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

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for severe obesity. Prior research suggests a volume-outcome relationship, where higher hospital volumes correlate with improved patient safety. However, current accreditation standards may not reflect contemporary practice.

Objectives: To evaluate the impact of hospital volume on postoperative complications, as measured by Patient Safety Indicators (PSI-90), and mortality following bariatric surgery.

Setting: Nationwide Readmissions Database (NRD) from 2018 to 2020, representing 266,743 procedures across 1947 U S. hospitals.

Methods: Bariatric procedures (sleeve gastrectomy (SG), gastric bypass (GP), and duodenal switch (DS)) were categorized into low-, medium-, and high-volume hospitals based on tertiles of case volume. Risk-adjusted odds ratios (ORs) for PSI-90 complications and mortality were compared using high-volume centers as the reference.

Results: Medium-volume centers had significantly increased risk of PSI-90 complications for SG (OR 1.56, P < .001) and DS (OR 2.16, P = .035) compared to high-volume hospitals. No significant difference was found between low- and high-volume hospitals, suggesting patient selection bias at low-volume centers. GP outcomes did not significantly vary across volume tiers.

Conclusions: Higher hospital volume was associated with reduced postoperative complications for SG and DS. The increased complication risk in medium-volume centers suggests the need to reassess accreditation volume thresholds. Future policies should ensure standards align with evolving bariatric surgical practices to optimize patient outcomes.

Background: Obesity is a global health problem with alarming rates of morbidity and mortality. Although bariatric surgery is a proven safe and effective treatment for obesity, only a small fraction of eligible patients utilizes it.

Objectives: Assess the economic impact of bariatric surgery costs within 2 years of the index date and identify factors associated with cost differences.

Setting: U.S. national employer-based retrospective claims database.

Methods: Adults with obesity (body mass index [BMI] ≥ 35 kilograms per square meter) were identified in the Merative claims database. Individuals who had a bariatric procedure between January 2017 and December 2019, inclusive, were matched 1:1 with nonsurgical patients, based on age, BMI, sex, comorbidities, and health care costs in the year before the index date. Total and clinical care-specific costs were compared in the 2 years after the index date (excluding the cost of surgery).

Results: The study included 9432 surgical patients and 9432 well-matched controls. In the 2 years after the index date, follow-up was complete, and total health care costs were $5677 lower among surgical patients (P < .01). In 29 of 35 characteristics examined, health care costs were significantly reduced after surgery. The largest savings were noted among patients with type 2 diabetes ($15,270), steatohepatitis ($11,648), or ages 50-65 years ($11,105).

Conclusions: Bariatric surgery is associated with an average 22.6% reduction in health care costs within 2 years postindex date. Differences in health care costs varied substantially by baseline demographics, health conditions, and health care usage, highlighting surgery's economic and clinical benefits.

Background: Frailty is a state of reduced physiologic capacity, and our group has created a bariatric frailty index using 9 variables from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. We found that frailty scores had weakly positive correlations with increasing age and body mass index in bariatric patients.

Objective: To examine the effect of frailty and pre-frailty on Clavien-Dindo (CD) ≥III grade complications after bariatric surgery for all adults as well as outcomes of surgical approach using the MBSAQIP database (2016-2019).

Setting: Data pooled from American Society for Bariatric Surgery-accredited bariatric surgery centers, United States.

Methods: All adult patients were included. Fourteen variables of the Canadian Study of Health and Aging Frailty Index were mapped onto 9 variables of MBSAQIP to derive a bariatric frailty score (0-9) which were classified as Not frail (0), pre-frail (1-2), and frail (≥3). Logistic regression was performed to evaluate the effects of frailty on CD ≥III grade complications.

Results: Most patients undergoing bariatric surgery were pre-frail (56% versus not frail 33.6% vs frail 10.3%). There was a positive association between greater frailty scores and a greater frequency of CD ≥III grade complications in both laparoscopic and robotic cohorts. Regardless of surgical approach or operation, patients who were classified as pre-frail and frail had greater frequency of serious complications compared with patients classified as not frail.

Conclusions: Using a bariatric frailty score to identify patients who are pre-frail and frail may assist with prehabilitation before bariatric surgery and assist with decision-making for surgical approach.

Background: Gut microbiome and genetic biomarkers are increasingly guiding obesity treatment. Bariatric surgery leads to shifts in gut microbial composition and function, while genome-wide association studies reveal genetic underpinnings of polygenic obesity, informing risk, therapeutic outcomes, and nutrigenomics-based interventions.

Objectives: This pilot study aimed to identify gut microbiome and genetic biomarkers associated with weight loss 12 months after sleeve gastrectomy (SG).

Setting: Single academic institution university clinic.

Methods: Sixty-seven patients 12 months post-SG were enrolled: 34 had successful excess weight loss (EWL ≥50%), while 33 had unsuccessful EWL (EWL <50%). Microbiome and genetic profiles were collected and analyzed using ANOVA and regression methods.

Results: The genus Akkermansia was significantly associated with EWL (P = 9.9 × 10^-6). Several microbial pathways, including propionate synthesis and menaquinone (vitamin K2) production, showed nominally significant (P < .05) associations with greater weight loss. No differences emerged in the Firmicutes/Bacteroidetes ratio. Genetic analyses revealed significant correlations between EWL and polygenic scores for dietary needs and metabolic responses, including distinct vitamin D and K requirements, as well as higher LDL cholesterol levels and predisposition for major depression.

