Years Of Bariatric Surgery Research Articles

The Impact of Bariatric Surgery on Postoperative Complications and Outcomes following Primary Total Hip Arthroplasty

AbstractThe prevalence of obesity is significantly increasing in the U.S. population and is associated with both increased incidence of total hip arthroplasty (THA) and potentially worsened postoperative outcomes. Current guidelines strongly encourage exercise-based weight loss in morbidly obese THA candidates to decrease patient risk profiles, but data on the impact of receiving bariatric surgery (BS) for weight loss prior to THA are limited and controversial. The purpose of this study was to clarify the impact of BS on postoperative complications and outcomes following THA. Using Current Procedural Terminology, International Classification of Diseases (ICD)-9, and ICD-10 codes, patients undergoing primary THA from 2010 to 2018 were retrospectively collected from PearlDiver's Mariner dataset. Patients were divided into three cohorts who underwent primary THA: nonmorbidly obese patients, morbidly obese patients, and morbidly obese patients who underwent THA within 2 years of BS. Patients were subsequently matched based on age, Charlson Comorbidity Index, gender, and tobacco use. The primary outcome of this study was the frequency of 90-day and 2-year postoperative complications following primary THA. Compared with morbidly obese non-BS patients, morbidly obese patients who underwent BS prior to receiving a primary THA were less likely to have blood transfusion (4.24 vs. 7.44%, p < 0.05), cellulitis (2.92 vs. 6.11%, p < 0.05), myocardial infarction (2.39 vs. 4.91%, p < 0.05), and deep venous thrombosis (1.06 vs. 3.05%, p < 0.05) at 90-day follow-up. The remaining 90-day postoperative outcomes were not found to be statistically different between cohorts. There were no significant differences in 2-year surgical complications between the morbidly obese non-BS cohort and morbidly obese BS cohort. In this study, we found that morbidly obese patients who underwent BS prior to THA had fewer 90-day medical complications and no significant differences in 2-year surgical complications compared with those who did not undergo BS prior to THA.

Effects of preoperative sarcopenia-related parameters on the musculoskeletal and metabolic outcomes after bariatric surgery: a one-year longitudinal study in females

Reduced muscle mass and/or strength are risk factors for metabolic and musculoskeletal impairment. The present study evaluated anthropometric, metabolic, and musculoskeletal outcomes in females with and without sarcopenic-obesity parameters who underwent bariatric surgery during a 1-year follow-up. A prospective, single-center cohort study was conducted in females with obesity undergoing preoperative evaluation for surgery. In the preoperative period, females were allocated into obesity with sarcopenic-obesity parameters (SOP group, n = 15) and without sarcopenic-obesity parameters (obesity group, n = 21). Sarcopenic obesity parameters were defined as lower appendicular skeletal mass adjusted for weight (ASM/wt) and/or low handgrip strength (HGS). Anthropometric, metabolic, and musculoskeletal parameters were assessed before surgery and at 3 months, 6 months, and a 1-year after bariatric surgery. Weight loss was similar between groups (p > 0.05). Weight, body mass index, fat mass, body fat percentage, skeletal muscle mass, fat-free mass, fat-free mass index, HGS were reduced in both groups during the 1-year follow-up (p < 0.05). However, when muscle mass and strength were analyzed relative to body size, an improvement after bariatric surgery was found in both groups (p < 0.05). Total cholesterol, LDL-c, triglycerides, fasting glucose, glycated hemoglobin, insulin, and insulin resistance were reduced in both groups during the 1-year follow-up (p < 0.05). In addition, HDL-c serum concentration increased in females with and without sarcopenic-obesity parameters over the 1-year follow-up (p < 0.05). Both groups had decreased bone mineral density (BMD) at all sites (lumbar spine, femoral neck, and total femur) over the 1-year follow-up (p < 0.05). The highest quartile of ASM/wt was positively associated with BMD variables in a longitudinal analysis, suggesting that preserved ASM/wt in pre-surgery may be beneficial for BMD after 1 year of bariatric surgery. The results showed that bariatric surgery promotes similar musculoskeletal and metabolic changes in females with preserved muscle mass and strength or in females with sarcopenia-related parameters.

