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Ross KM, Worwag KE, Swanson TN, Shetty A, Barrett KL. Health Disparities in Obesity Treatment Outcomes, Access, and Utilization. Curr Obes Rep 2025; 14:47. [PMID: 40394323 DOI: 10.1007/s13679-025-00639-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2025] [Indexed: 05/22/2025]
Abstract
PURPOSE OF REVIEW We aimed to summarize research on disparities in obesity treatment outcomes, access, and utilization. RECENT FINDINGS We identified disparities in treatment effectiveness by race/ethnicity, sex/gender, and disability status. There were equivocal results regarding whether outcomes varied by socioeconomic status (SES) and there was no evidence for a rural/urban disparity. A different pattern emerged for treatment access/utilization; disparities were identified across all groups, including race/ethnicity, SES, rurality, sex/gender/sexual and gender minority (SGM) status, and disability status. Little is known regarding how multiple marginalized identities may interact in relation to treatment outcomes or access/utilization. Future research should adopt an intersectional framework to understand the complex interactions between an individual's identities and obesity treatment effectiveness, access, and utilization. Moreover, the field should look beyond the individual-level, using a multi-level approach to identify barriers and strategies to promoting access to effective treatment across system/organizational and policy levels.
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Affiliation(s)
- Kathryn M Ross
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA.
| | - Kate E Worwag
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA
| | - Taylor N Swanson
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA
| | - Armaan Shetty
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA
| | - Kelsey L Barrett
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610-0165, USA
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Roser P, McIntyre RD, Cremona S, Assiri A, Silva LB, Chamseddine G, Rubino F. Disease-Based Criteria vs BMI Level for Prioritization of Metabolic Surgery. Obes Surg 2025:10.1007/s11695-025-07896-4. [PMID: 40381136 DOI: 10.1007/s11695-025-07896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2025] [Revised: 04/23/2025] [Accepted: 04/26/2025] [Indexed: 05/19/2025]
Abstract
BACKGROUND BMI is widely used as a primary criterion for prioritizing candidates for metabolic surgery. However, it may not fully capture disease severity or mortality risks associated with comorbidities such as type 2 diabetes (T2D) and cardiovascular disease (CVD). This study aimed to assess whether BMI accurately reflects disease burden and risk in patients undergoing metabolic surgery. METHODS A retrospective audit included 723 adult candidates for primary metabolic surgery at a tertiary care center between January 2014 and December 2022. Patients undergoing revisional surgeries were excluded. Clinical data, including demographics, comorbidities, and disease severity indicators (e.g., ASA score, Charlson Comorbidity Index [CCI], medication usage, and estimated 10-year survival), were analyzed. Patients were grouped by BMI (< or ≥ 50 kg/m2), T2D, and CVD status for comparison. RESULTS Prevalence rates for T2D, BMI ≥ 50 kg/m2, and CVD were 41.6%, 37.3%, and 16.2%, respectively. Patients with BMI ≥ 50 kg/m2 were generally younger, had fewer comorbidities, lower CVD prevalence, and better estimated 10-year survival than those with BMI < 50 kg/m2. In contrast, patients with T2D and CVD had significantly higher ASA and CCI scores, greater medication usage, and reduced 10-year survival (p < 0.001 for T2D; p < 0.01 for CVD). CONCLUSION Higher BMI levels do not reflect greater disease burden and mortality risk among candidates for bariatric/metabolic surgery. These findings do not support the use of high BMI-based thresholds (e.g., ≥ 50 kg/m2) as criteria for expedited access. Clinically relevant measures of baseline disease burden should be used to determine the urgency of access to surgical treatment of obesity and T2D.
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Affiliation(s)
- Pia Roser
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- King's College London, London, United Kingdom.
| | - Robert D McIntyre
- King's College London, London, United Kingdom
- St Mary's University Twickenham, London, United Kingdom
| | - Simone Cremona
- King's College London, London, United Kingdom
- Hospital Del Mar, Barcelona, Spain
| | - Adel Assiri
- King's College London, London, United Kingdom
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Aly M, Iqbal F, Munasinghe A, Al-Taan O, Welbourn R, Khan O, Arhi C, Askari A. Disparities in Complication Rates Among Ethnic Minorities Undergoing Bariatric Surgery in the UK. Obes Surg 2025; 35:1800-1807. [PMID: 40185955 DOI: 10.1007/s11695-025-07845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 03/05/2025] [Accepted: 03/28/2025] [Indexed: 04/07/2025]
Abstract
BACKGROUND Ethnicity may play a significant role in determining surgical outcomes. This study examines the disease profiles across ethnic groups and investigates whether ethnicity influences the risk of complications following bariatric surgery. METHODS Data from the United Kingdom's National Bariatric Surgery Registry (NBSR) were analysed, encompassing all adult patients undergoing bariatric procedures. Comparative analyses were performed, and a multivariable regression model was developed to identify factors associated with postoperative complications. RESULTS A total of 77,710 (78.8% female) patients were included in the analysis, with a median age of 46 (IQR 37-55) years. Most patients were Caucasian (91.6%), followed by Asian (4.1%), Afro-Caribbean (2.5%), and African (1.7%) groups. Afro-Caribbean patients had the highest median BMI (44.5 kg/m2) and the highest prevalence of hypertension (43.2%), while Asian patients were younger (median age 41 years) and had a higher prevalence of diabetes mellitus (29.1%). African and Afro-Caribbean patients were less likely to self-fund their procedures (14.9% and 10.6%, respectively) compared to Caucasians (25.9%). Complication rates were the highest among Afro-Caribbean patients (5.8 vs 4.8%, p < 0.001) compared to Caucasians. Multivariable regression analysis identified ethnicity as an independent predictor of postoperative complications, with Afro-Caribbean (OR 1.47, 95% CI 1.22-1.87, p < 0.001) and African (OR 1.34, 95% CI 1.05-1.70, p = 0.019) patients demonstrating significantly increased risks. CONCLUSIONS This registry analysis identified ethnic disparities in disease profiles and postoperative outcomes among bariatric surgery patients in the UK, underscoring the need for targeted health policies to improve outcomes in these vulnerable populations.
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Affiliation(s)
- Mohamed Aly
- The Hillingdon Hospitals NHS Foundation Trust, London, UK.
- Brunel University London, London, UK.
| | | | | | - Omer Al-Taan
- Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
| | - Richard Welbourn
- Somerset NHS Foundation Trust, University of Bristol, Bristol, Taunton, UK
| | - Omar Khan
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Alan Askari
- Bedfordshire Hospitals NHS Foundation Trust, Luton, UK
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Hymowitz GF, Duarte BA, Salwen-Deremer JK. Comment on: Distressed community index as a predictor of metabolic and bariatric surgery outcomes. Surg Obes Relat Dis 2025:S1550-7289(25)00668-9. [PMID: 40374493 DOI: 10.1016/j.soard.2025.04.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2025] [Revised: 04/03/2025] [Accepted: 04/13/2025] [Indexed: 05/17/2025]
Affiliation(s)
- Genna F Hymowitz
- Department of Psychiatry and Behavioral Health, Stony Brook University School of Medicine, Stony Brook, New York
| | - Brooke A Duarte
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New York
| | - Jessica K Salwen-Deremer
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New York; Center for Digestive Health, Dartmouth Hitchcock Medical Center, Lebanon, New York
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Luo Y, Zhang J, Guo H. Alpha-lipoic acid on intermediate disease markers in overweight or obese adults: a systematic review and meta-analysis. BMJ Open 2025; 15:e088363. [PMID: 40180416 PMCID: PMC11969596 DOI: 10.1136/bmjopen-2024-088363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 03/14/2025] [Indexed: 04/05/2025] Open
Abstract
OBJECTIVES To evaluate the associations between alpha-lipoic acid (ALA) intake and intermediate disease markers in overweight or obese adults. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, EMBASE, Medline, APA PsycINFO, SocINDEX, CINAHL, SSRN, SocArXiv, PsyArXiv, medRxiv, and Google Scholar (from inception to October 2024). ELIGIBILITY CRITERIA This study included English-language randomised controlled trials (RCTs) on adults (body mass index ≥25 kg/m²) to assess the impact of ALA on intermediate disease markers. Studies lacking outcome data, duplicates or inaccessible full texts were excluded. DATA EXTRACTION AND SYNTHESIS Paired reviewers independently extracted the data. We used frequentist meta-analysis to summarise the evidence, employing the DerSimonian and Laird estimator to account for heterogeneity across study designs, settings and measurement methods. Heterogeneity was assessed via the I² statistic with CIs and τ² values. The risk of bias was independently assessed by two reviewers according to the Cochrane Handbook, covering domains such as randomisation, blinding and data completeness. Publication bias was assessed using Begg's test, while funnel plots and Egger's test were applied to outcomes with 10 or more studies. RESULTS This meta-analysis included 11 RCTs from an initial screening of 431 studies, encompassing a total of 704 adults. The meta-analysis results revealed no significant associations were detected between ALA supplementation and changes in intermediate disease markers, including triglyceride (TG) (standardised mean difference (SMD): -0.08, 95% CI: -0.24 to 0.09, p=0.36, I²=0.00%, τ²=0.00), total cholesterol (TC) (SMD: 0.08, 95% CI: -0.55 to 0.71, p=0.80, I²=87.50%, τ²=0.52), high-density lipoprotein cholesterol (HDL-C) (SMD: -0.05, 95% CI: -0.22 to 0.11, p=0.52, I²=0.00%, τ²=0.00), low-density lipoprotein cholesterol (LDL-C) (SMD: -0.13, 95% CI: -0.40 to 0.15, p=0.37, I²=0.00%, τ²=0.00), homeostasis model assessment of insulin resistance (HOMA-IR) (SMD: -0.23, 95% CI: -0.60 to 0.15, p=0.23, I²=26.20%, τ²=0.05) and fasting blood glucose (FBS) (SMD: 0.13, 95% CI: -0.16 to 0.41, p=0.39, I²=29.40%, τ²=0.04). According to the Grading of Recommendations Assessment, Development and Evaluation bias assessment approach, eight studies were rated as having low bias (grade A), and three studies were rated as having moderate bias (grade B). Begg's test indicated no evidence of publication bias. CONCLUSIONS No significant associations were detected between ALA intake and intermediate disease markers, including TG, TC, HDL-C, LDL-C, HOMA-IR and FBS levels, in overweight or obese adults. Further research is needed to explore the potential associations of ALA, especially in high-risk populations with metabolic disorders, by employing longer intervention durations, higher dosages and optimised formulations. PROSPERO REGISTRATION NUMBER CRD42023450239.
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Affiliation(s)
- Yao Luo
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Jizhen Zhang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Hongxia Guo
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
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Quinn CM, Leslie ZD, Schafer J, Ikramuddin S, Wise ES. Predictors and Trends of Hemorrhage After Bariatric Surgery Using Two Large National Datasets: A Retrospective Observational Study. J Surg Res 2025; 308:86-94. [PMID: 40088798 DOI: 10.1016/j.jss.2025.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 01/21/2025] [Accepted: 02/16/2025] [Indexed: 03/17/2025]
Abstract
INTRODUCTION The National Inpatient Sample (NIS) is a comprehensive representative database for inpatient hospitalizations; the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database aggregates surgical outcomes from nationally accredited bariatric surgical programs. There has been no comparison of postoperative hemorrhage rates nor a comparison of predictors of hemorrhage between the two databases. The aim of this study was to compare trends and predictors of significant hemorrhage after bariatric surgery using two national databases. METHODS The core NIS files of the Healthcare Cost and Utilization Project and the MBSAQIP Participant Use Data Files from 2016 to 2021 were concatenated, and vertical sleeve gastrectomy and Roux-en-Y gastric bypass procedures were included. Trends in a 3-d postoperative hemorrhage requiring blood transfusion were derived from both datasets. Demographic, comorbidity, and other health factors were analyzed to construct multivariable logistic regression models. RESULTS Briefly, 204,866 and 1,029,979 patients were identified in the NIS and MBSAQIP, respectively, and 3-d inpatient blood transfusion rates were 0.48% and 0.64%. Anticoagulants, Black race, diabetes, and increased age were associated with higher risk of a blood transfusion in both datasets. Vertical sleeve gastrectomy had a lower transfusion risk than Roux-en-Y gastric bypass (NIS: odds ratio: 0.62; 95% confidence interval [0.53, 0.71], P < 0.05; MBSAQIP: odds ratio: 0.52 [0.49, 0.55], P < 0.05). The NIS reported consistently lower annual 3-d transfusion rates relative to the MBSAQIP. CONCLUSIONS Health care professionals should be aware of the associated risk factors for blood transfusion after bariatric surgery. Most blood transfusions occurred during the initial hospitalization.
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Affiliation(s)
- Charles M Quinn
- University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | - Sayeed Ikramuddin
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Eric S Wise
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
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Wang Y, Huang Y, Al Jawish MM, Bakheet NG, Acosta A, Ordog T, Clift K, Chase K, Kumbhari V, Badurdeen DS. Rising Obesity-Associated Mortality in Men: Exploration of Gender Disparity from the Global Burden of Disease Study, 1990-2019. J Gen Intern Med 2025; 40:1097-1106. [PMID: 39302563 PMCID: PMC11968585 DOI: 10.1007/s11606-024-09033-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVES The global rise in overweight, obesity, and related diseases is undeniable; however, the pathogenesis of obesity and obesity-associated diseases is heterogeneous, with varied complications and a discordant response to treatment. Intriguingly, men have a shorter lifespan than women, despite being half as likely to be obese. This paradox suggests a potential gender disparity in the impact of obesity on mortality, with men potentially being more vulnerable to obesity-associated health risks. METHODS This retrospective study utilized Global Burden of Diseases data from 204 countries/territories to bridge the knowledge gap in understanding gender disparities in obesity-related mortality. Outcomes were obesity-associated mortality, years of life lost, years lived with disability, and disability-adjusted life years (DALYs). RESULTS In 2019, the global overweight/obesity-related disease burden reached 160.2 million DALYs, with 5.02 million associated deaths. From 1990 to 2019, the age-standardized death rates increased in males (from 58.19 to 66.55 per 100,000 person-years, APC = 0.36%, 95% CI: 0.30 to 0.42%, P < 0.001), while females experienced a decrease in age-standardized death rates (from 59.31 to 58.14 per 100,000 person-years, APC = -0.22%, 95% CI: -0.29% to -0.14%, P < 0.001). Age-standardized DALYs increased more in males (1632.5 to 2070.34 per 100,000 years, APC = 0.74%, 95% CI: 0.70% to 0.78%, P < .001) compared to females (1618.26 to 1789.67 per 100,000 years, APC = 0.24%, 95% CI: 0.19% to 0.29%, P < 0.001). Disparities were more pronounced in countries with a higher socioeconomic status and predominantly affected younger populations. CONCLUSIONS Overweight/obesity-related morbidity and mortality are higher among male sex. Identifying differences in pathogenesis, complications and treatment response is crucial to develop targeted interventions and equitable public health policies to combat this global burden.
