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

There is a paucity of research summarizing the impact of psychosocial factors on youth metabolic and bariatric surgery (MBS) outcomes and the impact of MBS on youth psychosocial health. This scoping review provides a comprehensive characterization of the state of the literature regarding psychosocial care for youth undergoing MBS to identify implications for practice and define knowledge gaps to inform future research. A search of articles published between 2010 and March 2025 was conducted focusing on study objectives from all peer-reviewed evidence sources except for review articles, commentaries, protocol papers, meta-analyses, editorials, and guidelines. One hundred forty-three articles were included for review. Frequency counts were utilized to provide narrative description of study findings which were also mapped in tabular form to demonstrate the state of the literature. Youth seeking MBS have high rates of psychosocial complexity which maintain or improve (at least in the short term) following MBS, with a subset experiencing symptom worsening, highlighting the importance of monitoring and support postoperatively. More research is needed in larger and diverse (e.g., age, race/ethnicity, gender, and neurodivergent) populations as well as in the areas of family relationships and social determinants of health to ensure that assessment, treatment, and informed consent processes allow families to make the most informed decisions for care.

Background: Transversus abdominis plane (TAP) block is an effective strategy to improve recovery after bariatric surgery, but its large-scale clinical impact remains uncertain.

Objectives: To evaluate the effect of concomitant TAP block on length of stay (LOS) and complication rates in bariatric surgery patients.

Setting: Multi-institutional analysis of 902 accredited bariatric surgery centers across the United States and Canada.

Methods: Retrospective analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Participant Use Data File (2020-2022) comparing patients undergoing primary Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) with or without concomitant TAP block. Primary outcomes were prolonged LOS (>2 standard deviations above mean) and 30-day serious complications. Multivariable logistic regression determined the independent predictive value of TAP block.

Results: Of 511,981 patients, 43,146 (8.4%) received concomitant TAP block. The distribution of procedures was similar between groups: SG (75.7% TAP versus 72.8% no TAP, P < .001) and RYGB (24.3% TAP versus 27.2% no TAP). TAP block patients had slightly more favorable clinical profiles, with lower rates of diabetes (21.8% versus 23.1%, P < .001) and hyperlipidemia (21.4% versus 22.4%, P < .001). Operative time was longer in the TAP block group (89.3 versus 83.8 min, P < .001). Prolonged LOS occurred in 5.6% of TAP block patients versus 5.9% in the no TAP block group. The TAP block group exhibited a statistically significant but clinically modest reduction in prolonged LOS (unadjusted odds ratio [OR] .89, 95% confidence interval [CI] .82-.97, P = .01) with no difference in serious complications (2.7% versus 2.7%, P = .993). Multivariable analysis confirmed TAP block was independently associated with reduced odds of prolonged LOS (adjusted OR .89, 95% CI .82-.97, P = .01).

Conclusions: Concomitant TAP block during bariatric surgery was independently associated with a statistically significant but modest reduction in odds of prolonged LOS, with an absolute difference of .3%, and no increased risk of serious complications. While the absolute effect size is small, at a population level this may translate to meaningful reductions in health care utilization. These findings suggest TAP block may be a safe adjunct for optimizing recovery in bariatric surgery, though the modest magnitude of benefit should be weighed against costs and resource utilization when considering implementation.

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.