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P45: Perceived barriers to bariatric surgery among morbidly obese patients
Abstracts: 2008 Poster Session 2 / Surgery for Obesity and Related Diseases 4 (2008) 312–357
similarly longer (223.4⫾63.9 vs. 203.5⫾57.3 minutes, p⫽0.005), while mean hospital stay (5.0⫾3.7 vs. 4.7⫾5.9 days, p⫽0.644), postoperative complication rates (61.4 vs. 55.2 %, p⫽0.293) and postoperative mortality rates (1.6 vs. 2.4 %, p⫽0.685) were not different between groups. Conclusion: Although it took on average 20 minutes longer, cholecystectomy can be safely added to RYGB without increasing hospital stay, postoperative morbidity and mortality rate in both laparoscopic and open surgery. We recommend routine simultaneous cholecystectomy be performed for patients with documented gallstones at the time of RYGB. PII: S1550-7289(08)00217-7
P45.
PERCEIVED BARRIERS TO BARIATRIC SURGERY AMONG MORBIDLY OBESE PATIENTS Bianca B. Afonso, MD; Samuel Szomstein, M.D.; Raul Rosenthal, M.D.; Cleveland Clinic Florida, Weston, FL, USA. Background: In 2006, over 200,000 weight loss operations were performed in the United States, out of an estimated 11 million potential candidates. We aimed to identify the potential barriers to obese patients being offered or considering a weight loss procedure. Methods: A two-page questionnaire was administered to patients who were clinically morbidly obese during routine medical appointments at our institution for what they perceived to be unrelated medical problems. The survey collected data on demographics, co-morbidities, physical activity, dietary habits, and reasons why patients had either not considered or could not undergo bariatric surgery. Results: A total of 50 patients, 30 females and 20 males, completed the survey. Median age was 51 (range 28-86) years with a mean BMI of 44 (range 35-66) kg/m2. Only 26% of patients were aware of being morbidly obese. 58% were not interested in a surgical procedure to correct their weight problems, with Caucasians and older patients less likely to be interested (P⬍0.04). When asked the reasons they had not considered bariatric surgery, 26% of patients stated that weight loss surgery was not covered by their insurance policy, 18% were unaware of being a surgical candidate, and 26% stated their primary care physician had not recommend a weight loss procedure. Patients with 4 or more co-morbidities were less likely to be referred for bariatric surgery by their primary care physician (P⬍0.002). Conclusion: This survey demonstrates that lack of insurance coverage is not the main reason for patients not undergoing bariatric surgery. Perceived barriers and lack of knowledge exist in both the minds of the general public and physicians. Education of both groups is needed regarding the medical implications of obesity as well as the benefits of bariatric surgery. PII: S1550-7289(08)00218-9
329
P46.
OUTCOMES OF BARIATRIC SURGERY IN PATIENTS WITH BMI LESS THAN 35 KG/M2 Patricio Fajnwaks, M.D.; Alexander Ramirez, M.D.; Pedro Martinez, M.D.; Enrique Arias, M.D.; Samuel Szomstein, M.D.; Raul Rosenthal, M.D.; Cleveland Clinic Florida, Weston, FL, USA. Background: Obesity with a body mass index (BMI) of between 30 and 35 kg/m2 is frequently associated with type 2 diabetes mellitus (DM), arterial hypertension (HTN), and dyslipidemia (DLD), among other comorbidities. The aim of this study was to investigate the improvements of such comorbidities in a class I obese population who have undergone a bariatric procedure for weight loss. Methods: A retrospective review of a prospectively maintained database was carried out. Nine patients with a BMI of ⬍35kg/m2 who underwent a bariatric procedure at our institution between February 2000 to August 2007 were identified. Fasting glucose, glycosylated hemoglobin levels, lipid profile, initial weight, and BMI were measured in the preoperative and postoperative period. Results: Our patient population consisted of 9 patients (7 females and 2 males) with a preoperative mean BMI of 34.7 kg/m2 and a mean follow up of 19.6 (range, 9-28) months. Six (66.6%) patients underwent a laparoscopic sleeve gastrectomy (LSG) and 3(33.3%) had a laparoscopic Roux en-Y gastric bypass (LRYGBP). Our series showed 4(44%) patients with DM, 3(33%) with glucose intolerance, 4(44%) with HTN, and 6 (66%) with DLD. Postoperative findings demonstrated a decreased mean BMI to 29.3 kg/m2, and a mean weight loss of 31lb. Of the 4 DM patients, 2 (50%) improved and 2 (50%) had total resolution. All 3(100%) patients resolved their glucose intolerance and of the 3 patients with HTN, 2(50%) showed improvement and 2 (50%) had complete resolution. Of the 6 patients with DLD, 2(33%) had complete resolution and 4(64%) required a lower dose of lipid lowering drugs. Conclusion: Bariatric surgery in patients with a BMI between 30 and 35 kg/m2 appears to be a safe and effective option that is associated with a marked improvement or resolution of comorbid conditions. PII: S1550-7289(08)00219-0
P47.
CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) IN THE IMMEDIATE POSTOPERATIVE PERIOD AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS: IS IT SAFE? Alexander Ramirez, M.D.; Peter F. Lalor, M.D.; Samuel Szomstein, M.D.; Raul Rosenthal, M.D.; Cleveland Clinic Florida, Weston, FL, USA. Background: Obstructive sleep apnea (OSA) is a common condition in the morbidly obese population. Many patients undergoing bariatric surgery require postoperative Continuous Positive Airway Pressure (CPAP) therapy. There is no literature evaluating gastrointestinal anastomotic morbidity in patients receiving CPAP therapy immediately after laparoscopic Roux-en-Y gastric bypass (LRYGBP). The objective of this study was to examine the short term morbidity of postoperative CPAP in patients after LRYGBP.
similarly longer (223.4⫾63.9 vs. 203.5⫾57.3 minutes, p⫽0.005), while mean hospital stay (5.0⫾3.7 vs. 4.7⫾5.9 days, p⫽0.644), postoperative complication rates (61.4 vs. 55.2 %, p⫽0.293) and postoperative mortality rates (1.6 vs. 2.4 %, p⫽0.685) were not different between groups. Conclusion: Although it took on average 20 minutes longer, cholecystectomy can be safely added to RYGB without increasing hospital stay, postoperative morbidity and mortality rate in both laparoscopic and open surgery. We recommend routine simultaneous cholecystectomy be performed for patients with documented gallstones at the time of RYGB. PII: S1550-7289(08)00217-7
P45.
PERCEIVED BARRIERS TO BARIATRIC SURGERY AMONG MORBIDLY OBESE PATIENTS Bianca B. Afonso, MD; Samuel Szomstein, M.D.; Raul Rosenthal, M.D.; Cleveland Clinic Florida, Weston, FL, USA. Background: In 2006, over 200,000 weight loss operations were performed in the United States, out of an estimated 11 million potential candidates. We aimed to identify the potential barriers to obese patients being offered or considering a weight loss procedure. Methods: A two-page questionnaire was administered to patients who were clinically morbidly obese during routine medical appointments at our institution for what they perceived to be unrelated medical problems. The survey collected data on demographics, co-morbidities, physical activity, dietary habits, and reasons why patients had either not considered or could not undergo bariatric surgery. Results: A total of 50 patients, 30 females and 20 males, completed the survey. Median age was 51 (range 28-86) years with a mean BMI of 44 (range 35-66) kg/m2. Only 26% of patients were aware of being morbidly obese. 58% were not interested in a surgical procedure to correct their weight problems, with Caucasians and older patients less likely to be interested (P⬍0.04). When asked the reasons they had not considered bariatric surgery, 26% of patients stated that weight loss surgery was not covered by their insurance policy, 18% were unaware of being a surgical candidate, and 26% stated their primary care physician had not recommend a weight loss procedure. Patients with 4 or more co-morbidities were less likely to be referred for bariatric surgery by their primary care physician (P⬍0.002). Conclusion: This survey demonstrates that lack of insurance coverage is not the main reason for patients not undergoing bariatric surgery. Perceived barriers and lack of knowledge exist in both the minds of the general public and physicians. Education of both groups is needed regarding the medical implications of obesity as well as the benefits of bariatric surgery. PII: S1550-7289(08)00218-9
329
P46.
OUTCOMES OF BARIATRIC SURGERY IN PATIENTS WITH BMI LESS THAN 35 KG/M2 Patricio Fajnwaks, M.D.; Alexander Ramirez, M.D.; Pedro Martinez, M.D.; Enrique Arias, M.D.; Samuel Szomstein, M.D.; Raul Rosenthal, M.D.; Cleveland Clinic Florida, Weston, FL, USA. Background: Obesity with a body mass index (BMI) of between 30 and 35 kg/m2 is frequently associated with type 2 diabetes mellitus (DM), arterial hypertension (HTN), and dyslipidemia (DLD), among other comorbidities. The aim of this study was to investigate the improvements of such comorbidities in a class I obese population who have undergone a bariatric procedure for weight loss. Methods: A retrospective review of a prospectively maintained database was carried out. Nine patients with a BMI of ⬍35kg/m2 who underwent a bariatric procedure at our institution between February 2000 to August 2007 were identified. Fasting glucose, glycosylated hemoglobin levels, lipid profile, initial weight, and BMI were measured in the preoperative and postoperative period. Results: Our patient population consisted of 9 patients (7 females and 2 males) with a preoperative mean BMI of 34.7 kg/m2 and a mean follow up of 19.6 (range, 9-28) months. Six (66.6%) patients underwent a laparoscopic sleeve gastrectomy (LSG) and 3(33.3%) had a laparoscopic Roux en-Y gastric bypass (LRYGBP). Our series showed 4(44%) patients with DM, 3(33%) with glucose intolerance, 4(44%) with HTN, and 6 (66%) with DLD. Postoperative findings demonstrated a decreased mean BMI to 29.3 kg/m2, and a mean weight loss of 31lb. Of the 4 DM patients, 2 (50%) improved and 2 (50%) had total resolution. All 3(100%) patients resolved their glucose intolerance and of the 3 patients with HTN, 2(50%) showed improvement and 2 (50%) had complete resolution. Of the 6 patients with DLD, 2(33%) had complete resolution and 4(64%) required a lower dose of lipid lowering drugs. Conclusion: Bariatric surgery in patients with a BMI between 30 and 35 kg/m2 appears to be a safe and effective option that is associated with a marked improvement or resolution of comorbid conditions. PII: S1550-7289(08)00219-0
P47.
CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) IN THE IMMEDIATE POSTOPERATIVE PERIOD AFTER LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS: IS IT SAFE? Alexander Ramirez, M.D.; Peter F. Lalor, M.D.; Samuel Szomstein, M.D.; Raul Rosenthal, M.D.; Cleveland Clinic Florida, Weston, FL, USA. Background: Obstructive sleep apnea (OSA) is a common condition in the morbidly obese population. Many patients undergoing bariatric surgery require postoperative Continuous Positive Airway Pressure (CPAP) therapy. There is no literature evaluating gastrointestinal anastomotic morbidity in patients receiving CPAP therapy immediately after laparoscopic Roux-en-Y gastric bypass (LRYGBP). The objective of this study was to examine the short term morbidity of postoperative CPAP in patients after LRYGBP.