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Affiliation(s)
- Yichen Wang
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yuting Huang
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Mhd Manar Al Jawish
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Nader G Bakheet
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Andres Acosta
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Tamas Ordog
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kristin Clift
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Katherine Chase
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Vivek Kumbhari
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - Dilhana S Badurdeen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA.
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Osiakwan SE, Jones KS, Reddy SB, Omotosho P, Skertich NJ, Torquati A. Pregnancy and birth complications among women undergoing bariatric surgery: sleeve gastrectomy versus Roux-en-Y gastric bypass. Surg Obes Relat Dis 2025; 21:509-515. [PMID: 39732584 DOI: 10.1016/j.soard.2024.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 10/20/2024] [Accepted: 11/13/2024] [Indexed: 12/30/2024]
Abstract
BACKGROUND 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. OBJECTIVES To compare obstetric outcomes in women who gave birth post-RYGB versus SG to determine whether there are differences in perinatal outcomes. SETTING United States, all patients within commercial, Medicare, Medicaid, government, and cash payor systems. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
| | - Kiana S Jones
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Swathi B Reddy
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Philip Omotosho
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | | | - Alfonso Torquati
- Department of Surgery, Rush University Medical Center, Chicago, Illinois.
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Wildes MP, Higgins RM, Gould JC, Chunara F, Szabo A, Kindel TL. Distressed community index as a predictor of metabolic and bariatric surgery outcomes. Surg Obes Relat Dis 2025:S1550-7289(25)00104-2. [PMID: 40121141 DOI: 10.1016/j.soard.2025.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 02/14/2025] [Accepted: 02/18/2025] [Indexed: 03/25/2025]
Abstract
BACKGROUND Obesity is associated with serious health and social consequences. Socioeconomically disadvantaged people are less likely to undergo metabolic and bariatric surgery (MBS) than their socioeconomically advantaged counterparts and experience increased complications or health care resource utilization, such as longer length of stay. The Economic Innovation Group's Distressed Communities Index (DCI) offers a metric to broadly assess socioeconomic distress. OBJECTIVES This study investigated the relationship between community distress, as determined by DCI, and complications following MBS, including length of hospital stay, likelihood of an emergency department (ED) visit, 30-day readmissions, and perioperative/postoperative occurrences. SETTING Academic Medical Center, United States. METHODS We conducted a retrospective analysis on a cohort of patients undergoing primary sleeve gastrectomy or Roux-en-Y bypass at a large academic hospital from 2016 to 2020 (n = 758). Patients were categorized based on the DCI of their community. We used the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database to record each patient's postoperative complications. Descriptive statistics were used to evaluate the association between community distress and complications. RESULTS Patients from distressed communities were more likely to have Medicaid and less likely to have private insurance (P < .001). Community distress was significantly correlated with longer hospital stay (P < .001) and a higher likelihood of an ED visit (P < .007). No significant correlation was observed between community distress and 30-day readmissions or perioperative/postoperative occurrences. CONCLUSIONS DCI is not an independent risk factor for complications after adjusting for other variables but increase resource utilization.
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Affiliation(s)
- Micah P Wildes
- College of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rana M Higgins
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jon C Gould
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Farheen Chunara
- Division of Biostatistics, Data Science Institute, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aniko Szabo
- Division of Biostatistics, Data Science Institute, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Weiss C, Botvinov J, Jawed A, Merchant A. Retrospective Cohort Study of Gastric Bypass Versus Sleeve Gastrectomy in Gastroesophageal Reflux Disease Patients: Procedure Use and Racial Disparity. Obes Surg 2025; 35:952-959. [PMID: 39907982 DOI: 10.1007/s11695-025-07707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 12/13/2024] [Accepted: 01/18/2025] [Indexed: 02/06/2025]
Abstract
BACKGROUND Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are common bariatric procedures, with GERD being a frequent obesity-associated disease among individuals undergoing these surgeries. RYGB is recommended for patients with GERD due to the increased control of GERD symptoms. This study examines RYGB and SG use in this population and factors influencing procedure choice. METHODS This study analyzed 2016-2022 data from the MBSAQIP database comprising patients with GERD who underwent SG or RYGB. Statistical analysis included univariate and multivariable logistic regression to identify factors associated with procedure receipt. RESULTS RYGB rates are rising annually but remain lower than SG for GERD. Compared to White individuals, Hispanics are 14% less likely, and African Americans are 19% less likely, to receive RYGB. CONCLUSIONS The study notes a research gap in choosing RYGB or SG for patients with GERD, despite consensus favoring RYGB. It highlights a disparity between recommendations and practice, with GERD predicting the use of RYGB but SG being more prevalent in this population overall. The analysis links race to procedure choice, showing African American and Hispanic patients are less likely to undergo RYGB, indicating potential disparities in access and decision-making.
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Affiliation(s)
- Conrad Weiss
- Department of Surgery, JFK University Medical Center, Hackensack Meridian School of Medicine, Edison, NJ, USA
| | - Julia Botvinov
- Department of Surgery, JFK University Medical Center, Hackensack Meridian School of Medicine, Edison, NJ, USA
| | - Aram Jawed
- Department of Surgery, JFK University Medical Center, Hackensack Meridian School of Medicine, Edison, NJ, USA
| | - Aziz Merchant
- Department of Surgery, JFK University Medical Center, Hackensack Meridian School of Medicine, Edison, NJ, USA.
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Noria SF, Pratt KJ, Abdel-Rasoul M, Diaz K, Shalash B, Abul-Khoudoud D, Needleman B, Magallanes M. The impact of social determinants of health (SDOH) on completing bariatric surgery at a single academic institution. Surg Endosc 2025; 39:1234-1242. [PMID: 39537861 DOI: 10.1007/s00464-024-11364-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 10/13/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Underutilization of bariatric surgery is multifactorial. This study aimed to understand the association of SDOH on not achieving surgery. METHODS 1081 applications for primary MBS from January-December 2021 were stratified into those that completed surgery (COM; n = 415), in progress > 1-year (IP; n = 107), dropped out (DO; n = 379), and never started (NS; n = 180). Using the American-Community-Survey results (2015-2020) and patient zip-codes, population differences in 4-domains of SDOH (demographic/social/housing/economic) were examined between COM versus the other groups. Additionally, using institutional MBSAQIP and EMR data, patient-specific differences in comorbidities were evaluated for COM versus IP/DO. Univariate analysis using Kruskal-Wallis, chi-squared/Fisher's exact tests were used for continuous and/or categorical variables. For patient-level analysis multinomial logistic regression was used to determine predictors of not achieving surgery. Hypothesis testing was conducted at an overall 5 percent type-I error rate (alpha = 0.05) and Bonferroni's method was used to adjust for multiple comparisons. RESULTS Compared to COM, IP-patients resided in zip-codes characterized by fewer married people (43% vs 46%; p = 0.019), lower education levels (49% vs 43%; p = 0.048), more households where rent was > 50% of household income (10% vs 8%, p = 0.002), and households below the poverty line (17.6% vs 14.5%, p = 0.017). At the patient-level, IP were more likely to be male (27.9% vs 14.9%; p = 0.014), publicly insured (44.9% vs 28.4%; p = 0.004), Black (35.5% vs 22.2%; p = 0.006), an active smoker (8.9% vs 2.2%; p = 0.018), have a higher BMI (49.6 vs 47.6; p = 0.01), and coronary intervention (5.8% vs 1.7%, p = 0.034). Comparison of COM vs DO was similar for both phases. Multinomial multivariable logistic regression demonstrated higher BMI (OR = 1.03,[CI]:1.01-1.05, p = 0.001), males (OR = 1.9,[CI]:1.09-3.32, p = 0.024), smoking (OR = 4.58,[CI]:1.74-12.02, p = 0.002), and Medicaid (OR = 2.16,[CI]:1.33-3.49, p = 0.002) independently predicted not achieving surgery. CONCLUSION Patient-level data demonstrated social not clinical factors predicted surgery completion. Given zip-codes characterizing the IP/DO groups had a greater prevalence of social risk, more attention needs to be directed patient-level social risks.
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Affiliation(s)
- Sabrena F Noria
- Division of General and GI Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N718 Doan Hall, 410 W 10th Avenue, Columbus, OH, 43210, USA.
| | - Keeley J Pratt
- Division of General and GI Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N718 Doan Hall, 410 W 10th Avenue, Columbus, OH, 43210, USA
- Department of Human Sciences, Human Dev. & Family Science Program, College of Education & Human Ecology, The Ohio State University, Columbus, OH, USA
| | - Mahmoud Abdel-Rasoul
- Center for Biostatistics, College of Medicine Department of Biomedical Informatics, Columbus, OH, USA
| | - Kayla Diaz
- Division of General and GI Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N718 Doan Hall, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Bayan Shalash
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Bradley Needleman
- Division of General and GI Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N718 Doan Hall, 410 W 10th Avenue, Columbus, OH, 43210, USA
| | - Maximiliano Magallanes
- Division of General and GI Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, N718 Doan Hall, 410 W 10th Avenue, Columbus, OH, 43210, USA
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12
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Hamid SA, Graetz E, Bakkila BF, Chao GF, Zolfaghari EJ, Schultz KS, Chetty AK, Trabilsy M, Schneider EB, Gibbs KE. Analysis of Online Crowdfunding Among Patients Pursuing Metabolic and Bariatric Surgery in the United States. Obes Surg 2025; 35:170-180. [PMID: 39633092 DOI: 10.1007/s11695-024-07605-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 11/03/2024] [Accepted: 11/23/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Use of online crowdfunding to mitigate health-related cost burden is common in the US, but its usage among candidates for metabolic and bariatric surgery (MBS) is unknown. We aimed to identify GoFundMe campaigns fundraising for MBS and characterize sources of financial strain. We also aimed to determine factors associated with successful crowdfunding. METHODS We searched GoFundMe for campaigns fundraising for MBS. Data items were extracted by two investigators with disagreements resolved by a third. We assessed associations between these data items and category of money raised using ordered logistic regression. RESULTS We identified 539 campaigns, of which 33.6% were raising funds for sleeve gastrectomy, 24.1% for Roux-en-Y gastric bypass, and 2.0% for biliopancreatic diversion with duodenal switch. Most campaigns were created by the patient (73.1%) who had health insurance (53.4%) and at least one obesity-associated disease (56.8%). Over half (53.6%) sought funds for a direct medical expense and 35.1% sought funds for a non-medical expense, which included lost wages (15.6%), food (10.8%), transportation (10.2%), childcare (7.1%), and/or housing (5.8%). The median requested was $8000 (IQR 10,440) and the median raised was $860 (IQR 3173). The majority (63.1%) of campaigns earned less than 25% of their requested amount. Campaigns that shared mental health-related disease (aOR 0.55, 95% CI 0.32-0.95) and non-surgical attempts to lose weight (aOR 0.59, 95% CI 0.37-0.94) had lower odds of raising a higher category of money compared to campaigns not disclosing these details. CONCLUSIONS Patients pursuing MBS in the US use online crowdfunding to subsidize both medical and non-medical expenses, but the majority of campaigns are unsuccessful. Our study highlights unmet financial need among MBS candidates.
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Affiliation(s)
- Safraz A Hamid
- Yale School of Medicine, New Haven, CT, USA.
- Yale National Clinician Scholars Program, New Haven, CT, USA.
| | | | | | | | | | - Kurt S Schultz
- Yale School of Medicine, New Haven, CT, USA
- Yale Investigative Medicine Program, New Haven, CT, USA
| | | | - Maissa Trabilsy
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | - Karen E Gibbs
- Yale School of Medicine, New Haven, CT, USA
- Bridgeport Hospital, Bridgeport, CT, USA
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13
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Sager La Ganga C, García-Sanz I, Carrillo López E, Navas-Moreno V, Marazuela M, Gancedo-Quintana Á, Marín-Campos C, Carraro R, Sebastián-Valles F. Equitable Access, Lasting Results: The Influence of Socioeconomic Environment on Bariatric Surgery Outcomes. Obes Surg 2025; 35:59-66. [PMID: 39466525 DOI: 10.1007/s11695-024-07529-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 09/26/2024] [Accepted: 09/26/2024] [Indexed: 10/30/2024]
Abstract
PURPOSE Low socioeconomic status (SES) correlates with higher obesity rates and challenges in accessing treatments like bariatric surgery (BS). This study aims to assess SES's influence on medium-term BS outcomes in a setting of universal healthcare, ensuring equitable treatment access. MATERIAL AND METHODS We conducted a retrospective analysis of 193 BS patients (1997-2018) at a tertiary care hospital. Weight loss was expressed as change in % total weight loss (%TWL) and excess body weight (EBW) loss. Successful BS was defined as > 50% EBW loss. SES was gauged using quartiles of the Spanish Deprivation Index. A multivariable Cox regression model evaluated SES impact on BS success over follow-up. RESULTS The mean follow-up was 6.9 ± 4.6 years; patients averaged 43.9 ± 11.8 years, with 29.7% men. Preoperative BMI was 48.2 ± 8.2 kg/m2. At follow-up, BMI was 33.9 ± 6.6 kg/m2, with 29.3 ± 12.02% of %TWL. No SES quartile differences in BS success were noted at follow-up (log rank p = 0.960). Cox regression revealed no SES disparities in BS outcomes post-adjustment. However, female sex (HR 1.903; p = 0.009) and diabetes mellitus (HR = 0.504; p = 0.010) correlated with weight-related outcomes. CONCLUSION In a universal healthcare system with equitable treatment access, medium-term BS outcomes remain consistent irrespective of patients' socioeconomic status.
