Postoperative Weight Change Research Articles

Early Post-operative Weight Change After Roux-en-Y Gastric Bypass Predicts Weight Loss at 12-Month Follow-up.

Sub-optimal weight loss following Roux-en-Y gastric bypass (RYGB) represents an important clinical challenge in a significant number of patients. Early identification of such patients would be advantageous, as it could aid in the selective implementation of targeted adjunct interventions during the first post-operative year. Clinical audit data from 1137 patients undergoing RYGB between 2013 and 2016 at the Instituto Sallet in Brazil were prospectively registered in an online database (BOLD) and analyzed. Forty-eight percent of patients achieving less than 5% total weight loss after the first post-operative month achieved a 20% total weight loss at 1year (n = 626; OR = 0.6 CI = 95%). Eighty-three percent of patients losing between 5 and 10% at 1month and 95% of patients losing greater than 10% at 1month had lost at least 20% of total body weight after the first post-operative year. Forty-four percent of patients achieving less than 10% total weight loss after the third post-operative month achieved 20% total weight loss at 1year (n = 494; OR = 0.3 CI = 95%). Total bodyweight reduction after RYGB of < 5% at 1month and < 10% at 3months is associated with suboptimal weight loss at 1year. These results reinforce findings from other studies reporting that patients tend to follow a common weight loss trajectory. Identifying the patients with weight trajectory requiring adjunct therapies early on is crucial so appropriate adjustments can be made to post-operative care.

Analysis of factors contributing to postoperative body weight change in patients with gastric cancer: based on generalized estimation equation.

AimsThe study aimed to explore factors contributing to body weight change over time in gastric cancer patients after gastrectomy, in order to find risk factors to implement nutritional intervention beforehand.MethodsA cohort of gastric cancer patients who were treated with gastrectomy from January to March 2019 at a university affiliated hospital in Shanghai were consecutively identified in this study. Demographics, disease related information, nutrition knowledge, attitude, and practice score were collected before gastrectomy. In addition, body weight before surgery (T0), body weight at one month (T1), two months (T2), and three months (T3) after gastrectomy were recorded. Generalized estimation equation was used to describe body weight change and analyze factors contributing to body weight change after surgery.ResultsThere were 49 patients recruited in the study. Patient body weight decreased by 9.2% at T1 (Wald χ = 271.173, P <0.001), 11.0% at T2 (Wald χ2 = 277.267, P <0.001), and 11.4% at T3 compared to baseline at T0 (Wald χ = 284.076, P <0.001). The results of GEE for multivariable analysis showed that surgery type (Wald χ = 6.027, P = 0.014) and preoperative BMI (Wald χ = 12.662, P = 0.005) were contributing factors of body weight change. Compared with distal gastrectomy patients, total gastrectomy patients experienced greater body weight loss (β = 2.8%, P = 0.014). Compared with patients with BMI&λτ; 18.5 kg/m2, patients with BMI ≥ 25 kg/m2experienced greater body weight loss (β = 4.5% P = 0.026).ConclusionGastric cancer patients experienced significant weight loss during 3 months after gastrectomy. Total gastrectomy and BMI ≥ 25 kg/m2were risk factors to postoperative body weight loss for GC patients. The results suggested hinted that clinician should pay attention to postoperative nutrition status of patient undergoing total gastrectomy and obesity patients.

