Published in March Issue             

The Tipping Point: Factors Influencing A Patient’s Decision To Proceed With Bariatric Surgery (SOARD)

A qualitative, single center study identify factors that “tipped the scales” in a patient’s experience leading to a decision to move ahead with surgery. The study utilized semi-structured interviews with patients (n=24) at the time of their “decision visit” to determine the factors related to their positive decision to move forward. Two main factors that led to the decision to move ahead with surgery were identified: their own worsening health issues and low energy levels that limited activities. Participants also noted additional factors that impacted their “tipping point” such as financial considerations and family influences.

Factors Associated with Bariatric Postoperative Emergency Department Visits (SOARD)

Using the Truven Health Analytics MarketScan® Database, patients undergoing primary bariatric operations in the 2012 and 2013 were identified to determine the frequency of and risk factors associated with 90-day postoperative ED visits following bariatric surgery. The primary outcome of the study was the presence of an ED visit not resulting in a hospital readmission. Postoperative ED visits not associated with an inpatient admission occurred in 14.6% of patients. The most common diagnoses associated with these visits were abdominal pain (24.4%) and dehydration, nausea, or vomiting (20.8%). Factors associated with increased odds of an ED visit include: younger age, female sex, increased comorbidities, North Central region, open bariatric or laparoscopic gastric bypass operations, >=2 prior ED visits, and increased initial length of hospital stay following surgery. The researchers concluded that postoperative ED visits are a frequent and potentially preventable occurrence with several risk factors. Tracking ED visits and risk factors as quality indicators will allows for intervention to improve the transition of care to the outpatient setting following
bariatric surgery.

Laparoscopic Roux-en-Y gastric bypass for failed gastric banding: outcomes in 642 patients (SOARD)

A retrospective review of prospectively collected data on revisional Roux-en-Y gastric bypass (LRYGB) following failed laparoscopic adjustable gastric banding (LAGB) was performed to analyze short- and long-term results of reoperative procedures. A total of 642 patients (569 women and 73 men) had revisional procedures between 1999 and 2013. There were no mortalities and the overall complication rate was 9.7%, including 3.6% major complications. Follow-up rate was 88% at 10 years. The mean excess BMI loss was between 65% and 70% throughout the study period, and the mean total weight loss was between 28% and 30% based on the maximum weight. Mean BMI decreased from 44.7 kg/m2 before LAGB to 31.6, 32.2, and 32.5 kg/m2 at 1, 5, and 10 years after revision. Revisional LRYGB is well tolerated and feasible after failed LAGB. Results up to 10 years after revision are comparable to those reported after primary LRYGB.

Guideline-concordant weight-loss programs in an urban area are uncommon and difficult to identify through the internet (Obesity)

To determine the reliability of Internet-based information on community-based weight-loss programs and grade their degree of concordance with 2013 American Heart Association, American College of Cardiology, and The Obesity Society weight-management guidelines, an online search was conducted for weight-loss programs in the Maryland-Washington, DC-Virginia corridor. Content analysis was performed to abstract program components from their websites. Of the 191 programs, 1% were graded as high, 8% as moderate, and 91% as low with respect to guideline concordance based on website content. Fifty-two programs participated in a telephone survey to verify the website information. Program intensity, diet, physical activity, and use of behavioral strategies were underreported on websites as compared to description of these activities during the phone interview. Within the telephone subsample, 6% of programs were graded as high based on website information, whereas 19% were graded as high after the telephone interview. Most weight-loss programs in an urban, mid-Atlantic region do not currently offer guideline-concordant practices and fail to disclose key information online, which may make clinician referrals challenging.

A Pilot Study of an Acceptance-Based Behavioral Intervention for Weight Regain After Bariatric Surgery (Obesity Surgery)

A sample of bariatric surgery patients (n = 11) who regained at least 10 % of their maximum lost postoperative weight were recruited to evaluate the feasibility, acceptability, and preliminary effectiveness of a novel 10-week acceptance-based behavioral intervention to stop postoperative weight regain. All participants received the intervention, which emphasized psychological skills thought to be integral to successful weight control post-surgery. The intervention was shown to be feasible and acceptable, with 72 % retention and high mean rating of program satisfaction among participants (4.25 out of 5.00). Weight regain was stopped, and even reversed, with a mean total body weight loss of 3.58% throughout the 10-week intervention. There were also significant improvements in eating-related and acceptance-related variables. These findings provide initial support for the use of a psychological acceptance-based intervention for weight regain in bariatric
surgery patients.