BACKGROUND: Dehydration is a common cause of emergency department visits and readmissions following bariatric surgery. Despite the increasing use of outpatient rehydration therapy (ORT) to manage this complication, predi...BACKGROUND: Dehydration is a common cause of emergency department visits and readmissions following bariatric surgery. Despite the increasing use of outpatient rehydration therapy (ORT) to manage this complication, predictors of ORT utilization remain poorly understood. OBJECTIVES: To identify independent predictors of ORT utilization following bariatric surgery and examine its relationship with same-day discharge (SDS) protocols. SETTING: Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database across accredited bariatric surgical centers. METHODS: We analyzed Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data from 2020-2023 for adult patients who underwent primary laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB). Multivariable logistic regression identified independent predictors of ORT utilization. RESULTS: Of 692,525 patients, 26,215 (3.8%) required ORT. These patients were younger (41.5 ± 11.3 versus 43.2 ± 11.8 years, P < .001), had higher body mass index (45.3 ± 7.4 versus 45.1 ± 7.7 kg/m, P < .001), and were more likely to be female (90.0% versus 81.8%, P < .001). ORT rates were higher among RYGB versus sleeve gastrectomy patients (4.3% versus 3.6%, P < .001). SDS patients comprised 7.5% of the cohort but 12.6% of those requiring ORT. Independent predictors of ORT included younger age (odds ratio [OR]: .86 per 10 years), female sex (OR: 1.94), SDS (OR: 2.04), Black race (OR: 1.25), and RYGB (OR: 1.19) (all P < .001). CONCLUSIONS: Identifying predictors of ORT use supports effective implementation of SDS protocols through strategic resource allocation. ORT represents a cost-effective approach that enables the benefits of accelerated discharge pathways while preventing costly readmissions. These findings can help bariatric programs optimize outpatient hydration services for high-risk patients, enhancing the overall efficiency and value of care delivery.
BACKGROUND: The triglyceride-glucose index (TyG) has shown comprehensive value in relation to numerous obesity-associated comorbidities, especially cardiovascular diseases. Although their incidence risk and severity are...BACKGROUND: The triglyceride-glucose index (TyG) has shown comprehensive value in relation to numerous obesity-associated comorbidities, especially cardiovascular diseases. Although their incidence risk and severity are lowered following sleeve gastrectomy (SG), the extent of relief varies. OBJECTIVES: To analyze potential influencing factors of decrease in the TyG index (△TyG) following SG, and establish a predictive model using preoperative data. SETTING: University hospital, China. METHODS: Preoperative and 1-year postoperative data of patients with obesity who underwent SG were collected. After being randomly divided at a proportion of 70%, the patients in the modeling group were further divided into group A (decreased poorly) and group B (decreased satisfactorily) based on the degree of △TyG. After screening the variables with significant differences between the groups, we conducted logistic regression analysis to identify the influencing factors related to △TyG and those with a predictive value. Subsequently, a nomogram was established. Internal, external validations and decision curve analysis (DCA) were performed. Clinical impact curve (CIC) was drawn. RESULTS: The study included 744 patients. Four independent predictors, namely waist-hip ratio (WHR), high-density lipoprotein cholesterol (HDL-c), uric acid (UA), and TyG index were identified. The joint predictor formed by combining these four factors had an area under the curve of .838 (.803-.868) and a significantly better predictive value. The predictive accuracy and clinical net benefit of the nomogram established utilizing the joint predictor were verified. CONCLUSIONS: SG can lead to significant △TyG, with preoperative WHR, HDL-c, UA, and TyG index being independent predictors. The joint predictor can effectively predict the magnitude of the decrease.
