Influence of Preoperative Weight Loss on Outcomes of Bariatric Surgery for Patients Under the Enhanced Recovery After Surgery Protocol

Abstract

Introduction The enhanced recovery after surgery (ERAS) protocol, which emphasizes preoperative interventions, is safely implemented in patients undergoing bariatric surgery. Patients are additionally encouraged to achieve weight loss preoperatively. We aimed to identify factors contributing to preoperative weight loss and assess their influence on outcomes of bariatric surgery among patients under the ERAS protocol. Materials and Methods We reviewed a prospectively created database in two bariatric centers with 909 bariatric patients treated in accordance with ERAS principles. The database included demographic characteristics, factors related to the surgery or perioperative period, and short-term outcomes. Our endpoints included analyses of (1) factors potentially contributing to preoperative weight loss and (2) the influence of preoperative weight loss on short-term outcomes of bariatric treatment. Results Diabetes mellitus (p = 0.007), obstructive sleep apnea (p < 0.001), and previous surgery (p = 0.012) were identified as predictors of preoperative weight loss. Steatohepatitis (p < 0.001) and respiratory disorder (p = 0.004) decreased the chance of achieving satisfactory preoperative body mass reduction. Except for operative time, early outcomes of bariatric surgery were not influenced by preoperative weight loss. Patients who achieved preoperative weight loss were less likely to be lost to follow-up (p = 0.023). Postoperative weight loss was better in patients who could lose ≥ 5% total weight preoperatively (p = 0.009).

Are the Results of a Combined Behavioural and Surgical Treatment of Morbid Obesity Satisfactory and Predictable?

“…However, since the maximum weight loss was observed 12 to 24 months after the surgery, a few more subjects could reach the treatment goal [25]. The results in this study are in accordance with larger studies with six month to ten year follow-up periods [2,3,[25][26][27][28].…”

“…Comparisons with other studies are difficult because the behavioural weight loss regimens vary in length and content and are not always completely described. In large, the weight reduction was as reported in other studies [25,27,28].…”

“…The purpose is to evaluate compliance with the necessary dietary changes before and after surgery, reduce complications and improve the outcomes [8]. The benefit from this mandatory weight loss before surgery is at best dubious [25,27,28]. In this study, neither the reduction in BMI nor the %EBMIL in the two treatment periods were significantly associated.…”

“…Short-and long-term weight loss after bariatric surgery has been thoroughly studied [2][3][4][25][26][27][28]. The results after the second treatment period are in accordance with studies with the same surgical procedures and observation time [25][26][27][28]. Comparisons are, however, difficult because not all studies specify if the preoperative weight loss is included in surgically induced weight loss.…”

Nutritional Guidelines in Bariatric/Metabolic Surgery - Recommendations of the Portuguese Society for the Study of Obesity

“…10,32 É consensual que a perda ponderal pré-operatória é preditora da perda de peso no primeiro ano após a intervenção, 38 mantendo--se até aos 4 anos após a cirurgia uma correlação significativa entre a perda ponderal pré e pós-cirúrgica. 27,39,40 Assim, no acompanhamento pré-operatório, a perda de peso prévia à cirurgia deve ser fortemente encorajada. 21 Porém, tornar essa perda mandatória e condicional para acesso à cirurgia é um tema controverso e não consensual.…”