Prior Bariatric Surgery Research Articles

Risk Factors for Wound Complications After Periprosthetic Fractures.

The number of hip and knee arthroplasties performed annually continues to rise. Revision rates are projected to increase by 137% to 601%, with periprosthetic fractures to be among the leading cause of revision. Wound complications following surgical treatment of periprosthetic fractures are a major source of patient morbidity and health care costs. This study evaluated risk factors for wound healing complications in patients undergoing surgical management of periprosthetic fractures around the hip and knee. This was a retrospective analysis of 67 consecutive lower-extremity periprosthetic hip and knee fracture surgeries. Descriptive data, comorbidities, dressing type, and rates of wound complications treated nonoperatively and operatively were collected. Logistic regression analysis was performed to calculate odds ratios (ORs) of having a wound complication. There was an overall wound complication rate of 22%; the majority of these complications (16%) were treated operatively. On multivariate analysis, prior bariatric surgery (OR, 12.02; 95% confidence interval [CI], 1.24-116.71; P=.03), peripheral vascular disease (OR, 6.84; 95% CI, 1.32-35.39; P=.02), and pulmonary disease (OR, 11.23; 95% CI, 1.85-68.31; P=.01) were all associated with an increased risk of developing a wound complication. Closed-incision negative-pressure therapy was associated with a decreased risk of developing a wound complication (OR, 0.04; 95% CI, 0.00-0.49, P=.01). Surgery to treat hip and knee periprosthetic fractures is associated with a high rate of wound complications. History of bariatric surgery, peripheral vascular disease, and pulmonary disease are all associated with an increased risk of developing a wound complication. Future payment models should reflect this elevated level of complications and risk. [Orthopedics. 2020;43(4):e258-e262.].

Effect of bariatric surgery on outcomes in the operative treatment of hip fractures

IntroductionFew studies have evaluated the effect of prior bariatric surgery on outcomes following the operative treatment of hip fractures. The purpose of this study is to evaluate these metrics in a population of bariatric surgery patients compared to a control group who were operatively treated for hip fractures. Materials and MethodsThe California Office of Statewide Health Planning & Development (OSHPD) discharge database was accessed to identify patients who sustained a hip fracture between 2000–2014. CPT codes were utilized to identify patients who had a prior history of bariatric surgery within this time period. A control cohort of patients who had undergone previous appendectomy were queried similarly. The study evaluated complication rates and inpatient mortality at 30- and 90-days postoperatively as well as 30- and 90-day readmission rates. ResultsThere were 1,327 bariatric and 2,127 control patients identified. Survival rates were significantly lower in bariatric patients compared to controls (87.2% vs. 91.8%, p = 0.048) at 5 years. After controlling for confounders, bariatric patients had higher 30- (OR 1.46, p = 0.005) and 90-day (OR 1.38, p = 0.011) readmission rates. There were no differences in all-cause complication and inpatient mortality rates between groups at 30 or 90 days. DiscussionBariatric surgery patients are at increased risk of readmission after hip fracture surgery. Further research is warranted to delineate potential risk factors and mitigate readmission in these patients. Level of EvidenceIII

Prior bariatric surgery is associated with lower complications, in-hospital mortality, and healthcare utilization after elective spine fusion surgery.

Grade 3 obesity could potentially increase postoperative complications after spinal fusion surgery. However, the relationship between prior bariatric surgery (BS) and postoperative complications after spinal fusion surgery is not well-established. Inpatient hospital admissions from the Nationwide Inpatient Sample. Patients with a primary procedure of spinal fusion surgery discharged between 2006 and 2014 were identified. In-hospital outcomes included postoperative complications, mortality, cost, and length of stay were compared between patients with prior BS and grade 3 obesity. A total of 3,132,192 patients who underwent elective spinal fusion surgery were identified. There were 33,936 (1.1%) patients with a diagnosis of prior BS. The prevalence of prior BS increased significantly from .1% in 2006 to 1.5% in 2014. Compared with patients with grade 3 obesity, patients with prior BS were younger, more likely to be female, had less co-morbidities, and higher proportion of cervical surgery. Multivariable analysis indicated that patients with prior BS had lower risk of overall complications (odds ratio [OR]: .44; 95% confidence interval [CI]: .38-.49), neurologic (OR: .55; 95%CI: .35-.84), respiratory (OR: .30; 95%CI: .23-.37), cardiac (OR: .38; 95%CI: .24-.60), gastrointestinal (OR: .61; 95%CI: .44-.84), urinary and renal (OR: .34; 95%CI: .26-.44), venous thromboembolism (OR: .35; 95%CI: .19-.63), wound-related complications (OR: .67; 95%CI: .53-.85), and in-hospital mortality (OR: .12; 95%CI: .02-.88). Prior BS was also related to 13% shorter length of stay and 2% lower cost. Among patients undergoing spinal fusion surgery, prior BS is associated with lower complications, in-hospital mortality, and healthcare utilization. BS might mitigate risk of worse outcomesassociated with grade 3 obesity after spine fusion surgery.

