Weight loss at first postoperative visit predicts long-term outcome of Roux-en-Y gastric bypass using Duke weight loss surgery chart

Abstract

Introduction The Roux-en-Y gastric bypass (RYGB) has been employed for more than 3 decades. However, there are no normative data to aid the bariatric surgeon in assessing the adequacy of weight loss at each postoperative visit. Objective To construct nomograms to aid in assessment of weight loss. Setting University Hospital, United States Methods We used data prospectively collected from 1216 patients who underwent RYGB at Duke University between April 2000 and September 2007. Percent excess weight loss (EWL) was determined for each follow-up visit (1, 3, 6, 12, and 36 months). EWL velocity was also determined using postoperative data collected at 1 and 3 month visits. Multivariate analysis was used to determine predictive factors that influence long term results. Results At 12 months follow up, the majority of patients, especially those in the 1st and 4th quartiles (p=0.01) continue to be in the same weight loss quartile where they were initially classified at 1 month postoperatively. The positive and negative predictive values for 1st quartile EWL at 1 month resulting in 1st quartile EWL at 12 months was 39% and 81%, respectively. The multivariate analysis indicated that sex, preoperative body mass index (BMI), EWL at 1 month, and EWL velocity were statistically significant predictors of EWL at 12 months. Conclusions We are the first group to determine that weight loss performance in the early period is a significant predictor of long term outcome. The clinical utility of the weight loss chart is to identify underperformers early postoperatively and potentially improve outcomes.

The Use of Predictive Markers for the Development of a Model to Predict Lowest Quartile Weight Loss following Roux-en-Y Gastric Bypass.

“…Literature is also split of whether age effects weight loss however we did not find it to be significant (7,23 paper (26) and this one as well.…”

“…The first one in this category was from Mor et al who showed that weight loss results of RYGB are determined from early post-operative visits (7). They found that gender, pre-operative BMI, and weight loss at 1-month post-operative determine weight loss results.…”

The Time to Weight-Loss Steady State After Gastric Bypass Predicts Weight-Loss Success

“…Each patient's chart was individually evaluated to see if they lost >5 %EWL at the last study follow-up once achieving SS. IWLV was calculated with slight modification from that described by Mor et al with the difference between %EWL at 3 months and 6 weeks divided by 6 weeks and reported as %EWL/week [10].…”

“…The initial weight-loss velocity (IWLV) has recently been described as a potential risk factor for poor maximal weight loss. The 1-month %EWL, pre to 1-month IWLV, and 3 to 6-month IWLV after RYGB have all been found to be associated with the maximal post-operative weight loss [10,11].…”

Psychosomatic and Psychosocial Questions Regarding Bariatric Surgery: What Do We Know, or What Do We Think We Know?

“…While some studies found that super-obese patients lost less weight compared to patients with a lower BMI, these patients were still able to decrease their excess weight by 30-60% depending on the type of surgical intervention (Anthone et al 2003;Jan et al 2005;Diniz et al 2009). Irrespective of the chosen surgical technique, there is consistent evidence that better early weight loss, particularly during the first six months, is indicative of more successful weight outcome up to 24 months post-surgery (Mor et al 2012;Nikolic et al 2015;Obeidat et al 2016). However, although early weight loss appears to be important for maximum weight loss, the time at which people reach a steady weight was shown to impact the long-term weight maintenance.…”