. Some new items were added in this updated guideline including "weight regain" and "pregnancy after bariatric surgery." Other fields were updated based on new evidence and guidelines.

Effectiveness of a Modified Nurse-Led COUGH Bundle for Obese Patients After Bariatric Surgery.

Obesity commonly affects postsurgical pulmonary outcomes and is associated with increased oxygen usage, length of recovery and hospital stay, discharge to high levels of care, cost, morbidity, and mortality. No standardized pulmonary care bundle for obese patients after bariatric surgery was available in the postanesthesia care unit (PACU) at a hospital in Singapore. This quality improvement project was a prospective, single-cohort, pre- and posttest intervention design with 151 patients recruited. Teaching and implementation of a modified nurse-led COUGH bundle was carried out on obese patients after their bariatric surgery. Postbariatric surgery patients with the nurse-led COUGH bundle had significantly less consumption of oxygen in the PACU and step-down units. The PACU and hospital length of stay were also reduced. The modified nurse-led COUGH bundle can reduce patients' oxygen usage and hospital stay after their bariatric surgery.

1020-P: A New Ambulatory Glucose Profile Report to Evaluate and Support Glucose Control in People after Bariatric Surgery

Bariatric surgery increases postprandial glucose excursions with higher peaks and lower nadirs. Etiologically linked is the phenomenon of postbariatric hypoglycaemia (PBH), an increasingly recognized metabolic disorder. Continuous glucose monitoring (CGM) has become an important tool in the diagnosis and management of PBH. The Ambulatory Glucose Profile (AGP) is an internationally recognized and standardized format that provides structured and graphical compilation of CGM data to guide treatment decisions in people with diabetes. However, its applicability to patients suffering from bariatric surgery-induced dysglycaemia, such as PBH, remains limited. Based on the collection of CGM data in healthy individuals and post-bariatric surgery patients with and without PBH, we selected a set of summary statistics that are important to diagnose the condition, decide on and evaluate the efficacy of therapeutic strategies. We propose a novel AGPr which contains the following: %time spent with non-physiological glucose values, the diurnal distribution of hypoglycaemic events (including level and duration) and information on postprandial glucose excursions by colour-coding of rate of glucose change and variability metrics. The new AGPr uses data generated by CGM to provide a rapid visual presentation of glucose dynamics and hypoglycemia burden in post-bariatric surgery individuals. Disclosure L.Cossu: None. G.Cappon: Consultant; Dexcom, Inc. D.Herzig: None. A.Facchinetti: None. L.Bally: Research Support; Dexcom, Inc., Ypsomed AG. Funding University of Padova, Italy (SID-Networking Project 2021)