Pub Date : 2026-02-01Epub Date: 2025-10-30DOI: 10.1016/j.soard.2025.10.009
Kyle B. LaPenna , Florina Corpodean , Celestino Castanon , Michael Kachmar , Philip R. Schauer , Vance L. Albaugh
Background
The rising prevalence of heart failure (HF) and coexisting metabolic syndrome underscores the need to better understand how these conditions affect postoperative outcomes following metabolic and bariatric surgery.
Objectives
To test the hypothesis that HF is associated with a greater risk of postoperative morbidity following metabolic and bariatric surgery.
Setting
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.
Methods
Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the year 2023, postbariatric surgery complications of patients with a history of HF (n = 3422) were compared with patients without HF (n = 3422) using 1:1 propensity matching. Composite 30-day outcomes included length of stay (LOS) > 5 days (LOS > 5), infectious complications, serious complications, major adverse cardiovascular and cerebrovascular events, and death.
Results
Compared to matched controls, HF patients had higher incidence of prolonged LOS > 5 days (4.49% vs. 1.66%, P < .001) and increased rates of infectious (3.07% vs. 1.72%, P < .001) and serious complications (5.26% vs. 2.70%, P < .001). No differences were observed in major adverse cardiovascular events (.53% vs. .35%, P = .36) or 30-day mortality (.68% vs. .38%, P = .12).
Conclusions
A history of HF in patients undergoing bariatric surgery is associated with significant increases in major postoperative morbidity. Efforts directed toward preoperative optimization of patients with HF and attentive postoperative monitoring as warranted. Further research is necessary to determine optimal perioperative management of patients with HF undergoing metabolic surgery.
背景：心力衰竭（HF）和共存代谢综合征的患病率不断上升，强调有必要更好地了解这些疾病如何影响代谢和减肥手术后的术后结果。目的：验证心衰与代谢和减肥手术后更高的术后发病率相关的假设。环境：代谢和减肥手术认证和质量改进程序数据库。方法：使用2023年代谢和减肥手术认证和质量改进计划数据库，采用1:1倾向匹配将有HF病史的患者（n = 3422）与无HF患者（n = 3422）的减肥手术后并发症进行比较。30天综合结局包括住院时间(LOS) > ~ 5天（LOS > ~ 5天）、感染并发症、严重并发症、主要心脑血管不良事件和死亡。结果：与对照组相比，HF患者的LOS延长发生率（4.49% vs. 1.66%, P < 0.001）、感染性发生率（3.07% vs. 1.72%, P < 0.001）和严重并发症发生率（5.26% vs. 2.70%, P < 0.001）均增加。在主要不良心血管事件(。53% vs.。35%, P = 0.36)或30天死亡率（P = 0.36）。68% vs.。38%, p = .12)。结论：接受减肥手术的患者有HF病史与术后主要发病率显著增加相关。针对心衰患者的术前优化和术后密切监测的努力是必要的。需要进一步的研究来确定心衰患者接受代谢手术的最佳围手术期管理。
{"title":"Impact of heart failure on postoperative outcomes in bariatric surgery","authors":"Kyle B. LaPenna , Florina Corpodean , Celestino Castanon , Michael Kachmar , Philip R. Schauer , Vance L. Albaugh","doi":"10.1016/j.soard.2025.10.009","DOIUrl":"10.1016/j.soard.2025.10.009","url":null,"abstract":"<div><h3>Background</h3><div>The rising prevalence of heart failure (HF) and coexisting metabolic syndrome underscores the need to better understand how these conditions affect postoperative outcomes following metabolic and bariatric surgery.</div></div><div><h3>Objectives</h3><div>To test the hypothesis that HF is associated with a greater risk of postoperative morbidity following metabolic and bariatric surgery.</div></div><div><h3>Setting</h3><div>Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.</div></div><div><h3>Methods</h3><div>Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database for the year 2023, postbariatric surgery complications of patients with a history of HF (n = 3422) were compared with patients without HF (n = 3422) using 1:1 propensity matching. Composite 30-day outcomes included length of stay (LOS) > 5 days (LOS > 5), infectious complications, serious complications, major adverse cardiovascular and cerebrovascular events, and death.</div></div><div><h3>Results</h3><div>Compared to matched controls, HF patients had higher incidence of prolonged LOS > 5 days (4.49% vs. 1.66%, <em>P</em> < .001) and increased rates of infectious (3.07% vs. 1.72%, <em>P</em> < .001) and serious complications (5.26% vs. 2.70%, <em>P</em> < .001). No differences were observed in major adverse cardiovascular events (.53% vs. .35%, <em>P</em> = .36) or 30-day mortality (.68% vs. .38%, <em>P</em> = .12).</div></div><div><h3>Conclusions</h3><div>A history of HF in patients undergoing bariatric surgery is associated with significant increases in major postoperative morbidity. Efforts directed toward preoperative optimization of patients with HF and attentive postoperative monitoring as warranted. Further research is necessary to determine optimal perioperative management of patients with HF undergoing metabolic surgery.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"22 2","pages":"Pages 228-233"},"PeriodicalIF":3.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644151","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 : 2026-02-01Epub Date: 2025-10-10DOI: 10.1016/j.soard.2025.10.004
Xinlei Zhu M.D. , Qi Wang M.D. , Valentin Mocanu M.D., Ph.D. , Pattharasai Kachornvitaya M.D. , Mélissa V. Wills M.D. , Andrew Strong M.D. , Salvador Navarrete M.D. , Juan S. Barajas-Gamboa M.D. , Ricard Corcelles M.D. , Matthew Kroh M.D. , Jerry Dang M.D., Ph.D.
