Journal Watch 07/09/2022

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 SADI-S has a higher incidence of perioperative complications than RYGB and SG, the uptake of IFSO recommendation is variable according to each recommendation with better compliance among surgeons with regard to pre-operative esophago-gastro-duodenoscopy (EGD), SG was associated with a lower risk of mortality, complications, hospitalisation, ED use and reoperations, vs. RYGB for Medicaid patients, both experienced and internalised weight bias were associated with a host of negative psychosocial, behavioural and medical sequelae for patients seeking or who have undergone surgery, open hernia repair with adhesive or self-gripping mesh appears most cost-effective, and the mean annual incremental cost of excess weight in Belgium is of concern and stresses the need for policy actions aiming to reduce excess body weight (please note, log-in maybe required to access the full paper).


SADI-S in the United States: A First Comparative Safety Analysis of the MBSAQIP Database

US researchers, writing in SOARD, have found single anastomosis duodenoileal bypass with sleeve (SADI-S), in its early adoption stage, has a higher incidence of perioperative complications than RYGB and SG with comparable 30 days outcomes to biliopancreatic diversion with duodenal switch (BPD/DS).


The researchers sought to study the perioperative safety of SADI-S and compare it to other established bariatric procedures utilizing the MBSAQIP database. A 5:1 propensity matched analysis (PMA) for 20 variables was performed to compare the outcomes of the SADI-S to the Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) and a 2:1 PMA to the BPD/DS.


There were 255 primary SADI-S reported in 2020. After PMA, the only significant complications between the RYGB and SADI-S cohorts were Clavien-Dindo grade 4a and 4b (0.1% and 1.4% versus 1.6% and 7.1% respectively). SADI-S had more Clavien-Dindo grade 2, 4a, and 4b complications than the SG cohort (1.3% vs. 3.5%, p=0.03; 0.2% vs. 1.6%, p=0; 1.% vs. 7.1%, p=0). When compared to BPD/DS, outcomes including readmission, reoperation and intervention were not statistically significant.


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Routine Use of Esophago-gastro-duodenoscopy (EGD) in Bariatric Surgery—an International Survey of Our Current Practice

Researchers from South Tyneside & Sunderland NHS Foundation Trusts, Sunderland, UK, have found that the uptake of IFSO recommendation is variable according to each recommendation with better compliance among surgeons with regard to pre-operative esophago-gastro-duodenoscopy (EGD).


For their study, reported in Obesity Surgery, they conducted an international survey assessing bariatric surgeons’ practice on the use of EGD. The survey aimed to identify whether surgeons offer EGD in the following settings: pre-operative, post-operative at 1 year, every 2–3 years following longitudinal sleeve gastrectomy (LSG) or one-anastomosis gastric bypass (OAGB).


Among 121 respondents, 72% are aware of the IFSO recommendations. 53.7% surgeons routinely offer pre-operative EGD and 14.3% routinely offer post-operative EGD for bariatric patients at one year after surgery. Majority do not routinely offer EGD after LSG (74.8%) or OAGB (79.7%) every 2–3 years as proposed by IFSO.


They added that further research is necessary to develop robust evidence-base for the role of endoscopy after bariatric surgery with the inclusion of patient and public involvement.


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Comparative Safety of Sleeve Gastrectomy and Gastric Bypass Up to 5 Years After Surgery in Patients with Medicaid

Sleeve gastrectomy was associated with a lower risk of mortality, complications, hospitalisation, ED use and reoperations, but a higher risk of revision compared to gastric bypass, for Medicaid patients undergoing bariatric surgery according to researchers from the University of Michigan, Ann Arbor, Michigan


The retrospective cohort study, reported in the Annals of Surgery, included 132,788 patients with Medicaid, 84,717 (63.8%) underwent sleeve gastrectomy and 48,071 (36.2%) underwent gastric bypass. Compared to gastric bypass, sleeve gastrectomy was associated with a lower five-year cumulative incidence of mortality (1.29% vs. 2.15%), complications (11.5% vs. 16.2%), hospitalisation (43.7% vs. 53.7%), ED use (61.6% vs. 68.2%), and reoperation (18.5% vs. 22.8%), but a higher cumulative incidence of revision (3.3% vs. 2.0%).


“Although the difference between sleeve and bypass was generally similar among White, Black, and Hispanic patients, the magnitude of this difference was smaller among Black patients for ED use and Hispanic patients for reoperation,” they authors concluded.


