Bariatric surgery: 1-year weight loss outcomes in patients with bipolar and other psychiatric disorders.

BACKGROUND: Bariatric surgery is the most effective obesity treatment in terms of weight loss and resolution of comorbidities. Roux-en-Y bypass surgery achieves weight loss of 60% to 70% excess body weight in most morbidly obese individuals. Patients with psychological disorders are reported to have less optimal results and those with bipolar, possibly worse. METHODS: A retrospective survey of Roux-en-Y bypass bariatric surgery patient clinical records to assess weight loss outcomes for morbidly obese patients, including those with bipolar disorders, other psychiatric conditions, and those without psychiatric diagnoses, was conducted. RESULTS: For all three study subgroups, the baseline mean weight exceeded 300 lbs, and mean BMI was 50. At 6 months, mean values for weight, percent weight loss, BMI, and percent change in BMI for all three groups were not significantly different. At 1 year, overall mean weight was less than 200 lbs, percent weight loss exceeded 35%, and mean BMI was 32. These outcomes were remarkably similar and not significantly different for those with bipolar disorder, other psychological conditions, and those without. The percent reaching follow-up at 12 months also did not differ between the three psychiatric status subgroups. CONCLUSION: In patients who undergo Roux-en-Y gastric bypass surgery, those with bipolar disorder have successful weight loss outcomes at 12 months that are not significantly different than those who have other psychiatric diagnoses and those with no psychiatric disorder. Despite practices that suggest the contrary, well-managed morbidly obese bipolar patients should be considered as suitable candidates for bariatric surgery using established criteria for risk assessment.

Retrievable inferior vena cava filters are not getting retrieved: where is the gap?

OBJECTIVE: The purpose of this study is to assess the retrieval rate and the predictors of successful retrieval of Retrievable Inferior Vena Cava (RIVC) filters. METHODS: We retrospectively reviewed the medical records of adult patients who had RIVC filter placements from 2004-2008. We excluded patients who died or were lost to follow-up and those who refused or had unsuccessful retrieval. We collected demographic and clinical data including indications for placement and follow-up. Successful retrieval was defined as objective evidence of retrieval by medical records. RESULTS: Over a 4 year period, we identified 351 patients who had RIVC filter placements. We excluded 99 patients (65 died, 24 decided to leave filter in place, 7 had unsuccessful retrieval and 3 lost follow-up). Majority of the filters were placed for surgical patients (161, 63.9%). Of 252 eligible patients for retrieval, only 47 filters were successfully retrieved yielding a retrieval rate of 18.7%. We identified three predictors for successful retrieval: Male gender, home discharge and follow up with procedural service. CONCLUSION: In this large cohort we found that the retrieval rate of retrievable IVCF is extremely low consistent with national statistics. Male patients, patients who were discharged home and patients who were followed by the procedural service had higher chance of successful retrieval. We recommend that procedural service placing the filter should ascertain adequate follow-up. We are not certain why more males had successful retrieval than females. Further studies are necessary to investigate this finding.