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Chemosensory function, dietary preference and dietary behaviors from pre- to 6-months post-bariatric surgery: A pilot study
ASMBS E-Poster Abstracts / Surgery for Obesity and Related Diseases 13 (2017) S66–S226
patients, MLR revealed that operating on Friday (p¼0.028) was an independent non-clinical predictor of LOS, when adjusting for other confounders, and an operative date in the third quarter trended towards significance (p¼0.077). Conclusion: Early arrival to the floor after surgery is associated with a significantly shorter LOS for patient undergoing LSG, while day of the week and time of the year may impact LOS for patients undergoing LRNYGB. This suggests that at an academic medical center, while strategic scheduling of LSG may improve LOS, further analysis is required to understand the weekly (e.g. patients’ expectation) and seasonal (e.g. resident experience) effects on LOS after LRNYGB.
A5158
CHEMOSENSORY FUNCTION, DIETARY PREFERENCE AND DIETARY BEHAVIORS FROM PRE- TO 6-MONTHS POST-BARIATRIC SURGERY: A PILOT STUDY Andrea Stone1; Pavlos Papasavas2; Helen Swede3; Darren Tishler2; Patrice Hubert4; Valerie Duffy4; 1Hartford Hospital, Glastonbury CT; 2Hartford Hospital, Hartford CT; 3University of Connecticut Health Center, Farmington CT; 4University of Connecticut, Storrs CT Background: The chemosenses (taste, smell) are important contributors to food/beverage preferences, healthy eating behaviors, and weight. However, less is understood about changes in these senses and relationships with preference and dietary behaviors across bariatric surgery. Aim: We sought to describe changes in taste, flavor, food preference and dietary behaviors between females with morbid obesity before bariatric surgery and 6 months post-surgery. Methods: In a pre-post test design, 22 females were evaluated pre-surgery and 6-months post-surgery (13 sleeve gastrectomy; 9 Roux-en-Y gastric bypass). Patients averaged 54% excess weight loss, 21% total weight loss. At pre/post-surgery and following the National Health and Nutrition Examination protocol, patients selfreported their chemosensory function and were measured for taste function via perceived intensity of concentrated, aqueous quinine hydrochloride and NaCl. They also rated sweetness, flavor intensity, and preference for sampled jellybeans (cherry, coffee, chocolate and tabasco) and reported the bitterness of aqueous propylthiouracil (PROP, a taste genetics probe). Finally, they completed the three-factor eating inventory and survey-reported their food and activity preferences (scored into valid/reliable indexes of diet quality). Results: Via descriptive statistics, 9 of 22 patients reported changes in smell (smells stronger or not right) and 14 reported changes in taste (tastes stronger or not right, can’t taste some) function since surgery. Patients varied in the ability to taste PROP, capturing nontasters to supertasters. We were unable to detect changes in measured chemosensory function paralleling these selfreported changes. In repeated measures analysis of variance (accounting for surgery type, pre-surgery weight), there was neither significant changes in jellybean sweetness, flavor, or preference, nor in the perceived intensity of salt or bitters (quinine and PROP). From pre- to post-surgery, patients reported significant differences in dietary behaviors (greater dietary restraint, less disinhibition, less hunger). They also reported reduced preference for alcoholic beverages, sweets, and high-fat meats, and increased
S137
preference for fiber foods, and overall, improvements in diet quality. In simple regression, greater diet quality improvement was seen in patients who, at baseline, reported greater intensity for the tastes (averaged across bitters and salts, a¼0.85). Change in dietary behaviors failed to show association with taste function. Discussion: From these pilot data, bariatric surgery is associated with perceived chemosensory changes that were not captured in simple basic measures of taste and smell function ascertained 6months post-surgery. Further study is needed to assess relationships between taste, preference, and dietary behaviors with sustained weight loss in bariatric surgery patients.
A5159
BAND TO BARIATRIC STAPLING CONVERSION SURGERY PERFORMED ON AN OUTPATIENT BASIS: OUR EARLY EXPERIENCE Titus Duncan; Karleena Tuggle; Alberto Zarak; The Surgery Center of Atlanta, Atlanta Georgia Introduction: Some primary bariatric surgical procedures have been shown to be performed safely on an ambulatory outpatient basis. When performed in select patients, lap band placement on an outpatient basis has been shown to be safe and effective and has been commonly performed worldwide. However, to date, little data exists on the safety of performing more complex bariatric procedures on an outpatient basis. Lately, a substantial number of patients have had to undergo removal of previously placed lap bands either as a result of complications from the band, or as a result of patient dissatisfaction for lack of acceptable weight loss. When clinically and technically feasible, several of these patients request to have a secondary bariatric procedure at the time of removal of the lap band system. Removal of the lap band with conversion to a secondary bariatric procedure during the same operation, such as the sleeve gastrectomy or gastric bypass procedure is indisputably a more complex procedure and has thus been tiered as a “high acuity” surgical technique. We reviewed and present our series of patients undergoing lap band removal and immediate conversion to either sleeve gastrectomy or Roux–en-y gastric bypass on an ambulatory outpatient basis. Materials and Methods: Between January 2010 and September 2016 there were 165 patients who had surgery for removal of lap band for either lap band complications, or unsatisfactory loss of weight. Sixty-six (66) patients had their bands removed and had a concurrent bariatric procedure following removal of the lap band on an ambulatory outpatient basis. Results: All patients were discharged to home on an ambulatory outpatient basis. No patients who had to be returned to the operating room. There were no leaks and no staple line bleeding. Three patients (3%) were readmitted for nausea vomiting and dehydration within the first 30 days of surgery. There were no deaths and no major complications. Discussion: There has been a recent increase in patients suffering from complications of previously placed lap bands. This has resulted in an inordinate increase in surgery to remove these devices. There were no major complications and no deaths in this series. This suggests that patient characteristics, including age, sex
patients, MLR revealed that operating on Friday (p¼0.028) was an independent non-clinical predictor of LOS, when adjusting for other confounders, and an operative date in the third quarter trended towards significance (p¼0.077). Conclusion: Early arrival to the floor after surgery is associated with a significantly shorter LOS for patient undergoing LSG, while day of the week and time of the year may impact LOS for patients undergoing LRNYGB. This suggests that at an academic medical center, while strategic scheduling of LSG may improve LOS, further analysis is required to understand the weekly (e.g. patients’ expectation) and seasonal (e.g. resident experience) effects on LOS after LRNYGB.