Background
Obesity and rheumatoid arthritis (RA) are chronic, often coexisting conditions that compound clinical complexity. Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity, but its long-term safety and impact on RA disease control are not well defined.
Objectives
To evaluate the long-term safety (≤5 years) and potential disease-modifying effects of MBS in patients with RA.
Setting
Multicenter, retrospective cohort study using the TriNetX global federated health research network across multiple healthcare institutions worldwide.
Methods
Adults (≥18 years) who underwent MBS between 2010 and 2024 were identified. Three cohorts were created: RA with MBS, RA without MBS, and MBS without RA. Propensity score matching was performed using demographic and comorbidities. Primary outcomes included long-term safety, nutritional complications, and RA disease-modifying indicators such as medication use and inflammatory markers.
Results
One thousand nine-hundred thirty-one patients with RA who underwent MBS were matched 1:1 with controls. Patients with RA experienced higher nutritional complications including vitamin D (52.4% versus 42.7%), B12 (18.0% versus 14.0%), and iron deficiency (11.5% versus 8.5%). Sleeve gastrectomy was associated with fewer complications than Roux-en-Y gastric bypass. Postoperatively, patients with RA showed significant reductions in use of corticosteroids (34.3% versus 53.6%), tumor necrosis factor inhibitors (6.3% versus 14.5%), and disease-modifying antirheumatic drugs (9.7% versus 31.6%), along with lower inflammatory makers levels. Five-year mortality was lower in the RA surgical group (1.8% versus 3.8%).
Conclusions
MBS in patients with RA is associated with improved disease control and reduced mortality, though higher nutritional risks warrant careful postoperative monitoring and multidisciplinary care.
{"title":"Evaluating the long-term safety and disease-modifying potential of metabolic surgery in patients with rheumatoid arthritis: a TriNetX cohort study","authors":"Xinlei Zhu M.D. , Qi Wang M.D. , Valentin Mocanu M.D., Ph.D. , Pattharasai Kachornvitaya M.D. , Mélissa V. Wills M.D. , Andrew Strong M.D. , Salvador Navarrete M.D. , Juan S. Barajas-Gamboa M.D. , Ricard Corcelles M.D. , Matthew Kroh M.D. , Jerry Dang M.D., Ph.D.","doi":"10.1016/j.soard.2025.10.004","DOIUrl":"10.1016/j.soard.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Obesity and rheumatoid arthritis (RA) are chronic, often coexisting conditions that compound clinical complexity. Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity, but its long-term safety and impact on RA disease control are not well defined.</div></div><div><h3>Objectives</h3><div>To evaluate the long-term safety (≤5 years) and potential disease-modifying effects of MBS in patients with RA.</div></div><div><h3>Setting</h3><div>Multicenter, retrospective cohort study using the TriNetX global federated health research network across multiple healthcare institutions worldwide.</div></div><div><h3>Methods</h3><div>Adults (≥18 years) who underwent MBS between 2010 and 2024 were identified. Three cohorts were created: RA with MBS, RA without MBS, and MBS without RA. Propensity score matching was performed using demographic and comorbidities. Primary outcomes included long-term safety, nutritional complications, and RA disease-modifying indicators such as medication use and inflammatory markers.</div></div><div><h3>Results</h3><div>One thousand nine-hundred thirty-one patients with RA who underwent MBS were matched 1:1 with controls. Patients with RA experienced higher nutritional complications including vitamin D (52.4% versus 42.7%), B12 (18.0% versus 14.0%), and iron deficiency (11.5% versus 8.5%). Sleeve gastrectomy was associated with fewer complications than Roux-en-Y gastric bypass. Postoperatively, patients with RA showed significant reductions in use of corticosteroids (34.3% versus 53.6%), tumor necrosis factor inhibitors (6.3% versus 14.5%), and disease-modifying antirheumatic drugs (9.7% versus 31.6%), along with lower inflammatory makers levels. Five-year mortality was lower in the RA surgical group (1.8% versus 3.8%).</div></div><div><h3>Conclusions</h3><div>MBS in patients with RA is associated with improved disease control and reduced mortality, though higher nutritional risks warrant careful postoperative monitoring and multidisciplinary care.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"22 2","pages":"Pages 219-227"},"PeriodicalIF":3.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446996","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 : 2026-02-01Epub Date: 2025-10-30DOI: 10.1016/j.soard.2025.10.006
Yonas E. Teklu , Florina Corpodean , Michael Kachmar , Philip R. Schauer , Michael W. Cook , Vance L. Albaugh
Background
Obesity increases the risk of metabolic-associated steatotic liver disease (MASLD), and metabolic and bariatric surgery (MBS) mitigates progression to severe and end-stage liver disease (LD). Preoperative LD was added as a new variable for the 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, allowing for analysis of this variable on perioperative and postoperative outcomes.
Objective
To examine the impact of preoperative LD diagnosis on 30-day outcomes following MBS and quantify intraoperative liver biopsy frequency.
