Study Roundup

Published in January Issue             

Cardiovascular Risk Factors After Adolescent Bariatric Surgery  (Pediatrics)

To assess predictors of change in cardiovascular disease risk factors (CVD-RFs) in adolescents with severe obesity undergoing bariatric surgery data was prospectively collected from the Teen-Longitudinal Assessment of Bariatric Surgery study on anthropometric and health status for 242 patients at 5 centers. Predictors of change in CVD-RFs (blood pressure, lipids, glucose homeostasis and inflammation) were examined preoperatively and at three years after Roux-en-Y gastric bypass (n=161), vertical sleeve gastrectomy (n=67) and adjustable gastric banding (n=14).The mean age of participants at baseline was 17 years, 76% were girls, and the median BMI was 51. Increasing weight loss was an independent predictor of normalization in dyslipidemia, elevated blood pressure, hyperinsulinemia, diabetes, and elevated high-sensitivity C-reactive protein. Older participants at time of surgery were less likely to resolve dyslipidemia compared with younger participants, whereas girls were more likely than boys to demonstrate improvements in elevated blood pressure. Even those participants without dyslipidemia or elevated blood pressure at baseline showed significant improvements in lipid and blood pressure values over time. The findings show numerous CVD-RFs improve among adolescents undergoing bariatric surgery with increased weight loss, female sex and younger age predictors of a higher probability of resolution of
specific CVD-RFs.

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

To determine the relationship between reducing surgical complications and costs, researchers conducted a retrospective review of Medicare beneficiaries who had bariatric surgery (n=37,329 patients) in the years 2005 to 2006 and 2013 to 2014. Hospitals (n=562 hospitals) were ranked into quintiles based on their degree of improvement in risk and 30-day rates of serious complications across the time periods. The top 20% of hospitals had a decrease in average serious complication rate of 7.3% (10.0%–2.7%) and an average per-patient savings of $4,861 ($3921–$5802). Conversely, the bottom 20% of hospitals had a smaller decrease in complication rate of 0.8% (4.4% to 3.6%) and a smaller average savings of $2,814 ($2139–$3490). The findings suggest a strong association between reductions in complications and decreased Medicare payments and demonstrate the potential savings associated with quality improvement in high-risk surgical procedures.

Early Major Complications After Bariatric Surgery in the USA, 2003–2014: A Systematic Review and Meta-Analysis (Obesity Reviews)

Seventy-one studies conducted in the U.S. between 2003 and 2014 were reviewed to assess 30-day postoperative risk of three major complications associated with bariatric surgery: anastomotic leak, myocardial infarction and pulmonary embolism. A total of 107,874 were included in the studies and had a mean body mass index (BMI) of 46.5 kg/m2 had gastric bypass, gastric banding or sleeve gastrectomy. Rate of 30-day anastomotic leak was 1.15%, myocardial infarction rate was 0.37%, and pulmonary embolism rate was 1.17%. Among all patients, mortality rate following anastomotic leak, myocardial infarction and pulmonary embolism was 0.12%, 0.37% and 0.18%, respectively. Thirty days after surgery, sleeve gastrectomy patients had a higher anastomotic leak rate than gastric bypass (1.21% vs. 1.14%), gastric bypass had higher rates of myocardial infarction and pulmonary embolism than gastric banding or sleeve gastrectomy. Among all procedures, the overall 30-day rate of the three major complications ranged from 0% to 1.55%. Mortality following the complications ranged from 0% to 0.64%. The investigators note that the quality of complication reporting was lower than the reporting of other outcomes.

Rate of Revisions or Conversion Following Bariatric Surgery Over Ten Years in the State of New York (SOARD)

The study evaluated the rate of revisions/conversions (RC) following three common bariatric procedures over ten years. A New York state database was used to identify all patients undergoing laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) between 2004 and 2010. Patients were followed for RC to other bariatric procedures for at least four years (up to 2014). There were 40,994 bariatric procedures with 16,444 LAGB, 22,769 RYGB, and 1,781 SG. Rate of RC was 26.0% for LAGB, 9.8% for SG, and 4.9% for RYGB. Multiple RC (≥2) were more common for LAGB -- 5.7% for LAGB, 0.5% for RYGB, and 0.2% for LSG).

