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Journal Watch 22/11/2023

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 OAGB outperforms RYGB and SADI-S, surgery reduces rheumatoid arthritis, ABCD predicts transit bipartition post SG and OAGB, changes in attitudes to surgery of primary care practitioners, MBSAQIP bariatric risk/benefit calculator and RYSA study outcomes, and more (please note, log-in maybe required to access the full paper).

One anastomosis gastric bypass as a primary bariatric surgery: MBSAQIP database analysis of short-term safety and outcomes

One anastomosis gastric bypass (OAGB) had better 30-day outcomes and shorter operative times than Roux-en-Y gastric bypass (RYGB) and single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) and therefore, could be considered a viable alternative, according to researchers from Mayo Clinic, Jacksonville, FL.

Writing in Surgical Endoscopy, they examined the outcomes from patients who underwent primary OAGB, RYGB, and SADI-S using the MBSAQIP database of 2020 and 2021. An analysis of patient demographics and 30-day outcomes were compared between these three bypass procedures. In addition, a multilogistic regression for overall complications, blood transfusions, unplanned ICU admissions, readmission, reoperation, and anastomotic leak stratified by surgical procedure was performed.

In total, 1607 primary OAGBs were reported between 2020 and 2021. In terms of patient demographics, patients who underwent RYGB and SADI-S showed a higher incidence of comorbidities. Conversely, OAGB had shorter length of stay (1.39±1.10 days vs 1.62±1.42 days and 1.90±2.04 days) and operative times (98.79±52.76 min vs 125.91±57.76 min and 139.85±59.20 min) than RYGB and SADI-S.

OAGB also showed lower rates of overall complications (1.9% vs 4.5% and 6.4%), blood transfusions (0.4% vs 1.1% and 1.8%), unplanned ICU admission (0.3% vs 0.8% and 1.4%), readmission (2.4% vs 4.9% and 5.0%), and reoperation (1.2% vs 1.9% and 3.1%). A multilogistic regression analysis was performed, RYGB and SADI-S demonstrated higher odds of 30-day complications.

Interestingly, the incidence of primary OAGB has increased since its approval by ASMBS, from 0.05% reported between 2015 and 2019 to 0.78% between 2020 and 2021.

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Effect of bariatric and metabolic surgery on rheumatoid arthritis outcomes: A systematic review

Bariatric and metabolic surgery (BMS) seems a promising alternative in reducing rheumatoid arthritis (RA) disease activity as well as morbidity and mortality in patients with obesity, according to a systematic review by researchers from the University Tunis El Manar, Tunis, Tunisia.

Reporting in PLOSone, the identified three studies that included 33193 patients with RA, 6700 of them underwent BMS. Compared to non-surgical patients, weight loss after BMS was associated with lower disease activity outcomes at 12 months (p<0.05).

Prior BMS in RA patients was significantly associated with reduced odds ratios for all the morbidities and in-hospital mortality compared with no prior BMS (36.5% vs 54.6%, OR = 0.45, 95% CI (0.42, 0.48), p<0.001) and (0.4% vs 0.9%, OR = 0.41, 95% CI (0.27–0.61), p<0.001), respectively.

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Comparison of the ABCD Score's Accuracy in Predicting Remission of Type 2 Diabetes Mellitus One Year After Sleeve Gastrectomy, One Anastomosis Gastric Bypass, and Sleeve Gastrectomy with Transit Bipartition

Investigators at the University of Firat, Elazig, Turkey, have concluded ABCD score predicts the probability of remission at one-year follow-up in T2DM patients undergoing transit bipartition (TB) as accurately as in patients receiving SG or OAGB.

Writing in Obesity Surgery, they sought to evaluate the predictive value of ABCD score in TB after both procedures. Of 438 patients with T2DM, 191 underwent SG, 136 underwent OAGB, and 111 underwent TB. Retrospective analysis of ABCD scores, one-year postoperative remission rates, and the predictive accuracy of ABCD scores for these were conducted.

In the SG, OAGB and TB groups, respectively, median ABCD scores were 7, 6, and 4, while complete remission rates were 95.3%, 84.6%, and 76.6% (p<0.001). The area under curves (AUCs) for SG, OAGB and TB were 0.829 (95% CI = 0.768 to 0.879, p<0.0001), 0.801 (95% CI = 0.724 to 0.865, p<0.0001) and 0.840 (95% CI = 0.758 to 0.902, p<0.0001), respectively. There was no statistically significant difference between AUCs.