Setting
MBSAQIP, 2023.
Methods
A total of 217,952 cases (24,240 with LD; 193,712 without LD) were analyzed to compare operative length, length of stay (LOS), infectious complications, serious complications, major adverse cardiovascular events (MACE), and mortality. Chi-square and Wilcoxon rank-sum tests were used, and propensity matching was performed based on age, sex, race, body mass index, and preoperative comorbidities.
Results
Patients with LD had a slight increase in operative length (99.6 vs. 92.0 min; P < .0001) and were more likely to experience prolonged LOS (>5 days: .84% vs. .67%; P < .05). Rates of infectious complications (1.86% vs. 1.40%; P < .0001) and serious complications (1.65% vs. 1.31%; P < .01) were higher among those with LD. There were no differences in 30-day mortality (.08% vs. .11%; p = NS) or MACE (MACE: .10% vs. .07%; p = NS) between groups. Only 3.5% of cases included intraoperative liver biopsy.
Conclusion
Patients with LD experienced higher rates of postoperative infections and serious complications, as well as prolonged LOS, than those without LD. These findings highlight the importance of preoperative LD screening in bariatric surgery patients.
背景：肥胖增加代谢性脂肪变性肝病（MASLD）的风险，而代谢性和减肥手术（MBS）可减轻严重和终末期肝病（LD）的进展。术前LD作为2023年代谢和减肥手术认证和质量改进计划（MBSAQIP）数据库的新变量添加，允许分析该变量对围手术期和术后结果的影响。目的：探讨术前LD诊断对MBS术后30天预后的影响，量化术中肝活检频率。设定：MBSAQIP， 2023。方法：分析217,952例（合并LD 24,240例，未合并LD 193,712例）的手术时间、住院时间（LOS）、感染并发症、严重并发症、主要心血管不良事件（MACE）和死亡率。采用卡方和Wilcoxon秩和检验，并根据年龄、性别、种族、体重指数和术前合并症进行倾向匹配。结果：LD患者的手术时间略有增加（99.6 vs. 92.0 min; P < 0.0001），且更有可能出现LOS延长（bbb50天：）。84% vs. 67%；P < 0.05)。感染性并发症（1.86%比1.40%,P < 0.0001）和严重并发症（1.65%比1.31%,P < 0.01）发生率在LD组中较高。08% vs. 11%；p = NS)或MACE (MACE：。10% vs. 0.07%；p = NS)。只有3.5%的病例包括术中肝活检。结论：与没有LD的患者相比，LD患者术后感染和严重并发症的发生率更高，并且LOS延长。这些发现强调了术前LD筛查对减肥手术患者的重要性。
{"title":"Impact of preoperative liver disease diagnosis on postoperative outcomes in bariatric surgery","authors":"Yonas E. Teklu , Florina Corpodean , Michael Kachmar , Philip R. Schauer , Michael W. Cook , Vance L. Albaugh","doi":"10.1016/j.soard.2025.10.006","DOIUrl":"10.1016/j.soard.2025.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Obesity increases the risk of metabolic-associated steatotic liver disease (MASLD), and metabolic and bariatric surgery (MBS) mitigates progression to severe and end-stage liver disease (LD). Preoperative LD was added as a new variable for the 2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, allowing for analysis of this variable on perioperative and postoperative outcomes.</div></div><div><h3>Objective</h3><div>To examine the impact of preoperative LD diagnosis on 30-day outcomes following MBS and quantify intraoperative liver biopsy frequency.</div></div><div><h3>Setting</h3><div>MBSAQIP, 2023.</div></div><div><h3>Methods</h3><div>A total of 217,952 cases (24,240 with LD; 193,712 without LD) were analyzed to compare operative length, length of stay (LOS), infectious complications, serious complications, major adverse cardiovascular events (MACE), and mortality. Chi-square and Wilcoxon rank-sum tests were used, and propensity matching was performed based on age, sex, race, body mass index, and preoperative comorbidities.</div></div><div><h3>Results</h3><div>Patients with LD had a slight increase in operative length (99.6 vs. 92.0 min; <em>P</em> < .0001) and were more likely to experience prolonged LOS (>5 days: .84% vs. .67%; <em>P</em> < .05). Rates of infectious complications (1.86% vs. 1.40%; <em>P</em> < .0001) and serious complications (1.65% vs. 1.31%; <em>P</em> < .01) were higher among those with LD. There were no differences in 30-day mortality (.08% vs. .11%; p = NS) or MACE (MACE: .10% vs. .07%; p = NS) between groups. Only 3.5% of cases included intraoperative liver biopsy.</div></div><div><h3>Conclusion</h3><div>Patients with LD experienced higher rates of postoperative infections and serious complications, as well as prolonged LOS, than those without LD. These findings highlight the importance of preoperative LD screening in bariatric surgery patients.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"22 2","pages":"Pages 249-254"},"PeriodicalIF":3.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558688","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 : 2026-02-01Epub Date: 2025-12-06DOI: 10.1016/j.soard.2025.11.022
Cornelia L. Griggs M.D., M.P.H. , Josélio Rodrigues de Oliveira Filho M.D.
