Factors contributing to weight loss success after bariatric procedures in patient over 65 years old - a multicenter retrospective cohort study.

BACKGROUND: Although bariatric surgery in patients over 65 years of age gives comparable results to treatment in the younger population, there are still controversies regarding the indications for surgery, risk assessment and choice between different types of surgery. The study aimed to identify the factors contributing to weight loss success after bariatric surgery in patients over 65 years of age. MATERIAL AND METHODS: This is a retrospective, multicenter cohort study of patients with obesity aged over 65 years undergoing primary laparoscopic bariatric surgery in the years 2008-2022. Data came from 11 bariatric centers. Patients were divided into two groups: responders (R) who achieved more than 50% EWL and non-responders (NR) who achieved less than 50% EWL. Both groups were compared. Uni- and multivariate logistic regression was used to identify predictors of weight loss success. RESULTS: Out of 274 analyzed patients, the average BMI before surgery was 42.9 kg/m2. The most common obesity-related diseases were hypertension (85.1%) and type 2 diabetes (53.3%). Sleeve gastrectomy was the most frequently performed procedure (85.4%). Uni- and multivariate logistic regression analysis confirmed preoperative BMI (OR=0.9, 95%CI:0.82-0.98, P=0.02), duration of diabetes >10 years (OR=0.3, 95%CI:0.09-0.82, P=0.02), balloon placement (OR=10.6, 95%CI: 1.33-84.83, P=0.03), time since first visit (OR=0.9, 95%CI:0.84-0.99, P=0.04), preoperative weight loss (OR=0.9, 95%CI:0.86-0.98, P=0.01) and OAGB (OR=15.7, 95%CI:1.71-143.99, P=0.02) to have a significant impact on weight loss success 1 year after bariatric surgery. CONCLUSIONS: Patients with higher preoperative weight loss may have a poorer response to surgery. OAGB emerged as the most beneficial type of surgery in terms of weight loss. Intragastric balloon placement before surgery may be effective in patients above 65 years of age and may be considered as a two-stage approach.

Risk factors for bariatric surgery in patients over 65 years of age-a multicenter retrospective cohort study.

PURPOSE: Societies are aging, life expectancy is increasing, and as a result, the percentage of elderly people in the population is constantly increasing. When qualifying patients over 65 years of age for bariatric surgery, the benefits and risks should be carefully assessed. Weighing risk factors against each other to improve the quality of life and better control of obesity-related diseases. The study aimed to determine risk factors for bariatric surgery among patients over 65 years of age. METHODS: A multicenter, retrospective analysis of patients undergoing laparoscopic bariatric procedures from 2008 to 2022. The patients were divided into two groups: complicated (C) and uncomplicated (UC). Uni- and multivariate logistic regression analysis was performed to obtain significant, independent risk factors. RESULTS: There were 20 (7.0%) patients in C group and 264 (93.0%) patients in UC group. The most common complication was intraperitoneal bleeding (8, 2.8). There was no postoperative mortality. The mean follow-up was 47.5 months. In a multivariate logistic regression analysis, length of stay and %EWL significantly corresponded to general complications (OR 1.173, OR 1.020). A higher weight loss before surgery lowered the risk for hemorrhagic events after surgery (OR 0.889). A longer length of stay corresponded to leak after surgery (OR 1.175). CONCLUSIONS: Bariatric and metabolic surgery appears to be a safe method of obesity treatment in patients over 65 years of age. The most common complication was intraperitoneal bleeding. A prolonged hospital stay may increase the risk of leakage, while a higher weight loss before the surgery may lower the risk of bleeding.

No association between history of psychiatric treatment and postoperative weight reduction after bariatric surgery.

PURPOSE: The objective of the study was to assess whether the history of psychiatric treatment was associated with (1) body weight and BMI on admission for bariatric surgery, (2) weight loss > 5 kg prior to bariatric surgery, and (3) postoperative body weight reduction. METHODS: Data from medical records of all consecutive patients admitted for surgical treatment of obesity in the 2nd Department of General Surgery Jagiellonian University Medical College were obtained. There were 1452 records of patients who underwent bariatric surgery between 2009 and 2021 included in the study. RESULTS: History of psychiatric treatment was found in 177 (12%) of the sample and was inversely associated with body weight and BMI on admission for surgery in women. Men with history of psychiatric treatment were 54% less likely to lose > 5 kg before the surgery (OR = 0.46 95% CI = 0.24-0.88). Both in men and women %TWL did not differ significantly by history of psychiatric treatment (Me: 40.7 vs. 45.9; p = 0.130 and Me: 27.0 vs. 23.9; p = 0.383, respectively). After adjustment for covariates no association was found between history of psychiatric treatment and body weight reduction one year after surgery. CONCLUSION: Although men with preoperative history of psychiatric treatment had lower odds of losing weight before the surgery, psychiatric treatment did not differentiate the effectiveness of bariatric treatment in 1 year of observation. Bariatric surgery appears to be an effective obesity care for people treated for mental disorders. LEVEL OF EVIDENCE: III Evidence obtained from cohort or case-control analytic studies.