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Affiliation(s)
- Carolina Sager La Ganga
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Iñigo García-Sanz
- Department of General Surgery, Hospital Universitario de La Princesa Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Elena Carrillo López
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Víctor Navas-Moreno
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Mónica Marazuela
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Álvaro Gancedo-Quintana
- Department of General Surgery, Hospital Universitario de La Princesa Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Cristina Marín-Campos
- Department of General Surgery, Hospital Universitario de La Princesa Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Raffaele Carraro
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain
| | - Fernando Sebastián-Valles
- Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, 28006, Madrid, Spain.
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14
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Kumar SS, Wunker C, Collings A, Bansal V, Zoumpou T, Chang J, Rodriguez N, Sabour A, Hilton LR, Ghanem OM, Kushner BS, Loss LJ, Aleassa EM, Haskins IN, Ayloo S, Reid A, Overby DW, Hallowell P, Kindel TL, Slater BJ, Palazzo F. SAGES guidelines for the management of comorbidities relevant to metabolic and bariatric surgery. Surg Endosc 2025; 39:1-10. [PMID: 39663246 PMCID: PMC11666733 DOI: 10.1007/s00464-024-11433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2024] [Accepted: 11/14/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND Patients who are under consideration for or have undergone metabolic and bariatric surgery frequently have comorbid medical conditions that may make their perioperative care more complex. These recommendations address routine intraoperative cholangiography in patients with bypass-type anatomy, the management of reflux disease after sleeve gastrectomy, and the optimal bariatric procedure for patients with comorbid inflammatory bowel disease. METHODS A systematic review was conducted including studies published from 1990 to 2022 to address these questions. These results were then presented to a panel of bariatric surgeons who formulated recommendations based on the best available evidence or utilized expert opinion when the evidence base was lacking. RESULTS Conditional recommendations were made in favor of routine intraoperative cholangiography in patients with bypass-type anatomy undergoing laparoscopic cholecystectomy, trialing medical management prior to surgical management in patients with reflux after sleeve gastrectomy, and sleeve gastrectomy rather than Roux en Y gastric bypass in patients with inflammatory bowel disease. The strength of these recommendations was limited by the quality of evidence available. Recommendations for future research were made for all questions. CONCLUSIONS These recommendations should provide guidance regarding management of these comorbidities in patients who are under consideration for or have undergone metabolic and bariatric surgery. These recommendations also identify important areas where the future research should focus to strengthen the evidence base.
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Affiliation(s)
- Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Claire Wunker
- Department of Surgery, Saint Louis University, St. Louis, MO, USA
| | - Amelia Collings
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Varun Bansal
- Department of Surgery, University of Colorado, Aurora, CO, USA
| | - Theofano Zoumpou
- Department of Surgery Rutgers, New Jersey Medical School, Newark, NJ, USA
| | - Julietta Chang
- Department of Surgery, Kaiser Permanente Bellevue Medical Center, Baldwin Park, CA, USA
| | - Noe Rodriguez
- Department of Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Sabour
- Department of Surgery, University of Nevada, Las Vegas, NV, USA
| | | | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bradley S Kushner
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Lindsey Jean Loss
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Essa M Aleassa
- Department of Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Ivy N Haskins
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Adam Reid
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - David Wayne Overby
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Peter Hallowell
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Tammy Lyn Kindel
- Department of Surgery, Medical College of Wisconsin, Madison, WI, USA
| | | | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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15
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Saikali LM, Herrera CD, Chen AT, Lepore G, Ramadan OI, Lam D, Anandarajah A, Morales CZ, Goldshore M, Morris JB, Guerra CE. Evaluating patient experience with a surgical navigation program for under-resourced patients. Am J Surg 2024; 238:115955. [PMID: 39276488 DOI: 10.1016/j.amjsurg.2024.115955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/13/2024] [Accepted: 09/06/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND This study aimed to characterize patient satisfaction with navigators and surgical care accessed through a novel navigation program for under-resourced communities. METHODS PSN-I and PSQ-18 questionnaires assessed satisfaction with navigators and care, respectively. Primary outcomes were PSN-I and PSQ-18 scores. Secondary analyses tested associations between satisfaction and patient factors and between PSN-I and PSQ-18 scores. RESULTS Of 294 patients contacted, 88 (29.9 %) responded. Most were Hispanic/Latinx (76.1 %), Spanish-speaking (71.5 %), and uninsured (85.2 %). Participants were highly satisfied with navigators (mean 38.5, SD 7.6; max. 45) and most care domains except Financial Aspects (mean 3.2, SD 1.0; max. 5) and Accessibility/Convenience (mean 3.5, SD 0.6; max. 5). Higher navigator satisfaction was associated with post-consultation need for surgery (coeff. 5.6, 95 % CI[0.9, 10.3]) and increased the odds of care satisfaction (OR 1.1, 95 % CI[1.0, 1.2]). CONCLUSIONS Patients are satisfied with navigation services-a previously unstudied aspect of this unique surgical equity program.
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Affiliation(s)
- Linda M Saikali
- Center for Surgical Health, Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, USA
| | - Christopher D Herrera
- Center for Surgical Health, Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, USA; Division of Urology, Department of Surgery, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Angela T Chen
- Center for Surgical Health, Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, USA
| | - Gina Lepore
- Center for Surgical Health, Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Omar I Ramadan
- Center for Surgical Health, Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, USA; Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA
| | - Doreen Lam
- Center for Surgical Health, Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Aaron Anandarajah
- Center for Surgical Health, Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA
| | - Carrie Z Morales
- Center for Surgical Health, Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, USA
| | - Matthew Goldshore
- Center for Surgical Health, Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA
| | - Jon B Morris
- Center for Surgical Health, Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA; Department of Surgery, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, USA
| | - Carmen E Guerra
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA, USA; Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, USA; Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, USA.
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16
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Rahimi AO, Hsu CH, Soliman D, Maegawa FB, Ghaderi I. The impact of COVID-19 pandemic on patient selection and access to care, approach type, and postoperative outcomes in bariatric surgery. Surg Obes Relat Dis 2024; 20:1047-1054. [PMID: 38955647 DOI: 10.1016/j.soard.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 04/29/2024] [Accepted: 05/17/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The COVID-19 pandemic had affected the health systems across the world since early 2020 with a concern about access to medical care during the first wave of COVID-19 pandemic. OBJECTIVES The objective of this study was to examine how the COVID-19 pandemic influenced patient selection, approach type, and postoperative outcomes in elective bariatric surgery. SETTING United States. METHODS Data from the MBSAQIP database for the years 2016-2020 were queried. Wilcoxon rank-sum test and Fisher's exact test were employed for continuous and categorical variables, respectively. Postoperative outcomes within 30 days were assessed separately and based on the Clavien-Dindo (CD) classification of III-V. χ2 test and logistic regression were used to compare outcomes between procedure and approach types, as well as surgical operation periods. RESULTS A total of 741,620 patients underwent robotic and laparoscopic sleeve gastrectomy and Roux-en-Y gastric-bypass. The cases performed in 2020 exhibited lower comorbidities and postoperative complications compared to prepandemic years, regardless of the approach type. Notably, the proportion of White patients decreased during the pandemic, while there was an increase in the number of African American and Hispanic patients who had bariatric surgery. CONCLUSIONS Patients who underwent bariatric surgery during the COVID-19 pandemic appeared to be healthier with fewer comorbidities and experienced fewer adverse postoperative outcomes compared to those who had surgery prior to the pandemic. This study highlights the limited access to bariatric surgery for high-risk patients during the pandemic.
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Affiliation(s)
- Ahmad Omid Rahimi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, Arizona
| | - Diaa Soliman
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Felipe B Maegawa
- Division of General & GI Surgery, Department of Surgery, Emory University, Atlanta, Georgia
| | - Iman Ghaderi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona.
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17
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Dewedar DHH, Deghidy EAA, Hany M, Abu-Sheasha GA, Yassine OG. Understanding preferences of patients with obesity for metabolic bariatric surgery: a comprehensive adaptive choice-based conjoint analysis. Surg Obes Relat Dis 2024; 20:1108-1118. [PMID: 38902189 DOI: 10.1016/j.soard.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Patient preferences toward metabolic bariatric surgery (MBS) remain inadequately explored. OBJECTIVE This study aims to identify and analyze the key factors influencing the decision-making process of patients considering MBS. SETTING The research was conducted at the metabolic bariatric surgery clinic of the Medical Research Institute Hospital, Alexandria University, Egypt. METHOD Patients with obesity were recruited at the clinic before MBS. The surgical profiles were characterized by attributes including treatment method, recovery and reversibility, treatment tenure, expected weight loss, impact on associated medical problems, risk of complication, side effects, dietary changes, and out-of-pocket costs. Patients engaged in an online survey comprising sociodemographic data, Build Your Own (BYO) section, screening section, and choice tournament section. Adaptive choice-based conjoint analysis was employed to discern the preferences. RESULTS Of the 299 respondents, the surgical profiles with the highest preference involved a loss of 80% of excess weight without any recurrence (14.67 [95% CI, 14.10-15.23]), 0% risk of complication (13.74 [95% CI, 13.03-14.45]), and absence of adverse effects (11.32 [95% CI, 10.73-11.91]). K-mean cluster analysis identified 2 distinct groups: "patients prioritize weight loss" group prioritized excess weight loss, surgery availability, and diet change, whereas "patients prioritize avoidance of complications" group focused on the risk of complication, adverse effects, and the surgery mechanism. CONCLUSIONS MBS candidates predominantly value weight loss without recurrence, followed by minimization of complication risks and adverse effects, within 3 years postsurgery. Conversely, initial out-of-pocket costs and resolution of medical conditions were deemed the least influential attributes.
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Affiliation(s)
- Doaa Hussein Hassan Dewedar
- Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Ministry of Health, Alexandria, Egypt
| | - Ehsan Akram Ahmed Deghidy
- BioMedical Statistics and Medical Informatics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt.
| | - Ghada Ahmed Abu-Sheasha
- BioMedical Statistics and Medical Informatics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Omaima Gaber Yassine
- Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
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18
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Ahmed SM, Johns A, Timbang L, Wang A, Singh NK, Lyo V, Ali M. Effect of COVID-19 changes on outcomes and socioeconomic disparities following metabolic and bariatric surgery. Surg Endosc 2024; 38:6446-6455. [PMID: 39266760 PMCID: PMC11525417 DOI: 10.1007/s00464-024-11212-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/19/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND We previously showed worse outcomes among lower socioeconomic status (SES) groups following metabolic/bariatric surgery (MBS). In light of healthcare changes in response to COVID-19, this study aims to evaluate post-pandemic MBS outcomes and determine if prior socioeconomic disparities persisted in the post-COVID era. METHODS A retrospective chart review of patients undergoing primary Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between 2015 and 2022 was performed. Patients were stratified into pre- and post-COVID groups. Post-COVID cohort was further stratified into high (HT) and low (LT) tier status based on Distressed Communities Index, a geocoded composite measure of SES. Preoperative characteristics and postoperative outcomes were compared between pre- and post-COVID cohorts, as well as between post-COVID HT and LT groups. RESULTS Of 709 patients, 82.9% were pre-COVID and 17.1% were post-COVID. Post-COVID cohort had greater rate of public insurance (46% vs. 37%, p < 0.001), longer wait time to surgery (mean 358 ± 609.8 days vs 241.9 ± 368.5 days, p = 0.045), and were more likely to undergo RYGB (69% vs. 56%, p = 0.010). Post-COVID patients also had lower risk of any complications on multivariable analysis (OR 0.599, 95% CI 0.372-0.963), had higher follow-up rates at post-discharge (95.8% vs 79.7%, p < 0.005), 6-month (93% vs. 82%, p < 0.001) and 12-month visits (75% vs. 63%, p = 0.005), and lost more weight at 12 months (67% excess weight loss (%EWL) vs. 58%EWL, p = 0.002). Among post-COVID HT and LT cohorts, previously seen disparities in complications were no longer seen. Finally, there were no differences in weight or follow-up rates between post-COVID HT and LT. CONCLUSIONS Post-COVID changes to MBS care have resulted in improved short-term outcomes and reduced disparities for patients of lower SES. Further studies are needed to identify these positive factors to perpetuate practice patterns that optimize care for patients of all socioeconomic status.
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Affiliation(s)
- Shushmita M Ahmed
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6th Floor, Sacramento, CA, 95817, USA.
- Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA.
| | - Alexandra Johns
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6th Floor, Sacramento, CA, 95817, USA
| | - Leah Timbang
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6th Floor, Sacramento, CA, 95817, USA
| | - Annie Wang
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6th Floor, Sacramento, CA, 95817, USA
| | | | - Victoria Lyo
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6th Floor, Sacramento, CA, 95817, USA
- Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA
| | - Mohamed Ali
- Department of Surgery, University of California, Davis, 2335 Stockton Blvd, 6th Floor, Sacramento, CA, 95817, USA
- Center for Metabolic and Alimentary Science, University of California, Davis, Sacramento, USA
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Mathai SK, Garofalo DM, Myers QW, Heron CH, Clair VS, Bonner I, Dyas AR, Velopulos CG, Hazel K. Analyzing the Social Vulnerability Index With Metabolic Surgery. J Surg Res 2024; 303:164-172. [PMID: 39357347 PMCID: PMC11778274 DOI: 10.1016/j.jss.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 08/01/2024] [Accepted: 09/02/2024] [Indexed: 10/04/2024]
Abstract
INTRODUCTION The social vulnerability index (SVI) is a census tract-level population-based measure generated from 16 socioeconomic and demographic variables on a scale from 1 (least) to 100 (most) vulnerable. This study has three objectives as follows: 1) to analyze multiple ways of utilizing SVI, 2) compare SVI as a group measure of marginalization to individual markers, and 3) to understand how SVI is associated with choice of surgery in metabolic surgery. METHODS We retrospectively identified adults undergoing Roux-en-Y gastric bypass and gastric sleeve in 2013-2018 National Surgical Quality Improvement Program data from a single academic center. High SVI was defined as >75th percentile. Low SVI was coded as <75th percentile in measure 1 and < 25th percentile in measure 2. Chi-square and Mann-Whitney U tests were utilized for categorical and continuous variables, respectively. Multivariable regression models were performed comparing SVI to marginalized status as a predictor for type of metabolic surgery. RESULTS We identified 436 patients undergoing metabolic surgery, with a low overall morbidity (6.1%). Complication and readmission rates were similar across comparator groups. The logistic regression models had similar area under the curve, supporting SVI as a proxy for individual measures of marginalization. CONCLUSIONS SVI performed as well as marginalized status in predicting preoperative risk. This suggests the validity of using SVI to identify high risk patients. By providing a single, quantitative score encompassing many social determinants of health, SVI is a useful tool in identifying patients facing the greatest health disparities.
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Affiliation(s)
- Samuel K Mathai
- University of Colorado School of Medicine, Aurora, Colorado.
| | - Denise M Garofalo
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Quintin W Myers
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Charlotte H Heron
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - India Bonner
- University of Colorado School of Medicine, Aurora, Colorado
| | - Adam R Dyas
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Catherine G Velopulos
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kweku Hazel
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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20
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Muscogiuri G, Verde L, Frias-Toral E, Reytor-González C, Annunziata G, Proganò M, Savastano S, Simancas-Racines D, Colao A, Barrea L. Weight loss, changes in body composition and inflammatory status after a very low-energy ketogenic therapy (VLEKT): does gender matter? J Transl Med 2024; 22:949. [PMID: 39427162 PMCID: PMC11490016 DOI: 10.1186/s12967-024-05733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 10/06/2024] [Indexed: 10/21/2024] Open
Abstract
BACKGROUND Considering differences in body composition and inflammatory status between sexes, as well as recent recommendations advocating for personalized dietary approaches, this study aimed to explore how sex influences weight loss, changes in body composition, and inflammatory status in subjects with grade I and II obesity undergoing a 45-day of the Very Low-Energy Ketogenic Therapy (VLEKT). METHODS Participants (21 premenopausal females and 21 males), included in the study adhered to the 45-day of the VLEKT and underwent assessments of anthropometric parameters (weight, height, body mass index-BMI -, and waist circumference), body composition via bioelectrical impedance analysis, and inflammatory status measured by high sensitivity C-reactive protein (hs-CRP) levels at baseline and post-intervention. RESULTS At baseline, premenopausal females and males did not differ in BMI (p = 0.100) and hs-CRP levels (p = 0.948). Males demonstrated overall larger benefits than premenopausal females from the VLEKT in terms of weight loss (Δ% = - 11.63 ± 1.76 vs - 8.95 ± 1.65 kg, p < 0.001), fat mass (Δ% = - 30.84 ± 12.00 vs -21.36 ± 4.65 kg, p = 0.002), and hs-CRP levels (Δ% = - 41.42 ± 21.35 vs - 22.38 ± 17.30 mg/L, p = 0.003). Of interest, in males phase angle values are statistically improved compared to female (Δ% = 17.11 ± 9.00 vs 7.05 ± 3.30°, p < 0.001). CONCLUSION These findings underscore the importance of considering sex-specific responses in personalized obesity treatment strategies, particularly dietary interventions like VLEKTs.
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Affiliation(s)
- Giovanna Muscogiuri
- Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Università Degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Università Degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Ludovica Verde
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Università Degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Evelyn Frias-Toral
- School of Medicine, Universidad Católica de Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil, 090615, Ecuador
| | - Claudia Reytor-González
- Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Quito, 170129, Ecuador
| | - Giuseppe Annunziata
- Facoltà Di Scienze Umane, Della Formazione E Dello Sport, Università Telematica Pegaso, Via Porzio, Centro Direzionale, Isola, F2, 80143, Naples, Italy
| | - Mattia Proganò
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Università Degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Silvia Savastano
- Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Università Degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Università Degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Daniel Simancas-Racines
- Facultad de Ciencias de la Salud Eugenio Espejo, Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Universidad UTE, Quito, 170129, Ecuador
| | - Annamaria Colao
- Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Università Degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Università Degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute e Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Luigi Barrea
- Dipartimento di Benessere, Nutrizione e Sport, Centro Direzionale, Università Telematica Pegaso, Via Porzio, Isola, F2, 80143, Naples, Italy.
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21
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Walter FA, Hoyt T, Michl TM. When insurance is not a barrier: psychological factors predicting whether bariatric candidates undergo surgery. Surg Obes Relat Dis 2024; 20:953-961. [PMID: 38777643 DOI: 10.1016/j.soard.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Despite the effectiveness of bariatric surgery, utilization rates have increased only marginally over the last 2 decades; candidates who are eligible for bariatric surgery regularly fail to undergo surgery. The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) has previously been used to assist in identification of those who will not move forward with surgery after being identified as eligible. However, medical insurance has been identified as a significant barrier to surgery; research in those who have universal healthcare may yield different results. OBJECTIVES Determine if MMPI-RF scales are associated with failure to undergo bariatric surgery in patients eligible to have the procedure. SETTING Large military hospital in the Northwestern U.S. METHODS This study used archival data for 279 patients psychologically screened for eligibility for bariatric surgery. All assessments took place between January 2017 and December 2019. T-tests and chi-square tests were used to compare groups of patients who did and did not have surgery on relevant medical and demographic variables. Profile analyses of patient MMPI-2-RF scores were conducted to examine scale associations with undergoing surgery. RESULTS A total of 86 bariatric surgery candidates (30.8%) did not undergo surgery. Results showed that sex, age, employment status, and arthritis were different between groups. Additionally, MMPI-2-RF scales were different between groups, including somatic complaints, neurological complaints, cynicism, and helplessness/hopelessness. CONCLUSIONS MMPI-2-RF scales were associated with not having bariatric surgery, although not all scales exceeded clinical cut-offs. Findings indicate psychological and psychosocial differences, rather than psychopathology per se, may play a role in who undergoes bariatric surgery.
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Affiliation(s)
| | - Tim Hoyt
- Madigan Army Medical Center, Tacoma, Washington.
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22
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Trooboff S, Pohl A, Spaulding AC, White LJ, Edwards MA. County health ranking: untangling social determinants of health and other factors associated with short-term bariatric surgery outcomes. Surg Obes Relat Dis 2024; 20:935-946. [PMID: 38760296 DOI: 10.1016/j.soard.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/10/2024] [Accepted: 03/09/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The complex interplay of the social determinants of health, race/ethnicity, and traditional surgical risk factors on outcomes following metabolic surgery is poorly understood. OBJECTIVE To evaluate the relationship between the social determinants of health as measured by county health ranking (CHR) and short-term metabolic surgery outcomes. SETTING Five accredited bariatric program sites at a national academic health system. METHODS Data were collected from 5 sites of a single health system from 2010 to 2021. Current procedural terminology codes identified primary and revisional cases. Patient characteristics, procedural data, and 30-day occurrences were collected. CHRs for health factors were determined by ZIP Code and stratified into best, middle, and worst terciles. The primary outcome was 30-day complications, readmissions, or reinterventions/reoperations. Logistic regression assessed the correlation between CHR tercile and morbidity. RESULTS We analyzed 4,315 primary and 370 revisional metabolic surgery cases. Overall, 64.0%, 27.4%, and 8.6% of patients lived in the best, middle, and worst CHR terciles, respectively. Patients in the middle and worst CHR terciles were more commonly older; non-Hispanic Black or Hispanic; suffered from preexisting chronic obstructive pulmonary disease or hypertension, were dialysis dependence, were on therapeutic anticoagulation, or had inferior vena cava filters. Middle and worst CHR tercile patients were more likely to undergo index sleeve gastrectomy or robotic-assisted surgery and have surgery performed by a self-designated general surgeon. Thirty-day outcomes were similar across CHR terciles. Racial disparity in multiple short-term outcomes persisted despite adjustment for CHR tercile. CONCLUSION Higher-risk patients are more likely to be from counties with lower CHRs, but CHR was not independently associated with 30-day outcomes after metabolic surgery.
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Affiliation(s)
- Spencer Trooboff
- Department of Surgery, Division of Advanced GI and Bariatric Surgery, Mayo Clinic, Jacksonville, Florida
| | - Abigail Pohl
- Department of Surgery, Division of Advanced GI and Bariatric Surgery, Mayo Clinic, Jacksonville, Florida
| | - Aaron C Spaulding
- Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, Florida
| | - Launia J White
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Florida
| | - Michael A Edwards
- Department of Surgery, Division of Advanced GI and Bariatric Surgery, Mayo Clinic, Jacksonville, Florida.
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23
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Mustian MN, Naik G, Wood L, Wong K, Stahl R, Grams J, Chu DI. Early postoperative outcomes following bariatric surgery in the United States: Are racial disparities improving? Surg Endosc 2024; 38:5948-5956. [PMID: 39060625 PMCID: PMC11458734 DOI: 10.1007/s00464-024-11056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Bariatric surgery offers effective treatment for morbid obesity and associated medical comorbidities, with excellent short- and long-term outcomes. Although it has been well documented that racial minority bariatric patients have worse outcomes than White patients, it remains unclear whether this recognition has led to improvement. Herein, we assess recent trends in bariatric surgery among Black and White patients and compare early postoperative outcomes by race. METHODS Primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) patients from 2015 to 2021 reported to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program were studied. Bariatric patients were stratified by race (Black and White) and perioperative outcomes were compared between matched Black and White patients. Primary outcome was 30-day mortality. Secondary outcomes included hospital readmissions, hospital length of stay (LOS), reoperation, and postoperative complications. RESULTS Overall, there were 193,071 Black and 645,224 White primary bariatric patients, with a higher volume of SG and RGYB performed among White patients. A total of 219,566 Black and White bariatric patients were matched and included in the case-control. Black patients were found to have higher rates of 30-day mortality (0.02% vs. 0.01%; p = 0.03) and readmissions (3.68% vs. 2.65%; p < 0.001). There were no significant differences in LOS, reoperations, or overall postoperative complications. However, there was a higher postoperative pulmonary thromboembolism rate (0.16% vs 0.08%; p < 0.001).). The differences in perioperative outcomes stratified by race persisted over the study period (Fig. 1). CONCLUSION Black bariatric surgery patients continue to have worse perioperative outcomes compared with their White counterparts. Further work must be done to determine contributing factors in order to effect improvement in outcomes in bariatric surgical care for racial minority patients.
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Affiliation(s)
- Margaux N Mustian
- Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building, 5th Floor, Birmingham, AL, 35294, USA.
| | - Gurudatta Naik
- Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building, 5th Floor, Birmingham, AL, 35294, USA
| | - Lauren Wood
- Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building, 5th Floor, Birmingham, AL, 35294, USA
| | - Kristen Wong
- Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building, 5th Floor, Birmingham, AL, 35294, USA
- Department of Surgery, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Richard Stahl
- Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building, 5th Floor, Birmingham, AL, 35294, USA
| | - Jayleen Grams
- Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building, 5th Floor, Birmingham, AL, 35294, USA
- Department of Surgery, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Daniel I Chu
- Department of Surgery, Division of Gastrointestinal Surgery, University of Alabama at Birmingham, 1808 7th Avenue South, Boshell Diabetes Building, 5th Floor, Birmingham, AL, 35294, USA
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24
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Phelps HM, Shelton M, Nicol GE, Stoll J, Sumski CA, Kaar CRJ, Eagon JC, Dimou FM, Eckhouse SR, Sprague JE, Shakhsheer BA. Factors Associated with Non-Completion of a Pediatric Metabolic and Bariatric Surgery Program. J Pediatr Surg 2024; 59:161582. [PMID: 38879401 DOI: 10.1016/j.jpedsurg.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/08/2024] [Accepted: 05/22/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Childhood obesity is a devastating disease process disproportionately affecting minority and low-income populations. Though bariatric surgery leads to durable weight loss and reversal of multiple obesity-related comorbidities, only a small fraction of pediatric patients undergoes the procedure. We sought to identify factors associated with non-completion in a pediatric bariatric surgery program. METHODS Retrospective review of consecutive patients ≤18-years-old referred to an academic adolescent bariatric surgery program between 2017 and 2022 (n = 20 completers, 40 non-completers) was completed. Demographics and medical and psychosocial histories were summarized by completion status. RESULTS Of the 33% (20/60; 85% female, 30% racial minorities) who successfully completed the program, the median age was 16 years [IQR 16, 17]. The median age of non-completers was 16 years [IQR 15, 17] (55% female, 56% racial minorities). Non-completion was associated with male gender (15% of completers vs 45% of non-completers, p = 0.022), neighborhood income <150% poverty level (0 completers vs 17.5% of non-completers, p = 0.047), and presence of environmental or family stressors (22% of completers vs 65% of non-completers, p = 0.008). Though not statistically significant, non-completers tended to be racial minorities (p = 0.054). CONCLUSIONS Non-completion of the bariatric surgery pathway was more prevalent among male patients from lower-income neighborhoods with significant environmental or family stressors. These patients also tended to be racial and ethnic minorities. The findings underscore the need for further investigation into barriers to pediatric bariatric surgery. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hannah M Phelps
- Department of Surgery, Division of Pediatric Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Lous, MO, United States
| | - Megan Shelton
- Department of Psychology, St. Louis Children's Hospital, One Children's Place, St. Louis, MO, United States
| | - Ginger E Nicol
- Department of Psychiatry, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Lous, MO, United States
| | - Janis Stoll
- Department of Pediatrics, Division of Gastroenterology, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Lous, MO, United States
| | - Christopher A Sumski
- Department of Pediatrics, Division of Cardiology, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Lous, MO, United States
| | - Courtney R J Kaar
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Lous, MO, United States
| | - J Chris Eagon
- Department of Surgery, Division of General Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Lous, MO, United States
| | - Francesca M Dimou
- Department of Surgery, Division of General Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Lous, MO, United States
| | - Shaina R Eckhouse
- Department of Surgery, Division of General Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Lous, MO, United States
| | - Jennifer E Sprague
- Department of Pediatrics, Division of Endocrinology, Diabetes, and Metabolism, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St. Lous, MO, United States
| | - Baddr A Shakhsheer
- Section of Pediatric Surgery, Department of Surgery, University of Chicago, 5839 South Maryland Avenue, Chicago, IL, United States.
