Obesity Surgery最新文献

Background: Obesity is a multifaceted problem for global healthcare, influenced by socioeconomic factors. Bariatric surgery is an effective treatment where less invasive management has been unsuccessful. The impact of socioeconomic deprivation on surgical outcomes is a novel area of research. The present study aims to investigate the effect of socioeconomic deprivation on bariatric surgery outcomes.

Methods: Data was prospectively collected at a regional bariatric centre in Scotland. The study included patients who received either a Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG) (2008-2022). Follow-up occurred postoperatively at 6 months, 1 year and annually thereafter. Socioeconomic deprivation was measured using the Scottish Index of Multiple Deprivation (SIMD) using residential postcodes to generate a deprivation quintile (Q1-5). The primary outcome was percentage total weight loss (%TWL). Secondary outcomes included postoperative complications, comorbidity status, nutritional status, length of stay and re-admissions. Grouped analysis was conducted to represent a more deprived group (Q1-3) and a less deprived group (Q4-5). Statistical analysis was carried out of the data. The study was carried out using the STROBE principles.

Results: 316 patients were included (median follow-up, 7 years; median %TWL, 23.8%). There was no significant difference in median %TWL (p = 0.528), short-term (p = 0.619) or long-term (p = 0.164) complications and resolution (p = 0.472), improvement (p = 0.282) or exacerbation of comorbidities (p = 0.717) between socioeconomic quintiles.

Conclusion: Socioeconomic deprivation does not limit bariatric surgery outcomes and should not be a barrier to surgery.

Background: A barrier to same-day discharge (SDD) in bariatric and metabolic surgery (BMS) is concern over missing the early signs of complication, often detected by measurement of physiological observations. Remote patient monitoring has gained popularity in other surgeries; however, its effectiveness in BMS remains uncertain. This systematic review aims to examine the impact of remote monitoring (RM) on postoperative readmissions and complications in patients undergoing SDD after BMS.

Methods: A literature search of Embase, Ovid MEDLINE, and Cochrane Central databases was conducted to identify all studies on RM used in SDD in bariatric surgery. Data were collected on patient demographics and postoperative outcomes including readmission and morbidity rates.

Results: Seventeen studies including 20,380 patients were analysed. The mean age and preoperative body mass index (BMI) of patients were 41.3 ± 2.7 years and 43.3 ± 1.6 kg/m² respectively. The incidence of readmission for patients with and without RM was 6% (95% CI 0.03-0.13) and 2% (95% CI 0.01-0.04) respectively (p = 0.01). The overall complication rates for patients with and without RM were found to be 7% (95% CI 0.04-0.13) and 3% (95% CI 0.02-0.09) (p = 0.08). Most of the patients who were readmitted had a Clavien-Dindo score of 1 or 2 (68%). There was no mortality described in studies with the use of RM.

Conclusions: SDD with RM enables a shorter hospital stay while providing a safety net for patients and clinicians; the readmission rate is expected marginally higher given the early discharge date. Future studies reporting on healthcare economics are encouraged.

Background: Obesity poses significant challenges by altering upper airway anatomy and making mask ventilation and tracheal intubation difficult. In 2023, 46.1% women and 35.9% men > 18 years were classified as obese in Qatar, yet intubation complications in this group have not been extensively studied. The aim of this study was to evaluate the frequency and types of intubation complications in adults with severe obesity undergoing bariatric surgery and to identify incidence of difficult intubation and associated risk factors.

Methods: In this retrospective cohort study, 2421 patients (1664 females and 746 males) were analyzed. All patients with severe obesity aged over 18 years with a BMI of 40 kg/m² or higher, who underwent bariatric surgery from January 2014 to January 2024, were included. Difficult intubation was defined as the need for video laryngoscopy, cricothyrotomy, intubation via a supraglottic airway device, use of a stylet or bougie, more than one intubation attempt, or desaturation during intubation.

Results: None of the patients experienced any complications of interest. Video laryngoscope was used in 85 patients (3.5%), first-attempt intubation success rate was 95.4%, with more than one attempt required in 4.6% of cases. Logistic regression revealed that the odds of complicated intubation were 1.5 times higher in patients with a BMI > 60, 8.9 times higher in those with Cormack-Lehane class IV, and 5.1 times higher in patients with Mallampati score of IV. Comorbidities increased the odds by 1.3 times, with asthmatic patients having 2.1-fold higher odds.

Conclusion: This study highlights the challenges of tracheal intubation in patients with severe obesity undergoing bariatric surgery and the need for tailored strategies to manage these difficulties.

Background: Studies have discussed the efficacy of bariatric surgery (BS) in remission of individual components of metabolic syndrome (MS). We aimed to analyse the prevalence of MS following BS.

