Anaemia remains a significant but still manageable condition five and ten years after bariatric surgery, but despite the prescription of oral iron supplements to 45% of the patients ten years after surgery, the Hb levels could still not be fully restored, according to Swedish researchers reporting data from the Scandinavian Obesity Surgery Registry (SOReg). The results demonstrate the importance of follow-up visits and continuous evaluation of the need for supplementation, the investigators cautioned. The findings were reported in the paper, ‘Anemia in patients ten years after bariatric surgery’, published in the International Journal of Obesity.
SOReg is a national research and quality register that started in 2007 covering virtually all bariatric surgical procedures in Sweden. The register has more than 80,000 operations with follow-up visits are registered at six weeks, one year, two years, five years and ten years after the operation.
The study authors noted that for patients who have undergone bariatric surgery the risk for anaemia after five and ten years has been scarcely investigated. Therefore, the researchers sought to determine the occurrence of anaemia after bariatric surgery in a national cohort over a longer time span and how it was related to substitution therapy, and complications.
All patients in the SOReg database who had undergone primary bariatric surgery (i.e., Roux-en-Y gastric bypass, sleeve gastrectomy or a Bilio-pancreatic diversion with duodenal switch) with a follow-up period of at least five years were included.
In total, the study included 39,992 patients with a registered Hb value at one or more of the control visits - 29,877 patients prior to surgery, 17,993 after five years and 4,347 after ten years. The Hb mean level was lower at the five-year follow-up compared to preoperative Hb (p<0.001). The difference was lower between the Hb levels at the five-year follow-up compared to the ten-year follow-up, the difference was highly significant (p<0.001). For the group that was followed for ten years (4,347 patients) the mean Hb level was 131.6 g/l, a decrease compared to the level before surgery (140.1 g/l in 474 patients) but comparable to the levels at five years (130.4 g/l in 2,662 patients).
The percentage of patients with anaemia was 18.3 in the whole group after five years vs. 4.1% prior to surgery. The mean Hb levels in the total population of women at ten years follow-up were 129.1 g/L and for men 140.5 g/L, respectively. The mean Hb in the groups with anaemia was 108.5 and 108.8g/L for women and 119.4 and 117.8g/L for men after five and ten years, respectively. The use of oral iron increased from 40 to 45% at follow-up at ten years and the need for parenteral iron intake increased from 5 to 11% at follow-up at ten years.
The prevalence of stomal ulceration was 1–2% in all groups. The use of PPI was 14% after ten years compared to 10% after five years. After ten years in women with anaemia 76 out of 644 patients (12%) were treated with PPI and in men 29 out of 178 (16%) were treated with PPI.
“Even though supplements are prescribed to a substantial subgroup it has not been possible to fully restore the Hb levels to their original levels. Adjustments of the doses or in some cases a more thorough investigation of the underlying causes could be contemplated. In these patients, several causes behind anaemia could be present at the same time,” the authors concluded. “In view of the large minority requiring substitution, it is recommended that the importance of regular follow-up visits is emphasised and that the medication is maintained over time. In view of the high incidence of anaemia after such a long time span as ten years, it is extra important to be aware of the substantial risk for the development of anaemia and malabsorption as time goes by. A patient that has gone through surgery for better health should not have to risk developing other diseases instead that impairs the quality of life.”
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