Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery最新文献

Background: With the rise of glucagon-like peptide-1 receptor agonists for obesity, rigorous long-term data on surgical outcomes are essential to establish benchmarks and inform future comparative effectiveness studies.

Objective: To evaluate long-term weight loss, safety, and survival following Roux-en-Y gastric bypass (RYGB).

Setting: Community Teaching Hospital.

Methods: This retrospective cohort included all primary RYGB procedures between 2006 and 2011. Outcomes assessed included complications, mortality, and weight loss before glucagon-like peptide 1 (GLP-1) initiation. Mortality was compared with a propensity-weighted national reference cohort to establish population-level benchmarks.

Results: One thousand three-hundred fourteen consecutive RYGB patients were identified with an average follow-up of 11.7 years; 82% had available data at 10 years. In weighted, adjusted models, RYGB was associated with a 67% mortality reduction in patients aged 55-64 (.33; P = .045) and 53% reduction for patients ≥65 (.47; P = .005), but no reduction in patients <55. Total body weight loss at 2 years was 35% ± .3%, and at 10 years, 28.5% ± .4%. Higher initial weight, younger age, and Caucasian race were associated with greater weight loss. At 10 years, 1.8% of patients weighed more than before surgery. At least 5% of RYGB patients developed "severe" alcohol use disorder, with younger patients at higher risk. Of the 137 deaths, we identified a cause in 99. Seven deaths were directly attributable to RYGB complications, and 22 (16%) to liver failure.

Conclusion: RYGB provides durable, meaningful long-term weight loss and a marked survival benefit in patients older than 55. These findings establish a benchmark for emerging medical therapies.

Background: Research on changes in cannabis use prevalence from pre- to postmetabolic and bariatric surgery (MBS) is limited.

Objectives: To assess the change in legal cannabis use prevalence from pre-to post-MBS and the association between postoperative alcohol and cannabis use.

Setting: Single Michigan health system.

Methods: Patients who received MBS between 2018 and 2021 were invited to participate. The analytic sample included 612 participants who completed online surveys regarding cannabis, alcohol, and other substance use, psychiatric symptoms, and demographic information.

Results: Findings indicate a 52.4% relative increase in cannabis use prevalence from pre-to post-MBS (P = .0001). Specifically, 16% of participants reported postoperative cannabis use of which 45.9% were new initiates. Among initiates, 11.8% screened positive for hazardous cannabis use while 19.2% who used cannabis pre- and post-MBS screened positive for hazardous cannabis use. Of 61.9% participants who reported past year alcohol use, 41.4% screened positive for hazardous alcohol use. Those who screened positive were more likely to initiate cannabis use post-MBS (odds ratio [OR]_adj = 2.8; 95% CI: 1.4, 5.4) and more likely to persist cannabis use post-operatively (OR_adj = 3.0; 95% CI: 1.6, 5.8).

Conclusions: Cannabis use initiation post-MBS is not uncommon. The increase in cannabis use prevalence might be explained by its use as a coping mechanism and cannabis legalization, though most participants underwent MBS after legalization. Results suggest a significant association between past year hazardous alcohol use and higher odds of persistent and new initiate post-MBS cannabis use. MBS programs might consider monitoring patients for cannabis use, particularly among patients using alcohol.

Obesity is a growing concern in pediatric populations, with severe obesity impacting 10% of adolescents in the United States. Children and Youth with Special Healthcare Needs (CYSHCN) and those with syndromic obesity face increased risks of comorbidities, including diabetes, cardiovascular disease, and obstructive sleep apnea. Traditional interventions, such as dietary and behavioral modification, are often ineffective in these groups. The American Academy of Pediatrics now recommends treating CYSHCN similarly neurotypical children with obesity, encouraging the use of antiobesity medications and metabolic and bariatric surgery (MBS) for adolescents aged 13 and older. This review examines the outcomes of MBS in pediatric populations with special considerations, focusing on CYSHCN, those with monogenic and syndromic forms of obesity, and preteen children (<13 years of age). Laparoscopic sleeve gastrectomy results in significant weight loss and improvement in obesity-related comorbidities, with similar outcomes between neurodiverse and neurotypical patients. Additionally, emerging data suggest that MBS in children under 13 can be safe and effective when performed at specialized centers. In patients with monogenic and syndromic forms of obesity, MBS may offer long-term benefits where pharmacotherapy falls short.