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25
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Suvarnakar A, Hose BZ, Busog DN, McCloud S, Chao GF, Miller K, Pardo I, Alimi Y. Falling short in bariatric surgery: An exploration of key barriers and motivators of attrition. Am J Surg 2024; 236:115827. [PMID: 39029267 DOI: 10.1016/j.amjsurg.2024.115827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/25/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND In the United States, obesity-related diseases pose significant healthcare challenges, with bariatric surgery offering a potential solution. However, bariatric surgery completion rates, particularly among Black and Hispanic populations, remain low. OBJECTIVE This study applied the Theoretical Domains Framework (TDF) to explore behavioral factors influencing bariatric surgery program attrition among a majority Black participant population to inform interventions for improving attrition. METHODS We conducted semi-structured interviews with 40 surgical and non-surgical participants and conducted deductive content analysis informed by six TDF constructs to explore factors influencing bariatric surgery program attrition. RESULTS Participants' decision-making regarding bariatric surgery is influenced by behavioral factors, including knowledge, skills, social roles, beliefs about capabilities, optimism, and beliefs about consequences. CONCLUSION Understanding multifaceted factors influencing bariatric surgery attrition will inform the development of tailored interventions that address knowledge gaps, enhance skills, and consider social role conflicts to improve patient engagement and decision-making in managing obesity, especially for Black populations.
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Affiliation(s)
| | - Bat-Zion Hose
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, 20008, USA
| | - Deanna-Nicole Busog
- National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, 20008, USA
| | - Summer McCloud
- Georgetown University School of Medicine, Washington, DC, USA
| | - Grace F Chao
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Kristen Miller
- Georgetown University School of Medicine, Washington, DC, USA; National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, 20008, USA
| | - Ivanesa Pardo
- Georgetown University School of Medicine, Washington, DC, USA; Division of Minimally Invasive Surgery and Bariatric Surgery, Medstar Washington Hospital Center, Washington, DC, USA
| | - Yewande Alimi
- Georgetown University School of Medicine, Washington, DC, USA; Division of Minimally Invasive Surgery and Bariatric Surgery, Medstar Washington Hospital Center, Washington, DC, USA; Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.
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26
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Midura D, Levano S, Fiori KP, Farber BA. Analysis of Social Determinants of Health in the Pediatric General Surgical Population of a Northeastern Urban Health System. J Pediatr Surg 2024; 59:1822-1827. [PMID: 38760308 DOI: 10.1016/j.jpedsurg.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/01/2024] [Accepted: 04/23/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Social determinants of health (SDOH) have been identified as factors that influence patient health outcomes. These are well described in adult and pediatric general populations, however, there is a paucity of data for surgical patients. This study compares the prevalence of health-related social needs (HRSN) among pediatric surgery and general pediatric patients. METHODS We retrospectively assessed electronic health record data to identify patients who completed a standardized HRSN screener within our health system and underwent surgery by a pediatric surgeon between January 2019 and December 2021. We compared this population to non-surgical pediatric patients during this time. Bivariate and multivariate logistic regressions were conducted to estimate the likelihood of having 1 or more HRSN given a patient's surgery status. Logistic and linear regressions were conducted to estimate healthcare utilization in pediatric surgery patients given their HRSN status. RESULTS 33,989 general pediatric and pediatric surgery patients (age <21 years) were screened for HRSNs, and 2112 operations were performed during the study period. 343 (20%) of the surgical patients operated on by pediatric surgeons were screened for HRSNs. Surgical patients were more likely to be younger, Latinx, Spanish-speaking, and non-commercially insured (p < 0.0001). Surgical patients were 50% more likely to report one or more HRSN, when adjusting for demographic characteristics (aOR 1.50, 95% CI 1.16, 1.94). CONCLUSION Pediatric surgery patients are more likely to report HRSNs compared to the general pediatric population. Surgical patients may represent an at-risk group, and universal HRSN screening and support should be considered to improve outcomes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Devin Midura
- Department of Surgery, Division of Pediatric Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, 3355 Bainbridge Avenue, Bronx, NY 10467, USA
| | - Samantha Levano
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, 3415 Bainbridge Avenue, Bronx, NY, 10467, USA; Department of Family & Social Medicine, Division of Research, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Kevin P Fiori
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, 3415 Bainbridge Avenue, Bronx, NY, 10467, USA; Department of Family & Social Medicine, Division of Research, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA; Office of Community & Population Health, Montefiore Health System, 3514 DeKalb Avenue, Bronx, NY, 10467, USA
| | - Benjamin A Farber
- Department of Surgery, Division of Pediatric Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, 3355 Bainbridge Avenue, Bronx, NY 10467, USA.
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27
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Swanson KA, Steinberger AE, Nickel KB, Keller M, Sprague JE, Nicol GE, Christopher Eagon J, Dimou FM, Eckhouse SR, Shakhsheer BA. Characteristics in pediatric metabolic and bariatric surgery. Obes Res Clin Pract 2024; 18:396-399. [PMID: 39482117 DOI: 10.1016/j.orcp.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 10/15/2024] [Accepted: 10/18/2024] [Indexed: 11/03/2024]
Abstract
Childhood obesity continues to be a significant public health concern, and metabolic and bariatric surgery (MBS) is a contemporary intervention that remains underutilized. Records from the Kids' Inpatient Database (KID) were analyzed from 2009 to 2016 were analyzed to evaluate utilization characteristics of pediatric MBS. Annual procedure rates increased from 2.98 to 4.94 per 100,000 US adolescents. White children received the highest proportion of MBS at all time points; however, significant increases were seen among Black and Hispanic children. Despite these increases, a disproportionate racial bias persists indicating a need for further provider education and research into the utilization gap for minority patients.
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Affiliation(s)
- Kerry A Swanson
- Department of Surgery, Washington University, St Louis, MO, United States.
| | | | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, MO, United States
| | - Matthew Keller
- Division of Infectious Diseases, Department of Medicine, Washington University, St. Louis, MO, United States
| | - Jennifer E Sprague
- Pediatric Endocrinology, Department of Pediatrics, Washington University, St. Louis, MO, United States
| | - Ginger E Nicol
- Child and Adolescent Psychiatry, Department of Psychiatry, Washington University, St. Louis, MO, United States
| | - J Christopher Eagon
- Division of Minimally Invasive Surgery, Department of Surgery, Washington University, St Louis, MO, United States
| | - Francesca M Dimou
- Division of Bariatric and Metabolic Surgery, Department of Surgery, USF Health, Tampa, FL, United States
| | - Shaina R Eckhouse
- Division of Minimally Invasive Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC, United States
| | - Baddr A Shakhsheer
- Department of Surgery, Section of Pediatric Surgery, The University of Chicago, Comer Children's Hospital, Chicago, IL, United States
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Song K, Kong X, Yu Z, Xiao H, Ren Y. Research progress on bariatric surgery for hyperuricemia. BMC Surg 2024; 24:235. [PMID: 39169366 PMCID: PMC11337558 DOI: 10.1186/s12893-024-02525-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/06/2024] [Indexed: 08/23/2024] Open
Abstract
Hyperuricemia is closely linked to obesity. As lifestyles and dietary patterns evolve, the prevalence of hyperuricemia has been on the rise. Bariatric surgery, an efficacious intervention for morbid obesity and its associated metabolic disorders, not only manages the weight of patients with severe obesity but also exerts beneficial therapeutic effects on hyperuricemia and gout. Moreover, it demonstrates substantial efficacy against other obesity-related metabolic conditions. However, the dramatic fluctuations in serum uric acid levels and acute gouty attacks in the immediate postoperative period are issues that should not be overlooked, and effective preventative strategies for some related adverse complications are still underexplored. This review discusses and reviews the advancements in the treatment of obese patients with hyperuricemia through bariatric surgery. By reviewing pertinent literature, it summarizes the short-term and long-term therapeutic outcomes of bariatric surgery for hyperuricemia, as well as common adverse reactions. Furthermore, by discussing preoperative and postoperative interventional measures and influential factors, this review aims to provide novel perspectives for the clinical management of hyperuricemia and offer insights for the prevention of related complications.
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Affiliation(s)
- Ke Song
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Xiangxin Kong
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Zhenghang Yu
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - He Xiao
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China
| | - Yixing Ren
- Department of Gastroenterology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China.
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, Sichuan Province, China.
- General Surgery, Chengdu XinHua Hospital Affiliated to North Sichuan Medical College, Chengdu, 610000, Sichuan Province, China.
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Bitencourt THB, de Oliveira CM, Porto AA, de Andrade DC, Garner DM, Raimundo RD, Valenti VE. A Systematic Review and Meta-Analysis of Randomized Trials to Evaluate the Impact of Exercise on Heart Rate Variability Post-Bariatric Surgery. J Cardiovasc Dev Dis 2024; 11:248. [PMID: 39195156 DOI: 10.3390/jcdd11080248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/01/2024] [Accepted: 08/03/2024] [Indexed: 08/29/2024] Open
Abstract
Bariatric surgery is an approach used to treat patients with obesity in a small minority of eligible patients. Non-pharmacological therapies are important to maintain decent health status post-bariatric surgery. We performed a systematic review with meta-analysis to evaluate the effects of exercise on heart rate variability (HRV) in patients submitted to bariatric surgery. The searches were made via MEDLINE/PubMed (via the National Library of Medicine), EMBASE, Web of Science, and Scopus databases. We included non-blind, single-, or double-blind randomized control trials in patients older than 18 years of age submitted to bariatric surgery. The intervention group should be submitted to an exercise training protocol, including aerobic, strength, and other exercise modality after bariatric surgery. We documented 245 studies, and after screening and eligibility phases, only 4 were included. We observed no significant change for the SDNN: subtotal = 19.74 (CI: -4.98, 44.45), p = 0.12, I2 = 85% (very low quality of evidence); pNN50: subtotal = 13.09 (CI: -9.17, 35.35), p = 0.25, I2 = 93% (very low quality of evidence); RMSSD: subtotal = 8.44 (CI: -3.61, 25.50), p = 0.17, I2 = 95% (very low quality of evidence); SD1: subtotal = 9.36 (CI: -4.48, 23.21), p = 0.19, I2 = 96% (very low quality of evidence). We could not detect significant effects of exercise on resting HRV after bariatric surgery. The low certainty of the results via the evidence level analysis suggest further studies might be beneficial.
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Affiliation(s)
- Tulio H B Bitencourt
- Autonomic Nervous System Center, Sao Paulo State University (UNESP), Marilia 17525-900, SP, Brazil
| | | | - Andrey A Porto
- Autonomic Nervous System Center, Sao Paulo State University (UNESP), Marilia 17525-900, SP, Brazil
| | - Davi C de Andrade
- Autonomic Nervous System Center, Sao Paulo State University (UNESP), Marilia 17525-900, SP, Brazil
| | - David M Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Gipsy Lane, Oxford OX3 0BP, UK
| | - Rodrigo D Raimundo
- Laboratório de Delineamento de Estudos e Escrita Científica, Centro Universitário Faculdade de Medicina do ABC, Santo Andre 09060-870, SP, Brazil
| | - Vitor E Valenti
- Autonomic Nervous System Center, Sao Paulo State University (UNESP), Marilia 17525-900, SP, Brazil
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Ebadifard R, Kiani Z, Keshavarz Z, Sheikhan Z, Alemrajabi M, Nasiri M. Comparing sexual self-concept in women with obesity pre- and post-bariatric surgery. BMC Public Health 2024; 24:1744. [PMID: 38951823 PMCID: PMC11218136 DOI: 10.1186/s12889-024-19279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/26/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Obesity leads to increased disease burden, decreased life expectancy, and disrupted sexual life. One of the most effective ways of obesity treatment is bariatric surgery. This study was conducted aiming to determine and compare sexual self-concept in women with obesity pre- and post-bariatric surgery. METHOD A longitudinal study comparing sexual self-concept pre and post- surgery was conducted on women with obesity referring to obesity clinics in the city of Tehran in 2020-2021. Data collection was performed using Snell's Multidimensional Sexual Self-Concept Questionnaire (MSSCQ), which was completed online. Data were analyzed using SPSS version 16 statistical software and Fisher's exact test, chi-square, Mann-Whitney, independent t, and logistic and linear regression tests. A p-value of less than 0.05 was considered significant. RESULTS According to the findings, the mean (standard deviation) score of sexual self-concept was 240.26 (26.82) in the post-surgery group and 200.26 (32.24) in the pre-surgery group (P = 0.001), and the highest mean (standard deviation) score of sexual self-concept both in the pre-surgery group (13.06 [4.00]) and in the post-surgery group (15.46 [2.16]) was related to the area of sexual depression (P = 0.05). Also, with increasing educational level, the odds of bariatric surgery increased by 33%, and those who had no private bedroom had lower odds of bariatric surgery by 65%. In those who did not have other individuals living in their house and their spouse was not a smoker, the self-concept score was 52.35 and 23.11 units higher. CONCLUSION In general, bariatric surgery can improve sexual self-care. Considering the issue of sexual self-concept in bariatric surgery, it is recommended to design appropriate counseling and planning before surgery according to the culture of each country.
