BODY-Q eating-related symptoms following sleeve gastrectomy.

BACKGROUND: Recent data describing gastrointestinal (GI) symptoms experienced by patients after bariatric surgery is lacking, and previous studies in sleeve gastrectomy patients have been limited in scope of follow-up time or extent of GI symptoms examined. We sought to characterize the prevalence and time course of patient-reported eating-related symptoms in sleeve gastrectomy patients. METHODS: From July 2020 to July 2021, sleeve gastrectomy patients seen at three Boston area hospitals received electronic surveys and prospectively reported GI symptoms using the BODY-Q eating-related symptoms scale. Descriptive analyses were performed for patient demographics and symptom prevalence. Chi-square tests were used to compare prevalence of eating-related symptoms between follow-up time intervals. RESULTS: 491 sleeve gastrectomy patients completed postoperative surveys with mean follow-up time of 1.9 years. Mean age was 46.6 years, and 81.3% were female. The most reported GI symptoms overall included constipation (56.6%), bloating (54.0%), heartburn when standing (41.5%), and heartburn when lying down (39.9%) while the least commonly reported symptoms were palpitations (16.3%), low blood sugar (15.7%), and emesis (15.1%). At greater than 12 months, the most reported symptoms similarly included bloating (60.3%), constipation (53.2%), and heartburn while standing (46.0%). When comparing prevalence of eating-related symptoms across follow-up time intervals from < 1 to > 12 months, patients reported a significant decrease in constipation, abdominal pain, and nausea over time (p = 0.012, p < .0001, p = 0.03, respectively). CONCLUSION: Patients experience both upper and lower GI symptoms following sleeve gastrectomy, and symptoms, including bloating, constipation, and heartburn may persist through long-term follow-up. These patient-centered measures add value by guiding preoperative counseling, informing postoperative expectations, and providing real-time clinical feedback for bariatric surgery patients.

Patient Satisfaction and Healthcare Utilization with the Transition to Virtual Care in a Multidisciplinary Bariatric Program.

BACKGROUND: The COVID-19 pandemic saw an acceleration in virtual-visits (VV) for healthcare delivery. However, the impact of virtual care in metabolic/bariatric surgery (MBS) programs is not well described. METHODS: Appointment data from three time-points: pre-pandemic (1/1/19-3/15/20, n = 19,290), pandemic (3/16/20-10/31/21, n = 29,459) and current-state (11/1/21-12/31/2022, n = 24,270) was retrieved in our multi-hospital ambulatory MBS program. Appointments were grouped by health care provider (HCP) (MD, dietician, and psychologist) and type (VV and in-person). Surveys assessing patient satisfaction were distributed electronically. All pre-op and post-op appointment data was analyzed for the time-points above. Appointment completion rates and patient reported preferences were described. RESULTS: Our data showed an increase in scheduled VV from 0.5% for all HCP visits to 81% during the pandemic and a current VV visit of 77%. The number of completed VV increased for all HCPs, most prominently for dieticians. Parallel to this, the percentage of no-show visits also improved for all HCP, with MDs having the lowest no-show rate currently. Survey data revealed 89% of patients experience added benefits with VV and > 90% reported their VV experience as very good. VV were preferred over in-person visits for psychologists and dietitians (> 61%), but the majority preferred to see MDs in-person (70%). CONCLUSIONS: Our findings reveal significant changes in healthcare utilization trends since the transition to virtual care. While overall satisfaction with virtual care is high, most patients prefer in-person visits with MDs. Thus, multi-disciplinary MBS care can be performed effectively using a hybrid model to ensure efficient distribution of resources.

Nutrition and metabolic support recommendations for the bariatric patient.

Managing the metabolic needs of the patient with obesity is a challenge unto itself without the added demands of accounting for an altered gastrointestinal tract. Nevertheless, with about 200,000 bariatric procedures being performed annually in the United States, clinicians must be prepared to manage the critically ill bariatric surgery patient. This article reviews the recent literature relating to nutrient needs and metabolic support for the bariatric patient. Bariatric patients are at risk for several micronutrient deficiencies, including vitamins D and B12, calcium, and iron; some bariatric procedures affect macronutrient needs as well. Literature on nutrition support guidelines for the bariatric population is limited. However, with an understanding of the anatomical and physiological effects of bariatric surgery, recent guidelines for critically ill patients with obesity can be applied to the bariatric surgery population. The unique needs of the bariatric population, such as susceptibility to micronutrient deficiencies and specialized access routes, must be considered to provide safe and efficacious nutrition support. Further research is necessary to develop specific nutrition support recommendations for the bariatric population.