SAT-436 Long-Term Analysis of Weight Change Following Thyroidectomy

Introduction: Weight gain is a common source of apprehension for patients undergoing thyroidectomy. However, contradictory reports exist regarding the presence and degree of weight gain following thyroid surgery and all known studies have short term follow-up This study evaluated weight changes following total thyroidectomy (TT) and lobectomy (L) over an extended time period. Methods: Retrospective analysis was performed of weight changes following surgery for patients who underwent TT or L (n=387) as compared with those undergoing parathyroidectomy for primary hyperparathyroidism (n=201) in a tertiary referral hospital between 2007-2012. Clinical, demographic and pre- and postoperative weight data was collected with a median follow-up of 55.6 months. Results: Postoperative weight change was observed at 1, 6, 12, and 36-months in patients who underwent TT (μ=+0.21kg, μ=+1.33kg, μ=+0.59kg, μ=+0.60kg; p<0.05) and at 6-months for patients who underwent L (μ=+0.93kg, p<0.05) compared with those who underwent parathyroidectomy. Patients having TT and L showed a general trend of weight gain compared to the control group up to 108-months post-operation; however, this weight gain was non-significant (p<0.05). Significant postoperative weight gain was observed in patients who had TT (1-month μ=+0.40kg, 6-months μ=+2.14kg, and 12-months μ=+1.40kg) and L (6-months μ=+1.04kg) for benign conditions compared with the parathyroidectomy group. Patients who had TT gained 0.40kg more than L patients at 12-months post-op (p<0.05), but no significant difference existed at other time points up to 108-months. Tukey HSD post-hoc analysis showed weight gain in benign, thyroiditis, and thyroid cancer patient groups was not significantly different from 6-months to 108-months post-operation. Furthermore, neither race nor sex was correlated with weight gain. Relative risks with 95% CI for weight gain following TT and L compared to control are: 1-month TT=1.74, 0.96-3.14, L=1.59, 0.58-2.58; 6-month TT=1.27, 0.85-1.89, L=1.42, 0.85-2.11; 12-month TT=1.44, 0.92-2.28, L=1.34, 0.86-2.36; 24-month TT=1.17, 0.82-1.67, L=1.22, 0.69-1.60. In the group of patients who gained greater than 2kg, those who underwent TT had significant weight increase compared to the parathyroidectomy group at 6-months postoperatively (Mann-Whitney U, p=0.011). In the subgroup of patients with weight gain greater than 2kg, those who had L did not have significant weight increase at any time point. Conclusion: Weight change following TT when compared with parathyroidectomy is significant shortly after surgery. However, these changes are not significant at long-term follow-up.

Ileal Transposition in Rats Reduces Energy Intake, Body Weight, and Body Fat Most Efficaciously When Ingesting a High-Protein Diet

PurposeIleal transposition (IT) allows exploration of hindgut effects of bariatric procedures in inducing weight loss and reducing adiposity. Here we investigated the role of dietary macronutrient content on IT effects in rats.MethodsMale Lewis rats consuming one of three isocaloric liquid diets enriched with fat (HF), carbohydrates (HC), or protein (HP) underwent IT or sham surgery. Body weight, energy intake, energy efficiency, body composition, and (meal-induced) changes in plasma GIP, GLP-1, PYY, neurotensin, and insulin levels were measured.ResultsFollowing IT, HC intake remained highest leading to smallest weight loss among dietary groups. IT in HF rats caused high initial weight loss and profound hypophagia, but the rats caught up later, and finally had the highest body fat content among IT rats. HP diet most efficaciously supported IT-induced reduction in body weight and adiposity, but (as opposed to other diet groups) lean mass was also reduced. Energy efficiency decreased immediately after IT irrespective of diet, but normalized later. Energy intake alone explained variation in post-operative weight change by 80%. GLP-1, neurotensin, and PYY were upregulated by IT, particularly during (0–60 min) and following 17-h post-ingestive intake, with marginal diet effects. Thirty-day post-operative cumulative energy intake was negatively correlated to 17-h post-ingestive PYY levels, explaining 47% of its variation.ConclusionReduction in energy intake underlies IT-induced weight loss, with highest efficacy of the HP diet. PYY, GLP-1, and neurotensin levels are upregulated by IT, of which PYY may be most specifically related to reduced intake and weight loss after IT.

Does weight gain, throughout 15 years follow-up after Nissen laparoscopic fundoplication, compromise reflux symptoms control?