Adult- adult liver living donor after bariatric surgery. First report of 3 cases

Presenter: Gabriela Ochoa MD | Pontificia Universidad Católica de Chile Background: The increasing prevalence of bariatric surgery and the use of living donors for liver transplantation, could potentially face us with donors with this surgical history. Due to association between obesity and non-alcoholic liver disease, we must beware of some level of liver damage. Furthermore, it's been demonstrated that bariatric surgery decreases NASH progression and reverts simple steatosis cases. We present 3 cases of patients with prior bariatric surgery, who were selected as donors in our Living Donor Liver Transplant (LDLT) program. Methods: Retrospective descriptive analysis of patients with previous bariatric surgery, who underwent right donor hepatectomy for LDLT at Pontifical Catholic University of Chile Clinical Hospital. The information was obtained from clinical reports and telephone interviews. Data analysis was made with descriptive statistic. Results: Case 1: 53 years-old male, who underwent laparoscopic sleeve gastrectomy (LSG) in 2013 for BMI 33,1. In 2016, before hepatectomy, his BMI was 21,5. Normal liver function tests. Case 2: 46 years-old female, she underwent LSG (2009) and conversion to gastric bypass (2011) for severe obesity, BMI max 39,7. In pre-transplant study to become a donor BMI was 35 (2016). Liver biopsy without steatosis and normal liver function tests. Case 3: 53 years-old female, LSG performed (2013), BMI max 31,5. Normal preoperative study with BMI 24,2 (2016). The three patients underwent successfully to right donor hepatectomy. No complications were observed and postoperative trend of liver function tests were in expected ranges. No transfusion requirements, mean operative time was 300 minutes (program average 325 min), hospital stay 6,3 days, with adequate liver function in the recipients. Conclusion: The three patients underwent successfully to right donor hepatectomy. No complications were observed and postoperative trend of liver function tests were in expected ranges. No transfusion requirements, mean operative time was 300 minutes (program average 325 min), hospital stay 6,3 days, with adequate liver function in the recipients.

New Onset Cardiac Arrhythmias after Metabolic and Bariatric Surgery.

Background:Metabolic and bariatric surgery (MBS) has been shown to improve medical problems; however, there are known arrhythmias that can occur after MBS (i.e., sick sinus syndrome [SSS] and sinus bradyarrhythmias). While the literature in this area contains case reports, there is a lack of published data on a state or national level. We used a large state administrative database to evaluate the occurrence of cardiac arrhythmias after MBS.Methods:We studied the years 2016 to 2018 using the Texas Inpatient Public Use Data File. Inclusion criteria were patients who had a pacemaker installed and were ≥ 18 years. Quantitative variables were described using mean and standard deviation. Categorical variables were described using frequency and proportion. The student’s t-test and chi-squared test were used to assess the differences across pacemaker installation.Results:There were a total of 79,807 (10.2%) who had a history of MBS and 31,072 (4%) patients who underwent pacemaker insertion, respectively. After excluding all patients < 18 years, the prevalence of pacemakers installed in patients with prior bariatric surgery was 0.8% (n = 257/30,823) or about 8 in every 1000 patients. Of note, bariatric patients who had a pacemaker placed were younger than non-bariatric patients (P < 0.001). The most common reason for pacemaker placement was SSS (51.5%), followed by atrioventricular block (13.1%), and then bradycardia at 8.5%. The most common arrhythmia overall was bradycardia.Conclusions:Eight out of every 1000 patients with a pacemaker installed in the study period had a history of MBS. The most common arrhythmia was bradycardia and the most common reason for pacemaker placement was sick sinus syndrome. These results do not indicate causality but may demonstrate an association between MBS and arrhythmias. Bariatric patients undergo pacemaker placement at a younger age. The relationship between bariatric surgery and cardiac arrhythmias warrants further study.

