12-year trajectory of health-related quality of life in gastric bypass patients versus comparison groups

Background

Few prospective studies compare long-term health-related quality of life (HRQOL) outcomes between bariatric surgery patients and individuals with severe obesity who do not undergo bariatric surgery.

Two-year changes in health-related quality of life in gastric bypass patients compared with severely obese controls

BackgroundFew weight loss surgery trials have evaluated the changes in health-related quality of life (HRQOL) relative to obese individuals not participating in weight loss interventions. In a prospective study at a bariatric surgery practice, we evaluated the 2-year changes in HRQOL in gastric bypass patients compared with 2 severely obese groups who did not undergo surgical weight loss.MethodsA total of 308 gastric bypass patients were compared with 253 individuals who sought but did not undergo gastric bypass and 272 population-based obese individuals using the weight-related (Impact of Weight on Quality of Life-Lite) and general (Medical Outcomes Study 36-item Short-Form Health Survey) HRQOL questionnaires at baseline and 2 years of follow-up.ResultsThe percentage of weight loss was 34.2% for the gastric bypass and 1.4% for the no gastric bypass groups, with a .5% gain for population-based obese group. Both measures of HRQOL showed greater improvements for the gastric bypass group, even after controlling for baseline differences. Effect sizes for changes in physical and weight-related HRQOL were very large for gastric bypass, but small to medium for the 2 comparison groups. Effect sizes for changes in the psychosocial aspects of HRQOL were moderate to very large for gastric bypass, but small for the 2 comparison groups. Of the gastric bypass patients, 97% had meaningful improvements in the Impact of Weight on Quality of Life-Lite total score compared with 43% of the no gastric bypass group and 30% of the population-based obese group.ConclusionDramatic improvements had occurred in weight-related and physical HRQOL for gastric bypass patients at 2 years after surgery compared with 2 severely obese groups who had not undergone surgery. These results support the effectiveness of gastric bypass surgery in improving patients' HRQOL.     

Health-related quality of life in morbidly obese patients: effect of gastric bypass surgery

Background: The effect of gastric bypass on the health-related quality of life (HRQoL) of morbidly obese patients was investigated in a cross-sectional study. Methods: A postoperative group of 78 patients on average 13.8 years after gastric bypass was compared with a preoperative control group of 110 patients. The SF-36 was used to assess HRQoL. In preoperative patients, the SF-36 was self-administered, while in the postoperative group, telephone interviews were conducted. In the postoperative sample, multiple stepwise linear regression analyses were carried out to examine putative predictors of the physical (PCS) and the mental (MCS) composite scores of the SF-36. Results: Significant differences between the preand postoperative group were found for all subscales except Mental Health, in favor of the postoperative group. On average 13.8 years after gastric bypass, most of the sub-scales were similar to the US norm values. However, the Bodily Pain and the overall Physical Composite scale (PCS) scores were lower (more impaired) in the postoperative group compared with the US norms. Female patients, patients who were hospitalized since the surgery, and those who had lost less weight had more impaired values on the PCS and patients who reported binge-eating disorder (BED) at follow-up had more impaired values on the Mental Composite Scale (MCS) of the SF-36. Conclusion: HRQoL was significantly better in postoperative gastric bypass patients in comparison to a sample of preoperative patients. However, HRQoL, specifically the physical domain of the SF-36, was more impaired in long-term follow-up patients compared with US norm values. The reoccurrence of BED after surgery negatively influenced the mental domain of the SF-36.     

Health and health-related quality of life: differences between men and women who seek gastric bypass surgery