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Affiliation(s)
- Reyhane Ebadifard
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Kiani
- Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Keshavarz
- Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zohre Sheikhan
- Department of Midwifery, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Alemrajabi
- Firoozgar hospital, GILDRIC, Iran univetsity of Medical Sciences, Faculty of medicine, Tehran, Iran
| | - Maliheh Nasiri
- Department of Basic Sciences, School of Nursing and Midwifery , Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rahimi AO, Soliman D, Hsu CH, Ghaderi I. The impact of gender, race, and ethnicity on bariatric surgery outcomes. Surg Obes Relat Dis 2024; 20:454-461. [PMID: 38326184 DOI: 10.1016/j.soard.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND The rates of postoperative complications can vary among specific patient populations. OBJECTIVES The aim of this study is to examine how gender, race, and ethnicity can affect short-term postoperative complications in bariatric surgery patients. SETTING United States. METHODS Patients who underwent bariatric surgery between the years 2016 and 2021 were included and stratified based on gender, race/ethnicity, and procedure type. The 30-day outcomes were assessed using Clavien-Dindo (CD) classification of III-V. Wilcoxon rank-sum test was performed to compare continuous variables among groups and Chi-squared test for categorical variables. Logistic regression was performed to examine the effects of gender, race/ethnicity on CD classification ≥ III complications by the procedure type. RESULTS A total of 975,642 bariatric surgery patients were included. Descriptive univariate analysis showed that CD ≥ III complications were higher among non-Hispanic blacks (NHB) and lowest in Hispanic patients, regardless of their gender, except in the duodenal switch DS group, where non-Hispanic whites (NHW) had the lowest complication rate. There was no difference between male and female patients with regards to postoperative complications, except in the sleeve gastrectomy (SG) group, where NHW males had more complications than NHW females. Sleeve gastrectomy showed the lowest complication rates followed by gastric bypass and DS in all groups. In multivariate logistic regression model, for both females and males NHBs had higher odds of postoperative complications compared to NHWs in sleeve gastrectomy (Female aOR:1.31, 95% CI: [1.23-1.40]; Male aOR:1.24, 95% CI: [1.08-1.43], P < .001) and gastric bypass (Female aOR:1.24, 95% CI: [1.16-1.33]; Male aOR:1.25, 95% CI: [1.06-1.48], P < .01). CONCLUSIONS Non-Hispanic Black patients are at a higher rate of developing CD ≥ III complications compared to non-Hispanic Whites after bariatric surgery. The male gender was not a significant risk factor for serious postoperative complications. Among the different types of bariatric procedures, sleeve gastrectomy has the lowest rates of severe complications, followed by gastric bypass and duodenal switch. These results highlight the significance of considering gender, race, ethnicity, and procedure type during preoperative evaluation, surgical planning, and postoperative care.
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Affiliation(s)
- Ahmad Omid Rahimi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Diaa Soliman
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Chiu-Hsieh Hsu
- Epidemiology and Biostatistics Department, University of Arizona College of Public Health, Tucson, Arizona
| | - Iman Ghaderi
- Section of Minimally Invasive, Robotic and Bariatric Surgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona.
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Srinivasan N, Samaan JS, Rajeev ND, Kanu MU, Yeo YH, Samakar K. Large language models and bariatric surgery patient education: a comparative readability analysis of GPT-3.5, GPT-4, Bard, and online institutional resources. Surg Endosc 2024; 38:2522-2532. [PMID: 38472531 PMCID: PMC11078810 DOI: 10.1007/s00464-024-10720-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/28/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The readability of online bariatric surgery patient education materials (PEMs) often surpasses the recommended 6th grade level. Large language models (LLMs), like ChatGPT and Bard, have the potential to revolutionize PEM delivery. We aimed to evaluate the readability of PEMs produced by U.S. medical institutions compared to LLMs, as well as the ability of LLMs to simplify their responses. METHODS Responses to frequently asked questions (FAQs) related to bariatric surgery were gathered from top-ranked health institutions. FAQ responses were also generated from GPT-3.5, GPT-4, and Bard. LLMs were then prompted to improve the readability of their initial responses. The readability of institutional responses, initial LLM responses, and simplified LLM responses were graded using validated readability formulas. Accuracy and comprehensiveness of initial and simplified LLM responses were also compared. RESULTS Responses to 66 FAQs were included. All institutional and initial LLM responses had poor readability, with average reading levels ranging from 9th grade to college graduate. Simplified responses from LLMs had significantly improved readability, with reading levels ranging from 6th grade to college freshman. When comparing simplified LLM responses, GPT-4 responses demonstrated the highest readability, with reading levels ranging from 6th to 9th grade. Accuracy was similar between initial and simplified responses from all LLMs. Comprehensiveness was similar between initial and simplified responses from GPT-3.5 and GPT-4. However, 34.8% of Bard's simplified responses were graded as less comprehensive compared to initial. CONCLUSION Our study highlights the efficacy of LLMs in enhancing the readability of bariatric surgery PEMs. GPT-4 outperformed other models, generating simplified PEMs from 6th to 9th grade reading levels. Unlike GPT-3.5 and GPT-4, Bard's simplified responses were graded as less comprehensive. We advocate for future studies examining the potential role of LLMs as dynamic and personalized sources of PEMs for diverse patient populations of all literacy levels.
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Affiliation(s)
- Nitin Srinivasan
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA
| | - Jamil S Samaan
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nithya D Rajeev
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA
| | - Mmerobasi U Kanu
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA
| | - Yee Hui Yeo
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kamran Samakar
- Division of Upper GI and General Surgery, Keck School of Medicine of USC, 1510 San Pablo St HCC 3, Los Angeles, CA, 90033, USA.
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Chen SY, Telfser AJ, Olzomer EM, Vancuylenberg CS, Zhou M, Beretta M, Li C, Alexopoulos SJ, Turner N, Byrne FL, Santos W, Hoehn KL. Beneficial effects of simultaneously targeting calorie intake and calorie efficiency in diet-induced obese mice. Clin Sci (Lond) 2024; 138:173-187. [PMID: 38315575 PMCID: PMC10876416 DOI: 10.1042/cs20231016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/07/2024]
Abstract
Semaglutide is an anti-diabetes and weight loss drug that decreases food intake, slows gastric emptying, and increases insulin secretion. Patients begin treatment with low-dose semaglutide and increase dosage over time as efficacy plateaus. With increasing dosage, there is also greater incidence of gastrointestinal side effects. One reason for the plateau in semaglutide efficacy despite continued low food intake is due to compensatory actions whereby the body becomes more metabolically efficient to defend against further weight loss. Mitochondrial uncoupler drugs decrease metabolic efficiency, therefore we sought to investigate the combination therapy of semaglutide with the mitochondrial uncoupler BAM15 in diet-induced obese mice. Mice were fed high-fat western diet (WD) and stratified into six treatment groups including WD control, BAM15, low-dose semaglutide without or with BAM15, and high-dose semaglutide without or with BAM15. Combining BAM15 with either semaglutide dose decreased body fat and liver triglycerides, which was not achieved by any monotherapy, while high-dose semaglutide with BAM15 had the greatest effect on glucose homeostasis. This study demonstrates a novel approach to improve weight loss without loss of lean mass and improve glucose control by simultaneously targeting energy intake and energy efficiency. Such a combination may decrease the need for semaglutide dose escalation and hence minimize potential gastrointestinal side effects.
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Affiliation(s)
- Sing-Young Chen
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Aiden J. Telfser
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Ellen M. Olzomer
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Calum S. Vancuylenberg
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Mingyan Zhou
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Martina Beretta
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Catherine Li
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Stephanie J. Alexopoulos
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Nigel Turner
- Cellular Bioenergetics Laboratory, Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Frances L. Byrne
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Webster L. Santos
- Department of Chemistry and Virginia Tech Centre for Drug Discovery, Virginia Tech, Blacksburg, VA 24061, U.S.A
| | - Kyle L. Hoehn
- School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, NSW 2052, Australia
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Wilkerson AD, Gentle CK, Ortega C, Al-Hilli Z. Disparities in Breast Cancer Care-How Factors Related to Prevention, Diagnosis, and Treatment Drive Inequity. Healthcare (Basel) 2024; 12:462. [PMID: 38391837 PMCID: PMC10887556 DOI: 10.3390/healthcare12040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations and demographic groups. This review summarizes published works that contextualize modern disparities in breast cancer prevention, diagnosis, and treatment and presents potential strategies for reducing disparities. We conducted searches for studies that directly investigated and/or reported disparities in breast cancer prevention, detection, or treatment. Demographic factors, social determinants of health, and inequitable healthcare delivery may impede the ability of individuals and communities to employ risk-mitigating behaviors and prevention strategies. The disparate access to quality screening and timely diagnosis experienced by various groups poses significant hurdles to optimal care and survival. Finally, barriers to access and inequitable healthcare delivery patterns reinforce inequitable application of standards of care. Cumulatively, these disparities underlie notable differences in the incidence, severity, and survival of breast cancers. Efforts toward mitigation will require collaborative approaches and partnerships between communities, governments, and healthcare organizations, which must be considered equal stakeholders in the fight for equity in breast cancer care and outcomes.
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Affiliation(s)
- Avia D Wilkerson
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Corey K Gentle
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Camila Ortega
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Breast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Gala K, Brunaldi V, McGowan C, Sharaiha RZ, Maselli D, VanderWel B, Kedia P, Ujiki MB, Wilson E, Vargas EJ, Storm AC, Abu Dayyeh BK. Practice patterns and outcomes of endoscopic sleeve gastroplasty based on provider specialty. Endosc Int Open 2024; 12:E253-E261. [PMID: 38415023 PMCID: PMC10898995 DOI: 10.1055/a-2251-3738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/05/2024] [Indexed: 02/29/2024] Open
Abstract
Background and study aims Endoscopic sleeve gastroplasty (ESG) is performed in clinical practice by gastroenterologists and bariatric surgeons. Given the increasing regulatory approval and global adoption, we aimed to evaluate real-world outcomes in multidisciplinary practices involving bariatric surgeons and gastroenterologists across the United States. Patients and methods We included adult patients with obesity who underwent ESG from January 2013 to August 2022 in seven academic and private centers in the United States. Patient and procedure characteristics, serious adverse events (SAEs), and weight loss outcomes up to 24 months were analyzed. SPSS (version 29.0) was used for all statistical analyses. Results A total of 1506 patients from seven sites included 235 (15.6%) treated by surgeons and 1271 (84.4%) treated by gastroenterologists. There were no baseline differences between groups. Gastroenterologists used argon plasma coagulation for marking significantly more often than surgeons ( P <0.001). Surgeons placed sutures in the fundus in all instances whereas gastroenterologist placed them in the fundus in less than 1% of the cases ( P <0.001>). Procedure times were significantly different between groups, with surgeons requiring approximately 20 minutes more during the procedure than gastroenterologists ( P <0.001). Percent total body weight loss (%TBWL) and percent responders achieving >10 and >15% TBWL were similar between the two groups at 12, 18, and 24 months. Rates of SAEs were low and similar at 1.7% for surgeons and 2.7% for gastroenterologists ( P >0.05). Conclusions Data from a large US cohort show significant and sustained weight loss with ESG and an excellent safety profile in both bariatric surgery and gastroenterology practices, supporting the scalability of the procedure across practices in a multidisciplinary setting.
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Affiliation(s)
- Khushboo Gala
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Vitor Brunaldi
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
- Gastroenterology department, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | | | - Daniel Maselli
- GI, True You Weight Loss Georgia LLC, Cary, United States
| | | | - Prashant Kedia
- Gastroenterology, Methodist Dallas Medical Center, Dallas, United States
| | - Michael B Ujiki
- NorthShore Center for Simulation and Innovation, NorthShore University Health Systems, Evanston, United States
| | - Erik Wilson
- Surgery, University of Texas McGovern Medical School, Houston, United States
| | - Eric J. Vargas
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Andrew C Storm
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
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Murphy E, Finucane FM. Addressing uncertainty about the role of structured lifestyle modification for metabolic surgery patients. Metabolism 2024; 151:155739. [PMID: 37984732 DOI: 10.1016/j.metabol.2023.155739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023]
Abstract
There is good evidence that structured lifestyle modification programmes improve health in patients with metabolic and cardiovascular disorders, but there is no specific evidence that they improve outcomes in patients undergoing metabolic or obesity surgery. Despite expert consensus guidelines stating this fact, some healthcare systems still compel patients to participate in a structured lifestyle modification programme prior to metabolic or obesity surgery. There is a well-established need for individualised multidisciplinary dietetic and physical activity care for metabolic and obesity surgery patients, and the benefits of intentional weight loss prior to surgery are well proven, but these are distinct from potentially harmful requirements for patients to undertake compulsory structured lifestyle programmes of fixed duration, frequency and intensity, which may delay surgery and reinforce obesity stigma. A critical step in rejuvenating metabolic surgery is to reframe patient participation in structured lifestyle modification programmes as an opportunity for education and empowerment, not as an indicator of motivation or suitability for metabolic surgery. Large, well-designed and adequately powered clinical trials are needed to address uncertainties in the evidence base for these programmes. Given genuine equipoise, they will need to determine whether "surgery plus lifestyle" is superior to "surgery plus placebo". Moreover, they will need to determine the cost-effectiveness of these programmes and identify some of the factors giving rise to the substantial heterogeneity in responses to structured lifestyle modification.
