Additional preconditioning program for bariatric surgery: Any benefits? A large cohort study

Abstract

Postbariatric outcomes may improve by providing an additional preconditioning program (APP) in targeted patients. However, APPs are a demand for health resources while only little and inconsistent evidence consists to support their effectiveness. This cohort study aims to evaluate the effectiveness of APP, by comparing outcomes of patients with and without such APP. We carried out a retrospective single-centre cohort study in a before-after design. Patients signing up for primary gastric bypass or sleeve gastrectomy and eligible for surgery were included if screened as vulnerable patients. Vulnerable patients screened between September 2017 and March 2018 followed an APP and formed the APP-group. Due to a policy change, APPs were no longer performed since September 2018. Vulnerable patients screened between September 2018 and March 2019 thus did not receive an APP (comparator-group).Multidisciplinary follow-up remained unchanged. Endpoints included percentage total weight loss (%TWL), bodyweight, evolution of comorbidities, protein intake, and number of no-shows. The APP-group comprised 231 patients and the comparatorgroup 153. %TWL differed statistically significantly at 7 (Δ1.5%, p = .01) and 12 months postoperative (Δ2.8%, p < .01) in favour of the comparator-group, as did bodyweight 12 months postoperative (Δ1.8 kg, p < .01). Statistically significant differences were also found in the evolution of comorbidities, protein intake, and the number of no-shows, most in favour for the comparator-group. APP proofed not to be superior to Non-App. It is debatable whether statically significant differences are clinically relevant given their small magnitude. A care pathway without an APP seems at least as effective as a care pathway without.

Additional preparation program for bariatric surgery: Two‐year results of a large cohort study

“…A retrospective cohort study was conducted between September 2017 and March 2019. Data on weight, length, sex, age, and the multidisciplinary discussion result were collected from patients who underwent primary sleeve gastrectomy (SG) or Roux‐en‐Y gastric bypass (RYGB) 7 . This study was approved by the local Institutional Review Board and informed consent was obtained from all patients.…”

“…Data on weight, length, sex, age, and the multidisciplinary discussion result were collected from patients who underwent primary sleeve gastrectomy (SG) or Roux‐en‐Y gastric bypass (RYGB). 7 This study was approved by the local Institutional Review Board and informed consent was obtained from all patients. Patients who were lost to follow‐up, who underwent secondary surgery, or were pregnant before the 2‐year postoperative mark were excluded from this study.…”