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Early Feeding Post Bariatric Surgery Reduces Length of Stay
S14
Oral Presentations / Surgery for Obesity and Related Diseases 11 (2015) S1–S34
AGB (21, 41, 44, p¼0.466 and 19, 28, 37, p¼0.173). However, patients in the WL group had significantly higher rates (%) of hypertension remission for all procedures: RYGB (46, 46, 51, p¼0.035), SG (35, 41, 46, p¼0.046) and AGB (17, 18, 24, p¼0.029). Conclusions: Preoperative weight loss was associated with a lower adjusted rate of any complication with RYGB but otherwise did not affect rates of any or serious complication with any of the other bariatric procedures. Nor did it affect adjusted rates of diabetes remission with any procedure. However, preoperative weight loss was associated with a significant increase in excess weight loss and remission of hypertension across all procedures. Preoperative weight loss over 5% serves as a useful marker for an enhanced weight loss response to RYGB, SG and AGB. A120
EARLY FEEDING POST BARIATRIC SURGERY REDUCES LENGTH OF STAY Beverly Shirkey, PhD; Linda Moore, MS, RDN; Richard Ogunti, MBBS, MPH; Mamta Puppala, MS; Stephen Wong, PhD, PE; Patricia Wilson, LVN MBSCR; Vadim Sherman, MD; Nabil Tariq, MD; Houston Methodist Hospital, Houston, TX, USA Introduction: Minimally invasive surgery can enable quicker recovery and decreased length of stays (LOS) across multiple surgical disciplines. However, even within the same minimally invasive surgery programs there can be variations in practice in the initiation of oral intake. Proponents of immediate allowance of oral intake post bariatric surgery (EF, early feeding) claim that it may decrease LOS, while those that wait till the next day (DF, delayed feeding) feel that it may decrease post operative problems like excessive nausea, vomiting, etc., leading to excess LOS and that EF and discharge may increase 30-day readmission rates. We decided to investigate the relationship of EF vs DF to LOS at our institution. Methods: Cases from a single-center bariatric surgery program performed between January 2006 and December 2014 were
Variable
N
All cases
1,842
All LOS, Mean (SD)
retrospectively reviewed. Bariatric surgeries were pulled from the locally managed clinical quality data repository and matched with the diet orders, comorbidity, and inpatient readmission data from the electronic medical records using the Methodist Environment for Translational Enhancement and Outcomes Research (METEOR). ICD-9-CM codes were used to capture the comorbidities hypertension (HTN), diabetes (DM), coronary artery disease (CAD), and sleep apnea (SA). Length of hospital stay (LOS) was recorded and 30-day readmission was determined using the 30-day period from discharge to another inpatient admission. Diet order details were pulled from the order flow records and recorded as either early feeding (EF, within a few hours of surgery) or delayed feeding (DF, the day after surgery or beyond). Statistical analysis was performed using Chi-square for categorical variables and t-test for continuous variables. Using 2-tailed statistics, significance was assumed if p-value was o0.05. Results: A total of 3,120 cases of bariatric surgery were obtained from the locally managed clinical quality data repository. Laparoscopic gastric band (LGB) surgeries and revisional surgeries (n¼1,195) were excluded from the analysis; 83 additional cases were excluded due to having no diet information leaving a total of 1,842 for the analysis: Laparoscopic sleeve gastrectomy (LSG), n¼444,24.1%; Laparoscopic roux-en-y gastric bypass (LRYGB), n¼1,397, 75.9%). Females (n¼1,463, 79.4%) represented the majority of cases. Mean (SD) age was 44.6 (12.0) years and ranged