Insurance-Mandated Pre-Operative Diet and Outcomes Following Bariatric Surgery

Keith, Charles J.; Goss, Lauren; Blackledge, Camille; Stahl, Richard; Grams, Jayleen

doi:10.1016/j.soard.2016.08.075

Cited by 2 publications

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“…However, these targets do add to the complexity of the pathway for the patients and variation in time and access to surgery, and therefore the usefulness of these targets is currently a subject of debate. [96][97][98][99] Impacts resulting from the benefits of dietician and psychological support prior to bariatric surgery have been published. Livhits et al 100 undertook a systematic review which found that preop weight loss appears to be associated with greater weight loss postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…Studies to date have either looked at those achieving significant weight loss preoperatively or have compared those with and without insurance-mandated weight loss. 97,141,142 What is required is a large randomised trial of weight loss versus weight stability in the population seeking bariatric surgery with follow-up for several years postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes and adverse events of bariatric surgery in adults with severe obesity in Scotland: the SCOTS observational cohort study

Mackenzie,

Ali,

Bruce

et al. 2024

Health Technol Assess

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Background Bariatric surgery is a common procedure worldwide for the treatment of severe obesity and associated comorbid conditions but there is a lack of evidence as to medium-term safety and effectiveness outcomes in a United Kingdom setting. Objective To establish the clinical outcomes and adverse events of different bariatric surgical procedures, their impact on quality of life and the effect on comorbidities. Design Prospective observational cohort study. Setting National Health Service secondary care and private practice in Scotland, United Kingdom. Participants Adults (age >16 years) undergoing their first bariatric surgery procedure. Main outcome measures Change in weight, hospital length of stay, readmission and reoperation rate, mortality, diabetes outcomes (HbA1c, medications), quality of life, anxiety, depression. Data sources Patient-reported outcome measures, hospital records, national electronic health records (Scottish Morbidity Record 01, Scottish Care Information Diabetes, National Records Scotland, Prescription Information System). Results Between December 2013 and February 2017, 548 eligible patients were approached and 445 participants were enrolled in the study. Of those, 335 had bariatric surgery and 1 withdrew from the study. Mean age was 46.0 (9.2) years, 74.7% were female and the median body mass index was 46.4 (42.4; 52.0) kg/m2. Weight was available for 128 participants at 3 years: mean change was −19.0% (±14.1) from the operation and −24.2% (±12.8) from the start of the preoperative weight-management programme. One hundred and thirty-nine (41.4%) participants were readmitted to hospital in the same or subsequent 35 months post surgery, 18 (5.4% of the operated cohort) had a reoperation or procedure considered to be related to bariatric surgery gastrointestinal complications or revisions. Fewer than five participants (<2%) died during follow-up. HbA1c was available for 93/182 and diabetes medications for 139/182 participants who had type 2 diabetes prior to surgery; HbA1c mean change was −5.72 (±16.71) (p = 0.001) mmol/mol and 65.5% required no diabetes medications (p < 0.001) at 3 years post surgery. Physical quality of life, available for 101/335 participants, improved in the 3 years post surgery, mean change in Rand 12-item Short Form Survey physical component score 8.32 (±8.95) (p < 0.001); however, there was no change in the prevalence of anxiety or depression. Limitations Due to low numbers of bariatric surgery procedures in Scotland, recruitment was stopped before achieving the intended 2000 participants and follow-up was reduced from 10 years to 3 years. Conclusions Bariatric surgery is a safe and effective treatment for obesity. Patients in Scotland, UK, appear to be older and have higher body mass than international comparators, which may be due to the small number of procedures performed. Future work Intervention studies are required to identify the optimal pre- and post surgery pathway to maximise safety and cost-effectiveness. Study registration This study is registered as ISRCTN47072588. Funding details This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 10/42/02) and is published in full in Health Technology Assessment; Vol. 28, No. 7. See the NIHR Funding and Awards website for further award information.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical outcomes and adverse events of bariatric surgery in adults with severe obesity in Scotland: the SCOTS observational cohort study

Mackenzie,

Ali,

Bruce

et al. 2024

Health Technol Assess

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Variations in bariatric surgical care pathways: a national costing study on the variability of services and impact on costs

et al. 2018

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BackgroundWe undertook a survey of all bariatric centres in Scotland in order to describe current pre- and post-operative care, to estimate their costs and explore differences in financial impact.MethodsA questionnaire was distributed to each health centre. Descriptive statistics were used to present average cost per patient along with 95% confidence intervals, and the range of costs.ResultsResults show nearly a five-fold difference in costs per patient for pre-operative services (range £226 - £1071) and more than a three-fold difference for post-operative services (range £259 - £896).ConclusionsThere is a lack of evidence base and a clear requirement for the evaluation of bariatric surgical services to identify the care pathways pre- and post-surgery which lead to largest improvements in health outcomes and remain cost-effective.Electronic supplementary materialThe online version of this article (10.1186/s40608-018-0223-3) contains supplementary material, which is available to authorized users.

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Insurance-Mandated Pre-Operative Diet and Outcomes Following Bariatric Surgery

Cited by 2 publications

References 0 publications

Clinical outcomes and adverse events of bariatric surgery in adults with severe obesity in Scotland: the SCOTS observational cohort study

Clinical outcomes and adverse events of bariatric surgery in adults with severe obesity in Scotland: the SCOTS observational cohort study

Variations in bariatric surgical care pathways: a national costing study on the variability of services and impact on costs

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