Laparoscopic Gastric Bypass for the Treatment of Type 2 Diabetes: A Comparison of Roux-en-Y versus Single Anastomosis Gastric Bypass (SOARD)

To evaluate the differences between Roux-en-Y gastric bypass (RYGB) and another single anastomosis gastric bypass (SAGB) in the efficacy of type 2 diabetes remission in patients with obesity. Outcomes of 406 patients who had undergone RYGB (157) or SAGB (249) for the treatment of diabetes with one year follow-up were assessed. The remission of diabetes after surgery was evaluated in matched groups, including BMI and ABCD scoring system, which is composed of the age, BMI, C-peptide levels and duration of diabetes in years. The weight loss of the SAGB patients at one year was better than the RYGB patients [24.1% vs. 30.7%]. The mean BMI decreased from 39.9 to 27.4 kg/m2 in SAGB patients at one year and decreased from 34.5 to 26.2 kg/m2 in the RYGB patients. The mean glycated hemoglobin A1C decreased from 8.6 to 6.2% of the RYGB group and from 8.6 to 5.5% of the SAGB group. Eighty-seven (55.4%) patients of the RYGB group and 204 (81.9%) of the SAGB group achieved complete remission (HbA1c < 6.0%) at one year after surgery. SAGB exhibited significantly better glycemic control than RYGB surgery in selected groups stratified by different BMI and ABCD score. At 5-year after surgery, SAGB still had a better remission than RYGB (70.5% vs. 39.4). Findings indicate that SAGB carries a higher power in type 2 diabetes remission than RYGB.

The Outcome of Bariatric Surgery in Patients Aged 75 Years and Older (Obesity Surgery)

Study evaluated outcomes in patients aged 75 years and older who had bariatric surgery. A total of 19 patients were identified in two academic centers between 2006 and 2015. Eleven (58%) were male, the median age was 76 years old (range 75–81), and the median preoperative BMI was 41.4 kg/m2 (range 35.8–57.5). Eleven patients underwent sleeve gastrectomy (58%), four had gastric banding (21%), two had Roux-en-Y gastric bypass (RYGB) (11%), one patient had gastric plication (5%) and one patient underwent banded gastric plication (5%). The median operative time was 120 minutes and the median length of stay was 2 days. Three patients (16%) developed postoperative atrial fibrillation which completely resolved at discharge. At 1 year, the median percentage of total weight loss was 18.4% and varied among the procedures: SG (21%), RYGB (22%), gastric banding (7%), and gastric plications (8%). There were no 30-day readmissions, reoperations, or mortalities. Findings suggests that bariatric surgery in selected patients aged 75 years and older would be safe and effective despite being higher risk, and age alone should not be the limiting factor for selecting patients for bariatric surgery.

Inflammatory Bowel Disease Is Not a Contraindication for Bariatric Surgery (Obesity Surgery)

The study assessed the safety and efficacy of bariatric surgery and postoperative quality of life (QoL) in patients with inflammatory bowel diseases (IBD), a contraindication for bariatric surgery in various guidelines due to a theoretical higher complication risk. Postoperative QoL was assessed using a disease-specific questionnaire (IBDQ). Forty-five patients were included in the study, all diagnosed with IBD [16 ulcerative colitis (UC) and 29 Crohn’s disease (CD)] prior to bariatric surgery. Bariatric procedures included Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding and revisional surgery. There was no mortality in the follow-up period and there were no major perioperative complications. During the follow-up period, two major complications occurred in two CD patients: gastro-enterostomy bleeding and pyelonephritis with secondary pancreatitis. Mean percentage of overall excess weight loss (%EWL) and total body weight loss (%TBWL), 12 months after surgery, were 62.9% and 26.2%, respectively. Twenty-four months postoperatively, mean overall %EWL and %TBWL were similar for both UC and CD patients (62.9% and 26.6%). Median total IBDQ score was 170.8 (min. 77; max. 218). Both scores did not differ significantly between UC and CD patients. The findings suggest that, despite IBD being a contraindication, bariatric procedures appear safe and effective in this UC and CD population.