from 17 to 78 years. The initial BMI was 46.3 (8.2) kg/m2. For the comorbidities, 1,096 (59.5%) were coded as having HTN, while 636 (34.5%) had DM, 93 (5.1%) had CAD, and 699 (38.0%) had SA. The overall mean (SD) LOS was 54.2 (87.4) hours. Diet orders indicated that 974 (52.9%) patients were in the EF and 868 (47.1%) were in the DF group. No difference in sex, age, BMI and comorbidities was apparent between the EF or DF groups, all p-values 40.05. EF patients had a mean (SD) LOS of 44.6 (67.1) hours and DF patients had LOS of 65.1 (104.6) hours; mean LOS difference of 20.5 hours (po0.001). The LOS difference between EF and DF groups remained significant when outlier cases were removed by restricting the LOS to o5 days (Table 1). The 30 day readmission rates were
N
LOS <5 days, Mean (SD) outliers removed
EF
973
44.6 (67.1)
953
38.3 (15.0)
DF
868
65.1 (104.6)
831
51.7 (15.5)
p-value Surgery LSG
<0.001
<0.001
444
EF
338
45.5 (74.2)
331
39.5 (14.4)
DF
106
73.4 (160.4)
101
52.3 (18.0)
p-value Surgery LRYGB
0.007
<0.001
1,397
EF
635
44.1 (63.1)
622
37.7 (15.3)
DF
762
63.9 (94.4)
730
51.7 (15.1)
p-value
<0.001
<0.001
Oral Presentations / Surgery for Obesity and Related Diseases 11 (2015) S1–S34
similar in the EF and DF groups, 45/974 (4.6%) and 42/826 (4.8%), respectively (p¼NS). Conclusion: Early feeding post bariatric surgery decreased LOS by almost a day (20.5 hours) at our institution. This phenomenon persisted throughout the years, from 2006 to 2014. The LOS difference was found in both LSG and LRYGB patients. This early discharge did not result in increased 30-day readmission rates. Early feeding post bariatric surgery may enhance recovery without increasing readmission.
S15
demonstrated that pregnancy before bariatric surgery had a more negative effect on weight loss compared to patients who had never been pregnant (odds ratio, -3.02; 95% CI, -0.58 to -5.57; p¼0.005). Conclusions: Pregnancy before bariatric surgery increases the likelihood of reduced weight loss following surgery. Patients wishing to conceive should be informed that weight loss outcomes may vary depending on the timing of pregnancy relative to bariatric surgery. A122
A121
THE EFFECT OF PREGNANCY BEFORE OR AFTER BARIATRIC SURGERY ON WEIGHT LOSS Dvir Froylich; Ricard Corcelles, MD, PhD; Chris Daigle, MD; John Kirwan, PhD; Stacy Brethauer, MD; Philip Schauer, MD; Cleveland Clinic, Cleveland, OH, USA Introduction: Women of childbearing age represent 31-36% of patients undergoing bariatric surgery. However, the influence of pregnancy before or after bariatric surgery on surgery outcomes is unclear. We aimed to compare the effect of pregnancy before and after bariatric surgery on overall weight loss. Methods: We included all female patients who had a successful pregnancy between 2005 and 2014. The window of inclusion was 3-year or less, either before or after surgery. Control subjects included a cohort of female patients who had not been pregnant, matched on a 2:3 ratio for age, initial Body Mass Index (BMI), type of procedure, and duration of follow-up. Results: A total of 62 patients delivered within 3 years either before or after surgery. Data were compared to a matched cohort of 92 patients who had never conceived. Mean age at surgery was 33.8 years and BMI 48.2 Kg/m2. Laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (AGB) were performed in 75.9%, 12.9% and in 11.0%, respectively. Following an average matched follow-up period of 43.9 months, percent excess weight loss (%EWL) was 68.0⫾ 26.0% in the non-pregnant group compared to 53.0⫾25.0% in the pregnant group (po0.01). The percent total body weight loss (% WL) was 24.0⫾11.0% in the study group compared to 31.0⫾ 12.0% in the matched cohort (po0.01). Multivariate analysis
