Study Roundup

Published in January Issue             

Long-Term Outcomes of Bariatric Surgery in Adolescents with Severe Obesity [FABS-5+]: A Prospective Follow-up Analysis (The Lancet Diabetes & Endocrinology)

To analyze long-term outcomes of Roux-en-Y gastric bypass (RYGB) in young adults who underwent surgery during adolescence, a cohort of 58 patients 13–21 years old with clinically severe obesity were identified at Cincinnati Children's Hospital Medical Center between May 2001, and February 2007. Prospective follow-up analysis of the patient outcomes 5–12 years after surgery assessed for BMI, comorbidities, micronutrient status, safety and other risks. At baseline, the mean age of the cohort was 17.1-years-old and mean BMI was 58·5 kg/m2. At mean follow-up of 8 years, the mean age of the cohort was 25.1-years-old and mean BMI was 41·7 kg/m2. From baseline to long-term follow-up, significant declines were recorded in the prevalence of elevated blood pressure, dyslipidaemia, and type 2 diabetes. At follow-up, 25 (46%) of 58 patients had mild anaemia that did not require intervention, 22 (45%) had hyperparathyroidism, and eight (16%) had low amounts of vitamin B12. The findings indicate that RYGB resulted in substantial and durable bodyweight reduction and cardiometabolic benefits for young adults.

Laparoscopic Roux-en-Y Gastric Bypass in Adolescents with Severe Obesity [AMOS]: A Prospective, 5-year, Swedish Nationwide Study (The Lancet Diabetes & Endocrinology)

To compare 5-year outcomes of adolescent surgical patients (n=81) undergoing Roux-en-Y gastric bypass (RYGB) with those of conservatively treated adolescents (n=80) and of adults undergoing RYGB (n=81), a nationwide, prospective study was conducted at three specialized pediatric obesity treatment centers in Sweden between April 2006 and May 2009. The primary outcome measure was change in BMI over 5 years. Among the surgical adolescent cohort the mean age was 16.5 years and the mean BMI was 45.5 kg/m2. Bodyweight in adolescent surgical patients over the study period decreased by a mean 36.8 kg, resulting in a reduction in BMI of 13.1 kg/m2, although weight loss less than 10% occurred in nine (11%) of patients. Mean BMI rose in adolescent controls (3.3 kg) over the 5 years, whereas the BMI change in adult controls was similar to that in adolescent surgical patients (mean change -12.3 kg/m2). Comorbidities and cardiovascular risk factors in adolescent surgical patients showed improvement and compared favorably with those in adolescent controls. Twenty (25%) of 81 adolescent surgical patients had additional abdominal surgery for complications of surgery or rapid weight loss and 58 (72%) showed some type of nutritional deficiency; healthcare consumption (hospital attendances and admissions) was higher in adolescent surgical patients compared with adolescent controls. Twenty (25%) of 81 adolescent controls had bariatric surgery during the 5-year follow-up. The findings show adolescents with severe obesity undergoing RYGB achieve substantial weight loss, alongside improvements in comorbidities and risk factors. However, gastric bypass is associated with additional surgical interventions and nutritional deficiencies.

Suicide, Self-harm, and Depression After Gastric Bypass Surgery: A Nationwide Cohort Study
(Annals of Surgery)

To examine the risks of self-harm, hospitalization for depression and death by suicide after gastric bypass surgery up to two years after surgery, a review of the Swedish National Patient Register was conducted, which identified 22,539 patients who had gastric bypass during 2008 to 2012. Main outcome measures were hazard ratios for postoperative self-harm or hospitalization for depression among patients with a history of preoperative self-harm and/or depression. A diagnosis of self-harm during the two years before surgery was associated with a hazard ratio of 36.6 for self-harm during the two years following surgery, compared to surgery patients who had no preoperative self-harm diagnosis. Patients with a diagnosis of depression preceeding surgery had a hazard ratio of 52.3 for hospitalization owing to depression after surgery, compared to bypass patients without a previous diagnosis of depression. The standardized mortality ratio for suicide after gastric bypass increased among females (n = 13) compared to males (n = 4), 4.50 vs. 1.71 respectively. Results indicate a need to identify vulnerable patients with a history of self-harm or depression, which may be in need of psychiatric support after surgery.

