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Changes in Fat and Fat Free Mass a Decade after Gastric Bypass: the Utah Obesity Study
S60
2017 Quickshot Abstracts / Surgery for Obesity and Related Diseases 13 (2017) S52–S65
higher leak, surgical site infection (SSI), and venous-thrombotic event (VTE) rates at ambulatory centers (%, Leak: 0.57 A, 0.15 C, po.0001; SSI: 1.10 A, 0.51 C, p¼.0002; VTE: 0.43 A, 0.19 C, p¼0.0178). After propensity matching, differences in SSI and Readmission percent rates remained with Comprehensive Centers as Reference (SSI: 1.11 A, 0.33 C, OR 3.40, p¼0.0024; Readmissions: 3.62 A, 2.63 C, OR 1.39, p¼0.0484). After adjusting for independent risk factors, SSI and Readmission rates still remained higher at Ambulatory Centers (SSI: 3.41 OR, p¼0.0011; Readmissions: 1.41 OR, p¼0.0377). Futher accounting for clustering effect resulted in no significant differences between the two center populations. Conclusions: In a selected, low acuity population and with standards in place, MBSAQIP ambulatory surgery centers can achieve similar outcomes as MBSAQIP comprehensive bariatric surgery centers.
A518
ANALYSIS OF 214 CONSECUTIVE PATIENTS WITH MARGINAL ULCER AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS IN A SINGLE INSTITUTION Luciano Poggi; Leslie Schuh; Brenda Logan; Margaret Inman; David Diaz; Brenda Cacucci; Christopher Evanson; Douglas Kaderabeck; St Vincent Carmel Hospital, Carmel IN Introduction: Marginal ulcers remain a current problem in bariatric surgery. Its incidence varies significantly in the literature. Despite several reviews, the predisposing factors are unclear and some authors also state that this problem might be underreported. Methods: A total of 1358 laparoscopic Roux-en-Y gastric bypass (LRYGB) were performed at our institution by 5 surgeons from January 2014 and December 2016. A review of a prospectively collected database was conducted analyzing risk factors associated with marginal ulcers. Results: A total of 214 (15,7%) patients were diagnosed with marginal ulcer. Patients with ulcers had a mean age of 45.8 years when surgery was performed and a BMI of 50.4 kg/m2. Patients with marginal ulcers did not differ significantly from those without ulcer in race, age or gender. The mean time to ulceration was 7.4 (±6.8) months post-surgery. The most frequent time of ulceration was 2 months post-surgery. Patients with ulcer had significantly longer lengths of stay after RYGB vs. non-ulcer patients (2.31 vs. 2.17 days, p¼0.035) and they were more likely to have had Medicaid as their insurance type (15.4% vs. 9.8%, p¼0.014). The technique of gastrojejunostomy was also reviewed and ulcerationwas found to be similar between circular EEA and linear stapler, 15.5% and 16.0% respectively (p¼0.80). Other variables including NSAID use, GERD, Preoperative H. pylori or smoking did not deffer between patients with and without ulcer (P¼NS). However, post-surgical smoking rates were higher for the ulcer patients than non-ulcer (10.7 vs. 4.4%, po0.001). Conclusion: The incidence of marginal ulcer was higher than anticipated in our patients however between the ranges reported in the literature. It occurred early in the postoperative course despite the routine use of proton pump inhibitors. The surgical technique used for gastrojejunal anastomosis was not a risk factor. The only
significant factor associated were smoking and Medicaid insurance.
