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

{"title":"Cost drivers of gastric sleeve procedures performed using robotic platform.","authors":"Benjamin L Clapp, Shahrukh Chaudry, Helmuth T Billy, Rami Lutfi, S Julie-Ann Lloyd, I-Wen Pan","doi":"10.1016/j.soard.2024.12.008","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.008","url":null,"abstract":"<p><strong>Background: </strong>Robotic bariatric surgery adoption rates have increased, and the higher costs associated with robotic sleeve gastrectomy (rSG) are a concern.</p><p><strong>Objectives: </strong>To investigate the factors associated with increased costs of rSG.</p><p><strong>Setting: </strong>US hospital database.</p><p><strong>Methods: </strong>Patients who underwent rSG between January 1, 2018 and December 31, 2022 were extracted from PINC AI Healthcare Data. Inpatient total, variable, and fixed costs were converted to 2022 USD. Factors including patients and provider characteristics, types of staplers used (laparoscopic bedside staplers [LBS], other unspecified bedside staplers [OBS], and robotic staplers [RS]) were evaluated. Univariate and bivariate analyses were used to examine baseline balance among groups. Multivariable general linear model was used to identify cost drivers.</p><p><strong>Results: </strong>There were 27,778 patient records, of which 25.6% used LBS, 10.3% used OBS, and 64.1% were RS cases. Increased costs were driven by type of stapler, patients aged 55-64, male, non-White race, non-Medicare insurance, higher comorbidity, and disease severity, and hospitals in West region, rural, more than 500 beds, with the lower hospital and surgeon's volume. After adjusting for other cost drivers, the procedures done by LBS significantly reduced variable costs by $651 ± $86 (mean difference ± standard error) and $564 ± $54 and fixed costs by $1716 ± $62 and $2297 ± $54 compared to OBS and RS. In total, the use of LBS significantly reduced total inpatient costs by $2384 ± $118 and $2692 ± $90 compared to OBS and RS, respectively. Also, LBS had fewer blood transfusions and intensive care unit visits than OBS and RS.</p><p><strong>Conclusions: </strong>RS and OBS were critical cost drivers in patients undergoing rSG compared to major brand bedside staplers.</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":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960828","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":"Pregnancy and birth complications among women undergoing bariatric surgery: sleeve gastrectomy versus Roux-en-Y gastric bypass.","authors":"Shavonne E Osiakwan, Kiana S Jones, Swathi B Reddy, Philip Omotosho, Nicholas J Skertich, Alfonso Torquati","doi":"10.1016/j.soard.2024.11.012","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.012","url":null,"abstract":"<p><strong>Background: </strong>Metabolic bariatric surgery is the most effective therapy for severe obesity, which affects the health of millions, most of whom are women of child-bearing age. Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most common bariatric procedures and are associated with durable weight loss and comorbidity resolution. Although obstetric outcomes broadly improve, the safety profile comparing the impact of RYGB and SG on obstetric outcomes is underexplored.</p><p><strong>Objectives: </strong>To compare obstetric outcomes in women who gave birth post-RYGB versus SG to determine whether there are differences in perinatal outcomes.</p><p><strong>Setting: </strong>United States, all patients within commercial, Medicare, Medicaid, government, and cash payor systems.</p><p><strong>Methods: </strong>The PearlDiver-Mariner database was used to identify women aged 18-52 years who underwent RYGB or SG between 2010 and 2020 and became pregnant within 2 years of surgery. Outcomes were defined by the presence of 1 or more pregnancy-related complications including gestational diabetes, preeclampsia, and hysterectomy. A 1:1 propensity-matched analysis was performed.</p><p><strong>Results: </strong>In total, 16,911 individuals, 10,675 (63.1%) and 6236 (36.9%) underwent SG and RYGB, respectively. Obstetric complication rates were 28.3% in the SG versus 32.1% in the RYGB group (P < .01). The RYGB group had an increased relative odds of experiencing an obstetric complication compared with the SG group (odds ratio 1.26; 95% confidence interval 1.14-1.38).</p><p><strong>Conclusions: </strong>Although both are safe, RYGB was associated with a greater obstetric complication rate than SG. These findings can help women and surgeons decide which procedure to pursue and inform discussions regarding the timing of pregnancy after surgery.