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

{"title":"Impact of high-protein bariatric diet on the prevention of postoperative nausea and vomiting.","authors":"Brigitte Anderson, Amrita Iyer, Martina Rama, Abigail M O'Connell, Anna P Torres, Scott H Koeneman, Renee Tholey, Alec Beekley, Francesco Palazzo, Talar Tatarian","doi":"10.1016/j.soard.2025.02.002","DOIUrl":"https://doi.org/10.1016/j.soard.2025.02.002","url":null,"abstract":"<p><strong>Background: </strong>Postoperative nausea and vomiting (PONV) commonly occurs following metabolic/bariatric surgery, contributing to increased health care utilization and length of stay (LOS). Studies have suggested the benefit of protein-predominant meals in suppressing gastric tachyarrhythmia and PONV.</p><p><strong>Objective: </strong>To investigate the impact of a high-protein postoperative liquid diet on PONV and LOS after primary sleeve gastrectomy (SG).</p><p><strong>Setting: </strong>University Hospital, United States.</p><p><strong>Methods: </strong>This prospective randomized trial included adult patients undergoing primary SG. Exclusion criteria were history of bariatric/foregut surgery, chronic nausea/vomiting, HbA1C ≥9, or therapeutic anticoagulation. Patients were randomized 1:1 to receive a clear liquid (control) or high-protein full-liquid diet (intervention) starting 4 hours postoperatively. The primary endpoint was incidence of PONV. Secondary endpoint was increased LOS due to PONV. Pearson's chi squared test for independence compared outcomes between groups on an intention to treat basis.</p><p><strong>Results: </strong>One-hundred and twelve patients were randomized (56 control, 56 intervention). Most patients were female (80.4%). All underwent laparoscopic (72.3%) or robotic (27.7%) SG and 90.2% received inhalational anesthesia. In the intervention arm, 15 patients had zero protein intake due to PONV, 6 had missing data, and 35 had a mean intake of 24.2 grams. There was no observed treatment effect on PONV (78.6% control versus 89.3% intervention; P = .20). Almost 70% of patients were discharged home on postoperative day (POD) 1. Delay in discharge due to PONV was not significant between groups (32.1% control versus 28.6% intervention; P = .84).</p><p><strong>Conclusions: </strong>Early introduction of liquid protein after SG does not improve PONV or LOS.</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":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639953","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: Risk assessment for esophageal cancer after bariatric surgery: a comparative cohort study between sleeve gastrectomy and gastric bypass.","authors":"Enrico Facchiano, Emanuele Soricelli","doi":"10.1016/j.soard.2025.01.013","DOIUrl":"https://doi.org/10.1016/j.soard.2025.01.013","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":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538287","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":"Payor status differences in 30-day and 1-year outcomes after primary laparoscopic bariatric surgery.","authors":"Arielle Grieco, Clifford Y Ko, Stacy A Brethauer, Anthony T Petrick","doi":"10.1016/j.soard.2025.01.015","DOIUrl":"https://doi.org/10.1016/j.soard.2025.01.015","url":null,"abstract":"<p><strong>Background: </strong>There was a call for research regarding safety and efficacy of bariatric surgery in Medicare beneficiaries. Payor status may be an indicator of both health and socioeconomic status.</p><p><strong>Objectives: </strong>The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) sought to explore the association of insurance type in U.S. patients receiving primary bariatric surgery on both postoperative risks and benefits.</p><p><strong>Setting: </strong>Not-for-profit organization, clinical data registry.</p><p><strong>Methods: </strong>MBSAQIP data from primary laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) cases performed in 2021 along with follow-up records through 18 months postoperatively were included (N = 156,046). All analyses were stratified by age (<65 years, n = 149,949; ≥65 years, n = 6097). Hierarchical logistic regression models for 30-day adverse events, and longitudinal models for percent total weight loss and cox regression models for mortality and comorbidity remission rates through 1 year were performed.</p><p><strong>Results: </strong>Among those <65 years, Medicare patients showed greatest risk for 30-day postoperative complications followed by Medicaid, private insurance, and self-pay patients aligning with preoperative risk profiles. Private insurance holders <65 years lose 1.5% more of their total preoperative weight and show greater rates of comorbidity remission at 12 months than Medicare patients. Across all payor groups <65 years, scenario-based survival probabilities through 1-year are ∼99%, 25% total weight loss or greater is realized, and 33% to over 75% of those with respective comorbidities experience remission. No meaningful payor status differences were noted among those ≥65 years.