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Quality of life

Surgery improves quality of life finds MA II questionnaire

They noted significant differences in QoL improvements between different types of bariatric surgery

Bariatric surgery improves the quality of life of (QoL) patients – and using the Moorehead–Ardelt Quality of Life Questionnaire II (MA II) – researchers were able to identify those factors patients associated with improvements in the QoL. They report that QoL among obese patients was dependent on age, gender, history of bariatric surgery and partnered status, although BMI was was not associated with outcome in MAII.

The paper, ‘Quality of Life and Bariatric Surgery: Cross-Sectional Study and Analysis of Factors Influencing Outcome’, published in the journal Obesity Surgery, compared quality of life (QOL) in obese patients after bariatric surgery with that in controls seeking surgery and to investigate which factors are associated with QOL in the Moorehead–Ardelt Quality of Life Questionnaire II (MA II).

In this cross sectional study, data were collected from two separate groups – the operated groups comprised 28 patients at 12–18 months after LSG (post-LSG subgroup) and 30 patients at 12–18 months after LRYGB (post-LRYGB subgroup), and a control group consisting of 101 patients seeking bariatric surgery.

A questionnaire was sent via e-mail to the operated group and there was a response rate of 19%. In the controls, the questionnaires were collected prior to surgery and resulted in a 90% response rate.

The Moorehead–Ardelt Quality of Life Questionnaire II (MA II) is used as a part of the Bariatric Analysis and Reporting Outcome System (BAROS). The authors explain that is a six-item self-report questionnaire that assesses the patient’s subjective impression of QOL across six areas of general self-esteem, physical activity, social contacts, work satisfaction, sexual pleasure, and focus on eating behavior. Each item is scored from −0.5 to +0.5. The total score ranges from −3 to +3 and defines five outcome groups: poor, very poor, fair, good, and very good. Good and very good outcomes are considered as satisfactory.

Outcomes

The outcomes revealed that the operated and control groups were comparable regarding gender, age, and partnered status, although the prevalence of diabetes and hypertension was higher in the control group. The post-LRYGB and post-LSG subgroups were comparable regarding gender, partnered status, smoking status, and hometown population. There were differences in age, BMI, and hypertension between the post-operative and control groups.

Nineteen patients had hypertension including ten patients in LRYGB subgroup and nine patients in LSG group. There were eleven cases had diabetes, including nine patients in LRYGB subgroup and two patients in LSG group. Patients qualified to LRYGB were younger and had a higher percentage of diabetes. Preoperative characteristic of operated group was comparable to controls in terms of BMI, prevalence of diabetes, and hypertension.

In the MA II, the total score was 1.70±0.76 in the operated group, which was significantly higher than 0.59±1.17 in the control group (p<0.01). Detailed analysis revealed significantly higher scores in the following areas: general self-esteem, physical activity, social contacts, and focus on eating behavior. The QoL outcomes were significantly different between the post-operative and control groups. A satisfactory QoL outcome in MA II (endpoint) was achieved in 48 patients in the operated group and 33 in the control group (8.89, 95 % confidence interval (CI) 3.98–19.79, p<0.05).

The total MA II score in the post-LSG patients was 1.71±0.76 and 1.70±0.77 in the post-LRYGB subgroup. Regarding detailed QoL scoring, there was no difference between patients who underwent LSG or LRYGB, and the prevalence of different outcomes was similar in both post-surgical groups.

Of the nine examined variables, only the following were predictive for satisfactory QOL outcome in multivariate analysis: age (OR 0.955; 95 % CI 0.911–1.002), female gender (OR 0.546; 95 % CI 0.241–1.234), no history of bariatric surgery (OR 0.113; 95 % CI 0.044–0.290), and non-partnered status (OR 3.154; 95 % CI 0.752–13.222).

“Among nine examined variables, age, gender, history of bariatric surgery, and partnered status had an influence on QoL. History of surgery had the strongest independent association with the probability of satisfactory QoL outcome.” the authors write. “…The study revealed that age, gender, and partnered status were confounders for QoL outcome and should be take into account in further studies about QoL and bariatric surgery. Surprisingly, BMI was not associated with QoL score. Moreover, in the detailed analysis of post-operative patients we found that the body mass reduction was not correlated with total score in MAII.”

They also noted significant differences in QoL improvements between different types of bariatric surgery and remarked that there is a need for new studies comparing QoL outcome after LSG and LRYGB, as in the reported literature there is little about the difference between these two procedures in terms of QoL.

“This study demonstrates that patients after bariatric surgery have a higher score in the MA II, which reflects better QOL,” the authors conclude. “However, the scoring adjusted for the type of operation is comparable. QOL among obese patients is dependent on age, gender, history of bariatric surgery, and partnered status. Weight loss was not associated with better outcome in MAII.”

This article was published under the Open Access license.

To access this paper, please click here

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