Analysis of Changes in Glucose and Lipid Metabolism in Patients with Clinically Severe Obesity and Type 2 Diabetes Mellitus Undergoing Laparoscopic Sleeve Gastrectomy-Prospective Observational Study.

INTRODUCTION: We still lack studies providing analysis of changes in glucose and lipid metabolism after laparoscopic sleeve gastrectomy (LSG) in patients with type 2 diabetes mellitus (DM2). We aimed to investigate postoperative changes in glucose and lipid metabolism after LSG in patients with DM2. MATERIAL AND METHODS: Prospective, observational study included patients with BMI ≥ 35 kg/m2 and ≤ 50 kg/m2, DM2 < 10 years of duration, who were qualified for LSG. Perioperative 14-day continuous glucose monitoring (CGM) began after preoperative clinical assessment and OGTT, then reassessment 1 and 12 months after LSG. Thirty-three patients in mean age of 45 ± 10 years were included in study (23 females). RESULTS: EBMIL before LSG was 17 ± 11.7%, after 1 month-36.3 ± 12.8%, while after 12 months-66.1 ± 21.7%. Fifty-two percent of the patients had DM2 remission after 12 months. None required then insulin therapy. 16/33 patients initially on oral antidiabetics still required them after 12 months. Significant decrease in HbA1C was observed: 5.96 ± 0.73%; 5.71 ± 0.80; 5.54 ± 0.52%. Same with HOMA-IR: 5.34 ± 2.84; 4.62 ± 3.78; 3.20 ± 1.99. In OGTT, lower increase in blood glucose with lesser insulin concentrations needed to recover glucose homeostasis was observed during follow-ups. Overtime perioperative average glucose concentration in CGM of 5.03 ± 1.09 mmol/L significantly differed after 12 months, 4.60 ± 0.53 (p = 0.042). Significantly higher percentage of glucose concentrations above targeted compartment (3.9-6.7 mmol/L) was observed in perioperative period (7% ± 4%), than in follow-up (4 ± 6% and 2 ± 1%). HDL significantly rose, while triglyceride levels significantly decreased. CONCLUSIONS: Significant improvement in glucose and lipid metabolism was observed 12 months after LSG and changes began 1 month after procedure.

Predicting complications following bariatric surgery: the diagnostic accuracy of available tools.

BACKGROUND: Bariatric surgery is effective and safe obesity treatment. Obesity-related co-morbidities contribute to higher postoperative morbidity. Assessment of possible outcomes seems to be crucial in the qualification process and perioperative care. Recently, various tools predicting complications after bariatric surgery have been proposed. OBJECTIVES: The objective of the study was to validate the performance of available diagnostic algorithms as the predictors of 30-day complications after bariatric procedures. SETTING: Department of General Surgery, University Hospital, Poland. METHODS: The literature review was done to identify available risk prediction models. The analysis included patients after Roux-en-Y gastric bypass or sleeve gastrectomy (SG). The probability of postoperative complications was calculated for each patient. The assessed endpoints were general and severe morbidity stratified with Clavien-Dindo classification. The relationship between predicted and observed outcomes was assessed by logistic regression. Diagnostic accuracy was evaluated by the area under the receiver operating characteristic curves and Hosmer-Lemeshow test. RESULTS: Out of 1329 patients, 65.31% were women with a mean body mass index of 45 kg/m2. The majority of patients underwent SG (75.02%). The most common co-morbidities were as follows: dyslipidemia, hypertension, and diabetes. General morbidity reached 8.43%, whereas severe morbidity was 2.78%. We identified 10 eligible models. Only Gupta and Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) calculators presented a significant association with any and severe complications and reached acceptable accuracy in predicting severe complications. None of the models achieved sufficient discrimination in predicting general morbidity. All models remained well-fitted. CONCLUSIONS: MBSAQIP and Gupta's calculators seem to be helpful in the assessment of severe complications after bariatric surgery. Further studies should focus on improving the predictive accuracy of existing models.

External validation of predictive scores for diabetes remission after metabolic surgery.

PURPOSE: Bariatric surgery has proven to be the most efficient treatment for obesity and type 2 diabetes mellitus (T2DM). Despite detailed qualification, desirable outcome after an intervention is not achieved by every patient. Various risk prediction models of diabetes remission after metabolic surgery have been established to facilitate the decision-making process. The purpose of the study is to validate the performance of available risk prediction scores for diabetes remission a year after surgical treatment and to determine the optimal model. METHODS: A retrospective analysis comprised 252 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2009 and 2017 and completed 1-year follow-up. The literature review revealed 5 models, which were subsequently explored in our study. Each score relationship with diabetes remission was assessed using logistic regression. Discrimination was evaluated by area under the receiver operating characteristic (AUROC) curve, whereas calibration by the Hosmer-Lemeshow test and predicted versus observed remission ratio. RESULTS: One year after surgery, 68.7% partial and 21.8% complete diabetes remission and 53.4% excessive weight loss were observed. DiaBetter demonstrated the best predictive performance (AUROC 0.81; 95% confidence interval (CI) 0.71-0.90; p-value > 0.05 in the Hosmer-Lemeshow test; predicted-to-observed ratio 1.09). The majority of models showed acceptable discrimination power. In calibration, only the DiaBetter score did not lose goodness-of-fit in all analyzed groups. CONCLUSION: The DiaBetter score seems to be the most appropriate tool to predict diabetes remission after metabolic surgery since it presents adequate accuracy and is convenient to use in clinical practice. There are no accurate models to predict T2DM remission in a patient with advanced diabetes.

