Surgery for Obesity and Related Diseases最新文献

{"title":"Association of psychiatric history with hypertension among adults who present for metabolic and bariatric surgery","authors":"Gabriel S. Tajeu Dr.P.H., M.P.H. ,&nbsp;Jingwei Wu Ph.D. ,&nbsp;Colleen Tewksbury Ph.D. ,&nbsp;Jacqueline C. Spitzer M.S.Ed. ,&nbsp;Daniel J. Rubin M.D., M.Sc ,&nbsp;Crystal A. Gadegbeku M.D. ,&nbsp;Rohit Soans M.D. ,&nbsp;Kelly C. Allison Ph.D. ,&nbsp;David B. Sarwer Ph.D.","doi":"10.1016/j.soard.2024.10.004","DOIUrl":"10.1016/j.soard.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Psychiatric diagnoses are common among adults with severe obesity (body mass index [BMI] ≥40 kg/m²) and may be associated with hypertension.</div></div><div><h3>Objectives</h3><div>To determine the association between lifetime and current psychiatric diagnoses, separately, with hypertension, uncontrolled blood pressure (BP), and systolic BP (SBP) among adults with severe obesity undergoing metabolic and bariatric surgery (MBS).</div></div><div><h3>Setting</h3><div>Academic medical center.</div></div><div><h3>Methods</h3><div>Outcomes were identified from electronic medical records. Psychiatric diagnoses were assessed by clinical interview and included any bipolar and related disorder or depressive disorders, anxiety, alcohol use disorder, substance use disorder, post-traumatic stress disorder, and eating disorders. Adjusted odds ratios for the association between psychiatric diagnoses and hypertension and uncontrolled BP, separately, were calculated using logistic regression. Linear regression was used to determine the association of psychiatric diagnoses with SBP. Models were adjusted for age, sex, race, and BMI.</div></div><div><h3>Results</h3><div>There were 281 participants with mean age of 40.5 years (standard deviation = 10.9) and BMI of 45.9 kg/m² (standard deviation = 6.2). Participants were predominantly women (86.5%) and Black (57.2%). Overall, 44.8% had hypertension and 32.5% of these individuals had uncontrolled BP. The adjusted odds ratios for hypertension was higher (2.95; 95% confidence interval 1.48–5.87) and SBP was greater (3.50 mm Hg; <em>P</em> = .048) among participants with a lifetime diagnosis of anxiety compared with those without. Participants with any current psychiatric diagnosis had a higher SBP compared to those who did not have a current psychiatric diagnosis (3.62 mm Hg; <em>P</em> = .029).</div></div><div><h3>Conclusions</h3><div>A diagnosis of anxiety during the lifetime of patients undergoing MBS was associated with almost three times increased odds of hypertension.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"21 3","pages":"Pages 279-287"},"PeriodicalIF":3.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National trends in using revisional surgeries post-sleeve gastrectomy due to reflux and weight recurrence: a matched case-control analysis","authors":"Thomas H. Shin M.D., Ph.D. ,&nbsp;Pourya Medhati M.D. ,&nbsp;Vasundhara Mathur M.D. ,&nbsp;Abdelrahman Nimeri M.D. ,&nbsp;Eric G. Sheu M.D., Ph.D. ,&nbsp;Ali Tavakkoli M.D.","doi":"10.1016/j.soard.2024.09.011","DOIUrl":"10.1016/j.soard.2024.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Several options exist for surgical conversion after sleeve gastrectomy (SG), but a definitive safety profile for each option by indication for conversion remains unclear.</div></div><div><h3>Objectives</h3><div>To determine and compare 30-day risk profiles of SG conversion to Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodenoileostomy (SADI).</div></div><div><h3>Methods</h3><div>Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program national database entries from 2020 to 2022 were used to identify 25,760 adult patients who underwent SG conversion to RYGB, BPD-DS, or SADI. Subgroup analyses were performed among 6106 conversions completed for weight-related complications (RYGB: 3053 patients; BPD-DS: 1826 patients; SADI: 1227 patients). Multivariable analysis and 1:1 nearest-neighbor matching were used to further characterize the 30-day risk profile of each conversion.