Prior bariatric surgery is associated with an increased rate of complications after primary shoulder arthroplasty independent of body mass index

Bariatric surgery (BS) is a debated, yet commonly used, management strategy in the treatment of morbidly obese patients. Despite recent advances in BS techniques, there is limited data on the potential impact of prior BS in patients undergoing shoulder arthroplasty. This investigation evaluated the outcomes of primary shoulder arthroplasty (SA) in patients with prior BS when compared to matched controls. Over a 31-year period (1989-2020), 183 primary SA (12 hemiarthroplasties [HAs], 59 anatomic total shoulder arthroplasties [aTSAs], and 112 reverse shoulder arthroplasties [RSAs]) in patients with prior BS and a minimum of 2-year follow-up had been performed at a single institution. This cohort was matched 1:1:1 according to age, sex, diagnosis, implant, American Society of Anesthesiologists score, Charlson Comorbidity Index, and SA surgical year to separate control groups of SA with no history of BS and a BMI of either <40 (low BMI group) or≥40(high BMI group). Surgical complications, medical complications, reoperations, revisions, and implant survivorship were assessed. The mean follow-up time was 6.8 years (range, 2-21 years). The bariatric surgery cohort had a higher rate of any complication (29.5% vs. 14.8% vs. 14.2%; P<.001), surgical complications (25.1% vs. 12.6% vs. 12.6%; P=.002), and noninfectious complications (20.2% vs. 10.4% vs. 9.8%; low P=.009 and high P=.005) relative to both low and high BMI groups. For BS patients, the 15-year survivorship free of any complication was 55.6 (95% confidence interval [CI], 43.8%-70.5%) compared with 80.3% (95% CI, 72.3%-89.3%) in the low BMI group and 75.8% (65.6%-87.7%) in the high BMI group (P<.001). Comparisons of the bariatric and matched groups demonstrated no statistical differences between the risk of reoperation or revision surgery. When SA was performed within 2 years of BS, higher rates of complications (50% vs. 27.0%; P=.030), reoperations (35.0% vs. 8.0%; P=.002), and revisions (30.0% vs. 5.5%; P=.002) were observed. Primary shoulder arthroplasty in patients with prior bariatric surgery demonstrated an elevated complication profile when compared to matched cohorts of patients with no history of BS and either low or high BMI. These risks were more pronounced when shoulder arthroplasty was performed within 2 years of bariatric surgery. Care teams should be aware of the potential implications of the postbariatric metabolic state and investigate whether further perioperative optimization is warranted.

Quality of Life Outcomes After 3 Years of Bariatric Surgery: Comparison of Roux-En-Y Gastric Bypass and One Anastomosis Gastric Bypass

Quality of Life Outcomes After 3 Years of Bariatric Surgery: Comparison of Roux-En-Y Gastric Bypass and One Anastomosis Gastric Bypass

Remission of diabetes and cardiometabolic risk in patients after 5 years of bariatric surgery: A case-control study

The treatment of obesity and diabetes involves weight loss and metabolic control. Therefore, this study aimed to evaluate the remission of diabetes mellitus (T2DM) and the reduction of cardiometabolic risk (CR), in patients with obesity and T2DM, after five years of Bariatric Surgery (BS) and followed up in the Public Healthcare System (PHS). This is an observational, retrospective, and analytical study, single-center, with pre-diabetes or T2DM, with five years or more of conventional treatment (CT, n = 38) or BS (n = 33). Socioeconomic, lifestyle, anthropometric, biochemical, drugs intake, cardiovascular, and glycemic parameters were evaluated. The baseline characteristics of the BS and CT samples were similar. The study consisted predominantly of women (91.6%) and had a mean age of 46.1 ± 9.0 years. The BS group waited an average of 28.3 ± 24.4 months prior to surgery, and 93.9% had a gastric bypass. Compared to the CT group, the BS group had a higher level of educational achievement (p = 0.001), a higher prevalence of social drinkers (p = 0.006), and a higher BMI (p < 0.001). After five years, 22 patients (66,7%) of the BS group had complete remission of T2DM and 20 (60,6%) had remission of CR (both p < 0.0001). In the CT group 1 (2,6%) and 7 (18.4%) had remission of T2DM and CR respectively. BS is superior to CT for achieving remission of pre-diabetes/T2DM, reducing CR, and anthropometric markers in patients with obesity. • Bariatric surgery can promote long-term remission of diabetes. • Bariatric surgery was able to reduce cardiovascular risk. • Bariatric surgery was able to reduce cardiometabolic risk. • Bariatric surgery promotes the reduction of biochemical, hemodynamic, and anthropometric parameters.