TASTE AND OLFACTORY CHANGES FOLLOWING LAPAROSCOPIC GASTRIC BYPASS AND SLEEVE GASTRECTOMY Carlos Zerrweck, MD1; Luis Zurita, MD2; Guillermo Alvarez, MS3; Hernán Maydón, MD3; Elisa Sepúlveda, MD3; Francisco Campos, MD2; Lizbeth Guilbert, MD3; Omar Pineda, MD3; Omar Espinosa, MD3; Veronica Pratti, Lic2; 1ABC Medical Center, Mexico City, Mexico; 2 Hospital General "Rubén Leñero,"Mexico City, Mexico; 3 Hospital General Tláhuac, Mexico City, Mexico Background: Alterations in taste and smell after bariatric surgery have been observed, but few data is available. Some authors documented these changes and their role on weight loss following laparoscopic gastric bypass (LGBP) and gastric banding, without existing evidence after laparoscopic sleeve gastrectomy (LSG). Here we analyzed changes in taste/smell after LGBP and LSG, and their impact on weight loss. Methods: Cohort study, with patients submitted to LGBP and LSG that were asked to participate in a 23-question validated survey; the questionnaire was adapted from a previously used by other authors. Questionnaires were applied at the office to patients who were at least one month postoperative. The primary objective was to determinate the differences between procedures in terms of taste and smell changes; a demographic and anthropometric analysis were also performed and compared. Secondarily, the relation between food aversion and weight loss was also obtained. Results: In a 6 months period, 183 questionnaires were obtained. Twenty-nine were excluded from the study; 26 had incomplete
Table 1: Baseline characteristics of the matched groups Never pregnant Pregnancy * p-value N=92 N=62 Age (years) 34.6±6.6 33.3±5.1 0.18 Pre-op weight (kg) 130.7±20.6 130.3±20.2 0.90 Pre-op BMI (kg/m2) 48.2±7.7 48.1±7.0 0.98 Length of follow-up (month) 46.3±22.1 40.2±28.2 0.13 Type of procedure LRYGB 70 (76.0%) 47 (75.8%) 0.98 LSG 12 (13.0%) 8 (12.9%) 0.97 LAGB 10 (10.8%) 7 (11.2%) 0.93 *Pregnancy before and/or aer bariatric surgery Abbreviaons: BMI-Body Mass Index, LRYGP-Laparoscopic Roux en Y Gastric Bypass, LSG- Laparoscopic Sleeve Gastrectomy, LAGB-Laparoscopic Adjustable Gastric Banding.
Oral Presentations / Surgery for Obesity and Related Diseases 11 (2015) S1–S34
AGB (21, 41, 44, p¼0.466 and 19, 28, 37, p¼0.173). However, patients in the WL group had significantly higher rates (%) of hypertension remission for all procedures: RYGB (46, 46, 51, p¼0.035), SG (35, 41, 46, p¼0.046) and AGB (17, 18, 24, p¼0.029). Conclusions: Preoperative weight loss was associated with a lower adjusted rate of any complication with RYGB but otherwise did not affect rates of any or serious complication with any of the other bariatric procedures. Nor did it affect adjusted rates of diabetes remission with any procedure. However, preoperative weight loss was associated with a significant increase in excess weight loss and remission of hypertension across all procedures. Preoperative weight loss over 5% serves as a useful marker for an enhanced weight loss response to RYGB, SG and AGB. A120
EARLY FEEDING POST BARIATRIC SURGERY REDUCES LENGTH OF STAY Beverly Shirkey, PhD; Linda Moore, MS, RDN; Richard Ogunti, MBBS, MPH; Mamta Puppala, MS; Stephen Wong, PhD, PE; Patricia Wilson, LVN MBSCR; Vadim Sherman, MD; Nabil Tariq, MD; Houston Methodist Hospital, Houston, TX, USA Introduction: Minimally invasive surgery can enable quicker recovery and decreased length of stays (LOS) across multiple surgical disciplines. However, even within the same minimally invasive surgery programs there can be variations in practice in the initiation of oral intake. Proponents of immediate allowance of oral intake post bariatric surgery (EF, early feeding) claim that it may decrease LOS, while those that wait till the next day (DF, delayed feeding) feel that it may decrease post operative problems like excessive nausea, vomiting, etc., leading to excess LOS and that EF and discharge may increase 30-day readmission rates. We decided to investigate the relationship of EF vs DF to LOS at our institution. Methods: Cases from a single-center bariatric surgery program performed between January 2006 and December 2014 were
