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Prevalence of Psychiatric Disorders in Hospitalized Patients After Bariatric Surgery Using a National Database
Poster Presentations / Surgery for Obesity and Related Diseases 12 (2016) S76–S232
surgical evaluation process, before any weight loss has occurred, to establish a euthyroid baseline. Future studies should also test whether the presence of hypothyroidism after surgery influences later unsuccessful weight loss or weight regain.
A5103
PREVALENCE OF PSYCHIATRIC DISORDERS IN HOSPITALIZED PATIENTS AFTER BARIATRIC SURGERY USING A NATIONAL DATABASE Jin Sol Oh1,2; Phillip Ham1,2; James Drinane1,2; Brian Lane1,2; Sean Lee1,2; 1Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA; 2Division of Minimally Invasive and Digestive Diseases Surgery, Department of Surgery, Medical College of Georgia, Agusta University, Augusta, GA Background: Obesity and psychiatric disorders are complexly linked comorbid conditions. A high prevalence of psychiatric
S119
disorders exists in patients with obesity, particularly mood disorders including depression and anxiety. Bariatric surgery is historically associated with improvement of psychiatric conditions. However, persistent psychiatric disorders may be linked to increased risks of other diseases and higher utilization of health care resources. The purpose of this study is to examine prevalence of psychiatric disorders among hospitalized patients who have a history of bariatric surgery. Methods: The National Inpatient Sample (NIS) is the largest inpatient database in the USA, containing information from approximately 8 million hospital discharges per year. Using data from the NIS database from 2010 to 2013, we identified 986,120 discharges with patients who have a diagnosis of history of bariatric surgery. A prevalence of psychiatric disorders among the patients was examined and compared with patients with obesity and with all patients from the NIS database. Patients with depression and bipolar disorder were examined and compared to the patients without mood disorder.
S120
Poster Presentations / Surgery for Obesity and Related Diseases 12 (2016) S76–S232
Results: The prevalence of any mood disorder in patients who have a history of bariatric surgery was significantly higher compared to those with obesity (34.4% vs 21.3; p o 0.001), with depression being the most common mood disorder (22.7% vs 14.1%; p o 0.001). The bariatric group had also higher prevalence of anxiety disorder (15.0% vs 10.2%; p o 0.001), alcohol related disorder (6.8% vs 3.2%; p o 0.001), and substance related disorder (6.1% vs 4.0%; p o 0.001). The prevalence of these psychiatric disorders were also higher compared with all patients from the NIS database (Table 1). Compared to patients with obesity, bariatric patients had a higher rate of hospitalizations with mood disorder as a primary diagnosis (3.7% vs 2.3%; p o 0.001). Suicide attempt and ideation were also more prevalent in the bariatric group than the other groups. Among the bariatric patients, those with depression or bipolar disorder were younger than those without any mood disorder (51.7 y vs. 51.5 y vs. 45.9 y; p o 0.001) and more likely to be female (77% vs 85% vs 88%) (Table 2). They also are more likely to have more chronic conditions (4.4 vs 6.3 vs 5.9; p o 0.001) and increased length of stay (4.0 day vs 4.5 day vs 5.7 day; p o 0.001). Total hospital charges were lower in the patients with depression or bipolar disorder ($41143.36 vs $37685.18 vs $28160.13; p o 0.001). High prevalence of anxiety, alcohol, and substances related disorders were observed in the bipolar group. Conclusion: Psychiatric disorders were frequently observed in hospitalized bariatric patients. Particularly, an increased prevalence of mood disorders among the hospitalized bariatric patients suggests that bariatric patients with a comorbid mood disorder are more likely to be hospitalized. Given the current literature showing decreased rates of mood disorders after bariatric surgery, further study on identifying patients who will have persistent mood disorder following bariatric surgery is warranted.
A5104
PREOPERATIVE TRANSTHORACIC ECHOCARDIOGRAPHY IN PATIENTS WITH SUPER OBESITY FOR BARIATRIC SURGERY: IS IT NECESSARY? Fatemah AlMarri1; Salman Alsabah2; 1Kuwait University, FOM, Kuwait City Mubarak AlKabeer; 2Royale Hyatt Hospital, Kuwait, Mesilla Kuwait Introduction: Cardiac abnormalities are not uncommon in asymptomatic morbidly obese patients and can influence operative and postoperative care in those particular patients. Bariatric surgery although a very beneficial surgery to treat obesity, like any other surgery, has its operative risks and postoperative complications, particularly in those who are morbidly obese. In Amiri Hospital Kuwait, all patients with a BMI of 50 and above are referred for preoperative echocardiography (ECHO). There are no clear guidelines for screening patients with super obesity. Our study aims to identify asymptomatic morbidly obese patients with cardiovascular abnormalities prior to surgery and whether those cardiac abnormalities influence bariatric surgery.