Effects of bariatric surgery on renal function and associated factors with bivariate analysis: a cohort study

Background: Obesity is a global pandemic, caused by genetic, biological and social factors, increasing the risk of many chronic diseases, including kidney disease. Bariatric surgery can control associated comorbidities and also improve renal function. Thus, the aim of this study was to evaluate the effect of bariatric surgery on renal function and associated factors, through bivariate analysis. Methods: A cohort, prospective, analytical study was carried out in the Department of surgery and obesity, in Campina Grande - Paraíba, Brazil. Thirty-five obese patients were evaluated in the preoperative period of bariatric surgery and after one year of bariatric surgery. Sociodemographic and anthropometric data were collected, body mass index was calculated, and renal function was estimated through the glomerular filtration rate. Results: Predominantly female (71.4%) and white (77.1%) patients were observed. Regarding the type of bariatric surgery, most patients (65.7%) underwent the sleeve technique. There was no significant difference between the mean levels of cystatin C pre and post bariatric surgery. There was a significant improvement in the mean glomerular filtration rates in the postoperative period (p=0.09). In further analysis of the association between the variables: type of bariatric surgery, diabetes or hypertension outcomes, no association was observed with the outcome improvement in glomerular filtration rate, without statistical significance, respectively (p = 0.312; p =0.217; p = 0.476). Similarly, there was no statistically significant difference between the variable loss of body mass index, under the effect of bariatric surgery, in relation to the outcome of the glomerular filtration rate (p = 0.904). Conclusion: After analyzing the association between outcome of glomerular filtration rate and the studied variables, no association was observed between these variables, under the effect of bariatric surgery, with improvement in glomerular filtration rate. Thus, bariatric surgery is associated with improvement of renal function independently.

Seventy years of bariatric surgery: A systematic mapping review of randomized controlled trials.

While research publications on bariatric surgery (BS) have grown significantly over the past decade, there is no mapping of the existing body of evidence on this field of research. We performed a systematic review followed by a mapping of randomized controlled trials (RCTs) in BS for people with obesity. From January 2020 to December 2020, we performed a systematic review of RCTs evaluating BS, versus another surgical procedure, or versus a medical control group, through a search of Embase and PubMed. There was no restriction on outcomes for study selection. A total of 114 RCTs were included, most (73.7%) of which were based on a comparison with Roux-en-Y gastric bypass (RYGB) and conducted between 2010 and 2020. Only 15% of the trials were multicenter and few (3.5%) were international. The median number of patients enrolled was 61 (interquartile range [IQR]: 47.3-100). Follow-up time was 1 to 2 years in 36% and 22.8% of the trials, respectively. Weight loss was the most studied criterion (87% of RCTs), followed by obesity-related diseases, and medical and surgical complications (73%, 54%, and 47% of RCTs, respectively). Nutritional deficiency frequency, body composition, and mental health were little studied (20%, 18% and 5% of RCTs, respectively). Our literature review revealed that much research in BS is wasted because of replication of RCTs on subjects for which there is already body of evidence, with small populations and follow-up times mostly below 2 years. Yet several research questions remain unaddressed, and there are few long-term trials. Future studies should take into account the experience of the past 70 years of research in this field.

Abstract 10420: Protective Role of Bariatric Surgery in Prevalence and Risk of Atrial Fibrillation in Obese Patients on Long-Term, with Gradually Waning Effect Over a Decade: A Meta-Analysis

