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Journal Watch 5/04/2023

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 stroke-related risk factors during pregnancy after bariatric surgery, outcomes in elderly patients undergoing bariatric surgery, substance use disorder and mortality post-surgery, hiatus hernia repair with a new-generation biosynthetic mesh, swallowable intragastric balloon outcomes and ketamine infusion vs.dexmedetomidine infusion outcomes from bariatric surgery and more (please note, log-in maybe required to access the full paper).

Stroke-related risk factors during pregnancy in women who had metabolic and bariatric surgery compared to women without metabolic and bariatric surgery

US researchers have reported metabolic and bariatric surgery (MBS) helps women lose weight and decreases the incidence of some pregnancy-related risk factors for stroke.

The study authors, writing in SOARD, examined stroke and stroke risk factors including preeclampsia, eclampsia, gestational hypertension, and embolism/thrombosis in women of reproductive age who have had MBS.

The cross-sectional study included women between the ages of 20 and 44 who had a maternal admission code. Weighted logistic regression was conducted to assess the odds of stroke and stroke risk factors in women with a history of MBS compared to other women of reproductive age.

The found that women with a history of MBS have 12% lower adjusted odds of developing preeclampsia/eclampsia and 10% lower adjusted odds of gestational hypertension compared to women did not have MBS. When stratified by race, the difference was significant in white women (preeclampsia/eclampsia: aOR=0.89, 95%CI=0.81-0.98, gestational hypertension: aOR=0.91, 95%CI=0.83-1.00). Latinas with MBS had significantly lower odds of preeclampsia/eclampsia (aOR=0.75, 95%CI=0.64-0.90).

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A 5-year characterization of trends and outcomes in elderly patients undergoing elective bariatric surgery

In elderly patients (≥ 65 years) undergoing elective bariatric surgery, functional status remains the most predictive factor for poor outcomes, according to investigators from the University of Alberta, Edmonton, Canada.

Reporting in Surgical Endoscopy, the researchers used data from the MBSAQIP database to identify elderly patients (≥ 65 years) undergoing elective bariatric surgery and analysed their unique characteristics, surgical operative trends, and outcomes by comparing to a non-elderly cohort. Multivariable logistic regression identified independent predictors of serious complications and 30-day mortality.

From 2015 to 2019, a total of 39,854 elderly patient had bariatric surgery. They had higher American Society of Anesthesiologists classification, lower functional status, more insulin dependent diabetes, and hypertension, among other comorbidities, compared to younger patients. Sleeve gastrectomy remained the most common (73.7% non-elderly; 72.3% elderly); however, operative time was longer among the elderly. Functional status was most predictive for both serious complications (OR 1.72; CI 1.53–1.94) and mortality (OR 2.92; CI 1.98–4.31). Surgery among elderly patients was associated with poorer 30-day postoperative outcomes across all categories and was independently associated with serious complications (p<0.001) and 30-day mortality (p<0.001), after adjusting for comorbidities.

After adjusting for comorbidities, functional status remains the most predictive factor for poor outcomes; however, elderly patients have increased 30-day odds of serious complications and 30-day mortality, suggesting a need to tailor our approach to these individuals that carry a unique operative risk.

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Pre-Operative Substance Use Disorder is Associated with Higher Risk of Long-Term Mortality Following Bariatric Surgery

Researchers from the University of Utah have found that pre-operative substance use disorders (SUD) was associated with higher hazards of all-cause, internal cause and external cause mortality in patients who undergo bariatric surgery.

Reporting in Obesity Surgery, the study assessed long-term mortality of patients (17,215 patients) with and without pre-operative SUD who underwent surgery from the Utah Bariatric Surgery Registry (UBSR) and the Utah Population Database.

The found that subjects with pre-operative SUD had a 2.47 times higher risk of death vs. those without SUD (p<0.01). Furthermore, those with pre-operative SUD had a higher internal cause of death than those without SUD by 129% (p< 0.01) and 216% higher external mortality risk than those without pre-operative SUD (p<0.01).

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Hiatus hernia repair with a new-generation biosynthetic mesh: a 4-year single-center experience

Hiatus hernia (HH) repair with biosynthetic long-term resorbable meshes (BSM) is feasible and safe with low perioperative morbidity and acceptable postoperative failure rates at early to mid-term follow-up, researchers from the University Hospital Zurich, Zurich, Switzerland, have found.

Writing in Surgical Endoscopy, the study included 97 patients (elective primary cases n=76, redo cases n=13, emergency cases n=8) who underwent HH with BSM augmentation. Overall (Clavien–Dindo ≥ 2) and severe (Clavien–Dindo ≥ 3b) postoperative morbidity was 15% and 3%, respectively. Postoperative complications was achieved in 85% of cases (elective primary surgery 88%, redo cases 100%, emergencies cases 25%). After a median (IQR) postoperative follow-up of 12 months, 69 patients (74%) were asymptomatic, 15 (16%) reported improvement, and 9 (10%) had clinical failure, of which 2 patients (2%) required revisional surgery.

They concluded that BSM may be a useful alternative to non-resorbable materials in HH surgery.

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The Swallowable Intragastric Balloon Combined with Lifestyle Coaching: Short-Term Results of a Safe and Effective Weight Loss Treatment for People Living with Overweight and Obesity

Swallowable intragastric balloon, combined with lifestyle coaching, is a safe and effective treatment option for patients living with overweight and obesity, according to researchers from the Netherlands.

Reporting their findings in Obesity Surgery, their retrospective study of 336 patients with a swallowable IB placement between December 2018 and July 2021, combined with a 12-month coaching program. Before balloon placement, patients underwent multidisciplinary screening. The IB was swallowed and filled with fluid once in the stomach and naturally excreted around 16 weeks.

The mean baseline weight and BMI were 107.54 (±19.16) kg and 36.1 (±5.02) kg/m2. After one year, the mean total weight loss was 11.0% (±8.4). The mean placement duration was 13.1 (±2.82) min, and in 43.7%, a stylet was used to facilitate placement. The most common symptoms were nausea (80.4%) and gastric pain (80.3%). In the majority of patients, complaints were resolved within a week. The early deflation of the balloon occurred in eight patients (2.4%) of which one showed symptoms suggesting a gastric outlet obstruction.

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Perioperative use of ketamine infusion versus dexmedetomidine infusion for analgesia in obese patients undergoing bariatric surgery: a double-blinded three-armed randomized controlled trial

A research team led by investigators from the Ain Shams University, Cairo, Egypt, have found that dexmedetomidine effectively decreased intraoperative fentanyl requirement and the time to extubation, while ketamine decreased the need for morphine, post-bariatric surgery.

Writing in BMC Anesthesiology, they assessed whether ketamine or dexmedetomidine infusion would affect postoperative total morphine consumption. They randomised 90m patients into three groups:

  • The ketamine group received a bolus dose (0.3 mg/kg) of ketamine over 10 min, followed by an infusion of the same drug (0.3 mg/kg/h).

  • The dexmedetomidine group received a bolus dose (0.5 mcg/kg) of dexmedetomidine over 10 min, followed by an infusion of this drug (0.5 mg/kg/h).

  • The control group received a saline infusion.

They reported that compared with ketamine, dexmedetomidine decreased the need for fentanyl intraoperatively (160±42µg), shortened the time to extubation (3±1min) and improved modified observer’s agitation/sedation scale (MOASS) and postoperative nausea and vomiting (PONV) scores. In turn, ketamine decreased postoperative NRS scores and the need for morphine (3 ± 3 mg).

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