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Examining weight bias before and/or after bariatric surgery: A systematic review

US investigators, reporting in Obesity reviews, have reported that results suggested that both experienced and internalized weight bias were associated with a host of negative psychosocial, behavioural and medical sequelae for patients seeking or who have undergone bariatric surgery.


The study aimed to systematically review the literature for quantitative evidence that explores the medical, psychosocial, and behavioural sequelae associated with experienced, internalized, and/or externalized weight bias in patients seeking or who have undergone bariatric surgery. Five databases were systematically searched for English peer-reviewed quantitative studies, which examined weight bias in a sample of individuals seeking or who had undergone bariatric surgery.

Twenty-nine studies were included, of which 13 examined internalized weight bias, 12 examined experienced weight bias, four examined both and none examined externalized weight bias. Most studies were cross-sectional, and the results showed high risk of bias.


“The findings of this review underscore the need for more rigorous research to better understand the relationship between weight bias and bariatric surgery, particularly longitudinally,” the authors concluded. “Future patients may benefit from research developing interventions for reducing weight bias prior to and following bariatric surgery in order to reduce the associated negative correlates and improve outcomes.”


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Cost-effectiveness analysis of mesh fixation techniques for laparoscopic and open inguinal hernia surgeries

An international team of researchers, writing in BMC Health Services, have reported open hernia repair with adhesive or self-gripping mesh appears most cost-effective.


For the study, the authors conducted an economic evaluation of mesh fixation in open and laparoscopic hernia repair from a prospective real-world cohort study, using cost-effectiveness analysis (CEA) and cost-utility analysis (CUA).


A prospective real-world cohort study was conducted in two university-based hospitals in Thailand from November 2018 to 2019. Patient data on hernia features, operative approaches, clinical outcomes, associated cost data, and quality of life were collected. Models were used to determine each group’s treatment effect, potential outcome means, and average treatment effects. An incremental cost-effectiveness ratio was used to evaluate the incremental risk of hernia recurrences.


The 261 patients in this study were divided into six groups: laparoscopic with tack (LT, n=47), glue (LG, n=26), and self-gripping mesh (LSG, n=30), and open with suture (OS, n=117), glue (OG, n = 18), and self-gripping mesh (OSG, n=23). Hernia recurrence was most common in LSG. The mean utility score was highest in OG and OSG (both 0.99).


Treatment costs were generally higher for laparoscopic than open procedures. The cost-effectiveness plane for utility and hernia recurrence identified LSG as least cost effective. Cost-effectiveness acceptability curves identified OG as having the highest probability of being cost effective at willingness to pay levels between $0 and $3,300, followed by OSG.


They added that given the similarity of hernia recurrence among all major procedures, the cost of surgery may impact the decision.


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Health care costs and lost productivity costs related to excess weight in Belgium

Belgian investigators have reported that the mean annual incremental cost of excess weight in Belgium is of concern and stresses the need for policy actions aiming to reduce excess body weight. Reporting their findings in BMC Public Health, the study sought to estimate annual health care and lost productivity costs associated with excess weight among the adult population in Belgium, using national health data.


Health care costs and costs of absenteeism were estimated using data from the Belgian national health interview survey (BHIS) 2013 linked with individual health insurance data (2013–2017). Average yearly health care costs and costs of absenteeism were assessed by body mass index (BMI) categories. Health care costs were also analysed by type of cost (i.e. ambulatory, hospital, reimbursed medication). The cost attributable to excess weight and the contribution of various other chronic conditions to the incremental cost of excess weight were estimated using the method of recycled prediction (standardisation).


According to BHIS 2013, 34.7% and 13.9% of the Belgian adult population were respectively affected by overweight or obesity. They were mostly concentrated in the age-group 35–65 years and had significantly more chronic conditions compared to the normal weight population. Average total healthcare expenses for people with overweight and obesity were significantly higher than those observed in the normal weight population.


The adjusted incremental annual health care cost of excess weight in Belgium was estimated at €3,329,206,657. The comorbidities identified to be the main drivers for these incremental health care costs were hypertension, high cholesterol, serious gloom and depression. Mean annual incremental cost of absenteeism for overweight accounted for €242 per capita but was not statistically significant, people with obesity showed a significantly higher cost (p<0.001) compared to the normal weight population (€2,015 per capita).


The annual total incremental costs due to absenteeism of the population affected by overweight and obesity was estimated at €1,209,552,137. Arthritis, including rheumatoid arthritis and osteoarthritis, was the most important driver of the incremental cost of absenteeism in individuals with overweight and obesity, followed by hypertension and low back pain.


The authors added that this study can be used as a baseline to evaluate the potential savings and health benefits of obesity prevention interventions.


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