Assessment of two different diagnostic guidelines criteria (National Cholesterol Education Adult Treatment Panel III [ATP III] and International Diabetes Federation [IDF]) for the evaluation of metabolic syndrome remission in a longitudinal cohort of patients undergoing Roux-en-Y gastric bypass.

BACKGROUND: Bariatric surgery has proven to provide durable weight loss and control of comorbid conditions, including the metabolic syndrome (MS). Existing definitions of MS have caused substantial confusion regarding their concordance for identifying the same individuals. The aim of this study was to assess the value of 2 different diagnostic guidelines criteria (National Cholesterol Education Adult Treatment Panel III [ATP III] and International Diabetes Federation [IDF]) for the evaluation of remission of MS after Roux-en-Y gastric bypass (RYGB). PATIENTS AND METHODS: A cohort of 381 patients who underwent a primary RYGB, satisfied the criteria for MS, and had at least o1 postoperative visit were selected. Weight loss and MS remission were analyzed 6 and 12 months after surgery by ATP III and IDF criteria. RESULTS: Before surgery, 381 (48.9%) and 354 (45.4%) patients fulfilled the criteria for MS according to the ATP III and IDF, respectively. According to the ATP III definition, remission of MS after bariatric surgery occurred in 209 of 239 (87.4%) and 98/102 (96.1%) patients at 6 and 12 months, respectively. According to the IDF definition, this occurred in 180 of 232 (77.6%) and 54 of 64 (84.4%) at the same time periods. On the basis of different percentage of excess body weight loss cut-off values, the area under the curve in receiver operating characteristic analysis at 12 months was slightly better for ATP III (0.77) than IDF criteria (0.68) for remission of MS. CONCLUSIONS: With the use of the IDF definition, the remission rate of MS was 10% more rigorous than with use of the ATP-III criteria. This feature is attributable to a greater discrimination of patients with high blood pressure, glycemia, and dyslipidemia. The IDF criteria seem more accurate to evaluate MS remission.

Analysis of Causes and Risk Factors for Hospital Readmission After Roux-en-Y Gastric Bypass.

BACKGROUND: Identification of causes and preventable triggers for hospital readmission after bariatric surgery is very important to implement strategies for surgical outcome optimization. The aim of the study was to analyze our readmissions after a Roux-en-Y gastric bypass (RYGB). PATIENTS AND METHODS: From our prospectively constructed database, patients who were readmitted to the hospital within the following 30 and 90 days after discharge were analyzed. Hospital charts were reviewed to determine the cause of readmission and the outcome. Potential risk factors for readmission were statistically analyzed. RESULTS: Between June 2004 and November 2013, 657 patients underwent a primary RYGB and 100 revisions. There were 442 (58%) females and 315 (42%) males with a mean age of 40.1 ± 11.5 years and a mean BMI of 42.4 ± 6.5 Kg/m(2). Comorbidities were present in 441 (58.2%) patients. Operations were completed laparoscopically in 741 (97.8%) patients. Mean hospital stay after the RYGB was 2.5 ± 1.6 days. The 30-day and 90-day readmission rate was 2.6 and 4.58%, respectively. Most common causes for readmission at 30 days were gastrointestinal bleeding in 30%, lung disease in 15%, and food intolerance in 15%. At 90 days, they were stricture of the gastrojejunostomy in 20%, gastrointestinal bleeding in 13.3%, and nephrolithiasis in 13.3%. Open surgery and previous upper abdominal surgery were significant risk factors for 90-day readmission. CONCLUSION: Our readmission rate after RYGB was low. Most common causes for readmission were upper gastrointestinal bleeding and food intolerance. Associated risk factors were open surgery and previous upper abdominal surgery.