Perioperative Morbidity and Long-term Outcomes of Bariatric Surgery in Patients with Severe Obesity.

BACKGROUND: Long-term outcome data for bariatric surgery in patients with severe obesity (SO) (body mass index [BMI]  50 kg/m2) are scarce. OBJECTIVES: To compare perioperative morbidity and long-term outcomes between patients with SO and non-SO (NSO). METHODS: Patients with SO who underwent primary bariatric surgery with a follow-up  5 years were age- and gender-matched with NSO patients in a retrospective, case-control study. Data included demographics, BMI, co-morbidities, early outcomes, current and nadir weight, co-morbidity status, and general satisfaction. RESULTS: Of 178 patients, 49.4% were male, mean age 44.5 ± 14 years. Mean preoperative BMI was 54.7 ± 3.6 and 41.8 ± 3.8 kg/m2 in SO and NSO, respectively (P = 0.02). Groups were similar in preoperative characteristics. Depression/anxiety was more prevalent in NSO (12.4% vs. 3.4%, P = 0.03). Obstructive sleep apnea was higher in SO (21.3% vs. 10.1%, P = 0.04). Sleeve gastrectomy was performed most often (80.9%), with a tendency toward bypass in SO (P = 0.05). Early complication rates were: 13.5% in SO and 12.4% in NSO (P = 0.82). Mean follow-up was 80.4 ± 13.3 months. BMI reduction was higher in SO (31.8 ± 5.9 vs. 26.8 ± 4.2 kg/m2, P < 0.001) and time to nadir weight was longer (22.1 ± 21.3 vs. 13.0 ± 12.0 months, P = 0.001). Co-morbidity improvement and satisfaction were similar. CONCLUSIONS: Patients with SO benefited from bariatric surgery with reduced BMI and fewer co-morbidities. No added risk of operative complications was found compared to patients with NSO.

When patients run the show: the Sderot Psychiatric Center's Puppet Theater.

Psychiatric rehabilitation combats the damaging effects of mental illness on living, occupational and social skills, and strives to help patients lead creative and fulfilling lives. Medical and social changes, as well as financial pressure, have all increased the need for community rather than institutional rehabilitation. New philosophical emphases highlight patient self-actualization and empowerment. This paper describes the development of a puppet theater, whose members and artistic director are almost all chronic psychiatric patients; the project has achieved steady sheltered employment status and been awarded the first Zussman-JDC prize by the president of Israel. Interviews with patients elicited major differences between patient perceptions of traditional rehabilitation frameworks and the theater. Theater is more creative than typical sheltered employment opportunities for mental patients, and puppet theater has unique aspects that may be especially suited to their needs. Patients found participation an empowering experience.