According to a new meta-analysis published in the British Medical Journal (BMJ, Oct. 22), bariatric surgery leads to greater body weight loss and higher remission rates of type 2 diabetes and metabolic syndrome than non-surgical treatments for obesity. However, the authors results are limited to two years of follow-up and based on a small number of studies and individuals. The meta-analysis included 11 studies with 796 individuals. The relative risk of type 2 diabetes remission was pooled for four studies. Bariatric surgery patients were 22 times more likely to achieve diabetes remission and almost 2.5 times more likely to show improvements in signs of metabolic syndrome than non-surgical treatment patients.
A study in the October 10 issue of the New England Journal of Medicine links “less-skilled” bariatric surgeons to significantly more patient complications. In the study, 20 surgeons submitted a videotape of themselves performing a laparoscopic gastric bypass. The videotapes were then assessed by at least 10 surgeons from the Michigan Bariatric Surgery Collaborative, who rated their peers on a scale of 1-5 for each of five skill domains plus overall proficiency -- a score of one indicated the skill expected of a general surgery chief resident, and a grade of five indicated the skill of a master bariatric surgeon. The study found lower ratings were associated with higher complication rates – 14.5 percent in the bottom group compared to 5.2 percent in the top group – and higher mortality (0.26% compared to 0.05%). Also, surgeons with lower skill scores had reoperation rates (3.4% vs. 1.6%) , higher readmission rates (6.3% vs. 2.7%) and longer operations (137 minutes vs. 98 minutes).
Dr. Danny O. Jacobs, MPH, from the University of Texas Medical Branch, Galveston, wrote in an accompanying editorial that the study raises more questions than it answers, noting those questions included: “Why were no significant differences in the rate of leak, perforation, or hemorrhage observed among the different quartiles of skill?... Was the training of surgeons with the best outcomes somehow different from that of the others? Does the observed relationship still hold when surgeons age or operate less?”
Long-term data shows laparoscopic Roux-en-Y gastric bypass is safer (10% vs. less than 5%) than open surgery, and has a lower overall all-cause mortality rate (about 5% vs. 20%). In addition, open gastric bypass surgery leaves patients with higher medical bills related to surgery ($87,026 vs. $56,170). The 135,000-patient study is one of the longest and largest of its kind. Dr. Anna Weiss of the University of California presented the findings at the Annual Clinical Congress of the American College of Surgeons in early October.
Bariatric surgery may be most effective in remitting metabolic syndrome for patients who are younger, female, non-Hispanic and Hispanic black and less obese, according to a study published in the October 4 online edition of the Annals of Surgery. Researchers compared the results of patients (82% women, 17% non-Hispanic black and 32% Hispanic) who had laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical sleeve gastrectomy up to two years post surgery. Sleeve patients with a higher BMI experienced a lower rate of metabolic syndrome remission than patients who had gastric bypass.
A study published in the October online edition of Plastic & Reconstructive Surgery found patients who had body contouring following bariatric surgery experienced better long-term weight control following laparoscopic gastric bypass than those who did not have it. The study compared 98 patients who had bariatric surgery and body contouring with 102 matched control patients who just had bariatric surgery. At two years (1.78 kg/year vs. 0.51 kg/year) and after seven years (10.8% vs. 3.6% mean) the results showed a difference in the amount of weight gain. Study authors concluded “body contouring must be considered as a reconstructive operation in the treatment of patients suffering from morbid obesity.”
A study published in the October issue of the Annals of Surgery found type 2 diabetes patients who had bariatric surgery (162 gastric bypass, 32 gastric banding and 23 gastric sleeve patients) within five years of a diagnosis of this disease experienced a high rate of long-term remission. Mean EWL of 55 percent was associated with mean reductions in A1C from 7.5 percent ± 1.5% to 6.5 percent ± 1.2% (P < 0.001) and fasting blood glucose (FBG) from 155.9 ± 59.5 mg/dL to 114.8 ± 40.2 mg/dL (P < 0.001). Long-term complete and partial remission rates were 24 percent and 26 percent, respectively, whereas 34 percent improved and 16 percent remained unchanged. Shorter duration of type 2 diabetes and higher long-term EWL predicted long-term remission.
According to a study published in SOARD (October 2 online), the decision to have bariatric surgery is strongly associated with patient perceptions of their current quality of life. In addition, lower decisional conflict and higher self-efficacy are predictive of surgery. The study noted that factors that clinicians might consider important, such as gender, age, and the presence of obesity-associated co-morbidities did not influence patient decisions. Researchers surveyed 200 patients over an eight month period.
Assessing bariatric surgery quality through a composite measure that includes procedure complications, patients and surgeon volume and other outcomes may provide a more objective site rating than using individual characteristics at surgical centers, according to a study published online in JAMA Surgery. The researchers developed the three-star rating scale through data from the Michigan Bariatric Surgical Collaborative clinical registry on 2,942 patients who had a bariatric procedure in Michigan between 2008 and 2010. The scale included scores for hospital volume, risk-adjusted complication rates and risk-and-reliability-adjusted complication rates, and hospitals were scored on each of these categories individually and as a composite scale.