In the USA, less than 1% of eligible patients who qualify for bariatric surgery ultimately undergo surgery. Perceptions of endoscopic bariatric therapies (EBTs) for weight management remain unknown.
Methods
A 22-question survey was distributed to primary care physicians (PCPs) across the Mayo Clinic healthcare system. Survey invitations were sent via email, and all surveys were unanimously conducted electronically.
Results
A total of 130 PCPs participated in the survey (40% response rate). Twenty-four PCPs were between 20 and 24 years out of training (18.5%), and 71 (54.6%) were female. Most providers had a body mass index (BMI) between 18.5 and 24.9 kg/m2 (n?=?62, 47.7%). Among the weight loss options discussed during clinic visits, PCPs discussed lifestyle modification including diet and exercise (n?=?129; 99.2%), and 68 PCPs (52.3%) were not aware of EBTs as weight loss interventions. While 46.2% of the PCPs agreed that a bariatric endoscopy is an effective option for weight loss, only 24.6% of PCPs were familiar with the indications for EBTs. Most of the cohort (n?=?69, 53.1%) experienced barriers in referring their patients. Moreover, most of the patients referred to bariatric clinics were from PCPs who had a BMI between 18.5 and 24.9 kg/m2 (n?=?62, 47.7%) as compared to PCPs with a BMI of 40 kg/m2 and greater (n?=?5, 3.8%).
Conclusions
Due to the rise of bariatric therapies in recent years, PCPs are increasingly involved in the referral and management of patients with obesity and obesity-related comorbidities. However, knowledge gaps regarding weight loss options, including EBTs, could limit optimal care to patients desiring medically monitored weight loss.
The objective of this study was to assess Canadian general surgeons’ knowledge of bariatric surgery and perceived availability of resources to manage bariatric surgery patients.
Methods
A self-administered questionnaire was developed using a focus group of general surgeons. The questionnaire was distributed at two large general surgery conferences in September and November 2012. The survey was also disseminated via membership association electronic newsletters in November and December 2012.
Results
One hundred sixty-seven questionnaires were completed (104 practicing surgeons, 63 general surgery trainees). Twenty respondents were bariatric surgeons. Among 84 non-bariatric surgeons, 68.3 % referred a patient in the last year for bariatric surgery, 79 % agreed that bariatric surgery resulted in sustained weight loss, and 81.7 % would consider referring a family member. Knowledge gaps were identified in estimates of mortality and morbidity associated with bariatric procedures. The majority of surgeons surveyed have encountered patients with complications from bariatric surgery in the last year. Over 50 % of surgeons who do not perform bariatric procedures reported not feeling confident to manage complications, 35.4 % reported having adequate resources and equipment to manage morbidly obese patients, and few are able to transfer patients to a bariatric center. Of the respondents, 73.3 % reported residency training provided inadequate exposure to bariatric surgery, and 85.3 % felt that additional continuing medical education resources would be useful.
Conclusions
There appears to be support for bariatric surgery among Canadian general surgeons participating in this survey. Knowledge gaps identified indicate the need for more education and resources to support general surgeons managing bariatric surgical patients.
Various definitions for bariatric surgery (BS) success exist, with weight loss and comorbidity resolution outcomes being the most prominent. The study’s aim was to compare how various healthcare professionals perceive success in BS.
Methods
A 29-item, 10-point Likert scale online survey was distributed via email to Israeli healthcare professionals involved in the different BS aspects using common national professional organizations. These included bariatric surgeons, dietitians, social workers, psychologists, psychiatrists, primary care physicians, gastroenterologists, and nurses. Statement relevancy to BS success was rated. An item was classed as “very important” for BS success if at least 70% of participants rated it 8 or higher in each subgroup. Inter-observer agreement was calculated using kappa statistics. Data on specific occupation, years-in-practice, and major workplace were collected as well.
Results
A total of 155 responses was obtained. The majority of respondents were dietitians (34.8%, n = 54), followed by bariatric surgeons (31.0%, n = 48) and nurses (14.8%, n = 23). Most respondents work mainly at public hospitals (32.9%, n = 51), followed by private hospitals (26.5%, n = 41). The mean years-in-practice among all healthcare professionals was 8.5 ± 8.5 years. Overall inter-observer agreement for prioritized items in accordance to BS success among all health professional subgroups was fair (Fleiss kappa = 0.278, P < 0.001), while dietitians and mental health specialists showed the highest agreement rate (Cohen’s kappa = 0.592, P < 0.001).
Conclusion
The study highlights the various views on defining BS success by different healthcare professionals, although there was some overlap of core outcomes prioritized by all professionals. International uniform definitions for BS success are required.