{"title":"Comment on: long-term outcomes of Roux-en-Y gastric bypass in the adolescent population: a systematic review and single-arm meta-analysis","authors":"Cornelia L. Griggs M.D., M.P.H. , Josélio Rodrigues de Oliveira Filho M.D.","doi":"10.1016/j.soard.2025.11.022","DOIUrl":"10.1016/j.soard.2025.11.022","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"22 2","pages":"Pages e5-e6"},"PeriodicalIF":3.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897170","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 : 2026-02-01Epub Date: 2025-11-10DOI: 10.1016/j.soard.2025.11.008
Federica Tomaselli M.D., Roberta Albanese M.D., Damiano Tambasco M.D.
{"title":"Body contouring surgery as a key factor in long-term weight maintenance and functional recovery after bariatric surgery","authors":"Federica Tomaselli M.D., Roberta Albanese M.D., Damiano Tambasco M.D.","doi":"10.1016/j.soard.2025.11.008","DOIUrl":"10.1016/j.soard.2025.11.008","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"22 2","pages":"Pages 303-304"},"PeriodicalIF":3.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679961","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 : 2026-02-01Epub Date: 2025-11-11DOI: 10.1016/j.soard.2025.10.019
Alaina P. Vidmar M.D. , My H. Vu M.S. , Matthew J. Martin M.D. , Aimee G. Kim M.D. , Stuart A. Abel M.D. , Harry J. Wong M.D. , Kamran Samakar M.D.
Background
Antio-besity medications (OMs) are increasingly used in youth before and after metabolic and bariatric surgery (MBS), but their impact on surgical outcomes remains unclear.
Objectives
This study examined whether perioperative OM exposure affects early postoperative body mass index (BMI) reduction in youth undergoing sleeve gastrectomy (SG), and whether presurgery OM response influences outcomes.
Setting
Pediatric MBS program at a free-standing, tertiary care, safety-net children’s hospital.
Methods
A retrospective review was conducted of youth (age 7–21) who underwent SG from November 2023 to March 2025. Youth were stratified based on perioperative OM use, defined as OM use for at least 3 months prior to surgery (n = 74). Among these 74 youth, 47 (64%) resumed OM use within 6 months postoperatively. This group was compared to youth with no OM exposure either before or after SG (n = 20). Primary outcomes were percent change in BMI (%BMI), percent excess BMI loss (% EBMIL), and percent total weight loss (% TWL) at 1-, 2-, and 3-months postsurgery. Secondary outcomes included 90-day postoperative safety and eating behavior changes. A secondary analysis compared “high responders” to OM (>5% BMI loss pre-SG, n = 23) versus “low responders” (≤5%, n = 51). Mixed-effects models adjusted for BMI at consult, age, and time between medical weight management and surgery date.
Results
Among 94 youth (mean age 16.5 ± 2.3 years; BMI 50.1 ± 9.7 kg/m2; 57% female; 80% Hispanic; 77% publicly insured), OM users had more comorbidities (type 2 diabetes [T2D] 20% versus 0%) and longer presurgical care (P < .05). Median OM duration was 10.2 mo (IQR 6.0–22.0); semaglutide was most common (51/74). Adjusted analyses demonstrated no significant effect of perioperative OM use on postoperative outcomes at 1-, 2-, 3-months. Compared to youth with no OM exposure (n = 20), there were no significant differences in %BMI, %TWL, or %EBMIL at 3 months. Specifically, the between-group differences at 3 months were as follows: %BMI change: −.4 (95% CI: −2.9, 2.2; P = .8), %TWL: −.1 (95% CI: −2.6, 2.5; P = .9), and %EBMIL: +1.4 (95% CI: −.8, 3.5; P = .2). High responders to preoperative OM (n = 23) had greater postoperative weight loss than low responders (n = 51): at 3 months, %BMI change was −19.3% [95% CI: −21.1, −17.6] versus −15.5% [95% CI: −16.7, −14.3]; P < .001. Safety outcomes were similar across groups.
Conclusions
Perioperative OM use alone did not predict short-term weight loss after SG, but high OM responders before surgery had greater benefit. Further research is needed to optimize OM–MBS integration in youth.
