Postoperative Bariatric Patients Research Articles

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.

A Qualitative Exploration of Postoperative Bariatric Patients' Psychosocial Support for Long-Term Weight Loss and Psychological Wellbeing.

There is a paucity of research exploring postoperative psychosocial interventions for bariatric surgery patients exceeding 2 years, and therefore, an interdisciplinary postoperative approach is warranted. This qualitative study explored the psychosocial support that bariatric surgery patients feel they need to sustain long-term weight loss and their psychological wellbeing. Fifteen postoperative patients participated in recorded semi-structured online interviews that were transcribed verbatim and analysed using a reflexive thematic analysis approach. Three themes and six subthemes emerged. Theme 1, Journey to surgery, has two subthemes: Deep roots and Breaking point. Theme 2, The precipice of change, has two sub-themes: Continuity of care and Can't cut the problem out. Theme 3, Bridging the Gap, has two subthemes: Doing it together and Taking back the reigns. The inconsistencies participants experienced in their pre- and postoperative care led to dissonance, and they felt unprepared for the demands of life postoperatively. Bariatric surgery is a catalyst for physical change, but surgery alone is insufficient to ensure sustained change. Surgical and psychosocial interventions are interdependent rather than mutually exclusive. Patients favour an integrative, personalised, stepped-care approach pre- and postoperatively, with active participation fostering autonomy and access to ongoing support extending into the long-term.

Prevalence of Anxiety and Depression Symptoms among Post Bariatric Surgery Patients in Baghdad-Iraq

J. Fac. Med. Baghdad 2023. Vol 65, No. 4 Background: Obesity is a major public health concern and is on the rise worldwide. Numerous studies revealed that the best method for treating morbid obesity is bariatric surgery, which has indicated its effectiveness in controlling weight. Published studies reported that patients who had undergone bariatric surgery may have psychiatric illnesses when compared to other obese individuals with similar preoperative characteristics. Objectives: Estimate the rates of anxiety and depression among post-operative bariatric surgery patients. Methods: A cross-sectional study on 61 patients was conducted at the bariatric clinic in the Gastroenterology and Hepatology Baghdad teaching hospital and the Private Nursing Home Hospital in Medical city, Baghdad-Iraq from 1st of April to the 30th of December 2021. Generalized Anxiety Assessment – 7 (GAD-7) Scale, and Patient Health Questionnaire – 9 (PHQ-9) scale were applied to assess these conditions. Results: The prevalence of depression among the studied patients was 32.8%, while the prevalence of anxiety was 44.3%. Marital status, diabetes mellitus, post-operative BMI, and past psychiatric history were significantly associated with depression, P value < 0.05. Chronic diseases (diabetes mellitus and hypertension), post-operative BMI,nd psychiatric history were significantly associated with anxiety, P value<0.05. Conclusions: Anxiety was found to be more common than depression among patients who underwent bariatric surgery. Variables predicting both depression and anxiety were diabetes mellitus, post-operative severe obesity, and a history of psychiatric disorders before surgery. Received May. 2023 Accepted July 2023 Published Jan. 2023

Knowledge Regarding Surgical Site Infection Among Post-Operative Bariatric Surgical Patients in Al Ahsa City