BACKGROUND: Metabolic and bariatric surgery (MBS) is a highly durable, safe and effective treatment for severe obesity in adults. However, MBS remains underutilized in the pediatric and adolescent population, likely due...BACKGROUND: Metabolic and bariatric surgery (MBS) is a highly durable, safe and effective treatment for severe obesity in adults. However, MBS remains underutilized in the pediatric and adolescent population, likely due to safety concerns of elective surgery in children. OBJECTIVES: We aimed to analyze whether the benefits of MBS outweigh the risks in adolescents when compared to young adults. SETTING: Multicenter, national database study. METHODS: Patients aged 10-39 who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Patients with prior foregut surgery were excluded. RESULTS: 556,628 patients were identified; 10,883 (2.0%) were aged 10-19 (adolescents), 161,938 (29.1%) were 20-29 (young adults), and 383,807 (69.0%) were 30-39 (adults). Preoperative body mass index (BMI) was clinically similar between groups, though statistically significant due to large sample size (10-19: 46, 20-29: 45, 30-39: 45 kg/m, P < .001). SG was more common in younger cohorts (10-19: 86%, 20-29: 77%, 30-39: 75%, P < .001). At 30 days postoperatively, adolescents demonstrated marginally greater BMI reduction (10-19: 2.91, 20-29: 2.69, 30-39: 2.53 kg/m, P < .001). Adolescents had fewer postoperative complications, including surgical site infections, gastrointestinal bleeding, and blood transfusions (P < .001). Among adolescents, SG (aOR: .39, CI: .31-.48, P < .001) was associated with reduced postoperative complications. CONCLUSIONS: Adolescents undergoing MBS have BMI reductions similar to those of young adults and have lower rates of complications and readmissions. MBS should be offered as a safe treatment for adolescents to treat morbid obesity with at least similar frequency as it is offered to adults.
BACKGROUND: Despite the well-known safety and efficacy of metabolic and bariatric surgery, certain patients require revisional bariatric surgery (RBS) due to weight-related and/or procedure-related complications. Date on...BACKGROUND: Despite the well-known safety and efficacy of metabolic and bariatric surgery, certain patients require revisional bariatric surgery (RBS) due to weight-related and/or procedure-related complications. Date on long-term RBS outcomes remains limited in the elderly. OBJECTIVES: To evaluate the safety and efficacy of RBS in the elderly. SETTING: Tertiary referral centers with prospectively maintained metabolic and bariatric surgery databases. METHODS: A retrospective review was conducted for patients aged ≥ 60 years who underwent RBS between 2008 and 2023. Patient demographics, type of revisional procedure, postoperative outcomes, weight loss data, and nutritional parameters were collected. All patients had at least a 6-month follow-up and were followed at least 5 years after RBS when possible. RESULTS: 201 patients were included. The most common indication for RBS was gastroesophageal reflux (37.8%). Conversion to Roux-en-Y gastric bypass was the most common RBS procedure (65.2%). This subgroup achieved significantly sustained mean percentage of total weight loss throughout follow-up. Conversion to sleeve gastrectomy subgroup only maintained a significant mean percentage of total weight loss at 6 months, 1 year, and 2 years postoperatively. The overall 30-day and late complication rates within the cohort were 17.4% and 26.9%, respectively. A .5% 30-day mortality rate and 0% long-term RBS-related morality rate were reported. For patients indicated for revision, RBS was successful in resolving malnutrition and did not result in recurrence of any nutritional deficiencies. CONCLUSIONS: Our study demonstrated that RBS is safe and effective in elderly patients in the long term. Proper RBS procedure selection is integral to address revision indication and decrease the risk of long-term complications.