</div></div><div><h3>Results</h3><div>Patients with RYGB conversions had a lower preoperative body mass index compared with those with BPD-DS + SADI conversions (39.8 versus 46.1, <em>P</em> &lt; .001) and significantly lower rates of medical comorbidities. The distribution of conversion indication for each MBS configuration varied, where most RYGB conversions were for reflux (56.1%) whereas most BPD-DS + SADI conversions were for weight-related complications (87.3%; <em>P</em> &lt; .001). On 1:1 matched analysis of conversions for weight recurrence, odds of 30-day complications (odds ratio .73, <em>P</em> = .019) and readmission (odds ratio .77, <em>P</em> = .031) were lower in BPD-DS + SADI conversions compared with RYGB. There were no significant differences in odds of 30-day reintervention or reoperation between conversion to RYGB and BPD-DS + SADI. Major differing drivers of complications between conversion types included hemorrhage (RYGB 1.98% versus BPD-DS + SADI .87%; <em>P</em> = .001).</div></div><div><h3>Conclusions</h3><div>For weight recurrence after SG, conversion to BPD-DS + SADI does not have greater 30-day complications than RYGB and may be a safe conversion option.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"21 3","pages":"Pages 240-246"},"PeriodicalIF":3.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subjective improvement of reflux symptoms after conversion of sleeve gastrectomy to Roux-en-Y gastric bypass and concomitant repair of hiatal hernia","authors":"Luke Umana M.D.,&nbsp;Jenalee Corsello M.D.,&nbsp;Thomas Grist B.S.,&nbsp;John Paul Gonzalvo D.O.,&nbsp;John Dietrick M.D.,&nbsp;Michel M. Murr M.D.","doi":"10.1016/j.soard.2024.09.014","DOIUrl":"10.1016/j.soard.2024.09.014","url":null,"abstract":"<div><h3>Background</h3><div>Symptoms of reflux after sleeve gastrectomy (SG) are common and may be refractory to medical treatment.</div></div><div><h3>Objectives</h3><div>To assess outcomes of conversion of SG to Roux-en-Y gastric bypass (RYGB) with concomitant repair of hiatal hernias on symptoms of reflux.</div></div><div><h3>Setting</h3><div>Tertiary community hospital.</div></div><div><h3>Methods</h3><div>We reviewed data from all consecutive patients (2018–2021) who underwent conversion from SG to RYGB for refractory reflux symptoms. Concomitant hiatal hernias were diagnosed endoscopically or radiographically. Improvement in reflux symptoms, nausea, vomiting, dysphagia, or abdominal pain and postoperative proton pump inhibitor (PPI) use were compared with McNemar statistical test. Data are reported as mean ± standard deviation.</div></div><div><h3>Results</h3><div>In total, 64 patients (92% female; 48 ± 10 years) underwent conversion from SG to RYGB and repair of concomitant hiatal hernias 4 ± 3 years after the index SG. A hiatal hernia was detected preoperatively in 57 of 64 patients (89%) by either upper gastrointestinal contrast studies, computed tomography scan, or esophagogastroduodenoscopy. At 29 ± 14 months postconversion to RYGB, percent total body weight loss was 14 ± 9% and percent excess weight loss was 37 ± 29%, and body mass index decreased from 37 ± 7 to 32 ± 6 kg/m². Symptoms of reflux and use of PPI improved during the early follow-up period (median: 14 months; <em>P</em> &lt; .001) and was sustained at late follow-up (median: 32 months; <em>P</em> &lt; .01). Improvement of nausea and dysphagia reached statistical significance at late follow-up (median: 32 months; <em>P</em> &lt; .01). Vomiting and abdominal pain decreased with time but did not reach statistical significance. Postoperative complications were deep surgical-site infection (n = 3), pulmonary embolism (n = 1), bleeding (n = 5), reoperation (n = 3), and 30-day readmission (n = 6).</div></div><div><h3>Conclusions</h3><div>Conversion of SG to RYGB and repair of concomitant hiatal hernia improves reflux symptoms, nausea, and dysphagia, reduces PPI use, and confers additional weight loss.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"21 3","pages":"Pages 256-262"},"PeriodicalIF":3.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparable results 5 years after one anastomosis gastric bypass compared to Roux-en-Y gastric bypass: a propensity-score matched analysis","authors":"Lindsy van der Laan M.D. ,&nbsp;Dionne Sizoo M.Sc., Ph.D. ,&nbsp;André P. van Beek M.D., Ph.D. ,&nbsp;Marloes Emous M.D., Ph.D.","doi":"10.1016/j.soard.2024.09.009","DOIUrl":"10.1016/j.soard.