Cultural indoctrination throughout childhood largely defines adult value systems including stereotypic attitudes towards the
obese. It is possible that medical education may alter physicians' earlier stereotypes of obesity. One-hundred and fifty-eight
subjects, comprising six distinct adult groups, morbidly obese persons, their family members and significant others, college
undergraduates, medical students, medical and surgical residents, and medical school faculty, were surveyed with a questionnaire.
It required that each of 32 bipolar adjectives describing obese persons be answered on a 0- to 9-point scale. The adjectives
were selected to provide a sweeping array of attributes used commonly to note differences among people (e.g. intelligent-unintelligent,
happy-sad, complex-simple) with a low values corresponding to the first, usually more favorable, adjective of each pair. Discriminant
analysis identified only five of 32 adjective pairs (16%) as useful (p < 0.05) in isolating the respondent groups. Although it reached statistical significance, the magnitudes of these differences
were not very substantive with reference to a 9-point scale. We conclude that obesity appears to carry a burdensome degree
of societal prejudice, as reflected by negative stereotypes, which is largely unaffected by undergraduate or postgraduate
medical education. 相似文献
There is currently little evidence available on various aspects of Revisional Bariatric Surgery (RBS) and no published consensus amongst experts. The purpose of this study was to understand variation in practices concerning RBS.
Methods
Bariatric surgeons from around the world who perform RBS were invited to participate in a questionnaire-based survey on SurveyMonkey®.
Results
A total of 460 respondents from 62 countries took the survey. For revision after gastric banding, Roux-en-Y gastric bypass (RYGB) (75.5%, n?=?345) emerged as the commonest choice followed by sleeve gastrectomy (SG) (56.9%, n?=?260) and one anastomosis gastric bypass (OAGB) (37.2%, n?=?170). For revision after SG, RYGB (77.7%, n?=?355) was the commonest option followed by OAGB (42.45%, n?=?194) and re-sleeve (22.32%, n?=?102). For revision after RYGB, surgical pouch reduction (49.1%, n?=?223), prolongation of bilio-pancreatic limb (30.0%, n?=?136), and surgical stoma size reduction (26.43%, n?=?120) were the most preferred options. Approximately 90.0% of respondents (n?=?406/454) routinely perform an upper gastrointestinal endoscopy before an RBS, and 85.6% (n?=?388/453) routinely perform a contrast study. Ninety percent (n?=?403/445) reported that the demand for RBS was usually patient-driven, and there was wide variation in criteria used to define successful response, non-responders, and significant weight regain.
Conclusions
This survey is the first attempt to understand various aspects of RBS. The findings will help in identifying areas for research and allow consensus building amongst experts.
Background: Obese patients occasionally require either elective or emergency critical care services following bariatric surgery.
We describe this subgroup of patients. Methods: From July 1, 1991 to July 31, 2004, we performed 1,279 bariatric operations;
241 (19%) required admission to the surgical critical care service. We retrospectively reviewed medical records for gender,
body mass index (BMI), age, whether the operation was initial or revisional, and whether critical care admission was elective
or emergent. 3 complication clusters (thromboembolic, pulmonary, and anastomotic) were identified using discharge ICD-9 codes.
The costs and length of stay of these subpopulations was calculated. Results: Patients were on average 46 ± 10 years old,
with BMI 59 ± 13. Critical care admission was emergent in 52.7% (n=127) of cases. Revisional cases did not differ from the
initial cases in BMI (56.4 vs 59.2, P=0.42) and they were no more likely to require emergent critical care admission than initial cases (P=0.16). Revisional cases were hospitalized longer (27.2 ± 25.6 vs 12.5 ± 18.7 days, P =0.003); had higher total hospital costs (US$ 60,631 ± 78,337 vs 27,697 ± 52,351, P=0.025); and were more likely to die from their complications (revisional surgery mortality 6.5% vs 1.9% for initial surgery
[P=0.002]). Conclusions: An increasing number of surgical revisions will likely accompany the recent increase in popularity
of bariatric surgery. In our experience, these patients require significant critical care services, and have longer, complicated,
and more costly hospitalizations. 相似文献
Charcot neuroarthropathy secondary to diabetes mellitus is a serious complication, requiring specialist management. As a relatively rare pathology bearing similarity to other, more common diseases, it may be misdiagnosed at initial presentation, potentially leading to delays in appropriate management. We conducted a 2-part online survey of primary care physicians within an academic medical institution to assess knowledge of presentation, complications, diagnosis, and treatment of Charcot neuropathy. The first section was designed to assess physician knowledge of Charcot foot, while the second section was completed only by physicians who were familiar with the condition and was designed to gauge their level of knowledge. Most clinicians were familiar with Charcot, encountering it at least annually. They identified common signs of Charcot (eg, swelling, pain) and complications due to its mismanagement (eg, ulcer, amputation). However, there was some disagreement on how to diagnose the pathology, with some relying on film, others referring to specialists, and some saying they were unsure. There was uncertainty on when to choose surgical options; fewer than half referred to specialists for help with this decision, and a quarter were unsure how to make the decision. While, in general, clinicians were aware of Charcot and its characteristics, there was confusion regarding how to diagnose or appropriate nonsurgical treatment. 相似文献
Best practices for patient education in bariatric surgery (BS) remain undefined. The aims of this study were to evaluate the effect of an online lecture on nutrition knowledge, weight loss expectations, and anxiety among BS candidates and present a new tool to assess this knowledge before BS.
