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Complications, Adverse Events and Healthcare Consumption the First Ten Years after Duodenal Switch and Gastric Bypass in a Matched National Cohort
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Gastrointestinalkirurgi.ORCID-id: 0000-0002-6243-2859
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Abstract [en]

Background:Roux-en-Y Gastric Bypass (RYGB), risk unsatisfactory weight loss in super obese patients. Duodenal switch (DS) is more effective, however, considered to have an increased complication rate. 

 

Objectives:To compare early complications, healthcare consumption, long-term adverse events and mortality up until 10 years after primary DS and RYGB, respectively.

 

Setting:Nationwide study in Sweden

 

Methods:In this nationwide population-based cohort study, propensity-score matching (1DS:4RYGB) was used. Five national registers were cross-matched; the Scandinavian Obesity Surgery Register (perioperative data), the Prescribed Drug Register (comorbidities, i.e. medication for the specific conditions), Statistics Sweden (socioeconomic data), the National Patient Register (subsequent healthcare) and the Death Register (mortality). 

 

Results:The study population consisted of 333 DS and 1332 RYGB, operated 2007-2017 (BMI of 55 kg/m2, 38.5 years and 60.7% females). Early complications (≤30 days) were more common after DS (15.3% vs. 8.1%, p<0.01). Hospital admissions and in-hospital days over the 10-year period were similar (1.3 vs. 1.1 admission, p=0.30 and 6.6 vs. 7.2 in-hospital days, p=0.81), while DS had more visits to specialized outpatient clinics (7.1 vs. 4.2, p<0.01). DS were associated with an increased risk of protein-malnutrition/malabsorption (OR 11.7 [3.1-43.5]) and having an additional abdominal operation (any type) (OR 1.9 [1.4-2.6]). Overall mortality did not differ between groups. 

 

Conclusion:DS was associated with more early complications and an increased risk for protein-malnutrition/malabsorption and more additional abdominal surgeries, however, the overall mortality and long-term requirement of in-hospital care were similar to RYGB.

Nyckelord [en]
bariatric surgery, duodenal switch, gastric bypass, complications, adverse event
Nationell ämneskategori
Kirurgi
Forskningsämne
Kirurgi
Identifikatorer
URN: urn:nbn:se:uu:diva-377035OAI: oai:DiVA.org:uu-377035DiVA, id: diva2:1288311
Tillgänglig från: 2019-02-12 Skapad: 2019-02-12 Senast uppdaterad: 2019-03-19
Ingår i avhandling
1. Bariatric Surgery: Outcomes after Gastric Bypass and Duodenal Switch
Öppna denna publikation i ny flik eller fönster >>Bariatric Surgery: Outcomes after Gastric Bypass and Duodenal Switch
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Obesity is associated with increased morbidity and mortality. A BMI >40 kg/mshortens life expectancy by about 10 years. The obesity related comorbidities diabetes, hypertension, dyslipidemia and sleep apnea contributes to the increased risk of cardiovascular events. There is also an increased risk of some forms of cancer (e.g. colon, breast, and prostate cancer) as well as mental illness (depression and low self-esteem). Bariatric surgery is indicated for those with a BMI >35 kg/m2. Unfortunately, there are an increasing number of patients seeking bariatric surgery who are super obese (BMI >50 kg/m2), a condition more difficult to treat because of insufficient weight loss with standard operations, like the Roux-en-Y Gastric Bypass (RYGB). Therefore some surgeons advocate the Duodenal Switch (DS) in super obese patients, because DS results in greater and more sustained weight loss. However, DS is a technically more challenging operation and is associated with an increased risk of malnutrition and surgical complications. There are also concerns about an excessive loss of fat-free mass during weight loss after RYGB and especially after DS.

This thesis focuses on weight-loss, effect on comorbidities, quality of life and complications after DS and RYGB, respectively, with comparisons between the two procedures in patients with super obesity. 

DS resulted in a superior weight loss compared to RYGB (paper I, II and III) and body composition after weight loss did not differ compared with non-operated controls with the same BMI after surgery, for neither DS nor RYGB (paper I). Both DS and RYGB resulted in an improved metabolic control (paper II and III), but the effect on diabetes and hypertension was greater and maintained in the long-term after DS (paper III). Both DS and RYGB resulted in an improved physical quality of life, with greater improvements after DS (paper III). However, complications and long-term adverse effects were more common after DS (paper II and IV).

In conclusion, the superior weight loss and greater improvements in several obesity-related comorbidities after DS must be weighed against the increased risk of complications and long-term adverse effects compared to RYGB. 

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2019. s. 76
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1550
Nyckelord
Body composition, fat-free mass, resting metabolic rate, bariatric surgery, obesity, Roux-en-Y Gastric Bypass, Duodenal Switch, air-displacement plethysmography, Bod Pod, indirect calorimetry assessment, BAROS, quality of life, weight loss, diabetes, hypertension, dyslipidmia, depression, pain, antidepressants, opioids, complications, healthcare consumption, adverse events
Nationell ämneskategori
Kirurgi
Forskningsämne
Kirurgi
Identifikatorer
urn:nbn:se:uu:diva-377036 (URN)978-91-513-0593-6 (ISBN)
Disputation
2019-05-17, Grönwallsalen, Ingång 70, BV, Akademiska sjukhuset, Uppsala, 13:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2019-04-18 Skapad: 2019-02-25 Senast uppdaterad: 2019-06-18

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Löfling Skogar, MartinSundbom, Magnus

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