{"title":"Impact of preoperative and postoperative anti-obesity medications on early postoperative body mass index reduction after sleeve gastrectomy in pediatrics","authors":"Alaina P. Vidmar M.D. , My H. Vu M.S. , Matthew J. Martin M.D. , Aimee G. Kim M.D. , Stuart A. Abel M.D. , Harry J. Wong M.D. , Kamran Samakar M.D.","doi":"10.1016/j.soard.2025.10.019","DOIUrl":"10.1016/j.soard.2025.10.019","url":null,"abstract":"<div><h3>Background</h3><div>Antio-besity medications (OMs) are increasingly used in youth before and after metabolic and bariatric surgery (MBS), but their impact on surgical outcomes remains unclear.</div></div><div><h3>Objectives</h3><div>This study examined whether perioperative OM exposure affects early postoperative body mass index (BMI) reduction in youth undergoing sleeve gastrectomy (SG), and whether presurgery OM response influences outcomes.</div></div><div><h3>Setting</h3><div>Pediatric MBS program at a free-standing, tertiary care, safety-net children’s hospital.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of youth (age 7–21) who underwent SG from November 2023 to March 2025. Youth were stratified based on perioperative OM use, defined as OM use for at least 3 months prior to surgery (n = 74). Among these 74 youth, 47 (64%) resumed OM use within 6 months postoperatively. This group was compared to youth with no OM exposure either before or after SG (n = 20). Primary outcomes were percent change in BMI (%BMI), percent excess BMI loss (% EBMIL), and percent total weight loss (% TWL) at 1-, 2-, and 3-months postsurgery. Secondary outcomes included 90-day postoperative safety and eating behavior changes. A secondary analysis compared “high responders” to OM (>5% BMI loss pre-SG, n = 23) versus “low responders” (≤5%, n = 51). Mixed-effects models adjusted for BMI at consult, age, and time between medical weight management and surgery date.</div></div><div><h3>Results</h3><div>Among 94 youth (mean age 16.5 ± 2.3 years; BMI 50.1 ± 9.7 kg/m<sup>2</sup>; 57% female; 80% Hispanic; 77% publicly insured), OM users had more comorbidities (type 2 diabetes [T2D] 20% versus 0%) and longer presurgical care (<em>P</em> < .05). Median OM duration was 10.2 mo (IQR 6.0–22.0); semaglutide was most common (51/74). Adjusted analyses demonstrated no significant effect of perioperative OM use on postoperative outcomes at 1-, 2-, 3-months. Compared to youth with no OM exposure (n = 20), there were no significant differences in %BMI, %TWL, or %EBMIL at 3 months. Specifically, the between-group differences at 3 months were as follows: %BMI change: −.4 (95% CI: −2.9, 2.2; <em>P</em> = .8), %TWL: −.1 (95% CI: −2.6, 2.5; <em>P</em> = .9), and %EBMIL: +1.4 (95% CI: −.8, 3.5; <em>P</em> = .2). High responders to preoperative OM (n = 23) had greater postoperative weight loss than low responders (n = 51): at 3 months, %BMI change was −19.3% [95% CI: −21.1, −17.6] versus −15.5% [95% CI: −16.7, −14.3]; <em>P</em> < .001. Safety outcomes were similar across groups.</div></div><div><h3>Conclusions</h3><div>Perioperative OM use alone did not predict short-term weight loss after SG, but high OM responders before surgery had greater benefit. Further research is needed to optimize OM–MBS integration in youth.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"22 2","pages":"Pages 280-289"},"PeriodicalIF":3.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746434","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 : 2026-02-01Epub Date: 2025-10-10DOI: 10.1016/j.soard.2025.10.002
Raul Sebastian M.D. , Alba Zevallos M.D. , Oscar Tuesta M.D. , Adrian Riva M.D. , Jorge Cornejo M.D. , Tarek Hassab M.D. , Gina Adrales M.D., M.P.H. , Christina Li M.D. , Michael Schweitzer M.D.
Background
Elderly patients undergo bariatric surgery less frequently than younger patients due to several factors such as increased complication risk. Obesity exacerbates frailty among elderly patients through sarcopenia and metabolic dysfunction. Therefore, specific preoperative risk assessment in elderly patients is crucial.
Objectives
We created the modified Bariatric Frailty Score (mBFS) and compared the 30-day outcomes between low versus high mBFS in elderly patients after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).
Setting
2015–2022 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.
Methods
Patients aged ≥ 60 years who underwent SG and RYGB were included. 14 variables of the Canadian Study of Health and Aging-Frailty Index were mapped onto 9 variables of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (each component equals 1 point). Correlations and multivariate logistical regression analysis were performed between mBFS and 7 postoperative outcomes (nonhome discharge, mortality, prolonged hospital stay, intensive care unit admissions, cardiac complications, pulmonary complications, and renal complications). Finally, a propensity score matching between low mBFS (0–4) and high mBFS (5–9) was performed for SG and RYGB.
Results
A total of 90,239 and 40,272 patients were included for SG and RYGB, respectively. The increasing mBFS was strongly correlated with linear regression. In the multivariate analysis, scores of 5, 6, 7, and 8 strongly predicted the 7 postoperative outcomes of interest. After the propensity score matching, the matched cohorts for SG and RYGB were 3337 and 1655, respectively. A high mBFS (5–9) was associated with an increased rate of postoperative complications in the SG and RYGB groups.
Conclusions
Our mBFS is a better predictor of nonhome discharge, prolonged hospital stays, 30-day mortality, unplanned intensive care unit admissions, and cardiac, pulmonary, and renal complications than the American Society of Anesthesiologists score of III, American Society of Anesthesiologists score of IV–V, renal insufficiency, or smoker status. Our study validated the cumulative deficit theory in elderly bariatric surgery patients.
