Weight loss after bariatric surgery: a propensity score analysis.

BACKGROUND: Laparoscopic vertical sleeve gastrectomy (LSG) has replaced laparoscopic Roux-en-Y gastric bypass (LRYGB) as the most commonly performed bariatric surgical procedure in the US for more than the past several years. Identifying which patients will achieve optimal outcomes remains challenging. We compared 90-d and 1-y outcomes between LSG and LRYGB patients and identified predictors of surgery type and excess body weight loss (EBWL). METHODS: Patient demographics, comorbidities, and weight loss were extracted from electronic health records of patients who underwent LRYGB (n = 270) or LSG (n = 74) from January 2010 through March 2014 at a single institution. Variables hypothesized to be associated with surgery type were included in a multivariable model to generate a propensity score for each patient. Propensity score-adjusted multivariable odds ratios (ORs) for characteristics associated with EBWL >50% were calculated. RESULTS: Overall 90-d complication rates were similar between the LRYGB and LSG cohorts. LRYGB patients had more frequent emergency department visits (27.1% versus 14.1%; P = 0.029) but similar rates of readmission (12.3% versus 8.5%; P = 0.53). Female sex, presence of gastroesophageal reflux disease, and surgeon age ≥40 were associated with a greater likelihood of undergoing LRYGB. On propensity score-adjusted multivariable analysis, lower body mass index (OR 3.00 [95% confidence interval (CI) 1.66-5.40]), absence of type 2 diabetes (OR 2.55 [95% CI 1.43-4.54]), and undergoing LRYGB (OR 5.29 [95% CI 2.52-11.09]) were associated with EBWL >50%. CONCLUSIONS: Sleeve gastrectomy patients had similar rates of complications compared with gastric bypass patients. Lower body mass index and absence of type 2 diabetes were associated with optimal weight loss. Incorporating these findings into preoperative discussions may help patients set reasonable postoperative goals.

Psychosocial Factors Are Associated with Quality of Life After Laparoscopic Antireflux Surgery.

BACKGROUND: Laparoscopic antireflux surgery (LARS) is the gold standard treatment for refractory gastroesophageal reflux disease (GERD). Traditional surgical outcomes following LARS are well described, but limited data exist regarding patient-reported outcomes. We aimed to identify preoperative characteristics that were independently associated with a high GERD health-related quality of life (GERD-HRQL) following LARS. METHODS: Clinical data from our single institution foregut surgery database were used to identify all patients with GERD who underwent primary LARS from June 2010 to November 2015. Electronic health record data were reviewed to extract patient characteristics, diagnostic study characteristics, and operative data. Postoperative GERD-HRQL data were obtained through telephone follow-up. Variables hypothesized a priori to be associated with high GERD-HRQL after LARS, which were significant at P ≤ .2 on bivariate analysis, were entered into a multivariable linear regression model with GERD-HRQL as the outcome. RESULTS: The study included 248 patients; 69.0% were female, 56.9% were married, and 58.1% had concurrent atypical symptoms. The most commonly performed fundoplications were Nissen (44.8%), Toupet (41.3%), and Dor (14.1%), respectively. The median follow-up interval was 3.4 years. The telephone response rate was 60.1%. GERD-HRQL scores improved from 24.8 (SD ±11.4) preoperatively to 3.0 (SD ±5.9) postoperatively. 79.9% of patients were satisfied with their condition at follow-up. On multivariable analysis, being married (P = .04) and absence of depression (P = .02) were independently associated with a higher postoperative QoL. CONCLUSIONS: Strong social support and psychiatric well-being appear to be important predictors of a higher QoL following LARS. Optimizing social support and treating depression preoperatively and postoperatively may improve QoL outcomes for LARS patients.