Background: Bariatric surgery (BS) has been shown to be beneficial in improving co-morbid conditions in morbidly obese patients. Long-term cardiovascular complications remain undefined and warrant further investigation. We examined the prevalence and risk of atrial fibrillation (AF) in obese patients who underwent BS. Methods: PUBMED/Medline, SCOPUS, EMBASE databases were systematically reviewed using relevant keywords to search prospective and retrospective studies reporting AF with long-term (at least &gt;1-year follow-up) follow-up in patients who had undergone BS. Random effects models were used for meta-analysis and subgroup analysis. I 2 statistics was used to identify substantial (&gt;75%) heterogeneity. Results: Nine studies (3 USA, 2 UK, 4 Sweden) including 24,164 patients who had undergone BS (mean BMI cut off: 35, mean age 42 years) with 29,330 controls were included in the analysis with a median follow-up of 8 years. Pooled prevalence of AF was lower in BS arm (3.0%, 95%CI: 1.4%-5%) as compared to non-BS arm (3.8%, 95% CI: 1.8%-5.0%). The Forest Plot (Fig. 1) depicts significantly reduced odds of having AF in patients who have undergone BS vs controls (OR: 0.74, 95%CI: 0.60-0.91, I 2 =70.2%, p&lt;0.01). Sensitivity analysis using the leave-one-out method did confirm equivalent results. On subgroup analysis, AF prevalence in the BS group was slightly higher in studies with a mean age of ≥50 years (4.8%, 0-12%) as compared to cohorts with mean age &lt;50 (2.0%, 1.4-5.0%). The pooled rate of AF was low on short-term follow-up compared to long-term follow-up after BS: 1.5% (0.9-2.5%) in 1-5 years, 1.9% (0.2-4.5%) in 6-10 years, 5.4% (0-13.9%) ≥10 years of BS. Conclusions: Obese patients undergoing BS had nearly 25% lower risk and lower pooled rate of AF when compared to controls over 8 years of follow-up. The protective effect of BS on reduced risk of AF was seen to gradually wane over longer follow-up which warrants continued efforts to effectively control CVD risk factors.

Evaluation of Lipoprotein Profile and Residual Risk Three Years After Bariatric Surgery.

Obesity is a chronic disease associated with other comorbidities, including atherogenic dyslipidemia (AD). Bariatric surgery (BS) has shown to reduce cardiovascular risk (CVR) by achieving a significant weight reduction and improving the lipid profile. Different surgical techniques may have a different effect on the lipoprotein profile. To evaluate the lipid profile at 3 years after BS according to the surgical technique used and to determine which variables predict variation in the lipid profile at 3 years after BS. Retrospective observational study of 206 patients who underwent BS between 2010 and 2019. We analyzed the variation of lipid parameters in the 3 years of follow-up according to the surgical technique, including a group analysis of patients according to whether they had dyslipidemia and whether they were treated or untreated and determined which variables predict variation in the lipid profile at 3 years after BS. There was a significant increase in high-density lipoprotein cholesterol (HDL-c) with sleeve gastrectomy (SG) and a significant decrease in total cholesterol (TC), LDL-cholesterol (LDL-c), non-HDL, and LDL/non-HDL with biliopancreatic diversion (BPD). Variables predicting lipid profile variation were surgical technique and pre-surgery lipoprotein level. Malabsorptive techniques achieve a greater decrease in TC and LDL-c throughout follow-up and could also improve residual cardiovascular risk (non-HDL and LDL/non-HDL). The type of surgical technique and the presurgery lipid profile predict variation after 3 years of BS.

Non-pregnant Women Have a Lower Vitamin D than Pregnant Women After Gastric Bypass.

To compare the nutritional status of vitamin D, calcium, and serum concentrations of parathyroid hormone (PTH) between women undergoing Roux-en-Y gastric bypass (RYGB) who became pregnant and women who did not become pregnant during the same postoperative period, as well as the impact of these changes on maternal and child health. This is a longitudinal and retrospective study of women who previously underwent RYGB, paired by age and preoperative body mass index (BMI), divided into two groups: group 1 (G1), comprising 79 women who did not become pregnant, and group 2 (G2), comprising 40 pregnant women assessed in the overall trimesters. Both groups were analyzed before surgery (T0) and in the same interval after surgery: less than or equal to 1year (T1) or greater than 1year (T2), with a 2-year period at the most. Serum concentrations of vitamin D, calcium, parathyroid hormone (PTH), and gestational and neonatal complications were investigated. Statistical analysis was performed by the Statistical Package for the Social Sciences 21.0 (p < 0.05). Despite the additional nutritional demands at pregnancy, women evaluated after 1year of RYGB had the highest demands of vitamin D when compared with pregnant women in the second trimester(p = 0.04). Women who became pregnant within 1year of bariatric surgery were more likely to develop a urinary tract infection which, in turn, was associated with vitamin D inadequacy (p = 0.02).In the same period, the concentrations of calcium in the second and third trimesters showed a strong correlation with the number of pregnancies (R = 0.8, p = 0.008, R = 0.8, p = 0.003) and deliveries (R = 0.7, p = 0.013, R = 0.8, p = 0.006) and its nutritional status in the first trimester also showed a strong correlation with the occurrence of small newborns for gestational age/large for gestational age (SGA/LGA) (R = 0.8, p = 0.007). Since the highest vitamin D depletions occurred in G1 when compared with G2, the study suggests that a period of time for supplementation and its adjustments in post-bariatric pregnancy may be beneficial. It also encourages further investigation on the number of pregnancies/deliveries during prenatal care, due to vitamin D influence on the nutritional status of calcium, and it points out that changes in concentrations of this vitamin in pregnant women may lead to SGA/LGA newborns' births.

