Pub Date : 2024-08-17DOI: 10.1016/j.soard.2024.08.022
Annie Wang M.D., Victoria Lyo M.D. M.T.M., John C. Lew M.S. R.D., Tiffany L. Wong B.S., Sandra L. Taylor Ph.D., Zainab Akinjobi M.Sc., Hazem N. Shamseddeen M.D., Shushmita M. Ahmed M.D. D.A.B.O.M., Mohamed R. Ali M.D. F.A.C.S. F.A.S.M.B.S.
Severity stratification and longitudinal evaluation of metabolic conditions in response to Roux-en-Y gastric bypass (RYGB) are not standardized. Our Assessment of Obesity-related Metabolic Comorbidities (AOMC) scoring tool combines pharmacotherapy and biochemical data to objectively define type 2 diabetes (T2D), hypertension (HTN), and dyslipidemia (DYS) severity. We previously showed that AOMC more accurately describes disease severity than clinical history alone. We aimed to show that AOMC more precisely and reproducibly measures metabolic disease response to RYGB and preoperative disease severity influences remission rates. University hospital, United States. AOMC scores for T2D, DYS, and HTN were calculated preoperatively and postoperatively (1-, 2-, and 5-years) for patients who underwent RYGB over 14 years. Generalized linear mixed-effect models were used to evaluate AOMC score trends and remission over time. Of 351 patients, 214, 188, and 303, presented with any T2D, DYS, or HTN respectively. One-year remission rates were: T2D 57.1%, DYS 59.7%, and HTN 29.3%. Over 5 years post-RYGB, remission rates declined for T2D ( < .05) and DYS ( < .05) but remained steady for HTN ( > .05). Remission was associated with preoperative disease severity: those with premetabolic disease had the highest remission rates (i.e., 1-year: pre-T2D 81.4%, pre-DYS 91.4%, pre-HTN 53.5%, all < .05), while those with most severe scores preoperatively (untreated/uncontrolled) had the lowest remission rates. AOMC allows precise assessment of comorbidity severity and disease-specific postoperative quantification of comorbidity responses and remission rates. These findings can guide preoperative metabolic disease optimization and postoperative metabolic recovery expectations and standardize communication regarding comorbidity severity.
{"title":"Metabolic disease remission after Roux-en-Y gastric bypass depends on preoperative disease severity: use of a new objective metabolic scoring system","authors":"Annie Wang M.D., Victoria Lyo M.D. M.T.M., John C. Lew M.S. R.D., Tiffany L. Wong B.S., Sandra L. Taylor Ph.D., Zainab Akinjobi M.Sc., Hazem N. Shamseddeen M.D., Shushmita M. Ahmed M.D. D.A.B.O.M., Mohamed R. Ali M.D. F.A.C.S. F.A.S.M.B.S.","doi":"10.1016/j.soard.2024.08.022","DOIUrl":"https://doi.org/10.1016/j.soard.2024.08.022","url":null,"abstract":"Severity stratification and longitudinal evaluation of metabolic conditions in response to Roux-en-Y gastric bypass (RYGB) are not standardized. Our Assessment of Obesity-related Metabolic Comorbidities (AOMC) scoring tool combines pharmacotherapy and biochemical data to objectively define type 2 diabetes (T2D), hypertension (HTN), and dyslipidemia (DYS) severity. We previously showed that AOMC more accurately describes disease severity than clinical history alone. We aimed to show that AOMC more precisely and reproducibly measures metabolic disease response to RYGB and preoperative disease severity influences remission rates. University hospital, United States. AOMC scores for T2D, DYS, and HTN were calculated preoperatively and postoperatively (1-, 2-, and 5-years) for patients who underwent RYGB over 14 years. Generalized linear mixed-effect models were used to evaluate AOMC score trends and remission over time. Of 351 patients, 214, 188, and 303, presented with any T2D, DYS, or HTN respectively. One-year remission rates were: T2D 57.1%, DYS 59.7%, and HTN 29.3%. Over 5 years post-RYGB, remission rates declined for T2D ( < .05) and DYS ( < .05) but remained steady for HTN ( > .05). Remission was associated with preoperative disease severity: those with premetabolic disease had the highest remission rates (i.e., 1-year: pre-T2D 81.4%, pre-DYS 91.4%, pre-HTN 53.5%, all < .05), while those with most severe scores preoperatively (untreated/uncontrolled) had the lowest remission rates. AOMC allows precise assessment of comorbidity severity and disease-specific postoperative quantification of comorbidity responses and remission rates. These findings can guide preoperative metabolic disease optimization and postoperative metabolic recovery expectations and standardize communication regarding comorbidity severity.","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"43 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-16DOI: 10.1016/j.soard.2024.08.020
Alexis Deffain M.D., Ronald Denis M.D., Heba Alfaris M.D., Karim Ataya M.D., Samah Melebari M.D., Marc Belliveau M.D., Adam Di Palma M.D., Pierre Garneau M.D., Anne-Sophie Studer M.D.