ABSTRACT Background: Gastroesophageal reflux disease is defined by the abnormal presence of gastric content in the esophagus, with 10% incidence in the Western population, being fundoplication one treatment option. Aim: To evaluate the early (six months) and late (15 years) effectiveness of laparoscopic fundoplication, the long term postoperative weight changes, as well as the impact of weight gain in symptoms control. Methods: Prospective study of 40 subjects who underwent laparoscopic Nissen’s fundoplication. Preoperatively and early postoperatively, clinical, endoscopic, radiologic, manometric and pHmetric evaluations were carried out. After 15 years, clinical and endoscopic assessments were carried out and the results compared with the early ones. The presence or absence of obesity was stratified in both early and late phases, and its influence in the long-term results of fundoplication was studied, measuring quality of life according to the Visick criteria. Results: The mean preoperative ages, weight, and body mass index were respectively, 51 years, 69.67 kg and 25.68 kg/m2. The intraoperative and postoperative complications rates were 12.5% and 15%, without mortality. In the early postoperative period the symptoms were well controlled, hernias and esophagitis disappeared, the lower esophageal sphincter had functional improvement, and pHmetry parameters normalized. In the late follow-up 29 subjects were assessed. During this period there was adequate clinical control of reflux regardless of weight gain. In both time periods Visick criteria improved. Conclusion: Fundoplication was safe and effective in early and late periods. There was late weight gain, which did not influence effective symptoms control.

Defining Postoperative Weight Change Following Pancreatectomy: Factors Associated With Distinct And Dynamic Weight Trajectories

Presenter: Maxwell Trudeau BS | University of Pennsylvania Background: Weight change offers the simplest, global indication of a patients’ surgical recovery, and is aligned with long-term quality of life. Yet, no studies have thoroughly investigated postoperative weight dynamics following pancreatectomy, with wide disparity amongst surgeons’ perceptions of this concept. This study aims to define postoperative weight change dynamics following pancreatectomy and determine factors associated with optimal and poor weight trajectories. Methods: From 2004-2019, 1,156 proximal (PD; 66%) and distal (DP; 34%) pancreatectomies were performed at a single institution for benign and malignant pathologies. Patient weights were acquired preoperatively and at postoperative months 1, 3 and 12. Optimal (Top Quartile, weight restoration) and poor (Bottom Quartile, persistent weight loss) postoperative weight cohorts were identified at 1-year. Multivariable analyses (MVA) were used to identify pre-, intra- and postoperative factors associated with these particular courses. Results: The median percentage weight change (PWC) 1-year post-pancreatectomy was -7% (IQR: -2% to -13%), with similar median PWC between PD (-8.2%) and DP (-4.4%, p=0.568). Median weight loss primarily occurs within the first month and then plateaus thereafter. Just 19.4% of patients obtained their original weight within one year. No factors were significantly associated with postoperative PWC as a continuous variable, including: elderly age [>65] (p=0.495), obesity (p=0.409), preoperative diabetes or exocrine insufficiency (p=0.536; p=0.883, respectively), jaundice at presentation (p=0.492), malignancy (p=0.522), pre- or postoperative TPN/TEN (p=0.890; p=0.509, respectively), severe complications (p=0.627), adjuvant therapy (p=0.524), and tumor recurrence (p=0.368). Subsequently, weight restoration and persistent weight loss cohorts were analyzed (Figure 1). MVA revealed the independent factors associated with weight restoration were: non-elderly age (OR 1.73), non-obesity (OR 2.56), jaundice (OR 1.63), DP [reference: PD] (OR 2.34), not experiencing 30-day readmission (OR 1.61), and lack of tumor recurrence (OR 2.53). Conversely, persistent weight loss was associated with: elderly age (OR 1.51), obesity (OR 2.36), PD (OR 2.02), operative time>325minutes (OR 1.65), experiencing any complication (OR 1.68), receipt of adjuvant therapy (OR 1.44), and experiencing tumor recurrence (OR 5.46). Overall, 33% of the persistent weight loss cohort experienced tumor recurrence. Subset analysis of pancreatic adenocarcinoma patients (N=424, 37%) revealed factors associated with weight restoration to be: non-obesity (OR 2.95), DP (OR 1.74), estimated blood loss < 400 (OR 1.71), not experiencing a severe complication (OR 5.73), and lack of recurrence (OR 2.32). For all patients, weight restoration was associated with longer median overall survival (31 vs. 18 months, p=0.039), while patients with persistent weight loss lived a median of 16 months. Conclusion: These data define postoperative weight kinetics following major pancreatectomy, and identify optimal and poor weight trajectories. Overall, 80% of patients will not obtain their original weight, which may negatively impact their quality of life. Ultimately, weight restoration appears to be predetermined, driven by immutable characteristics. Persistent weight loss also appears to be inevitable due to demographic/pathological factors, particularly tumor recurrence, but may be mitigated by limiting operative time and complications. This study provides insight to post-pancreatectomy recovery, helping to guide patient expectations. Moreover, it offers a foundation for future studies directed towards nutritional optimization for pancreatic resections.