Effects of a High-Intensity Exercise Program on Weight Regain and Cardio-metabolic Profile after 3 Years of Bariatric Surgery: A Randomized Trial

Weight regain is one of the most common problems in the long-term after bariatric surgery. It is unknown if high-intensity exercise programs applied in late phases of post-surgical follow-up could counteract this trend. After a 3-year follow-up, 21 patients underwent sleeve gastrectomy were randomized into an exercise group (EG, n = 11), that performed a 5-month supervised exercise program, and a control group (CG, n = 10), that followed the usual care. Body composition, cardiorespiratory fitness, glycaemia and blood cholesterol were evaluated before and after the intervention. Finally, the EG repeated the evaluations 2 months after the end of the exercise program. Both groups reached their maximum weight loss at the first year after surgery and showed significant weight regain by the end of the follow-up. After the exercise program, the EG showed reductions in fat mass (−2.5 ± 2.6 kg, P < 0.05), glycaemia (−13.4 ± 8.7 mg·dL−1,P < 0.01) and blood cholesterol (−24.6 ± 29.1 mg·dL−1, P < 0.05), whereas the CG during the same period showed increases in weight (1.5 ± 1.3 kg, P < 0.05) and fat mass (1.8 ± 0.9, P < 0.01). Two months after the end of the program, EG had increases in weight (1.1 ± 1.2 kg, P < 0.05), fat mass (2.6 ± 2.2 kg, P < 0.01), glycaemia (8.2 ± 11.6 mg·dL−1, P < 0.05) and blood cholesterol (20.0 ± 22.1 mg·dL−1, P < 0.05), when compared with the values after the exercise program. Therefore, in the medium-term after sleeve gastrectomy exercise may contribute to prevent weight regain and to reduce fat mass, glycaemia, and blood cholesterol.

Low overall mortality during 10 years of bariatric surgery: nationwide study on 63,469 procedures from the Scandinavian Obesity Registry.

Bariatric surgery results in an improvement in quality of life, co-morbid diseases, and an increased life expectancy. However, to obtain these benefits perioperative mortality rates need to be low. Evaluate 90-day and 1-year mortality after bariatric surgery in Sweden from 2008 to2017. National quality register. Data on applicable patients from the Scandinavian Obesity Surgery Registry, including 63,469 patients (85.1% gastric bypass, 12.5% sleeve gastrectomy, .8% duodenal switch, .5% minor revisions, and 1.1% other procedures), were retrieved and matched to the Cause of Death registry. During the 10-year period, 36 patients died within 90 days, resulting in a .06% overall mortality. The 1-year mortality rate was .19% (n = 111). Both mortality rates decreased over the study period. In a multivariate analysis, depression (odds ratio [OR] 2.38, [95% confidence interval 1.48-3.84]), leakage (OR 9.32 [4.85-17.94]), and thromboembolic events (OR 7.60 [1.63-35.37]) increased mortality risks at both 90 days and 1 year, whereas age (OR 1.03 [1.01-1.06] per increased year of age) and abdominal circumference (OR 1.03 [1.01-1.05] per cm) were also associated with increased mortality at 1 year. The predictive value of the Obesity Surgery Mortality Risk Score was confirmed. The low 90-day and 1-year mortality, .06% and .19%, respectively, demonstrates that bariatric surgery in Sweden is safe. The use of antidepressants and 2 serious postoperative complications were the most significant risk factors for early deaths, while increased age and preoperative abdominal circumference also contributed at 1 year.