BackgroundThe aim of this study was to examine the differences between male and female bariatric surgery candidates with respect to health-related quality of life (HRQOL), health, sociodemographic variables, and interactions among these variables in a bariatric surgery practice in the United States. Women seek bariatric surgery 5 times more often than men. Research on gender differences in HRQOL is limited, and the results are conflicting.MethodsA total of 794 surgery candidates (mean age 42.2 y; body mass index 46.9 kg/m²; 84.8% women) completed both a weight-related (Impact of Weight on Quality of Life-Lite questionnaire) and a generic (Medical Outcomes Study Short-Form-36) measure of HRQOL. Health was evaluated by questionnaire and clinical interviews.ResultsCompared to men, women reported reduced HRQOL on 3 of the 5 scales assessing obesity-specific HRQOL and also the physical aspects of general HRQOL. Women also had double the rate of depression (48.5% versus 22.5%), and men had double the rate of sleep apnea (80.3% versus 40.2%). Women were younger, less obese, and were less likely to be married. No gender differences were found in the association between HRQOL and co-morbidities. However, an increasing number of co-morbidities was associated with decreasing physical and mental HRQOL. Additionally, depression was associated with decreased mental HRQOL, and coronary heart disease was associated with decreased physical HRQOL.ConclusionWomen's reduced HRQOL, particularly in self-esteem, sexual life, and physical functioning, and their greater rates of depression, might play a role in their decision to seek bariatric surgery. Although we could not determine causality, this study is a first step toward understanding why women seek surgery 5 times more often than men.     

Predictors of health-related quality of life after coronary artery bypass surgery

BACKGROUND: Little is known about the determinants of health-related quality of life after coronary artery bypass surgery. We determined the predictors of overall physical and mental health status 6 months after the operation. METHODS: We evaluated 1,973 patients enrolled in a multicenter Veterans Affairs prospective cohort study who completed preoperative and 6-month postoperative Short Form-36 (SF-36) health status surveys. Multiple linear regression was used to identify the significant independent predictors of 6-month physical and mental component summary scores from the SF-36. RESULTS: In multivariable analyses adjusting for baseline health status, significant predictors of postoperative physical health status were a history of neurologic disease, peripheral vascular disease, chronic obstructive pulmonary disease, hypertension, current smoking, forced expiratory volume, left ventricular ejection fraction, and serum creatinine. Significant predictors of postoperative mental health status were a history of psychiatric disease, chronic obstructive pulmonary disease, current smoking, age, and New York Heart Association functional class. CONCLUSIONS: These predictors of health-related quality of life after coronary artery bypass surgery may be useful for preoperative risk assessment and counseling of patients with regard to anticipated health status outcomes. Factors such as current smoking and psychiatric disease may be targets for interventions to improve health-related quality of life outcomes.     

Changes in health-related quality of life following coronary artery bypass graft surgery

Background. There are limited data to help clinicians identify patients likely to have an improvement in quality of life following CABG surgery. We evaluated the relationship between preoperative health status and changes in quality of life following CABG surgery.

Methods. We evaluated 1,744 patients enrolled in the VA Cooperative Processes, Structures, and Outcomes in Cardiac Surgery study who completed preoperative and 6-month postoperative Short Form-36 (SF-36) surveys. The primary outcome was change in the Mental Component Summary (MCS) and Physical Component Summary (PCS) scores from the SF-36.

Results. On average, physical and mental health status improved following the operation. Preoperative health status was the major determinant of change in quality of life following surgery, independent of anginal burden and other clinical characteristics. Patients with MCS scores less than 44 or PCS scores less than 38 were most likely to have an improvement in quality of life. Patients with higher preoperative scores were unlikely to have an improvement in quality of life.

Conclusions. Patients with preoperative health status deficits are likely to have an improvement in their quality of life following CABG surgery. Alternatively, patients with relatively good preoperative health status are unlikely to have a quality of life benefit from surgery and the operation should primarily be performed to improve survival.     

EuroSCORE predicts health-related quality of life after coronary artery bypass grafting

Three hundred and two patients were evaluated for the EuroSCORE risk and health-related quality of life (HRQoL) during three years after CABG as assessed by the 15D instrument. Both additive and logistic EuroSCORE correlated significantly with the 15D score at 6, 18 and 36 months. A clinically important increase > or =0.03 in the 15D score was achieved by 50.6% of patients at 6 months, 40.0% at 18 months and 35.9% at 36 months. The rates were similar among patients with increasing EuroSCORE at 6 and 18 months, but tended to decrease at 36 months in the highest EuroSCORE group (EuroSCORE 0-2: 46.8%; 3-5: 34.8%; and 6-14: 33.3%, respectively, P=0.13). Both additive (area under the receiver operating characteristic curve, AUC: 0.582, P=0.024) and logistic EuroSCORE (AUC: 0.575, P=0.039) were predictors of a significant increase of the 15D score. The best cut-off value of the additive EuroSCORE for prediction of a clinically important improvement of the 15D score during 3-year follow-up was 3, as 46.7% of patients with EuroSCORE 0-3 and 30.1% of patients with a score >3 (P=0.006) improved clinically. The present study showed that the EuroSCORE also predicts long-term HRQoL after CABG.     

