Pre-Bariatric Surgery Weight Loss Seems to Boost Outcomes
Tied to greater rate of post-op excess weight loss over a year
Weight loss prior to metabolic surgery had a positive impact on postoperative outcomes, researchers reported.
Patients who lost ≥8% of their excess weight loss prior to surgery achieved a 7.5% greater weight loss after a year, according to Deborah A. Hutcheon, DCN, RD, LD, of Greenville Health System in Greenville, South Carolina, and colleagues.
These patients also achieved a greater percentage of excess weight loss at several points after surgery compared with those who lost <8% of their excess weight before surgery, they wrote in the Journal of the American College of Surgeons:
- 3 months post-op: 42.3% versus 36.1% (P<0.001)
- 6 months post-op: 56.0% versus 47.5% (P<0.001)
- 12 months post-op: 65.1% versus 55.7% (P=0.003)
"Currently, controversy exists for the optimal preoperative dietary optimization of patients prior to bariatric surgery. On one side, insurance policies often mandate six or 12 month weight management programs. This mandate is in direct contrast to many bariatric surgeons, who prefer to use short-term, calorie-restricted diets several weeks prior to surgery in order to optimize outcomes," said co-author John David Scott, MD, of the University of South Carolina School of Medicine in Greenville, in a statement.
"Our ultimate goal was to see what makes postoperative outcomes better for our patients undergoing this lifesaving procedure," he added.
The analysis included patients with a BMI ≥35 who underwent sleeve gastrectomy (n=167) or Roux-en-Y gastric bypass (n=188). All patients met with nutritionists prior to surgery and completed 10 in-person support group sessions regarding behavioral lifestyle interventions for weight management. They were then recommended to adhere to a 4-week low-calorie diet, consisting of a 1,200 kcal per day diet with meal replacement products (OPTIFAST 800).
Following the diet, 63.3% of patients successfully achieved ≥8% of excess weight loss during the 4-week preoperative diet period, while 36.9% patients achieved <8%. Among those who met the preoperative weight loss goal, they tended to be male, Caucasian, and were more likely to be taking anti-hypertensive medications before surgery. The group who did not meet the weight loss goal prior to surgery had a higher ratio of female and African-American patients.
Other than greater postoperative weight loss, those who achieved ≥8% of excess weight loss preoperatively also had a significantly shorter length of stay at the hospital after surgery compared with those who did not reach that goal (1.8 days versus 2.1 days, P=0.006). They also experienced slightly shorter median operation duration -- roughly 8 minutes faster -- although this was not statistically significant (117 min versus 124 min, P=0.061).
No major differences were seen between the two groups for reoperations rates, postoperative readmission rates, or percentage of excess weight loss 1 month after surgery between the groups (21.6% versus 19.8 ± 9.0%, P=0.052).
Follow-up rates after surgery were also similar between the groups, with both seeing a drop-off in the rate of follow-up 1-year after surgery (65.2% versus 58.0%, P=0.256).
"Ultimately, we believe that preoperative preparation for bariatric surgery should be mediated by individual surgeons taking care of their patients. And this 8 percent target should not be used as a hard set point to qualify patients for bariatric surgery," Scott stressed. "Because patients with obesity who weren't able to achieve that 8 percent goal still had dramatic effects in terms of how much weight they lost and comorbidity resolutions."
The authors noted that these findings were only based upon 12-month post-operative outcomes, and that future research is needed to assess preoperative weight loss with outcomes beyond one year.
They also highlighted that although preoperative weight loss can help improve outcome, the "inability to lose a specific amount of weight preoperatively is not a barrier for success after surgery," and should not be used as a "mandate" for surgery, adding that "access to bariatric surgical care is ultimately more important."
by Kristen Monaco, Staff Writer, MedPage TodayFebruary 05, 2018
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