Mortality after bariatric surgery: findings from a 7-year multicenter cohort study

BackgroundPatients having bariatric surgery have lower mortality compared with those with similar body mass index who do not undergo surgery. It is unclear whether mortality post–bariatric surgery is similar to the general population. The benefit of bariatric surgery would be highlighted should people previously at high risk for premature death have comparable, or better, mortality as the general population. ObjectiveTo compare mortality after bariatric surgery to the general U.S. population of the same age, sex, and race. SettingThe Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) prospective cohort of 2458 adults who underwent bariatric surgery at 10 U.S. hospitals between 2006 and 2009. MethodsDeaths were identified via LABS-2 follow-up and the National Death Index. Standardized mortality ratios (SMR) of post–bariatric surgery mortality observed in LABS-2 versus age-, sex-, race-, and year-adjusted expected mortality in the general U.S. population were calculated and compared with 1, which results when the number of observed and expected deaths are equal. ResultsLABS-2 median follow-up was 6.6 (interquartile range: 5.9–7.0) years postsurgery. Seventy-six deaths were observed over 15,616 person-years (PY) of observation (4.9 deaths/1000 PY). The rate expected in the general U.S. population with the same age, sex, race, and year distribution was 4.8 deaths per 1000 PY (SMR = 1.02, 95% confidence interval [CI]: .80–1.27). There were no significant differences between observed and expected mortality by surgical procedure. Compared with expected mortality in the general U.S. population, people 35–44 years old at time of surgery had significantly more deaths (SMR = 2.06, 95% CI: 1.22–3.25), while people at least 55 years of age had significantly fewer (SMR = .63, 95% CI: .42–.92). Significantly more deaths than expected occurred in the perioperative period and 5–7 years after surgery. ConclusionsMortality within 7 years of bariatric surgery is comparable to the general U.S. population, which is likely to have better survival than people with severe obesity. However, more deaths than expected were identified 5–7 years after surgery.

Results at 2 years of bariatric surgery in patients with type 2 diabetes mellitus

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

SAT-120 Weight Regain after Bariatric Surgery Rectified by Dietary Intervention and Metformin

Patients who undergo bariatric surgery may often report weight regain (1). A study by Ferreira and Merhi found that 41% of patients had weight regain 10 years after Roux-en-Y Gastric bypass (2). Recent studies are investigating the efficacy of weight loss pharmacotherapy as an adjunct to bariatric surgery in patients with weight regain (3). The aim of this study was to investigate the impact of a dietary intervention coupled with metformin on the weight and metabolic profile of patients complaining of weight regain after bariatric surgery. We reviewed the medical charts of 157 non-diabetic patients (23% male) who attended our clinic in Beirut and Dubai with the chief complaint of weight regain (BMI of 36.7±0.6kg/m2) after a mean of 5 years of bariatric surgery. Their mean age was 40.8±0.8years, and average weight lost following surgery was 33.3±1.6kg. An outstanding feature in their metabolic profile was their insulin resistance reflected by a fasting insulin 12.0±0.8 µIU/mL and HOMA ratio 3.0±0.3. We instructed patients on an ad-libitum, low carbohydrate non-ketogenic high-protein (LCNK) diet coupled with Metformin (1800±350mg/day). No restrictions on use, amount, or type of fat were made, though use of canola and olive oil was recommended. The diet provided 130-150g of carbohydrate per day to prevent ketosis. A total of 110 patients came for a follow-up visit within 2.4 months of being instructed on diet and given metformin. Significant weight loss was observed in these patients (104.2±2.4 vs. 99.4±2.3 Kg, p<0.001); almost equivalent to a 5% decrease in weight. We also observed a significant decrease in fasting blood sugar (100.5±4.3 vs. 91.2±1.8 mg/dl; P<0.05); HBA1c (5.8±0.2 vs. 5.3±0.1; P<0.05); cholesterol (209.8±6.7 vs. 188.1±6.6 mg/dl; P<0.05); LDL (133.6±5.8 vs. 119.1±5.8 mg/dl; P<0.05); and HOMA-IR (4.1±0.7 vs. 2.7±0.4; P<0.05). We observed a noteworthy improvement in patient’s weight and metabolic profile following our intervention. We recommend that non-diabetic patients complaining of weight regain following bariatric surgery be tested for insulin resistance and given metformin along with a LCNK diet for a safe and immediate improvement in weight and metabolic profile.

40 Years of Bariatric Surgery in Romania - Keeping up in Trend

40 Years of Bariatric Surgery in Romania - Keeping up in Trend

A509 - Secondary Hyperparathyroidism and Hypovitaminosis D one year after post-bariatric surgery

Background: Patients with obesity submitted to bariatric procedures have a high risk of secondary hyperparathyroidism (SHPT) (up to 53%) and hypovitaminosis D (33 to 96.7%). These morbidities could imply in future adverse bone conditions. The aim of this study was to evaluate vitamin D deficiency and SHPT in South Brazilian patients after one year of bariatric surgery (Y-en-Roux bypass procedure).