Patient knowledge of surgical site infection (SSI) is essential for their safety and reduced complications. This study aimed to assess the knowledge and awareness of post-surgical site infections among post-bariatric surgical patients in Al Ahsa City. The research, conducted with 90 participants, revealed that Patient knowledge of surgical site infection is a fair level of knowledge (55.6%), while the remaining 44.4% exhibited a poor level of knowledge. Descriptive analysis provided insights into participants' personal data, education, work, previous surgery, and post- surgical infection. Notably, 65.6% of participants were not employed, and 44 (48.9%) had a history of previous operations, with 13 (14.4%) reporting experiences of post-surgery infections. Participants' knowledge and awareness of SSIs were also evaluated, with a majority demonstrating awareness of various SSI symptoms and preventive measures. Overall, 55.6% of participants exhibited a good level of knowledge and awareness about SSIs. Furthermore, the study highlighted healthcare professionals as the most commonly reported sources of information about post-surgical site infections. These findings emphasize the importance of tailored educational interventions to increase the level of knowledge and enhance patient understanding of SSI symptoms and preventive measures among post-bariatric surgical patients. The study underscores the significance of considering demographic and experiential factors in developing targeted patient education strategies to improve post-surgery infection awareness and promote patient safety and decreased the rate of readmission following bariatric surgery. Future research can explore the educational interventions such as the use of virtual clinic. Background Patient knowledge of surgical site infection (SSI) is essential for their safety and reduced complications. Literature Review An infection at the surgical site in a deep or superficial wound within 30 days of the surgery is called a surgical site infection. Emergency surgeries (p=0.0001), American Society of Anesthesiologists high index (47.4%), long duration of surgical procedures, stay in the hospital before surgery for more than 24 hours and age from 18 to 81 years were found to be important contributing factors for SSI in this article by [1]. Surgical site infection is the third most commonest infection in the hospital, found in up to 38% of surgical patients. The rate of mortality is 77%. About 93% of patients have severe infections at the site of operation [2]. Surgical site infections reported by a national survey conducted in England hospitals was 1807 cases among various specialties and procedures [3]. Moreover, 1.7% of 120 patients' surgical site infections in the last 5 years were reported by researchers in Riyadh (Alotaibi et al., 2020). A previous study found that surgical site infection is more common among obese patients undergoing abdominal surgery (p<0.001) [4]. Pseudomonas aeruginosa, Staphylococcus aureus, and coagulase-negative staphylococci were the most frequently isolated organisms in surgical sites (Julius et al., 2018). Surgical site infection is a life-threatening if not managed well. It can lead to various complications such as reoperation (36.2%) and readmission (49.7%). Moreover, SSI correlates with delayed discharge from the hospital by 34.1% [3]. A study done on the economic burden caused by SSI found that the median additional cost attributable to SSI was to the tune of 5,239 GBP in a 2-year study done in an NHS trust hospital [5]. Based on relevant practical guidelines, antimicrobial prophylaxis should be administered before surgical procedures and patients should take complete bath with or without antimicrobial soap. Before making a skin incision, clean the skin with an antiseptic solution. Avoid topical antimicrobial agents at the surgical incision after surgery [6]. Surgical site infection is one of the most commonly acquired infections at hospitals. Determination of knowledge of patients on SSI and symptoms may be useful in improving their awareness and safety after discharge. Therefore, in this study, we will evaluate patients' knowledge of SSI and its symptoms.

High Prevalence of Positive Genetic Obesity Variants in Postoperative Bariatric Surgery Patients with Weight Regain Presenting for Medical Obesity Intervention.

Genetic obesity susceptibility in postoperative bariatric surgery weight regain (PBSWR) remains largely unexplored. A retrospective case series of adult (N = 27) PBSWR patients who had undergone genetic obesity testing was conducted between Sept. 2020 and March 2022. frequency of genetic variants in patients experiencing weight regain following bariatric surgery. prevalence of obesity-related comorbidities, nadir BMI achieved post-bariatric surgery, and percent total body weight loss (%TBWL) achieved with obesity pharmacotherapies. Heterozygous mutations were identified in 22 (81%) patients, with the most prevalent mutations occurring in CEP290, RPGR1P1L, and LEPR genes (3 patients each). Median age was 56years (interquartile range (IQR) 46.8-65.5), 88% female. Types of surgery were 67% RYGB, 19% SG, 4% gastric band, and 13% revisions. Median nadir BMI postoperatively was 34.0kg/m2 (IQR 29.0-38.5). A high prevalence of metabolic derangements was noted; patients presented median 80months (IQR 39-168.5) postoperative for medical weight management with 40% weight regain. BMI at initiation of anti-obesity medication (AOMs) was 41.7kg/m2 (36.8-44.4). All received AOM and required at least 3 AOMs for weight regain. Semaglutide (N = 21), topiramate (N = 14), and metformin (N = 12) were most prescribed. Median %TBWL for the cohort at the first, second, and third visit was 1.7, 5.0, and 6.5 respectively. Fourteen (52%) achieved 5%TBWL, 10 (37%) achieved 10%TBWL, and 4 (15%) achieved 15%TBWL with combination AOMs and supervised medical intervention. An unusually high prevalence of genetic obesity variants in PBSWR was found, warranting further research.

