Bariatric surgery–induced weight loss is associated with changes in relationship status. Researchers examined changes in the relationship status after bariatric surgery in 2 cohorts: the prospective Swedish Obese Subjects (SOS) compared to nonsurgical control group and the Scandinavian Obesity Surgery Registry (SOReg) and comparator participants from the general population matched on age, sex, and place of residence. In the SOS study, information on relationship status was obtained from questionnaires, while in the SOReg and general population cohort, information on marriage and divorce was obtained from the Swedish Total Population Registry. The SOS study included 1,958 patients who had bariatric surgery (70.9% female) and 1,912 matched controls (70.8% female) and had a median (range) follow-up of 10 years. The SOReg cohort included 29,234 patients who had gastric bypass surgery (75.6% female) and 283,748 comparators from the general population (75.5% female), and had a median follow-up of 2.9 years. In the SOS study, 18.8% received gastric banding, 68% vertical banded gastroplasty and 13.2% gastric bypass, while the control subjects received usual obesity care. In SOReg, all surgical participants received gastric bypass surgery. In the SOS study, bariatric surgery was associated with increased incidence of divorce/separation compared with controls for those in a relationship (adjusted hazard ratio [aHR] = 1.28) and increased incidence of marriage or new relationship (aHR = 2.03) in those who were unmarried or single at baseline. In the SOReg and general population cohort, gastric bypass was associated with increased incidence of divorce compared with married control participants (aHR = 1.41) and increased incidence of marriage in those who were unmarried at baseline (aHR = 1.35). Within the surgery groups, changes in relationship status were more common in those with larger weight loss.
In a secondary analysis of data collected by the Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) consortia, researchers compared glycemic control of 30 adolescents with severe obesity and type 2 diabetes who had bariatric surgery (Teen-LABS) and 63 patients who had medical therapy (TODAY). At two years out, mean hemoglobin A1c concentration decreased from 6.8% to 5.5% in Teen-LABS and increased from 6.4% to 7.8% in TODAY. Compared with baseline, body mass index (BMI) decreased by 29% in Teen-LABS and increased by 3.7% in TODAY. Twenty-three percent of Teen-LABS participants required a subsequent operation during the two-year follow-up. Overall, the surgical treatment of adolescents with severe obesity and type 2 diabetes was associated with better glycemic control, reduced weight, and improvement of other comorbidities than medical therapy.
Risk Factors for Gastrointestinal Leak after Bariatric Surgery: MBSAQIP Analysis
(Journal of the American College of Surgeons)
Using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, researchers analyzed 133,478 patients who underwent laparoscopic sleeve gastrectomy (LSG, N=92,495, 69.3%) or Roux-en-Y gastric bypass (LRYGB, N=40,983, 30.7%). Multivariate logistic regression was used to analyze risk factors for gastrointestinal leak including provocative testing of anastomosis, surgical drain placement, and use of postoperative swallow study. The overall leak rate was low at 0.7%. Factors associated with increased risk for leak were oxygen dependency (adjusted odd ratios [AOR], 1.97), hypoalbumenia (AOR, 1.66), sleep apnea (AOR, 1.52), hypertension (AOR, 1.36), and diabetes (AOR, 1.18). Compared to LRYGB, LSG was associated with a lower risk of leak (AOR 0.52). The leak rate was higher in patients with versus without an intraoperative provocative test (0.8% vs. 0.4%, respectively), higher in patients with versus without a surgical drain placed (1.6% vs. 0.4%, respectively) and similar between patients with versus without swallow study (0.7% vs. 0.7%). The researchers concluded that while the overall rate of gastrointestinal leak in bariatric surgery is low, certain preoperative factors, procedural type, and interventions (intraoperative provocative test and surgical drain placement) are associated with a higher risk for leaks.
Patients with a history of trauma exposure who undergo bariatric surgery could benefit from closer medical, dietetic, and/or psychological follow-up care to avoid reappearance of dysfunctional eating patterns after surgery. Researchers used logistic regression analyses on a sample of 200 adult patients who underwent bariatric surgery to identify associations of lifetime traumatic experience with pre- and post-surgery eating pathology and postoperative weight loss. During their lifetime, 60.5% of the patients (81.5% women, age 44.4; baseline BMI 44.9 ± 5.5 kg/m2) reported that they were exposed to a traumatic event. Prior to surgery, trauma exposure was associated with impulsive, compulsive, or restrictive eating patterns (odds ratio [OR] = 2.40), overeating or disturbed eating (OR = 1.55), and grazing or night eating behaviors (OR = 1.72). After surgery, trauma exposure was associated with lower total weight loss at 6 (OR = 2.06) and 24 months (OR = 2.06) post-op, and to overeating or disturbed eating (OR = 1.53) 12 months post-op.