On the basis of our extensive experience in same-day discharge (SDD) sleeve gastrectomy, we extended this management strategy to anastomotic metabolic and bariatric surgeries (MBS). To retrospectively analyze early outcomes (≤30 d) after anastomotic MBS with planned SDD (≤12 hr). University Hospital, Canada; Public Practice. SDD anastomotic MBS were proposed with strict preoperative criteria and included single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and single-anastomosis sleeve ileal bypass (SASI). Enhanced recovery after bariatric surgery protocols and post-anesthesia care unit criteria were followed. Unplanned overnight stay, emergency department (ED) visit, readmission, morbidity-mortality, and reintervention rates were analyzed. Since 2021, 208 patients (191 female and 17 male) have undergone SDD anastomotic MBS, with 76% conversion procedures: 92 SADI-S, 72 RYGB, 35 OAGB, and 9 SASI (mean age = 41.4 yr and mean preoperative body mass index = 41.9 kg/m). Unplanned overnight stays and ED visits were 4.8% and 4.3%, respectively. Readmission rate was 5.8% (5 SADI-S, 5 RYGB, 1 OAGB, and 1 SASI). Overall morbidity rate was 14.9%, including 3.9% major complications. Within 30 days postoperatively, there were 2 duodenal leaks, 1 intrabdominal collection, 1 common bile duct stenosis, and 1 acute appendicitis in the SADI-S group. There were 2 occlusions on the jejunojejunal anastomosis and 1 bleeding on the gastrojejunal anastomosis in the RYGB group. Five (2.4%) required reintervention with no mortality. We report low and acceptable rates of unplanned overnight stay, readmission, and reintervention. Early outcomes suggest that SDD anastomotic MBS seems safe and feasible with an experienced team, selective criteria, and appropriate postoperative follow-up.