Conclusions: These findings suggest that both the gut microbiome and genetics may modulate weight loss following bariatric surgery. Integrating microbiome and genetic profiling into bariatric care pathways could enhance personalized obesity treatment. While this pilot, exploratory, and proof-of-concept study has limitations, it supports prior work linking gut microbial pathways to weight loss and suggests new associations. Follow-up studies are warranted to validate these results and further inform precision obesity interventions.

Background: The impact of food environment on weight loss after Roux-en-Y gastric bypass and sleeve gastrectomy in South Carolina is not well studied. Specifically, there is a lack of evidence in the Upstate region of South Carolina regarding the efficacy of weight loss surgery in patients who live in a poor food environment.

Objectives: Assess the relationship between food environment after bariatric surgery.

Setting: South Carolina, USA.

Methods: Our study is a single-center, retrospective review of 134 postbariatric surgery patients. We determined patients' food environments using the Center for Disease Control modified retail food environment index (mRFEI) and the South Carolina Department of Health and Environmental Control food desert map. We assessed weight loss using percent of total body weight loss (TBWL%).

Results: We found no linear correlations between weight loss and food environment in bivariate analyses at 6 months (r = -.121; P = .165), 13 months (r = -.109; P = .275), 18 months (r = -.124; P = .326), or 36 months (r = -.331; P = .106) after bariatric surgery. At 24 months, there was a low negative correlation between weight loss and food environment (r = -.302; P = .041). In repeated measures multivariate analysis, adjusting for age, sex, race, payor status, and type of surgery, we found no statistically significant association between mRFEI and TBWL% (P = .214).

Conclusions: Our data suggest there is no significant association between weight loss after bariatric surgery and living in an area with poor access to healthy food retailers. This study supports bariatric surgery as an effective method for weight loss regardless of patients' food environment.

Bariatric surgery is effective for achieving substantial weight loss and improving metabolic comorbidities in patients with severe obesity. However, both obesity and bariatric surgery elevate the risk of thromboembolic events. Traditionally, venous thromboembolism (VTE) prophylaxis in individuals who undergo bariatric surgery has relied on heparins, particularly enoxaparin. Concerns regarding pharmacologic limitations linked to the adipose tissue-related impact on the drug's pharmacodynamics in high-BMI patients have led to increased interest in direct oral anticoagulants (DOACs) as a potential alternative. This systematic review and meta-analysis aimed to assess the efficacy and safety of DOACs for thromboprophylaxis in people undergoing bariatric surgery. We systematically searched PubMed, EMBASE, and Cochrane Central for studies evaluating DOAC use for VTE prophylaxis in bariatric surgery patients up to November 2024. Primary outcomes included thrombotic and bleeding event rates (classified as major or minor), with secondary outcomes including the prevalence of allergic reactions. Randomized controlled trials and observational studies were included. Study weights were calculated using the inverse variance method, with statistical analyses performed using R version 4.4.0 (R Foundation for Statistical Computing, Vienna, Austria). Seven studies with a total of 7706 patients were included. The incidence of thrombotic events post-surgery with DOAC use was .23% (95% CI: .14-.39). Major bleeding events were reported at .33% (95% CI: .11-1.03), minor bleeding at 1.27% (95% CI: .45-3.54), and allergic reactions at 1.33% (95% CI: .59-2.98). There was one reported death due to pulmonary embolism. These findings suggest a low incidence of adverse effects with DOAC use in this population. Our meta-analysis supports the use of DOACs as a safe and effective option for thromboprophylaxis in individuals undergoing bariatric surgery. Further research, including direct comparisons with enoxaparin, is needed to establish definitive guidelines for postoperative management.

Background: Abdominal hernias are a prevalent complication of abdominal surgery, occurring in 13% of midline laparotomy. The recurrence rate is considerable, reaching 28% within 2 years postrepair. The most significant factor contributing to recurrence after hernia repair and complications is obesity.

Objectives: This study assesses the impact of a two-stage approach, comprising initial bariatric surgery (BS) followed by hernia repair, on morbidity and mortality associated with hernia surgery.

Setting: Bicentric retrospective study conducted at two university hospitals (France).

Methods: Patients with obesity who were eligible for BS and underwent incisional hernia repair (IHR) between January 2013 and August 2023 were divided into two groups: those who underwent IHR alone and those who received initial BS followed by IHR. Data included demographic, anthropometric, and procedural details, as well as short- and long-term complications.

Results: The 140 patients were divided into two groups: 103 undergoing IHR alone (body mass index [BMI] 40.5kg/m²) and 37 in the BS-then-IHR group (BMI reduction from 43.7kg/m² to 32.4kg/m²). Intraoperative data showed a lower incidence of complications in the BS-first group (0%) than in the IHR-group (13.7%), even after excluding emergency surgeries (P < .05). Postoperative morbidity was lower in the two-stage group, with intensive care unit admissions at 5.4% versus 17.5% and no mortalities. Median hospital stay was shorter (4.5 days vs. 7 days, P < .05). Three-year clinical recurrence was 8.3% versus 19.8%.

Conclusion: A two-stage approach may improve IHR outcomes by reducing recurrence, hospital stay, and postoperative morbidity and mortality. This approach should be considered if the patient is eligible for BS.