</p><p><strong>Conclusions: </strong>Payor status may be an indicator of both health and socioeconomic status, where traditional risk adjustment is inappropriate. Results reinforce these complex relationships, but also prove immense benefits of bariatric surgery regardless of payor type.</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":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589134","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":"The relationship between physical activity, sedentary time, and cognitive function following bariatric surgery.","authors":"Urja Bhatia, Dale Bond, Jeffrey A Ciesla, John Gunstad, Ian Carroll, Ross Crosby, James E Mitchell, Christine M Peat, Kristine Steffen, Leslie Heinberg","doi":"10.1016/j.soard.2025.01.010","DOIUrl":"https://doi.org/10.1016/j.soard.2025.01.010","url":null,"abstract":"<p><strong>Background: </strong>Obesity is associated with cognitive impairment. Metabolic and bariatric surgery (MBS) improves cognitive functioning and weight loss is not a primary mechanism. Physical activity (PA) and sedentary time (ST) may play an important role in cognitive outcomes following MBS, though few studies have examined this possibility.</p><p><strong>Objectives: </strong>Prospectively examine the relationship among PA, ST, and cognitive function following MBS, as well as possible sex differences in these associations.</p><p><strong>Setting: </strong>Data were collected at 2 health centers in the United States.</p><p><strong>Methods: </strong>MBS patients (n = 138, 42.9 ± 10.5 years of age, body mass index of 46.3 ± 7.3 kg/m²) completed the National Institute of Health Toolbox, a computerized neuropsychological battery, and wore an accelerometer for 7 days at preoperative baseline and 1, 6, and 12-month postoperative follow-up to measure ST, light-intensity PA (LPA), and moderate-to-vigorous intensity PA (MVPA).</p><p><strong>Results: </strong>Total attrition rate was 33.3%. Multilevel modeling showed that ST was negatively associated with List Sorting Working Memory (β_0j=-.02,t(379.77)=-3.89,p<.001,95%CI=[-.03,-.01],d=0.26) and Picture Sequence Memory (β_0j=-.02,t(337.93)=-.02,p=.009,95%CI=[-.03,-.004],d=0.47), and positively associated with Flanker Inhibitory Control and Attention (β_0j=.02,t(378.56)=2.89,p=.004,95%CI=[.005,.025],d=0.22). MVPA was positively associated with Card Sort (β_0j=.10,t(139.02)=2.79,p=.006,95%CI=[.03,.17],d=0.58). No significant relationships were found between LPA and cognitive function, and no sex differences were found in any associations.</p><p><strong>Conclusions: </strong>The current study links ST and MVPA to cognitive function, though ST was both positively and negatively associated with test performance. Such findings suggest a role for movement and activity levels in cognitive outcomes following MBS, though further investigation is needed to clarify possible mechanisms.</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":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143589139","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":"Letter to Editor regarding comments by Dr. Axer et al. for manuscript weight loss specific to indication, remission of diabetes, and short-term complications after sleeve gastrectomy conversion to Roux-en-Y gastric bypass: a systematic review and meta-analysis.","authors":"Matyas Fehervari, Bibek Das, Hutan Ashrafian","doi":"10.1016/j.soard.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.soard.2025.01.011","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":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639954","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: Variation in opioid-free discharge after metabolic surgery from 2018 to 2023: a state-wide analysis from the Michigan Bariatric Surgery Collaborative.","authors":"Michael Kachmar, Vance L Albaugh","doi":"10.1016/j.soard.2025.02.003","DOIUrl":"https://doi.org/10.1016/j.soard.2025.02.003","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":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477324","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: Patients experience with preoperative use of anti-obesity medications and associations with bariatric surgery expectations.","authors":"Marius Nedelcu, Anamaria Nedelcu, Ramon Vilallonga","doi":"10.1016/j.soard.