Prior bariatric surgery is effective on morbidly obese patients following total knee arthroplasty.

Prior bariatric surgery is effective on morbidly obese patients following total knee arthroplasty.

1226: Pregnancy outcomes with specialist care after bariatric surgery

Nutrient assessment and follow-up with bariatric specialists is recommended for pregnant women with prior bariatric surgery. The rates at which pregnant women are seen by these specialists varies. We sought to identify the rate of follow-up with bariatric specialists and the impact on maternal and neonatal outcomes in pregnancy after bariatric surgery. This was a single center, retrospective cohort study of 151 singleton pregnancies in women who became pregnant after bariatric surgery and delivered between 2005 and 2018. Women were separated into two groups based on whether they had follow-up with a specialist either during or within one year prior to pregnancy. Maternal variables, neonatal data, and additional pregnancy information was compared between these two groups using univariable and multivariable analyses. Of the 151 pregnancies included in the study, 52 (34.4%) had follow-up with a bariatric specialist within 1 year or during pregnancy. There was no difference between maternal weight gain, maternal body mass index (BMI), gestational age (GA) at delivery, rates of gestational diabetes mellitus (GDM) or hypertensive disorders of pregnancy between groups (Table 1). Women who received specialist care were younger (32.8 ± 4.5 vs 34.4 ± 4.1 years, p=0.0350), more likely to be married (69.2% vs 58.2%, p=0.009), and had surgery within the prior 18 months before pregnancy (30.8% vs 9.3%). Cesarean rates were lower in the specialist care group, although this was not statistically significant (30.8% vs 41.4%, p=0.200) (Table 1). After controlling for confounding factors, a maternal composite outcome including post-operative wound infection, venous thromboembolism, or blood transfusion was similar between groups (3.3% vs 2.1%, p=0.691), and there were no differences in neonatal outcomes including a composite neonatal outcome (aOR 0.69, 95% CI 0.25-1.90) (Table 2). Follow-up with a bariatric specialist during or within 1 year of pregnancy was not associated with improved maternal or neonatal outcomes, although there was a trend toward lower rates of cesarean delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Long-Term Outcomes After One-Anastomosis Gastric Bypass (OAGB) in Morbidly Obese Patients.

One-anastomosis gastric bypass (OAGB) has gradually gained in popularity. Evidence of the validity of the technique and the quality of life in the longer term is scarce. The aim of this study was to retrospectively evaluate the longitudinal (≥ 5 years) safety, weight-loss efficacy, comorbid disease improvement, and quality of life of patients following OAGB. Data from patients who underwent OAGB from January 2009 to December 2011 were retrospectively reviewed. Preoperative clinical characteristics and data through 8 years were analyzed. A total of 163 patients completed 5 to 8 years of follow-up with a mean age of 41 ± 11.4 years (22-65). Ninety-four patients (57.6%) had undergone prior bariatric surgery (gastric band). Mean body mass index (BMI, kg/m2) at the time of OAGB was 41.2 ± 6.5 (range 30.1-50.6). Twenty-one patients (13.0%) suffered from type 2 diabetes mellitus (T2DM), 59 (36.2%) hypertension, 31 osteoarthritis (19.0%), and 24 had obstructive sleep apnea (14.7%). At 5, 6, 7, and 8 years of follow-up, respective mean BMI reduction was 12.6 (n = 163), 11.8 (n = 100), 10.7 (n = 82), and 8.8 (n = 40). Respective mean excess weight loss was 81.8 ± 23.6%, 75.9 ± 20.8%, 69.1 ± 20.4%, and 62.3 ± 23.4%. All obesity-related comorbidities decreased significantly at follow-up time points. Five patients (3%) underwent laparoscopic reoperation within 90 days after surgery. Incidence of recurrent reflux was 14.0%. At a mean follow-up of 92 months (76-111), improved or greatly improved quality of life was reported by 86.0% of patients. OAGB provided very good weight loss, comorbidity improvement, and quality of life at follow-up of ≥ 5 years.