Laparoscopic Roux-en-Y gastric bypass in morbidly obese and super morbidly obese patients

BACKGROUND: Our objective was to compare the outcomes after laparoscopic Roux-en-Y gastric bypass (RYGB) in morbidly obese (body mass index [BMI] <50) patients with super morbidly obese (BMI >50) patients. METHODS: A prospective analysis of 120 patients who underwent laparoscopic RYGB at a community based teaching hospital between January 2002 and August 2002 was performed. Sixty patients with BMI <50 were compared with 60 patients with BMI >50. Study endpoints included: operative time, length of stay, and overall complication rates including early (<7 days) and late (>7 days) complications. RESULTS: Mean BMI in the obese group was 44.6 (range 39 to 49) versus 58.6 (range 50 to 100) in the superobese group. Medical comorbidities, age, and sex distribution were similar in both groups. Mean operative time in the obese group was 128 minutes (range 75 to 225) versus 144 minutes (range 75 to 240) in the superobese group. The overall complication rate was 10% in the obese group versus 20% in the superobese group. (P = 0.2) With regard to the obese group, the early complication rate was 5% (n = 3). These included 2 upper gastrointestinal bleeds and 1 respiratory failure. The late complication rate in this group was also 5% (n = 3). These were all anastomotic strictures requiring endoscopic dilation. In comparison, in the superobese group, the early complication rate was 8% (n = 5). These included 2 upper gastrointestinal bleeds, 1 pneumonia, 1 superficial wound infection, and 1 small bowel obstruction. The late complication rate in this group was 12% (n = 7). These included 4 anastomotic strictures, 1 incisional hernia, 1 pulmonary embolism, and 1 anastomotic leak. There were no conversions to open gastric bypass or deaths in either group. Median length of stay in both groups was 2 days. CONCLUSIONS: Our data demonstrate no significant difference in operative times, complication rates or length of stay between morbidly obese and super morbidly obese patients undergoing laparoscopic RYGB. Laparoscopic RYGB is safe and technically feasible in the super morbidly obese patient population.     

Outcome of hand-assisted laparoscopic gastric bypass in super obese patients

BackgroundThe optimal surgical treatment for super obese patients (body mass index [BMI] ≥50 kg/m²) has been a challenge and debate for most bariatric surgeons. To compare the outcomes of hand-assisted laparoscopic Roux-en-Y gastric bypass (HALGB) in super obese patients (BMI ≥50 kg/m²) to morbidly obese patients (BMI <50 kg/m²).MethodsA total of 295 patients who underwent HALGB from October 2003 to December 2005 were studied. These patients included 177 with a BMI of ≤49 kg/m² (morbidly obese) and 118 with a BMI of ≥50 kg/m² (super-obese). The patient demographics, complications, and outcomes were examined. Additionally, the 12-month postoperative outcomes included the percentage of excess weight loss and improvement of co-morbidities.ResultsThe patient age and gender were similar between the 2 groups. The super-obese patients had significantly more co-morbidities and required a greater number of medications. A significant difference was found in 3 early postoperative complications, with super-obese patients experiencing more wound infections (P = .039), nausea/vomiting (P = .003), and pulmonary failure (P = .010). Logistic regression analysis found, after controlling for significant risk factors, that the difference in the incidence of nausea/vomiting was still significant (odds ratio 14.33, 95% confidence interval 1.73–118.60, P = .01). Morbidly obese patients had a significantly greater percentage of excess weight loss at 12 months postoperatively compared with the super-obese patients (80% versus 55%, respectively, P <.001).ConclusionHALGB is a safe and effective procedure in the super obese but with less favorable outcomes compared with those for morbidly obese patients regarding the percentage of excess weight loss.     