{"title":"Anastomotic metabolic and bariatric surgeries with same-day discharge: 30-day outcomes of a cohort from a high-volume center in Canada","authors":"Alexis Deffain M.D., Ronald Denis M.D., Heba Alfaris M.D., Karim Ataya M.D., Samah Melebari M.D., Marc Belliveau M.D., Adam Di Palma M.D., Pierre Garneau M.D., Anne-Sophie Studer M.D.","doi":"10.1016/j.soard.2024.08.020","DOIUrl":"https://doi.org/10.1016/j.soard.2024.08.020","url":null,"abstract":"On the basis of our extensive experience in same-day discharge (SDD) sleeve gastrectomy, we extended this management strategy to anastomotic metabolic and bariatric surgeries (MBS). To retrospectively analyze early outcomes (≤30 d) after anastomotic MBS with planned SDD (≤12 hr). University Hospital, Canada; Public Practice. SDD anastomotic MBS were proposed with strict preoperative criteria and included single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and single-anastomosis sleeve ileal bypass (SASI). Enhanced recovery after bariatric surgery protocols and post-anesthesia care unit criteria were followed. Unplanned overnight stay, emergency department (ED) visit, readmission, morbidity-mortality, and reintervention rates were analyzed. Since 2021, 208 patients (191 female and 17 male) have undergone SDD anastomotic MBS, with 76% conversion procedures: 92 SADI-S, 72 RYGB, 35 OAGB, and 9 SASI (mean age = 41.4 yr and mean preoperative body mass index = 41.9 kg/m). Unplanned overnight stays and ED visits were 4.8% and 4.3%, respectively. Readmission rate was 5.8% (5 SADI-S, 5 RYGB, 1 OAGB, and 1 SASI). Overall morbidity rate was 14.9%, including 3.9% major complications. Within 30 days postoperatively, there were 2 duodenal leaks, 1 intrabdominal collection, 1 common bile duct stenosis, and 1 acute appendicitis in the SADI-S group. There were 2 occlusions on the jejunojejunal anastomosis and 1 bleeding on the gastrojejunal anastomosis in the RYGB group. Five (2.4%) required reintervention with no mortality. We report low and acceptable rates of unplanned overnight stay, readmission, and reintervention. Early outcomes suggest that SDD anastomotic MBS seems safe and feasible with an experienced team, selective criteria, and appropriate postoperative follow-up.","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"60 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-16DOI: 10.1016/j.soard.2024.08.018
Peter N. Benotti M.D., Jila Kaberi-Otarod M.D., G. Craig Wood M.D., Glenn S. Gerhard M.D., Christopher D. Still D.O., Bruce R. Bistrian M.D. Ph.D.
Iron deficiency has been recognized as a potentially modifiable nutritional complication of metabolic and bariatric surgery (MBS) since prior to the turn of the century. Despite this, it remains the most common and clinically significant nutritional complication of this surgery with the potential to negate quality of live and the health benefits of surgical weight loss. This narrative review summarizes the current literature regarding iron deficiency as it relates to patients with severe obesity and those who undergo MBS. Advances in the clinical knowledge of iron homeostasis in severe obesity as a chronic disease, current diagnostic criteria for the diagnosis of iron deficiency in this patient population, the significance of preoperative iron deficiency, postoperative iron deficiency, and the status of supplementation and treatment will be reviewed with emphasis on gaps in knowledge and needed areas of further study.
{"title":"Iron homeostasis in obesity and metabolic and bariatric surgery: a narrative review","authors":"Peter N. Benotti M.D., Jila Kaberi-Otarod M.D., G. Craig Wood M.D., Glenn S. Gerhard M.D., Christopher D. Still D.O., Bruce R. Bistrian M.D. Ph.D.","doi":"10.1016/j.soard.2024.08.018","DOIUrl":"https://doi.org/10.1016/j.soard.2024.08.018","url":null,"abstract":"Iron deficiency has been recognized as a potentially modifiable nutritional complication of metabolic and bariatric surgery (MBS) since prior to the turn of the century. Despite this, it remains the most common and clinically significant nutritional complication of this surgery with the potential to negate quality of live and the health benefits of surgical weight loss. This narrative review summarizes the current literature regarding iron deficiency as it relates to patients with severe obesity and those who undergo MBS. Advances in the clinical knowledge of iron homeostasis in severe obesity as a chronic disease, current diagnostic criteria for the diagnosis of iron deficiency in this patient population, the significance of preoperative iron deficiency, postoperative iron deficiency, and the status of supplementation and treatment will be reviewed with emphasis on gaps in knowledge and needed areas of further study.","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"12 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-16DOI: 10.1016/j.soard.2024.08.019
