Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery最新文献

{"title":"Identifying drivers of emergency department overutilization following bariatric surgery: insights from the MBSAQIP.","authors":"Qais AbuHasan, Wendy S Li, Louis Massoud, Charles P Burney, Dimitrios Stefanidis, Tarik K Yuce","doi":"10.1016/j.soard.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.soard.2025.01.004","url":null,"abstract":"<p><strong>Background: </strong>Emergency department (ED) overutilization represents an avoidable source of increased health care costs. While bariatric surgery has low rates of postoperative complications, postoperative ED visits have been reported in 10%-15% of patients.</p><p><strong>Objectives: </strong>We aimed to describe the prevalence, predictors, and timing of ED overutilization following bariatric surgery in addition to readmission patterns in ED overutilizers.</p><p><strong>Setting: </strong>Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) centers of excellence across the United States.</p><p><strong>Methods: </strong>Adult patients who underwent bariatric procedures from 2016 to 2022 were identified. Overutilization was defined as ≥2 ED visits without readmission within 30 days of surgery. Multivariable logistic regression, adjusting for patient and procedural characteristics, was used to determine predictors of overutilization and association with 30-day readmission. ED and readmission reasons in addition to days of ED visits and readmissions were characterized in the overutilization cohort.</p><p><strong>Results: </strong>Of the 1,259,946 patients included, 11,818 (.9%) were ED overutilizers. ED overutilizers were predominantly female (88.7%) and had a mean age of 40.8 ± 11 years. Multivariable analysis revealed higher odds of ED overutilization in Black patients (1.30% vs. .84%, adjusted odds ratio [aOR]: 1.46, 95% confidence interval [CI]: 1.40-1.53) and those who underwent Roux-en-Y gastric bypass (1.39% vs. .75%, aOR: 1.74, 95% CI: 1.67-1.82). Postoperative pain (42.7%) and nausea and vomiting (34.5%) were the predominant diagnoses associated with ED visits. Overutilizers presented to the ED earlier compared to patients with only one ED visit (median days postoperatively (interquartile range): 8 (4, 14) versus 11 (5, 19), P < .001). Overutilizers were more likely to get readmitted than patients with no prior ED visits (17.2% vs. 2.9%, aOR: 5.75, 95% CI: 5.47-6.05).</p><p><strong>Conclusion: </strong>ED overutilization following bariatric surgery represents a rare event that appears to be driven by potentially preventable causes including pain, nausea, and vomiting. Predictors of overutilization include patient demographics and procedure type. Understanding these drivers can guide targeted interventions to optimize postoperative care and reduce ED burden.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of food addiction symptomatology with bariatric surgical attrition: a cross-sectional analysis.","authors":"Daisuke Hayashi, Travis D Masterson, Andrea Rigby, Melissa Butt","doi":"10.1016/j.soard.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.soard.2025.01.002","url":null,"abstract":"<p><strong>Background: </strong>Despite the effectiveness of bariatric surgery, there remains a high rate of attrition from surgical programs, highlighting the need to understand factors that influence presurgical attrition rates.</p><p><strong>Objectives: </strong>To investigate the association between food addiction (FA) symptomatology and attrition from bariatric surgery.</p><p><strong>Setting: </strong>Surgical weight-loss program at a single academic medical center.</p><p><strong>Methods: </strong>Data for this analysis were collected from August 2020 until August 2022. Measures included sociodemographic variables, mental health, eating assessments, and FA symptomatology. Data were analyzed using a combination of descriptive statistics, univariable logistic regressions, and a multivariable stepwise logistic regression model.</p><p><strong>Results: </strong>A total of 505 adult patients were included (76.98% female, mean age 42.61 years, 263 [52.08%] undergoing surgery). FA scores were significantly and positively correlated with surgical attrition, current food insecurity, anxiety and depression symptoms, internalized weight bias, lower dietary quality, and distress and impairment due to FA. In the multivariable model, only current food insecurity, depressive symptoms, internalized weight bias, and impairment caused by FA were significant predictors of surgical attrition.</p><p><strong>Conclusions: </strong>Although the number of FA symptoms was not associated in the multivariable model, impairment attributable to FA remained a significant predictor of surgical attrition. This trend suggests that an evaluation of FA may reflect a complex network of factors. Further, FA may not be a predictor of surgical attrition in the absence of perceived clinically significant impairment. Additional research should explore the relationship between impairment attributable to FA and surgical attrition to test the generalizability of these findings.