Racial differences in health-related quality of life among hemodialysis patients

BACKGROUND; Despite technical progress in therapy, hemodialysis patients continue to report health-related quality of life (HRQOL) substantially lower than that of the general population. While African Americans with end-stage renal disease (ESRD) survive longer than members of other races, few studies have compared the HRQOL of African Americans with that of non-African Americans. METHODS: We examined differences in sociodemographic, clinical, and HRQOL variables by race. A multiple regression model assessed the extent to which race was associated with differences in HRQOL scores after adjustment for sociodemographic and clinical variables. Racial differences in the relationship between comorbid disease severity and HRQOL were explored. RESULTS; In adjusted models, African Americans had higher scores in the Index of Well-Being and burden of kidney disease, but lower scores in cognitive function (all P < 0.05). For scales reflecting symptoms and effects of kidney disease, sleep quality, and the Physical Component Summary, the fall in HRQOL with increasing comorbidity was significantly greater in non-African Americans (all P < 0.05). After adjustment, there were no racial differences in scores on the Mental Component Summary, social support, dialysis staff encouragement, or patient satisfaction. CONCLUSION: To our knowledge, ESRD is the only chronic illness for which African Americans report significantly better psychologic well being and a lower burden of disease than non-African Americans. Further research is needed to understand whether these experiences affect health care utilization, medical decision making, and patient survival. Clarification of the reasons for race differences may suggest measures to improve HRQOL for all patients with ESRD.     

Effects of dexmedetomidine in morbidly obese patients undergoing laparoscopic gastric bypass

BACKGROUND: Obese patients may be sensitive to the respiratory depressant effect of opioid analgesics. Alternative methods for analgesia may be beneficial for management of bariatric surgery. We evaluated the effect of dexmedetomidine on anesthetic requirements during surgery, hemodynamic, recovery profile and morphine use in the postoperative period. METHODS: Eighty adult patients scheduled for elective laparoscopic Roux-en-Y gastric bypass surgery were randomly assigned to one of two study groups; Group D (40 patients) received dexmedetomidine (0.8-microg/kg bolus, 0,4 microg kg(-1) h) and Group P (40 patients) received normal saline (placebo) in the same volume and rate. Intraoperative and postoperative mean blood pressure and heart rate were recorded. The total amount of intraoperative fentanyl and propofol required to maintain anesthesia were measured. Recovery profile, pain score and total amount of morphine used via patient controlled analgesia (PCA) were assessed. RESULTS: During surgery, dexmedetomidine decreased the total amount of intraoperative fentanyl and propofol required for maintenance of anesthesia compared to placebo. Patients who received dexmedetomidine showed significant decrease of intraoperative and postoperative mean blood pressure, heart rate. In the postoperative period, dexmedetomidine decreased pain scores and PCA morphine use significantly and showed better recovery profile as compared to the placebo Group. There was no difference in the incidence of postoperative nausea and vomiting (PONV) between both groups. CONCLUSION: The intraoperative infusion of dexmedetomidine decreased the total amount of propofol and fentanyl required to maintain anesthesia, offered better control of intraoperative and postoperative hemodynamics, decreased postoperative pain level, decreased the total amount of morphine used and showed better recovery profile compared with placebo.     

Composition of weight loss in morbidly obese patients after gastric bypass

Optimal treatment of morbid obesity requires reduction of excess body fat while minimizing lean tissue loss. In order to determine if gastric bypass surgery satisfies both these requirements, we have studied changes in body composition and weight loss in adult (mean age = 33 years) morbidly obese patients (14 males, 68 females) after gastric bypass surgery. The preoperative weight of this cohort was 136 ± 27 (SD) kg, which was 228 ± 37% of ideal body weight by actuarial standards. Lean body mass (LBM) was estimated from potassium-40 measurements obtained from a wholebody potassium-40 counter and by urine creatinine excretion on a subgroup of 20 patients. The average weight loss at 3, 6, and 12 months after surgery was 25, 35, and 46 kg, respectively. The weight loss phase lasted approximately 1 year, at which time 34% of the initial weight was lost and the percentage of loss of excess weight above ideal body weight plateaued at 61%. LBM accounted for 32% of the total weight loss at 1 month, 11% at 6 months, and only 3% at the end of 1 year. The percentage of body weight represented by LBM increased from 35% prior to surgery to 51% by 18 months after gastric bypass. Actual LBM content increased steadily after the first month following surgery. Mean total weight loss following three different surgical procedures for gastric bypass did not differ significantly. Gastric bypass surgery appears to satisfy the objectives of reducing excess weight contributed by fat while minimizing lean tissue loss in morbidly obese patients.     