A5158
CHEMOSENSORY FUNCTION, DIETARY PREFERENCE AND DIETARY BEHAVIORS FROM PRE- TO 6-MONTHS POST-BARIATRIC SURGERY: A PILOT STUDY Andrea Stone1; Pavlos Papasavas2; Helen Swede3; Darren Tishler2; Patrice Hubert4; Valerie Duffy4; 1Hartford Hospital, Glastonbury CT; 2Hartford Hospital, Hartford CT; 3University of Connecticut Health Center, Farmington CT; 4University of Connecticut, Storrs CT Background: The chemosenses (taste, smell) are important contributors to food/beverage preferences, healthy eating behaviors, and weight. However, less is understood about changes in these senses and relationships with preference and dietary behaviors across bariatric surgery. Aim: We sought to describe changes in taste, flavor, food preference and dietary behaviors between females with morbid obesity before bariatric surgery and 6 months post-surgery. Methods: In a pre-post test design, 22 females were evaluated pre-surgery and 6-months post-surgery (13 sleeve gastrectomy; 9 Roux-en-Y gastric bypass). Patients averaged 54% excess weight loss, 21% total weight loss. At pre/post-surgery and following the National Health and Nutrition Examination protocol, patients selfreported their chemosensory function and were measured for taste function via perceived intensity of concentrated, aqueous quinine hydrochloride and NaCl. They also rated sweetness, flavor intensity, and preference for sampled jellybeans (cherry, coffee, chocolate and tabasco) and reported the bitterness of aqueous propylthiouracil (PROP, a taste genetics probe). Finally, they completed the three-factor eating inventory and survey-reported their food and activity preferences (scored into valid/reliable indexes of diet quality). Results: Via descriptive statistics, 9 of 22 patients reported changes in smell (smells stronger or not right) and 14 reported changes in taste (tastes stronger or not right, can’t taste some) function since surgery. Patients varied in the ability to taste PROP, capturing nontasters to supertasters. We were unable to detect changes in measured chemosensory function paralleling these selfreported changes. In repeated measures analysis of variance (accounting for surgery type, pre-surgery weight), there was neither significant changes in jellybean sweetness, flavor, or preference, nor in the perceived intensity of salt or bitters (quinine and PROP). From pre- to post-surgery, patients reported significant differences in dietary behaviors (greater dietary restraint, less disinhibition, less hunger). They also reported reduced preference for alcoholic beverages, sweets, and high-fat meats, and increased
S137
preference for fiber foods, and overall, improvements in diet quality. In simple regression, greater diet quality improvement was seen in patients who, at baseline, reported greater intensity for the tastes (averaged across bitters and salts, a¼0.85). Change in dietary behaviors failed to show association with taste function. Discussion: From these pilot data, bariatric surgery is associated with perceived chemosensory changes that were not captured in simple basic measures of taste and smell function ascertained 6months post-surgery. Further study is needed to assess relationships between taste, preference, and dietary behaviors with sustained weight loss in bariatric surgery patients.
A5159
BAND TO BARIATRIC STAPLING CONVERSION SURGERY PERFORMED ON AN OUTPATIENT BASIS: OUR EARLY EXPERIENCE Titus Duncan; Karleena Tuggle; Alberto Zarak; The Surgery Center of Atlanta, Atlanta Georgia Introduction: Some primary bariatric surgical procedures have been shown to be performed safely on an ambulatory outpatient basis. When performed in select patients, lap band placement on an outpatient basis has been shown to be safe and effective and has been commonly performed worldwide. However, to date, little data exists on the safety of performing more complex bariatric procedures on an outpatient basis. Lately, a substantial number of patients have had to undergo removal of previously placed lap bands either as a result of complications from the band, or as a result of patient dissatisfaction for lack of acceptable weight loss. When clinically and technically feasible, several of these patients request to have a secondary bariatric procedure at the time of removal of the lap band system. Removal of the lap band with conversion to a secondary bariatric procedure during the same operation, such as the sleeve gastrectomy or gastric bypass procedure is indisputably a more complex procedure and has thus been tiered as a “high acuity” surgical technique. We reviewed and present our series of patients undergoing lap band removal and immediate conversion to either sleeve gastrectomy or Roux–en-y gastric bypass on an ambulatory outpatient basis. Materials and Methods: Between January 2010 and September 2016 there were 165 patients who had surgery for removal of lap band for either lap band complications, or unsatisfactory loss of weight. Sixty-six (66) patients had their bands removed and had a concurrent bariatric procedure following removal of the lap band on an ambulatory outpatient basis. Results: All patients were discharged to home on an ambulatory outpatient basis. No patients who had to be returned to the operating room. There were no leaks and no staple line bleeding. Three patients (3%) were readmitted for nausea vomiting and dehydration within the first 30 days of surgery. There were no deaths and no major complications. Discussion: There has been a recent increase in patients suffering from complications of previously placed lap bands. This has resulted in an inordinate increase in surgery to remove these devices. There were no major complications and no deaths in this series. This suggests that patient characteristics, including age, sex