Postoperative Weight Changes, Nutritional Status and Clinical Significance of Colorectal Cancer Patients

Postoperative Weight Changes, Nutritional Status and Clinical Significance of Colorectal Cancer Patients

Early postoperative weight gain is associated with increased risk of graft failure in living donor liver transplant recipients

Fluid overload (FO) has been shown to adversely affect multiple organs and survival in critically ill patients. Liver transplantation (LT) carries the risk of massive transfusion, which frequently results in FO. We investigated the association of postoperative weight gain with graft failure, early allograft dysfunction (EAD), and overall mortality in LT. 1833 living donor LT (LDLT) recipients were retrospectively analysed. Patients were divided into 2 groups according to postoperative weight gain (<3% group [n = 1391] and ≥3% group [n = 442]) by using maximally selected log-rank statistics for graft failure. Multivariate Cox and logistic regression analyses were performed. The ≥3% group was associated with graft failure (adjusted HR [aHR], 1.763; 95% CI, 1.248–2.490; P = 0.001). When postoperative weight change was used as a continuous variable, the aHR for each 1% increase in postoperative weight was 1.045 (95% CI, 1.009–1.082; P = 0.015). In addition, the ≥3% group was associated with EAD (adjusted OR [aOR], 1.553; 95% CI, 1.024–2.356; P = 0.038) and overall mortality (aHR, 1.731; 95% CI, 1.182–2.535; P = 0.005). In conclusion, postoperative weight gain may be independently associated with increased risk of graft failure, EAD, and mortality in LDLT recipients.

Impact of postoperative weight gain on complications after liver surgery

BackgroundRecent data has suggested that excessive perioperative weight gain may be associated with adverse outcomes after abdominal surgery, but this observation remains unexplored following liver surgery. The present study aimed to investigate the predictive value of perioperative weight fluctuation in predicting complications after liver surgery. MethodsRetrospective monocentric analysis of consecutive patients undergoing liver surgery between 2010 and 2016. Patients without available perioperative weight were excluded. Test variable was postoperative weight change (ΔWeight) measured on day 2 (POD2). Primary outcome was postoperative major morbidity according to Clavien classification (grades III–IV). Secondary outcomes were overall complications, Comprehensive Complication Index (CCI) and length of hospital stay (LoS). Area under the receiver operating characteristic curve (AUROC) and logistic regression with multivariable analysis were performed. ResultsA total of 181 patients met the inclusion criteria. Major and overall postoperative complications were reported in 25 (14%) and 87 (48%) patients, respectively. On POD2, median ΔWeight was 2.6 Kg (IQR: 1.1–4.0). Patients with major complications showed increased ΔWeight of 4.2 Kg (IQR: 2.7–5.7), compared to 2.3 Kg (IQR: 0.9–3.7) in patients without major complications (p < 0.001). AUROC of ΔWeight for major complications was 0.74, determining an optimal cut-off of 3.5 Kg, which yielded a negative predictive value of 94%. Multivariable analysis identified ΔWeight ≥3.5 Kg as independent predictor of major complications (OR, 4.73; 95% CI, 1.51–14.80; p = 0.008). ConclusionΔWeight ≥3.5 Kg was independently associated with major complications after liver surgery. Perioperative fluctuation of weight appears as an important predictor of adverse outcomes after liver surgery.

Internalizing, Externalizing, and Interpersonal Components of the MMPI-2-RF in Predicting Weight Change After Bariatric Surgery.

