Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system

Coleman, Karen J.; Huang, Yii-Chieh; Hendee, Fadi; Watson, Heather; Casillas, Robert A.; Brookey, John

doi:10.1016/j.soard.2014.02.044

Cited by 101 publications

(72 citation statements)

References 35 publications

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“…However, other prior studies examining selected outcomes that were examined in the present study have reported relatively similar overall findings. For example, in three prior longitudinal cohort studies of patients undergoing bariatric surgeries (separately representing 19,651, 28,616, and 57,918 patients) including LRYGB, LSG, and other types of bariatric surgeries, the average hospital length of stay was reported to be 2.5 days 26 , which is relatively similar to the 2.0 days reported in the present study. The half-day difference between the prior studies and the present study may be driven by the fact that there has been a secular trend of decreasing hospital lengths of stay over time 27 and that the present study's 28 .…”

Section: Discussionsupporting

confidence: 84%

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers

Roy¹,

Yoo

Yadalam

et al. 2017

Journal of Medical Economics

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Aims: To compare economic and clinical outcomes between patients undergoing laparoscopic Rouxen-Y gastric bypass (LRY) or laparoscopic sleeve gastrectomy (LSG) with use of powered vs manual endoscopic surgical staplers. Materials and methods: Patients (aged !21 years) who underwent LRY or LSG during a hospital admission (January 1, 2012-September 30, 2015 were identified from the Premier Perspective Hospital Database. Use of powered vs manual staplers was identified from hospital administrative billing records. Multivariable analyses were used to compare the following outcomes between the powered and manual stapler groups, adjusting for patient and hospital characteristics and hospital-level clustering: hospital length of stay (LOS), total hospital costs, medical/surgical supply costs, room and board costs, operating room costs, operating room time, discharge status, bleeding/transfusion during the hospital admission, and 30, 60, and 90-day all-cause readmissions. Results: The powered and manual stapler groups comprised 9,851 patients (mean age ¼ 44.6 years; 79.3% female) and 21,558 patients (mean age ¼ 45.0 years; 78.0% female), respectively. In the multivariable analyses, adjusted mean hospital LOS was 2.1 days for both the powered and manual stapler groups (p ¼ .981). Adjusted mean total hospital costs ($12,415 vs $13,547, p ¼ .003), adjusted mean supply costs ($4,629 vs $5,217, p ¼ .011), and adjusted mean operating room costs ($4,126 vs $4,413, p ¼ .009) were significantly lower in the powered vs manual stapler group. The adjusted rate of bleeding and/or transfusion during the hospital admission (2.46% vs 3.22%, p ¼ .025) was significantly lower in the powered vs manual stapler group. The adjusted rates of 30, 60, and 90-day all-cause readmissions were similar between the groups (all p > .05). Sub-analysis by manufacturer showed similar results. Limitations: This observational study cannot establish causal linkages. Conclusions: In this analysis of patients who underwent LRY or LSG, the use of powered staplers was associated with better economic outcomes, and a lower rate of bleeding/transfusion vs manual staplers in the real-world setting.ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 84%

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers

Roy¹,

Yoo

Yadalam

et al. 2017

Journal of Medical Economics

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“…This study showed that the type of procedure may have impact on weight loss and ethnic differences (19). At 3 years, non-Hispanic white RYGB patients had a higher % EWL than non-Hispanic black (P , 0.001) and Hispanic (P , 0.001) RYGB patients; however, there were no differences between sleeve gastrectomy racial/ethnic groups in % EWL.…”

Section: Outcomes: Weight Reduction and Comorbidity Remissionmentioning

confidence: 72%

Ethnic Considerations for Metabolic Surgery

Morton

2016

Diabetes Care

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Obesity and diabetes represent twin health concerns in the developed world. Metabolic surgery has emerged as an established and enduring treatment for both obesity and diabetes. As the burden of obesity and diabetes varies upon the basis of ethnicity, it is also apparent that there may be differences for indications and outcomes for different ethnic groups after metabolic surgery. Whereas there appears to be evidence for variation in weight loss and complications for different ethnic groups, comorbidity remission particularly for diabetes appears to be free of ethnic disparity after metabolic surgery. The impacts of access, biology, culture, genetics, procedure, and socioeconomic status upon metabolic surgery outcomes are examined. Further refinement of the influence of ethnicity upon metabolic surgery outcomes is likely imminent.

