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

Background: Robotic bariatric surgery adoption rates have increased, and the higher costs associated with robotic sleeve gastrectomy (rSG) are a concern.

Objectives: To investigate the factors associated with increased costs of rSG.

Setting: US hospital database.

Methods: Patients who underwent rSG between January 1, 2018 and December 31, 2022 were extracted from PINC AI Healthcare Data. Inpatient total, variable, and fixed costs were converted to 2022 USD. Factors including patients and provider characteristics, types of staplers used (laparoscopic bedside staplers [LBS], other unspecified bedside staplers [OBS], and robotic staplers [RS]) were evaluated. Univariate and bivariate analyses were used to examine baseline balance among groups. Multivariable general linear model was used to identify cost drivers.

Results: There were 27,778 patient records, of which 25.6% used LBS, 10.3% used OBS, and 64.1% were RS cases. Increased costs were driven by type of stapler, patients aged 55-64, male, non-White race, non-Medicare insurance, higher comorbidity, and disease severity, and hospitals in West region, rural, more than 500 beds, with the lower hospital and surgeon's volume. After adjusting for other cost drivers, the procedures done by LBS significantly reduced variable costs by $651 ± $86 (mean difference ± standard error) and $564 ± $54 and fixed costs by $1716 ± $62 and $2297 ± $54 compared to OBS and RS. In total, the use of LBS significantly reduced total inpatient costs by $2384 ± $118 and $2692 ± $90 compared to OBS and RS, respectively. Also, LBS had fewer blood transfusions and intensive care unit visits than OBS and RS.

Conclusions: RS and OBS were critical cost drivers in patients undergoing rSG compared to major brand bedside staplers.

Background: The risk of esophageal cancer after bariatric surgery is a matter of debate.

Objective: This study aims to evaluate the risk of esophageal cancer following sleeve gastrectomy (SG) and gastric bypass (GB).

Methods: We extracted data from the national discharge database (Programme De Médicalisation des Systèmes d'Information) for patients who underwent bariatric surgery in France between 2007 and 2020. Adult patients undergoing SG or GB were included and followed until December 2022. The primary endpoints were the occurrence of esophageal and gastroesophageal junction (GEJ) cancers. The impact of bariatric procedures on cancer development was assessed using multivariate analysis, along with several sensitivity analyses to validate the findings.

Results: Among the 370,271 patients included, 68.4% underwent SG and 31.6% underwent GB. The median follow-up duration was 7.4 years (interquartile range: 5.3-9.6 years), with approximately 81,000 patients followed for at least 10 years. A total of 96 cases of esophageal cancer were identified: 25 in the GB group and 71 in the SG group. The incidence rates were 2.6 per 100,000 person-years for GB and 3.9 for SG, resulting in an incidence rate ratio of .64 (95% confidence interval [CI]: .40-1.01, P = .055). In multivariate analysis, no significant difference in cancer incidence was found between SG and GB (hazard ratio [HR]: 1.60, 95% CI: .90-2.5, P = .06). Sensitivity analyses further confirmed these findings, showing similar nonsignificant differences across various models.

Conclusion: In this extensive national cohort of bariatric surgery patients, no significant differences were observed in the incidence of esophageal and GEJ cancer between SG and GB.

Background: Women represent 40% of patients undergoing bariatric surgery. This highlights the importance of understanding its effects on pregnancy and newborns (NBs).

Objective: To compare pregnancy and neonatal outcomes between a group of pregnant women with obesity and those who had prior bariatric surgery.

Setting: University Hospital, Argentina; Private Practice.

Methods: A retrospective analysis of patients with bariatric surgery before pregnancy (n = 49) and women with obesity (body mass index [BMI] ≥ 30 kg/m2) without previous bariatric surgery (n = 146) was performed. Variables assessed included type of bariatric surgery, age at pregnancy, interval between surgery and conception, maternal weight and BMI at pregnancy onset and end, weight gain during pregnancy, NB weight, gestational age, premature birth, macrosomia, low birth weight, pregnancy-induced hypertension, gestational diabetes mellitus (GDM), anemia, pre-eclampsia, congenital anomalies, fetal deaths, and mode of delivery.

Results: BMI at the start and end of pregnancy was lower in the postbariatric group compared to the group with obesity (P < .001). Weight gain during pregnancy was greater in the postbariatric group compared to the group with obesity (P < .001). The weight of NBs was lower in the postbariatric group compared to the group with obesity (P < .001). The incidence of GDM was lower in the postbariatric group compared to the group with obesity (P < .001). Other variables did not show significant differences between the 2 groups.

Conclusion: Pregnant women with obesity have high rates of gestational diabetes and neonatal macrosomia compared to those who underwent surgery.

Background: Genetic background of severe obesity is inadequately understood. The effect of genetic factors on weight loss after metabolic bariatric surgery (MBS) has shown inconclusive results.