Methods: A retrospective study collected data between 2012 and 2016 on 1187 patients post-sleeve gastrectomy (LSG), of those 112 patients with BMI of 50 kg/m2 and above were selected. Demographic data, BMI, percentage of excess weight loss and echocardiographic findings were collected and analyzed over 18 months follow-up. Results: A total of 112 patients out of the 1187 patients who underwent bariatric surgery had an ECHO report, of which 74.5% had a BMI of 450. The mean age is 36.79 ⫾ 13 and 73 (66%) were female. The Mean BMI of patients was 54.5-kg/ m2 ⫾ 9.9 SD. Analysis showed that the majority of patients (81%) were younger than fifty years of age. The majority of patients (70%) were found to have a normal ECHO report. Almost all patients (95%) were found to have a normal Ejection fraction of Z55%. The most common abnormalities found on the ECHO report were mild diastolic dysfunction (17%), mild atrial or ventricular enlargement (6%) and mild valvular abnormalities (5%). No morbidities or mortalities were observed postoperatively. Conclusion: Preoperative transthoracic echocardiography has revealed a wide range of cardiac findings in super obese patients. No cardiac complications were observed among the patients postoperatively. We recommend a selective approach for indicated super obese patients. Larger studies and cost-benefit analysis are needed to validate our results.
A5105
IMPACT OF ADJUVANT PHARMACOTHERAPY ON WEIGHT LOSS OUTCOMES AFTER BARIATRIC SURGERY emre bucak1; Elie Nasr2; Zubaidah Nor Hanipah1; Gautam Sharma1; Suriya Punchai1; Bartolome Burguera1; Ali Aminian1; Philip Schauer3; Stacy Brethauer3; Derrick Cetin3; 1 Cleveland Clinic Foundation, Cleveland Ohio; 2Cleveland Clinic Foundation, Westlake Ohio; 3Cleveland Clinic Foundation, Cleveland OH Background: Bariatric surgery has been proven as effective treatment for obesity and metabolic disease. However, there are patients who do not achieve optimal weight loss or regain weight after bariatric procedures. In this study we aim to determine the effectiveness of adjuvant medical weight loss medications after surgery for this group of patients. Method: After IRB approval, patients who received weight loss medications after bariatric surgery from 2012 to 2015 were identified at a single academic center. Data collected included baseline characteristics, co-morbidities, perioperative parameters, postoperative outcomes, types of medication given and outcomes at one year after initiating pharmacotherapy. Results: Eighty three patients received weight loss medication after primary bariatric procedures: Roux-en-Y gastric bypass (n¼56), sleeve gastrectomy (n¼22), adjustable gastric band (n¼3), gastric plication (n¼1) and duodenal switch (n¼1). Median age was 52 years (IQR 45-58) and 93% were female. Preoperative comorbidities before starting medication included obstructive sleep apnea (n¼34, 41%), hypertension (n¼32, 39%), hyperlipidemia (n¼22, 27%), type-2 diabetes (n¼18,
surgical evaluation process, before any weight loss has occurred, to establish a euthyroid baseline. Future studies should also test whether the presence of hypothyroidism after surgery influences later unsuccessful weight loss or weight regain.
A5103
PREVALENCE OF PSYCHIATRIC DISORDERS IN HOSPITALIZED PATIENTS AFTER BARIATRIC SURGERY USING A NATIONAL DATABASE Jin Sol Oh1,2; Phillip Ham1,2; James Drinane1,2; Brian Lane1,2; Sean Lee1,2; 1Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA; 2Division of Minimally Invasive and Digestive Diseases Surgery, Department of Surgery, Medical College of Georgia, Agusta University, Augusta, GA Background: Obesity and psychiatric disorders are complexly linked comorbid conditions. A high prevalence of psychiatric
S119
disorders exists in patients with obesity, particularly mood disorders including depression and anxiety. Bariatric surgery is historically associated with improvement of psychiatric conditions. However, persistent psychiatric disorders may be linked to increased risks of other diseases and higher utilization of health care resources. The purpose of this study is to examine prevalence of psychiatric disorders among hospitalized patients who have a history of bariatric surgery. Methods: The National Inpatient Sample (NIS) is the largest inpatient database in the USA, containing information from approximately 8 million hospital discharges per year. Using data from the NIS database from 2010 to 2013, we identified 986,120 discharges with patients who have a diagnosis of history of bariatric surgery. A prevalence of psychiatric disorders among the patients was examined and compared with patients with obesity and with all patients from the NIS database. Patients with depression and bipolar disorder were examined and compared to the patients without mood disorder.
