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LSG gender differences

Pre-operative gender differences substantial but significant

There were very few differences in baseline characteristics pre-surgery - women had a significantly lower weight than men, although BMI was not different

A Canadian study examining the socio-demographic profile, morbidity and health-related quality of life (HRQoL) of patients accessing laparoscopic sleeve gastrectomy (LSG), has reported that baseline characteristics were similar between men and women, although gender specific differences were observed in comorbid profile and HRQoL. The paper, ‘Morbidity and health-related quality of life of patients accessing laparoscopic sleeve gastrectomy: a single-centre cross-sectional study in one province of Canada’, was published in BMC Obesity.

One hundred ninety-five patients who completed the baseline questionnaires were included in the study, 82% of patients accessing bariatric surgery were women. The average age, weight and BMI were 44±10 years (range 22–70 years), 135±23.2kg and 49±6.7, respectively. A small number of eligible patients gained weight between the initial assessment/acceptance for surgery and actual surgery (n=10) resulting in a range of BMI values between 35.2–67.2.

The majority of the sample had post-secondary or some post-secondary education (75%) and were in full or part-time employment (62%). The average number of comorbidities reported was five and 74% of the sample reported ≥4 comorbidities. Obstructive sleep apnoea (OSA) (65%), dyslipidaemia (48%), back pain (51%), hypertension (47%), osteoarthritis (44%), gastroesophageal reflux disease (GERD) (43%) and type 2 diabetes mellitus (T2DM) (42%) were reported most often.

According to the EQ-5D-3L, patients reported some or extreme problems in mobility (47.2%), usual activity (53.1%), pain/discomfort (67.0%) and anxiety/depression (44.1%) with few reporting problems in self-care (12.4%). The average EQ-5D index and VAS scores were 0.78 ± 0.01SE and 59.8 ± 18.7SD, respectively. (data not published)

According to the SF-12v2, the PCS and MCS were 36.4 and 47.8 respectively, with normative scores of 50(10). As the SF-12v2 provides normative data for the general US population, it is possible to calculate what percentage of the current surgical sample provided scores below, at or above the population norm (mean 50 ± 10). For the total surgical sample, the percentages of patients that scored below, at or above the population norm were 77%, 21% and 2% for PCS and 36%, 29% and 35% for MCS.

According to the IWQOL-Lite questionnaire, an instrument developed to specifically assess weight-related quality of life where lower scores (0–100) indicate greater impairment, the domains most impacted by weight were self-esteem (30.4), physical function (41.9), public distress (44.1), sexual life (51.8) and work (61.0). The IWQOL-Lite total score was 43.2±18.7.

There were very few differences in baseline characteristics pre-surgery - women had a significantly lower weight than men (130.2kgs vs 155.8kgs, p<.001), although BMI was not different. Women were less likely to be partnered (69.0% vs 86.1%, p<0.05). Women and men were similar in terms of age, income, education, employment status, ethnicity and smoking behaviour.

Men most often presented for surgery with OSA, hypertension, dyslipidaemia, GERD and T2DM, while women presented with OSA, back pain, dyslipidaemia, osteoarthritis and gallbladder disease. There were some statistically significant gender differences; compared to women, men reported more OSA, dyslipidaemia, hypertension, and gout, while women reported double the prevalence of gallbladder disease/gallstones compared to men pre-surgery.

Fewer women reported problems with self-care compared to men (9.5% vs. 25%, p < 0.05) and while fewer women reported problems with mobility (44.0% vs. 61.1%) and usual activities (50.6% vs 63.9%) compared to men, these differences were not significant. In contrast, more women reported problems with pain/ discomfort (69.0% vs 58.3%) and anxiety/depression (45.3% vs 38.9%) compared to men, although not significantly different.

Women reported significantly lower scores than men for self-esteem (27.3 vs. 44.1, p<0.05) and sexual life (49.2 vs. 63.6, p<0.05) suggesting that in women, these domains were more impaired by their weight. Men and women did not differ in scores for three of five domains (i.e., physical function, public distress or work). The IWQOL-Lite total score was significantly lower for woman compared to men (42.0 vs 48.7, p<0.05).

“Future research should explore reasons why men are less likely to seek out bariatric surgery than women as this may signal potential sex-related disparities in access to bariatric surgery...” the researchers concluded. “Women and men presented with substantial but significantly different pre-operative comorbid profiles. HRQoL was significantly impaired in men and women. Women compared to men reported better scores in general and physical health and fewer problems with self-care. However, weight impaired women’s sexual life and self-esteem significantly more than men.”

To access this paper, please click here

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