Welcome to our weekly round-up of the latest bariatric and obesity-related papers published in the medical literature. As ever, we have looked far and wide to give you an overview of papers including a comparison of LSG plus NF vs LSG alone, bariatric surgery decreases prescription drug costs, VTE rates after primary and revisional RYGB, OAGB has a lower reported postoperative morbidity and comparable weight loss to RYGB or SG, morbidity and mortality by Clavien-Dindo after antireflux and hiatal hernia surgery, and PwO were rated as less urgent and experienced longer wait times and length of stay, and more (please note, log-in maybe required to access the full paper).
Comparative analysis of readmission rates and outcomes: Sleeve gastrectomy with versus without Nissen fundoplication using a National Database
Patients who underwent laparoscopic sleeve gastrectomy (LSG) with Nissen Fundoplication (NF) had a higher prevalence of comorbidities and a longer hospital length of stay, according to researchers from the University of Toledo Medical Center, Toledo, OH.
Reporting in Obesity Reviews, they conducted a retrospective cohort study including 236,111 patients who underwent LSG with and without NF. A matched cohort of 1,096 without NF and 548 with NF was obtained.
The median length of hospital stay was higher in the LSG with NF group and the median total charge was higher in the LSG with NF group. There was no statistically significant difference in 30-day readmission rates in patients with obesity and GERD who received LSG with NF compared to those who received LSG alone. Complications after both procedures were low, which the researchers stated highlights the safety of both procedures.
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Bariatric surgery decreases prescription drug costs for metabolic syndrome: a Canadian population-based cohort study
Bariatric surgery decreases prescription drug costs for metabolic syndrome, according to investigators from the University of Manitoba, Winnipeg, MB, Canada.
Writing in Surgical Endoscopy, the researchers compared the cost of dispensed common prescription medications for metabolic syndrome before and after gastric bypass or sleeve gastrectomy between 2013 and 2019. Specific drug categories that were reviewed for costs five years before and after surgery included antihypertensives, lipid lowering agents, insulin and non-insulin diabetic drugs.
In total, 1184 patients were included in the study, which found there was a decrease in the overall amount of drug dispensed and the overall cost for all drug categories in the five years following surgery. These categories included antihypertensives ($506,268.8), lipid lowering agents ($173,866.48), insulin ($549,305.92) and other diabetes drugs ($513,371.1). They reported that older patients experienced a larger proportion of cost savings compared to younger patients, with the exception of non-insulin diabetic medications which trended to have more cost savings in the 30–49 year old grouping.
The researchers said that future studies will include subgroup analysis by patient age, gender, income quintile and geography.
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Venous Thromboembolic Events Following Revisional Gastric Bypass: An Analysis of the MBSAQIP Database from 2015 to 2019 Using Propensity Matching
US researchers have reported that thromboembolic events (VTE) rates for both primary and revisional Roux-en-Y gastric bypass (RYGB) are similar.
Writing in Obesity Surgery they sought to define the risk of VTE following revisional RYGB compared to primary RYGB. Thirty-day VTE and transfusion rates were compared between the two groups using propensity score matching of 3:1.
Primary RYGB was performed in 197,186 (92.4%) patients compared to 16,144 (7.6%) in the revisional group. Patients in the revisional group had fewer comorbidities than those undergoing primary RYGB. In the matched cohort of 64,258 procedures, there were 48,116 (74.9%) primary RYGB cases compared to 16,142 (25.1%) RYGB revisions. The rate of VTE was similar in the revisional surgery group compared to the propensity matched primary RYGB group (0.4% vs. 0.3%, p>0.580).
They reported transfusion was more common in the revisional group (1.4% vs. 1.0%, p=0.005). Revisional group had higher rates of readmission, reoperation, increased length of stay, and operation length ≥180min, compared to matched primary RYGB group (p<0.001).
However, they found that revisional RYGB cases impose increased risk of bleeding among other outcomes therefore, the researchers cautioned that identifying those at higher risk of complications is critical.
