Bariatric surgery outcomes in morbidly obese with the metabolic syndrome at US academic centers.
ABSTRACT The metabolic syndrome is associated with significant cardiovascular morbidity and mortality. We assessed the in-hospital outcomes of bariatric surgery in morbidly obese patients with the metabolic syndrome in comparison to a control group without the metabolic syndrome.
Using ICD-9-CM diagnosis and procedure codes, clinical data for 20,242 patients with and without the metabolic syndrome who underwent bariatric surgery over a 5-year period were obtained from the University HealthSystem Consortium database.
The prevalence of the metabolic syndrome among bariatric surgery patients was 27.4%. Patients with the metabolic syndrome presented significantly higher overall morbidity as compared to morbidly obese patients without the metabolic syndrome (8.6% vs. 5.8%; p < 0.01), and similar mortality (0.04% vs. 0.01%; p = 0.2) after bariatric surgery. Hispanics with the metabolic syndrome had the highest morbidity rates, and men had the uppermost mortality. In-hospital bariatric surgery outcomes were significantly improved among patients who underwent laparoscopic adjustable gastric banding.
The data suggest that the presence of the metabolic syndrome affects inter-ethnic and gender-specific short-term outcomes after bariatric surgery.
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ABSTRACT: To determine predictors of metabolic syndrome and its resolution in a large, ethnically diverse adult population undergoing bariatric surgery. There is still limited knowledge about the impact of bariatric surgery on chronic health conditions such as metabolic syndrome. Adults having had a laparoscopic Roux-en-Y gastric bypass or a laparoscopic vertical sleeve gastrectomy between 2007 and 2009 (n = 4088) without revision during the study period of January 1, 2007 through December 31, 2011 were eligible for the study. Diagnosis and resolution of metabolic syndrome were determined using standard criteria with electronic medical records of laboratory, diagnosis, and pharmacy information. Patients were primarily women (82%), non-Hispanic black (17%) or Hispanic (32%), 45 ± 11 years old, and had a body mass index (BMI) of 47.10 ± 7.73 kg/m at the time of surgery. After multivariate adjustment, metabolic syndrome was less likely to resolve in patients if they had a laparoscopic vertical sleeve gastrectomy procedure and a higher BMI at surgery, were older, were male or were either Hispanic or non-Hispanic black. The effects of age, race/ethnicity, and BMI at the time of surgery remained after accounting for weight loss. On the basis of our findings, bariatric surgery may be most effective for younger, less obese patients who are early in the course of their cardiometabolic disease. Future research should investigate the factors that lead to lower rates of disease resolution after bariatric surgery for racial/ethnic minority groups.Annals of surgery 10/2013; 259(2). DOI:10.1097/SLA.0000000000000258 · 7.19 Impact Factor
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ABSTRACT: Pharmacotherapy is considered the primary treatment modality for diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DYS). We sought to investigate the status of DM, HTN, and DYS in patients who seek bariatric surgery. Demographic and comorbidity history were prospectively collected on 1,508 patients referred for bariatric consultation at a single institution from February 2008 to March 2012. We utilized published consensus guidelines (GL) to benchmark the efficacy of standard pharmacotherapy for these metabolic diseases, and 881 patients met the study design criteria. Most patients exhibited at least one form of metabolic dysregulation (pre-DM or DM, 75.8 %; pre-HTN or HTN, 91.1 %; pre-DYS or DYS, 84.0 %; metabolic syndrome, 76.0 %). The majority of patients either did not meet GL treatment goals (DM, 45.7 %; HTN, 39.5 %; DYS, 22.3 %) or were previously undiagnosed (DM, 15.8 %; HTN, 13.7 %; DYS, 41.7 %). Non-GL pharmacotherapy was significantly less effective than GL pharmacotherapy at achieving treatment goals for DM (31.8 vs 53.2 %, p < 0.001) and HTN (43.6 vs 63.2 %, p = 0.007). Patients with concurrent DM, HTN, and DYS (35.5 %) were less likely than patients with only one or two of these metabolic diseases to achieve GL treatment goals for HTN (38.1 vs 72.6 %, p < 0.001) and DYS (55.7 vs 73.8 %, p = 0.002). Only 8.0 % of these patients achieved treatment goals for all three metabolic comorbidities. In this patient group, DM, HTN, and DYS were poorly compensated, even when pharmacotherapy was consistent with published GL. This may be due to disease burden in bariatric surgery candidates or to inadequate medical management prior to presentation.Obesity Surgery 02/2014; 24(6). DOI:10.1007/s11695-014-1196-z · 3.74 Impact Factor
Gastroenterology 142(5):S-13. DOI:10.1016/S0016-5085(12)60049-3 · 12.82 Impact Factor