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Long-term BPD-DS outcomes

Long-term BPD-DS outcomes show improvement in HrQoL

Study finds that BPD-DS surgery is highly effective and durable, and demonstrate that in the US,the HrQoL in a cohort of 27 patients was reported to be significantly improved with current status

The long-term outcomes of patients who underwent biliary pancreatic diversion surgery with duodenal switch (BPD-DS) revealed significant improvement in health-related quality of life (HrQoL). The 12-14 year outcomes were published in a paper, ‘Biliopancreatic Diversion Revisited: Health-Related Quality of Life Outcomes of Biliary Pancreatic with Duodenal Switch’, were published in the Bariatric Surgical Practice and Patient Care journal.

The authors, Drs Birgit Khandalavala, Jenenne Geske, Maya Nirmalaj from the University of Nebraska, and Ranjan Sudan from the Duke University School of Medicine, North Carolina, used the SF-36 assessment tool to evaluate health-related quality of life (HrQoL) in this group of 27 patients. They then compared the HrQoL scores from the long-term bariatric surgery patients to those obtained pre-surgery from a similar population of patients and to scores from the general population.

They noted that previous European and Canadian studies have shown significant improvement of HrQoL after BPP-DS, ranging from one year after surgery to 12 years post-surgery, “although no data are available from the US population of any duration or type.” As a result, they decided to evaluate the HrQoL in patients who have had BPP-DS at a single academic medical centre in the US, 12–14 years since the time of the procedure, to assess the long-term outcomes.

The study was conducted between January 2014 and April 2014 and the SF-36 survey was mailed to all patients who had bariatric surgery over the past 15 years at the academic medical centre, and included 136 patients who had undergone BPD bariatric surgery (surgeries were performed from 1999 to 2004). A review of electronic medical records provided patient demographic information, including age, preoperative weight, BMI, race, and sex, as well as the details of the date and type of surgery.

Outcomes

Of the 27 patients included in the study, 21 had an open BPD-DS procedure and two a laparoscopic procedure (the type of procedure was unknown for four patients). The SF-36 scores were recorded as t-scores, which could be compared to the overall US population, with a mean of 50 and a population SD of 10 and higher scores representing better health.

As the researchers did not have access to pre-surgical HrQoL scores they used z-tests to compare the results of survey respondents to pre-surgery HrQoL from a similar population of patients who had BPD surgery just before the turn of the century. The comparison population is from a neighbouring Midwestern state and, although not identical to their survey sample, is a close approximation. Both groups had similar presurgical BMIs, the comparison population was a bit younger at the time of surgery, and had fewer men than the surgical sample (Table 1). They estimate, based on the publication date that their surgeries occurred, on average, five to seven years earlier than the surgeries of our sample respondents.

Table 1: Raw Data

The authors said that, “results of z-tests comparing survey respondents to this population suggest that the PCS and MCS scores 12-years post-surgery (Figure 1) are significantly higher than the pre-surgical scores of a similar population, suggesting that the benefits of BPD on HrQoL are long lasting. Our survey sample HrQoL scores did not differ significantly from the expected norms for an average population (mean=50, SD=10).”

Figure 1: SF-36 mean scores

“The results of this study are unique and provide new information, while addressing a void in the literature regarding this operation in the United States. In addition to the weight loss benefits, overall improvement in health and HrQoL is one of the primary goals of surgical treatment,” the authors write. “Our results indicate that, in our sample, the HrQoL was significantly improved, and did not differ from the general population, hence their quality of life (QoL) was normalized and on par with the nonobese cohort. These findings complement those of international studies that demonstrate that long-term outcomes after BPD include an improved QoL.”

They conclude that although BPD-DS surgery is highly effective and durable, their findings demonstrate that in the United States, with a mean follow-up of 12 years, the HrQoL in a cohort of 27 patients was reported to be significantly improved with current status, indicating normalisation of generic HrQoL.

"This is one of the unique studies that describe long-term effectiveness for an operation that is less often performed now," said the journal’s Editor-in-Chief, Dr Edward Lin, Surgical Director, Emory Bariatrics and Director, Gastroesophageal Treatment Center, Emory University School of Medicine, Atlanta, GA. "To know how we are doing with an intervention, it is not enough to say that the patient did well in the first 30-days. The follow-up reported here is one example of patient care excellence."

To access this paper, please click here

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