Objective(s) Roux-en-Y Gastric Bypass (RYGB) is well-known to ameliorate type 2 diabetes mellitus (T2DM), and recent work suggests that the pre-operative DiaREM model predicts successful remission up to 1-year post-RYGB. However, no data exist for long-term validity. Therefore, we sought to determine the utility of this score on long-term RYGB effectiveness for T2DM resolution at 2 and 10 years respectively. Methods T2DM patients (Age: 48, BMI: 49, HbA1C: 8.1) undergoing RYGB at the University of Virginia between 2004-2006 (n=42) and 2012-2014 (n=59) were evaluated prospectively to assess pre-operative DiaREM score, defined from insulin use, age, HbA1C and type of antidiabetic medication. T2DM partial remission status was based on the American Diabetes Association guidelines (HbA1C <6.5% and fasting glycemia <125 mg/dl, and no anti-diabetic medications). Chi-square test was used to compare patient's T2DM status to their DiaREM probability of remission. Results Among RYGB patients with 2-year postoperative data, 2 were lost (n=1 no follow-up and n=1 died) resulting in 57 patients for analysis. For the 10-year postoperative data, 11 were lost (n=6 no follow-up and n=5 died) thereby resulting in only 31 patients for analysis. Patients were distributed by DiaREM score to correlate with the predicted probability of remission as follows: 0-2 (Predicted 94%, 2-year 100% p=0.61, 10-year 100% p=0.72), 3-7 (Predicted 76%, 2-year 94% p=0.08, 10-year 83% p=0.57), 8-12 (Predicted 36%, 2-year 47% p=0.38, 10-year 43% p=0.72), 13-17 (Predicted 22%, 2-year 20% p=0.92, 10-year 33% p=0.64), and 18-22 (Predicted 9%, 2-year 15% p=0.40, 10-year 14% p=0.64). Conclusions Pre-operative DiaREM scores are a good tool for predicting both short- and long-term T2DM remission following RYGB. This study highlights the need to identify strategies that improve T2DM remission in those at highest risk.

Objective(s) Monitoring and prevention of long-term nutrient deficiency after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) remains ill defined due to limited surgical follow-up after bariatric surgery. This study compared nutrient supplementation as well as surgeon and primary care physician (PCP) follow-up between patients with short-term versus long-term follow-up. Methods All patients undergoing LRYGB at a single institution in 2004 (long-term group, n=281) and 2012–2013 (short-term group, n=149) were evaluated. Prospectively collected database, Electronic Medical Record (EMR) review and telephone survey were used to obtained follow-up for both cohorts. Multivariate logistic regression was used to assess factors independently predicting multivitamin use. Results Complete follow-up was achieved in 172 (61%) long-term and 107 (72%) short-term patients. We demonstrate a significant difference (p < 0.0001) in time since last surgeon follow-up (13.3±7.8 vs 86.9±39.9 months) for the long-term group with no difference in PCP follow-up, (3.1±4.3 vs 3.7±3.4). Nutrient supplementation was higher in the short-term group, including multivitamin (70.3% vs 58.9%, p<0.05), iron (84.2% vs 67.1%, p=0.02) and calcium (49.5% vs 32.9%, p=0.01). After adjusting for interval since surgery, %EBMI, and current comorbidities logistic regression (c=0.797) demonstrated shorter time since last surgeon visit was independently predictive of multivitamin use (p=0.001). Conclusions While it appears patients prefer to follow-up with their PCP this study reveals a large disparity in malnutrition screening and nutrient supplementation following LRYGB. Therefore, implementation of multidisciplinary, best-practice guidelines to recognize and prevent malnutrition is paramount in the management of this growing population of high-risk patients.

Background Increasingly, patients are faced with farther travel distances to undergo bariatric surgery at high-volume centers. Objective(s) This study sought to evaluate the impact of travel distance on access to care and outcomes following bariatric surgery. Setting Patients who underwent Roux-en-Y Gastric Bypass (RYGB) at an academic bariatric surgery center from 1985–2004 were examined and stratified by patient travel distance. Methods Univariate analyses were performed for preoperative risk factors, 30-day complications, and long-term (10-year) weight loss between “local” defined as <1 hour travel time and “regional” defined as >1 hour travel time. Survival analysis was performed with Kaplan-Meier and Cox proportional hazards models. Results 650 patients underwent RYGB, 316 (48.6%) of whom traveled <1 hour to undergo surgery and 334 (51.4%) traveled >1 hour. Median BMI (Body Mass Index) between the groups was equivalent (52.9 kg/m2 local, 53.2 regional kg/m2, p=0.76). Patients who traveled longer distances had higher rates of preoperative comorbidities, including Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), Diabetes Mellitus (DM), and sleep apnea (all p<0.05). Complications within 30 days of surgery and long-term reduction of excess BMI were equivalent between groups. Travel time was an independent predictor of risk-adjusted reduced long-term survival (HR 1.23, p=0.0002). Conclusions A majority of patients who underwent bariatric surgery at our center traveled more than one hour. Despite longer travel time for care, 30-day complications and long-term weight loss were equivalent compared to local patients. As expected, patients who live in close proximity were more likely to adhere to yearly follow up in surgery clinic. Travel time was an independent predictor of risk-adjusted reduced long-term survival.