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is commonly used to assess psychological factors that may adversely impact weight loss. Research is limited on the specific MMPI-2-RF scales that may predict poor postoperative outcomes following bariatric surgery. The current study compared preoperative MMPI-2-RF profiles associated with postoperative weight change to novel component scores in a bariatric surgery sample. One hundred twenty-seven patients completed a preoperative medical evaluation, a test of reading ability, and the MMPI-2-RF. Percent weight loss was obtained postoperatively at 6 and 12months. Principal components analysis (PCA) generated five novel subcomponents from within the internalizing, externalizing, and interpersonal substantive scales of the MMPI-2-RF. Among these components, higher externalizing and social conflict scores at baseline were predictive of less percent weight change postoperatively at 6months. A similar trend was observed with higher insecurity scores predicting less weight loss at 6months postoperatively. At 12-month follow-up, higher insecurity scores at baseline remained predictive of lower percentage weight loss, while social conflict trended toward significance in the same direction. Model comparisons of traditional MMPI-2-RF scales were found to be more sensitive than the novel subcomponents. Specifically, demoralization (RCd), antisocial behavior (RC4), hypomanic activation (RC9), family problems (FML), and shyness (SHY) significantly predicted weight change after surgery. Results suggested that specific problems scales were not more effectively differentiated into more sensitive and specific component scores, but demonstrated supportive evidence that the traditional MMPI-2-RF scales indicating higher degrees of behavioral dysregulation, poor self-efficacy, and lower social support predict reduced postoperative weight loss.

Association of Obesity Subtypes in the Longitudinal Assessment of Bariatric Surgery Study and 3-Year Postoperative Weight Change.

The study objective was to empirically identify subgroups of patients with obesity and investigate their association with postoperative weight change. A longitudinal analysis of 2,458 adults in the Longitudinal Assessment of Bariatric Surgery (LABS) study was used. Baseline data were used to identify subgroups. The outcome was 3-year weight change after bariatric surgery. We identified four classes (subtypes) of obesity, which could be characterized as diabetes with low rates of high-density lipoprotein (Class 1), disordered eating (Class 2), mixed (Class 3), and extreme obesity with early onset (Class 4). Approximately 98% of participants in Class 1 had diabetes compared with < 40% in the other classes. There were high rates of binge eating in Class 2, and more than 92% of those in this class reported eating when not hungry. Class 4 was characterized by a higher BMI at baseline. Adults in Class 4 lost an average of 25.0% (males) and 30.3% (females) of their baseline weight over 3 years. In contrast with participants in Class 1, those in Classes 2 and 3 had significantly larger 3-year weight losses than their peers in Class 4. Obesity is a heterogeneous disease. Bariatric surgery may be most beneficial for adults with disordered eating.

Segmental reversal of distal small intestine in short bowel syndrome: a study on the influence on postoperative weight and intestinal topography in piglets.

The objective of the present study was to investigate the effect of segmental reversal of the distal 20cm of the small intestine in piglets with induced SBS compared to controls with SBS alone. Primary endpoint was postoperative weight change over a period of 1month. Secondary endpoints were the influence on cell proliferation and mucosal architecture shown by histological analysis. Sixteen piglets underwent a 60% resection of the distal small intestine and were randomized into two groups. Group 1 short bowel syndrome alone (SBS) (n = 8) and group 2 with reversal of a distal small intestinal segment (SBS-RS) (n = 8). Body weight was measured daily and the pigs were euthanized after 1month. Crypt depths, villus heights and muscle layers thicknesses were measured. For the evaluation of microvilli of the brush border of the epithelium and cell proliferation, immunohistochemical staining with Villin and Ki-67 was performed. No statistically significant differences were observed concerning weight gain. Mean ± SD weight gain was 2.31 ± 2.85kg for SBS-RS and 2.03 ± 1.27kg for SBS (p = 0.8). In the proximal jejunal segment a significant increase in villus heights was found in the SBS group and increase in the thickness of the circular and longitudinal muscle layers in the SBS-RS group. In the distal ileal segment the longitudinal muscle layer thicknesses were increased in the SBS group. Otherwise, no significant changes were found. Reversal of a 20-cm distal segment showed no effect on weight gain, but there were some significant histological changes of unknown clinical significance.

Does Size Matter? Correlation of Excised Gastric Specimen Size in Sleeve Gastrectomy to Postoperative Weight Loss and Comorbidities.