Objectives: To determine the prevalence of rare obesity-associated gene variants in a secondary analysis of a randomized clinical trial (RCT) comparing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for the treatment of severe obesity and examine their association with long-term weight loss at 10 years.

Setting: University Hospital, Finland.

Methods: Targeted sequencing panel was used to examine variants in 79 obesity-associated genes and 16p11.2 copy number variants. Weight loss was evaluated by percentage total weight loss (%TWL).

Results: Out of 240 patients, 113 patients [mean body mass index 48.4 kg/m², (6.8 standard deviation [SD]) kg/m² and median age 49 (range 26-64) years, LSG n = 60, LRYGB n = 53] were available for this post-hoc study. We identified 7 rare heterozygous likely/suspected pathogenic (LP/SP) variants in SH2B1, PCSK1, DNMT3A, BDNF, and AFF4 in 6 patients (5.3%), 5 heterozygous variants of uncertain significance in PLXNA4, PLXNA2, NRP1, and SEMA3D in 5 patients (4.4%), heterozygous Bardet-Biedl syndrome variants in 3 patients (2.7%), and PCKS1 risk allele p.Asn221Asp in 9 patients (8.0%). The patients with LP/SP variants had earlier age of obesity onset (P = .0089) and higher %TWL (P = .0446) compared with patients without LP/SP variants.

Conclusions: There were LP/SP pathogenic variants in 5% of the patients supporting the potential benefits of genetic testing to optimize targeted therapies in the future. Despite deleterious gene defects the long-term MBS outcome can be favorable.

Background: The prevalence of obesity has risen dramatically worldwide. Beyond its metabolic implications, obesity profoundly impacts sexual health, particularly in males, with erectile dysfunction (ED) emerging as a prevalent and distressing co-morbidity. Studies show that bariatric surgery alleviates ED. Patients suffering from obesity have lower testosterone levels, which increase after weight loss surgery.

Objectives: This study aims to investigate the relationship between ED improvement, weight loss, and hormonal changes after surgery.

Setting: University Hospital, Poland.

Methods: This prospective study included 108 patients who underwent sleeve gastrectomy from 2022 to 2023. All patients completed a section of International Index of Erectile Function questionnaire before surgery and 1 year postoperatively. Patients with a score <25 were included in the analysis. Linear regression models were created to evaluate the impact of weight loss and hormonal changes on ED remission.

Results: Sixty patients with ED underwent analysis. The mean age was 41.9 and mean body mass index was 46.67. The average excess weight loss of the analyzed group was 59%. Significant improvements in erectile functioning were observed postsurgery: 40% of patients experienced full remission, and another 40% showed symptom alleviation. Multiple regression model identified preoperative severity of ED, weight loss, and diabetes as independent factors influencing ED remission Although testosterone levels increased significantly after the surgery, it was not an independent factor. Loss to follow-up was 20%.

Conclusions: Bariatric surgery improves erectile function, with weight loss and diabetes mellitus being key factors influencing ED. ED should be considered as an obesity-related co-morbidity similarly as hypertension.

Background: Metabolic and Bariatric Surgery (MBS) is often difficult to access for the adolescent population. Eligibility criteria have been recently updated to attempt to remove barriers in accessing this care.

Objectives: Analyze recent trends in adolescent MBS in the context of these recent policy changes.

Setting: Member programs of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

Methods: Adolescents age 10-17 who underwent MBS from 2017 to 2022 were identified. Demographic trends and surgical details were analyzed through standard statistical comparison methods, linear regression, and multivariate logistic regression.

Results: From 2017-2022, 2229 adolescent patients underwent MBS. These approximately 372 cases per year represent about 15%-20% of the total estimated annual cases in the US. Of these, 69% were female, 59% were white, and mean age was 16.1 years. There were no significant differences in age and sex distributions by year. Body mass index (BMI) at surgery did not vary with age. Fourteen and 15 year olds had the highest rates of diabetes (20% and 21% versus 16% for the overall cohort), whereas sleep apnea was more common in 13-year-old patients (36% versus 22%). Females had lower BMI at surgery (46 versus 49) and higher rates of robotic-assisted surgery (16% versus 11%). Case volume decreased with COVID and rapidly increased thereafter. Sleeve gastrectomy increased in relative prevalence compared to bypass, and robotic-assisted cases are increasing twice as fast as laparoscopic procedures. The overall complication rate was 2.9%, with dehydration being most common. Readmission, reoperation, and reintervention did not vary by year.

Conclusions: Despite recent efforts to expand care to younger patients, the majority of pediatric MBS is performed for white, female patients over age 16. Cases have returned to prepandemic levels, with robotic-assisted cases increasing. Complication rates and reoperation rates remain low.