Changing Knowledge and Attitudes towards Bariatric Surgery in Primary Care: a 10-Year Cross-Sectional Survey.

Some 28% of the Scottish population suffer from obesity. Bariatric procedures per population carried out in England when compared to Scotland (NBSR 2018) are significantly higher. Primary care practitioners (PCP) influence equality of access to secondary care bariatrics and frequently manage post-operative bariatric patients. Examining changes in PCP knowledge and attitude could improve access to bariatric procedures in Scotland. Following a sample pilot, all PCPs within three Scottish NHS health boards were emailed a questionnaire-based survey (2011; n = 902). A subsequent 10-year follow-up encompassed a greater scope of practice, additionally distributed to all PCPs in five further health boards (2021; n = 2049). Some 452 responses were achieved (2011, 230; 2021, 222). PCPs felt bariatric surgery offered a greater impact in both weight management and that of obesity-related diseases (p < .0001). More PCPs were aware of local bariatric surgical referral criteria (2011, 43%; 2021, 57% (p = .003)), and more made referrals (2011, 60%; 2021, 72% (p = .018)) but were less familiar with national bariatric surgical guidelines (2011, 70%; 2021, 48% (p < .001)). Comfort at managing post-operative bariatric surgical patients were unchanged (2011, 24%; 2021, 27% (p = .660)). Minimal progress through dietetic-lead weight management services, plus rejection of patients thought to be good candidates, was reasons for referral hesitancy. Over 10years, PCPs were more aware of local referral criteria, making increased numbers of referrals. Knowledge deficits of national guidelines remain, and overwhelmingly PCPs do not feel comfortable looking after post-operative bariatric surgical patients. Further research into PCP educational needs, in addition to improving the primary to secondary care interface, is required.

Telephone-Based Cognitive Behavioral Therapy for Post-Operative Bariatric Surgery Patients: Preliminary Results from a Randomized Controlled Trial

Telephone-Based Cognitive Behavioral Therapy for Post-Operative Bariatric Surgery Patients: Preliminary Results from a Randomized Controlled Trial

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.

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.

Associations of COVID-19 Lockdowns on Eating Behaviors and Body Mass Index in Patients with a History of Bariatric Surgery: a Cross-Sectional Analysis.

Few studies have explored the impact of the COVID-19 pandemic on the eating behaviors, dietary quality, and changes in weight of postoperative bariatric surgery patients. A cross-sectional survey on eating behaviors and attitudes toward food was emailed or given to patients who had bariatric surgery before March 2020. Patient charts were reviewed for weight measures. Seventy-five (71.43%) patients experienced weight recurrence with an average increase in body mass index (BMI) of 2.83kg/m2 (SD: 2.19). The majority of patients reported no symptoms of binge eating (n = 81, 77.14%) with 16 (15.24%) qualifying for loss of control eating (LOCE). LOCE was significantly associated with grazing behavior (p = 0.04), emotional over-eating (p = 0.001), and food responsiveness (p = 0.002). LOCE was negatively associated with dietary quality (p = 0.0009) and satiety responsiveness (p = 0.01). Grazing behavior was significantly associated with emotional over-eating (p < 0.0001) and food responsiveness (p < 0.0001) as well as negatively associated with dietary quality (p < 0.0001). Slow eating was negatively associated with grazing (p = 0.01), emotional over-eating (p = 0.003), and food responsiveness (p < 0.0001). When included in a regression model controlling for age and sex, emotional over-eating was a significant predictor of weight recurrence (β = 0.25; p = 0.04). Our results suggest that maladaptive eating behaviors contributed to LOCE and poor dietary quality during the COVID-19 pandemic; however, slow eating may be protective against grazing, emotional over-eating, and food responsiveness.