</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":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901367","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":"Response to \"Racial disparities in the utilization and outcomes of robotic bariatric surgery: correspondence\".","authors":"Qais AbuHasan, Payton M Miller, Wendy S Li, Charles P Burney, Tarik K Yuce, Dimitrios Stefanidis","doi":"10.1016/j.soard.2024.11.023","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.023","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":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928919","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":"Risk assessment for esophageal cancer after bariatric surgery: a comparative cohort study between sleeve gastrectomy and gastric bypass.","authors":"Andrea Lazzati, Tigran Poghosyan, Seydou Goro, Caroline Gronnier","doi":"10.1016/j.soard.2024.12.002","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.002","url":null,"abstract":"<p><strong>Background: </strong>The risk of esophageal cancer after bariatric surgery is a matter of debate.</p><p><strong>Objective: </strong>This study aims to evaluate the risk of esophageal cancer following sleeve gastrectomy (SG) and gastric bypass (GB).</p><p><strong>Methods: </strong>We extracted data from the national discharge database (Programme De Médicalisation des Systèmes d'Information) for patients who underwent bariatric surgery in France between 2007 and 2020. Adult patients undergoing SG or GB were included and followed until December 2022. The primary endpoints were the occurrence of esophageal and gastroesophageal junction (GEJ) cancers. The impact of bariatric procedures on cancer development was assessed using multivariate analysis, along with several sensitivity analyses to validate the findings.</p><p><strong>Results: </strong>Among the 370,271 patients included, 68.4% underwent SG and 31.6% underwent GB. The median follow-up duration was 7.4 years (interquartile range: 5.3-9.6 years), with approximately 81,000 patients followed for at least 10 years. A total of 96 cases of esophageal cancer were identified: 25 in the GB group and 71 in the SG group. The incidence rates were 2.6 per 100,000 person-years for GB and 3.9 for SG, resulting in an incidence rate ratio of .64 (95% confidence interval [CI]: .40-1.01, P = .055). In multivariate analysis, no significant difference in cancer incidence was found between SG and GB (hazard ratio [HR]: 1.60, 95% CI: .90-2.5, P = .06). Sensitivity analyses further confirmed these findings, showing similar nonsignificant differences across various models.</p><p><strong>Conclusion: </strong>In this extensive national cohort of bariatric surgery patients, no significant differences were observed in the incidence of esophageal and GEJ cancer between SG and GB.</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":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974195","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: \"Assessment of predictors of acute kidney injury and progression to chronic kidney disease following bariatric surgery\".","authors":"Sean M O'Neill, Nabeel R Obeid","doi":"10.1016/j.soard.2024.12.005","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.005","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":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904718","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":"Gestational diabetes and other maternal and neonatal-associated conditions could improve after bariatric surgery.","authors":"Micaela Milagros Rossi, Franco José Signorini, Ramiro Leandro Veliz, Martín Andrada, Nicolás Zoela, Sofía Ramirez, Federico Moser","doi":"10.1016/j.soard.2024.11.020","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.020","url":null,"abstract":"<p><strong>Background: </strong>Women represent 40% of patients undergoing bariatric surgery. This highlights the importance of understanding its effects on pregnancy and newborns (NBs).</p><p><strong>Objective: </strong>To compare pregnancy and neonatal outcomes between a group of pregnant women with obesity and those who had prior bariatric surgery.</p><p><strong>Setting: </strong>University Hospital, Argentina; Private Practice.