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Post-operative complications

Complications and re-hospitalisation after RYGB

Credit: Samuel Bendet, US Air Force
The symptoms most commonly leading to healthcare contact after RYGB surgery were abdominal pain, fatigue and anaemia

The prevalence of symptoms such as abdominal pain and fatigue after Roux-en-Y gastric bypass (RYGB) surgery are were high and nearly one-third of patients hospitalised, according to a study published online by JAMA Surgery. The paper, ‘Prevalence of Self-reported Symptoms After Gastric Bypass Surgery for Obesity’, examined patients’ overall well-being and the prevalence and predictors of medical, nutritional, and surgical symptoms after RYGB surgery, and their association with quality of life (QoL).

For patients with morbid obesity, bariatric surgery (including RYGB surgery), is an effective treatment for weight loss and diseases associated with obesity. However, various medical, nutritional and surgical symptoms requiring treatment may occur after RYGB surgery and may impair patients' quality of life (QoL). The study authors note that knowledge about possible predictors of these symptoms is important for prevention.

Dr Sigrid Bjerge Gribsholt of Aarhus University Hospital, Aarhus, Denmark, and colleagues surveyed patients who underwent RYGB surgery between January 2006 and December 2011 in the Central Denmark Region. A comparison cohort of 89 individuals who were matched with patients according to sex and body mass index but who did not undergo RYGB surgery were surveyed as a point of reference. The researchers measured the prevalence and severity (based on contacts with health care system, ranging from no contact to hospitalisation) of self-reported symptoms following RYGB surgery.

Of 2,238 patients undergoing RYGB surgery, 1,429 (63.7%) responded to the survey. Among these patients, 1,266 (88.6%) reported one or more symptoms a median of 4.7 years after RYGB surgery. Mean age at the time of the survey was 47.1 years (range, 26.9-68.0 years) and 286 were men (20.0%). A total of 1,219 of 1,394 patients (87.4%) reported that their well-being was improved after vs before RYGB surgery, while 113 (8.1%) reported reduced well-being.

Symptoms after RYGB surgery were reported by 1,266 patients (88.6%); 966 patients (67.6%) had been in contact with the healthcare system about their symptoms vs 31 [34.8%] of those in the comparison group, and 416 (29.1%) had been hospitalised vs 6 [6.7%] of those in the comparison group.

The symptoms most commonly leading to healthcare contact after RYGB surgery were abdominal pain (489 [34.2%]), fatigue (488 [34.1%]), and anaemia (396 [27.7%]). The risk of symptoms was higher among women (crude PR, 1.23; 95% CI, 1.11-1.37), among patients younger than 35 years (PR, 1.24; 95% CI, 1.13-1.36), among smokers (PR, 1.11; 95% CI, 1.02-1.20), among unemployed persons (PR, 1.15; 95% CI, 1.06-1.24) and in those with surgical symptoms before RYGB surgery (PR, 1.34; 95% CI, 1.25-1.43). Quality of life was inversely associated with the number of symptoms (r = –0.30; P < .001).

The researchers note that although most patients reported improved well-being after RYGB surgery, the prevalence of symptoms was high and nearly one-third of patients were hospitalized, 4- to 5-fold more than among the comparison group. They add that predictors of symptoms included young age, female sex, smoking and experiencing symptoms before RYGB surgery.

"Focus on the QoL among patients with many symptoms may be required since such patients are at risk of depression. Development of new weight loss treatments with less risk of subsequent symptoms should be a high priority," the authors write. 

This study was supported by the NovoNordisk Foundation, The AP Moller Foundation and the Research Council of Central Denmark Region. 

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