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Journal Watch 15/05/2024

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 surgery vs GLP-1 in preventing congestive heart failure, health expenditures surgery, redo sleeve gastrectomy, exercise interventions following bariatric surgery and body contouring surgery after bariatric surgery, and more (please note, log-in maybe required to access the full paper).

Effectiveness of Bariatric Metabolic Surgery versus Glucagon-Like Peptide-1 Receptor Agonists for prevention of Congestive Heart Failure

Bariatric metabolic surgery is associated with a stronger reduction in primary incidence of congestive heart failure compared to treatment with glucagon-like peptide-1 receptor agonists, Israeli researchers report in Nature Medicine.


The study included 2,205 matched pairs of patients (64.5% female) who were followed for a median of 6.6 years and up to 12 years. Primary incidence of CHF occurred in 26 (1.2%) BMS patients and in 90 GLP1-RA patients (4.1%), adjusted HR: 0.43, 95% CI: 0.27-0.68. The differential effect was not mediated through the relative advantage of surgery in maximal weight reduction.


With the increasing use of highly potent next-generation GLP1-RAs, further comparative long-term studies are warranted.


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Health Expenditures After Bariatric Surgery A Retrospective Cohort Study

Researchers from Duke University, Durham, NC, have reported bariatric surgery translates into lower medication expenditures than matched controls, but not lower overall long-term expenditures.


Writing in the Annals of Surgery, their retrospective study compared expenditures between surgical (22,698 bariatric surgery, n=7,127 RYGB, 15,571 sleeve gastrectomy) and matched non-surgical patients (n=66,769) three years before and 5.5 years after surgery.


Estimated total expenditures were similar between surgical and non-surgical groups three years before surgery ($27 difference, 95% confidence interval (CI): −42, 102)), increased six months prior to surgery for surgical patients, and decreased below pre-period levels for both groups after 3-5.5 years to become similar (difference at 5.5 y=-$61, 95% CI: −166, 52). However, long-term outpatient expenditures were similar between groups and surgical patients’ lower long-term medication expenditures ($314 lower at 5.5 y, 95% CI: −419, −208) were offset by a higher risk of hospitalisation.


Total expenditures were similar between RYGB and SG patients 3.5 to 5.5 years after surgery.


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Safety of Redo Sleeve Gastrectomy as a Primary Revisional Procedure

Redo laparoscopic sleeve gastrectomy is associated with increased rates of postoperative complications and operative time, according to researchers from Keck Medical Center of University of Southern California, Los Angeles, CA.


Writing in SOARD, the examined the 30-day safety of redo-LSG(RSG) with LSGwith data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Registry.


A total of 226,029 patients were reviewed; 1,454(0.7%) underwent RSG and 224,575(99.3%) underwent initial LSG. RSG patients demonstrated increased overall complications (3.6% vs 2.1%, p<0.001), and longer operative time (81min vs 62min, p<0.001), but there was no difference in mortality. On multivariable analysis, patients undergoing RSG were independently associated with increased risk of overall postoperative complications (OR 1.493, p=0.018), organ space infection (OR 6.231, p<0.001), staple line leak (12.838, p<0.001), pneumonia (3.85, p=0.013), ventilator requirement over 48hours (OR 6.404, p=0.035), sepsis (OR 4.397, p=0.010), septic shock (OR 8.669, p<0.001), reoperation (OR 1.808, p=0.013), readmission (OR 2.104, p<0.001), reintervention (OR 4.435, p<0.001) and longer operative times (β 12.790, p<0.001).


“While these results are concerning further studies are required to examine long-term outcomes,” they concluded.


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Exercise interventions following bariatric surgery are poorly reported: A systematic review and a call for action

Exercise interventions following bariatric surgery are poorly reported, non-transparent, and generally not replicable, researchers from the University of Almería, Almería, Spain, have report in Obesity Reviews.


Their systematic review assessed the transparency and replicability of exercise-based interventions following bariatric surgery by evaluating the content reporting of exercise-based clinical trials.


The outcomes showed that 53% of the trials did not report the training intensity, whereas 25% did not indicate the duration of the major exercise component within the training session. The mean CERT score was 5 out of a possible score of 19. No studies reached Consensus on Exercise Reporting Template (CERT) score >10, while 13 out of the total 19 CERT items were not adequately reported by ≥75% of the studies.


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Body Contouring Surgery After Bariatric Surgery Improves Long-Term Health-Related Quality of Life and Satisfaction With Appearance - An International Longitudinal Cohort Study Using the BODY-Q

An international team of researchers have reported that patients who underwent body contouring surgery (BCS) maintained an improvement in health-related quality of life (HRQL) and satisfaction with appearance in contrast to patients who only underwent bariatric surgery, who reported a decline in scores 1 to 2 years postoperatively.


Writing in the Annals of Surgery, the investigators included 24,604 assessments from 5620 patients from six European countries (Denmark, the Netherlands, Finland, Germany, Italy, and Poland).


Bariatric surgery initially led to improved HRQL and appearance scores throughout the first post-bariatric year, followed by a gradual decrease. Patients who underwent subsequent BCS after surgery experienced a sustained improvement in HRQL and appearance or remained relatively stable for up to ten years postoperatively.


“Our results emphasise the pivotal role that BCS plays in the completion of the weight loss trajectory,” they concluded.


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