</p><p><strong>Methods: </strong>A retrospective analysis of patients with bariatric surgery before pregnancy (n = 49) and women with obesity (body mass index [BMI] ≥ 30 kg/m2) without previous bariatric surgery (n = 146) was performed. Variables assessed included type of bariatric surgery, age at pregnancy, interval between surgery and conception, maternal weight and BMI at pregnancy onset and end, weight gain during pregnancy, NB weight, gestational age, premature birth, macrosomia, low birth weight, pregnancy-induced hypertension, gestational diabetes mellitus (GDM), anemia, pre-eclampsia, congenital anomalies, fetal deaths, and mode of delivery.</p><p><strong>Results: </strong>BMI at the start and end of pregnancy was lower in the postbariatric group compared to the group with obesity (P < .001). Weight gain during pregnancy was greater in the postbariatric group compared to the group with obesity (P < .001). The weight of NBs was lower in the postbariatric group compared to the group with obesity (P < .001). The incidence of GDM was lower in the postbariatric group compared to the group with obesity (P < .001). Other variables did not show significant differences between the 2 groups.</p><p><strong>Conclusion: </strong>Pregnant women with obesity have high rates of gestational diabetes and neonatal macrosomia compared to those who underwent surgery.</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":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928915","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":"Rare gene variants and weight loss at 10 years after sleeve gastrectomy and gastric bypass - a randomized clinical trial.","authors":"Petra Loid, Sofia Grönroos, Saija Hurme, Paulina Salminen, Outi Mäkitie","doi":"10.1016/j.soard.2024.11.021","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.021","url":null,"abstract":"<p><strong>Background: </strong>Genetic background of severe obesity is inadequately understood. The effect of genetic factors on weight loss after metabolic bariatric surgery (MBS) has shown inconclusive results.</p><p><strong>Objectives: </strong>To determine the prevalence of rare obesity-associated gene variants in a secondary analysis of a randomized clinical trial (RCT) comparing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) for the treatment of severe obesity and examine their association with long-term weight loss at 10 years.</p><p><strong>Setting: </strong>University Hospital, Finland.</p><p><strong>Methods: </strong>Targeted sequencing panel was used to examine variants in 79 obesity-associated genes and 16p11.2 copy number variants. Weight loss was evaluated by percentage total weight loss (%TWL).</p><p><strong>Results: </strong>Out of 240 patients, 113 patients [mean body mass index 48.4 kg/m², (6.8 standard deviation [SD]) kg/m² and median age 49 (range 26-64) years, LSG n = 60, LRYGB n = 53] were available for this post-hoc study. We identified 7 rare heterozygous likely/suspected pathogenic (LP/SP) variants in SH2B1, PCSK1, DNMT3A, BDNF, and AFF4 in 6 patients (5.3%), 5 heterozygous variants of uncertain significance in PLXNA4, PLXNA2, NRP1, and SEMA3D in 5 patients (4.4%), heterozygous Bardet-Biedl syndrome variants in 3 patients (2.7%), and PCKS1 risk allele p.Asn221Asp in 9 patients (8.0%). The patients with LP/SP variants had earlier age of obesity onset (P = .0089) and higher %TWL (P = .0446) compared with patients without LP/SP variants.</p><p><strong>Conclusions: </strong>There were LP/SP pathogenic variants in 5% of the patients supporting the potential benefits of genetic testing to optimize targeted therapies in the future. Despite deleterious gene defects the long-term MBS outcome can be favorable.</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":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916744","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":"Improved erectile function after bariatric surgery: role of testosterone and other factors-a cohort prospective study.","authors":"Piotr Małczak, Michał Wysocki, Ilona Kawa, Tomasz Wikar, Magdalena Pisarska-Adamczyk, Michał Pędziwiatr, Piotr Major","doi":"10.1016/j.soard.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.004","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of obesity has risen dramatically worldwide. Beyond its metabolic implications, obesity profoundly impacts sexual health, particularly in males, with erectile dysfunction (ED) emerging as a prevalent and distressing co-morbidity. Studies show that bariatric surgery alleviates ED. Patients suffering from obesity have lower testosterone levels, which increase after weight loss surgery.</p><p><strong>Objectives: </strong>This study aims to investigate the relationship between ED improvement, weight loss, and hormonal changes after surgery.