Does the socio-demographic profile of patients limit access to bariatric surgery?

Abstract Purpose Surgery remains the only treatment allowing for a significant and sustainable weight loss in case of severe obesity. Patients undergo a specific multidisciplinary preparation and selection before the operation. This study aims to correlate the psychosocial profile with the likelihood of undergoing bariatric surgery in patients enrolled in the preparation program of a Swiss reference center. Methods All patients referred to an obesity center between January 1, 2016, and June 30, 2017, seeking a first bariatric procedure were included. Socio-demographic data, BMI, preoperative psychological and dietary evaluations were collected. Usually, the preoperative process lasts 1 year. Patients who left the preparation or who had not undergone surgery after more than 2 years of follow-up were considered withdrawers. Surgery completion predictors were reviewed with bivariate analysis and socio-demographic clusters established using the K-means method. Results Out of a total of 221 patients, 99 (45%) patients had not undergone bariatric surgery 2 years after their first consultation. The patients were divided into four distinct socio-demographic clusters, among which a particularly deprived one. Criteria such as unfavorable psychological (p < 0.001) and dietary (p < 0.001) evaluations, and male gender (p < 0.05) were significantly associated with non-operation, unlike socio-demographic indicators and clusters (p > 0.1). Conclusion Almost half of the patients starting a bariatric program are not operated on, which is related to an unfavorable psychological or dietary evaluation and to the male gender. This study also demonstrates that a significant share of patients combines several factors of social deprivation, without influencing the likelihood of surgery completion. Level of evidence Level V: Descriptive study.

Download Full-text

T1 PELVIC ANGLE IN IMPROVEMENT OF PAIN IN HIGH-GRADE LUMBAR SPONDYLOLISTHESIS

Coluna/Columna ◽

10.1590/s1808-185120201902224228 ◽

2020 ◽

Vol 19 (2) ◽

pp. 108-111

Author(s):

JOSÉ ALBERTO ALVES OLIVEIRA ◽

VINÍCIUS TAPIE GUERRA E SILVA ◽

LUIZ EDUARDO PEREIRA COSTA ASSIS DE ALMEIDA ◽

RICARDO DE SOUZA PORTES MEIRELES ◽

GUILHERME DE REZENDE LOPES ◽

...

Keyword(s):

Strong Correlation ◽

Sagittal Alignment ◽

Demographic Data ◽

Case Series ◽

Slip Angle ◽

High Grade ◽

Data Types ◽

Level Of Evidence ◽

Global Sagittal Alignment

ABSTRACT Objective To evaluate the correlation between global sagittal alignment variables and pain improvement after surgery for High-Grade Spondylolisthesis (HGS). Methods A sample with 20 patients with L5-S1 HGS, submitted to arthrodesis with instrumentation from 01/2004 to 12/2016. Patients’ demographic data, types of surgeries, complications, sagittal alignment parameters, and Visual Analog Scale (VAS) score (ranging from 0 to 4) were recorded before surgery and at the last follow-up. The data were processed in SPSS 22.0. The confidence level was 0.05. Results The majority of the sample were women, 17 (85%); age at surgery: 52.60 ± 17.15 years; mean follow-up: 3.58 ± 1.62 years; isthmic etiology, 16 (80%) and dysplastic, 4 (20%); Meyerding Grading 3: 12 (60%), Grading 4: 3 (15%) and Grading 5: 5 (25%); SDSG type 4: 6 (30%), type 5a: 3 (15%), 5b: 3 (15%), type 6: 7 (35%) and not classified 1 (5%); surgery: in situ fusion 3 (15%) and reduction 17 (85%); fusion levels: L3-S1: 1 (5%), L3-Iliac: 1 (5%), L4-S1: 1 (5%), L4-Iliac: 6 (30%) and L5-S1: 11 (55%). Comparing the pre- and postoperative parameters, a significant improvement (p <0.05) was seen in the VAS, T1 slope, T1 pelvic angle (TPA), slip angle, Dubousset’s lumbosacral angle and slip %. Evaluating the correlation between the variation in sagittal parameters and the improvement in VAS scale, it was found that the TPA showed a strong correlation (r = 0.709, p = 0.032). Conclusions the present study found a strong correlation between the improvement/reduction in TPA values and the reduction in pain intensity in the VAS. Level of evidence IV; Case Series.