We present the correlation between excised specimen size in laparoscopic sleeve gastrectomy and patient demographics, comorbidities, and postoperative weight loss. This study aims to address whether the size of gastric specimen excised during laparoscopic sleeve gastrectomy has any correlation with patient demographics, comorbidities, and postoperative percent of excess body weight lost. Study was performed at a community teaching hospital in Michigan. We examined data from 204 patients who underwent sleeve gastrectomy between August 2011 and January 2015. Data was collected retrospectively including demographics, comorbidities, body mass index (BMI), percent of excess body weight lost, and the size of the gastric specimen removed including specimen volume in cubic centimeters, length, width, and thickness in centimeters. We found that gastric specimen size does not correlate with initial BMI or change in BMI at 3, 6, or 12months. Larger specimen sizes were found in males, increasing age, and patients with diabetes mellitus. There was no correlation between excised stomach size in laparoscopic sleeve gastrectomy and postoperative weight loss (percent of excess body weight lost) or change in BMI. Male gender, diabetes, and increasing patients' age correlated with larger excised stomach size. Initial BMI and having histological gastritis did not correlate with excised stomach size.

Weight Loss Before Complex Ventral Hernia Repair: Is It Sustainable?

Motivation of patients to lose weight is a principal concern in preoperative preparation of patients for complex ventral hernia repair (cVHR). Weight changes following cVHR, however, are not well characterized. In this study, we explored 3 questions: 1) is preoperative weight loss sustainable after operation, 2) can patients unable to lose weight preoperatively initiate weight loss after cVHR, and 3) are there clinical factors that predict postoperative weight change? We performed a retrospective medical record review of patients who underwent open cVHR at an academic tertiary referral center from January 2013 through August 2015. Exclusions were inflammatory bowel disease, metastatic cancer, and bariatric operation specifically in anticipation of cVHR. There were 112 patients included with the following profile: average age 58.4 ± 11.2 years, 84.8% with operative BMI ≥ 30 kg/m2, 29.5% Ventral Hernia Working Group Grade ≥ 3. Sixty-three (56.3%) patients lost weight preoperatively; of these, 57.1% had gained weight 1 year after cVHR. Forty-nine (43.0%) patients gained weight preoperatively; 42.9% of these lost weight postoperatively. No risk factors were identified that predict a high likelihood of pre- or postoperative weight loss. Despite success in promoting weight loss prior to surgery, a high rate of recidivism to weight gain occurs postoperatively. Further, in those patients unable to lose weight preoperatively, cVHR did prompt weight loss in a minority of patients. Together, these findings emphasize the importance of developing weight reduction programs for cVHR patients that not only optimize preoperative conditions but that are also sustainable.

Evaluation of Weight Change During Carboplatin Therapy in Dogs With Appendicular Osteosarcoma.

BackgroundThe prevalence of cancer cachexia in veterinary medicine has not been studied widely, and as of yet, no definitive diagnostic criteria effectively assess this syndrome in veterinary patients.Objectives(1) To determine the patterns of weight change in dogs with appendicular osteosarcoma treated with amputation and single‐agent carboplatin during the course of adjuvant chemotherapy; and (2) to determine whether postoperative weight change is a negative prognostic indicator for survival time in dogs with osteosarcoma.AnimalsEighty‐eight dogs diagnosed with appendicular osteosarcoma. Animals were accrued from 3 veterinary teaching hospitals.MethodsRetrospective, multi‐institutional study. Dogs diagnosed with appendicular osteosarcoma and treated with limb amputation followed by a minimum of 4 doses of single‐agent carboplatin were included. Data analyzed in each patient included signalment, tumor site, preoperative serum alkaline phosphatase activity (ALP), and body weight (kg) at each carboplatin treatment.ResultsA slight increase in weight occurred over the course of chemotherapy, but this change was not statistically significant. Weight change did not have a significant effect on survival. Institution, patient sex, and serum ALP activity did not have a significant effect on survival.Conclusions and Clinical ImportanceWeight change was not a prognostic factor in these dogs, and weight loss alone may not be a suitable method of determining cancer cachexia in dogs with appendicular osteosarcoma.

Gender differences in the correlation between prognosis and postoperative weight loss in patients with non-small cell lung cancer.