Effect of Resident Participation on Hysterectomy Outcomes in Morbidly Obese Patients

Study Objective To assess the effect of resident participation on hysterectomy-related complications in morbidly obese patients. Design Retrospective cohort study. Setting Tertiary-care academic medical center. Patients or Participants Patients with BMI > 40 kg/m2 who underwent any route of hysterectomy between 4/2014 and 3/2018 were eligible for inclusion. 225 patients were randomly selected, excluding patients with gynecologic malignancy or prior bariatric surgery. Interventions 108 patients with resident participation in hysterectomy were compared to 117 patients with no resident participation. Data was collected by manual chart review and polytomous logistic regression was used for analysis. Measurements and Main Results Mean BMI in the group with resident participation was 46.4 kg/m2, compared to 45.2 kg/m2 in the group with no resident (P=0.12). Mean operative time was 69 minutes longer in the group with resident participation (241.6 minutes v. 172.9 minutes, P Conclusion In this cohort of morbidly obese patients, resident participation in hysterectomy was associated with significantly longer operative time, substantially greater odds of complications occurring during surgery, and greater odds of any 30-day hysterectomy-related complication.

Offspring of women following bariatric surgery and those of patients with obesity are at an increased risk for long-term pediatric endocrine morbidity.

To assess whether offspring of women following bariatric surgery as well as offspring of obese women are at an increased risk for long-term pediatric endocrine morbidity. This study was conducted at the university hospital. A population-based cohort study compared the incidence of long-term (up to the age of 18years) occurrence of endocrine morbidity between offspring of mothers following bariatric surgery and obese mothers, as compared with parturients without obesity and without prior bariatric surgery. During the study period 220,563 newborns met the inclusion criteria; 1001 were delivered by patients following bariatric surgery, 2275 were delivered by obese women and 217,287 were delivered by normal weight women without prior bariatric surgery. Long-term endocrine morbidity was more common in the bariatric group (2.3%) and the obesity group (1.5%) as compared with the comparison group (0.5%; P < 0.001). Specifically, pediatric obesity was significantly more common in children of mothers following bariatric surgery (1.8%) and of mothers with obesity (1.2%) as compared with the comparison group (0.2%; P < 0.001). Children born to women following bariatric surgery as well as obese women had higher cumulative incidence of pediatric endocrine morbidity (Log rank, P < 0.001). The results remained significant when controlling for maternal factors, adjusted HR 6.25, 95% CI 4.10-9.50; P < 0.001 for women following bariatric surgery and aHR 2.40 95% CI 1.69-3.40; P < 0.001 for obese women. Offspring of women following bariatric surgery as well as those of obese women are at an increased risk for long-term pediatric endocrine morbidity.

1130 Bariatric Surgery Is Associated With a Recent Temporal Increase in Colorectal Cancer Resections, Most Pronounced in Adults &lt;50 Years of Age: A 2006-2013 National Analysis