Download Full-text

Postoperative follow-up time and justification in prospective hand surgery research: a systematic review

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420931478 ◽

2020 ◽

Vol 45 (9) ◽

pp. 899-903

Author(s):

Rachel C. Hooper ◽

Jacob S. Nasser ◽

Helen E. Huetteman ◽

Shale J. Mack ◽

Kevin C. Chung

Keyword(s):

Carpal Tunnel Release ◽

Demographic Data ◽

Tendon Repair ◽

Hand Surgery ◽

Level Of Evidence ◽

Thumb Carpometacarpal Joint ◽

Expected Time ◽

Surgery Research ◽

Thumb Carpometacarpal

We systematically reviewed prospective studies for five hand procedures to analyse postoperative follow-up time, clinical or radiographic plateau, and whether the authors provide justification for times used. Demographic data, outcomes and mean follow-up were analysed. A total of 188 articles met our inclusion criteria. The mean postoperative follow-up time among these studies were carpal tunnel release, 21 months (range 1.5–111); cubital tunnel release, 27 months (2.5–46); open reduction and internal fixation for the distal radius fracture, 24 months (3–120); thumb carpometacarpal joint arthroplasty, 64 months (8.5–228); and flexor tendon repair, 25 months (3–59). Authors provided justification for follow-up intervals in 10% of these reports. We conclude that most prospective clinical studies in hand surgery do not properly justify follow-up length. Clinically unnecessary follow-up is costly without much benefit. In prospective research, we believe justified postoperative follow-up is essential, based on expected time to detect clinical plateau, capture complications and determine the need for secondary surgery. Level of evidence: III

Download Full-text

Third reported case of rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-En-Y gastric bypass: case report and literature review

Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity ◽

10.1007/s40519-021-01154-z ◽

2021 ◽

Author(s):

Yassmin Salaheldin ◽

Walid El Ansari ◽

Esraa Aljaloudi ◽

Wahiba Elhag

Keyword(s):

Bariatric Surgery ◽

Gastric Bypass ◽

Risk Factor ◽

Case Report ◽

Zinc Deficiency ◽

Nutritional Deficiencies ◽

Level Of Evidence ◽

Necrolytic Migratory Erythema ◽

High Index Of Suspicion

Abstract Introduction Obesity is a risk factor for zinc deficiency. After bariatric surgery, non-compliance to diet/vitamin supplements, surgical complications leading to vomiting/diarrhea, poor follow-up and malabsorption can precipitate or exacerbate pre-existing zinc deficiency. Case report We report a patient with rare necrolytic migratory erythema associated with bacteraemia due to severe zinc deficiency after revisional Roux-en-Y gastric bypass (following primary laparoscopic sleeve gastrectomy). Conclusion Bariatric teams should screen patients before bariatric surgery for nutritional deficiencies and continue surveillance of their nutritional status after surgery. They should maintain a high index of suspicion for zinc deficiency in patients with skin rash after bariatric surgery. Level of evidence Level V, case report.

Download Full-text

Does the IOFix implant Improve Union Rates?

10.21203/rs.3.rs-22714/v2 ◽

2020 ◽

Author(s):

david segal ◽

Nissim Ohana ◽

Meir Nyska ◽

Ezequiel Palmanovich

Keyword(s):

Demographic Data ◽

Retrospective Chart Review ◽

Fusion Rate ◽

Hallux Rigidus ◽

Hardware Removal ◽

Functional Score ◽

Level Of Evidence ◽

Operation Rate ◽

The Mean

Abstract BACKGROUND First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. METHODS We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. RESULTS Thirty patients were included in the study. The mean age was 60.36±9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2±12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5±10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%.CONCLUSIONS This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices.LEVEL OF EVIDENCE: 4

Download Full-text

Influence of social deprivation on provision of bariatric surgery: 10-year comparative ecological study between two UK specialist centres

BMJ Open ◽

10.1136/bmjopen-2016-015453 ◽

2017 ◽

Vol 7 (10) ◽

pp. e015453 ◽

Cited By ~ 3

Author(s):

Shivam Bhanderi ◽

Mushfique Alam ◽

Jacob Henry Matthews ◽

Gavin Rudge ◽

Hamish Noble ◽

...