Background: The difference in survival between sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) remains controversial.

Objective: To investigate the comparative survival difference between SG and RYGB in adults with morbid obesity.

Setting: A meta-analysis.

Methods: MEDLINE, EMBASE, and Cochrane Library Central Register of Controlled Trial were searched through June 30th, 2023 to identify studies comparing SG and RYGB. To minimize confounding, only adjusted outcomes were used from observational studies. The primary outcome was all-cause mortality during follow-up. Secondary outcomes were revision, reoperation, reintervention, hospitalization, endoscopic procedure, and emergency department visit.

Results: Twenty-two studies (10 randomized controlled trials [RCTs] and 12 observational studies) met the inclusion criteria. Three RCTs and seven observational studies with 333,713 patients (SG, n = 172,909; RYGB, n = 160,804) were analyzed for all-cause mortality, with a weighted median follow-up of 34.4 months. SG was associated with decreased risks of all-cause mortality during follow-up (hazard ratio [HR]: .85; 95% confidence interval [CI]: .79 to .92), reoperation (HR: .69; 95% CI: .59 to .80), reintervention (HR: .74; 95% CI: .66 to .81), hospitalization (HR: .86; 95% CI: .77 to .97), and endoscopic procedure (HR: .55; 95% CI: 0.40-.76), whereas SG was associated with a higher risk of revision (HR: 2.18, 95% CI: 1.52 to 3.14). Meta-regression suggested consistent survival advantages of SG regardless of the proportion of patients with diabetes or follow-up duration.

Conclusion: In adults with morbid obesity undergoing bariatric surgery, SG was associated with a decreased risk of all-cause mortality during follow-up compared with RYGB. A large-scale randomized trial with long-term follow-up is still necessary for validation.

Background: Weight and shape overvaluation (WSO; undue influence of weight and shape on self-evaluation) is common among individuals undergoing bariatric surgery. Little is known about how WSO relates to poorer outcomes for patients remote from surgery.

Objectives: To examine associations between WSO with anxiety and depression symptoms and various maladaptive eating behaviors in patients up to 4 years post-bariatric surgery.

Setting: Henry Ford Health, United States.

Methods: Patients who underwent surgery between 2018 and 2021 were invited to complete the study between 2021 and 2022. Participants (N = 765) completed anxiety and depression symptom and eating behavior measures.

Results: Participants endorsed moderate WSO (M = 3.62, standard deviation = 1.87), which was positively related to anxiety (r = .37) and depression (r = .20) symptoms; eating in response to anger/frustration (r = .26), anxiety (r = .28), and depression (r = .31); and addictive eating behaviors (r = .26); and was significantly associated with the presence of loss-of-control (odds ratio [OR] = 1.39), binge (OR = 1.39), and graze (OR = 1.24) eating. WSO also was related to more frequent grazing (r = .23) but not loss-of-control or binge eating frequency for participants who endorsed behavior presence.

Conclusions: Findings underscore that links between WSO, psychiatric distress, and maladaptive eating behaviors persist up to 4 years after bariatric surgery. These domains should be assessed at bariatric follow-ups, and assessment of WSO may help providers identify patients at risk for poorer outcomes. Findings should be used to inform temporal modeling of how WSO may predispose patients to poorer bariatric outcomes.

Background: Utilization of metabolic and bariatric surgery has increased significantly over the last 2decades, yet barriers to access remain.

Objectives: This study aimed to 1) define rates of metabolic and bariatric surgery utilization for qualifying adults in Illinois and 2) describe patient characteristics associated with undergoing surgery at Illinois hospitals with low metabolic and bariatric surgery volume.

Setting: Metabolic and bariatric surgery at all nonfederal Illinois hospitals was included.

Methods: Illinois hospital administrative data for 2016-2022 metabolic and bariatric surgery procedures (numerators) and Illinois Behavioral Risk Factor Surveillance System population estimates (denominators) were used to compute metabolic and bariatric surgery rates per estimated 100,000 Illinois residents ages 18-69 who qualified for metabolic and bariatric surgery based on National Institutes of Health Guidelines. Zip code median income was obtained from census data. Multivariable logistic regression was used to identify patient characteristics associated with receiving metabolic and bariatric surgery at low volume hospitals (LVHs), defined as less than 50 annual bariatric procedures.

Results: The average annual metabolic and bariatric surgery rate was 702 per 100,000 qualifying Illinois adults. Rates were highest among non-Hispanic Black patients (890/100,000) and lowest for Hispanic patients (396/100,000) and patients from zip codes with median household income <$75,000. Lower median household income was the only characteristic associated with use of LVHs.

Conclusions: Metabolic and bariatric surgery procedures almost doubled over the study period in Illinois, increasing the most for non-Hispanic Black and Medicaid patients. However, Hispanic and low-income patients still have rates well below the state average.