Methods
An interventional non-randomized controlled trial on 200 BS candidates recruited while attending a pre-BS committee. The first 100 consecutive patients were assigned to the control group and the latter 100 consecutive patients to the intervention group and were instructed to watch an online lecture of 15-min 1–2 weeks prior to surgery. All participants completed a BS nutrition knowledge and the state-trait anxiety inventory (STAI) questionnaires at the pre-BS committee and once again at the pre-surgery clinic. Body mass index (BMI), comorbidities, surgery type, marital status, and number of dietitian sessions were obtained from medical records.
Results
Data for paired study questionnaires scores were available for 128 patients (n?=?69 and n?=?59 for the control and intervention groups, respectively), with a mean age and BMI of 40.3?±?11.4 years and 41.3?±?4.9 kg/m2, respectively. The BS nutrition knowledge and the state anxiety scores increased for both study groups at the pre-surgery clinic as compared to the pre-BS committee (P?≤?0.028), but the improvement in the nutrition knowledge score was significantly higher for the intervention group (P?=?0.030). No within or between-group differences were found for the trait anxiety items score. The “dream” and “realistic” weight goals were lower than the expected weight loss according to 70% excess weight loss (EWL) for both study groups at both time-points (P?<?0.001 for all).
Conclusion
Education by an online lecture prior to the surgery improves BS nutrition knowledge, but not anxiety. ClinicalTrials.gov number: NCT02857647.
Background: Multiple personality disorder (MPD) can occur in patients with morbid obesity in need of bariatric surgery, though
few reports noting this association exist in the literature. Herein we address MPD in morbid obesity, in the context of a
patient presenting to us seeking surgical treatment of her morbid obesity. Methods: A 31-year-old morbidly obese (BMI 49 kg/m2) Hispanic female presented in early 1994 requesting bariatric surgery. She had been a victim of violent sexual abuse as a
young girl. Subsequently, she developed at least three personalities, including one male personality. Results: Although she
has lost nearly 45 kg after gastroplasty, her care has been complicated by her named multiple personalities. While MPD are
infrequent and unfamiliar to most care providers, successful outcomes can be promoted with a proper approach. Conclusions:
This patient's care illustrates that: (1) all personalities must agree to proposed operative intervention; (2) consent must
be obtained from the ‘true’ patient; and (3) postoperative care and follow-up must address all personalities for an optimal
outcome. 相似文献
While AF is a disease of the elderly, it can occur earlier in the presence of risk factors such as obesity. Bariatric surgery patients are significantly younger and more obese than previously described populations with AF. Therefore, it remains to be determined whether current estimates of the prevalence and predictors for AF remain true in the bariatric surgery population.
Methods
We performed a cross-sectional analysis of 1,341 consecutive patients who underwent bariatric surgery from January 2008 to October 2012. Baseline characteristics were compared between patients with and without AF. For additional comparison, 176 patients with AF and body mass index (BMI) >40 kg/m2 were identified from the Vanderbilt AF Registry. A multivariable logistic regression was performed to identify predictors of AF within the bariatric surgery cohort.
Results
The prevalence of AF in the bariatric surgery cohort was 1.9 % (25/1,341). Patients with AF were older (median 56 years (interquartile range [52–64) vs.46 [38–56] years, p?<?0.001), were more often male (48 vs. 23 %, p?=?0.004), had more comorbidities, but had no difference in BMI (50 kg/m2 [44–58] vs. 48 [43–54], p?=?0.4). In multivariable analysis, the odds of AF increased 2.2-fold by age per decade (95 % CI, 1.4–3.5; p?<?0.001) and 2.4-fold by male gender (1.1–5.4, p?=?0.03) when adjusted for BMI. BMI was not independently associated with AF (OR 1.15 [95 % CI, 0.98–1.41], p?=?0.09).
Conclusions
The prevalence of AF is 1.9 % among patients undergoing bariatric surgery. Risk of AF was found to increase with age and male gender, but not with higher BMI. 相似文献
Rhabdomyolysis (RML) is a rare complication of bariatric surgery. A systematic review was performed to identify risk factors and patient outcomes in morbidly obese patients undergoing bariatric surgery who develop RML.