BACKGROUND: Weight bias internalization (WBI), or the internalization of "antifat" attitudes, is associated with greater eating-disorder psychopathology, body image, and mental health concerns in patients following baria...BACKGROUND: Weight bias internalization (WBI), or the internalization of "antifat" attitudes, is associated with greater eating-disorder psychopathology, body image, and mental health concerns in patients following bariatric surgery. Yet, WBI in patients seeking body contouring surgery (BCS) after bariatric surgery remains unstudied. OBJECTIVES: This study prospectively examined the relationship between WBI, eating-disorder psychopathology, and depressive symptoms in patients seeking BCS after bariatric surgery. SETTING: Yale University School of Medicine, United States METHODS: Participants were 56 adults (93% female) seeking consultation for BCS after bariatric surgery; 42.9% (n = 24) went on to have BCS. Participants completed established measures assessing WBI, eating-disorder psychopathology, and depressive symptoms at baseline following the BCS consultation, then repeated at 1-month and 3-month follow-ups. RESULTS: WBI was positively associated with eating-disorder psychopathology and depression at all assessments (all P < .01) including baseline (all r > .40), 1-month (all r > .33), and 3-month (all r > .45) follow-ups. In a prospective analysis of WBI, a significant group by time interaction was observed (P = .03) owing to lower postbaseline levels among BCS at both 1-month (P = .03) and 3-months (P = .009) assessments. Groups with and without BCS did not differ significantly on body mass index (BMI), weight loss, or eating-disorder psychopathology. CONCLUSIONS: WBI is associated significantly with greater eating-disorder psychopathology and depressive symptoms, but not BMI or weight loss, in patients seeking BCS after bariatric surgery. Group differences in WBI at 1-month and 3-month follow-ups suggest that BCS may help reduce WBI independent of BMI. Bariatric teams should be aware that higher WBI may persist for patients unable to obtain BCS.
BACKGROUND: Elevated hemoglobin A1C (HbA1C) is a surrogate for poor glycemic control, but its association with outcomes in metabolic surgery is not well established with respect to diabetes severity. This study aimed to...BACKGROUND: Elevated hemoglobin A1C (HbA1C) is a surrogate for poor glycemic control, but its association with outcomes in metabolic surgery is not well established with respect to diabetes severity. This study aimed to extend prior evidence and evaluate the influence of preoperative HbA1C on postsurgical outcomes in patients undergoing primary laparoscopic sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB), hypothesizing that poor glycemic control and/or worse diabetes severity would lead to increased postoperative complications. OBJECTIVES: Identify the association of HbA1C or diabetes status on postoperative complications. SETTING: Metabolic and Bariatric Surgery Accreditation Quality Improvement Project (MBSAQIP) database (2017-2022). METHODS: Primary SG and RYGB cases were analyzed in patients with diabetes (n = 106,486), identified by a known diagnosis or preoperative HbA1C ≥ 6.5%. Multivariate logistic regression models with generalized estimating equations were used to assess the effects of preoperative HbA1C on clinical outcomes, controlling for demographics, procedure type, and co-morbidities. RESULTS: Similar to smaller studies, no significant association was found between preoperative HbA1C levels and clinical outcomes for SG or RYGB. In contrast, subset analysis revealed increased odds ratios (ORs) for serious complications in both noninsulin-using (OR: 1.04, 95% confidence interval [CI]: 1.00-1.09) and insulin-using (OR: 1.07, 95% CI: 1.03-1.12) patients with diabetes. Insulin-using diabetes was also associated with an increased risk of infectious complications (OR: 1.05, 95% CI: 1.01-1.10). Stratification by procedure type showed that the association was significant only for RYGB (OR: 1.08, 95% CI: 1.02-1.14). CONCLUSIONS: Increased preoperative HbA1C levels are not associated with increased risk for complications overall; however, higher HbA1C in patients with insulin-using diabetes, which is suggestive of more advanced disease, is associated with an increased risk of serious and infectious complications following RYGB. While preoperative glycemic control does not lead to poor outcomes, this study demonstrates that patients with more severe diabetes do have slightly higher risk of complications but that risk is not modifiable and intrinsic to their chronic disease status.