Variable
N
All cases
1,842
All LOS, Mean (SD)
retrospectively reviewed. Bariatric surgeries were pulled from the locally managed clinical quality data repository and matched with the diet orders, comorbidity, and inpatient readmission data from the electronic medical records using the Methodist Environment for Translational Enhancement and Outcomes Research (METEOR). ICD-9-CM codes were used to capture the comorbidities hypertension (HTN), diabetes (DM), coronary artery disease (CAD), and sleep apnea (SA). Length of hospital stay (LOS) was recorded and 30-day readmission was determined using the 30-day period from discharge to another inpatient admission. Diet order details were pulled from the order flow records and recorded as either early feeding (EF, within a few hours of surgery) or delayed feeding (DF, the day after surgery or beyond). Statistical analysis was performed using Chi-square for categorical variables and t-test for continuous variables. Using 2-tailed statistics, significance was assumed if p-value was o0.05. Results: A total of 3,120 cases of bariatric surgery were obtained from the locally managed clinical quality data repository. Laparoscopic gastric band (LGB) surgeries and revisional surgeries (n¼1,195) were excluded from the analysis; 83 additional cases were excluded due to having no diet information leaving a total of 1,842 for the analysis: Laparoscopic sleeve gastrectomy (LSG), n¼444,24.1%; Laparoscopic roux-en-y gastric bypass (LRYGB), n¼1,397, 75.9%). Females (n¼1,463, 79.4%) represented the majority of cases. Mean (SD) age was 44.6 (12.0) years and ranged from 17 to 78 years. The initial BMI was 46.3 (8.2) kg/m2. For the comorbidities, 1,096 (59.5%) were coded as having HTN, while 636 (34.5%) had DM, 93 (5.1%) had CAD, and 699 (38.0%) had SA. The overall mean (SD) LOS was 54.2 (87.4) hours. Diet orders indicated that 974 (52.9%) patients were in the EF and 868 (47.1%) were in the DF group. No difference in sex, age, BMI and comorbidities was apparent between the EF or DF groups, all p-values 40.05. EF patients had a mean (SD) LOS of 44.6 (67.1) hours and DF patients had LOS of 65.1 (104.6) hours; mean LOS difference of 20.5 hours (po0.001). The LOS difference between EF and DF groups remained significant when outlier cases were removed by restricting the LOS to o5 days (Table 1). The 30 day readmission rates were
N
LOS <5 days, Mean (SD) outliers removed
EF
973
44.6 (67.1)
953
38.3 (15.0)
DF
868
65.1 (104.6)
831
51.7 (15.5)
p-value Surgery LSG
<0.001
<0.001
444
EF
338
45.5 (74.2)
331
39.5 (14.4)
DF
106
73.4 (160.4)
101
52.3 (18.0)
p-value Surgery LRYGB
0.007
<0.001
1,397
EF
635
44.1 (63.1)
622
37.7 (15.3)
DF
762
63.9 (94.4)
730
51.7 (15.1)
p-value
<0.001
<0.001
Oral Presentations / Surgery for Obesity and Related Diseases 11 (2015) S1–S34
similar in the EF and DF groups, 45/974 (4.6%) and 42/826 (4.8%), respectively (p¼NS). Conclusion: Early feeding post bariatric surgery decreased LOS by almost a day (20.5 hours) at our institution. This phenomenon persisted throughout the years, from 2006 to 2014. The LOS difference was found in both LSG and LRYGB patients. This early discharge did not result in increased 30-day readmission rates. Early feeding post bariatric surgery may enhance recovery without increasing readmission.