Quality of Life After Bariatric and Body Contouring Surgery in the Australian Public Health System

IntroductionThe goals of bariatric surgery are weight loss, improved management of obesity-related diseases, and enhanced health-related quality of life (HRQoL). The aim of this study is to determine HRQoL among postoperative bariatric surgery patients. The aim of this study was to evaluate the utility of bariatric surgery and the role of body contouring surgery (BCS) when considering quality of life in low-volume centres in the Australian public health system. MethodsThis cohort study compared patients who underwent bariatric surgery between 2008 and 2018, to those awaiting surgery. An additional analysis was completed for patients who also underwent BCS. Patients completed the Short Form-36 quality of life (SF-36) survey. Linear regression was used to assess the differences in mean scores between cohorts for each of the SF-36 domains. ResultsA total of 131 postoperative patients were identified, with a follow up rate of 68%. The mean follow up was 5.4 y. The mean scores for all domains of the SF-36 in the postoperative group were higher than the preoperative group (P ≤ 0.0001). A significant difference in scores persisted after controlling for patients’ current BMI. When considering patients who underwent BCS (n = 24), there was a further global improvement in HRQoL in physical function (P = 0.0065), role limitation to physical health (P = 0.0026), pain (P = 0.0004), energy (P = 0.0023) and general health perceptions (P = 0.0023). ConclusionsBariatric surgery followed by BCS may improve HRQoL for the patient when compared to bariatric surgery alone. We advocate for the use of bariatric surgery followed by BCS in low-volume centres in the Australian public health system.

Telephone-based cognitive behavioural therapy for patients with postoperative bariatric surgery to manage COVID-19 pandemic-related mental health issues and distress (TELE-BARICARE): a protocol for a randomised controlled trial

IntroductionBariatric surgery is currently the most effective treatment for obesity, and is performed yearly in over 8000 patients in Canada. Over 50% of those who live with obesity also have...

The use of enoxaparin as venous thromboembolism prophylaxis in bariatric surgery: A retrospective cohort study

IntroductionVenous thromboembolism (VTE) is one of the major causes of morbidity and mortality in bariatric patients. The use of low-molecular-weight heparin (LMWH), as enoxaparin, is considered one of the mainstays thromboprophylaxis regimens in postoperative bariatric patients. Despite the universal agreement on the importance of thromboprophylaxis in these patients, there are inadequate strong recommendations for its dosing and duration. The aim of our study is to explore the current practice on using enoxaparin in bariatric patients, as well as to assess both the efficacy and safety of varying dosing regimens. Material and methodsThis is a retrospective cohort study of morbidly obese patients who underwent bariatric procedure at a tertiary care hospital between 2016 and 2019. All adult patients who met the eligibility criteria for bariatric surgery and received enoxaparin with a minimum follow-up period of one month were included in our study. Participants with a history of coagulopathy, renal or hepatic insufficiency were excluded from the study. Data collected include patient demographics, VTE risk factors, and co-morbidities. The outcome of treatment failure was defined as the composite of either VTE or major bleeding. ResultsA total of 1,169 patients who underwent bariatric surgery were included in the study. The mean age was 35.54 years, with mean body mass index (BMI) of 45.78 kg/m2. The mean duration of enoxaparin use was 9 days, and the majority of patients (78%) received a prophylaxis dose of 40 mg subcutaneously (SC) once daily. The overall rate of VTE at 90 days was 1.4% while only 0.1% of patients developed major bleeding. There was no statistically significant difference in patients’ age, gender, BMI, or various enoxaparin dosing regimens between patients who developed VTE or bleeding versus patients who did not develop. Patient’s weight was the only statistically significant risk factor that directly correlated to higher risk of complications (P = 0.006). In the multivariable logistic regression model, higher BMI was significantly associated with treatment failure, either VTE or major bleeding [OR 1.05 (95% CI 1.0–1.09); P = 0.038]. ConclusionsThe rate of VTE or major bleeding did not differ in patients who received various enoxaparin regimens. Patients undergoing bariatric surgery may benefit from enoxaparin thromboprophylaxis dose of 40 mg SC daily for a total duration of 14 days, with higher doses may be needed for extremely obese patients. We recommend standardizing the current practice of VTE prophylaxis post bariatric surgery and unifying the optimal dose and duration.

Associations of Use of Social Media and Psychopathology and Body Image in Pre- and Post-surgical Bariatric Samples: a Cross-sectional Analysis.