INTRODUCTION: The incidence rates of early-age onset colorectal cancer (CRC) are rapidly rising in the United States. In parallel, evolving evidence suggests an unexpected increase in long-term risk of CRC after bariatric surgery (BRS). BRS utilization expanded in the past three decades, however limited knowledge exists regarding the impact of BRS on age-stratified trends of obesity-related gastrointestinal cancers (OGCs) including that of CRC. METHODS: We queried the 2006-2013 National Inpatient Sample (NIS), the largest publicly available all-payer data repository, to identify patients who underwent resections for OGCs. We investigated patients with morbid obesity (body mass index ≥ 40 kg/m2) and those with prior BRS. In a separate analysis, we also looked at non-BRS/non-obese individuals. We divided OGCs into two groups: CRC and non-CRC OGCs (esophageal, gastric, liver, gallbladder and pancreatic cancers combined). Joinpoint regression analysis was used to calculate the average annual percent change (AAPC) in patients undergoing cancers resections across age groups (age &lt; 50 and ≥ 50 years old). RESULTS: We identified 28,041 patients with morbid obesity and 2,238 patients with a prior BRS who had resections for OGCs in 2006-2013. BRS patients were younger, with more females and fewer comorbidities (Table 1). The yearly number of morbidly obese and BRS patients who underwent CRC resections concurrently increased across all age groups (Figures 1 and 2). When stratified by age, the steepest rise in CRC was observed in BRS patients &lt;50 years of age (AAPC +18.7%, P &lt; 0.001). Conversely, non-CRC OGCs did not go up after BRS, while number of morbidly obese patients undergoing non-CRC OGCs increased in patients ≥50 years of age (AAPC +18.1%, P = 0.004). Finally, in a supplementary analysis, the number of non-BRS/non-obese patients with CRC resections, decreased in 2006-2013 [AAPC -3.3 (P = 0.002) and -3.4 (P &lt; 0.001) for patients &lt; and ≥50 respectively]. CONCLUSION: Our results identify a recent paradoxical increase in CRC resections after bariatric surgery, most pronounced for early-age onset CRC. Other obesity-related gastrointestinal cancers did not increase after bariatric surgery, suggesting a low probability of referral bias leading to our findings. Further research is warranted to elaborate on these trends and provide biological context.

1755 A Case of Xylophagia

INTRODUCTION: To describe a case of xylophagia with esophageal obstruction. CASE DESCRIPTION/METHODS: A 59-year-old female with prior medical history of hypertension, depression and PTSD presented with a sensation of mid retrosternal dysphagia and sialorrhea, which began during a meal consisting of eggs and toast. Prior surgical history was significant for prior sleeve gastrectomy. Upon her presentation, the patient noted that there was a several year history of chronic watery diarrhea for which she underwent extensive evaluation at an outside institution. The etiology of her diarrhea remained unclear and multiple empiric medication trials were unsuccessful. A friend of the patient suggested that she might try ingesting small amounts of toilet paper each day to solidify the stool. The patient began this practice several months prior to her presentation to the ED. The patient corroborated that by ingesting a small amount of toilet paper each day, her diarrhea had completely resolved. Aside from sialorrhea, her physical examination was unremarkable. The patient underwent urgent upper GI endoscopy under general anesthesia with endotracheal intubation. The mid and distal esophagus were found to be obstructed with a large amount of fluffy, soft toilet paper (Figure 1). The obstruction was painstakingly relieved by use of rat-tooth forceps and a polyp retrieval net. After nearly 2 hours of endoscopic manipulation, the esophageal obstruction was completely relieved and the duodenum was able to be intubated, with there being only scant amounts of residual toilet paper within the gastric sleeve and proximal duodenum. Post-procedure, the patient was able to ingest liquids and small amounts of solids without difficulty. After psychiatric consultation, the patient was discharged. It was strongly advocated by both the gastroenterology and psychiatric teams, that the patient curtail her habit of xylophagia. DISCUSSION: Xylophagia is a form of pica, involving the ingestion of items made of wood (such as paper, pencils, tree bark). Our patient endorsed commencing her habit of xylophagia in an effort to improve her chronic diarrheal disorder. It was suspected that her underlying psychiatric disease, prior bariatric surgery and willingness to accept another's ill–advised recommendation–all conspired to produce this unusual clinical presentation.

Benefits of bariatric surgery in patients with acute ischemic stroke-a national population-based study.

