Expectations for Weight Loss and Willingness to Accept Risk Among Patients Seeking Weight Loss Surgery

Wee, Christina C.; Hamel, Mary Beth; Apovian, Caroline M.; Blackburn, George L.; Bolcic‐Jankovic, Dragana; Colten, Mary Ellen; Hess, Donald T.; Huskey, Karen W.; Marcantonio, Edward R.; Schneider, Benjamin E.; Jones, Daniel B.

doi:10.1001/jamasurg.2013.1048

Cited by 62 publications

(55 citation statements)

References 27 publications

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“…Although we have demonstrated that surgery can significantly improve outcomes for the very elderly and comatose, patients will vary in their acceptance of the trade-off against surgical risk [24,25]. The impact on outcomes following surgery reported in recent randomised controlled trials such as DECRA [26] and RESCUEicp [27] have highlighted that patients' opinion on whether a particular surgical outcome is considered as improvement or not will vary.…”

Section: Discussionmentioning

confidence: 90%

Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Christopher

Poon²,

Glancz

et al. 2018

Neurosurg Rev

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Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH. Seven hundred eighty-five patients were included in the study. Thirty-two (4.1%) patients had pre-operative GCS ≤ 8 and 70 (8.9%) patients were aged ≥ 90 years. A higher proportion of comatose patients had an unfavourable functional outcome (38.7 vs 21.7%; p = 0.03), although similar proportion of comatose (64.5%) and noncomatose patients (61.8%) functionally improved after surgery (p = 0.96). Compared to patients aged < 90 years, a higher proportion of patients aged ≥ 90 years had unfavourable functional outcome (41.2 vs 20.5%; p < 0.01), although approximately half had functional improvement following surgery. Mortality risk was higher in both comatose (6.3 vs 1.9%; p = 0.05) and very elderly (8.8 vs 1.1%; p < 0.01) groups. There was a trend towards a higher recurrence risk in the comatose group (19.4 vs 9.5%; p = 0.07). Surgery can still provide considerable benefit to very elderly and comatose patients despite their higher risk of morbidity and mortality. Further research would be needed to better identify those most likely to benefit from surgery in these groups.

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Section: Discussionmentioning

confidence: 90%

Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Christopher

Poon²,

Glancz

et al. 2018

Neurosurg Rev

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“…Of those eligible, 654 enrolled, representing a 70 % response rate. Details on recruitment and data collection have been described elsewhere and include an hour-long baseline telephone interview [10]. The study was approved by the institutional review boards at Beth Israel Deaconess Medical Center, Boston Medical Center, and University of Massachusetts.…”

Section: Methodsmentioning

confidence: 99%

“…By using a common metric, the impact of diseases and treatment outcomes can be compared across conditions [9]. In a survey study of over 650 patients seeking bariatric surgery [10], we measured the health utility or the quantifiable value patients placed on their current weight and health. In that study, we identified the two strongest correlates of patients’ utility among the QOL domains measured by the SF-36 and IWQOL-lite were social stigma and obesity’s adverse impact on role or work functioning, suggesting that these were the two most important QOL domains that drove diminished overall well-being or how much patients devalued their current state of being (disutility).…”

Section: Introductionmentioning

confidence: 99%

Sex, Race, and the Quality of Life Factors Most Important to Patients’ Well-Being Among Those Seeking Bariatric Surgery

et al. 2015

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Background Evidence suggests obesity-related social stigma and impairment in work function may be the two most detrimental quality of life (QOL) factors to overall well-being among patients seeking weight loss surgery (WLS); whether the relative importance of QOL factors varies across patient sex and race/ethnicity is unclear. Methods We interviewed 574 patients seeking WLS at two centers. We measured patient’s health utility (preference-based well-being measure) as determined via standard gamble scenarios assessing patients’ willingness to risk death to achieve weight loss or perfect health. Multivariable models assessed associations between patients’ utility and five weight-related QOL domains stratified by gender and race: social stigma, self-esteem, physical function, public distress (weight stigma), and work life. Results Depending on patients’ sex and race/ethnicity, mean utilities ranged from 0.85 to 0.91, reflecting an average willingness to assume a 9–15 % risk of death to achieve their most desired health/weight state. After adjustment, African Americans (AAs) reported higher utility than Caucasians (+ 0.054, p=0.03), but utilities did not vary significantly by sex. Among Caucasian and AA men, impairment in physical functioning was the most important factor associated with diminished utility; social stigma was also a leading factor for Caucasian men. Among Caucasian women, self-esteem and work function appeared equally important. Social stigma was the leading contributor to utility among AA women; QOL factors did not appear as important among Hispanic patients. Conclusion AAs reported higher utilities than Caucasian patients. Individual QOL domains that drive diminished well-being varied across race/ethnicity and sex.

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“…Details of the data collection have been described previously. [12, 14] Of 654 patients who participated, 541 underwent surgery. We previously reported the baseline alcohol use of the 654 patients seeking WLS.…”

Section: Methodsmentioning

confidence: 99%

High-risk alcohol use after weight loss surgery

Wee

Mukamal

Huskey

et al. 2014

Surgery for Obesity and Related Diseases

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Background Bariatric or weight loss surgery (WLS) may alter alcohol metabolism resulting in a higher prevalence of problem drinking post-operatively. Few studies distinguish those who report improvements in drinking from those who report worsening behavior after surgery. Objectives To characterize high risk alcohol use before and after WLS and according to surgery type. Setting 2 academic WLS centers in the United States. Methods We interviewed patients before and annually after WLS. High risk alcohol use as assessed via a modified version of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Results Of 541 participants who underwent WLS, 375 (69% retention) completed the 1-year and 328 (63% retention) completed the 2-year interview. At 1 year, 13% reported high risk drinking compared to 17% at baseline, p=0.10; at Year 2, 13% reported high risk drinking compared to 15% at baseline, p=0.39; 7% and 6% of patients, respectively, reported new high risk drinking at 1- and 2-year follow-up. At both follow-up time points, more than half of those who reported high risk drinking at baseline no longer did so; A larger proportion of gastric bypass patients (71%) reported amelioration in high risk drinking than gastric banding (48%) at Year 1, but this difference did not reach statistical significance (p=0.07); the difference largely dissipated by Year 2 (50% vs. 57%). Conclusion Although 7 % of patients report new high risk alcohol use 1 year after WLS, more than half who reported high risk alcohol use prior to surgery discontinued high risk drinking.

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Expectations for Weight Loss and Willingness to Accept Risk Among Patients Seeking Weight Loss Surgery

Cited by 62 publications

References 27 publications

Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Sex, Race, and the Quality of Life Factors Most Important to Patients’ Well-Being Among Those Seeking Bariatric Surgery

High-risk alcohol use after weight loss surgery

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