Background: Metabolic and bariatric surgery (MBS) preoperative evaluation involves a psychosocial assessment, but no formal guidelines dictate how these MBS psychosocial assessments are conducted. The Millon Behavioral Medicine Diagnostic (MBMD) is a broadband personality assessment increasingly used in MBS populations. In this study, we used the MBMD to assess the associations of coping styles, psychiatric indicators, stress moderators, treatment prognostics, and management guides on MBS postoperative weight loss outcomes.

Setting: University Hospital, United States.

Methods: Ninety-seven participants underwent MBS and preoperative MBMD evaluation at a single institution and were identified through retrospective record review. Preoperative MBMD scores were compared to surgical outcomes, which included reduction in postoperative body mass index (BMI) as compared to preoperative BMI at both 6 (n = 90) and 12 (n = 63) months post procedure. Associations were assessed using Pearson correlations and linear models.

Results: At 6 months, reduced BMI was positively correlated with increased Inhibited and Dejected coping styles, psychiatric indicators of Anxiety-Tension, treatment prognostics of Interventional Fragility, and management guides for Psychiatric Referral, and higher BMI was associated with increased Confident and Sociable scales. At 12 months, reduced BMI was positively correlated with higher Anxiety-Tension, Social Isolation, and Psychiatric Referral, and negatively correlated to the Confident scale. The Illness Apprehension scale was associated with improved BMI in the Sleeve Gastrectomy group only at 12 months.

Conclusions: We found several MBMD scales associated with weight loss following MBS. Given our study is exploratory and associations are unadjusted, these results should be interpreted as associations that can be further explored in future studies to validate these findings.

Background: Individuals who come from vulnerable groups such as those from racial or ethnic minorities and/or those from low socioeconomic groups have a high prevalence of obesity but are less likely to receive metabolic/bariatric surgery (MBS). This is believed to be related to inequities in access to MBS due to travel (those living in rural communities), financial burden, and/or lack of education. The objective of this study is to understand the impact of telemedicine interventions on improving access to MBS in such groups.

Setting: Academic Health Center.

Methods: A search was conducted using EMBASE, Medline, and Google Scholar. Articles related to telemedicine in bariatric surgery patients published in peer-reviewed journals were reviewed and selected using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Results: Of 131 articles reviewed, 8 met eligibility criteria, representing 6881 patients with a mean age of 47.9 years; majority of whom were female (>60%). Barriers to MBS access included distance, transportation, time off from work, and number of visits, leading to attrition rates exceeding 60% in some vulnerable populations. Telemedicine increased show rate over 2-fold and increased MBS throughput (odds ratio [OR] 3.53) in some vulnerable cohorts. Telemedicine use is also correlated with increased nutrition knowledge, better eating behavior, physical activity, and weight loss. Vulnerable groups, particularly from rural communities, had higher satisfaction ratings with telemedicine utilization.

Conclusion: The use of telemedicine interventions can have a significant impact on improving access and throughput to MBS among vulnerable groups, while achieving high satisfaction and low attrition rates.

Background: Marginal ulcers (MUs) are one of the most common late complications after gastric bypass. In France, the absence of reliable epidemiological data has precluded the formulation of recommendations concerning dosage or total duration of treatment and the establishment of an endoscopic monitoring strategy.

Objectives: The aim of this study was to describe the frequency and time to onset of MUs following gastric bypass surgery in a nationwide database and to assess risk factors for developing this complication.

Setting: We conducted a population-based study. Patients were included using the French Hospital Discharge Database.

Methods: All patients who underwent gastric bypass between January 2015 and December 2021 were included and followed up for 1 year. Ulcer diagnosis was based on upper gastrointestinal endoscopy (including day care) or revision surgery. Patients with undocumented clinical suspicion of ulcer were excluded.

Results: A total of 83,450 patients were included. The incidence of ulcers in the year following surgery was 2.11%, with 25% occurring in the first month. The significant factors identified in multivariable analysis were history of Helicobacter pylori infection (adjusted hazard ratio [aHR]: 1.25 [1.07-1.45]), men (aHR: 1.46 [1.31-1.63]), history of ulcers (aHR: 1.51 [1.16-1.97]), smoking (aHR: 1.91 [1.57-2.33]), and postoperative complications (aHR = 6.89 [6.22-7.61]). Increased body mass index and previous bariatric surgery appeared to be protective.

