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 prior MBS associated with reduced risk recurrent stroke, Higher-scoring Bariatric Surgery Assessment and Prioritisation Tool (BAPT) patients have better outcomes, surgery can resolve metabolically unhealthy obesity, MBS and Helicobacter pylori infection, costs of robotic and laparoscopic bariatric surgery, and more (please note, log-in maybe required to access the full paper).
Bariatric surgery association with risk of recurrent stroke hospitalization among older stroke survivors with obesity: A national inpatient sample study (2016–2019)
Researchers from the US and India have reported that prior bariatric surgery (PBS) in older individuals with obesity who survived a stroke was associated with a 23% lower risk of recurrent acute ischemic stroke (AIS) hospitalisation with a decreasing trend of prevalence since 2016.
Their retrospective analysis, published in Obesity Pillars, used National Inpatient Sample data from 2016 to 2019 and assessed older individuals with obesity who survived a stroke (>65 years) and had a recurrent AIS hospitalisation, with or without PBS. Recurrent stroke trends, demographic characteristics and comorbidities between the cohorts were compared.
Analysing 643,505 older individuals with obesity who survived a stroke, 11,820 had undergone PBS. Both groups (no PBS vs. PBS) were predominantly female (59.7% vs. 73.7%), identified as white (76.5 % vs. 83.8 %) and covered by Medicare (91.7% vs. 90.7%). Diabetes, hyperlipidaemia, prior myocardial infarction, and peripheral vascular diseases were more common in those without PBS. In contrast, tobacco use disorder, drug abuse, and valvular diseases were more common in those with PBS. There was no significant difference in the prevalence of hypertension between groups.
From 2016 and 2019, recurrent AIS hospitalisations were less frequent in the PBS group (4%–2.9%, p=0.035) while remaining stable in the other group (4.4 %–4.2 %, p=0.064), therefore the risk of recurrent AIS hospitalisation was less frequent in the PBS cohort (aOR: 0.77, 95 % CI: 0.60–0.98).
The researchers concluded that these findings could influence clinical practice and contribute to developing secondary prevention strategies for recurrent stroke among these patients.
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Prioritising patients for publicly funded bariatric surgery in Queensland, Australia
Higher-scoring Bariatric Surgery Assessment and Prioritisation Tool (BAPT) patients should be prioritised for bariatric surgery as they have a greater likelihood of attaining diabetes remission, researchers from Griffith University, Gold Coast, Queensland, Australia, have reported.
The BAPT was designed as a patient prioritisation instrument to assess patients with excessive weight and type 2 diabetes suitable for bariatric surgery. Writing in the International Journal of Obesity, the researchers assessed whether the instrument successfully identified those who gained the greatest benefits including weight loss, diabetes remission, reduction in comorbidities and health-related quality of life (HR-QoL).
In total, 292 patients referred for bariatric surgery in Queensland between 2017 and 2020 based on their BMI, diabetes status, surgical risk (e.g. pulmonary embolism) and comorbidities (e.g. non-alcoholic steatohepatitis). These data were collected at referral and at 12-months post-surgery for 130 patients and stratified by BAPT scores.
Patients’ BAPT scores ranged from 12 to 78 (possible range 2–98). Those with higher scores tended to be younger (p<0.001), have higher BMI (p<0.001) or require insulin to manage diabetes (p<0.01). All patients lost similar percentages of body weight (20–25%, p=0.73) but higher-scoring patients were more likely to discontinue oral diabetes medications (p<0.001) and the improvement in glycated haemoglobin was four times greater in patients scoring 70–79 points compared to those scoring 20–29 (p<0.05).
Those who scored ≥ 50 on the BAPT were substantially more likely to obtain diabetes remission (57% vs 31%). BAPT scores of 40 and above tended to have greater improvement in HR-QoL.
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Preoperative non-alcoholic steatohepatitis and resolution of metabolic comorbidities after bariatric surgery
Bariatric surgery can resolve metabolically unhealthy obesity (MUO) independent of liver health status, operative procedure and sex, German researchers have reported.
Writing in SOARD, the aim of this study was to assess the influence of liver health status, operative procedure and sex on postoperative switch from a MUO to a metabolic health (MH) phenotype.
One hundred thirty-three patients (73% female) with a mean BMI of 52.0 kg/m2 and mean age of 43 years were included in this study (55.6% underwent RYGB, 44.4% underwent SG). Non-alcoholic fatty liver disease (NAFLD) was found in 51.1% and non-alcoholic steatohepatitis (NASH) in 33.8% patients. All patients were diagnosed MUO at baseline. Postoperatively, 38.3% patients (n=51) switched to a MH condition. Mean time to MH was 321 days and mean excess BMI loss to MH was 63.8%. There were no differences regarding liver health status, operative procedure or sex.
Patients should be closely monitored to ensure sustainable long-term outcomes following the switch to the MH condition, the researchers added.
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Effect of Helicobacter pylori on sleeve gastrectomy and gastric microbiome differences in patients with obesity and diabetes
Researchers from South Korea have found that patients with obesity and diabetes clearly benefit from MBS, but Helicobacter pylori infection may also affect clinical improvement.
Reporting in the International Journal of Obesity, they confirmed the effect of sleeve gastrectomy according to the state of the gastric microbiota in 40 patients with obesity, DM and H pylori infection. Patients with obesity were divided into four groups: non-DM without H. pylori infection (ND), non-DM with H. pylori infection (ND-HP), DM, and DM with H. pylori infection (DM-HP) using 16S V3–V4 sequencing.
In the DM group, ALT, haemoglobin, HbA1c, blood glucose, and HSI significantly decreased, whereas high-density lipoprotein significantly increased. However, in the H. pylori-positive group, no significant difference was observed. The diversity of gastric microbiota decreased in the order of the ND > DM > ND-HP > DM-HP groups.
They also conducted a correlation analysis between the preoperative microbes and clinical data. In the ND-HP group, most of the top 20 gastric microbiota were negatively correlated with glucose metabolism. However, H. pylori infection was positively correlated with pre-insulin levels.
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Costs of Robotic and Laparoscopic Bariatric Surgery: A Retrospective Propensity Score-matched Analysis
Overall hospital costs were higher in patients who underwent robotic procedures vs. laparoscopic yet a clinical advantage has not been demonstrated so far, according to researchers from Switzerland.
Reporting in Obesity Surgery, they retrospectively collected data of all patients (122 patients enrolled in the study, 42 were subsequently chosen based on propensity scores, with 21 patients allocated to each group), who underwent either robotic or laparoscopic bariatric surgery. The primary endpoint was hospital costs in the robotic and laparoscopic groups.
The found no difference in clinical characteristics and postoperative – the length of hospital stay was 2.4±0.7 days vs. 2.6±1.1 days (p = 0.520). In the robotic and laparoscopic groups, total costs were US$16,275±4,018 vs. US$12,690±2,834 (absolute difference US$3,585, 95%CI 1416–5753, p=0.002), direct costs were US$5,037±1,282 vs. US$3,720±1,308 (absolute difference US$1,316, 95% CI 509–2214, p=0.002) and indirect costs were US$11,238±3234 vs. US$8970±3,021 (absolute difference USD 2,268, 95% CI 317–4220, p=0.024). Subgroup analyses revealed a decreasing trend in the cost difference in patients undergoing primary gastric bypass and revisional surgery.
A subgroup analyses showed lesser disparity in costs among patients undergoing revisional bariatric surgery, where robotics are likely to be more worthwhile.
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