Keyword(s):

Bariatric Surgery ◽

Ecological Study ◽

Social Deprivation ◽

Demographic Data ◽

Socioeconomic Deprivation ◽

Obesity Prevalence ◽

Case Volume ◽

Prevalence Of Obesity ◽

National Analysis ◽

The Relationship

ObjectiveTo investigate the effect of residential location and socioeconomic deprivation on the provision of bariatric surgery.DesignRetrospective cross-sectional ecological study.SettingPatients resident local to one of two specialist bariatric units, in different regions of the UK, who received obesity surgery between 2003 and 2013.MethodsDemographic data were collected from prospectively collected databases. Index of Multiple Deprivation (IMD 2010) was used as a measure of socioeconomic status. Obesity prevalences were obtained from Public Health England (2006). Patients were split into three IMD tertiles (high, median, low) and also tertiles of time. A generalised linear model was generated for each time period to investigate the effect of socioeconomic deprivation on the relationship between bariatric case count and prevalence of obesity. We used these to estimate surgical intervention provided in each population in each period at differing levels of deprivation.ResultsData were included from 1163 bariatric cases (centre 1–414, centre 2–749). Incidence rate ratios (IRRs) were calculated to measure the associations between predictor and response variables. Associations were highly non-linear and changed over the 10-year study period. In general, the relationship between surgical case volume and obesity prevalence has weakened over time, with high volumes becoming less associated with prevalence of obesity.DiscussionAs bariatric services have matured, the associations between demand and supply factors have changed. Socioeconomic deprivation is not apparently a barrier to service provision more recently, but the positive relationships between obesity and surgical volume we would expect to find are absent. This suggests that interventions are not being taken up in the areas of need. We recommend a more detailed national analysis of the relationship between supply side and demand side factors in the provision of bariatric surgery.

Download Full-text

Effect of Fixation Type and Bone Graft on Tarsometatarsal Fusion

Foot & Ankle International ◽

10.1177/1071100718793567 ◽

2018 ◽

Vol 39 (12) ◽

pp. 1394-1402 ◽

Cited By ~ 7

Author(s):

Matteo Buda ◽

Noortje Catharina Hagemeijer ◽

Shaun Kink ◽

Anne Holly Johnson ◽

Daniel Guss ◽

...

Keyword(s):