Methods
A comprehensive search was performed between January 1990 and March 2012 using relevant MeSH terms. Studies were chosen based on predefined inclusion criteria. RML was defined as a creatine kinase of more than 1,000 IU/L. The parameters assessed included patient characteristics of the RML population, type of bariatric surgery performed, operating time, complications, presentation and diagnosis of RML.
Results
Twenty-two studies were analysed which included 11 case reports, two case series, six prospective and three retrospective comparative studies. Overall 145 patients with RML were reported following bariatric surgery. Acute renal failure was found in 20 patients (14 %) and was significantly more likely to occur in patients with postoperative muscle pain (p?<?0.05). The mortality rate after renal failure was 25 % (n?=?5). In the comparative studies, 87 RML patients were compared with 325 non-RML patients. The RML patients were more likely to be male, had a greater mean body mass index (BMI) (52 vs 48 kg/m2, p?<?0.01) and underwent a longer operation (255 vs 207 min, p?<?0.01) compared to non-RML patients.
Conclusions
Risk factors of developing RML following bariatric surgery include male gender, elevated BMI and prolonged operating time. Patients with a biochemical diagnosis of RML and postoperative myalgia after bariatric surgery are at increased risk of developing acute renal failure and mortality. These patients must be identified and treated promptly. 相似文献
Background Most studies on bariatric surgery outcomes have been performed in clinical trials (eg. the SOS) or reflect the clinical experience
and practice of specific and experienced centers. Little is known about the current practice at a nationwide level.
Methods This is a systematic nationwide study on the 2-year outcome of all consecutive 1,236 bariatric operations performed in France.
Data on mortality, weight loss, complications, and patient satisfaction were collected independently from the medical and
surgical team involved in the patients’ care.
Results 87.3% of the patients underwent an adjustable gastric banding (ABG), 8.6% a vertical banded gastroplasty (VBG), 3.8% a Roux-en-Y
gastric bypass (RYGBP) and 0.3% a biliopancreatic diversion (BPD). Loss of follow-up was 12% at year 1 and 18% at year 2.
The rate of laparoscopic procedures was 98% for ABG and 73% for RYGBP. Mortality rate was 0.16% in the operative period and
0.27% during follow-up. Excess weight loss ranged from 43% (AGB) to 66% (RYGBP). Co-morbidities improved in more than 70%
of patients.
Conclusion Outcomes of bariatric surgery in routine practice (mortality, weight loss, course of co-morbidities, and quality of life)
are similar to the results published in clinical trials. 相似文献
During the last two decades, an increasing number of bariatric surgical procedures have been performed worldwide. There is no consensus regarding optimal perioperative care in bariatric surgery. This review aims to present such a consensus and to provide graded recommendations for elements in an evidence-based “enhanced” perioperative protocol.
Methods
The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation.
Results
Although for some elements, recommendations are extrapolated from non-bariatric settings (mainly colorectal), most recommendations are based on good-quality trials or meta-analyses of good-quality trials.
Conclusions
A comprehensive evidence-based consensus was reached and is presented in this review by the enhanced recovery after surgery (ERAS) Society. The guidelines were endorsed by the International Association for Surgical Metabolism and Nutrition (IASMEN) and based on the evidence available in the literature for each of the elements of the multimodal perioperative care pathway for patients undergoing bariatric surgery.
BACKGROUND: The objective of this study was to compare the prevalence of Helicobacter pylori (HP) seropositivity in patients undergoing bariatric surgery with that of the general population. METHODS: H. pylori serologies, tested by ELISA, were collected on 240 morbidly obese patients seen at the Cleveland Clinic Florida and on 2444 randomly selected patients seen at the Cleveland Clinic Health System from 2003-2005. RESULTS: H. pylori prevalence was 61.3% in the bariatric surgery group versus 48.2% in the general population control group (p < 0.001). Bariatric patients had a 1.7-fold increased likelihood of having HP when compared with controls (95% CI = 1.3-2.2). Age over 35 years was an independent risk factor for HP seropositivity (p < 0.01) in both the bariatric and control groups. There was no association found between body mass index and seropositivity within the bariatric group. There was no significant association between seropositivity and gender (p = 0.776). However, there was a significant association between seropositivity and race (p < 0.01). African-Americans had four times more (OR = 4.05) probability of having HP seropositivity than Caucasians (p < 0.01). Hispanics had almost three times (OR = 2.6) more probability of having HP seropositivity than Caucasians (p < 0.01). CONCLUSION: The prevalence of HP seropositivity among bariatric patients is significantly higher than the general population control group. 相似文献
