Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including 30-day readmission higher for LRYGB vs LSG patients, predictors of improved psychological function post-surgery, surgery patients with T2DM have treatment much later when surgery is less effective, Asian race not associated with increased 30-day complication and endoscopic sleeve gastroplasty for class III obesity (please note, log-in maybe required to access the full paper).
Difference in 30-Day Readmission Rates After Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-En-Y Gastric Bypass: a Propensity Score Matched Study Using ACS NSQIP Data (2015–2019)
A team led by researchers from Baptist Health South Florida, Miami, FL, have reported 30-day readmission rates were significantly higher among those receiving LRYGB, compared to LSG.
Writing in Obesity Surgery, the investigators examined data from the National Surgical Quality Improvement Program (NSQIP) including 109,900 patients who underwent laparoscopic bariatric surgeries (67.5% LSG and 32.5% LRYGB). Readmissions were reported in 4,168 (3.8%) of patients and were more common among RYGB recipients compared to LSG (5.6% versus 2.9%, p<0.001).
Readmission rates were significantly higher among those receiving LRYGB, compared to LSG. Readmission were affected by many patient factors such as age, chronic obstructive pulmonary disease, hypertension, bleeding disorders, blood urea nitrogen, SGOT, alkaline phosphatase, haematocrit, and operation time were significantly predicting readmission rates.
The factors could help patients and providers to make informed decisions for selecting appropriate procedures.
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Predictors of improved Psychological Function after Bariatric Surgery
Researchers from The Netherlands have stated that patients with lower expectations concerning weight loss (<40% desired TWL), higher educational level, no history of psychiatric illness and employment before bariatric surgery demonstrated the highest psychological function scores after bariatric surgery.
Writing in SOARD, the authors evaluated the significant predictors of improved psychological function following bariatric surgery by analysing data from the BODY-Q questionnaire.
Analysing data from 836 patients who underwent bariatric surgery from 2015 to 2020. Patients with lower expectations concerning weight loss (<40% desired TWL), at one and two years after bariatric surgery, more weight loss was associated with significantly higher psychological function scores. Experiencing a major short-term complication did not significantly impact psychological function.
“This knowledge can be used to enhance patient education pre-operatively and identify patients at risk for poor psychological functioning post-operatively,” the authors concluded.
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Bariatric-metabolic surgery for NHS patients with type 2 diabetes in the United Kingdom National Bariatric Surgery Registry
UK researchers have reported that NHS bariatric-metabolic surgery patients with T2DM have surgery much later in the disease process when it is less effective, and noted that national guidance on bariatric-metabolic surgery and data from multiple RCTs have had little impact on clinical practice.
The study, published in Diabetic Medicine, analysed baseline characteristics, disease severity and operations undertaken in people with obesity and T2DM undergoing bariatric-metabolic surgery in the NHS, compared to those without T2DM. Baseline characteristics, trends over time and operations undertaken were analysed for people undergoing primary bariatric-metabolic surgery in the NHS using the National Bariatric Surgical Registry (NBSR) for 11 years from 2009 to 2019.
Clinical practice before and after the publication of the NICE guidance (2014) was examined.
Nearly a third of patients (14,948/51,715 (28.9%)) had T2DM, with 10,626 (71.1%) on oral hypoglycaemics, 4322 (28.9%) on insulin/other injectables, and with T2DM diagnosed ten+ years before surgery in 3876 (25.9%). Participants with T2DM, compared to those without T2DM, were associated with older age (p<0.001), male sex (p<0.001), poorer functional status (p<0.001), dyslipidaemia (OR: 3.58 (CI: 3.39–3.79); p<0.001), hypertension (OR: 2.32 (2.19–2.45); p<0.001) and liver disease (OR: 1.73 (1.58–1.90); p<0.001), but no difference in BMI was noted.
Fewer people receiving bariatric-metabolic surgery after 2015 had T2DM (p<0.001), although a very small percentage increase of those with class I obesity and T2DM was noted. T2DM status was associated with selection for gastric bypass, compared to sleeve gastrectomy (p<0.001).
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Asian race is not associated with increased 30-day serious complications or mortality: a MBSAQIP analysis of 594 837 patients
Investigators from the University of Alberta, Edmonton, AB, have found that despite the increased metabolic burden of Asian patients, there are no differences in 30-day outcomes compared to White patients.
Writing in Surgical Endoscopy, the retrospective study analysed the 2015–2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. All patients undergoing Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) who self-reported as Asian or White race were included.
Overall 594,837 patients met inclusion, with 4,229 self-reporting Asian racial status. Patients of Asian race were younger (41.8 vs 45.5 years, p<0.001) and had a lower BMI (42.8 vs 44.7 kg/m2 p<0.001) than White patients. They were also more likely to have insulin dependent diabetes (10.9% vs 8.2%, p<0.001), have received prior cardiac surgery (10.0% vs 1.2% p<0.001, and suffer from renal insufficiency (1.0% vs 0.5%, p<0.001).
There were no significant differences between rates of RYGB (28.3% vs 28.9%, p=0.4) and mean operative duration (87.7 vs 87.5 min, p=0.7). Additionally, there were no differences in 30 day outcomes including leak (0.5% vs 0.5%, p=0.625), bleeding (1.2% vs 1.0%, p=0.1), serious complications (3.4% vs 3.5%, p=0.6) or mortality (0.1% vs 0.1%, p=0.7) and after confounder control, Asian race was not independently associated with serious complications (OR 1.0, CI 0.9–1.2, p=0.7) or mortality (OR 1.1, CI 0.3–3.3, p=0.1).
The authors said that the data supports evidence suggesting these patients may safely undergo bariatric surgery independent of their increased metabolic burden.
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Endoscopic Sleeve Gastroplasty: A Safe Bariatric Intervention for Class III Obesity (BMI > 40)
A team led by researchers from the University of Virginia, Charlottesville, VA, have concluded that the feasibility and safety of endoscopic sleeve gastroplasty (ESG) in patients with class III obesity are comparable to patients with class I and II obesity.
Their study evaluated the short-term safety of ESG compared to sleeve gastrectomy (SG) and gastric bypass (RYGB) in patients with class III obesity. They retrospectively analysed over 500,000 ESG, SG, and RNYGB patients from 2016 to 2020. ESG patients were stratified by BMI to compare outcomes between class I and II versus class III patients with obesity. Class III obese patients who underwent ESG were also propensity matched to SG and RNYGB patients for matched comparisons.
Among ESG patients, those with BMI > 40 had no difference in adverse events, readmissions or re-interventions versus patients with BMI 30–40 (p>0.05), while achieving greater %TBWL at 30 days (p<0.05). In comparison to surgery, ESG had similar AE to SG and less than RNYGB, while producing comparable %TBWL to SG and RNYGB at 30 days.
Additionally, they noted in Obesity Surgery that the safety of ESG in patients with class III obesity is comparable to SG and safer than RYGB.
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