</p><p><strong>Setting: </strong>University Hospital, Poland.</p><p><strong>Methods: </strong>This prospective study included 108 patients who underwent sleeve gastrectomy from 2022 to 2023. All patients completed a section of International Index of Erectile Function questionnaire before surgery and 1 year postoperatively. Patients with a score <25 were included in the analysis. Linear regression models were created to evaluate the impact of weight loss and hormonal changes on ED remission.</p><p><strong>Results: </strong>Sixty patients with ED underwent analysis. The mean age was 41.9 and mean body mass index was 46.67. The average excess weight loss of the analyzed group was 59%. Significant improvements in erectile functioning were observed postsurgery: 40% of patients experienced full remission, and another 40% showed symptom alleviation. Multiple regression model identified preoperative severity of ED, weight loss, and diabetes as independent factors influencing ED remission Although testosterone levels increased significantly after the surgery, it was not an independent factor. Loss to follow-up was 20%.</p><p><strong>Conclusions: </strong>Bariatric surgery improves erectile function, with weight loss and diabetes mellitus being key factors influencing ED. ED should be considered as an obesity-related co-morbidity similarly as hypertension.</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":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049366","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":"Trends (2017-2022) in adolescent metabolic and bariatric surgery.","authors":"Zachary Ballinger, Jonathan Green, Muriel Cleary, Kaitlyn Wong, Nicole Cherng, Jeremy Aidlen","doi":"10.1016/j.soard.2024.12.003","DOIUrl":"https://doi.org/10.1016/j.soard.2024.12.003","url":null,"abstract":"<p><strong>Background: </strong>Metabolic and Bariatric Surgery (MBS) is often difficult to access for the adolescent population. Eligibility criteria have been recently updated to attempt to remove barriers in accessing this care.</p><p><strong>Objectives: </strong>Analyze recent trends in adolescent MBS in the context of these recent policy changes.</p><p><strong>Setting: </strong>Member programs of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).</p><p><strong>Methods: </strong>Adolescents age 10-17 who underwent MBS from 2017 to 2022 were identified. Demographic trends and surgical details were analyzed through standard statistical comparison methods, linear regression, and multivariate logistic regression.</p><p><strong>Results: </strong>From 2017-2022, 2229 adolescent patients underwent MBS. These approximately 372 cases per year represent about 15%-20% of the total estimated annual cases in the US. Of these, 69% were female, 59% were white, and mean age was 16.1 years. There were no significant differences in age and sex distributions by year. Body mass index (BMI) at surgery did not vary with age. Fourteen and 15 year olds had the highest rates of diabetes (20% and 21% versus 16% for the overall cohort), whereas sleep apnea was more common in 13-year-old patients (36% versus 22%). Females had lower BMI at surgery (46 versus 49) and higher rates of robotic-assisted surgery (16% versus 11%). Case volume decreased with COVID and rapidly increased thereafter. Sleeve gastrectomy increased in relative prevalence compared to bypass, and robotic-assisted cases are increasing twice as fast as laparoscopic procedures. The overall complication rate was 2.9%, with dehydration being most common. Readmission, reoperation, and reintervention did not vary by year.</p><p><strong>Conclusions: </strong>Despite recent efforts to expand care to younger patients, the majority of pediatric MBS is performed for white, female patients over age 16. Cases have returned to prepandemic levels, with robotic-assisted cases increasing. Complication rates and reoperation rates remain low.</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":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974198","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":"Comparison of food tolerance among bariatric surgery procedures: a systematic review.","authors":"Silvia Leite, Mary O'Kane","doi":"10.1016/j.soard.2024.11.018","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.018","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":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901346","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}