Jérémie Thereaux M.D. Ph.D., Mohammed Bennani, Jean Khemis, Elisabeth Ohayon, Isabelle Visnovec Buissez, Alexandre Lafourcade, Laëtitia Quiriconi, Caroline Philippe, Jean-Michel Oppert
The need for conversional metabolic bariatric surgery (CMBS) is still growing. No large-scale prospective cohort studies have assessed changes in lipid-lowering treatment (LLT) after CMBS. This study assesses and compares the effectiveness of the 4 main CMBS sequences after sleeve gastrectomy (SG) and adjustable gastric banding (AGB) on reimbursement and cost of LLT. France. This nationwide observational population-based cohort study analyzed data from the French National Health Insurance database. It included all patients who had undergone primary SG and AGB in France between January 1, 2012, and December 31, 2014, and followed until December 31, 2020. The study assessed LLT reimbursement evolution and costs across 4 different CMBS sequences. During follow-up, 6396 patients underwent the 4 CMBS sequences: SG-RYGB (Roux-en-Y gastric bypass) (n = 2400), AGB-SG (n = 2277), AGB-RYGB (n = 1173), and SG-SG (n = 546), with a rate of LLT reimbursement of 9.8%, 3.6%, 6.6%, and 7.9%, respectively, in the year before CMBS. The rates of discontinuation of treatment at 2 and 4 years were 41.9%, 35.4%, 45.6%, 20.5% and 45.6%, 31.3%, 64.3%, 31.6%, respectively. At 4 years, the median [interquartile range] annual costs (euros) per patient were significantly lower ( < .01) than the costs in the year before CMBS for each sequence: 86.8 [57.3; 136.1] versus 38.0 [.0; 64.6], 79.1 [50.5; 120.1] versus 50.4 [15.6; 64.1], 89.0 [66.5; 139.6] versus .0 [.0; 58.8], and 89.8 [66.1; 121.4] versus 63.1 [.0; 93.4]. Our study underlines the effectiveness of CMBS in significantly reducing the need and associated costs of LLT for patients with dyslipidemia over a 4-year period.
{"title":"Effectiveness of conversional metabolic bariatric surgery on dyslipidemia and the cost of lipid-lowering medications over 4 years: a French nationwide study","authors":"Jérémie Thereaux M.D. Ph.D., Mohammed Bennani, Jean Khemis, Elisabeth Ohayon, Isabelle Visnovec Buissez, Alexandre Lafourcade, Laëtitia Quiriconi, Caroline Philippe, Jean-Michel Oppert","doi":"10.1016/j.soard.2024.08.019","DOIUrl":"https://doi.org/10.1016/j.soard.2024.08.019","url":null,"abstract":"The need for conversional metabolic bariatric surgery (CMBS) is still growing. No large-scale prospective cohort studies have assessed changes in lipid-lowering treatment (LLT) after CMBS. This study assesses and compares the effectiveness of the 4 main CMBS sequences after sleeve gastrectomy (SG) and adjustable gastric banding (AGB) on reimbursement and cost of LLT. France. This nationwide observational population-based cohort study analyzed data from the French National Health Insurance database. It included all patients who had undergone primary SG and AGB in France between January 1, 2012, and December 31, 2014, and followed until December 31, 2020. The study assessed LLT reimbursement evolution and costs across 4 different CMBS sequences. During follow-up, 6396 patients underwent the 4 CMBS sequences: SG-RYGB (Roux-en-Y gastric bypass) (n = 2400), AGB-SG (n = 2277), AGB-RYGB (n = 1173), and SG-SG (n = 546), with a rate of LLT reimbursement of 9.8%, 3.6%, 6.6%, and 7.9%, respectively, in the year before CMBS. The rates of discontinuation of treatment at 2 and 4 years were 41.9%, 35.4%, 45.6%, 20.5% and 45.6%, 31.3%, 64.3%, 31.6%, respectively. At 4 years, the median [interquartile range] annual costs (euros) per patient were significantly lower ( < .01) than the costs in the year before CMBS for each sequence: 86.8 [57.3; 136.1] versus 38.0 [.0; 64.6], 79.1 [50.5; 120.1] versus 50.4 [15.6; 64.1], 89.0 [66.5; 139.6] versus .0 [.0; 58.8], and 89.8 [66.1; 121.4] versus 63.1 [.0; 93.4]. Our study underlines the effectiveness of CMBS in significantly reducing the need and associated costs of LLT for patients with dyslipidemia over a 4-year period.","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"10 11 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.soard.2024.08.010
Emily M. Bartholomay Ph.D., Stephanie Cox Ph.D., Lawrence Tabone M.D., Nova Szoka M.D., Salim Abunnaja M.D., Laura Aylward Ph.D.