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One anastomosis gastric bypass versus Roux-en-Y gastric bypass as a revisional bariatric procedure: comparing 1-year postoperative outcomes.","authors":"Bradley Schwack, Loic Tchokouani, Akash Gujral, Akshitha Adhiyaman, Megan Jenkins, George Fielding, Christine Ren Fielding","doi":"10.1016/j.soard.2024.12.023","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.023","url":null,"abstract":"<p><strong>Background: </strong>Globally, many surgeons perform varying revisional procedures to convert either a primary sleeve gastrectomy (SG) or laparoscopic adjustable gastric band (LAGB) for the management of recurrent weight gain. There is no consensus on efficacious revision surgery in terms of long-term weight loss and comorbidity management. Nationally, the most common revision procedure is to a Roux-en-Y gastric bypass (RYGB). Internationally, there are other options in frequent use. This includes the one-anastomosis gastric bypass (OAGB). Both RYGB and OAGB have different potential complications and issues but have been very successful in many patients.</p><p><strong>Objectives: </strong>To assess OAGB and RYGB as revision surgery, differences in weight loss, and nutritional status at approximately 1 year.</p><p><strong>Setting: </strong>Single university hospital system.</p><p><strong>Methods: </strong>Patients who underwent OAGB as a revision of SG or LAGB were case matched by age, sex, and primary bariatric procedure to patients who underwent RYGB during January 2019 to October 2022.</p><p><strong>Results: </strong>This study looked at 113 patients with either a primary SG or LAGB. Fifty-eight patients were converted to OAGB, and 55 patients were converted to RYGB. The OAGB cohort had a greater total body weight loss compared with the RYGB. There were no significant differences in postoperative nutritional values between the groups, except for decreased vitamin B12 levels in the RYGB cohort.</p><p><strong>Conclusion: </strong>Patients who underwent conversion from either SG or LAGB to OAGB experienced a greater TBWL at 1-year postoperatively compared with those who underwent conversion to RYGB, without difference in nutritional deficiencies.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal and neonatal outcomes after metabolic and bariatric surgery among women with severe obesity.","authors":"Eylon J Arbel, Ajay A Myneni, Joseph D Boccardo, Iman Simmonds, Heather Link, Aaron B Hoffman, Katia Noyes","doi":"10.1016/j.soard.2024.12.027","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.027","url":null,"abstract":"<p><strong>Background: </strong>Earlier evidence indicated that metabolic and bariatric surgery (MBS) may adversely affect neonatal outcomes among patients conceiving soon after MBS, but recent studies demonstrated conflicting results, especially for new surgical techniques.</p><p><strong>Objectives: </strong>The aim of this study was to assess the effects of MBS types and surgery to birth interval on maternal, birth, and nonbirth outcomes in women with severe obesity.</p><p><strong>Setting: </strong>New York State's all-payer hospital discharge database (2008-2019).</p><p><strong>Methods: </strong>We identified women with severe obesity who underwent MBS (Post-MBS, n = 5001) or did not undergo MBS (No-MBS, n = 74,515), and examined maternal, neonatal, and nonbirth outcomes by MBS type and time since surgery in a propensity score-matched sample.</p><p><strong>Results: </strong>Compared with No-MBS mothers, Post-MBS mothers had a lower incidence of stillbirths, ectopic pregnancies, and miscarriages (nonoverlapping confidence intervals). Post-MBS mothers were also significantly less likely to have pregnancy hypertension, gestational diabetes, and cesarean deliveries, but were more likely to experience vaginal bleeding during early pregnancy and deliver low birthweight newborns compared with No-MBS mothers (P < .05). Among Post-MBS mothers, deliveries within 18 months after surgery were associated with higher rate of cesarean sections and neonatal deaths compared with deliveries 18+ months after MBS (P < .05). Pregnancies after gastric bypass (RYGB) were more likely to result in cesarean deliveries compared with pregnancies after sleeve gastrectomy (P < .01).</p><p><strong>Conclusions: </strong>Although weight loss surgery in women with obesity may reduce the rates of adverse maternal nonbirth outcomes and pregnancy complications, neonates born to women who conceived during the first year after MBS, especially RYGB, may be at higher risk for adverse outcomes.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roux-en-Y gastric bypass improves liver and glucose homeostasis in Zucker diabetic fatty rats by upregulating hepatic trefoil factor family 3 and activating the phosphatidylinositol 3-kinase/protein kinase B pathway.","authors":"Ke Song, Xiangxin Kong, Yin Xian, Zhenghang Yu, Ming He, Dingqi Xiao, Dianyuan Liang, Zhongyang Zhang, Ting Liu, Ziyan Huang, Xinxin Liao, Yixing Ren","doi":"10.1016/j.soard.2024.12.024","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.024","url":null,"abstract":"<p><strong>Background: </strong>Roux-en-Y gastric bypass (RYGB) surgery is effective in ameliorating type 2 diabetes mellitus (T2DM); but its mechanism remains incompletely understood.</p><p><strong>Objectives: </strong>This study aimed to investigate whether RYGB improves glucose metabolism by upregulating hepatic trefoil factor family 3 (TFF3) and thereby activating the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) pathway.</p><p><strong>Setting: </strong>Affiliated Hospital of North Sichuan Medical college in Nanchong city, China.