Defining Global Benchmarks in Elective Secondary Bariatric Surgery Comprising Conversional, Revisional, and Reversal Procedures.

OBJECTIVE: To define "best possible" outcomes for secondary bariatric surgery (BS). BACKGROUND: Management of poor response and of long-term complications after BS is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. METHODS: Out of 44,884 BS performed in 18 high-volume centers from 4 continents between 06/2013-05/2019, 5,349 (12%) secondary BS cases were identified. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of centers. Benchmark cases had no previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, thromboembolic events, BMI> 50 kg/m2 or age> 65 years. RESULTS: The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8 ±â€Š10 years, 8.4 ±â€Š5.3 years after primary BS, with a BMI 35.2 ±â€Š7 kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.6% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.37) and after conversional/reversal or revisional procedures with gastrointestinal suture/stapling (OR 1.84). Benchmark cutoffs for conversional BS were ≤4.5% re-intervention, ≤8.3% re-operation 90-days postoperatively. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation. CONCLUSION: Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.

Diabetes in Bolivia / La Diabetes en Bolivia

Objective. To measure the prevalence of diabetes mellitus (DM), hypertension, obesity, and related risk factors in major cities in Bolivia Methods. A population-based survey was conducted in four Bolivian cities: La Paz, El Alto, Santa Cruz, and Cochabamba. The total sample size was chosen to be 2 948 persons. The overall response rate was 86%, with the rate varying somewhat among the four cities. DM was diagnosed through an oral glucose tolerance test (OGTT) 2 hours after an overload of 75 grams of glucose, using World Health Organization criteria. Results. The overall prevalence of DM in the four urban areas combined was 7.2% (95% confidence interval (CI): 6.2%­8.3%) and of impaired glucose tolerance (IGT) was 7.8%. A total of 73.1% (95% CI: 65.0%­81.0% ) of those previously diagnosed with DM and 73.7% (95% CI: 61.0%­86.4%) of newly diagnosed cases were overweight, according to measurements of body mass index. Hypertension was found in 36.5% (95% CI: 27.6%­45.5%) of known diabetics and in 36.6% (95% CI: 23.0%­50.1%) of newly diagnosed cases, compared to only 15.9% (95% CI: 14.3%­17.5%) among people without DM. The disease was most common among older persons and those with little education. Conclusions. Diabetes is a genuine public health problem in Bolivia. Further, the high prevalence of IGT that was found suggests that diabetes prevalence will increase in the future in the country unless prevention strategies are implemented

Objetivos. Determinar la prevalencia de la diabetes sacarina, la hipertensión, la obesidad y los factores de riesgo relacionados en grandes ciudades de Bolivia. Métodos. Se realizó una encuesta poblacional en cuatro ciudades bolivianas: La Paz, El Alto, Santa Cruz y Cochabamba. El tamaño de la muestra fue de 2 948 personas. La tasa general de respuesta fue del 86%, con algunas variaciones entre las cuatro ciudades. La diabetes se diagnosticó mediante una prueba de tolerancia a la glucosa oral, con obtención de las muestras 2 h después de la administración de 75 g de glucosa; se siguieron los criterios de la Organización Mundial de la Salud. Resultados. La prevalencia global de la diabetes en el conjunto de las cuatro áreas urbanas fue del 7,2%, con un intervalo de confianza del 95% (IC95%) de 6,2 a 8,3%; la del deterioro de la tolerancia a la glucosa fue del 7,8%. El 73,1% (IC95%: 65,0 a 81,0%) de los casos diagnosticados anteriormente de diabetes y el 73,7% (IC95%: 61,0 a 86,4%) de los recién diagnosticados tenían sobrepeso, de acuerdo con las mediciones del índice de masa corporal. Se diagnosticó hipertensión en el 36,5% (IC95%: 27,6 a 45,5%) de los diabéticas diagnosticados previamente y en el 36,6% (IC95%: 23,0 a 50,1%) de los recién diagnosticados, en comparación con tan solo un 15,9% (IC95%: 14,3 a 17,5%) en los individuos sin diabetes. La enfermedad fue más frecuente en las personas de más edad y en aquellas con menor nivel educacional. Conclusiones. La diabetes es un verdadero problema de salud pública en Bolivia. Además, la alta prevalencia del deterioro de la tolerancia a la glucosa detectada en este estudio indica que la prevalencia de la diabetes seguirá aumentando en este país en el futuro cercano, a no ser que se pongan en práctica estrategias preventivas