{"title":"Modified bariatric frailty score to predict postoperative outcomes in elderly patients following sleeve gastrectomy and Roux-en-Y gastric bypass","authors":"Raul Sebastian M.D. , Alba Zevallos M.D. , Oscar Tuesta M.D. , Adrian Riva M.D. , Jorge Cornejo M.D. , Tarek Hassab M.D. , Gina Adrales M.D., M.P.H. , Christina Li M.D. , Michael Schweitzer M.D.","doi":"10.1016/j.soard.2025.10.002","DOIUrl":"10.1016/j.soard.2025.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Elderly patients undergo bariatric surgery less frequently than younger patients due to several factors such as increased complication risk. Obesity exacerbates frailty among elderly patients through sarcopenia and metabolic dysfunction. Therefore, specific preoperative risk assessment in elderly patients is crucial.</div></div><div><h3>Objectives</h3><div>We created the modified Bariatric Frailty Score (mBFS) and compared the 30-day outcomes between low versus high mBFS in elderly patients after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).</div></div><div><h3>Setting</h3><div>2015–2022 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database.</div></div><div><h3>Methods</h3><div>Patients aged ≥ 60 years who underwent SG and RYGB were included. 14 variables of the Canadian Study of Health and Aging-Frailty Index were mapped onto 9 variables of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (each component equals 1 point). Correlations and multivariate logistical regression analysis were performed between mBFS and 7 postoperative outcomes (nonhome discharge, mortality, prolonged hospital stay, intensive care unit admissions, cardiac complications, pulmonary complications, and renal complications). Finally, a propensity score matching between low mBFS (0–4) and high mBFS (5–9) was performed for SG and RYGB.</div></div><div><h3>Results</h3><div>A total of 90,239 and 40,272 patients were included for SG and RYGB, respectively. The increasing mBFS was strongly correlated with linear regression. In the multivariate analysis, scores of 5, 6, 7, and 8 strongly predicted the 7 postoperative outcomes of interest. After the propensity score matching, the matched cohorts for SG and RYGB were 3337 and 1655, respectively. A high mBFS (5–9) was associated with an increased rate of postoperative complications in the SG and RYGB groups.</div></div><div><h3>Conclusions</h3><div>Our mBFS is a better predictor of nonhome discharge, prolonged hospital stays, 30-day mortality, unplanned intensive care unit admissions, and cardiac, pulmonary, and renal complications than the American Society of Anesthesiologists score of III, American Society of Anesthesiologists score of IV–V, renal insufficiency, or smoker status. Our study validated the cumulative deficit theory in elderly bariatric surgery patients.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"22 2","pages":"Pages 206-218"},"PeriodicalIF":3.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447014","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 : 2026-02-01Epub Date: 2025-10-30DOI: 10.1016/j.soard.2025.10.011
Zachary D. Leslie , Charlie Quinn B.S. , Sayeed Ikramuddin M.D. , Abraham Matar M.D. , Raja Kandaswamy M.D. , Eric S. Wise M.D.
Background
Obesity is increasingly linked to chronic kidney disease, and most patients with end-stage renal disease would benefit from kidney transplantation. Bariatric surgery is the most effective treatment for obesity and possibly improves postrenal transplant outcomes in patients with obesity.
Objective
To determine if a history of bariatric surgery is predictive of length of stay (LOS) after kidney transplantation.
Setting
National inpatient stays in the United States.
Methods
The National Inpatient Sample (NIS) from 2016 to 2021 was combined, and patients undergoing kidney transplantation were identified with relevant health factors recorded. Cohorts stratified by prior bariatric surgery were identified. Characteristics and outcomes were compared with Welsh t-tests and chi-squared tests. A multivariable linear regression model was created against LOS. Five groups by LOS time were formed and rates of mortality, organ rejection or failure, sepsis, adverse reaction to immunosuppressant therapy, and urinary tract infection (UTI) compared.
Results
Twenty-four thousand seven hundred eighty-seven patients were identified with admission for kidney transplantation and 654 (2.6%) had undergone previous bariatric surgery. Patients with a history of bariatric surgery were more frequently female, had obesity, and had diabetes, anticoagulant therapy, sleep apnea, and anxiety or depression. The linear regression modeling showed that patients with history of bariatric surgery had decreased LOS (5.6 versus 6.4 days, P < .001). Patients with increased LOS were associated with greater morbidity (P < .05).
Conclusion
Previous bariatric surgery is associated with decreased LOS in patients undergoing kidney transplantation. Care teams should be aware of predictors of LOS, as longer LOS is associated with increased postoperative complications and hospital costs.