To explore the effects of prior bariatric surgery (prior BS) on clinical outcomes in hospitalized patients with acute ischemic stroke (AIS). Inpatient hospital admissions from the Nationwide Inpatient Sample. We identified hospitalized patients with a primary diagnosis of AIS between 2006 and 2014. The primary endpoint was in-hospital mortality. Secondary endpoints included disability status, poststroke complications, and healthcare utilization indicators, including length of hospital stay and total cost. Multivariate regression analyses were performed after adjusting for potential confounders to compare outcomes between patients with prior BS and those with morbid obesity. Of 24,534 (weighted 121,578) patients with AIS, 1654 (weighted 8154) reported a history of BS, and the rest were diagnosed with morbid obesity. Rates of prior BS and morbid obesity in AIS have significantly increased over the study period. Patients with prior BS were younger and more likely to be white, female, with fewer co-morbidities and poststroke complications, and higher rates of thrombolysis treatment. Multivariate regression analyses revealed that prior BS with body mass index <35 kg/m2 was associated with lower mortality (odds ratio [OR] .58, 95% confidence interval [CI] .37-.90), lower odds of moderate-to-severe disability (OR .64, 95% CI .56-.73), acute respiratory failure (OR .63, 95%CI .45-.87), sepsis (OR .50, 95% CI .26-.96), acute kidney failure (OR.67,95% CI .52-.87), 13% shorter hospitalization, and 6% lower total hospital costs. Among hospitalized patients with AIS, prior BS with body mass index <35 kg/m2 is associated with lower in-hospital mortality, fewer poststroke complications, improved disability status, and better healthcare utilization.

80. Bariatric surgery prior to elective anterior cervical discectomy and fusion in obese patients is associated with a reduced risk of 90-day postoperative complications and readmissions

BACKGROUND CONTEXT Obese patients, particularly those with a body mass index (BMI) ≥35 kg/m2, pose a major challenge for a spine surgeon. Though obesity has previously been shown to be linked with adverse outcomes following elective spine surgical procedures, the impact of prior bariatric surgery on altering postoperative outcomes following elective anterior cervical discectomy and fusions (ACDFs) has not been explored. PURPOSE To evaluate whether bariatric surgery prior to ACDF in obese Medicare patients reduces the risk of experiencing adverse postoperative outcomes. STUDY DESIGN/SETTING Retrospective review of 100% Medicare Claims Database. PATIENT SAMPLE The PearlDiver program was used to query the 2007-2013 100% Medicare Standard Analytical Files (SAF100) for patients undergoing an elective ACDF using International Classification of Diseases 9th Edition (ICD-9) procedure codes 81.02. Records were filtered to include only those patients who underwent a 1- to 2-level surgery using ICD-9 procedure code 81.62. Only those patients receiving an ACDF due to degenerative spine pathologies were included in the study. Finally, patients who did not have active enrollment up to 2 years prior and 1 year after the surgery were excluded. A total of 121,382 patients undergoing an elective 1- to 2-level ACDF were included in the final cohort. OUTCOME MEASURES ICD-9 diagnosis codes were used to identify patients having at least moderate/Class II obesity (V85.35-V85.45, V85.4 and 278.01) within the last 2 years prior to an ACDF. Based on previously published literature, ICD-9 procedure codes for high gastric bypass (44.31), laparoscopic gastroenterostomy (44.38), other gastroenterostomy without gastrectomy (44.39), laparoscopic gastroplasty (44.68), laparoscopic gastric restrictive procedure (44.95-44.98), insertion of gastric bubble (44.93), other repair of stomach (44.69), open and other partial gastrectomy (43.89), isolation of intestinal segment (45.50-45.51), intestinal anastomosis (45.90, 45.91), partial gastrectomy with anastomosis to esophagus (43.5), duodenum (43.6) and jejunum (43.7) and other operations on stomach, unspecified (44.99) being coded on the same day as an obesity code were used to categorize patients receiving a bariatric surgical procedure.Only those patients receiving a bariatric surgery within 2 years prior to an ACDF were included. The 2-year mark was chosen as an arbitrary value. The study cohort was divided into two groups: (1) obese ACDF patients (BMI ≥35) receiving a bariatric surgery procedure within two years prior to an ACDF and (2) obese ACDF patients (BMI ≥35) without a known history of a bariatric surgical procedure within the last 2 years. Primary outcomes included 90-day complications (wound, pulmonary, cardiac, sepsis, renal, deep venous thrombosis, pain and dysphagia), 90-day readmissions, 90-day and 1-year revision cervical fusions. METHODS Multivariate analyses were used to assess the impact of prior bariatric surgery on 90-day outcomes following ACDF, after adjusting for age, gender, region and Elixhauser Co-morbidity Index. RESULTS A total of 6,128 patients with a BMI >35kg/m2 underwent ACDF, of which 411 ACDF patients underwent a bariatric surgical procedure within the 2 years prior to an ACDF. Multivariate analysis adjusting for age, gender, region and Elixhauser Co-morbidity Index (ECI), demonstrated that a history of prior bariatric surgery was associated with a significantly reduced rate of 90-day pulmonary complications (6.6% vs 12.7%, OR 0.53 [95% CI 0.34-0.78]; p=0.002), cardiac complications (15.3% vs 24.2%, OR 0.69 [95% CI 0.51-0.92]; p=0.012), sepsis (9.5% vs 15.1%, OR 0.69 [95% CI 0.48-0.96]; p=0.035), renal complications (2.9% vs 7.1%, OR 0.54 [95% CI 0.28-0.94]; p=0.044) and 90-day readmissions (3.9% vs 8.0%, OR 0.53 [95% CI 0.30-0.85]; p=0.015). Prior bariatric surgery had no statistically significant impact on the rates of wound complications (p=0.325), deep venous thrombosis (p=0.176), pain complications (p=0.606), dysphagia (p=0.171), 90-day revision (p=0.875) and 1-year revisions (p=0.313). CONCLUSIONS Surgery-induced weight loss prior to an ACDF in obese patients is associated with reduced 90-day complication and readmission rates. Orthopedic and bariatric surgeons should counsel obese patients on the benefits of bariatric surgery following ACDFs. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Impact of Bariatric Surgery on Inpatient Complication, Cost, and Length of Stay Following Total Hip or Knee Arthroplasty