Quality of life and resolution of co-morbidities in super-obese patients remaining morbidly obese after Roux-en-Y gastric bypass.

BACKGROUND: Not all patients undergoing Roux-en-Y gastric bypass with an initial body mass index (BMI) >50 kg/m(2) attain a BMI of <35 kg/m(2) postoperatively. We hypothesized that even though many of these patients remain morbidly obese after surgery, they still realize an improvement in co-morbidities and quality of life. METHODS: Patients who had undergone Roux-en-Y gastric bypass and who had a preoperative BMI >50 kg/m(2) and postoperative BMI >35 kg/m(2) were identified. The records of 120 patients were reviewed for the presence of diabetes, hypertension, hyperlipidemia, and gastroesophageal reflux disease. Patients were queried about their use of medications, medical problems, and quality of life. RESULTS: The average preoperative and postoperative BMI was 63.2 and 43.7 kg/m(2). Of the 120 patients, 77 responded to the survey. In the preoperative group, the rate of diabetes, hypertension, hyperlipidemia, and gastroesophageal reflux disease was 35%, 50.8%, 15%, and 34.2%, respectively. Postoperatively, 73.8%, 62.3%, 38.9%, and 87.8% of patients had been cured of these co-morbidities. The change in the incidence of diabetes, hypertension, and gastroesophageal reflux disease was significant at P = 0.0014, P = 0.037, and P <0.0001, respectively. More than 90% of patients considered themselves to be better postoperatively in the areas of overall health and ability to move about; 80-90% had improved ability to exercise, greater energy levels, more self esteem, and an improved physical appearance; 70-80% saw their ability to work and their social relationships as improved; and 56% believed their sexual relationships had improved. CONCLUSION: Super-obese patients experience significant improvements in co-morbidities and quality of life after Roux-en-Y gastric bypass even if their BMI remains >35 kg/m(2).     

Return to work after gastric bypass in Medicaid-funded morbidly obese patients

OBJECTIVE: To determine whether medically disabled (Medicaid-funded) morbidly obese patients return to the workforce after Roux-en-Y gastric bypass (RYGB). DESIGN: Retrospective clinical data review. SETTING: A tertiary referral center. PATIENTS: From January 1, 1997, to December 31, 2002, 38 medically disabled patients underwent RYGB performed by a single surgeon. Sixteen medically disabled patients seen by the same surgeon did not undergo surgery and served as a control group. INTERVENTION: Roux-en-Y gastric bypass. MAIN OUTCOME MEASURE: Full-time employment. RESULTS: The patients who underwent RYBG were more likely to return to work, with 14 (37%) working, compared with 1 (6%) of the nonoperative control patients (P = .02). Elimination of comorbidities was associated with a greater likelihood of return to work. Patients who had greater than the mean decrease in comorbid conditions at the time of follow-up were statistically more likely to return to work than those who did not have a reversal in comorbid conditions (P = .001). Health-related quality of life was very poor preoperatively and improved in all domains after surgery. CONCLUSIONS: Morbid obesity is associated with many medical conditions that often render patients disabled. We found that 37% of morbidly obese patients with Medicaid coverage returned to work after RYGB, compared with 6% of patients in the nonoperative control group. This study suggests that RYGB, the most effective available means to achieve durable weight loss and reduction of comorbidities in morbidly obese patients, results in significant rehabilitation of Medicaid-funded morbidly obese individuals.     

Psychologic assessment of morbidly obese patients undergoing gastric bypass: a comparison of preoperative and postoperative adjustment

Thirty-three morbidly obese patients underwent gastric bypass operation after intensive medical and psychiatric evaluation. Five psychometric tests were administered before and after operation. The study patients were found to have less self-esteem and more depressive traits than a normal population. This did not change after operation despite weight loss. High levels of optimism were not associated with better weight loss. However, patients who understood before operation that the success of the operation depended upon changing their eating behavior lost more weight. After operation patients expressed satisfaction with life and a new freedom from constant hunger. There was a reported decrease in organic symptoms, an increase in social activities, an improvement in interpersonal relationships, and a social usefulness not experienced previously. In selected patients with no active psychiatric disease or psychologic instability, gastric bypass, coupled with consistent postoperative reinforcement, produces behavioral changes that can lead to permanent weight loss without concomitant psychologic deterioration.