The aim of this study was to investigate gender differences in the relationship between preoperative body mass index (BMI), postoperative body weight change and prognosis in patients with non-small cell lung cancer (NSCLC). Two hundred and sixty-three patients with NSCLC were enrolled in this study. Preoperative BMI was categorized based on WHO definition as follows: underweight (BMI <18.5): 21 patients (8.0%), normal (18.5 ≦ BMI <25): 179 patients (68%), overweight and obese (BMI ≧25): 63 patients (24%). Several factors such as age, sex, cancer stage, body weight change and BMI were recorded and correlated to the postoperative overall survival (OS). For male patients, those in the low-BMI group had the worst prognosis (P < 0.05) whereas female patients with low BMI did not. Male patients with low BMI had statistically significant poorer prognosis compared to corresponding female patients (P < 0.05). Male patients with more than 5% body weight loss within 1 year after operation when compared to preoperative body weight had poorer prognosis than those with less than 5% body weight loss (P < 0.001). Furthermore, these male patients had statistically significant worse prognosis than the corresponding female patients (P < 0.05). In multivariable analysis, gender, more than 5% of body weight loss compared to preoperative body weight, and pathological stage were independent prognostic factors in NSCLC. This study illustrates significant gender differences in the relationship between prognosis and BMI or body weight change in patients with postoperative NSCLC.

Postoperative complications and weight loss following jejunostomy tube feeding after total gastrectomy for advanced adenocarcinomas.

ObjectivePatients undergoing total gastrectomy for cancer are at risk of malnourishment. The aim of this self-controlled study was to examine the effect of jejunostomy tube feeding (JTF) and other factors on postoperative weight and the incidence of jejunostomy-related complications in patients undergoing total gastrectomy for cancer.MethodsAll consecutive patients who underwent total gastrectomy for gastric cancer with jejunostomy placement were included from a prospective single-center database (2003–2014). Jejunostomy-related complications and postoperative weight changes were evaluated up to 12 months after surgery. Multivariable linear regression analysis was performed to identify factors associated with weight loss 12 months after gastrectomy.ResultsOf 113 patients operated in the study period, 65 received JTF after total gastrectomy for a median duration of 18 d [interquartile range (IQR), 10–55 d]. Jejunostomy-related complications occurred in 11 (17%) patients, including skin leakage (n=3) and peritoneal leakage (n=2), luxation (n=3), occlusion (n=2), infection (n=1) and torsion (n=1). In 2 (3%) patients, a reoperation was needed due to jejunostomy-related complications. The mean preoperative weight of patients was 71.8 kg (100%), and remained stable during JTF (73.9 kg, 103%, P=0.331). After JTF was stopped, the mean weight of patients decreased to 64.9 kg (90%) at 12 months after surgery (P<0.001). A high preoperative body mass index (BMI) (≥25 kg/m2) was associated with high postoperative weight loss compared to patients with a low BMI (<25 kg/m2) (16.3% vs. 8.6%, P=0.016). ConclusionsJTF can prevent weight loss in the early postoperative phase. However, this is at the prize of possible complications. As weight loss in the long term is not prevented, routine JTF should be re-evaluated and balanced against the selected use in preoperatively malnourished patients. Special attention should be paid to patients with a high preoperative BMI, who are at risk of more postoperative weight loss.

Postoperative Behavioral Variables and Weight Change 3 Years After Bariatric Surgery.