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Affiliation(s)
- Enda Murphy
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta Health Care Group, Galway, Ireland; HRB Clinical Research Facility, University of Galway and Saolta University Health Care Group, Ireland; Cúram, University of Galway, Ireland.
| | - Francis M Finucane
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta Health Care Group, Galway, Ireland; HRB Clinical Research Facility, University of Galway and Saolta University Health Care Group, Ireland; Cúram, University of Galway, Ireland
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Ahmed L, Gebran S, Persaud A, Saeed K, Khan K, Saeed S, Alothman S, Passos-Fox B, DePaz H, Suman P. The Use of Noninvasive Scores in Predicting NAFLD Progression After Bariatric Surgery. Obes Surg 2023; 33:4026-4033. [PMID: 37884692 DOI: 10.1007/s11695-023-06912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Bariatric surgery has been postulated to impact liver function resulting in favorable effects on nonalcoholic fatty liver disease (NAFLD). We aimed to analyze the long-term impact of bariatric surgery on noninvasive scores predicting the progression of liver fibrosis in a bariatric population. METHODS We retrospectively reviewed the records of patients without pre-existing liver disease who underwent sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) at our center between 2010 and 2018. Four predictive scores for liver fibrosis (AST/ALT, APRI, Fib-4, and BARD) were calculated preoperatively, 6 months post-operatively, and annually up to 5 years. Correlations were analyzed with Pearson R. Subgroup and sensitivity analyses were performed to identify populations at increased risk. RESULTS A total of 2769 patients were included. The mean age was 40 years, and the majority was females (88.5%) and of Hispanic ethnicity (59.2%). There was a steady post-operative increase in the percentage of patients at increased risk of progression of liver fibrosis. The Fib-4 score showed the largest increase in the population at risk for liver fibrosis (11.3% preoperatively to 28.9% at 5 years). Patients with diabetes and those who underwent a sleeve gastrectomy continued to display a higher risk for liver fibrosis than did patients without diabetes and those who underwent RYGB, respectively. CONCLUSION There was an overall trend to increased liver fibrosis scores over the 5-year post-operative follow-up, but this increase remained lower than that reported in previous literature. Bariatric surgery offers NAFLD risk reduction in a high-risk population.
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Affiliation(s)
- Leaque Ahmed
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Selim Gebran
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA.
| | - Amrita Persaud
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Kashif Saeed
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Khuram Khan
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Saqib Saeed
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
| | - Sara Alothman
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Bianca Passos-Fox
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Hector DePaz
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
| | - Paritosh Suman
- Department of Surgery, Harlem Hospital Center, 506 Lenox Ave, New York, NY, 10037, USA
- Department of Surgery, Wyckoff Heights Medical Center, 374 Stockholm St, Room C-408, Brooklyn, NY, Brooklyn, NY, 11237, USA
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Chen G, Donahoo WT, Cardel MI, Holgerson A, Ayzengart A, Johnson-Mann CN, Gurka MJ. Variation by race/ethnicity in the utilization and weight loss following metabolic bariatric surgery. Surg Obes Relat Dis 2023; 19:1391-1404. [PMID: 37666726 DOI: 10.1016/j.soard.2023.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/02/2023] [Accepted: 06/13/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Understanding the disparities in utilization and weight loss outcomes of metabolic and bariatric surgery (MBS) by demographics will inform strategies targeting potential treatment gaps and enhance overall clinical obesity treatment. OBJECTIVE To identify factors associated with utilization and longitudinal weight loss after MBS. SETTING OneFlorida Clinical Research Consortium Database. METHODS We performed a retrospective study using data from the OneFlorida Clinical Research Consortium between 2012 and 2018. We used logistic regression with intersectional effects to identify factors associated with utilization of MBS. Mixed-effect models were used to estimate longitudinal percentage total weight loss among those who underwent MBS with up to 18 months of follow-up. RESULTS Among 429,821 patients eligible for MBS, 8290 (1.9%) underwent MBS between 2012 and 2018. Intersectional analysis revealed that non-Hispanic Black patients experienced an inferior utilization of MBS compared with non-Hispanic White and Hispanic counterparts, defined by the interaction between race/ethnicity and demographic factors, including male sex, older age, and insurance coverage. In the longitudinal weight loss assessment, 4016 patients (48.3% Roux-en-Y gastric bypass, 51.7% sleeve gastrectomy) were included. We found that non-Hispanic Black patients experienced significantly less weight loss than non-Hispanic White and Hispanic counterparts. Other factors associated with less weight loss over time included undergoing sleeve gastectomy, male sex, lower preoperative body mass index, and having type 2 diabetes at the time of surgery. CONCLUSIONS Our findings will help to design new strategies focusing on the intersection of race/ethnicity and sociodemographic factors to improve access and effectiveness of MBS.
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Affiliation(s)
- Guanming Chen
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida
| | - William T Donahoo
- Department of Endocrinology, University of Florida College of Medicine, Gainesville, Florida
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida; WW International, Inc., New York, New York
| | - Allison Holgerson
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, Florida
| | | | | | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida; Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.
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Alick CL, Braxton D, Skinner H, Alexander R, Ammerman AS, Keyserling TC, Samuel-Hodge CD. Rural African American Women With Severe Obesity: A Cross-Sectional Analysis of Lifestyle Behaviors and Psychosocial Characteristics. Am J Health Promot 2023; 37:1060-1069. [PMID: 37505193 PMCID: PMC10631280 DOI: 10.1177/08901171231190597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
PURPOSE To examine differences in lifestyle behavioral and psychosocial factors between rural African American women with Class 3 obesity and those with overweight, and Class 1-2 obesity. DESIGN Cross-sectional study. SETTING Rural Southeastern United States. SUBJECTS Participants included 289 African American women with a mean age of 56 years, 66% with a high school education or less, and a mean body mass index (BMI) of 38.6 kg/m2; 35% (n = 102) were classified with Class 3 obesity. MEASURES We objectively measured height, weight, and physical activity steps/day. Self-reported dietary and physical activity behaviors, general health-related quality of life, mental health, and social support were measured with validated surveys. ANALYSIS Chi-Square analysis for categorical variables and analysis of variance (ANOVA) - via multiple linear regression - for continuous variables. RESULTS There were no significant demographic differences between BMI groups, except for age, where women with Class 3 obesity were on average younger (51 vs 58 y, P < .001). Although dietary behaviors did not differ significantly between groups, we observed significant group differences in self-reported and objective measures of physical activity. The age-adjusted difference in means for self-reported total physical activity minutes/wk. was 91 minutes, with women categorized with Class 3 obesity reporting significantly fewer weekly minutes than those with overweight/Class 1-2 obesity (64.3 vs 156.4 min/wk. respectively, P < .01). Among psychosocial variables, only in the physical component scores of health-related quality of life did we find significant group differences - lower physical well-being among women with Class 3 obesity compared to those with overweight/Class 1-2 obesity (P = .02). CONCLUSION For African American women with Class 3 obesity living in rural setting, these findings suggest behavioral weight loss interventions may need to target physical activity strategies that address physical, psychosocial, and environmental barriers.
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Affiliation(s)
- Candice L. Alick
- Center for Health Promotion & Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
| | - Danielle Braxton
- Department of Health Promotion, North Carolina Wesleyan College, Rocky Mount, NC, USA
| | - Harlyn Skinner
- Department of Biological Science, Center for Human Health and the Environment, North Carolina State University, Chapel Hill, NC, USA
| | - Ramine Alexander
- Department of Family and Consumer Sciences, Food and Nutritional Sciences, North Carolina Agricultural & Technical State University, Greensboro, NC, USA
| | - Alice S. Ammerman
- Department of Nutrition, Gillings School of Global Public Health, Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C. Keyserling
- Internal Medicine, UNC School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Carmen D. Samuel-Hodge
- Department of Nutrition, Gillings School of Global Public Health, Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
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Myneni AA, Simmonds I, Orom H, Anderson LM, Singh R, Homish GG, Wright AJ, Pigott S, Onoh JC, Hoffman AB, Noyes K. A qualitative analysis of Black men's attitudes toward obesity and bariatric surgery. Surg Obes Relat Dis 2023; 19:1100-1108. [PMID: 37147204 DOI: 10.1016/j.soard.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/13/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is a safe and highly effective treatment for morbid obesity and related co-morbidities. While MBS access and insurance coverage have greatly improved, sex and racial disparities remain in utilization of MBS. OBJECTIVE To identify novel intrinsic factors that may explain Black underutilization of surgical treatments for weight management. SETTING This study was conducted in metropolitan communities of Western New York. METHODS We conducted semistructured face-to-face interviews with 27 adult Black men with a history of obesity and at least 2 obesity-related conditions (diabetes, hypertension, and/or chronic kidney disease [CKD]), about their attitudes, beliefs, behaviors, and habits related to obesity and obesity management. Interview transcripts were reviewed using thematic analysis for patterns and themes. RESULTS Most participants did not perceive obesity as a serious health condition and those who had weight-loss goals did not aim for a healthy body mass index (BMI). Trust and respectful communication with physician were very important in making healthcare decisions. MBS was perceived as extreme and dangerous option for weight loss, and only participants with severe symptoms such as chronic pain were open to discussing MBS with their providers. Participants acknowledged lack of role models of similar background who had successfully undergone MBS for obesity. CONCLUSIONS This study identified misinformation about risks and benefits of MBS and lack of community role models as important factors contributing to Black men's unwillingness to consider MBS. Further research is needed to facilitate patient-provider communication about weight and improve provider's ability and motivation for weight management in primary care settings.
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Affiliation(s)
- Ajay A Myneni
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.
| | - Iman Simmonds
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
| | - Heather Orom
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | | | - Ranjit Singh
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Alexander J Wright
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Sydney Pigott
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York; Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Joshua C Onoh
- Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Aaron B Hoffman
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Katia Noyes
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Division of Health Services Policy and Practice, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
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James TJ, Nguyen JD, Martin MJ. Comment on: A qualitative analysis of Black men's attitudes toward obesity and bariatric surgery. Surg Obes Relat Dis 2023; 19:1108-1109. [PMID: 37495502 DOI: 10.1016/j.soard.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/18/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Tayler J James
- Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - James D Nguyen
- Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Matthew J Martin
- Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, California
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Bakillah E, Brown D, Syvyk S, Wirtalla C, Kelz RR. Barriers and facilitators to surgical access in underinsured and immigrant populations. Am J Surg 2023; 226:176-185. [PMID: 37156680 DOI: 10.1016/j.amjsurg.2023.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/10/2023] [Accepted: 04/08/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Marginalized communities are at risk of receiving inequitable access to surgical care. We aimed to examine the barriers and facilitators to access to surgery in underinsured and immigrant populations. METHODS A systematic review of disparities in access to surgical care was performed between January 1, 2000-March 2, 2022. Methodological quality was assessed with the Mixed Methods Appraisal Tool. A convergent integrated approach was used to code common themes between studies. RESULTS Of 1315 publications, a total of 66 studies were included for systematic review. Eight studies specifically discussed immigrant patient populations. Barriers and facilitators to surgical access were categorized by patient and health systems related factors. CONCLUSIONS Established facilitators to improve surgical access are centered on patient-level factors while interventions to address systems-related barriers are limited and may be an area for further investigation. Research focused on access to surgery in immigrant populations remains sparse.
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Affiliation(s)
- Emna Bakillah
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Danielle Brown
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA
| | - Solomiya Syvyk
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA
| | - Christopher Wirtalla
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA
| | - Rachel R Kelz
- Department of Surgery, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA; Center for Surgery and Health Economics, Department of Surgery, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Frego N, D'Andrea V, Labban M, Trinh QD. An ecological framework for racial and ethnic disparities in surgery. Curr Probl Surg 2023; 60:101335. [PMID: 37316107 DOI: 10.1016/j.cpsurg.2023.101335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Nicola Frego
- Department of Urology, Istituto Clinico Humanitas IRCCS, Milan, Italy
| | - Vincent D'Andrea
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, MA
| | - Muhieddine Labban
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, MA
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, MA; Brigham and Women's Faulkner Hospital, Jamaica Plain, MA.
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Maselli DB, Hoff AC, Kucera A, Weaver E, Sebring L, Gooch L, Walton K, Lee D, Cratty T, Beal S, Nanduri S, Rease K, Gainey CS, Eaton L, Coan B, McGowan CE. Endoscopic sleeve gastroplasty in class III obesity: Efficacy, safety, and durability outcomes in 404 consecutive patients. World J Gastrointest Endosc 2023; 15:469-479. [PMID: 37397974 PMCID: PMC10308273 DOI: 10.4253/wjge.v15.i6.469] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is an effective therapy for class I-II obesity, but there are knowledge gaps in the published literature about its implementation in patients with class III obesity [body mass index (BMI) ≥ 40 kg/m2].
AIM To evaluate the safety, clinical efficacy, and durability of ESG in adults with class III obesity.
METHODS This was a retrospective cohort study that used prospectively collected data on adults with BMI ≥ 40 kg/m2 who underwent ESG and longitudinal lifestyle counseling at two centers with expertise in endobariatric therapies from May 2018-March 2022. The primary outcome was total body weight loss (TBWL) at 12 mo. Secondary outcomes included changes in TBWL, excess weight loss (EWL) and BMI at various time points up to 36 mo, clinical responder rates at 12 and 24 mo, and comorbidity improvement. Safety outcomes were reported through the study duration. One-way ANOVA test was performed with multiple Tukey pairwise comparisons for TBWL, EWL, and BMI over the study duration.
RESULTS 404 consecutive patients (78.5% female, mean age 42.9 years, mean BMI 44.8 ± 4.7 kg/m2) were enrolled. ESGs were performed using an average of 7 sutures, over 42 ± 9 min, and with 100% technical success. TBWL was 20.9 ± 6.2% at 12 mo, 20.5 ± 6.9% at 24 mo, and 20.3 ± 9.5% at 36 mo. EWL was 49.6 ± 15.1% at 12 mo, 49.4 ± 16.7% at 24 mo, and 47.1 ± 23.5% at 36 mo. There was no difference in TBWL at 12, 15, 24, and 36 mo from ESG. TBWL exceeding 10%, 15%, and 20% was achieved by 96.7%, 87.4%, and 55.6% of the cohort at 12 mo, respectively. Of the cohort with the relevant comorbidity at time of ESG, 66.1% had improvement in hypertension, 61.7% had improvement in type II diabetes, and 45.1% had improvement in hyperlipidemia over study duration. There was one instance of dehydration requiring hospitalization (0.2% serious adverse event rate).