Incidence and Risk Factors for Deliberate Self-harm, Mental Illness, and Suicide Following Bariatric Surgery: A State-wide Population-based Linked-data Cohort Study
(Annals of Surgery)

To assess the incidence and determinants of hospitalization for deliberate self-harm and mental health disorders, and suicide after bariatric surgery, data from the Australian Department of Health was reviewed from more 12,062 patients who were followed for an average of 30 months preoperatively and 40.6 months postoperatively between 2007 and 2011. Hospitalizations for deliberate self-harm occurred in 110 patients (0.9%), which was a higher incidence rate than the general population. Compared with before surgery, there was no significant increase in deliberate self-harm hospitalizations and a reduction in overall mental illness related hospitalizations after surgery. Younger age, no private-health insurance cover, a history of hospitalizations due to depression preoperatively, and gastrointestinal complications postoperatively were predictors for deliberate self-harm hospitalizations after bariatric surgery. Three suicides occurred during the follow-up period, a rate comparable to the general population during the same time period.

Laparoscopic Sleeve Gastrectomy: Preoperative Weight Loss and Other Factors as Predictors of Postoperative Success (Obesity Surgery)

To assess whether weight loss before sleeve gastrectomy is a predictor of success in terms of excess body weight loss (EBWL) after surgery, retrospective data was evaluated from 204 patients who had surgery between August 2011 and January 2015. Data included demographics, comorbidities, BMI, percentage of EBW lost prior to surgery, percentage of EBW lost postoperatively, and change in BMI at 3 months (191, 93.6%), 6 months (164, 80.4%), and 12 months (134, 65.7%). Patients who lost >5% of their EBW before surgery had statistically significant more weight loss postoperatively than those who lost <5%. There was a statistically significant, favorable difference in adjusted postoperative mean percentage EBWL and change in BMI for those who preoperatively lost >5% of their EBW compared to those who lost <5%. However, both groups still achieved similar postoperative weight loss success at 1 year.

Long-Term [11+years] Outcomes in Weight, Patient Satisfaction, Comorbidities, and Gastroesophageal Reflux Treatment After Laparoscopic Sleeve Gastrectomy (SOARD)

This study evaluated long-term (>11 years) outcomes in terms of patient satisfaction, progression of weight and co-morbidities, and treatment of gastroesophageal reflux disease (GERD) for patients undergoing laparoscopic sleeve gastrectomy (LSG). A chart review and personal interview was conducted with 110 consecutive patients between 2001 and 2003. Mean follow-up was 11.7 years, during which time two patients died of non–procedure-related causes. Twenty (31.7%) patients required 21 reoperations: 14 conversions for weight issues (10 duodenal switch, 4 gastric bypass and 3 re-sleeve procedures), and 2 conversions (RYGB) and 2 hiatoplasties for GERD. For the 47 (74.6%) patients who kept the sleeve construction, percentage of excess body mass index loss at 11+years was 62.5%, versus 81.7% for the 16 patients who converted to another procedure. Mean percentage of excess body mass index loss for the entire cohort was 67.4%. At 11+years postoperatively, 30 patients versus 28 preoperatively required treatment for co-morbidities. None of the 7 patients preoperatively suffering from GERD were cured by the LSG procedure. Nine additional patients developed de novo GERD. Overall satisfaction was 8 on a scale of 0–10. The study showed that patient satisfaction score remains good despite unfavorable GERD outcomes.

Long-Term [>10 year] Outcomes after Laparoscopic Roux-en-Y Gastric Bypass (SOARD)

To evaluate long-term laparoscopic Roux-en-Y gastric bypass (LRYGB) outcomes using 2015 Standards for Outcome Reporting definitions, data for 1,402 patients was collected from a prospective bariatric surgery registry at an integrated healthcare system. There were no 30-day mortalities. Early complications included anastomotic leak (0.2%), venous thromboembolism (0.6%), surgical site infections (1.4%) and urinary tract infections (1.6%). The 30-day readmission rate was 3.5%. Follow-up weight data was available for >70% of patients for up to 12 years postoperative. The highest mean %EWL and lowest BMI were reached at 18 months postoperative at 79% and 30.1 kg/m2, respectively. Remission of diabetes, dyslipidemia and hypertension were observed through 8 years postoperative. The study, which is the first report of long-term (>10 year) outcomes from a single integrated health system utilizing the 2015 Standards for Outcome Reporting, suggests integrated healthcare systems provide an optimal environment for data collection and
long-term follow-up.