Severe obesity (body mass index ≥35 [calculated as weight in kilograms divided by height in meters squared]) is associated with significant medical comorbidity and increased mortality. Bariatric surgery induces weight loss, the extent of which can vary. Postoperative predictors of weight loss have not been adequately examined. To describe postoperative eating behaviors and weight control and their effects on 3-year change in weight. The Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study is a multicenter observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Adults undergoing first-time bariatric surgical procedures as part of routine clinical care were recruited between 2006 and 2009 and followed up until September 2012. Participants completed detailed surveys regarding eating and weight control behaviors prior to surgery and then annually after surgery for 3 years. Twenty-five postoperative behaviors related to eating behavior, eating problems, weight control practices, and the problematic use of alcohol, smoking, and illegal drugs. Behaviors examined were divided into those that were never present (preoperatively or postoperatively), those that were always present (preoperatively and postoperatively), and those that underwent a healthy change after surgery (development of a positive behavior or omission of a negative behavior). The sample included a total of 2022 participants (median age, 47 years [interquartile range, 38-55 years]; median BMI, 46 [interquartile range, 42-51]; 78% women): 1513 who had undergone Roux-en-Y gastric bypass and 509 who had undergone laparoscopic adjustable gastric banding. If we consider the cumulative effects of the 3 behaviors that explain most of the variability (16%) in 3-year percent weight change following Roux-en-Y gastric bypass, ie, weekly self-weighing, continuing to eat when feeling full more than once a week, and eating continuously during the day, a participant who postoperatively started to self-weigh, stopped eating when feeling full, and stopped eating continuously during the day after surgery would be predicted to lose a mean (SE) of 38.8% (0.8%) of their baseline weight. This average is about 14% greater weight loss compared with participants who made no positive changes in these variables (mean [SE], -24.6% [1.6%]; mean difference, -14.2%; 95% CI, -18.7% to -9.8%; P < .001) and 6% greater weight loss compared with participants who always reported positive on these healthy behaviors (mean [SE], -33.2% [0.6%]; mean difference, -5.7%; 95% CI, -7.8% to -3.5%; P < .001). The results suggest the importance of assessing behaviors related to eating behavior, eating problems, weight control practices, and the problematic use of alcohol, smoking, and illegal drugs in bariatric surgery candidates and patients who have undergone bariatric surgery, and they suggest that the utility of programs to modify problematic eating behaviors and eating patterns should be addressed in research.

Enhanced recovery program is safe and improves postoperative insulin resistance in gastrectomy.

To assess the safety of enhanced recovery after surgery (ERAS) program in gastrectomy and influences on nutrition state and insulin-resistance. Our ERAS program involved shortening the fasting periods and preoperative carbohydrate loading. Eighty gastrectomy patients were randomly assigned to either the conventional group (CG) or ERAS group (EG). We assessed the clinical characteristics and postoperative outcomes prospectively. The primary endpoint was noninferiority in timely discharge from the hospital within 12 d. Secondary endpoints were the incidence of aspiration at anesthesia induction, incidence of postoperative complications, health related quality of life (HRQOL) using the SF8 Health Survey questionnaire, nutrition state [e.g., albumin, transthyretin (TTR), retinal-binding protein (RBP), and transferrin (Tf)], the homeostasis model assessment-insulin resistance (HOMA-R) index, postoperative urine volume, postoperative weight change, and postoperative oral intake. The ERAS program was noninferior to the conventional program in achieving discharge from the hospital within 12 d (95.0% vs 92.5% respectively; 95%CI: -10.0%-16.0%). There was no significant difference in postoperative morbidity between the two groups. Adverse events such as vomiting and aspiration associated with the induction of general anesthesia were not observed. There were no significant differences with respect to postoperative urine volume, weight change, and oral intake between the two groups. EG patients with preoperative HOMA-R scores above 2.5 experienced significant attenuation of their HOMA-R scores on postoperative day 1 compared to CG patients (P = 0.014). There were no significant differences with respect to rapid turnover proteins (TTR, RBP and Tf) or HRQOL scores using the SF8 method. Applying the ERAS program to patients who undergo gastrectomy is safe, and improves insulin resistance with no deterioration in QOL.

New Joints, Same Old Weight: Weight Changes After Total Hip and Knee Arthroplasty.

Obesity is a well-known risk factor for postoperative complications following total joint arthroplasty. However, because the operation is often successful, orthopedic surgeons continue to operate on obese individuals, and many surgeons do so under the assumption that patients will lose weight after they are able to walk and exercise without pain. In this article, we review a recent study by Ast et al., who performed a retrospective review, using a single-center institutional registry, to determine (1) whether patients do actually lose weight after total hip and/or total knee arthroplasty, (2) whether there are predictors of postoperative weight change, and (3) whether postoperative weight changes affect patient-reported clinical outcomes. The principle conclusion was that most patients maintained their body mass index (BMI) after total hip and total knee arthroplasty (73 and 69%, respectively). However, patients undergoing total knee arthroplasty, patients who had a higher preoperative BMI, and female patients were more likely to lose weight postoperatively. When examined in the context of the current literature, this study provides valuable information for the preoperative counseling of total joint arthroplasty candidates, especially in the setting of obesity.