S15
demonstrated that pregnancy before bariatric surgery had a more negative effect on weight loss compared to patients who had never been pregnant (odds ratio, -3.02; 95% CI, -0.58 to -5.57; p¼0.005). Conclusions: Pregnancy before bariatric surgery increases the likelihood of reduced weight loss following surgery. Patients wishing to conceive should be informed that weight loss outcomes may vary depending on the timing of pregnancy relative to bariatric surgery. A122
A121
THE EFFECT OF PREGNANCY BEFORE OR AFTER BARIATRIC SURGERY ON WEIGHT LOSS Dvir Froylich; Ricard Corcelles, MD, PhD; Chris Daigle, MD; John Kirwan, PhD; Stacy Brethauer, MD; Philip Schauer, MD; Cleveland Clinic, Cleveland, OH, USA Introduction: Women of childbearing age represent 31-36% of patients undergoing bariatric surgery. However, the influence of pregnancy before or after bariatric surgery on surgery outcomes is unclear. We aimed to compare the effect of pregnancy before and after bariatric surgery on overall weight loss. Methods: We included all female patients who had a successful pregnancy between 2005 and 2014. The window of inclusion was 3-year or less, either before or after surgery. Control subjects included a cohort of female patients who had not been pregnant, matched on a 2:3 ratio for age, initial Body Mass Index (BMI), type of procedure, and duration of follow-up. Results: A total of 62 patients delivered within 3 years either before or after surgery. Data were compared to a matched cohort of 92 patients who had never conceived. Mean age at surgery was 33.8 years and BMI 48.2 Kg/m2. Laparoscopic Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (AGB) were performed in 75.9%, 12.9% and in 11.0%, respectively. Following an average matched follow-up period of 43.9 months, percent excess weight loss (%EWL) was 68.0⫾ 26.0% in the non-pregnant group compared to 53.0⫾25.0% in the pregnant group (po0.01). The percent total body weight loss (% WL) was 24.0⫾11.0% in the study group compared to 31.0⫾ 12.0% in the matched cohort (po0.01). Multivariate analysis
TASTE AND OLFACTORY CHANGES FOLLOWING LAPAROSCOPIC GASTRIC BYPASS AND SLEEVE GASTRECTOMY Carlos Zerrweck, MD1; Luis Zurita, MD2; Guillermo Alvarez, MS3; Hernán Maydón, MD3; Elisa Sepúlveda, MD3; Francisco Campos, MD2; Lizbeth Guilbert, MD3; Omar Pineda, MD3; Omar Espinosa, MD3; Veronica Pratti, Lic2; 1ABC Medical Center, Mexico City, Mexico; 2 Hospital General "Rubén Leñero,"Mexico City, Mexico; 3 Hospital General Tláhuac, Mexico City, Mexico Background: Alterations in taste and smell after bariatric surgery have been observed, but few data is available. Some authors documented these changes and their role on weight loss following laparoscopic gastric bypass (LGBP) and gastric banding, without existing evidence after laparoscopic sleeve gastrectomy (LSG). Here we analyzed changes in taste/smell after LGBP and LSG, and their impact on weight loss. Methods: Cohort study, with patients submitted to LGBP and LSG that were asked to participate in a 23-question validated survey; the questionnaire was adapted from a previously used by other authors. Questionnaires were applied at the office to patients who were at least one month postoperative. The primary objective was to determinate the differences between procedures in terms of taste and smell changes; a demographic and anthropometric analysis were also performed and compared. Secondarily, the relation between food aversion and weight loss was also obtained. Results: In a 6 months period, 183 questionnaires were obtained. Twenty-nine were excluded from the study; 26 had incomplete
Table 1: Baseline characteristics of the matched groups Never pregnant Pregnancy * p-value N=92 N=62 Age (years) 34.6±6.6 33.3±5.1 0.18 Pre-op weight (kg) 130.7±20.6 130.3±20.2 0.90 Pre-op BMI (kg/m2) 48.2±7.7 48.1±7.0 0.98 Length of follow-up (month) 46.3±22.1 40.2±28.2 0.13 Type of procedure LRYGB 70 (76.0%) 47 (75.8%) 0.98 LSG 12 (13.0%) 8 (12.9%) 0.97 LAGB 10 (10.8%) 7 (11.2%) 0.93 *Pregnancy before and/or aer bariatric surgery Abbreviaons: BMI-Body Mass Index, LRYGP-Laparoscopic Roux en Y Gastric Bypass, LSG- Laparoscopic Sleeve Gastrectomy, LAGB-Laparoscopic Adjustable Gastric Banding.