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies comparing one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) are often limited by retrospective designs, or in randomized controlled trials, by small sample sizes or limited follow-up durations.</div></div><div><h3>Objectives</h3><div>This study aims to compare OAGB and RYGB during 5<!--> <!-->years of follow-up in terms of weight loss, remission of comorbidities, and complications.</div></div><div><h3>Setting</h3><div>This longitudinal prospective study includes all patients who underwent a primary OAGB or RYGB between 2015 and 2016 in the Netherlands, utilizing data from the nationwide registry, Dutch Audit for Treatment of Obesity.</div></div><div><h3>Methods</h3><div>A 1:1 propensity-score matched (PSM) comparison between patients with OAGB and RYGB.</div></div><div><h3>Results</h3><div>After 1:1 PSM, 2 nearly identical cohorts of 860 patients were obtained. OAGB was associated with more intraoperative complications (2.0% versus .6%; <em>P</em> = .031). Conversely, RYGB had a higher rate of short-term complications (7.6% versus 3.8%; <em>P</em> &lt; .001). Five-year data were available from 40.7% of the patients with OAGB and 34.9% with RYGB. No significant differences were observed in percentage total weight loss after 5<!--> <!-->years (30.0% after OAGB and 28.8% after RYGB; <em>P</em> = .099). The total remission rate of diabetes mellitus was 60.5% for OAGB and 69.4% for RYGB (<em>P</em> = .656). However, OAGB resulted in a significantly higher remission rate of hypertension compared to RYGB (60.2% versus 45.5%; <em>P</em> = .015).</div></div><div><h3>Conclusions</h3><div>OAGB and RYGB yield comparable weight loss outcomes. However, OAGB had more intraoperative complications, while RYGB had more short-term complications. Both procedures show similar efficacy in diabetes mellitus remission, but OAGB is more effective in achieving hypertension remission.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"21 3","pages":"Pages 263-270"},"PeriodicalIF":3.5,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Obesity-related Metabolic Conditions: a novel objective scoring system better informs metabolic disease severity","authors":"Victoria Lyo M.D., M.T.M. ,&nbsp;John Arriola M.D. ,&nbsp;Shushmita M. Ahmed M.D. ,&nbsp;Rouzbeh Mostaedi M.D. ,&nbsp;Zainab Akinjobi M.Sc. ,&nbsp;Hazem N. Shamseddeen M.D. ,&nbsp;Mohamed R. Ali M.D.","doi":"10.1016/j.soard.2024.09.004","DOIUrl":"10.1016/j.soard.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Reporting of obesity-associated metabolic disease severity and longitudinal response to bariatric surgery is not standardized. We updated our co-morbidity scoring tool to the Assessment of Obesity-related Metabolic Conditions (AOMC) to combine pharmacotherapy and biochemical data to score diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DYS) severity.</div></div><div><h3>Objectives</h3><div>The aim of this study is to determine whether the AOMC system more accurately stages metabolic disease severity than a clinically based Assessment of Obesity-Related Comorbidities (AORC) system.</div></div><div><h3>Setting</h3><div>University hospital, United States.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of prospectively collected demographic, clinical, and biochemical data was performed on adults evaluated for bariatric surgery over 6<!--> <!-->years. AORC versus AOMC scores and disease severity were compared using McNemar’s and Wilcoxon’s tests.</div></div><div><h3>Results</h3><div>Of 1442 patients, AOMC newly diagnosed metabolic disease in more patients than did AORC: DM (73.4% versus 44.5%), HTN (91.7% versus 67.9%), and DYS (63.8% versus 53.4%). Of those on pharmacotherapy, AOMC found fewer patients with adequately controlled disease: DM (39.9% versus 97.7%), HTN (64.7% versus 99.3%), and DYS (51.8% versus 99.0%). For those in whom both scores could be calculated, disease severity was upstaged in most patients: DM (65.9%), HTN (42.9%), and DYS (30.9%). There were also significant shifts toward higher scores for all conditions and severity classifications, with more patients diagnosed with pre–metabolic and severe disease (untreated/uncontrolled).