Updated Evidence‐based Recommendations for Best Practices in Weight Loss Surgery

Blackburn, George L.; Hu, Frank B.; Hutter, Matthew M.

doi:10.1038/oby.2008.572

Cited by 13 publications

(6 citation statements)

References 35 publications

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“…Mandated preoperative weight loss prior to bariatric surgery has been advocated in many publications and guidelines (35–40) but was not associated with 3 year weight change for either procedure. According to these results, that practice should be abandoned if it is required because of its presumed relation to post- operative weight loss.…”

Section: Discussionmentioning

confidence: 99%

Preoperative factors and 3-year weight change in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium

Courcoulas¹,

Christian²,

O’Rourke³

et al. 2015

Surgery for Obesity and Related Diseases

111

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BACKGROUND Limited data guide the prediction of weight loss success or failure following bariatric surgery according to pre-surgery factors. There is significant variation in weight change following bariatric surgery and much interest in identifying pre-operative factors that may contribute to these differences. OBJECTIVE This report evaluates the associations of a comprehensive set of baseline factors and three-year weight change. SETTING Ten hospitals in six geographically diverse clinical centers in the United States. METHODS: PARTICIPANTS and INTERVENTIONS Adults undergoing a first bariatric surgical procedure as part of clinical care by participating surgeons were recruited between 2006 and 2009. Participants completed research assessments utilizing standardized and detailed data collection on over 100 preoperative and operative parameters for individuals undergoing Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB). Weight was measured 3 years following surgery. METHODS: MAIN OUTCOME MEASURES Percent weight change for RYGB or LAGB from baseline to 3 years was analyzed as both a continuous and dichotomous outcome with cut points at 25% for RYGB and 10% for LAGB. Multivariable linear and logistic regression models were used to identify independent baseline predictors of the continuous and categorical outcomes, respectively. RESULTS The median weight loss 3 years following surgery for RYGB (n=1513) participants was 31.5% (IQR: 24.6%–38.4%; range, 59.2% loss to 0.9% gain) of baseline weight and 16.0% (IQR: 8.1%–23.1%; range, 56.1% loss to 12.5% gain) for LAGB (n=509) participants. The median age was 46 years for RYGB and 48 years for LAGB; 80% of RYGB participants and 75% of LAGB participants were female; and the median baseline Body Mass Index (BMI) was 46 kg/m2 for RYGB and 44 kg/m2 for LAGB. For RYGB, Black participants lost 2.7% less weight compared to Whites and participants with diabetes at baseline had 3.7% less weight loss at year 3 than those without diabetes at baseline. There were small but statistically significant differences in weight change for RYGB in those with abnormal kidney function and current or recent smoking. For LAGB participants, those with a large band had 75% greater odds of experiencing less than 10% weight loss after adjusting for BMI and sex. CONCLUSIONS Few baseline variables were associated with three year weight change and the effects were small. These results indicate that baseline variables have limited predictive value for an individual’s chance of a successful weight loss outcome following bariatric surgery. TRIAL REGISTRATION NCT00465829, ClinicalTrials.gov

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Section: Discussionmentioning

confidence: 99%

Preoperative factors and 3-year weight change in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium

Courcoulas¹,

Christian²,

O’Rourke³

et al. 2015

Surgery for Obesity and Related Diseases

111

View full text Add to dashboard Cite

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“…All adolescents considering WLS should be evaluated by a multidisciplinary treatment team on a case-by-case basis. The team should include those mentioned earlier as well as a pediatric obesity specialist [14]. Pediatric WLS should be performed within the supportive environment of clinical trials in medical centers with expertise in bariatric surgical techniques [308].…”

Section: Multidisciplinary Teamsmentioning

confidence: 99%

“…The Agency for Healthcare Research and Quality (AHRQ) abstracted the report for broad use and the American College of Surgeons (ACS) used it as the blueprint for its Bariatric Surgery Network Center accreditation program. Its recommendations influenced health care policy and medical practice in the United States and abroad [14]. …”

mentioning

confidence: 99%

Benchmarking Best Practices in Weight Loss Surgery

Lim

Blackburn²,

Jones

2010

Current Problems in Surgery

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“…87 However, a clear distinction between perioperative medical and surgical morbidity and mortality is made in only a few publications. 88 There is little doubt that apart from the dynamic of surgical technical expertise, the experience of the endocrinologist, anaesthetists and the extended team as a whole is ultimately the deciding factor in applying "best practise" recommendations 89 to secure low morbidity and even lower mortality.…”

Section: Aspiration Pneumonia 1 Pneumoniamentioning

confidence: 99%

Baseline patient profiling and three-year outcome data after metabolic surgery at a South African centre of excellence

Merwe

Fetter²,

Naidoo³

et al. 2015

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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The bariatric team at Waterfall City Hospital in Gauteng has performed 820 metabolic surgeries under the guidance of an extended team, and with comprehensive recordkeeping. Baseline profiling on more than 50 variables afforded insight into patients undergoing surgery. The available outcome data over three years were comparable with those in the documented literature. The attempted weight loss period prior to agreeing to surgery was 16-18 years. Weight loss in the overall cohort was 29% at three years, with a two-year outcome as follows: diabetes mellitus remission of 81.6% in males and 83.1% in females, full and part-hypertension resolution of 84.8% in males and 74.6% in females, hyperlipidaemia on no treatment of 76.8% in males and 72.1% in females, and sleep apnoea of 75.5% in males and 76.8% in females. Separating out the diabetic group indicated a diabetes mellitus remission of 73.9% in males and 75.1% in females at one year. Improvement in the components of metabolic syndrome was demonstrated in the total cohort. There was an worse profile and higher risk in the male patients. Similarly, higher risk was recorded in the biliopancreatic diversion-duodenal switch cohort, and there was a higher percentage of elected diabetic patients. A wide range of revision surgery was performed, with a higher complication rate (20%) experienced compared to that recorded with the primary surgeries. The morbidity data were separated into medical and surgical morbidity. Major medical morbidity was documented at 5.6% and surgical morbidity at 3.9%. Surgical morbidity in the first 250 cases was reported to be 6% vs. 2.7% in the last 570 cases. Mortality for the cohort was noted to be 0.1%.

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Updated Evidence‐based Recommendations for Best Practices in Weight Loss Surgery

Cited by 13 publications

References 35 publications

Preoperative factors and 3-year weight change in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium

Preoperative factors and 3-year weight change in the Longitudinal Assessment of Bariatric Surgery (LABS) consortium

Benchmarking Best Practices in Weight Loss Surgery

Baseline patient profiling and three-year outcome data after metabolic surgery at a South African centre of excellence

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