Follow-up care after bariatric surgery is essential in preventing postsurgical complications and promoting long-term weight loss maintenance. However, many patients do not attend postsurgical appointments with the bariatric team, which may contribute to poor surgical outcomes. This study sought to understand sociodemographic factors related to follow-up appointment attendance and weight outcomes. The first objective was to determine whether there was a relationship between 1-year follow-up appointment attendance and sociodemographic factors. The second objective was to determine whether patients from certain sociodemographic groups were more likely to attend a 2-year follow-up appointment. The third objective was to determine whether there were differences in weight outcomes for patients who attended follow-up appointments compared with those who did not attend. University hospital, United States. This study was a retrospective observational study. Participants included 841 adult patients who underwent bariatric surgery, of whom 505 (60.05%) attended a 1-year appointment with the bariatric team (348 attended a follow-up visit with another medical provider), and 398 (47.32%) who had any follow-up medical visit at 2 years after surgery. Sociodemographic variables were collected during a presurgical psychological evaluation. Weight-related variables were obtained through patients’ electronic medical records 12 and 24 months after surgery. Younger patients and those with lower education levels were less likely to attend the 1-year follow-up appointment with the bariatric team. People who attend 1-year follow-up with bariatric team have more favorable weight outcomes at 1 year and 2 years after surgery. Follow-up appointment attendance with the bariatric team may be a critical factor in the effectiveness of bariatric surgery. Bariatric surgery teams should employ strategies to increase attendance at the 1-year follow-up visit with the surgical team. Additional strategies should be enacted to increase follow-up appointment attendance for patients with lower education levels.
{"title":"Sociodemographic factors related to bariatric follow-up appointment attendance and weight outcomes","authors":"Emily M. Bartholomay Ph.D., Stephanie Cox Ph.D., Lawrence Tabone M.D., Nova Szoka M.D., Salim Abunnaja M.D., Laura Aylward Ph.D.","doi":"10.1016/j.soard.2024.08.010","DOIUrl":"https://doi.org/10.1016/j.soard.2024.08.010","url":null,"abstract":"Follow-up care after bariatric surgery is essential in preventing postsurgical complications and promoting long-term weight loss maintenance. However, many patients do not attend postsurgical appointments with the bariatric team, which may contribute to poor surgical outcomes. This study sought to understand sociodemographic factors related to follow-up appointment attendance and weight outcomes. The first objective was to determine whether there was a relationship between 1-year follow-up appointment attendance and sociodemographic factors. The second objective was to determine whether patients from certain sociodemographic groups were more likely to attend a 2-year follow-up appointment. The third objective was to determine whether there were differences in weight outcomes for patients who attended follow-up appointments compared with those who did not attend. University hospital, United States. This study was a retrospective observational study. Participants included 841 adult patients who underwent bariatric surgery, of whom 505 (60.05%) attended a 1-year appointment with the bariatric team (348 attended a follow-up visit with another medical provider), and 398 (47.32%) who had any follow-up medical visit at 2 years after surgery. Sociodemographic variables were collected during a presurgical psychological evaluation. Weight-related variables were obtained through patients’ electronic medical records 12 and 24 months after surgery. Younger patients and those with lower education levels were less likely to attend the 1-year follow-up appointment with the bariatric team. People who attend 1-year follow-up with bariatric team have more favorable weight outcomes at 1 year and 2 years after surgery. Follow-up appointment attendance with the bariatric team may be a critical factor in the effectiveness of bariatric surgery. Bariatric surgery teams should employ strategies to increase attendance at the 1-year follow-up visit with the surgical team. Additional strategies should be enacted to increase follow-up appointment attendance for patients with lower education levels.","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"6 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.soard.2024.08.008
Dong-Won Kang Ph.D. , Shouhao Zhou Ph.D. , Russell Torres Ph.D. , Abhinandan Chowdhury Ph.D. , Suman Niranjan Ph.D. , Ann Rogers M.D. , Chan Shen Ph.D.