This prospective study on 928 patients with obesity who underwent banded RYGB suggests banded RYGB leads to an optimal weight loss in a majority of individuals in a ten-year follow-up. The patients were divided into two groups according to their initial BMI: BMI 35-49.9 and BMI greater than 50. The percentages of excess weight loss (%EWL) and total weight loss (%TWL) at 18, 24, 36, 48, 60, 72, 84, 96, 108 and 120 months after surgery were assessed and compared. The maximal %EWL was achieved at 18 months. However, after ten years, there was no significant change in mean BMI (28.7±4.1 vs. 28.5±3.6 Kg/m2) or %EWL (80.4±19.1 vs. 79.7±23.4). The mean %TWL was significantly lower at 10 years (30.8±8.5 vs. 32.5±8.1) in the initial BMI 35-49.9 group, when compared with the values observed over five years, which suggests a slight late weight regain in the patients. For patients whose initial BMI was greater than 50, the %EWL significantly decreased from 77.7±16.5 kg/m2 at 24 months to 71.3±18.1 kg/m2 at 72 months; at five years, mean BMI (33.1±5.8 Kg/m2) and mean %TWL (40.1±8.5) did not differ from the mean BMI at ten years (36.4±5 Kg/m2) and mean %TWL at ten years (34.8±8.9).
To determine the risk of complications and mortality after gastric bypass in relation to age, researchers analyzed 47,660 patients in the Scandinavian Obesity Register undergoing gastric bypass between May 2007 and October 2016. Risk between age groups was compared by multivariate analysis. In the entire cohort, the 30-day complication rate was 8.4%, however that increased with age. For patients aged 50 to 54, 55 to 59, and ≥60 years, this rate increased to 9.8%, 10.0%, and 10.2%, respectively. The mortality rate was 0.03% in all patients without differences between groups. Given the rates of complications and mortality after 30 days were low and the benefits of bariatric surgery, the findings suggest that patients of older age should be considered for surgery after a thorough individual risk assessment rather than denied surgery based solely on a predefined age limit.
Researchers found that severe obesity in adolescents is associated with increased urinary excretion of sphingolipids despite the absence of microalbuminuria or decreased kidney function. Urinary sphingolipids (ceramides, glycosphingolipids, and sphingomyelins) were quantified at baseline and one year postoperatively in ten adolescents with severe obesity and no microalbuminuria or normal kidney function undergoing bariatric surgery. Participants with severe obesity had a mean BMI of 50 at baseline that decreased to 36 at one-year post-op. Almost all urinary ceramides, glycosphingolipids, and sphingomyelin were significantly elevated in participants with severe obesity compared with controls at baseline, which improved one-year post-op but were still significantly elevated compared with controls. Therefore, researchers concluded urinary sphingolipids represent a marker of early glomerular injury in adolescents with severe obesity.
To determine the incidence, indications, and outcomes of planned ICU admission in elderly, high-risk patients after laparoscopic sleeve gastrectomy (LSG) and to assess if preoperative risk factors for planned postoperative ICU admission in elderly patients undergoing LSG could be predicted preoperatively, researchers conducted a review of prospectively collected data for all patients aged ≥60 who underwent LSG between 2011 and 2016 at a single hospital in Qatar. Fifty-eight patients aged 60–75 were followed for 28 months. About 77.6% of patients were in the intermediate-risk group of the Obesity Surgery Mortality Risk Score (OS-MRS). Fourteen patients (24%) required ICU admission for 2 ± 1.2 days; all patients belonged to the American Society of Anesthesiologists (ASA) III class and intermediate to high risk on OS-MRS. There were no reported mortalities. The mean BMI decreased from
49 ± 10.6 to 37.6 ± 10.1 kg/m2. The number of patient comorbidities (OR, 1.43) and the diagnosis of obstructive sleep apnea (OSA; OR, 7.8) were associated with planned ICU admission. The findings suggest elderly patients undergoing LSG usually have excellent postoperative course despite the associated high risk and the required ICU admission.