A519
CHANGES IN FAT AND FAT FREE MASS A DECADE AFTER GASTRIC BYPASS: THE UTAH OBESITY STUDY Steven Simper1; Lance Davidson2; Ted Adams3; Rodrick McKinlay1; Steven Hunt4; 1Rocky Mountain Associated Physicians, Salt Lake City UT; 2Brigham Young University, Provo UT; 3Intermountain Health & Fitness Institute, Salt Lake City UT; 4 Weill Cornell Medicine in Qatar, Doha, Doha Qatar Background: Although weight loss appears to be relatively well-maintained long-term in most patients who undergo gastric bypass surgery, little is known about body composition changes that occur during the years after initial weight loss. This study investigates the dynamics of fat and fat free mass (FFM) after postsurgical weight loss compared with subjects who did not undergo surgery. Method: 235 gastric bypass patients from the Utah Obesity Study (83% female, pre-surgery age 44±11yrs, weight 132.4±25.0kg, BMI 46.3±6.8, fat percent 69.6±16%) with baseline and at least a 10-year follow-up bio-electrical impedance measure were assessed for changes in fat and FFM. Mixed models generated sex-adjusted mean(SE) changes in the surgery group and a comparable nonsurgical group (n¼291) at 2-year (T2), 6-year (T6) and 10-year follow-up (T10). Results: Post-surgical weight loss was (mean(SE)) -46.8(0.8)kg (po0.0001) by T2, with a rebound of þ9.9(0.8)kg (po0.0001) by T6 that was maintained (þ1.1(0.9)kg (NS)) until T10. FM change was -31.7(0.7)kg by T2, þ8.5(0.6)kg from T2-T6, and þ2.4(0.7)kg from T6-T10 (all po0.0005). FFM change was -15.1(0.4)kg by T2 (po0.0001), þ2.4(0.4)kg from T2-T6 (po0.0001), and -1.2(0.5)kg from T6-T10 (po0.05); combined T2-T10 was þ1.2(0.5)kg (po0.05). FFM was 32.2% of initial post-operative weight loss, and 11% of subsequent regain. Body weight in the non-surgery group did not change significantly (-1.4(0.9)kg (p40.10)) from T2-T10, nor did fat mass (þ1.1(0.8)kg (p40.10)), but FFM declined (-2.5(0.5)kg (po0.0001)). Conclusion: Nearly a third of initial weight loss after gastric bypass surgery is FFM, and a high percentage of weight regain is fat mass. However, FFM increases during the post-surgery maintenance phase (perhaps due to concomitant increases in fat mass from 2 to 10 years post-op) compared with a significant agerelated decline observed in non-operated subjects with severe obesity.
A520
UNDERSTANDING LENGTH OF STAY, EMERGENCY DEPARTMENT VISITS, AND RE-ADMISSIONS AFTER PRIMARY METABOLIC AND BARIATRIC PROCEDURES IN A MBSAQIP PARTICIPATING CENTER Fady Moustarah; Central Michigan University CMED, Saginaw MI Background: Quality initiatives to enhance recovery after metabolic and bariatric surgery (MBS) and reduce complications are welcome innovations aimed at improving patient outcome and
2017 Quickshot Abstracts / Surgery for Obesity and Related Diseases 13 (2017) S52–S65
higher leak, surgical site infection (SSI), and venous-thrombotic event (VTE) rates at ambulatory centers (%, Leak: 0.57 A, 0.15 C, po.0001; SSI: 1.10 A, 0.51 C, p¼.0002; VTE: 0.43 A, 0.19 C, p¼0.0178). After propensity matching, differences in SSI and Readmission percent rates remained with Comprehensive Centers as Reference (SSI: 1.11 A, 0.33 C, OR 3.40, p¼0.0024; Readmissions: 3.62 A, 2.63 C, OR 1.39, p¼0.0484). After adjusting for independent risk factors, SSI and Readmission rates still remained higher at Ambulatory Centers (SSI: 3.41 OR, p¼0.0011; Readmissions: 1.41 OR, p¼0.0377). Futher accounting for clustering effect resulted in no significant differences between the two center populations. Conclusions: In a selected, low acuity population and with standards in place, MBSAQIP ambulatory surgery centers can achieve similar outcomes as MBSAQIP comprehensive bariatric surgery centers.
