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Journal Watch 15/03/2023

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 RYBP mortality trends in racial cohorts, impact of covid-19 on postop patient experience, DRYGB as a revisional procedure, births after bariatric surgery, total knee arthroplasty and bariatric surgery and trends among metabolically healthy obesity among US adults (please note, log-in maybe required to access the full paper).

Gastric Bypass Mortality Trends in Racial Cohorts: Are We Improving?

Researchers from Mayo Clinic, Jacksonville, FL, have reported that year-to-year mortality remains higher in non-Hispanic black (NHB) patients after Roux-en-Y gastric bypass (RYGB).

Writing in Obesity Surgery, the authors wanted to determine RYGB procedure and mortality trends in racial cohorts. Using the 2015 to 2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project (MBSAQIP) database, they matched non-Hispanic white (NHW) and NHB patient cohorts were matched based on patient and surgical characteristics.

A total of 148,829 RYGB cases in NHW (82.8%) and Black (17.2%) patients were analysed. In matched cohorts, all-cause mortality, aggregate related readmission, related reintervention and VTE were more likely in NHB patients. During the study period, year-to-year mortality was higher in NHB patients compared to NHW patients.

While bariatric outcomes continue to improve, outcome gaps between racial cohorts seem to persist, the authors concluded.

To access this paper, please click here

Impact of COVID-19 on the Postoperative Bariatric Surgery Patient Experience

Researchers at the University of Wisconsin, Madison, WI, writing in the Annals of Surgery, have reported that as a result of COVID-19, bariatric surgery patients need ongoing support to access mental health professionals, develop new physical activity routines, and counteract increased food insecurity.

The investigators sought to characterise patient and provider perceptions of the impact of COVID-19 on weight loss following bariatric surgery via semistructured interviews with bariatric surgery patients, primary care providers and health psychologists.

Thirty-four participants were interviewed: 24 patients (12 Roux-en-Y gastric bypass and 12 sleeve gastrectomy), six primary care providers and four health psychologists. They found COVID-19 affected the postoperative bariatric surgery patient experience in three ways: (1) it disrupted dietary and physical activity routines due to facility closures and fear of COVID-19 exposure; (2) it required patients to transition their follow-up care to telemedicine delivery; and (3) it increased stress due to financial and psychosocial challenges.

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Distalization of Standard Roux-en-Y Gastric Bypass: Indications, Technique, and Long-Term Results

Investigators from Saint-Luc University Hospital, Brussels, Belgium, have found distalisation of Roux-en-Y gastric bypass (DRYGB) as a revisional procedure, results in substantial and sustained long-term weight loss.

They analysed retrospective data from 22 patients who had undergone RYGB and failed to achieve an excess weight loss (EWL) >50% or BMI <35 kg/m2 and underwent limb vitalization between 2013 and 2022. For DRYGB, the length of the common channel was 100 cm and the lengths of the biliopancreatic limb and the alimentary limb were 1/3 and 2/3 of the remaining bowel, respectively.

The mean BMI values before and after DRYGB were 43.7 kg/m2 and 33.5 kg/m2, respectively. Five years after DRYGB, mean %EWL was 74.3% and mean % total weight loss (TWL) was 28.8%. Mean %EWL and mean %TWL of the two procedures (RYGB and DRYGB) after five years were 80.9% and 44.7%, respectively. Three patients experienced protein calorie malnutrition. One was reproximalised and the others were treated with parenteral nutrition with no recurrence. There was a significant decrease in the incidence of diabetes type 2 and dyslipidaemia after DRYGB.

Due to the risk of malnutrition, patients must be strictly followed for life after the DRYGB, the authors concluded in Obesity Surgery.

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Births After Bariatric Surgery in the United States - Incidence, Obstetric Outcomes, and Reinterventions

Investigators at the University of Michigan, Ann Arbor, MI, have found giving birth was common in the first two years after bariatric surgery and was not associated with an increased risk of reinterventions.

Reporting in the Annals of Surgery, off 69,503 patients who underwent bariatric surgery, 1,464 gave birth. The incidence rate was 2.5 births per 100 patients in the two years after surgery. Overall, 85% of births occurred within 21 months after surgery. For 38,922 patients with full two-year follow-up, adverse obstetric event rates were 4.5% for gestational diabetes and 14.2% for hypertensive disorders.

In all, 48.5% were first-time caesarean deliveries. Almost all reinterventions during pregnancy were biliary. Multivariable logistic regression analysis showed no association between post-bariatric birth and reintervention rate (odds ratio: 0.93, 95% confidence interval: 0.78–1.12).

They concluded clinicians should consider shifting the dialogue surrounding pregnancy after surgery to shared decision-making with maternal safety as one component.

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Total knee arthroplasty and bariatric surgery: change in BMI and risk of revision depending on sequence of surgery

Örebro University, Örebro, Sweden, have report that the sequence of surgery in patients undergoing both bariatric surgery and total knee arthroplasty (TKA) does not appear to be associated with weight loss after bariatric surgery or the risk of revision after TKA.

Writing in BMC Surgery, they examined data from the Scandinavian Obesity Surgery Register (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) between 2007 and 2019 and 2009 and 2020, respectively. The cohort was divided into two groups; patients who underwent TKA before bariatric surgery (TKA-BS) and patients who underwent bariatric surgery before TKA (BS-TKA).

In total, 119 patients underwent TKA before BS and 465 underwent BS before TKA. No association was detected between the sequence of surgery and total weight loss 1 and 2 years post-BS, − 0.1 (95% confidence interval (CI), − 1.7 to 1.5) and − 1.2 (95% CI, − 5.2 to 2.9), or the risk of revision after TKA [hazard ratio 1.54 (95% CI 0.5–4.5)].

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Trends in the Prevalence of Metabolically Healthy Obesity Among US Adults, 1999-2018

Researchers from the Huazhong University of Science and Technology, Wuhan, China, have noted that the age-standardized proportion of metabolically healthy obesity (MHO) increased among US adults from 1999 to 2018, but differences in trends existed across sociodemographic subgroups.

Reporting in JAMA Network Open, they sought to characterise trends in the prevalence of MHO among US adults with obesity, overall and by sociodemographic subgroups.

The study included 20,430 participants (mean age was 47.1 (0.2) years; 50.8% were women, and 68.8% self-reported their race and ethnicity as non-Hispanic White) and the found that the age-standardised prevalence (95% CI) of MHO increased from 3.2% (2.6%-3.8%) in the 1999-2002 cycles to 6.6% (5.3%-7.9%) in the 2015-2018 cycles (p<0.001 for trend).

There were 7,386 adults with obesity and the age-standardized proportion (95% CI) of MHO among increased from 10.6% (8.8%-12.5%) in the 1999-2002 cycles to 15.0% (12.4%-17.6%) in the 2015-2018 cycles (p=0.02 for trend). In addition, there were significant decreases in the age-standardised prevalence (95% CI) of elevated triglycerides (from 44.9% [40.9%-48.9%] to 29.0% [25.7%-32.4%]; p<0.001 for trend) and reduced HDL-C (from 51.1% [47.6%-54.6%] to 39.6% [36.3%-43.0%]; p=0.006 for trend).

The authors concluded that effective strategies are needed to improve metabolic health status and prevent obesity-related complications in adults with obesity.

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