Risk Factors ◽

Bone Graft ◽

Plate Fixation ◽

Demographic Data ◽

Perioperative Period ◽

Fixation Method ◽

Autogenous Bone ◽

Level Of Evidence ◽

The Impact

Background: End-stage tarsometatarsal (TMT) arthritis is commonly treated with arthrodesis of involved joints. Fixation hardware can consist of varying combinations of screws, plates, and staples with or without supplemental bone graft. There are limited data to demonstrate either superiority of a given fixation method or the impact of bone graft on fusion rates. The purpose of this study, therefore, was to determine whether nonunion rates after TMT arthrodesis were influenced by either the use of screw vs plate fixation or the addition of bone graft vs no bone graft. Methods: All patients older than 18 years undergoing arthrodesis for TMT arthritis between July 1991 and July 2016 were identified retrospectively. Exclusion criteria included less than 12 months follow-up, prior midfoot surgery, any added procedure beyond TMT arthrodesis using plates or screws, and acute foot trauma. All patients with radiographic or clinical nonunion, including those requiring revision surgery, were identified. Demographic data and associated risk factors were recorded via chart and radiographic image review. Eighty-eight patients (88 feet, mean follow-up: 75.1 ± 51.4; range, 12-179), with a total of 189 joints and who met enrollment criteria were treated by 9 different surgeons with arthrodesis. Results: The overall nonunion rate was 11.4%. Significant independent risk factors associated with nonunion were (1) arthrodesis using plate fixation with all screws through the plate (odds ratio [OR], 6.2; 95% confidence interval [CI], 1.8-21.3; P = .004), (2) smoking during the perioperative period (OR, 7.9; 95% CI, 2.1-30.2; P = .002), and (3) postoperative nonanatomic alignment (OR, 11.2; 95% CI, 2.1-60.8; P = .005). Bone graft utilization was found to significantly lower the rate of nonunion (OR, 0.2; 95% CI, 0.1-0.6; P = .006). Conclusion: Isolated plate fixation, smoking, and postoperative nonanatomic alignment appear to significantly increase the rate of nonunion among patients undergoing TMT arthrodesis for midfoot arthritis. Concomitant use of autogenous bone graft significantly decreased this risk. Level of Evidence: Level III, retrospective comparative study.

Download Full-text

Does the IOFix implant improve union rates?

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03689-1 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

David Segal ◽

Nissim Ohana ◽

Meir Nyska ◽

Ezequiel Palmanovich

Keyword(s):

Demographic Data ◽

Retrospective Chart Review ◽

Fusion Rate ◽

Hallux Rigidus ◽

Hardware Removal ◽

Functional Score ◽

Level Of Evidence ◽

Operation Rate ◽

The Mean

Abstract Background First metatarso-phalangeal joint fusion is the current gold standard for severe hallux rigidus. Data regarding the union rate and the re-operation rate when IOFix (an Intra-osseous fixation device, Extremity medical, New Jersey, USA) is used for hallux rigidus fusion is limited but promising. The aim of this study was to review our outcomes with the IOFix implant. Methods We have conducted a retrospective chart review, following the approval of the hospital IRB committee. Exclusion criteria included bilateral operations on the same patient, multiple surgeries, charcot foot or other structural foot abnormalities (except hallux valgus), rheumatoid arthritis and a recent foot trauma. We collected demographic data, physical examination documentation, functional score evaluations (AOFAS), and Plain radiographic studies. Results Thirty patients were included in the study. The mean age was 60.36 ± 9.12 (range 36 to 77) years, 18 (60%) female patients and 12 (40%) male. Fourteen (53.33%) were left side pathologies. The average follow up period was 36.2 ± 12.31 (range 12 to 54) months. Union was obtained in 28 (93.33%) patients, of whom none had requested a hardware removal due to a prominent hardware during a minimum of 2 year follow up period. The mean postoperative AOFAS score was 80.5 ± 10.87 (range 35 to 90). A more stringent inclusion criteria and fusion definitions would have led to an exclusion of two more patients and a dropout of two patients from the “fused” group, which would have led to a fusion rate of 85.71%. Conclusions This is the largest series of hallux rigidus patients that were operated with an IOFix device. The rates of fusion and hardware removal in MTPJ1 arthrodesis performed with an IOFix implant were found to be similar at most when compared to previously described rates that were obtained with other cheaper and more simple fixation devices. Level of evidence 4

Download Full-text

Depression, anxiety, and suicidal ideation in young adults 5 years after undergoing bariatric surgery as adolescents

Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity ◽

10.1007/s40519-020-01024-0 ◽

2020 ◽

Author(s):

Kajsa Järvholm ◽

Torsten Olbers ◽

Markku Peltonen ◽

Claude Marcus ◽

Carl-Erik Flodmark ◽

...