BACKGROUND: Employers are adopting "destination care" (DC) to manage employee health care costs and assure quality. Providing bariatric surgical care in centers remote from the patient's home raises legitimate safety and...BACKGROUND: Employers are adopting "destination care" (DC) to manage employee health care costs and assure quality. Providing bariatric surgical care in centers remote from the patient's home raises legitimate safety and follow-up concerns. OBJECTIVES: To evaluate outcomes and complications of patients traveling for an initial bariatric procedure as part of a workplace health care benefit program compared to those locally referred. Secondary outcomes were to describe DC program patient satisfaction, 1-year follow-up, and cost. SETTING: Single center, tertiary referral, Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited bariatric surgery center, United States. METHODS: A retrospective review of a prospectively maintained database was conducted of DC (n = 63) and non-DC patients (n = 632) from December 2016 through July 2018. RESULTS: Sixty-three DC patients had either sleeve gastrectomy (SG) (36.5%; n = 23) or Roux-en-Y gastric bypass (63.5%; n = 40), with a higher ratio of SG procedure selection compared to locals. Despite DC patients being of higher acuity (age, body mass index, comorbidities, number of home medications, higher American Society of Anesthesiologists classification, decreased functional status), there were no statistically significant differences in 30-day complication (4.8% DC vs 8.2% non-DC; P = .464), readmission (4.8% DC vs 4.4% non-DC; P = .755), or mortality (0%). Weight loss was comparable. DC patients reported higher satisfaction. All DC patients had successful video conference follow-up at 6 months and 82.5% (n = 52) at 1 year. Of those that did not, 63% (n = 7) had follow-up data provided by their primary care physicians or followed-up at 2 years. CONCLUSIONS: A thoughtfully designed national DC program can be both feasible and effective, offering short-term outcomes comparable to those of locally treated patients in a high-volume, MBSAQIP-accredited bariatric center. However, these findings should be interpreted with caution, as the study was not powered to detect small differences. Moreover, the short follow-up period and single-institution design may limit the generalizability of the results. Successful implementation of such a program requires close coordination among providers, patients, and payers.
Miller-Matero LR, Pappas C, Christopher B
… +8 more, Grossi R, Vanderziel A, Barnett NP, Moore RS, Hamann A, Carlin AM, Varban OA, Braciszewski JM
Surg Obes Relat Dis
· 2025 Dec · PMID 40885652
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BACKGROUND: Patients who undergo metabolic and bariatric surgery (MBS) are at increased risk for an alcohol use disorder. A technology-based intervention, rooted in motivational interviewing, could broadly reach patients...BACKGROUND: Patients who undergo metabolic and bariatric surgery (MBS) are at increased risk for an alcohol use disorder. A technology-based intervention, rooted in motivational interviewing, could broadly reach patients after MBS and has the potential to reduce alcohol use. OBJECTIVE: Examine the feasibility, acceptability, and preliminary outcomes of a technology-based intervention to reduce alcohol use delivered after MBS. SETTING: Health system. METHODS: Participants (N = 60) who were 3-18 months post-MBS were randomized to the intervention or treatment-as-usual control group. The tailored intervention consisted of 2 (15-minute) sessions of interactive web-based content followed by 3-months of daily text messaging. Participants completed baseline and a postintervention assessment (91.7% retention). RESULTS: Participants were primarily female (90%), White (55.0%) or Black (43.3%), with a mean age of 44.6 years (SD = 10.4). Of those randomized to the intervention (n = 24), 83.3% (n = 20) began the intervention and 95% (n = 19) completed it. The majority of participants rated all intervention components positively and 100% agreed that other patients would use the intervention. The intervention group reported a significant increase in level of motivation to avoid alcohol use from baseline to postintervention (P = .02), whereas the control group did not show a significant change (P = .73). At the postintervention, the intervention group had significantly fewer participants endorsing alcohol use than the control group (43.5% versus 75%; X = 5.63, P = .02). CONCLUSION: A technology-based intervention delivered after MBS was feasible, acceptable, and showed promising preliminary outcomes for increasing motivation to avoid alcohol use as well as reducing alcohol use.