</div></div><div><h3>Conclusions</h3><div>Our study demonstrated that the severity of DM, HTN, and DYS is vastly under-represented by clinical history alone and lacks standardized assessments. Our AOMC tool more accurately describes longitudinal metabolic response to bariatric surgery.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"21 3","pages":"Pages 207-215"},"PeriodicalIF":3.5,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142484697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SOARD Category 1 CME Credit Featured Articles, Volume 20, October 2024","authors":"","doi":"10.1016/j.soard.2024.08.027","DOIUrl":"10.1016/j.soard.2024.08.027","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 10","pages":"Pages 987-989"},"PeriodicalIF":3.5,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cartoon","authors":"","doi":"10.1016/j.soard.2024.08.028","DOIUrl":"10.1016/j.soard.2024.08.028","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 10","pages":"Page 990"},"PeriodicalIF":3.5,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142162045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SOARD Category 1 CME Credit Featured Articles, Volume 20, September 2024","authors":"","doi":"10.1016/j.soard.2024.08.023","DOIUrl":"10.1016/j.soard.2024.08.023","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 9","pages":"Pages 890-892"},"PeriodicalIF":3.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cartoon","authors":"","doi":"10.1016/j.soard.2024.08.024","DOIUrl":"10.1016/j.soard.2024.08.024","url":null,"abstract":"","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 9","pages":"Page 893"},"PeriodicalIF":3.5,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142083519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting serious postoperative complications and evaluating racial fairness in machine learning algorithms for metabolic and bariatric surgery","authors":"Dong-Won Kang Ph.D. ,&nbsp;Shouhao Zhou Ph.D. ,&nbsp;Russell Torres Ph.D. ,&nbsp;Abhinandan Chowdhury Ph.D. ,&nbsp;Suman Niranjan Ph.D. ,&nbsp;Ann Rogers M.D. ,&nbsp;Chan Shen Ph.D.","doi":"10.1016/j.soard.2024.08.008","DOIUrl":"10.1016/j.soard.2024.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Predicting the risk of complications is critical in metabolic and bariatric surgery (MBS).</div></div><div><h3>Objectives</h3><div>To develop machine learning (ML) models to predict serious postoperative complications of MBS and evaluate racial fairness of the models.</div></div><div><h3>Setting</h3><div>Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database, United States.</div></div><div><h3>Methods</h3><div>We developed logistic regression, random forest (RF), gradient-boosted tree (GBT), and XGBoost model using the MBSAQIP Participant Use Data File from 2016 to 2020. To address the class imbalance, we randomly undersampled the complication-negative class to match the complication-positive class. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), precision, recall, and F1 score. Fairness across White and non-White patient groups was assessed using equal opportunity difference and disparate impact metrics.</div></div><div><h3>Results</h3><div>A total of 40,858 patients were included after undersampling the complication-negative class. The XGBoost model was the best-performing model in terms of AUROC; however, the difference was not statistically significant. While the F1 score and precision did not vary significantly across models, the RF exhibited better recall compared to the logistic regression. Surgery type was the most important feature to predict complications, followed by operative time. The logistic regression model had the best fairness metrics for race.</div></div><div><h3>Conclusions</h3><div>The XGBoost model achieved the highest AUROC, albeit without a statistically significant difference. The RF may be useful when recall is the primary concern. Undersampling of the privileged group may improve the fairness of boosted tree models.</div></div>","PeriodicalId":49462,"journal":{"name":"Surgery for Obesity and Related Diseases","volume":"20 11","pages":"Pages 1056-1064"},"PeriodicalIF":3.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}