Study Roundup

Published in December Issue             

Seven-Year Weight Trajectories and Health Outcomes in the Longitudinal Assessment of Bariatric Surgery (LABS) Study  (JAMA Surgery)

To examine long-term weight change and health status following Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB), data was reviewed from 2,348 participants in the Longitudinal Assessment of Bariatric Surgery (LABS) study who had surgery between 2006 and 2009 and were followed up with until January 31, 2015. A total of 1,738 underwent RYGB (74%) and 610 underwent LAGB (26%). Seven years following RYGB, mean weight loss was 38.2 kg, or 28.4% of baseline weight; between years 3 and 7 mean weight regain was 3.9% of baseline weight. Seven years after LAGB, mean weight loss was 18.8 kg, or 14.9% of baseline; between years 3 and 7 mean weight regain was 1.4% of baseline. Dyslipidemia prevalence was lower 7 years following both procedures; diabetes and hypertension prevalence were lower following RYGB only. Among those with diabetes at baseline (488 of 1,723 RYGB patients [28%]; 175 of 604 LAGB patients [29%]), the proportion in remission at 1, 3, 5, and 7 years were 71.2%, 69.4%, 64.6%, and 60.2%, respectively, for RYGB and 30.7%, 29.3%, 29.2%, and 20.3% for LAGB. Reoperations occurred in 14 RYGB and 160 LAGB participants. Findings indicate that bariatric surgery patients maintain much of their weight loss with fluctuations over the long term and experience some decline in diabetes remission over time, but the incidence of new cases is low following RYGB.

Effects of Bariatric Surgery in Obese Patients With Hypertension: The GATEWAY Randomized Trial (Circulation)

One hundred patients (70% female, mean age 43.8±9.2 years, mean BMI 36.9±2.7 kg/m2) with obesity and hypertension – defined as those using 2 or more medications at maximum doses or more than 2 medications at moderate doses – were randomized to gastric bypass plus medical therapy or medical therapy alone. A reduction of 30% or more of the total number of antihypertensive medications while maintaining controlled blood pressure occurred in 41 of 49 patients from the gastric bypass group (83.7%) compared with 6 of 47 patients (12.8%) from the control group. Remission of hypertension was present in 25 of 49 (51%) patients randomized to gastric bypass. No patient submitted to medical therapy was free of antihypertensive drugs at 12 months. Eleven patients (22.4%) from the gastric bypass group and none in the control group were able to achieve SPRINT levels without antihypertensives. Waist circumference, BMI, fasting plasma glucose, glycohemoglobin, low-density lipoprotein cholesterol, triglycerides, high-sensitivity C-reactive protein, and 10-year Framingham risk score were lower in the gastric bypass than in the control group. The results of the study indicate that bariatric surgery represents an effective strategy for blood pressure control in a broad population of patients.

Quality Improvement in Bariatric Surgery: The Impact of Reducing Postoperative Complications on Medicare Payments (Annals of Surgery)

The study aimed to determine the temporal relationship between reducing surgical complications and costs using data from a retrospective review of Medicare beneficiaries undergoing bariatric surgery in the years 2005 to 2006 and 2013 to 2014 (total N = 37,329 patients, 562 hospitals). Hospitals were ranked into quintiles based on their degree of improvement in risk and reliability-adjusted 30-day rates of serious complications across the time periods. There was a strong association between reductions in complications and decreased Medicare payments. The top 20% of hospitals had a decrease in average serious complication rate of 7.3% and an average per-patient savings of $4,861. Conversely, the bottom 20% of hospitals had smaller decrease in complication rate of 0.8% and a smaller average savings of $2,814. The findings demonstrate the potential savings associated with quality improvement in high-risk surgical procedures.

Bariatric Surgery and the Incidence of Psoriasis and Psoriatic Arthritis in the Swedish Obese Subjects Study (Obesity)

The aim of this study was to assess the effect of bariatric surgery compared with usual care on the incidence of psoriasis and psoriatic arthritis (PsA). A total of 1,991 subjects who underwent bariatric surgery and 2,018 controls with obesity were identified from the Swedish Obese Subjects study; none of them had psoriasis or PsA at baseline. During follow-up (up to 26 years), bariatric surgery was associated with a lower incidence of psoriasis compared with usual care (number of events = 174). Both smoking and a longer duration of obesity were independently associated with a higher risk for psoriasis. No significant difference was detected among the three surgical procedures in terms of lowering the risk of developing psoriasis. The association between bariatric surgery and psoriasis incidence was not influenced by baseline confounders. No significant difference in the risk of developing PsA (number of events = 46) was detected when comparing the surgery and the control groups.

Contraception and Conception After Bariatric Surgery (Obstetrics & Gynecology)

To examine conception rates after bariatric surgery, 740 women in the Longitudinal Assessment of Bariatric Surgery-2 study self-reported postsurgical contraceptive practices (no intercourse, protected intercourse, unprotected intercourse, or tried to conceive). Median preoperative age was 34 (30–39) years. In the first postsurgical year, 12.7% of women had no intercourse, 40.5% had protected intercourse only, 41.5% had unprotected intercourse while not trying to conceive, and 4.3% tried to conceive. The prevalence of the first three groups (no intercourse, protected intercourse and unprotected intercourse) did not significantly differ across the 7 years of follow-up; however, more women tried to conceive in the second year (13.1%). Age, being married or living as married, and rating future pregnancy as important preoperatively were associated with early conception. Outcomes of the study reveal postsurgical contraceptive use and conception rates do not reflect recommendations for an 18-month delay in conception after bariatric surgery.

Robotic Platform for Gastric Bypass is Associated with More Resource Utilization: An Analysis of MBSAQIP Datase (SOARD)

The study compared perioperative outcomes of patients who underwent robot-assisted Roux-en-Y gastric bypass (RA-RYGB) to laparoscopic RYGB (L-RYGB). Patients undergoing RA-RYGB and L-RYGB were identified using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and the 30-day outcomes of the propensity-matched cohorts were compared. In total, 36,158 patients met inclusion criteria, and included 2,660 RA-RYGB (7.4%) cases and 21,280 L-RYGB cases having similar preoperative characteristics. RA-RYGB was associated with longer median operative time (136 vs 107 minutes), and a higher 30-day readmission rate (7.3% vs 6.2%). There were no statistical differences between the RA-RYGB and L-RYGB cohorts with respect to all cause morbidity (10.6% vs 10.7%), serious morbidity (1.2% vs 1.7%), mortality (0.1% vs 0.2%), unplanned intensive care unit admission (1.1% vs 1.3%), re-operation (2.4% vs 2.4%), or re-intervention (3.0% vs 2.5%) within 30-days after surgery. Based on national data, RA-RYGB appeared to be safe compared to a conventional laparoscopic approach for gastric bypass.