A518
ANALYSIS OF 214 CONSECUTIVE PATIENTS WITH MARGINAL ULCER AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS IN A SINGLE INSTITUTION Luciano Poggi; Leslie Schuh; Brenda Logan; Margaret Inman; David Diaz; Brenda Cacucci; Christopher Evanson; Douglas Kaderabeck; St Vincent Carmel Hospital, Carmel IN Introduction: Marginal ulcers remain a current problem in bariatric surgery. Its incidence varies significantly in the literature. Despite several reviews, the predisposing factors are unclear and some authors also state that this problem might be underreported. Methods: A total of 1358 laparoscopic Roux-en-Y gastric bypass (LRYGB) were performed at our institution by 5 surgeons from January 2014 and December 2016. A review of a prospectively collected database was conducted analyzing risk factors associated with marginal ulcers. Results: A total of 214 (15,7%) patients were diagnosed with marginal ulcer. Patients with ulcers had a mean age of 45.8 years when surgery was performed and a BMI of 50.4 kg/m2. Patients with marginal ulcers did not differ significantly from those without ulcer in race, age or gender. The mean time to ulceration was 7.4 (±6.8) months post-surgery. The most frequent time of ulceration was 2 months post-surgery. Patients with ulcer had significantly longer lengths of stay after RYGB vs. non-ulcer patients (2.31 vs. 2.17 days, p¼0.035) and they were more likely to have had Medicaid as their insurance type (15.4% vs. 9.8%, p¼0.014). The technique of gastrojejunostomy was also reviewed and ulcerationwas found to be similar between circular EEA and linear stapler, 15.5% and 16.0% respectively (p¼0.80). Other variables including NSAID use, GERD, Preoperative H. pylori or smoking did not deffer between patients with and without ulcer (P¼NS). However, post-surgical smoking rates were higher for the ulcer patients than non-ulcer (10.7 vs. 4.4%, po0.001). Conclusion: The incidence of marginal ulcer was higher than anticipated in our patients however between the ranges reported in the literature. It occurred early in the postoperative course despite the routine use of proton pump inhibitors. The surgical technique used for gastrojejunal anastomosis was not a risk factor. The only
significant factor associated were smoking and Medicaid insurance.
A519
CHANGES IN FAT AND FAT FREE MASS A DECADE AFTER GASTRIC BYPASS: THE UTAH OBESITY STUDY Steven Simper1; Lance Davidson2; Ted Adams3; Rodrick McKinlay1; Steven Hunt4; 1Rocky Mountain Associated Physicians, Salt Lake City UT; 2Brigham Young University, Provo UT; 3Intermountain Health & Fitness Institute, Salt Lake City UT; 4 Weill Cornell Medicine in Qatar, Doha, Doha Qatar Background: Although weight loss appears to be relatively well-maintained long-term in most patients who undergo gastric bypass surgery, little is known about body composition changes that occur during the years after initial weight loss. This study investigates the dynamics of fat and fat free mass (FFM) after postsurgical weight loss compared with subjects who did not undergo surgery. Method: 235 gastric bypass patients from the Utah Obesity Study (83% female, pre-surgery age 44±11yrs, weight 132.4±25.0kg, BMI 46.3±6.8, fat percent 69.6±16%) with baseline and at least a 10-year follow-up bio-electrical impedance measure were assessed for changes in fat and FFM. Mixed models generated sex-adjusted mean(SE) changes in the surgery group and a comparable nonsurgical group (n¼291) at 2-year (T2), 6-year (T6) and 10-year follow-up (T10). Results: Post-surgical weight loss was (mean(SE)) -46.8(0.8)kg (po0.0001) by T2, with a rebound of þ9.9(0.8)kg (po0.0001) by T6 that was maintained (þ1.1(0.9)kg (NS)) until T10. FM change was -31.7(0.7)kg by T2, þ8.5(0.6)kg from T2-T6, and þ2.4(0.7)kg from T6-T10 (all po0.0005). FFM change was -15.1(0.4)kg by T2 (po0.0001), þ2.4(0.4)kg from T2-T6 (po0.0001), and -1.2(0.5)kg from T6-T10 (po0.05); combined T2-T10 was þ1.2(0.5)kg (po0.05). FFM was 32.2% of initial post-operative weight loss, and 11% of subsequent regain. Body weight in the non-surgery group did not change significantly (-1.4(0.9)kg (p40.10)) from T2-T10, nor did fat mass (þ1.1(0.8)kg (p40.10)), but FFM declined (-2.5(0.5)kg (po0.0001)). Conclusion: Nearly a third of initial weight loss after gastric bypass surgery is FFM, and a high percentage of weight regain is fat mass. However, FFM increases during the post-surgery maintenance phase (perhaps due to concomitant increases in fat mass from 2 to 10 years post-op) compared with a significant agerelated decline observed in non-operated subjects with severe obesity.
A520
UNDERSTANDING LENGTH OF STAY, EMERGENCY DEPARTMENT VISITS, AND RE-ADMISSIONS AFTER PRIMARY METABOLIC AND BARIATRIC PROCEDURES IN A MBSAQIP PARTICIPATING CENTER Fady Moustarah; Central Michigan University CMED, Saginaw MI Background: Quality initiatives to enhance recovery after metabolic and bariatric surgery (MBS) and reduce complications are welcome innovations aimed at improving patient outcome and