Conclusions: Among French adult patients who had gastric bypass surgery, 2.11% developed a MU within the first year postoperatively. History of bariatric surgery seems well accounted for. However, greater emphasis should be placed on smoking cessation and the consideration of postoperative complications that may arise during the follow-up period.

Background: The growing population of left ventricular assist device (LVAD) patients faces increasing obesity-related comorbidities, which can adversely impact heart transplant candidacy. As these patients live longer, metabolic and bariatric surgery may become necessary, yet safety outcomes remain underexplored.

Objective: This study evaluates safety and outcomes of primary bariatric procedures in LVAD patients using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

Setting: MBSAQIP participating centers across the United States.

Methods: Using the 2023 MBSAQIP database, we analyzed primary laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) procedures. Patients were stratified by LVAD status. Primary outcomes were 30-day serious complications; secondary outcomes included length of stay, operative time, and postoperative complications.

Results: Of 180,544 patients undergoing bariatric procedures, 133 (.07%) had LVADs. LVAD patients were older (49.5 versus 43.0 years, P < .001), female (60.1% versus 39.8%, P < .0001), and had higher rates of hypertension (79.7% versus 43.6%, P < .001), diabetes (51.8% versus 23.6%, P < .001), and therapeutic anticoagulation (45.9% versus 3.0%, P < .001). Most underwent SG (73.7%). LVAD patients had longer operative times (105.3 versus 84.6 min, P < .001), higher serious complications (11.3% versus 2.5%, P < .001), bleeding (5.3% versus .8%, P < .001), readmission (13.5% versus 2.9%, P < .001), and length of stay (4.9 vs 1.2 days, P < .001). After adjustment, LVAD and RYGB remained independently associated with serious complications (odds ratio [OR] 2.83, 95% confidence interval [CI] 1.62-4.97, P < .001 and OR 1.71; 95% CI 1.60-1.83; P < .001).

Conclusion: Although LVAD patients face increased complications with bariatric surgery, this intervention remains essential for meeting transplant body mass index criteria. Careful patient selection and perioperative optimization are crucial, and further research is needed to improve outcomes in this high-risk population.

Background: While bariatric surgery reduces short-term mortality and improves metabolic outcomes, less is known about the long-term causes of death in patients who undergo these procedures. Understanding these outcomes is critical for long-term care and risk counseling.

Objectives: To identify any shifts in the long-term causes of death among bariatric surgery patients in the United States and compare these to matched nonsurgical controls, as well as to obese and normal-weight individuals in the general population.

Setting: United States; National Health and Nutrition Examination Survey (NHANES) Linked Mortality Files.

Methods: We analyzed data from NHANES 2005 to 2018 linked to the National Death Index through 2019. Individuals with self-reported bariatric surgery were matched to controls by age, sex, and body mass index (BMI). We excluded deaths occurring within 1 year of survey participation. Causes of death were classified by International Classification of Diseases Version 10 (ICD-10) categories. Descriptive statistics and survival trends were analyzed.

Results: Among 435 bariatric patients and 1740 controls, there were 87 and 212 long-term deaths, respectively. The leading causes of death in the bariatric group were cardiovascular disease (30%), cancer (21%), and diabetes (9%). Compared to controls, bariatric patients had proportionally higher rates of suicide (6.6%) and liver disease (8.5%). In contrast, diabetes-related deaths occurred in 5.7% of bariatric patients compared to 9.8% in controls. Bariatric patients had a three times higher risk of death from suicide (standardized mortality ratios [SMRs] 3.33; 95% confidence interval (CI), 1.08-7.78) and a higher risk of death from liver disease (SMR 3.00; 95% CI, 1.10-6.53) compared to matched controls. Diabetes-related mortality was also markedly elevated (SMR 2.00; 95% CI, .86-3.94).

Conclusion: Long-term causes of death after bariatric surgery remain primarily cardiovascular and oncologic, but higher rates of suicide and liver-related mortality highlight the need for targeted follow-up and psychosocial care.