Predictors of Success in Bariatric Surgery: the Role of BMI and Pre-operative Comorbidities.

This is a retrospective review of 204 patients who underwent bariatric surgery. The impact of weight regain (WR), pre-operative comorbidities and BMI values on the recurrence of comorbidities was evaluated, and an equation was elaborated to estimate BMI at 5years of bariatric surgery. Pre-operative data, after 1year and after 5years, was collected from the medical records. Descriptive analyses and bivariate hypothesis tests were performed first, and then, a generalised linear regression model with Tweedie distribution was adjusted. The hit rate and the Kendall coefficient of concordance (Kendall's W) of the equation were calculated. At the end, the Mann-Whitney test was performed between the BMI, WR and the presence of comorbidities, after a post-operative period of 5years. The adjustment of the model resulted in an equation that estimates the mean value of BMI 5years after surgery. The hit rate was 82.35% and the value of Kendall's W was 0.85 for the equation. It was found that patients with comorbidities presented a higher median WR (10.13%) and a higher mean BMI (30.09kg/m2) 5years after the surgery. It is concluded that the equation is useful for estimating the mean BMI at 5years of surgery and that patients with low pre-operative HDL and folic acid levels, with depression and/or anxiety and a higher BMI, have a higher BMI at 5years of surgery and higher incidence of comorbid return and dissatisfaction with post-operative results.

Emergency department visits and readmissions within 1 year of bariatric surgery: A statewide analysis using hospital discharge records

Data are limited regarding emergency department visits and readmission rates beyond 30days after bariatric surgery. We analyzed emergency department visits and readmissions to all facilities in Wisconsin within 1year of bariatric surgery and identified their predictors. All adults who underwent a laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy from 2011-2014 were identified. Bivariate associations between patient/hospital factors and emergency department visits/readmissions were examined, and factors significant at P<.1 were included in multivariable logistic regression models. Within 1year of bariatric surgery, 36.9% of emergency department visits and 60.3% of readmissions were to the same institution in which bariatric surgery was performed. The frequency of emergency department visits ranged from 10.7% (postoperative days 0-30) to 5.7% (postoperative days 181-270). Readmission rates ranged from 4.4% (postoperative days 0-30) to 2.7% (postoperativedays 91-180). Readmission within 1year was associated with male sex, Roux-en-Y gastric bypass, ≥4 comorbidities, Medicare insurance, teaching hospitals, and inpatient complications (all P<.05). Emergency department visits and readmissions persist throughout the first year at a relatively steady rate after 30days and often do not occur where bariatric surgery was performed. Quality improvement efforts targeting these patients may improve outcomes and decrease hospital resource utilization.

Beneficial Effects of Bariatric Surgery on Cardiac Structure and Function in Obesity.

Bariatric surgery is being considered as a therapeutic option for morbidly obese patients. Data are accumulating showing that this surgical intervention may improve in major cardiovascular morbidity and mortality. We evaluated the effects of bariatric surgery on left ventricular (LV) structure and function including LV mechanics in obese patients. Thirty-seven patients (age=36±10years; male:female=11:26) undergoing bariatric surgery were enrolled. Echocardiography was performed before and after at least 1year of bariatric surgery. Conventional echocardiographic parameters, including tissue Doppler measurements, were measured. LV global longitudinal, circumferential, and radial deformations were assessed utilizing 2D speckle tracking software. Patients decreased body mass index by 11.8±4.7 over 15.6±5.5months. Bariatric surgery led to significant decreases in left ventricular (LV) size and mass (51.0±3.3 to 49.1±3.4mm, p<0.001 for LV end-diastolic dimension; 192.6±33.5 to 146.2±29.1g, p<0.001 for LV mass), and increases were noted in the ratio of early-to-late diastolic mitral inflow (E/A), early diastolic tissue Doppler velocity (Em), and LV longitudinal strain (1.42±0.52 to 1.59±0.56, p=0.04 for E/A ratio; 9.7±2.0 to 11.0±2.4cm/s, p<0.001 for Em; 14.1±1.9 to 16.2±1.4%, p<0.001 for longitudinal strain). Changes of LV longitudinal strain were related to LV mass reduction (p=0.04). However, LV ejection fraction, LV circumferential, and radial strains were all comparable at follow-up. Significant weight loss by bariatric surgery was associated with improved LV structure and function in obese patients, suggesting potential favorable effects of bariatric surgery to prevent future cardiovascular events.