BACKGROUND: Obesity and its associated medical problems are a global health concern. Combining metabolic and restrictive approaches may yield better results, as seen in one anastomosis gastric bypass (OAGB) and single an...BACKGROUND: Obesity and its associated medical problems are a global health concern. Combining metabolic and restrictive approaches may yield better results, as seen in one anastomosis gastric bypass (OAGB) and single anastomosis sleeve ileal (SASI) bypass, which evolved from Santoro's technique. OBJECTIVES: To compare the efficacy and safety of SASI bypass versus OAGB, focusing on weight loss, comorbidity remission, nutritional outcomes, and complications. SETTING: A systematic review and meta-analysis of published observational studies. METHODS: A literature search across PubMed, Scopus, Embase, and Cochrane databases identified 234 articles, with eight meeting inclusion criteria. Primary outcomes included obesity-related medical problem remission. Secondary outcomes assessed weight loss, complications, albumin, vitamin B12, and vitamin D levels. RESULTS: A total of 232 SASI and 313 OAGB patients were included, with follow-ups from 6 to 60 months. Body mass index change was not statistically different (-.64, 95% confidence interval {CI} [-3.37; 2.10]). Percent total weight loss favored SASI (mean difference [MD] 3.87, 95% CI [.96; 6.78], P < .05). Obesity-related medical problem remission rates were similar, including type 2 diabetes (odds ratio [OR] .99, 95% CI [.25-3.94]), hypertension (OR .53, 95% CI [.19-1.45]), dyslipidemia (OR 1.05, 95% CI [.39-2.81]), and obstructive sleep apnea (OR 3.46, 95% CI [.49-24.20]). SASI had higher vitamin B12 levels (MD 99.78, 95% CI [26.61; 172.95], P < .01), while vitamin D and albumin levels were similar. Complications were higher in SASI (OR 2.57, 95% CI [1.34; 4.92], P = .004), mainly Clavien-Dindo I-II. CONCLUSION: Both OAGB and SASI yield high remission rates and sustained weight loss. SASI had slightly lower vitamin deficiencies but higher mild-to-moderate complications.
BACKGROUND: Patients with severe obesity have glomerular hyperfiltration even without the overt renal dysfunction, but improvements are reported with metabolic surgery (MS). However, the mechanism underlying these effect...BACKGROUND: Patients with severe obesity have glomerular hyperfiltration even without the overt renal dysfunction, but improvements are reported with metabolic surgery (MS). However, the mechanism underlying these effects of MS has not been investigated. OBJECTIVE: The aim of the present study was to determine whether MS for patients with severe obesity alters retroperitoneal adipose tissue (RAT) and kidney volume (KV), and whether these alterations lead to improvements in renal function and hypertension (HTN). SETTING: University hospital, Japan. METHODS: This single-center study included 80 patients with severe obesity who underwent laparoscopic sleeve gastrectomy (LSG). RAT, KV, body weight, and metabolic-related parameters were evaluated using computed tomography volumetry preoperatively and 1 year after LSG and correlations were analyzed. RESULTS: All patients were seen as per protocol. RAT (1149.5 vs 734.5 mL) and KV (right 218.5 vs 201 mL, left 220 vs 206.5 mL) were significantly decreased at 1 year after LSG. Significant reductions were observed in the personalized estimated glomerular filtration rate (103.5 vs 93.7 mL/min), standard estimated creatinine clearance (eCrCl) (157.2 vs 134.8 mL/min/1.73 m), and personalized eCrCl (200.4 vs 153.4 mL/min/1.73 m) (all P < .001). The degree of change in RAT was correlated with the degree of change in the personalized eCrCl (ρ = .219, P = .005). The rate of change in KV was correlated with the rate of change in the standard/personalized eCrCl (ρ = .232, P = .043, ρ = .232, P = .043). CONCLUSION: LSG reduced body weight in patients with severe obesity and reduction of glomerular hyperfiltration and HTN correlating with RAT and KV reduction.
