Journal watch - review of the latest clinical papers 08/09/2021

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 the outcomes from the standardised use of a closed suction calibration system and its impact on leaks, the importance of surgical quality assurance methods to reduce variability of surgical performance and potential bias within RCTs, whether bariatric surgery before pregnancy lowers the risk of severe maternal morbidity to a level comparable to no obesity, Investigators from University College London, London, identify high-risk groups for changes in weight and BMI, and finally authors from Taiwan report that abdominal obesity and general obesity are significantly associated with male and female epigenetic age acceleration (EAA), respectively (please note, log-in maybe required to access the full paper).

Decreased Leak Rate and Need for Reintervention with Use of Closed Suction Calibration System: a Bariatric Surgery Quality Improvement Project

Reported in Obesity Surgery, researchers from Medstar Georgetown University Hospital/Washington Hospital Center sought to determine if leak rates and need for subsequent interventions are changed by the standardized use of a closed suction calibration system (CSCS) at a high-volume urban hospital.


Four hundred ninety cases were performed prior to CSCS being introduction in the hospital and 195 with CSCS. The overall leak rate was 0% for CSCS patients vs 1.4% without CSCS (p=0.09) and the overall need for post-operative interventions was also lower in those patients who had CSCS (9.6% vs 2.6%, p=0.009).


They concluded that the use of a standardised CSCS resulted in overall decreased leak rates and a clinically significant decrease in additional interventions.


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Assurance of surgical quality within multicenter randomized controlled trials for bariatric and metabolic surgery: a systematic review

Researchers from Imperial College London have cautioned that future trials for bariatric and metabolic surgery studies must implement surgical quality assurance methods to reduce variability of surgical performance and potential bias within RCTs.


They made their conclusions in SOARD, after they examined the measures undertaken to ensure surgical quality within multicentre RCTs investigating bariatric and metabolic surgery, and their influence upon clinical outcomes. Each RCT was evaluated for surgical quality measures; (i)standardisation of surgical techniques, (ii)credentialing of surgical experience, and (iii)monitoring of performance.


Overall, 19 RCTs were included in the analysis – 14 studies described complete standardisation of surgical techniques, 4 studies credentialed surgeons by case volume prior to enrolment and 2 studies monitored performance during the study. They also found that standardisation of surgery was associated with reduced re-operation rates but did not influence post-operative weight loss.


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Risk of Severe Maternal Morbidity After Bariatric Surgery - Retrospective Cohort Study

Writing in the Annals of Surgery, researchers from Canada assessed whether bariatric surgery before pregnancy lowers the risk of severe maternal morbidity to a level comparable to no obesity.


They analysed 2,654 deliveries of women who had bariatric surgery and compared them with 70,041 deliveries in women who had severe maternal morbidity. They found that the risk of severe maternal morbidity was not significantly elevated for bariatric surgery, but was greater for obesity compared with no obesity. Bariatric surgery was not associated with morbidities such as severe preeclampsia, sepsis, and cardiac complications compared with no obesity, but obesity was associated with elevated risks of these and other severe morbidities. Bariatric surgery was associated, however, with intensive care unit admission, compared with no obesity.


They concluded that pregnant women with prior bariatric surgery have similar risks as those women without obesity for most types of severe maternal morbidity, except for intensive care unit admission.


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Identifying adults at high-risk for change in weight and BMI in England: a longitudinal, large-scale, population-based cohort study using electronic health records

Investigators from University College London, London, sought to identify high-risk groups for changes in weight and BMI using electronic health records (EHR). In their longitudinal, population-based cohort study over two million patient records and more than nine million BMI measurements were analysed.


Reporting their findings in The Lancet Diabetes & Endocrinology, they found that young adult age (18–24 years) was the strongest risk factor for weight gain at one-, five- and ten-years of follow-up. They also found that adults in the youngest age group with overweight or obesity at baseline were also at highest risk to transition to a higher BMI category.


They recommend that a radical shift in policy is required to focus on individuals at the highest risk of weight gain (ie, young adults aged 18–24 years) for individual-level and population-level prevention of obesity and its long-term consequences for health and health care.


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Associations of five obesity metrics with epigenetic age acceleration: Evidence from 2,474 Taiwan Biobank participants

Finally, authors from the National Taiwan University, Taipei, Taiwan, report that abdominal obesity and general obesity are significantly associated with male and female epigenetic age acceleration (EAA), respectively.


They looked at the records of 2,474 Taiwan Biobank (TWB) and evaluated five obesity metrics - BMI, body fat percentage, waist circumference, hip circumference, and waist-hip ratio. Sex-stratified EAA was regressed on each of the five obesity metrics.


The noted that the prevention of abdominal obesity and general obesity is associated with a lower risk of EAA in men and women, respectively.


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