PurposeInterest has grown regarding the impact of social media platforms on mental health including body image and internalized weight bias (IWB) in those who have struggled with weight issues. However, few studies have addressed social media usage in bariatric patient samples. The objective of this study was to understand how the amount of time spent on social media could serve as a predictor for IWB in both pre- and post-operative bariatric patients.Materials and MethodsPre- and post-operative patients at one academic medical center completed self-report measures assessing patients’ IWB, depression, anxiety, body dissatisfaction, sociodemographic variables, and social media usage. Data were collected from March 2019 to April 2020. Statistical methods that included correlations, logistical regression models, and ANOVA analysis were used to determine the relationship between time spent on social media and other covariates.ResultsA total of 148 responses were collected from the pre-surgical population, with 81 responses from the post-surgical sample. At baseline, the majority of respondents used social media for approximately 1 h per day (n = 37; 27.82%). Time spent on social media was negatively associated with age (r = − 0.24 [− 0.40, − 0.08]), and positively associated with IWB (r = 0.20 [0.02, 0.36]) and anxiety (r = 0.21 [0.01, 0.39]). In the post-operative group, only the 6-month BMI (r = 0.29 [0.05, 0.49]) was positively associated with time spent on social media.ConclusionGiven this study’s findings, providers are encouraged to become aware of patients’ use of social media, and to understand the impact social media usage can have on the mental well-being of patients.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s11695-022-06206-6.

Despite regression of healthy lifestyle habits, weight loss after bariatric surgery is not affected during the COVID-19 pandemic.

BackgroundThe coronavirus pandemic has caused a worldwide health crisis. Bariatric patients require extensive pre- and post-operative follow-up, which may be less feasible during public health social distancing mandates. We assessed the impact of the pandemic on the behaviors and weight loss outcomes of our pre- and post-operative bariatric patients.MethodsA retrospective review of a prospectively maintained database identified patients who underwent either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) at a single institution between March 2018 and May 2020. A cohort undergoing surgery within 12 months before the pandemic as well as a cohort undergoing a medically supervised diet prior to surgery was surveyed regarding pre- and post-COVID-19 lifestyle habits. Excess weight loss (EWL) outcomes from a group of pre-COVID surgical patients were compared to that of a group of post-COVID surgical patients. Primary outcome was whether the lockdown changed 1-year weight loss outcomes. Secondary outcome was whether patient lifestyle behaviors were changed during the pandemic.ResultsThere was no difference in 1-year EWL between pre- and post-COVID SG patients (51.7% versus 55.9%, p = 0.35), or between pre- and post-COVID RYGB patients (88.9% versus 80.4%, p = 0.42). Pre-stay-at-home order, 91.8% endorsed physical activity compared to 80.3% post-stay-at-home order (p = 0.0025). Mean physical activity decreased from 4.2 h/week to 2.7 h/week after the stay-at-home order (p < 0.0001). Additionally, 41.3% reported worsened dietary habits post-stay-at-home order.ConclusionThe COVID-19 pandemic has greatly impacted the behaviors of bariatric surgery patients. Despite deterioration of lifestyle habits, 1-year weight loss outcomes after bariatric surgery remained the same before and after the instatement of social distancing measures. In the short term, the biological effect of metabolic procedures may mask the effects of suboptimal diet and physical activity, but more studies are necessary to better assess the impact of COVID-19 on outcomes after bariatric surgery.

Improving Bed Utilization in a Cohort of Bariatric Surgical Patients Using a Perioperative Obstructive Sleep Apnea Treatment and Bed Triage Protocol.

Postoperative bariatric management often includes high-intensity monitoring for respiratory complications since > 70% of patients have obstructive sleep apnea. Given the increasing number of bariatric surgeries, there is a need to determine safe and cost-effective processes for postoperative care.The objective of this study was to determine if a novel triage and perioperative management guideline reduces postoperative monitoring and costs following bariatric surgery. Using a pre-post design, this is a retrospective analysis of 501 patients who had bariatric surgery. Half the patients were managed with usual care, and the other half received obstructive sleep apnea screening and treatment of moderate/severe obstructive sleep apnea with perioperative continuous positive airway pressure. The intervention group was triaged preoperatively to a postoperative nursing location based on risk factors. There were no significant differences in demographics, comorbidities, frequency, or severity of OSA between groups. In the intervention group, there were fewer admissions to the intensive care unit (2.0% vs 9.1%; p < 0.01) and high acuity unit (9.6% vs 18.3%; p < 0.01). The length of stay was shorter in the intervention group (1.3 vs 2.3days; p < 0.01) with a 50% reduction in costs. There were no statistically significant differences in the incidence of postoperative respiratory and non-respiratory complications between the two groups. Most postoperative bariatric surgery patients can be safely managed on the surgical ward with monitoring of routine vitals alone if patients with moderate/severe obstructive sleep apnea receive perioperative continuous positive airway pressure.