BACKGROUND: Although metabolic and bariatric surgery (MBS) is highly effective for weight management, revisional procedures are often needed after sleeve gastrectomy (SG). While Roux-en-Y gastric bypass (RYGB) has histor...BACKGROUND: Although metabolic and bariatric surgery (MBS) is highly effective for weight management, revisional procedures are often needed after sleeve gastrectomy (SG). While Roux-en-Y gastric bypass (RYGB) has historically been the most commonly performed revisional procedure, single anastomosis duodeno-ileal bypass (SADI) is a more recently endorsed alternative. OBJECTIVE: To compare the safety profile of revisional RYGB and SADI after SG in the first postoperative 30 days. SETTING: United States of America. METHODS: Using the 2022-2023 MBSAQIP database, patients undergoing revisional RYGB or SADI after SG were identified and matched using propensity scores. Demographic, medical, and perioperative variables were analyzed, including length of stay, operative time, complications, and 30-day readmission, reoperation, and mortality rates. RESULTS: After propensity score matching, a total of 6108 patients were included; 4581 (75.0%) to RYGB group and 1527 (25.0%) to SADI group. Operative times were longer for RYGB (P = .03). Mean length of stay was 1.57 ± 1.84 days for RYGB and 1.44 ± 1.28 days for SADI (P < .01) Postoperative bowel obstruction was more common after RYGB (.9% vs .3%, P = .01). RYGB 30-day readmission rate was 5.5% and reoperation rate was 1.8%. SADI 30-day readmission rate was 4.3% and reoperation rate was 2.2% (P = .06 for readmission rates; P = .3 for reoperation rates). Thirty-day mortality was similarly low in both groups (Group 1: .2%, Group 2: .1%, P > .7). CONCLUSION: Revisional RYGB and SADI after SG are both safe and associated with low morbidity in a short-term period. However, SADI may offer advantages over RYGB for its lower risk of postoperative bowel obstruction.
BACKGROUND: Inferior vena cava filters (IVCFs) are utilized to mitigate the incidence of thromboembolic complications after bariatric surgery. OBJECTIVES: This study compared 30-day outcomes between patients with and wit...BACKGROUND: Inferior vena cava filters (IVCFs) are utilized to mitigate the incidence of thromboembolic complications after bariatric surgery. OBJECTIVES: This study compared 30-day outcomes between patients with and without IVCFs present at the time of sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). SETTING: Patients reported to the 2018-2021 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. METHODS: Adults undergoing primary SG or RYGB, with and without IVCFs present (SG-IVCF and SG-only or RYGB-IVCF and RYGB-only, respectively), were identified. Baseline characteristics by IVCF status for each procedure were adjusted using entropy balancing. Multivariable weighted logistic and linear regressions were subsequently developed to evaluate the independent association between the presence of IVCF at the time of bariatric surgery and outcomes of interest. RESULTS: Of 721,161 patients included, 71.9% (n = 518,454) underwent SG and 28.1% (n = 202,707) underwent RYGB, of which .3% (n = 1471) and .3% (n = 643) had IVCFs present, respectively. Compared to SG-only and RYGB-only, SG-IVCF and RYGB-IVCF had higher unadjusted 30-day rates of deep vein thrombosis, while only RYGB-IVCF had higher rates of pulmonary embolism (PE). After multivariate adjustment, SG-IVCF was associated with significantly higher odds of unplanned intensive care unit admission, reoperation, and ED visit, but lower odds of PE. RYGB-IVCF demonstrated higher odds of reoperation but no association with PE. Both SG-IVCF and RYGB-IVCF were linked to a lower likelihood of mortality. CONCLUSIONS: While IVCFs may associate with distinct outcomes by procedure, this study did not indicate a clear protective effect, instead demonstrating an association with greater postoperative morbidity after risk adjustment.