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“…Furthermore a 5 year controlled trial also confirmed the superiority of surgical intervention over medical management for obesity in T2DM, espousing that over 80% of individuals whom underwent bariatric surgery maintained a glycated haemoglobin A1c of <7% with no or few antidiabetic medications Mingrone et al [29]. Table 4 demonstrates further associated benefits and complications of bariatric surgery and a comparison of lifestyle with pharmaceutical intervention versus bariatric surgery; the evidence confirms that surgical intervention is superior to pharmalogical intervention for obesity in T2DM [30][31][32]. …”

Section: Comparison Of Interventionsmentioning

confidence: 86%

“…Median 3 years post-surgery 40% patients maintained>50% excess weight loss [31] Median 56% excess weight loss 1 year post-surgery Median 3 years post-surgery 46% patients maintained>50% excess weight loss [31] Median 66.5% excess weight loss 1 year postsurgery Median 3 years post-surgery 65% patients maintained>50% excess weight loss [31] Complications Meta-analysis of RCTs indicates complication rates of 13% [30] Meta-analysis of RCTs indicates complication rates of 13% [30] Meta-analysis of RCTs indicates complication rates of 21% [30] Indications for bariatric surgery are people with a BMI of 40 kg/m 2 or greater, or those with a BMI of 35 kg/m 2 or greater with co morbidities, such as T2DM (NICE, 2014). The NICE guidelines [19] advice that people diagnosed with T2DM in the past 10 years should receive expedited referrals without the need of having tried lifestyle management interventions first, due to improvements in quality of life and reduced risk of mortality that bariatric surgery can offer.…”

Section: Surgical Intervention For Obesity In T2dmmentioning

confidence: 99%

Review of the Pharmacological and Bariatric Surgery for Diabesity

Eligar

Gruchy

2017

MOJDDT

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Whilst some drugs are specifically licensed and targeted at weight loss there are also other classes of drugs that can elicit weight loss despite their primary usage or original design being for a different outcome. Table 2 highlights the efficacy of the most common drugs prescribed for weight loss as an adjunct therapy for T2DM.A new treatment being explored is the use of Botulinum Toxin, the premise being that Botox injections into the stomach wall inhibit vagus nerve afferents thus interrupting the brain-gut axis communication pathway resulting in weight loss [17]. Phase two of clinical trial is currently being conducted to assess the efficacy and safety of Botulinum Toxin as a weight loss intervention; this may offer a new innovative treatment for obesity in T2DM. Hypoglycaemia, headaches, diarrhoea [7] 5.8-5.9kg [7] 51-73% [7] Review of the Pharmacological interventions and Bariatric surgery for Diabesity 3/5Copyright: ©2017 Gruchy et al. Citation Surgical Intervention for Obesity in T2DMBariatric surgery is also called gastrointestinal surgery for obesity. Surgery changes the digestive process which elicits weight loss through reduction of nutrient absorption and thus lessens calorie intake [18]. The most common types of bariatric surgery are Adjustable Gastric Banding (AGB), Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB). RYGB is currently considered the gold standard of weight loss surgery [18]. The mechanism of weight loss and differences in outcomes of these procedures can be seen in Table 3. Indications for bariatric surgery are people with a BMI of 40 kg/m 2 or greater, or those with a BMI of 35 kg/m 2 or greater with co morbidities, such as T2DM (NICE, 2014). The NICE guidelines [19] advice that people diagnosed with T2DM in the past 10 years should receive expedited referrals without the need of having tried lifestyle management interventions first, due to improvements in quality of life and reduced risk of mortality that bariatric surgery can offer. Explored the effects of bariatric surgery during different stages of T2DM progression [20]. The results demonstrated that bariatric surgery during early onset of T2DM elicited highest rates of T2DM remission and reduced micro and macrovascular complications, whereas bariatric surgery on people with T2DM with existing micro or macrovascular complications produced no improvements in life expectancy or regression of microvascular complications [20]. Bariatric surgery is considered the most sustainable and effective management for obesity (class III) [21]. Several studies purport that weight loss through bariatric surgery is cost-effective compared to nonsurgical management [22,23,11].Following RYGB surgery NEFA levels initially increase with fat deployment through rapid weight loss, levels of NEFA normalise as weight loss plateaus Dirksen et al. [24]. SG and RYGB affect pancreatic β cell function, NEFA levels and insulin sensitivity thus enhancing glucose metabolism Thomas et al. [25].A meta-analysis by Buchwald et al. [26] demonstrated re...

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Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system

Cited by 101 publications

References 35 publications

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers

Ethnic Considerations for Metabolic Surgery

Review of the Pharmacological and Bariatric Surgery for Diabesity

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