S120
Poster Presentations / Surgery for Obesity and Related Diseases 12 (2016) S76–S232
Results: The prevalence of any mood disorder in patients who have a history of bariatric surgery was significantly higher compared to those with obesity (34.4% vs 21.3; p o 0.001), with depression being the most common mood disorder (22.7% vs 14.1%; p o 0.001). The bariatric group had also higher prevalence of anxiety disorder (15.0% vs 10.2%; p o 0.001), alcohol related disorder (6.8% vs 3.2%; p o 0.001), and substance related disorder (6.1% vs 4.0%; p o 0.001). The prevalence of these psychiatric disorders were also higher compared with all patients from the NIS database (Table 1). Compared to patients with obesity, bariatric patients had a higher rate of hospitalizations with mood disorder as a primary diagnosis (3.7% vs 2.3%; p o 0.001). Suicide attempt and ideation were also more prevalent in the bariatric group than the other groups. Among the bariatric patients, those with depression or bipolar disorder were younger than those without any mood disorder (51.7 y vs. 51.5 y vs. 45.9 y; p o 0.001) and more likely to be female (77% vs 85% vs 88%) (Table 2). They also are more likely to have more chronic conditions (4.4 vs 6.3 vs 5.9; p o 0.001) and increased length of stay (4.0 day vs 4.5 day vs 5.7 day; p o 0.001). Total hospital charges were lower in the patients with depression or bipolar disorder ($41143.36 vs $37685.18 vs $28160.13; p o 0.001). High prevalence of anxiety, alcohol, and substances related disorders were observed in the bipolar group. Conclusion: Psychiatric disorders were frequently observed in hospitalized bariatric patients. Particularly, an increased prevalence of mood disorders among the hospitalized bariatric patients suggests that bariatric patients with a comorbid mood disorder are more likely to be hospitalized. Given the current literature showing decreased rates of mood disorders after bariatric surgery, further study on identifying patients who will have persistent mood disorder following bariatric surgery is warranted.
A5104
PREOPERATIVE TRANSTHORACIC ECHOCARDIOGRAPHY IN PATIENTS WITH SUPER OBESITY FOR BARIATRIC SURGERY: IS IT NECESSARY? Fatemah AlMarri1; Salman Alsabah2; 1Kuwait University, FOM, Kuwait City Mubarak AlKabeer; 2Royale Hyatt Hospital, Kuwait, Mesilla Kuwait Introduction: Cardiac abnormalities are not uncommon in asymptomatic morbidly obese patients and can influence operative and postoperative care in those particular patients. Bariatric surgery although a very beneficial surgery to treat obesity, like any other surgery, has its operative risks and postoperative complications, particularly in those who are morbidly obese. In Amiri Hospital Kuwait, all patients with a BMI of 50 and above are referred for preoperative echocardiography (ECHO). There are no clear guidelines for screening patients with super obesity. Our study aims to identify asymptomatic morbidly obese patients with cardiovascular abnormalities prior to surgery and whether those cardiac abnormalities influence bariatric surgery.
Methods: A retrospective study collected data between 2012 and 2016 on 1187 patients post-sleeve gastrectomy (LSG), of those 112 patients with BMI of 50 kg/m2 and above were selected. Demographic data, BMI, percentage of excess weight loss and echocardiographic findings were collected and analyzed over 18 months follow-up. Results: A total of 112 patients out of the 1187 patients who underwent bariatric surgery had an ECHO report, of which 74.5% had a BMI of 450. The mean age is 36.79 ⫾ 13 and 73 (66%) were female. The Mean BMI of patients was 54.5-kg/ m2 ⫾ 9.9 SD. Analysis showed that the majority of patients (81%) were younger than fifty years of age. The majority of patients (70%) were found to have a normal ECHO report. Almost all patients (95%) were found to have a normal Ejection fraction of Z55%. The most common abnormalities found on the ECHO report were mild diastolic dysfunction (17%), mild atrial or ventricular enlargement (6%) and mild valvular abnormalities (5%). No morbidities or mortalities were observed postoperatively. Conclusion: Preoperative transthoracic echocardiography has revealed a wide range of cardiac findings in super obese patients. No cardiac complications were observed among the patients postoperatively. We recommend a selective approach for indicated super obese patients. Larger studies and cost-benefit analysis are needed to validate our results.
A5105
IMPACT OF ADJUVANT PHARMACOTHERAPY ON WEIGHT LOSS OUTCOMES AFTER BARIATRIC SURGERY emre bucak1; Elie Nasr2; Zubaidah Nor Hanipah1; Gautam Sharma1; Suriya Punchai1; Bartolome Burguera1; Ali Aminian1; Philip Schauer3; Stacy Brethauer3; Derrick Cetin3; 1 Cleveland Clinic Foundation, Cleveland Ohio; 2Cleveland Clinic Foundation, Westlake Ohio; 3Cleveland Clinic Foundation, Cleveland OH Background: Bariatric surgery has been proven as effective treatment for obesity and metabolic disease. However, there are patients who do not achieve optimal weight loss or regain weight after bariatric procedures. In this study we aim to determine the effectiveness of adjuvant medical weight loss medications after surgery for this group of patients. Method: After IRB approval, patients who received weight loss medications after bariatric surgery from 2012 to 2015 were identified at a single academic center. Data collected included baseline characteristics, co-morbidities, perioperative parameters, postoperative outcomes, types of medication given and outcomes at one year after initiating pharmacotherapy. Results: Eighty three patients received weight loss medication after primary bariatric procedures: Roux-en-Y gastric bypass (n¼56), sleeve gastrectomy (n¼22), adjustable gastric band (n¼3), gastric plication (n¼1) and duodenal switch (n¼1). Median age was 52 years (IQR 45-58) and 93% were female. Preoperative comorbidities before starting medication included obstructive sleep apnea (n¼34, 41%), hypertension (n¼32, 39%), hyperlipidemia (n¼22, 27%), type-2 diabetes (n¼18,