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National introduction of one-anastomosis gastric bypass in the UK National Bariatric Surgery Registry – a cohort study
One-anastomosis gastric bypass (OAGB) has been safely implemented in UK national bariatric surgery practice and has a lower reported postoperative morbidity and comparable weight loss to RYGB or SG, despite being offered to patients with more severe and complex obesity, UK researchers have reported in the International Journal of Surgery.
Using data from the UK National Bariatric Surgical Registry (2010-2019), a total of 59,226 patients underwent primary BMS during the study period (RYGB, 38,434; SG, 24,702; AGB, 12,627; OAGB, 3,408; and Others, 276). They reported the 30-day postoperative morbidity was lower for OAGB 1.8% (51/2,802) compared to RYGB 4.2% (1,391/32,853) and SG 3.4% (725/21,333) but higher than AGB 1.2% (123/9,915), while on multivariate regression, OAGB was associated with reduced morbidity once the institution caseload exceeded 50 operations (p<0.001) and no statistical difference to SG at lesser caseloads.
Overall, 12-month greater than 25% TBWL was seen in 69.4% (27736/39971) (RYGB: 82.9% (17617/21246)), SG: 65.4% (7383/11283)), AGB: 23.9% (1382/5572)) and OAGB: 82.9% (1328/1601)). On multivariate regression, OAGB was associated with the highest 12-month TBWL once the institution caseload exceeded 50 operations (p<0.001).
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Thirty- and 90-Day Morbidity and Mortality by Clavien-Dindo after Surgery for Antireflux and Hiatal Hernia
Antireflux and hiatal hernia operations are safe with rare mortality and modest rates of morbidity, according to researchers from the Providence-Swedish Medical Center, Seattle, WA.
Writing in the Journal of the American College of Surgeons, the study authors evaluated the incidence of 30- and 90-day morbidity and mortality in a large, single-institution dataset. They retrospectively reviewed 2,342 cases of antireflux and hiatal hernia operation from 2003 to 2020 for intraoperative complications causing postoperative sequelae, as well as morbidity and mortality within 90 days.
Of 2,342 patients, the overall 30-day morbidity and mortality rates were 18.2% (427 of 2,342) and 0.2% (4 of 2,342), respectively. Most of the complications were Clavien-Dindo (CD) less than 3a at 13.1% (306 of 2,342). In the 31- to 90-day postoperative period, morbidity and mortality rates decreased to 3.1% (78 of 2,338) and 0.09% (2 of 2,338). CD less than 3a complications accounted for 1.9% (42 of 2,338).
They concluded that the majority of complications patients experience are minor (CD less than 3a) and are easily managed. However, a minority of patients will experience major complications (CD 3a or greater) that require additional procedures and management to secure a safe outcome. These data are helpful to inform patients of the risks of operation and guide physicians for optimal consent, the researcher concluded.
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Healthcare outcomes and dispositions in persons with obesity within emergency departments in Ontario, Canada: A cross-sectional analysis of the National Ambulatory Care Reporting System (NACRS), 2018–2022
Persons with obesity (PwO) were rated as less urgent and experienced longer wait times and length of stay, compared to controls matched by sex, age and main diagnosis, according to researchers from York University, Toronto, ON, Canada.
Writing in PLOSONE, they researchers assessed care in PwO in emergency departments in Ontario, Canada. The study included 4,547 individuals with an obesity diagnosis, and 4547 controls.
They reported that PwO had 4.8 minutes longer wait time for a physician initial assessment (p<0.01), 3.56 hours longer length of stay in the emergency department (p<0.0001) and 55% greater odds of having a less urgent triage score, compared to controls matched for main diagnosis.
When further matched for triage score, PwO experienced over three hours longer length of stay for triage level 2 (emergent, p<0.01), five hours longer for triage level 3 (urgent, p<0.01) and nearly two hours longer for triage level 4 (less urgent, p<0.05) cases.
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