{"title":"A history of bariatric surgery is associated with a shorter length of stay for patients undergoing renal transplant","authors":"Zachary D. Leslie , Charlie Quinn B.S. , Sayeed Ikramuddin M.D. , Abraham Matar M.D. , Raja Kandaswamy M.D. , Eric S. Wise M.D.","doi":"10.1016/j.soard.2025.10.011","DOIUrl":"10.1016/j.soard.2025.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is increasingly linked to chronic kidney disease, and most patients with end-stage renal disease would benefit from kidney transplantation. Bariatric surgery is the most effective treatment for obesity and possibly improves postrenal transplant outcomes in patients with obesity.</div></div><div><h3>Objective</h3><div>To determine if a history of bariatric surgery is predictive of length of stay (LOS) after kidney transplantation.</div></div><div><h3>Setting</h3><div>National inpatient stays in the United States.</div></div><div><h3>Methods</h3><div>The National Inpatient Sample (NIS) from 2016 to 2021 was combined, and patients undergoing kidney transplantation were identified with relevant health factors recorded. Cohorts stratified by prior bariatric surgery were identified. Characteristics and outcomes were compared with Welsh t-tests and chi-squared tests. A multivariable linear regression model was created against LOS. Five groups by LOS time were formed and rates of mortality, organ rejection or failure, sepsis, adverse reaction to immunosuppressant therapy, and urinary tract infection (UTI) compared.</div></div><div><h3>Results</h3><div>Twenty-four thousand seven hundred eighty-seven patients were identified with admission for kidney transplantation and 654 (2.6%) had undergone previous bariatric surgery. Patients with a history of bariatric surgery were more frequently female, had obesity, and had diabetes, anticoagulant therapy, sleep apnea, and anxiety or depression. The linear regression modeling showed that patients with history of bariatric surgery had decreased LOS (5.6 versus 6.4 days, <em>P</em> < .001). Patients with increased LOS were associated with greater morbidity (<em>P</em> < .05).</div></div><div><h3>Conclusion</h3><div>Previous bariatric surgery is associated with decreased LOS in patients undergoing kidney transplantation. Care teams should be aware of predictors of LOS, as longer LOS is associated with increased postoperative complications and hospital costs.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"22 2","pages":"Pages 242-248"},"PeriodicalIF":3.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145558719","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 : 2026-02-01Epub Date: 2025-11-08DOI: 10.1016/j.soard.2025.10.014
Justine O. Chinn M.D. , Mark Shacker B.S. , Kelly A. Brennan M.S. , Michael Kochis M.D., Ed.M. , Alyssa Stetson M.D., M.P.H. , Christa Bizimana M.S. , Josélio Rodrigues de Oliveira Filho M.D. , Matthew A. Hornick M.D. , Janey S.A. Pratt M.D., F.A.C.S. , Marwa Abu El Haija M.D. , Cornelia Griggs M.D.
Background
While new medications are transforming the management of obesity, their association with outcomes in adolescents undergoing metabolic and bariatric surgery (MBS) is not clear.
Objectives
The objective was to determine how preoperative prescription of antiobesity medications (AOMs) is associated with postoperative weight loss after MBS.
Setting
The study was conducted using data from 3 academic children’s hospitals, spanning the period from March 2013 to September 2024.
Methods
This is a retrospective review in which demographics, obesity-related diseases, preoperative and postoperative weight and body mass index (BMI) were compared between patients who were treated preoperatively with topiramate or glucagon-like peptide-1 receptor agonists (GLP-1RAs) and those who were not. Statistical analyses included Wilcoxon rank-sum, Pearson’s χ2, and Fisher’s exact tests, plus 1:1 propensity score matching and multivariable linear regression sensitivity models adjusting for time-to-surgery.
Results
Of 324 patients, 22 were treated with topiramate and 30 with a GLP-1RA. Rates of obesity-related diseases were similar. Patients on GLP-1RA lost weight from first consultation to surgery (−2% BMI), while those on no medication gained (+1% BMI) and those on topiramate remained stable (0%, P = .023). There was no difference in weight/BMI at the time of surgery; however, patients pretreated with medications lost less weight than those not taking medications at 6 months (no medications: −20% BMI reduction; GLP-1RA: −18%; topiramate: −17%, P = .017) and 12 months (no medications −23% BMI reduction, GLP-1RA −15%, topiramate −17%, P = .015). From initial consultation to 12 months after surgery, the differences in weight loss between groups were not significant (P = .072).
Conclusion
Preoperative exposure to topiramate or GLP-1RA was associated with less postoperative weight loss, despite similar starting weights/BMIs. Total weight loss from consultation through 12 months did not differ significantly between groups. These findings raise important questions regarding the use and timing of obesity management medications in relation to surgery for adolescents.
{"title":"The impact of preoperative antiobesity medications on weight loss in adolescents undergoing metabolic and bariatric surgery – a COSMIC study","authors":"Justine O. Chinn M.D. , Mark Shacker B.S. , Kelly A. Brennan M.S. , Michael Kochis M.D., Ed.M. , Alyssa Stetson M.D., M.P.H. , Christa Bizimana M.S. , Josélio Rodrigues de Oliveira Filho M.D. , Matthew A. Hornick M.D. , Janey S.A. Pratt M.D., F.A.C.S. , Marwa Abu El Haija M.D. , Cornelia Griggs M.D.","doi":"10.1016/j.soard.2025.10.014","DOIUrl":"10.1016/j.soard.2025.10.014","url":null,"abstract":"<div><h3>Background</h3><div>While new medications are transforming the management of obesity, their association with outcomes in adolescents undergoing metabolic and bariatric surgery (MBS) is not clear.</div></div><div><h3>Objectives</h3><div>The objective was to determine how preoperative prescription of antiobesity medications (AOMs) is associated with postoperative weight loss after MBS.</div></div><div><h3>Setting</h3><div>The study was conducted using data from 3 academic children’s hospitals, spanning the period from March 2013 to September 2024.</div></div><div><h3>Methods</h3><div>This is a retrospective review in which demographics, obesity-related diseases, preoperative and postoperative weight and body mass index (BMI) were compared between patients who were treated preoperatively with topiramate or glucagon-like peptide-1 receptor agonists (GLP-1RAs) and those who were not. Statistical analyses included Wilcoxon rank-sum, Pearson’s χ<sup>2</sup>, and Fisher’s exact tests, plus 1:1 propensity score matching and multivariable linear regression sensitivity models adjusting for time-to-surgery.</div></div><div><h3>Results</h3><div>Of 324 patients, 22 were treated with topiramate and 30 with a GLP-1RA. Rates of obesity-related diseases were similar. Patients on GLP-1RA lost weight from first consultation to surgery (−2% BMI), while those on no medication gained (+1% BMI) and those on topiramate remained stable (0%, <em>P</em> = .023). There was no difference in weight/BMI at the time of surgery; however, patients pretreated with medications lost less weight than those not taking medications at 6 months (no medications: −20% BMI reduction; GLP-1RA: −18%; topiramate: −17%, <em>P</em> = .017) and 12 months (no medications −23% BMI reduction, GLP-1RA −15%, topiramate −17%, <em>P</em> = .015). From initial consultation to 12 months after surgery, the differences in weight loss between groups were not significant (<em>P</em> = .072).</div></div><div><h3>Conclusion</h3><div>Preoperative exposure to topiramate or GLP-1RA was associated with less postoperative weight loss, despite similar starting weights/BMIs. Total weight loss from consultation through 12 months did not differ significantly between groups. These findings raise important questions regarding the use and timing of obesity management medications in relation to surgery for adolescents.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"22 2","pages":"Pages 264-272"},"PeriodicalIF":3.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696462","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 : 2026-02-01Epub Date: 2025-11-10DOI: 10.1016/j.soard.2025.10.015
Florina Corpodean M.D. , Michael Kachmar D.O. , Hannah Megison B.S.P.E. , Jared Robinson B.S. , Philip R. Schauer M.D. , Vance L. Albaugh M.D., Ph.D. , Michael W. Cook M.D.
