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Study Roundup

Published in June Issue             

Variation in Outcomes at Bariatric Surgery Centers of Excellence   (JAMA Surgery)

To describe variation in surgical outcomes across bariatric centers of excellence and the geographic availability of high-quality centers, University of Michigan Institute for Healthcare Policy and Innovation investigators conducted a retrospective review of claims data from the Healthcare Cost and Utilization Project’s State Inpatient Database for 145,527 bariatric surgery patients from 165 centers in 12 states (Arkansas, Arizona, Florida, Iowa, Massachusetts, Maryland, North Carolina, Nebraska, New Jersey, New York, Washington, and Wisconsin) between January 2010 and December 2013. Patients included in the study were those with a primary diagnosis of morbid obesity and who had laparoscopic Roux-en-Y gastric bypass, open Roux-en-Y gastric bypass, laparoscopic gastric band placement or laparoscopic sleeve gastrectomy. The risk-adjusted and reliability-adjusted serious complication rates within 30 days of surgery at each center varied 17-fold, ranging from 0.6% to 10.3%. At the state level, variation ranged from 2.1- to 9.5-fold. After dividing hospitals into quintiles of quality on the basis of their adjusted complication rates, 38 of 132 (28.8%) had a center in a higher quintile of quality located within the same hospital service area. Variation in rates of complications existed at centers with low volume, medium volume and high volume.

Effect of Surgeon Age on Bariatric Surgery Outcomes (Annals of Surgery)

An analysis of all bariatric surgeons in Michigan that participated in a statewide collaborative quality improvement program (n = 71) who performed primary laparoscopic gastric bypass or sleeve gastrectomy was performed to explore the relationship between surgeon age and patient outcomes. Data from 60,430 patients over 10 years was collected for 30-day postoperative complications. Late career surgeons had more bariatric surgery experience and had a higher average annual case volume than early career surgeons. Older surgeons performed more gastric bypass (40%) and less sleeve gastrectomy (38.8%) than younger surgeons (34.7% and 51.5%). When adjusting for patient and surgeon characteristics, there were no statistically significant differences in overall or serious complication rates for either procedure among the age groups.

Systematic Review and Meta-Analysis of Outcomes After Revisional Bariatric Surgery Following a Failed Adjustable Gastric Band (Obesity Surgery)

A systematic review and meta-analysis of 36 studies including 2,617 patients evaluated the efficacy of revisional bariatric surgery (RBS) following failed laparoscopic adjustable gastric band (LAGB). Roux-en-Y gastric bypass (B-RYGB) was performed in 60.5% (n = 1583). There was one death within 30 days (0.0004%). The overall morbidity rate was 13.2%. There was no difference between the B-RYGB and sleeve gastrectomy (B-SG) groups in morbidity, leak rate or return to OR. Percentage excess weight loss (%EWL) following the revisional procedure for all patients combined at 6, 12 and 24 months was 44.5, 55.7 and 59.7%, respectively. There was no statistical difference in %EWL between B-RYGB and B-SG at any time point. The rates of remission of diabetes, hypertension and obstructive sleep apnoea were 46.5, 35.9 and 80.8%, respectively.

Quality of Life 1 Year After Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-en-Y Gastric Bypass: a Randomized Controlled Trial Focusing on Gastroesophageal Reflux Disease (Obesity Surgery)

To evaluate quality of life (QOL) after laparoscopic sleeve gastrectomy (LSG), mainly in association with gastroesophageal reflux disease (GERD), as compared to laparoscopic
Roux-en-Y gastric bypass (LRYGB), 150 patients were randomized to undergo either procedure at a single clinic between February 2013 and February 2014. Differences in QOL were compared between groups by using multiple QOL questionnaires preoperatively and
2 and 12 months after surgery. Most QOL questionnaires showed significant improvement in scores between preoperative and 12-months postoperative. GERD score deteriorated in the LSG group after 2 months, but recovered again after 12 months. After 2 months of follow-up, the mean GERD score was 6.95 ± 2.14 in the LSG group versus 5.50 ± 1.49 in the LRYGB group. After 1 year, the mean GERD score was 6.63 ± 2.26 in the LSG group and 5.60 ± 1.07 in the LRYGB group. Overall QOL did not differ significantly between the two groups.

Mental Illness in Bariatric Surgery: A Cohort Study from the PORTAL Network (SOARD)

Electronic health record data from several US healthcare systems were used to compare outcomes of four groups of patients (n=8192) who had bariatric surgery, which included people with (1) no mental illness, (2) mild-to-moderate depression or anxiety, (3) severe depression or anxiety, and (4) bipolar, psychosis, or schizophrenia spectrum disorders.
Fifty-seven percent of patients had preoperative mental illness. Groups were compared on weight loss trajectory, all-cause emergency department visits and hospital days, and negative binomial regression up to 2 years after surgery. There were no differences between groups for weight loss, but patients with preoperative severe depression or anxiety or bipolar, psychosis, or schizophrenia spectrum disorders had higher follow-up levels of emergency department visits and hospital days compared to those with no mental illness.

Alcohol and Other Substance Use After Bariatric Surgery: Prospective Evidence From a U.S. Multicenter Cohort Study (SOARD)

To evaluate substance use disorders (SUD)-related outcomes and identify factors associated with incident SUD-related outcomes, participants in the Longitudinal Assessment of Bariatric Surgery-2, self-reported past-year alcohol use disorder (AUD) symptoms, illicit drug use, and SUD treatment (counseling or hospitalization) presurgery and annually postsurgery for up to 7 years through January 2015. Of the 2,348 participants evaluated, the year-5 cumulative incidence of post-RYGB onset of AUD symptoms, illicit drug use and SUD treatment were 20.8%, 7.5% and 3.5%, respectively, and 11.3%, 4.9%, and .9% post-LAGB. The authors concluded undergoing RYGB versus LAGB was associated with twice the risk of incident AUD symptoms, and a higher risk for illicit drug use and SUD treatment.

A Comparison of Perceived and Calculated Weight Status Classification Congruence Between Pre- and Post-Bariatric Surgery Patients (SOARD)

A study examined the congruence between patients perceived and calculated weight status classifications (WSC) – underweight, healthy weight, overweight, class I obesity, class II obesity, and class III obesity – and analyzed differences in congruence between groups of pre- or post-surgery, male and female, and emerging/early adulthood and middle/late adulthood patients. Pre-surgery patients were more congruent in their perceptions of WSC compared to their post-surgery peers and emerging/early adulthood patients were more congruent in their perceptions of WSC compared to middle/late adulthood patients. No gender differences emerged in the full cohort, but when divided by surgical status, pre-surgery females reported more congruent perceptions of WSC compared to their post-surgery peers. Males did not differ in their rates of congruence.