Background
Predicting the risk of complications is critical in metabolic and bariatric surgery (MBS).
Objectives
To develop machine learning (ML) models to predict serious postoperative complications of MBS and evaluate racial fairness of the models.
Setting
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database, United States.
Methods
We developed logistic regression, random forest (RF), gradient-boosted tree (GBT), and XGBoost model using the MBSAQIP Participant Use Data File from 2016 to 2020. To address the class imbalance, we randomly undersampled the complication-negative class to match the complication-positive class. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), precision, recall, and F1 score. Fairness across White and non-White patient groups was assessed using equal opportunity difference and disparate impact metrics.
Results
A total of 40,858 patients were included after undersampling the complication-negative class. The XGBoost model was the best-performing model in terms of AUROC; however, the difference was not statistically significant. While the F1 score and precision did not vary significantly across models, the RF exhibited better recall compared to the logistic regression. Surgery type was the most important feature to predict complications, followed by operative time. The logistic regression model had the best fairness metrics for race.
Conclusions
The XGBoost model achieved the highest AUROC, albeit without a statistically significant difference. The RF may be useful when recall is the primary concern. Undersampling of the privileged group may improve the fairness of boosted tree models.
背景：在代谢和减肥手术（MBS）中，预测并发症的风险至关重要：预测并发症风险对于代谢和减肥手术（MBS）至关重要：开发机器学习（ML）模型来预测代谢与减肥手术术后严重并发症，并评估模型的种族公平性：方法：我们开发了逻辑回归、随机聚类分析和 "MBS "模型，以预测MBS术后严重并发症：我们使用2016年至2020年的MBSAQIP参与者使用数据文件开发了逻辑回归、随机森林（RF）、梯度增强树（GBT）和XGBoost模型。为了解决类别不平衡的问题，我们随机对并发症阴性类别进行低采样，以匹配并发症阳性类别。模型性能使用接收者操作特征曲线下面积（AUROC）、精确度、召回率和 F1 分数进行评估。使用机会均等差异和差异影响指标对白人和非白人患者群体的公平性进行了评估：结果：在对并发症阴性患者进行低采样后，共纳入了 40858 名患者。就 AUROC 而言，XGBoost 模型是表现最好的模型，但差异在统计学上并不显著。虽然不同模型的 F1 得分和精确度差异不大，但 RF 与逻辑回归相比具有更好的召回率。手术类型是预测并发症的最重要特征，其次是手术时间。逻辑回归模型的种族公平性指标最好：XGBoost模型获得了最高的AUROC，尽管在统计学上没有显著差异。当召回率是主要考虑因素时，RF 可能会有用。对特权组进行低采样可能会提高提升树模型的公平性。
{"title":"Predicting serious postoperative complications and evaluating racial fairness in machine learning algorithms for metabolic and bariatric surgery","authors":"Dong-Won Kang Ph.D. , Shouhao Zhou Ph.D. , Russell Torres Ph.D. , Abhinandan Chowdhury Ph.D. , Suman Niranjan Ph.D. , Ann Rogers M.D. , Chan Shen Ph.D.","doi":"10.1016/j.soard.2024.08.008","DOIUrl":"10.1016/j.soard.2024.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Predicting the risk of complications is critical in metabolic and bariatric surgery (MBS).</div></div><div><h3>Objectives</h3><div>To develop machine learning (ML) models to predict serious postoperative complications of MBS and evaluate racial fairness of the models.</div></div><div><h3>Setting</h3><div>Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database, United States.</div></div><div><h3>Methods</h3><div>We developed logistic regression, random forest (RF), gradient-boosted tree (GBT), and XGBoost model using the MBSAQIP Participant Use Data File from 2016 to 2020. To address the class imbalance, we randomly undersampled the complication-negative class to match the complication-positive class. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), precision, recall, and F1 score. Fairness across White and non-White patient groups was assessed using equal opportunity difference and disparate impact metrics.</div></div><div><h3>Results</h3><div>A total of 40,858 patients were included after undersampling the complication-negative class. The XGBoost model was the best-performing model in terms of AUROC; however, the difference was not statistically significant. While the F1 score and precision did not vary significantly across models, the RF exhibited better recall compared to the logistic regression. Surgery type was the most important feature to predict complications, followed by operative time. The logistic regression model had the best fairness metrics for race.</div></div><div><h3>Conclusions</h3><div>The XGBoost model achieved the highest AUROC, albeit without a statistically significant difference. The RF may be useful when recall is the primary concern. Undersampling of the privileged group may improve the fairness of boosted tree models.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 11","pages":"Pages 1056-1064"},"PeriodicalIF":3.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1016/j.soard.2024.08.017
Haya Subhi R.N., M.P.H. , Orly Manor Ph.D. , Ram Elazary M.D. , Dunia Kaluti R.D. , Tair Ben-Porat R.D., M.P.H., Ph.D.
Background
Promoting habitual physical activity (PA) among bariatric patients is crucial for long-term surgery success, yet it poses a significant challenge for healthcare practitioners.
Objectives
This randomized controlled trial (RCT) aimed to examine the effectiveness of a theory-based behavioral intervention on PA level in post-metabolic bariatric surgery (MBS) patients.
Setting
University Hospital, Israel
Methods
Forty-four patients undergoing MBS were randomized to the intervention (n = 22) or control group (n = 22). The intervention group received a 6-month PA counseling program based on self-determination theory (SDT) and the 5 A’s framework, while the control group received usual care. PA level and self-efficacy for exercise (SEE) were assessed pre- (baseline, preintervention) and postoperatively (14 and 28 weeks follow-ups). Anthropometrics, physical function, cardiovascular, and biochemical outcomes were measured at all time points.
Results
The intervention group showed greater increases in PA levels across time compared to the control group. A significant increase in step counts from baseline to 14 weeks was observed (P = .003). Significant differences favoring the intervention group were observed in self-reported PA changes from baseline to 14- and 28-week follow-ups (P = .020 and P = .024, respectively). Additionally, Physical function, as assessed by the 6-minute walk test (6MWT) and the 5 sit-to-stand (5STS) test, significantly improved in the intervention group throughout the follow-up period (P < .05 for all), However, no between-group differences were observed in SEE, anthropometrics, cardiovascular, or biochemical parameters.
Conclusions
A 6-month behavioral intervention post-MBS significantly enhanced patients' PA levels and physical function. Given its theory-based approach and structured protocol, this intervention could be disseminated to support MBS clinicians and centers. Further research with longer follow-up period is warranted to confirm these findings and assess the long-term effects.