Is It Possible to Predict Weight Loss After Bariatric Surgery?-External Validation of Predictive Models.

BACKGROUND: Bariatric surgery is the most effective obesity treatment. Weight loss varies among patients, and not everyone achieves desired outcome. Identification of predictive factors for weight loss after bariatric surgery resulted in several prediction tools proposed. We aimed to validate the performance of available prediction models for weight reduction 1 year after surgical treatment. MATERIALS AND METHODS: The retrospective analysis included patients after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) who completed 1-year follow-up. Postoperative body mass index (BMI) predicted by 12 models was calculated for each patient. The correlation between predicted and observed BMI was assessed using linear regression. Accuracy was evaluated by squared Pearson's correlation coefficient (R2). Goodness-of-fit was assessed by standard error of estimate (SE) and paired sample t test between estimated and observed BMI. RESULTS: Out of 760 patients enrolled, 509 (67.00%) were women with median age 42 years. Of patients, 65.92% underwent SG and 34.08% had RYGB. Median BMI decreased from 45.19 to 32.53kg/m2 after 1 year. EWL amounted to 62.97%. All models presented significant relationship between predicted and observed BMI in linear regression (correlation coefficient between 0.29 and 1.22). The best predictive model explained 24% variation of weight reduction (adjusted R2=0.24). Majority of models overestimated outcome with SE 5.03 to 5.13kg/m2. CONCLUSION: Although predicted BMI had reasonable correlation with observed values, none of evaluated models presented acceptable accuracy. All models tend to overestimate the outcome. Accurate tool for weight loss prediction should be developed to enhance patient's assessment.

Why do Polish medical students resign from pursuing surgical careers? A survey study.

<b>Background:</b> In recent years, the interest of Polish medical students in choosing a career in surgical subspecialties has been declining. In the face of a growing demand for surgical procedures it seems essential to find the reasons responsible for that situation. <br><b>Aim:</b> The aim of the study was to evaluate the level of interest in pursuing surgical careers among Polish medical students and to identify factors that may influence their decision. Material and methods: An anonymous questionnaire was distributed electronically among students from 11 different Polish medical universities. <br><b>Results:</b> We surveyed 595 individuals (190 male and 405 female). 48% of them declared interest in choosing surgical subspecialty as a career. The percentage of students who considered it before medical school was higher and reached almost 65%. Slight or no interest in surgery as a field of study (OR = 20.6), self-assessment of surgical predispositions as unsatisfactory (OR = 14.3), feeling unable to enter and accomplish surgical specialty (OR = 5.2), being discouraged by the partner (OR = 3.4), negative past experience with the surgical environment (OR = 3.2), not having a surgeon as a mentor (OR = 2.6), no authorship of journal articles or congress presentations (OR = 1.9) and first contact with the operating theatre >2nd year of study (OR = 1.9) were found to be the independent risk factors of abandoning a surgical career. <br><b>Conclusions:</b> Most medical students are interested in pursuing a surgical specialty at some time during their education. However, being discouraged by lifestyle issues, surgical training quality or experiencing gender discrimination, they often resign from such a career path.

A prothrombotic state and denser clot formation in patients following acute limb ischemia of unknown cause.

INTRODUCTION: Fibrin clot structure differs between healthy individuals and those following thromboembolic events. Dense and poorly lysable fibrin clots have also been reported in peripheral artery disease. We studied fibrin clot properties and its determinants in individuals with a history of acute lower limb ischemia (ALI) of unknown cause. MATERIALS AND METHODS: In this case-control study, we enrolled 43 patients who experienced ALI of unknown cause, and two age-and sex-matched reference groups: (1) patients with cryptogenic non-lacunar stroke (n = 43) and (2) individuals without any history of thromboembolism (n = 43, control group). Plasma fibrin clot properties, along with thrombin generation and fibrinolysis markers were assessed following ≥3 months of anticoagulation. RESULTS: Compared with the control group, the ALI group exhibited more compact plasma fibrin clots (13.4% lower permeability [Ks], p = .001), decreased formed clot lysis (12.5% lower D-Drate, p = .001) and unaltered clot lysis potential, along with enhanced thrombin generation potential (49% higher peak thrombin concentration, p < .0001). There were no differences in these variables between ALI and stroke patients. Patients with ALI had slightly higher α2-antiplasmin and lower plasminogen activator inhibitor 1 levels compared with the stroke and control groups (all p < .01). CONCLUSIONS: Patients who experienced ALI of unknown cause display a prothrombotic fibrin clot phenotype, including increased clot density and hypofibrinolysis associated with higher thrombin generation, which might suggest potential benefits from prolonged anticoagulation in this disease.