A comparative study between high-flow nasal oxygen therapy and venturi mask oxygen therapy for postoperative laparoscopic bariatric surgery patients with atelectasis: a randomized clinical trial

BackgroundObesity has been identified as an independent risk factor for postoperative respiratory complications in several studies. In the pediatric and newborn populations, high-flow nasal oxygen (HFNO2) therapy was initially demonstrated to be an effective treatment for acute respiratory failure. It becomes increasingly popular as a therapy for adult patients, with a growing range of clinical applications.ResultsOne hundred ten patients were admitted to the ICU for postoperative care after laparoscopic sleeve gastrectomy. They were examined and randomized equally into two groups: group A (HFNO2 therapy group) who received high-flow nasal oxygen therapy, group B (VMO2 therapy group) who received venturi mask oxygen therapy. The partial pressure of oxygen in arterial blood (PaO2), partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2), respiratory rate, and length of ICU stay were recorded. The partial pressure of oxygen in the arterial blood (PaO2) was 131.764 (95% CI 124.562–138.965) in the HFNO2 group versus 106.767 (95% CI 99.565–113.968) in the VMO2 group, partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) was 321.81 (95% CI 307.486–336.153) in the HFNO2 group versus 276.767 (95% CI 262.433–291.100) in the VMO2 group, and respiratory rate was 20.778 (95% CI 20.172–21.385) in the HFNO2 group versus 24.047 (95% CI 23.441–24.654) in the VMO2 group, while the length of ICU stay was the HFNO2 group (1.09 ± .29 days) and (1.00 ± .000 day) in the VMO2 group.ConclusionsIn conclusion, our study has shown that high-flow nasal oxygen therapy in postoperative laparoscopic sleeve gastrectomy patients with atelectasis-maintained oxygenation represented as PaO2 and PaO2/FiO2 higher than the venturi mask and significantly decreased the respiratory rate but did not decrease the length of ICU stay when compared to venturi mask oxygen therapy.Trial registrationClinical trial registered with http://www.pactr.org (PACTR202108492295773).

The Impact of Telephone-Based Cognitive Behavioral Therapy on Mental Health Distress and Disordered Eating Among Bariatric Surgery Patients During COVID-19: Preliminary Results from a Multisite Randomized Controlled Trial.

BackgroundPatients undergoing bariatric surgery have high rates of psychiatric comorbidity, which may increase their vulnerability to COVID-19-related mental health distress. Exacerbation of mental health distress and disordered eating could have significant negative effects on long-term weight management and quality of life for these patients if untreated.ObjectiveTo determine the efficacy of a telephone-based cognitive behavioral therapy (Tele-CBT) intervention in improving depressive, anxiety, and disordered eating symptoms during COVID-19.MethodsParticipants were recruited as part of a larger randomized controlled trial study (clinicaltrials.gov ID: NCT03315247) between March 2020 and March 2021 and randomized 1:1 to receive Tele-CBT or standard bariatric care. Outcomes of Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Emotional Eating Scale (EES), and Binge Eating Scale (BES) were measured at baseline, immediately post-intervention, and 3 months post-intervention. Linear mixed models were used to test the effect of intervention group, time, and group-by-time interaction for each outcome.ResultsEighty-one patients were included in the intention-to-treat analysis. Mean (SD) age of participants was 47.68 (9.36) years and 80.2% were female. There were significant group-by-time interactions for all outcomes and significant differences between groups across time. There were significant decreases in mean GAD-7 (p = 0.001), PHQ-9 (p < 0.001), EES-Total (p = 0.001), EES-Anger (p = 0.003), EES-Anxiety (p < 0.001), EES-Depression (p < 0.001), and BES (p = 0.002) scores for the Tele-CBT group at post-intervention and follow-up when compared to baseline and the control group.ConclusionTele-CBT is a feasible and effective treatment for improving psychological distress and disordered eating among post-operative bariatric surgery patients during the COVID-19 pandemic.Graphical abstract