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Changing Knowledge and Attitudes towards Bariatric Surgery in Primary Care: a 10-Year Cross-Sectional Survey

Researchers from Scotland have found in the last decade primary care practitioners (PCP) were more aware of local referral criteria, making increased numbers of referrals to surgery however, knowledge deficits of national guidelines remain, and overwhelmingly PCPs do not feel comfortable looking after post-operative bariatric surgical patients.

Reporting in Obesity Surgery, all PCPs within three Scottish NHS health boards were emailed a questionnaire-based survey in 2011 (n=902). A subsequent ten-year follow-up (2021) encompassed a greater scope of practice, additionally distributed to all PCPs in five further health boards (n=2049).

Some 452 responses were achieved (2011, 230; 2021, 222). PCPs felt bariatric surgery offered a greater impact in both weight management and that of obesity-related diseases (p<0.0001). More PCPs were aware of local bariatric surgical referral criteria (2011, 43%; 2021, 57% (p=0.003)) and more made referrals (2011, 60%; 2021, 72% (p=0.018)) but were less familiar with national bariatric surgical guidelines (2011, 70%; 2021, 48% (p<0.001)). Comfort at managing post-operative bariatric surgical patients were unchanged (2011, 24%; 2021, 27% (p=0.660)). Minimal progress through dietetic-lead weight management services, plus rejection of patients thought to be good candidates, was reasons for referral hesitancy.

They concluded that further research into PCP educational needs, in addition to improving the primary to secondary care interface, is required.

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Does the MBSAQIP Bariatric Risk/ Benefit Calculator Hold Its Weight? An Assessment of its Accuracy

The MBSAQIP Surgical Risk/Benefit Calculator prediction models for one-year BMI, 30-day reoperation and reintervention risks were fairly well calibrated with an acceptable level of discrimination except for OSA remission, according to investigators from the Indiana University School of Medicine, IN.

Writing in SOARD, they sought to evaluate the accuracy of the calculator predictions regarding the 30-day complication risk, one-year weight loss outcomes and comorbidity resolution.

In total, 1453 patients who underwent primary laparoscopic RYGB or SG at their institution between 2012 and 2019. The c-statistics for the complications and comorbidity resolution ranged from 0.533 for obstructive sleep apnea remission to 0.675 for 30-day reoperation. The number of comorbidity resolutions predicted by the calculator was significantly higher than the actual remissions for diabetes, hyperlipidaemia, hypertension and obstructive sleep apnoea (p<0.001).

On average, the calculator BMI predictions deviated from the observed BMI measurement by 3.24kg/m2. The RYGB procedure (Coef -0.89; p=0.005) and preoperative BMI (Coef -0.4; p=0.012) were risk factors associated with larger absolute difference between the predicted and observed BMI.

They concluded that the one-year BMI estimations were less accurate for RYGB patients and cases with very high or low preoperative BMI measurements. Therefore, the bariatric risk calculator constitutes a helpful tool that has a place in preoperative counselling.

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Roux-en-Y versus one-anastomosis gastric bypass (RYSA study): weight loss, metabolic improvements, and nutrition at 1 year after surgery, a multicenter randomized controlled trial

RYGB and OAGB were comparable in weight loss, metabolic improvement, remission of diabetes and hypercholesterolemia, and nutrition at 1-year follow-up, according to researchers from Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Reporting in Obesity, the authors standardised the bypass length in RYGB and OAGB and compared weight loss and metabolic outcomes in a randomized controlled trial. In total, 121 bariatric patients underwent RYGB (n=61) or OAGB (n=60).

Total weight loss was similar in RYGB and OAGB at six months 21.2% vs. 22.8% (p=0.136) and at 12 months 25.4% vs. 26.1% (p=0.635). Insulin sensitivity, lipids, and inflammation improved similarly between the groups (p>0.05). Remission of type 2 diabetes and hypercholesterolemia was marked and similar (p>0.05) but the use of antihypertensive medications was lower (p=0.037) and hypertension tended to improve more (p=0.053) with RYGB versus OAGB at 12 months.

Higher rates of vitamin D-25 deficiency (p < 0.05) and lower D-25 levels were observed with OAGB versus RYGB throughout the follow-up (p < 0.001), although no differences in adverse effects were observed.

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