Factors Associated With Long Wait Times for Bariatric Surgery (Annals of Surgery)
Researchers analyzed a statewide clinical data registry of 60,791 patients who had bariatric surgery from 2006 to 2016 to identify factors associated with longer wait-times for bariatric surgery between the initial clinic visit and the surgery. Over the study period, median wait-times increased from 86 to 159 days. Demographics, comorbidities, 30-day complications, and one-year patient-reported outcomes were compared between shortest and longest wait-time quartiles. The shortest wait-time quartile had median wait-times less than or equal to 67 days. The longest wait-time quartile had median wait-times of 204 or more days. Factors found to be independently associated with longer wait-times included Medicaid insurance [odds ratio (OR) 3.02], sleep apnea (OR 1.49), psychological disorder (OR 1.25), hyperlipidemia (OR 1.21), smoking history (OR 1.11), and white race (OR 0.665). Preoperative weight loss, risk-adjusted complication rates, postoperative self-reported weight loss, and comorbidity remission were similar between groups.
Psychiatric diagnoses are prevalent among adolescents with severe obesity, but these diagnoses are not associated with weight loss outcomes. Seventy-one percent of adolescents qualified for a psychiatric disorder. There were no differences in rates of specific disorders or numbers of diagnoses between those receiving surgery and those not receiving surgery. The presence or absence or number of diagnoses before surgery was not associated with weight loss outcomes after surgery. The presurgical psychological evaluation serves as an opportunity to identify adolescents experiencing psychiatric problems and provide them with care but should not necessarily be considered a contraindication to surgery.
Long-term Effects of Bariatric Surgery on Acute Kidney Injury: A Propensity-Matched Cohort in the UK Clinical Practice Research Datalink (BMJ Open)
Researchers used a propensity score-matched cohort of patients from the UK Clinical Practice Research Datalink database to compare rates of acute kidney injury episodes in 2,642 patients who had bariatric surgery with 2,595 who did not. In the first 30 days following their procedure, those who had bariatric surgery had an increased risk of acute kidney injury. However, that incidence substantially decreased during long-term follow-up (rate ratio 0.37,) even after accounting for chronic kidney disease status at baseline. Over the whole period of follow-up, bariatric surgery had a net protective effect on risk of acute kidney injury (rate ratio 0.45).
A Randomized, Double-Blind, Placebo-Controlled Trial of Intravenous Acetaminophen on Hospital Length of Stay in Obese Individuals Undergoing Sleeve Gastrectomy (Obesity Surgery)
To determine whether using intravenous (IV) acetaminophen reduces hospital length of stay and associated hospital costs in patients with severe obesity undergoing sleeve gastrectomy, a randomized, double-blind, placebo-controlled trial was performed. A total of 127 subjects were assigned to receive either acetaminophen IV (n=63) every 6 hours for a total of four doses or saline placebo IV (n=64). The first dose was administered after the induction of general anesthesia and the placebo group received saline IV on the same schedule. Across all subjects, the median hospital length of stay in the group receiving acetaminophen IV was 1.87, while the median hospital length of stay in the placebo group was 1.97 days. The acetaminophen IV group also had lower median hospital costs, $12,885, as opposed to the placebo group’s $12,977. Postoperatively, daily quality-of-recovery (QoR-15) scores, narcotic consumption, and the use of rescue antiemetics were not significantly different between the two groups.
Reducing Cardiovascular Risk In Patients With Morbid Obesity After Bariatric Surgery (Journal of Hypertension)
Researchers analyzed 164 patients with severe obesity, comparing 81 treated with diet, physical activity, and drugs, with 83 patients who had gastric bypass to confirm the use of bariatric surgery as a means to reduce cardiovascular risk. Those who had surgery had a significantly greater decrease in body weight, 22.8 percent, compared to those treated non-surgically (4.6%). Weight loss in patients after surgical treatment was accompanied by a 41.2 percent decrease in the number of patients with glucose intolerance and a 75 percent decrease in the number of patients with diabetes. Surgical patients experienced greater decreases in blood pressure and improvements in the daily blood pressure profile, reductions of left ventricular hypertrophy, and decreases of LDL cholesterol.
Efficacy of Video-based Education Program in Improving Metabolic Surgery Perception among Patients with Obesity and Diabetes (SOARD)
Patients with obesity and type 2 diabetes completed a survey evaluating their perception of metabolic surgery before and after watching a short video-based education program. Of the 51 patients recruited for the study, 98 percent had attempted weight loss in the past and about 90.1 percent expressed dissatisfaction with their current weight. Prior to the educational video, only 22.5 percent of the patients had an overall positive impression toward metabolic surgery and 41.7 percent were willing to undergo surgical consultation. After watching the educational video, those who had a positive impression towards metabolic surgery increased to 53.1 percent and those willing to undergo surgical consultation increased to 51 percent. Among the patients who remained unwilling to undergo surgical consulting, fear of surgery was the most commonly voiced reason (31.4%), with safety (27.5%) and cost of metabolic surgery (27.5%) being equally concerning. Overall, the study found that the patients held negative impressions of metabolic surgery due to its perceived risk profile, but a video-based educational intervention may improve that perception and increase the willingness to try surgery.