Comparative Study on Nutritional Intake and Nutritional Status of Elective Pre- and Post-operative Bariatric Surgery Patients

Obesity is a global epidemic affecting populations worldwide. Bariatric surgery is effective in treating morbid obesity in individuals who fail to lose weight even after modifying lifestyle, dietary habits, and pharmacotherapy. To provide better health care management pre- and post-bariatric surgery, it is imperative to establish the nutritional status of patients before surgery. The aim of this study was to assess and compare pre- and post-surgery nutritional status of bariatric candidates. Obesity is the basis for cluster of non-communicable diseases creating an enormous socioeconomic and public health burden. For this, laparoscopic bariatric procedures; sleeve gastrectomy, Roux-en Y Gastric Bypass, and Mini Gastric Bypass were done for treating obesity and other related co-morbidities. The medical records of 50 subjects were reviewed for this study. Mean age and body mass index are 42.2 ± 12.9 (kg/m2) and 42.77 ± 7.9 (kg/m2), respectively. The pre-surgery mean intake of energy, carbohydrate, protein, and fat was 3048 ± 485.4 (kcal/d), 200.4 ± 40.1 (g/d), 101.6 ± 17.02 (g/d), and 156.09 ± 108.4 (g/d), respectively, which were above Recommended Dietary Allowances. The mean intake of energy, carbohydrate, protein, and fat was significantly decreased post operatively (P &gt; 0.001) to 1400 ± 99 (kcal/d), 132.1 ± 22.3 (g/d), 69.9 ± 3.6 (g/d), and 30.9 ± 6.4 (g/d), respectively. Low intake of fiber, Vitamin A (74%), and Vitamin C (32%) was observed during pre-operative condition. The findings in this study advocates nutritional intervention and tailored supplementation pre- and post-bariatric surgery for promising results.

O-B01 Role of Ursodeoxycholic acid in prevention of gallstones formation in bariatric patients: need to amend recent BOMSS guidelines

Abstract Background During rapid weight-loss phase following bariatric procedures, biliary cholesterol homeostasis is altered leading to increased propensity to gallstone formation. Incidence of gallstone formation following bariatric procedures is shown to be 10-38%. There is no consensus regarding its prevention and current BOMSS guidelines do not address this issue. This meta-analysis aims to pool high level evidence (RCTs) to assess efficacy of Ursodeoxycholic acid (UDCA) in reducing risk of gallstone formation in this cohort of patients and the need for revision of current guidelines. Methods A systematic literature search was performed using electronic databases (Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, PROSPERO and Google Scholar) in line with PRISMA guidelines. Only randomised controlled trials were included without restrictions on study language, year, status of publication and patient’s age. Meta-analysis was performed using Review Manager Software to calculate pooled risk ratios (RR) using random-effects model. Results Fifteen trials were included (3952 patients analysed, 2487 in UDCA and 1465 in placebo group). The overall rate of gallstone formation was 16.0% (6.4% in UDCA vs 31.4% in placebo group). Trials included various bariatric procedures (SG/RYGB/OAGB/AGB/Gastroplasty). UDCA dose ranged from 300 to 1200mg per day. UDCA significantly reduced the risk of post-operative gallstone formation (3952 patients, RR 0.24, 95% CI 0.16-0.37, p &amp;lt; 0.0001). The absolute risk reduction and number needed to treat (NNT) were 25% and 4 respectively. Conclusions Oral Ursodeoxycholic acid treatment following restrictive bariatric surgical procedures significantly reduces the risks of gallstone formation. As such, its regular use in first 6 months (rapid weight-loss phase) can significantly reduce the risk of complications associated with gallstones. Such treatment would be cost effective and benefit 1 in 4 patients. There is significant evidence available on benefits of using UDCA in post-operative bariatric patients and that this should be added to the recent BOMSS guidelines.