CONCLUSION When combined with longitudinal nutritional support, ESG induces effective and durable weight loss in adults with class III obesity, with improvement in comorbidities and an acceptable safety profile.
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Affiliation(s)
- Daniel Barry Maselli
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Anna Carolina Hoff
- Bariatric Endoscopy, Angioskope Clinic, São José dos Campos 12243-680, São Paulo, Brazil
| | - Ashley Kucera
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Emily Weaver
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Laura Sebring
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Lori Gooch
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Kathleen Walton
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Daniel Lee
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Taylor Cratty
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Selena Beal
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Srikar Nanduri
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Kendall Rease
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Christina S Gainey
- Gastroenterology and Hepatology, University of North Carolina System, Chapel Hill, NC 27599, United States
| | - Laura Eaton
- UltaMed Corporation, UltaMed Corporation, Fort Lauderdale, FL 33308, United States
| | - Brian Coan
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
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Lucy AT, Rakestraw SL, Stringer C, Chu D, Grams J, Stahl R, Mustian MN. Readability of patient education materials for bariatric surgery. Surg Endosc 2023:10.1007/s00464-023-10153-3. [PMID: 37277519 DOI: 10.1007/s00464-023-10153-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/20/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Bariatric surgery is a successful treatment for obesity, but barriers to surgery exist, including low health literacy. National organizations recommend patient education materials (PEM) not exceed a sixth-grade reading level. Difficult to comprehend PEM can exacerbate barriers to bariatric surgery, especially in the Deep South where high obesity and low literacy rates exist. This study aimed to assess and compare the readability of webpages and electronic medical record (EMR) bariatric surgery PEM from one institution. METHODS Readability of online bariatric surgery and standardized perioperative EMR PEM were analyzed and compared. Text readability was assessed by validated instruments: Flesch Reading Ease Formula (FRE), Flesch Kincaid Grade Level (FKGL), Gunning Fog (GF), Coleman-Liau Index (CL), Simple Measure of Gobbledygook (SMOG), Automated Readability Index (ARI), and Linsear Write Formula (LWF). Mean readability scores were calculated with standard deviations and compared using unpaired t-tests. RESULTS 32 webpages and seven EMR education documents were analyzed. Webpages were overall "difficult to read" compared to "standard/average" readability EMR materials (mean FRE 50.5 ± 18.3 vs. 67.4 ± 4.2, p = 0.023). All webpages were at or above high school reading level: mean FKGL 11.8 ± 4.4, GF 14.0 ± 3.9, CL 9.5 ± 3.2, SMOG 11.0 ± 3.2, ARI 11.7 ± 5.1, and LWF 14.9 ± 6.6. Webpages with highest reading levels were nutrition information and lowest were patient testimonials. EMR materials were sixth to ninth grade reading level: FKGL 6.2 ± 0.8, GF 9.3 ± 1.4, CL 9.7 ± 0.9, SMOG 7.1 ± 0.8, ARI 6.1 ± 1.0, and LWF 5.9 ± 0.8. CONCLUSION Surgeon curated bariatric surgery webpages have advanced reading levels above recommended thresholds compared to standardized PEM from an EMR. This readability gap may unintentionally contribute to barriers to surgery and affect postoperative outcomes. Streamlined efforts are needed to create materials that are easier to read and comply with recommendations.
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Affiliation(s)
- Adam Timothy Lucy
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA.
- UAB Department of Surgery, 1808 7th Ave South, Boshell Diabetes Building, Suite 202, Birmingham, AL, 35233, USA.
| | - Stephanie L Rakestraw
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
| | - Courtney Stringer
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
| | - Daniel Chu
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
| | - Jayleen Grams
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
- Surgical Services, Birmingham Veterans Affairs Medical Center, 700 19th Street South, Birmingham, AL, 35233, USA
| | - Richard Stahl
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
| | - Margaux N Mustian
- Department of Surgery, University of Alabama at Birmingham (UAB) Heersink School of Medicine, 1808 7th Ave South, BDB 505, Birmingham, AL, 35233, USA
- Surgical Services, Birmingham Veterans Affairs Medical Center, 700 19th Street South, Birmingham, AL, 35233, USA
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Rosen CB, Roberts SE, Sharpe J, Gershuni V, Altieri MS, Kelz RR. A study analyzing outcomes after bariatric surgery by primary language. Surg Endosc 2023:10.1007/s00464-023-10127-5. [PMID: 37266743 DOI: 10.1007/s00464-023-10127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Communication is key to success in bariatric surgery. This study aims to understand how outcomes after bariatric surgery differ between patients with a non-English primary language and those with English as their primary language. METHODS This retrospective, observational cohort study of bariatric surgery patients age ≥ 18 years utilized the Michigan, Maryland, and New Jersey State Inpatient Databases and State Ambulatory Surgery and Services Databases, 2016 to 2018. Patients were classified by primary spoken language: English and non-English. Primary outcome was complications. Secondary outcomes included length of stay (LOS) and cost, with cost calculated using cost-to-charge ratios provided by Healthcare Cost and Utilization Project and reported in 2019 United States dollars. Multivariable regression models (logistic, Poisson, and quantile) were used to examine associations between primary language and outcomes. Given the uneven distribution of race by primary language, interaction terms were used to examine conditional effects of race. RESULTS Among 69,749 bariatric surgery patients, 2811 (4.2%) spoke a non-English primary language. Covariates, notably race distribution, and unadjusted outcomes differed significantly by primary language. However, after adjustment, non-English primary language was not associated with significantly increased odds of complications (odds ratio 1.24, p = 0.389), significantly different LOS (- 0.02 days, p = 0.677), nor significantly different mean healthcare costs (- $265, p = 0.309). There were no significant conditional effects of race seen among outcomes. CONCLUSIONS Though non-English primary language was associated with a significantly different distribution of observable characteristics (including race, income quartile, and insurance type), after adjustment, non-English primary language was not associated with significant differential risk of adverse outcomes after bariatric surgery, and there were no significant conditional effects of race. As such, this study suggests that disparities in bariatric surgery by primary spoken language more likely related to access to care, or the pre- and post-hospital care continuum, rather than index hospitalization after surgery.
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Affiliation(s)
- Claire B Rosen
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA.
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA.
| | - Sanford E Roberts
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
| | - James Sharpe
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
| | - Victoria Gershuni
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
| | - Maria S Altieri
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
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Williamson CG, Richardson S, Ebrahimian S, Kronen E, Verma A, Benharash P. Identifying the origin of socioeconomic disparities in outcomes of major elective operations. Surg Open Sci 2023; 13:66-70. [PMID: 37181545 PMCID: PMC10173262 DOI: 10.1016/j.sopen.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 05/16/2023] Open
Abstract
Background While the impact of socioeconomic status (SES) on surgical outcomes has been examined in limited series, it remains a significant determinant of healthcare outcomes at the national level. Therefore, the current study aims to determine SES disparities at three time-points: hospital accessibility, in-hospital outcomes, and post-discharge consequences. Methods The Nationwide Readmissions Database 2010-2018 was used to isolate major elective operations. SES was assigned using previously coded median income quartiles as defined by patient zip-code, with low SES defined as the lowest quartile and high SES as the highest. Results Of an estimated 4,816,837 patients undergoing major elective operations, 1,037,689 (21.3 %) were categorized as low SES and 1,288,618 (26.5 %) as high. On univariate analysis and compared to those of low SES, high SES patients were more frequently treated at high-volume centers (70.9 vs 55.6 %, p < 0.001), had lower rates of in-hospital complications (24.0 vs 29.0 %, p < 0.001) and mortality (0.4 vs 0.9 %, p < 0.001) as well as less frequent urgent readmissions at 30- (5.7 vs 7.1 %, p < 0.001) and 90-day timepoints (9.4 vs 10.7 %, p < 0.001). On multivariable analysis, high SES patients had higher odds of treatment at high-volume centers (Odds: 1.87, 95 % CI: 1.71-2.06), and lower odds of perioperative complications (Odds: 0.98, 95 % CI: 0.96-0.99), mortality (Odds: 0.70, 95 % CI: 0.65-0.75), and urgent readmissions at 90-days (Odds: 0.95, 95 % CI: 0.92-0.98). Conclusion This study fills a much-needed gap in the current literature by establishing that all of the aforementioned timepoints include significant disadvantages for those of low socioeconomic status. Therefore, a multidisciplinary approach may be required for intervention to improve equity for surgical patients.
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Affiliation(s)
| | | | | | | | | | - Peyman Benharash
- Corresponding author at: UCLA Center for Health Sciences, 10833 Le Conte Avenue, Room 62-249, Los Angeles, CA 90095, United States of America.
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Washington TB, Johnson VR, Kendrick K, Ibrahim AA, Tu L, Sun K, Stanford FC. Disparities in Access and Quality of Obesity Care. Gastroenterol Clin North Am 2023; 52:429-441. [PMID: 37197884 DOI: 10.1016/j.gtc.2023.02.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Obesity is a chronic disease and a significant public health threat predicated on complex genetic, psychological, and environmental factors. Individuals with higher body mass index are more likely to avoid health care due to weight stigma. Disparities in obesity care disproportionately impact racial and ethnic minorities. In addition to this unequal disease burden, access to obesity treatment varies significantly. Even if treatment options are theoretically productive, they may be more difficult for low-income families, and racial and ethnic minorities to implement in practice secondary to socioeconomic factors. Lastly, the outcomes of undertreatment are significant. Disparities in obesity foreshadow integral inequality in health outcomes, including disability, and premature mortality.
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Affiliation(s)
| | - Veronica R Johnson
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karla Kendrick
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Awab Ali Ibrahim
- Pediatric Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Lucy Tu
- Department of Sociology, Harvard College, 33 Kirkland Street, Cambridge, MA 02138, USA; Department of Molecular and Cellular Biology, Harvard College, 33 Kirkland Street, Cambridge, MA 02138, USA
| | - Kristen Sun
- Boston University School of Medicine, Boston, MA 02215, USA
| | - Fatima Cody Stanford
- Department of Medicine- Neuroendocrine Unit, Pediatric Endocrinology, MGH Weight Center, Nutrition Obesity Research Center at Harvard, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 430, Boston, MA 02114, USA
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Matabele MM, Haider SF, Wood Matabele KL, Merchant AM, Chokshi RJ. The Mediating Effect of Operative Approach on Racial Disparities in Bariatric Surgery Complications. J Surg Res 2023; 289:42-51. [PMID: 37084675 DOI: 10.1016/j.jss.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION A laparoscopic approach to bariatric surgeries confers a favorable side-effect profile as compared to an open approach. However, literature regarding the independent association of race with access to and postoperative outcomes in laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (GS) is scarce. MATERIALS AND METHODS All RYGB and GS cases recorded in American College of Surgeons National Quality Improvement Program data from 2012 to 2020 were subjected to propensity score matching to assess the independent association between Black self-identified race on access to a laparoscopic approach and postoperative complications. Finally, a series of logistic regressions enabled evaluation of the mediating effect of operative approach on racial disparities in postoperative complications. RESULTS 55,846 cases of RYGB and 94,209 cases of GS were identified. Following propensity score matching, logistic regression identified Black race as an independent predictor of open approach to RYGB (P < 0.001) and GS (P = 0.019). Black patients had increased incidence of any, minor and severe postoperative complications and unplanned readmissions in both RYGB (P < 0.001, P < 0.001, P = 0.0412, and P < 0.001, respectively) and GS (P < 0.001, P < 0.001, P = 0.0037, and P < 0.001, respectively). Open approach to RYGB was identified as a partial mediator of the independent association between Black race and any complication, minor complications, and unplanned readmission. CONCLUSIONS This methodology identified racial disparities in complications following RYGB and GS. Interestingly, reduced access to a laparoscopic approach mediated racial disparities in complications following RYGB but not GS. Further research might elucidate upstream determinants of health that catalyze these disparities.
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Affiliation(s)
- Mario M Matabele
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
| | - Syed F Haider
- General Surgery Minimally Invasive and Robotic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Aziz M Merchant
- General Surgery Minimally Invasive and Robotic Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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The Role of Body Appreciation in the Decision to Complete Metabolic and Bariatric Surgery Among Ethnically Diverse Patients. Obes Surg 2023; 33:879-889. [PMID: 36633761 DOI: 10.1007/s11695-023-06456-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/01/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE Metabolic and bariatric surgery (MBS) is an evidence-based safe, effective treatment for obesity. However, only half of referred or eligible persons complete the procedure for unknown reasons. The proposed study examined the association between the degree of body appreciation and the decision to complete MBS by ethnicity. METHODS This prospective cohort study included 409 participants who had been referred to a bariatric surgeon or an obesity medicine program between August 2019 and May 2022. Participants completed a survey about health behaviors and psychosocial characteristics, including body appreciation by MBS completion status (Y/N). Multivariate logistic regression models generated adjusted odd ratios (aOR) and 95% confidence intervals (CIs) of body appreciation among MBS completers vs. non-completers. RESULTS The sample mean age was 47.18 years (SD 11.63), 87% were female. 39.6% identified as non-Hispanic White (NHW), 38.5% as non-Hispanic Black (NHB), and 17.6% as Hispanic. Over a third of the sample (31.05%, n = 127) completed MBS. "Often" experiencing body appreciation was the most significant predictor of MBS completion (aOR: 28.19, 95% CI: 6.37-124.67, p-value < 0.001), followed by "Sometimes" (aOR: 20.47, 95% CI: 4.82-86.99, p-value < 0.001) and "Always" (aOR: 13.54, 95% CI: 2.55-71.87, p-value < 0.01) after controlling for sex, age, and race/ethnicity. There was not a significant interaction between body appreciation and race/ethnicity (p-value = 0.96). CONCLUSION Results showed a significant association between body appreciation and MBS completion, controlling for sex, age, and race/ethnicity. MBS clinical settings may want to assess body appreciation as a pre-operative screener among ethnically diverse patients.
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