</p><p><strong>Methods: </strong>Zucker diabetic fatty (ZDF) rats underwent RYGB or sham surgery (SHAM), and Zucker lean (ZL) rats served as controls (CON). TFF3 expression and PI3K/Akt pathway activity were compared between groups using western blot, immunofluorescence, and RT-qPCR. Adeno-associated virus (AAV) was used to specifically overexpress and interfere with hepatic TFF3. Liver fibrosis and steatosis were assessed using Masson trichrome and Oil Red O staining. HepG2 cells overexpressing or knocking out TFF3 were constructed using lentiviral transfection and CRISPR/Cas9 technology. After verifying the activity of the PI3K/Akt pathway by western blot, rescue experiments were performed on HepG2 cell overexpressing and knocking out TFF3 using LY294002 and 740Y-P, respectively. The activities of gluconeogenic enzymes and glucose uptake capacity in different HepG2 cells were evaluated using qPCR and flow cytometry.</p><p><strong>Results: </strong>Compared with the SHAM group, the blood glucose, body weight, insulin resistance, and lipid metabolism of ZDF rats in the RYGB group were significantly improved. The expression of TFF3 and PI3K/Akt phosphorylation in the liver of the RYGB group were higher than those of the rats that had undergone SHAM. In addition, compared with the SHAM group, the liver fibrosis and fatty degeneration of RYGB rats were milder, and the activity of gluconeogenic enzymes was lower. After tail vein injection of AAV that specifically overexpresses liver TTF3 in rats in the SHAM group, rats' insulin resistance, glucose tolerance, gluconeogenic enzymes, and other glucose metabolism indicators improved. After tail vein injection of AAV that interferes with liver TFF3 in rats in the RYGB group, rats' glucose metabolism indicators deteriorated. In in vitro experiments, the PI3K/Akt activity of TFF3-knocked-out HepG2 cells was lower than that of other groups. Lower glucose concentration were observed in TFF3-overexpressing cell lines. After rescue experiments, differences were found. The glucose metabolism level of the TFF3-expressing HepG2 cell line was positively correlated with the activity of the PI3K/Akt pathway.</p><p><strong>Conclusions: </strong>RYGB regulates the expression of TFF3 in the liver of ZDF rats, thereby activating the PI3K/Akt pathway and improving T2DM.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity/overweight prevalence and economic burdens by bariatric surgery, metabolic syndrome, and related comorbidity in 2013-2019: a nationwide descriptive analysis.","authors":"Kah Suan Chong, Chun-Ting Yang, Yi-Hsin Chang, Shihchen Kuo, Jian-Han Chen, Chia-Jung Audrey Lee, Erin Chang, Chu-Kuang Chou, Huang-Tz Ou","doi":"10.1016/j.soard.2024.12.026","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.026","url":null,"abstract":"<p><strong>Background: </strong>Existing studies are mainly focused on overall obesity or specific subpopulations, while the disease burden among patients with different characteristics of obesity progression remains uncertain.</p><p><strong>Objectives: </strong>To conduct a descriptive analysis of the contemporary obesity/overweight associated economic burdens stratified by clinically meaningful features associated with obesity.</p><p><strong>Settings: </strong>Utilizing Taiwan's 2013 National Health Interview Survey and the 2012-2019 National Health Insurance Research Database.</p><p><strong>Methods: </strong>Six groups of adults with obesity and/or obesity-related conditions were targeted, including people receiving bariatric surgery (BS, n = 1679), having metabolic syndrome (MS, n = 1437), having body mass index (BMI) ≥27/30 kg/m² with obesity-related comorbidities (ORCs, n = 1428/552), and having BMI ≥27/30 kg/m² (n = 3235/1191). Healthcare utilization/expenditures (in 2022 USD) were measured.</p><p><strong>Results: </strong>In the first year of follow-up, the BS group incurred the highest healthcare expenditures ($3494/person), followed by the MS group ($2852), the BMI ≥30/27 kg/m² with ORCs groups ($2025/$1920), and the BMI ≥30/27 kg/m² groups ($1160/$1032). In the years following BS, the prevalence and treatments for hypertension, diabetes, hyperlipidemia, and sleep apnea decreased significantly, and healthcare expenditures remained the lowest among the 6 groups but increased gradually. Heterogeneity of geographic distribution of obesity prevalence was observed.</p><p><strong>Conclusions: </strong>Interventions tailored to patient characteristics, especially advanced obesity with high economic burden and obesity-associated geographic disparities, are needed. BS may curtail ORCs/MS, but the gradually increasing expenditures following BS would suggest a need of routine follow-ups.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143367199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of candy cane syndrome after Roux-en-Y gastric bypass.","authors":"Hassan Nasser","doi":"10.1016/j.soard.2024.12.019","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.019","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Pregnancy and birth complications among women undergoing bariatric surgery: sleeve gastrectomy versus Roux-en-Y gastric bypass.","authors":"Yasamin Taghikhan, Victoria Lyo","doi":"10.1016/j.soard.2024.12.020","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.020","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on: Bariatric surgery targeting opioid prescribing: a national model for effectively reducing opioid use after bariatric surgery.","authors":"Lee Ying, Saber Ghiassi","doi":"10.1016/j.soard.2024.12.021","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.021","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Pregnancy and birth complications among women undergoing bariatric surgery: sleeve gastrectomy versus Roux-en-Y gastric bypass.","authors":"L Renee Hilton","doi":"10.1016/j.soard.2024.12.018","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.018","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}