BackgroundMorbid obesity is an important risk factor for arthroplasty and also closely associated with worse postoperative outcomes. Bariatric surgery is effective in losing weight and decreasing comorbidities associated with obesity. However, no study had demonstrated the influence of bariatric surgery on the outcome of arthroplasty in a large population. MethodsWe used 2006-2014 discharge records from the Nationwide Inpatient Sample, and identified study population and inpatient complications by International Classification of Diseases, 9th Revision, Clinical Modification diagnosis/procedure codes. Propensity score analysis was used to match total hip arthroplasty (THA) or total knee arthroplasty (TKA) patients with morbid obesity and THA or TKA patients with bariatric surgery. ResultsProportion of morbid obesity in both TKA and THA patients demonstrated a rising trend, while proportion of bariatric surgery in morbidly obese TKA and THA patients remains steady after 2007. For THA patients, there was fewer pulmonary embolism, more blood transfusion and anemia, and shorter length of stay in bariatric surgery group. For TKA patients, bariatric surgery group had a lower risk of pulmonary embolism, respiratory complications, death, and shorter length of stay, but bariatric surgery group had a higher risk of blood transfusion and anemia. ConclusionThere is evidence that bariatric surgery prior to arthroplasty, especially THA, appears to reduce rates of pulmonary complications and length of stay. But anemia and blood transfusion seem to be more common in patients with prior bariatric surgery.

Thiamine Deficiency in People with Obesity (P18-060-19)

ObjectivesThiamine (vitamin B1) and other micronutrient deficiencies are commonly observed after bariatric surgery. However, there is evidence that patients with obesity may be deficient in thiamine even before surgery, possibly due to metabolic changes following recent weight loss or decreased intake through dietary restriction. Type II diabetes may also adversely affect thiamine absorption and increase urinary thiamine losses, placing patients with this condition at increased risk of deficiency. The purpose of this research is to (1) determine the prevalence of thiamine deficiency in patients at a bariatric surgery clinic and compare this across type II diabetes status, race, and gender; and (2) determine the relationship between recent weight loss and thiamine deficiency. MethodsThis is a retrospective observational study of patients with obesity who were evaluated at the preoperative bariatric surgery clinic at the Washington, DC VA Medical Center between January 1, 2012 and April 1, 2018. Patients who had prior bariatric surgery, current or recent history of alcohol abuse, current use of diuretics or vitamin supplements, or for whom no thiamine test was ordered were excluded. All patients had a BMI of 31.7–49.0 kg/m2. Thiamine deficiency was defined as a test value below the reference range. Weight data were collected at the initial evaluation and up to four months prior. ResultsOf 155 clinic patients, 107 met all inclusion criteria. Thiamine deficiency was found in 36 (33.6%) patients. Chi-square tests did not show any differences in prevalence between patients with type II diabetes and those without, or by gender or race. Preliminary logistic regression analyses indicated that the odds of thiamine deficiency were 14% higher per % increase in recent weight loss (OR = 1.14, 95% CI: 1.01–1.29). ConclusionsApproximately one third of those evaluated at the bariatric surgery clinic were found to have a test result indicating thiamine deficiency. This suggests that people with obesity, especially those engaging in weight loss efforts, may benefit from additional nutritional screening. Funding SourcesNone.