Methods: On October 5, 2023, we conducted a literature search on PubMed, Scopus, Web of Science, and Cochrane. RevManv5.4 was used for the analysis.

Results: MS patients who underwent BS had lower odds of MS within the first year post-BS (OR 0.14, 95%CI 0.12-0.17); patients who had a preoperative BMI < 50 showed a higher reduction in MS post-BS compared with patients who suffered from super obesity (OR 0.12 versus OR 0.17). Older patients (age > 42) had lower odds of MS post-BS compared with younger patients (OR 0.05 versus OR 0.17). There was not a difference in MS prevalence between 1 and 2 years postoperatively (OR 1.07, 95%CI 0.72-1.58). Asians reported the highest reduction in MS post-BS (OR 0.08). MS patients who received medical treatment had three times the odds of having MS compared with patients who underwent BS. Patients who had BS reported a decline in their anti-hypertensives and oral anti-diabetic drugs (OR 0.26, 95%CI 0.15-0.46, OR 0.11, 95%CI 0.07-0.16, respectively). There was not a significant difference in MS prevalence between patients who underwent RYGB and those who had SG (OR 2.16, 95%CI 0.74-6.26).

Conclusions: BS is superior to medical treatment in the remission of MS. Age, preoperative BMI, and country of origin affect the rates of MS remission. BS results in a sustainable resolution of MS across 1, 2, and 5 years post-surgery. A tailored approach is warranted to achieve the best outcomes.

Background: Metabolic surgery's role in lower-BMI patients with type 2 diabetes mellitus (T2DM) remains debated, particularly regarding long-term outcomes.

Methods: This retrospective study analyzed 54 patients (BMI 24-30 kg/m²) with poorly controlled T2DM (HbA1c ≥ 10%) who underwent modified one anastomosis gastric bypass between 2016 and 2017. Primary outcomes included glycemic control, weight loss, and complications at 7 years.

Results: Mean preoperative BMI was 26.76 ± 1.82 kg/m², and HbA1c was 12.63 ± 1.67%. Follow-up rates were year 1 (54/54, 100%), year 3 (52/54, 96.3%), year 5 (48/54, 88.9%), and year 7 (36/38, 94.7% of eligible patients). At 7-year follow-up, mean HbA1c decreased to 6.17 ± 0.71% (p < 0.001), and %TWL was 13.1 ± 2.4%. Complete medication elimination occurred in 45 of 54 patients (83.3%) achieving HbA1c < 6.5%. No mortality or major complications were reported.

Conclusions: Modified OAGB demonstrates sustained glycemic control and safety in lower-BMI patients with severe T2DM through 7 years with potential benefits of early surgical intervention.

Background: Weight bias internalization (WBI) negatively effects health outcomes in people with obesity. Little is known about how these experiences relate to quality of life and vary in racially/ethnically diverse adolescents with severe obesity. Associations between WBI and health-related quality of life (HRQOL) by race/ethnicity among a sample of adolescents seeking metabolic and bariatric surgery (MBS) were examined in this analysis.

Methods: In this single-site cross-sectional study of adolescents seeking MBS (NCT05393570, March 2022 to October 2024), WBI was measured using the 11-item weight bias internalization scale and HRQOL by the standardized HRQOL scale. Race/ethnic group differences were evaluated by univariate/multivariable linear regression analysis. Multivariable regression models were adjusted for age, sex, body mass index, and race/ethnicity.

Results: The final sample consisted of 76 adolescents (mean age 15.7 [SD 1.4] years, mean BMI 44.7 kg/m², 69.7% females, 9.2% non-Hispanic white (NHW), 32.9% non-Hispanic Black (NHB), 56.6% Hispanic/Latino, 1.3% other). Mean WBIS score (4.0; SD = 1.3) did not differ among NHW (4.5 ± 1.7), NHB (3.6 ± 1.3), and Hispanic (4.3 ± 1.1) adolescents (P > 0.05). Adolescents with high WBI experienced significantly more days with poor mental health (β = 0.03 (SE = 0.01), p = 0.03), affected by pain (β = 0.07 (SE = 0.02), p < 0.01), feeling sad/blue/depressed (β = 0.05 (SE = 0.02), p < 0.01), and feeling worried/tensed or anxious (β = 0.05 (SE = 0.02), p < 0.01). A negative association was shown for days feeling very healthy and full of energy (β = - 0.04 (SES = 0.01), p = 0.01).

Conclusion: WBI was inversely associated with feeling healthy among racially/ethnically diverse adolescents seeking MBS. Adolescent MBS programs may consider screening and targeting WBI to optimize health outcomes.