{"title":"Effects of a 6-month physical activity behavioral intervention in patients following metabolic bariatric surgery: a randomized controlled trial","authors":"Haya Subhi R.N., M.P.H. , Orly Manor Ph.D. , Ram Elazary M.D. , Dunia Kaluti R.D. , Tair Ben-Porat R.D., M.P.H., Ph.D.","doi":"10.1016/j.soard.2024.08.017","DOIUrl":"10.1016/j.soard.2024.08.017","url":null,"abstract":"<div><h3>Background</h3><div>Promoting habitual physical activity (PA) among bariatric patients is crucial for long-term surgery success, yet it poses a significant challenge for healthcare practitioners.</div></div><div><h3>Objectives</h3><div>This randomized controlled trial (RCT) aimed to examine the effectiveness of a theory-based behavioral intervention on PA level in post-metabolic bariatric surgery (MBS) patients.</div></div><div><h3>Setting</h3><div>University Hospital, Israel</div></div><div><h3>Methods</h3><div>Forty-four patients undergoing MBS were randomized to the intervention (n = 22) or control group (n = 22). The intervention group received a 6-month PA counseling program based on self-determination theory (SDT) and the 5 A’s framework, while the control group received usual care. PA level and self-efficacy for exercise (SEE) were assessed pre- (baseline, preintervention) and postoperatively (14 and 28 weeks follow-ups). Anthropometrics, physical function, cardiovascular, and biochemical outcomes were measured at all time points.</div></div><div><h3>Results</h3><div>The intervention group showed greater increases in PA levels across time compared to the control group. A significant increase in step counts from baseline to 14 weeks was observed (<em>P</em> = .003). Significant differences favoring the intervention group were observed in self-reported PA changes from baseline to 14- and 28-week follow-ups (<em>P</em> = .020 and <em>P</em> = .024, respectively). Additionally, Physical function, as assessed by the 6-minute walk test (6MWT) and the 5 sit-to-stand (5STS) test, significantly improved in the intervention group throughout the follow-up period (<em>P</em> < .05 for all), However, no between-group differences were observed in SEE, anthropometrics, cardiovascular, or biochemical parameters.</div></div><div><h3>Conclusions</h3><div>A 6-month behavioral intervention post-MBS significantly enhanced patients' PA levels and physical function. Given its theory-based approach and structured protocol, this intervention could be disseminated to support MBS clinicians and centers. Further research with longer follow-up period is warranted to confirm these findings and assess the long-term effects.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 11","pages":"Pages 1072-1083"},"PeriodicalIF":3.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-10DOI: 10.1016/j.soard.2024.08.002
Adisa Poljo M.D., Jennifer M. Klasen M.D. Ph.D., Marko Kraljević M.D., Ralph Peterli M.D., Adrian T. Billeter M.D. Ph.D.
{"title":"Comment on: Elevated HbA1C level and revisional bariatric surgery complications","authors":"Adisa Poljo M.D., Jennifer M. Klasen M.D. Ph.D., Marko Kraljević M.D., Ralph Peterli M.D., Adrian T. Billeter M.D. Ph.D.","doi":"10.1016/j.soard.2024.08.002","DOIUrl":"10.1016/j.soard.2024.08.002","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 11","pages":"Pages e18-e19"},"PeriodicalIF":3.5,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-10DOI: 10.1016/j.soard.2024.08.009
Shaneeta Johnson M.D. M.B.A., Ryan Hill D.O., Tuesday Cook M.D., Larry Hobson M.D.
{"title":"Comment on: Beyond race: social vulnerability and access to metabolic and bariatric surgery","authors":"Shaneeta Johnson M.D. M.B.A., Ryan Hill D.O., Tuesday Cook M.D., Larry Hobson M.D.","doi":"10.1016/j.soard.2024.08.009","DOIUrl":"https://doi.org/10.1016/j.soard.2024.08.009","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"70 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-10DOI: 10.1016/j.soard.2024.08.012
Daniel R. Cronk M.D., F.A.C.S., F.A.S.M.B.S., D.A.B.S.-F.P.D.M.B.S.
{"title":"Comment on: Ambulatory discharge of patients undergoing sleeve gastrectomy results in significantly more adverse outcomes","authors":"Daniel R. Cronk M.D., F.A.C.S., F.A.S.M.B.S., D.A.B.S.-F.P.D.M.B.S.","doi":"10.1016/j.soard.2024.08.012","DOIUrl":"10.1016/j.soard.2024.08.012","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 11","pages":"Pages 1037-1038"},"PeriodicalIF":3.5,"publicationDate":"2024-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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