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Journal Watch 13/09/2023

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 short stay ward for laparoscopic sleeve gastrectomy, variations in MBS in patients with class 1 obesity, post-op cannabis on anxiety and maladaptive eating, post-op weight loss in patients with psychiatric disorders, phentermine and topiramate (Qsymia) more cost-effective than semaglutide (Wegovy), and more (please note, log-in maybe required to access the full paper).

Cost-savings of short stay sleeve gastrectomy and walk-in hydration clinic versus conventional inpatient care

Short stay ward (SSW) for laparoscopic sleeve gastrectomy (LSG) is cost-effective and should be preferred to inpatient management, according to researchers from Singapore General Hospital, Singapore.

Writing in Surgical Endoscopy, they evaluate the cost-saving of the SSW versus conventional inpatient care following LSG, as well as comparing the readmission rates pre- and post-inception of the intravenous hydration clinic and analysed the cost-savings.

They reported the total cost per SSW-subject was significantly lower at $13,647.81 compared to $15,565.27 for conventional inpatient care (p=0.0302). Lower average ward charges ($667.76 vs $1371.34, p<0.0001), lower average daily treatment fee per case ($235.68 vs $836.54, p < 0.0001), and lower average laboratory investigation fee ($612.31 vs $797.21, p<0.0001) accounted for the difference in costs between the groups.

The 30-day readmission rate reduced from 8.9 to 1.8% after implementation of the hydration clinic (p<0.01) with decreased 30-day readmission cost (S$96,955.57 vs. S$5910.27, p < 0.01).

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Bariatric and metabolic surgery in patients with low body mass index: an online survey of 543 bariatric and metabolic surgeons

An international team of researchers have reported that there are worldwide variations in metabolic/bariatric surgery in patients with class 1 obesity.

Reporting in BMC Surgery, an online 35-item questionnaire survey based on existing controversies surrounding MBS in class 1 obesity was created by 17 bariatric surgeons from 10 different countries, with a total of 543 bariatric surgeons from 65 countries participated in the survey.

In total, 52.29% of participants agreed with the statement that MBS should be offered to class-1 obese patients without any obesity related comorbidities. Most of the respondents (68.43%) believed that MBS surgery should not be offered to patients under the age of 18 with class I obesity, with 81.01% of respondents agreed with the statement that surgical interventions should be considered after failure of non-surgical treatments.

They concluded that a precise analysis of these results is useful for identifying different aspects for future research and consensus building.

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Cannabis Use following Bariatric Surgery is associated with Anxiety and Maladaptive Eating

Cannabis use after bariatric surgery was associated with anxiety symptoms and engaging in maladaptive eating behaviours, US researchers report in SOARD.

The study authors examined whether post-surgical cannabis use was associated with psychiatric symptoms and maladaptive eating among individuals up to four years after bariatric surgery.

In total, 765 patients who underwent bariatric surgery over a four-year period completed questionnaires online regarding post-surgical cannabis use, psychiatric symptoms and maladaptive eating.

Any cannabis use after bariatric surgery was associated with increased likelihood of having elevated symptoms of anxiety (OR= 1.88, p= .003; 37.8% vs. 24.4%), increased likelihood of grazing behaviours (OR= 1.77, p= .01; 71.2% vs. 58.2%) and higher scores for eating in response to depression (p=0.01; 12.13 vs. 10.75). Weekly cannabis use was associated with loss of control eating (OR= 1.81, p= .04; 37.2% vs. 24.7%), binge eating (OR= 2.16, p=0.03; 20.0% vs. 10.4%) and night eating behaviours (OR= 2.11, p=0.01; 40.0% vs. 24.0%). However, cannabis use was not associated with depression (p>0.05).

They concluded that clinicians involved in pre-surgical and post-surgical care may want to counsel patients currently using cannabis, especially those who are engaging in frequent use.

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Long-term weight loss outcomes after bariatric surgery: a propensity score study among patients with psychiatric disorders

Researchers from the University Hospital of Caen, Caen Cedex, France, have reported that substantial weight loss was reported among patients with psychiatric disorders receiving bariatric surgery at the cost of more non-severe surgical complications.

Writing in Surgical Endoscopy, they analysed the safety and long-term result of bariatric surgery in patients with psychiatric disorders. They assessed the outcomes from two groups: patients with psychiatric disorders (PG) and patients without psychiatric disorders (CG).

With 136 patients in each group, TWL% at 2 years in the PG was 32.7% versus 36.6% in the CG (p=0.002). Overall surgical morbidity was higher in the PG than the CG (28% vs 17%, p=0.01), although severe surgical complications were not statistically significant (4% vs 3%, p=0.44). Psychiatric adverse events were significantly more frequent in the PG than in the CG.

“Further, a psychiatric postoperative follow-up visit may be warranted for patients with preoperative psychiatric disorders, given the incidence of psychiatric adverse events,” they concluded.

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Cost-Effectiveness of Pharmacotherapy for the Treatment of Obesity in Adolescents

A study led by researchers from Columbia University Irving Medical Center, who assessed the cost-effectiveness of a range of anti-obesity medications in adolescents, have concluded that top-dose phentermine and topiramate (Qsymia) as adjunct to lifestyle counselling was estimated to be cost-effective after five years. Interestingly, they noted that semaglutide (Wegovy) found that the trendy obesity drug is not cost-effective at its current price in the US.

The researchers used a microsimulation model to project health and cost outcomes of lifestyle counselling alone and adjunct to liraglutide, mid-dose phentermine and topiramate, top-dose phentermine and topiramate, or semaglutide.

By five years, top-dose phentermine and topiramate became the preferred strategy, with an ICER of $56,876 per QALY gained vs lifestyle counselling. Over each time horizon, semaglutide was projected to accumulate the most QALYs. However, the ICERs for semaglutide vs top-dose phentermine and topiramate were well above our WTP threshold, ranging from $1.1 to $3.0 million per QALY gained.

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