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.soard.2025.01.007","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":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506648","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":"American Society for Metabolic and Bariatric Surgery: postoperative care pathway guidelines for Roux-en-Y gastric bypass.","authors":"Michael A Edwards, Kinga Powers, R Wesley Vosburg, Randal Zhou, Andrea Stroud, Nabeel R Obeid, John Pilcher, Shauna Levy, Karina McArthur, Givi Basishvili, Amy Rosenbluth, Anthony Petrick, Henry Lin, Tammy Kindel","doi":"10.1016/j.soard.2025.01.005","DOIUrl":"https://doi.org/10.1016/j.soard.2025.01.005","url":null,"abstract":"<p><strong>Background: </strong>Clinical care pathways and guidelines help guide and provide structure to clinicians and providers to improve healthcare delivery and quality. The Quality Improvement and Patient Safety (QIPS) Committee of the American Society for Metabolic and Bariatric Surgery (ASMBS) has previously published care pathways for the performance of laparoscopic sleeve gastrectomy (LSG), preoperative care of patients undergoing Roux-en-Y gastric bypass (RYGB), and most recently, intraoperative care of patients undergoing RYGB.</p><p><strong>Objectives: </strong>This current RYGB care pathway guideline was created to address postoperative care guidance.</p><p><strong>Setting: </strong>Academic Health Center.</p><p><strong>Methods: </strong>For this systematic review, PubMed queries were performed from January 1979 to December 2019. Follow-up queries were performed from January 2020 to July 2024. Peer-reviewed publications were reviewed according to the level of evidence (LoE) regarding specific key questions developed by the QIPS Committee and working group for this pathway.</p><p><strong>Results: </strong>Evidence-based recommendations are made for the postoperative care of patients undergoing RYGB, including recommendations for early postoperative care, postoperative medication management, and long-term postoperative surveillance.</p><p><strong>Conclusions: </strong>This document may provide a structure to providers based on current evidence for the postoperative care of patients with overweight or obesity undergoing RYGB.</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":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451294","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":"Variation in opioid-free discharge after metabolic surgery from 2018 to 2023: a state-wide analysis from the Michigan Bariatric Surgery Collaborative.","authors":"Mae Crumbley, Sarah Petersen, Aaron J Bonham, Phillip Yang, Ani Gururaj, Callie Deng, Alexander Dennis, Arthur M Carlin, Oliver A Varban","doi":"10.1016/j.soard.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.soard.2025.01.003","url":null,"abstract":"<p><strong>Background: </strong>Efforts have been made to reduce opioid prescribing after metabolic-bariatric surgery (MBS) given the increased risk for misuse. Variation in prevalence of opioid-free discharge following MBS and its impact on outcomes remains unclear.</p><p><strong>Objectives: </strong>To evaluate variation in opioid prescribing practices after MBS and the impact of opioid-free discharge on outcomes.</p><p><strong>Setting: </strong>MBS programs participating in a state-wide quality improvement collaborative.</p><p><strong>Methods: </strong>Using a state-wide bariatric-specific data registry, all patients who underwent MBS between 2018 and 2023 and had opioid prescribing data were identified (n = 54,276). Patient characteristics and 30-day risk-adjusted outcomes were compared between patients who were and were not prescribed opioids at discharge. Surgeon and practice characteristics were also compared between the top and bottom quartiles of opioid-free discharge.</p><p><strong>Results: </strong>The prevalence of opioid-free discharge increased from 7.7% to 32.1% over the study period. Only .4% of patients, who were opioid-free at discharge, obtained an opioid prescription within 30 days of discharge. Opioid-free discharge was associated with lower rates of emergency department (ED) visits (7.7% vs 8.2%, P = .0008), despite similar complication rates (7.6% vs 7.3%, P = .7261). There were no significant differences in age, case volume, or practice types between surgeons in the top quartile and bottom quartile for opioid-free discharge.</p><p><strong>Conclusions: </strong>Opioid-free discharge after MBS has increased in prevalence with extremely low failure rates without negatively impacting ED visit rates. Variation in opioid prescribing persists and may be due to patient-specific factors as well as surgeon-specific preference.</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":"143416592","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":"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":"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}