Bariatric Surgery Is Efficacious and Improves Access to Transplantation for Morbidly Obese Renal Transplant Candidates.

The surgical risk of morbidly obese patients is high and even higher for kidney transplant candidates. A BMI > 35-40kg/m2 is often a contraindication for that surgery. The safety, feasibility, and outcome of bariatric surgery for those patients are inconclusive. We conducted a retrospective chart review of prospectively collected data on morbidly obese renal transplant candidates who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in our institution between January 2009 and September 2017. The reported outcome included body weight and graft status after a mean follow-up of 47months (range 0.5-5years). Twenty-four patients (8 females, 16 males, average age 54years, average preoperative BMI 41kg/m2 [range 35-51]) underwent LSG (n = 17) or LRYGB (n = 7). Sixteen of them (67%) proceeded to kidney transplantation. Of the 8 pre-transplant and post-bariatric surgery patients, 5 are on the waitlist, and 2 patients died (one of staple line leakage, and one from sepsis unrelated to the bariatric surgery). The average time from bariatric surgery to transplantation was 1.5years (range 1month to 4.3years). The average pre-transplantation BMI was 28kg/m2 (range 19-36). The mean percentage of excess weight loss was 66% (n = 21), and the total percentage of weight loss was 29% (n = 21). Comorbidities (type 2 diabetes, hypertension, and dyslipidemia) improved significantly following both surgical approaches. LSG and LRYGB appear to effectively address obesity issues before kidney transplantation and improve surgical access. Morbidly obese transplant candidates would benefit from prior bariatric surgery.

Su1500 – Outcomes of Cirrhotic Patients with Prior Bariatric Surgery

Su1500 – Outcomes of Cirrhotic Patients with Prior Bariatric Surgery

The Effect of Bariatric Surgery on Post-Operative Outcomes After Hysterectomy [6D

INTRODUCTION: Bariatric surgery is common and has been associated with an improvement in obesity-related medical co-morbidities. However, outcomes after hysterectomy for women who have had bariatric surgery is unknown. Our objective was to compare post-hysterectomy outcomes between patients who had bariatric surgery before hysterectomy and obese patients without prior bariatric surgery. METHODS: We performed an IRB-approved study of patients who had hysterectomy by any route between 1/2000 and 3/2018 at a large academic medical center. Patients with malignancy were excluded. Multivariable logistic regression was used for analysis. RESULTS: 223 patients with bariatric surgery before hysterectomy were compared to 225 patients with body mass index (BMI) >40 kg/m2 and no previous bariatric surgery. The average BMI in the bariatric surgery group was 35 kg/m2, compared to 46 kg/m2 in the no bariatric surgery group. We observed a lower proportion of patients with diabetes, hypertension, and hyperlipidemia in the bariatric surgery group compared to the no bariatric surgery group. We found no significant difference in the odds of intraoperative (visceral injury, blood transfusion, conversion to laparotomy) or postoperative complications including major complications (transfusion, cuff dehiscence, surgical site complication, venous thromboembolism, bowel obstruction), minor complications, re-hospitalization, and re-operation within 30 days of hysterectomy, even after adjusting for confounding factors between groups. CONCLUSION: Despite a significantly higher BMI and higher proportion of obesity-related co-morbidities, there was no difference in the odds of intraoperative or postoperative complications after hysterectomy in morbidly obese women, compared to women with a history of bariatric surgery prior to hysterectomy.