Background
Health care access is influenced by geographic, socioeconomic, and systemic factors. For patients undergoing metabolic and bariatric surgery (MBS), travel distance may reflect disparities in service availability, insurance limitations, and referral patterns to specialized centers.
Objective
To test for an association between travel distance and 30-day postoperative outcomes, focusing on potential geographic biases to determine if patients who travel further face greater postoperative complications.
Setting
Three Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project centers (2020-2023).
Methods
Retrospective data from 1461 patients were analyzed. Travel distance from operative hospital was calculated using geocoding Area Deprivation Index (API) and Spearman’s rank correlation assessed its relationship with outcomes including prolonged length of stay (LOS), infectious and serious complications, major adverse cardiac events (MACE), mortality, emergency department (ED) visits, and 30-day readmissions and reoperations.
Results
No significant correlations were identified between travel distance and prolonged LOS > 5 days (P = .578), infectious complications (P = .703), serious complications (P = .190), MACE events (P = .159), or mortality (P = .073). Similarly, there was no significant association with the number of 30-day readmissions (P = .635) or reoperations (P = .094). However, a significant negative correlation between travel distance and emergency department visits (P < .0001) was observed.
Conclusion
While travel distance does not significantly impact postoperative complications or mortality, it may create logistical barriers that complicate follow-up care. Further research is needed to understand how travel-related challenges influence the management of postoperative complications.
{"title":"Association of socioeconomic disparities by payor status and perioperative outcomes in bariatric surgery","authors":"Florina Corpodean M.D. , Michael Kachmar D.O. , Hannah Megison B.S.P.E. , Jared Robinson B.S. , Philip R. Schauer M.D. , Vance L. Albaugh M.D., Ph.D. , Michael W. Cook M.D.","doi":"10.1016/j.soard.2025.10.015","DOIUrl":"10.1016/j.soard.2025.10.015","url":null,"abstract":"<div><h3>Background</h3><div>Health care access is influenced by geographic, socioeconomic, and systemic factors. For patients undergoing metabolic and bariatric surgery (MBS), travel distance may reflect disparities in service availability, insurance limitations, and referral patterns to specialized centers.</div></div><div><h3>Objective</h3><div>To test for an association between travel distance and 30-day postoperative outcomes, focusing on potential geographic biases to determine if patients who travel further face greater postoperative complications.</div></div><div><h3>Setting</h3><div>Three Metabolic and Bariatric Surgery Accreditation and Quality Improvement Project centers (2020-2023).</div></div><div><h3>Methods</h3><div>Retrospective data from 1461 patients were analyzed. Travel distance from operative hospital was calculated using geocoding Area Deprivation Index (API) and Spearman’s rank correlation assessed its relationship with outcomes including prolonged length of stay (LOS), infectious and serious complications, major adverse cardiac events (MACE), mortality, emergency department (ED) visits, and 30-day readmissions and reoperations.</div></div><div><h3>Results</h3><div>No significant correlations were identified between travel distance and prolonged LOS > 5 days (<em>P</em> = .578), infectious complications (<em>P</em> = .703), serious complications (<em>P</em> = .190), MACE events (<em>P</em> = .159), or mortality (<em>P</em> = .073). Similarly, there was no significant association with the number of 30-day readmissions (<em>P</em> = .635) or reoperations (<em>P</em> = .094). However, a significant negative correlation between travel distance and emergency department visits (<em>P</em> < .0001) was observed.</div></div><div><h3>Conclusion</h3><div>While travel distance does not significantly impact postoperative complications or mortality, it may create logistical barriers that complicate follow-up care. Further research is needed to understand how travel-related challenges influence the management of postoperative complications.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"22 2","pages":"Pages 273-279"},"PeriodicalIF":3.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145673188","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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