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Journal watch 14/07/2023

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 MBSAQIP risk calculator, financial impact of the COVID-19 pandemic on SG, post-op views on weight recurrence, the effect of sleeve gastrectomy on pregnancy complications and the associations between body mass index and all-cause mortality, and more (please note, log-in maybe required to access the full paper).

MBSAQIP risk calculator use in bariatric surgery is associated with a reduction in serious complications: A retrospective analysis of 210,710 patients

Using a risk calculator could reduce the incidence of complications by opening a dialogue between healthcare professionals and patients, according to researchers from the University of Alberta Edmonton, Alberta, Canada.

Writing in SOARD, the investigators used the Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) Bariatric Surgical Risk/Benefit Calculator to characterise the use and impact of the MBSAQIP calculator from 955 centres (35,158 patients) in North America.

The 2021 MBSAQIP database was evaluated for the use of the calculator on pre-operative counselling for patients undergoing bariatric surgery. Patient characteristics, operative techniques, and outcomes were compared with bivariate analysis. Multivariable modelling evaluated factors including use of the calculator independently associated with serious complications and mortality.

Patients where the calculator was used pre-operatively were older (43.8 ± 11.6 years vs 43.6 ± 11.7 years; p<0.001) and were more likely to have insulin dependent diabetes, hypertension, GERD, renal insufficiency and sleep apnoea. More patients had RYGB in the calculator cohort compared to the cohort that did not use the calculator (29.6% vs 28.6%; p<0.003). The rate of serious complication was significantly less in the calculator cohort (3.1% vs 3.4%; p<0.030) and multivariable modelling evaluating serious complications revealed the calculator was independently associated with reduced risk of serious complications (OR 0.87, CI 0.82-0.93, p<0.001), but was not with reduced mortality.

By liaising with patients and setting realistic expectations and identifying modifiable risk factors the incidence of complications could be reduced, they concluded.

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The financial impact of the COVID-19 pandemic on sleeve gastrectomy at a major academic institution

The post-COVID-19 sleeve gastrectomy (SG) significantly increased fixed cost (i.e., building maintenance, equipment, overhead) and labour costs (increased contract labour), resulting in precipitous profit decline, according to investigators from Emory University, Atlanta, GA, USA.

Reporting in Surgical Endoscopy, the authors reviewed the revenues, costs and profits per SG at an academic hospital (2017–2022). Fixed costs were obtained through surgery-specific allocation of inpatient hospital and operating-room costs, and direct variable costs were analysed with sub-components including labour and benefits, implants, drug cost, and medical/surgical supplies. The pre-COVID-19 period (10/2017–2/2020) and post-COVID-19 period (5/2020–9/2022) financial metrics were compared with student’s t-test.

In total, 739 SG patients were included and the average length of stay (LOS), Center for Medicaid and Medicare Case Mix Index (CMI) and percentage of patients with commercial insurance were similar pre vs. post-COVID-19 (p>0.05). More SG were performed per quarter pre-COVID-19 than post-COVID-19 (36 vs. 22; p=0.0056) and pre-COVID-19 and post-COVID-19 financial metrics per SG differed significantly for, respectively, revenues ($19,134 vs. $20,983) total variable cost ($9457 vs. $11,235), total fixed cost ($2036 vs. $4018), total profit ($7571 vs. $5442), and labor and benefits cost ($2535 vs. $3734; p<0.05).

The added that potential solutions include minimising contract labour cost and decreasing LOS.

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How to get back on track? Experiences of patients and healthcare professionals regarding weight recurrence and needs for an intervention after bariatric-metabolic surgery

Researchers from the Netherlands have stated that patients should be adequately counselled on weight recurrence after bariatric-metabolic surgery.

Writing in Obesity Reviews, they investigators sought to gain more insight into the experiences and needs of patients and HCP regarding weight recurrence after BMS and an intervention to get ‘Back on Track’ (BoT). In addition, they also assessed the attitudes towards integrating e-Health into the care programme.

The team carried out in-depth interviews and focus groups with 19 stakeholders, including patients and HCP involved in BoT. Interviews were transcribed verbatim and the data were analysed through thematic analysis.

Both patients and HCP reported a wide array of causes of weight recurrence, and patients found it difficult to decide when weight recurrence is problematic and when they should ask for help. Patients said they felt like the exception and were ashamed, therefore experiencing a high threshold to seek help. E-Health was seen as ‘a promising way’ to improve tailoring, screening, autonomy for the patient and accessible contact.

The authors concluded that it is important to lower the threshold for seeking help by offering more long-term standard care or by adding e-Health to the intervention.

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The Effect of Sleeve Gastrectomy on Pregnancy Complications: A Cross-Sectional Study in Saudi Arabia

Weight recurrence after sleeve gastrectomy (SG) negatively impacts pregnancy and increases the probability of several complications for the mother and foetus, particularly anaemia, gestational diabetes mellitus (GDM) and postpartum haemorrhage (PPH), according to researchers from Saudi Arabia.

Writing in Cureus, they investigated the consequence of sleeve gastrectomy and its relation with pregnancy outcomes among women in Saudi Arabia.

Result: Anemia was experienced by 78.8% of the patients during pregnancy. In our study, 18% of the individuals experienced complications during or right after delivery, with postpartum hemorrhage being the most frequent (43.1%). We discovered that pre-eclampsia and delivering a baby small for gestational age were considerably more common in pregnant women who smoked (p ≤ 0.05). On the other hand, no significant association was discovered between any comorbidity and mode of delivery, birth weight, child complications, or difficulties that occurred during or right after labour.

The concluded that weight gain after sleeve gastrectomy negatively impacted pregnancy and increased the probability of several complications for the mother and foetus. Therefore, healthcare providers must inform every woman undergoing bariatric surgery about the possible complication of an unhealthy lifestyle after the procedure.

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Associations between body mass index and all-cause mortality: A systematic review and meta-analysis

Canadian researchers have reported that the role of obesity as a driver of excess mortality should be critically re-examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.

Writing in Obesity Reviews, the objective of this study was to describe the “average” associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality.

All-cause mortality was regressed against mean BMI squared within seven broad clinical populations. The study was modelled as a random intercept. β coefficients and 95% confidence intervals were reported along with estimates of mortality risk by BMIs of 20, 30 and 40 kg/m2. Bubble plots with regression lines are drawn, showing the associations between mortality and BMI.

In total, 154 included studies (6,685,979 participants) and only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β −0.829 [95% CI −1.313, −0.345] and adjusted β −0.746 [95% CI −1.471, −0.021]), Covid-19 (unadjusted β −0.333 [95% CI −0.650, −0.015]), critically ill (adjusted β −0.550 [95% CI −1.091, −0.010]), and surgical (unadjusted β −0.415 [95% CI −0.824, −0.006]) populations.

The associations for general, cancer and non-communicable disease populations were not significant, and they noted that heterogeneity was very large (I2 ≥ 97%).

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