Keyword(s):

Mental Health ◽

Bariatric Surgery ◽

Young Adults ◽

Suicidal Ideation ◽

Depression And Anxiety ◽

Level Of Evidence ◽

Clinical Trial Registration ◽

Symptoms Of Depression ◽

The Mean

Abstract Purpose Metabolic and bariatric surgery (MBS) is increasingly used in adolescents. The aim was to explore symptoms of depression and anxiety in young adults over 5 years’ follow-up after undergoing MBS. Methods Beck Depression Inventory-2 and the Beck Anxiety Inventory were used to assess symptoms of depression and anxiety in 62 patients 1, 2, and 5 years after having Roux-en-Y gastric bypass at 13–18 years of age. Mental health, eating-related problems, and weight outcomes were tested for association with suicidal ideation at the 5-year follow-up. Results At the 5-year follow-up, the mean score for depression was 11.4 (± 12.4), indicating minimal symptoms of depression. The mean score for anxiety was 12.82 (± 11.50), indicating mild anxiety symptoms. Still, several participants reported moderate or severe symptoms of depression (26%) and anxiety (32%). Women reported more symptoms than men (P = 0.03 and 0.04). No significant changes were found in self-reported symptoms of depression and anxiety between the 1-year and the 5-year follow-up (P = 0.367 and 0.934). Suicidal ideation was reported by 16% at the 5-year follow-up. Participants reporting suicidal ideation had lost significantly less excess weight than participants without suicidal ideation (P = 0.009). Conclusion Five years after adolescent MBS, a substantial minority still struggles with mental health issues, and women are more burdened than men. Our results indicate an association between less optimal weight loss and suicidal ideation 5 years after MBS. The findings emphasize the importance of offering long-term follow-up and mental health treatment several years after MBS. Level of evidence Level III, cohort study. Clinical trial registration The study is registered with ClinicalTrials.gov (NCT00289705). First posted February 10, 2006.

Download Full-text

Treatment of Proximal Fifth Metatarsal Fractures and Refractures With Plantar Plating in Elite Athletes

Foot & Ankle International ◽

10.1177/1071100718791835 ◽

2018 ◽

Vol 39 (12) ◽

pp. 1410-1415 ◽

Cited By ~ 7

Author(s):

Derek T. Bernstein ◽

Ronald J. Mitchell ◽

Patrick C. McCulloch ◽

Joshua D. Harris ◽

Kevin E. Varner

Keyword(s):

Elite Athletes ◽

Demographic Data ◽

Case Series ◽

Radiographic Evaluation ◽

Autogenous Bone ◽

Level Of Evidence ◽

Patient Reported ◽

Metatarsal Fracture ◽

Metatarsal Fractures

Background: Fractures of the proximal fifth metatarsal are relatively common foot injuries in elite athletes. Acute fixation with intramedullary screws is the most common operative treatment. However, the rate of nonunion and refracture after this procedure remains a concern. The purpose of this study was to determine rates of clinical and radiographic fracture healing, return to sport, and patient-reported clinical outcomes of elite athletes with proximal fifth metatarsal fracture or refracture treated with plantar plating. Methods: An institutional review board–approved retrospective single-surgeon case series investigation assessed athletes (competing at college, Olympic, or professional levels) with proximal fifth metatarsal fracture or refracture, treated with open reduction internal fixation and calcaneal autogenous bone grafting using a plantar plate with a minimum 2-year follow-up. Demographic data, radiographic evaluation, and the time until return to unrestricted sporting competition were collected and analyzed. Means with standard deviations were calculated for continuous data, and frequencies of categorical data were calculated in percentages. Results: Four refractures and 4 primary fractures were treated in 8 male athletes with a mean age of 21.9 ± 1.9 years at a mean follow-up of 3.2 ± 0.4 years. Two patients experienced temporary neuropraxia of the sural nerve that resolved within 6 weeks. There were no incisional complications, delayed unions or nonunions, refractures, hardware loosening, or complaints of hardware prominence. Clinically asymptomatic radiographic union was observed in 100% of the athletes at 6.5 ± 1.1 weeks and full release given at 12.3 ± 1.9 weeks. All athletes returned to sport at the same level of competition. Conclusion: With minimum 2-year follow-up, plantar plating of proximal fifth metatarsal fractures was an effective and safe technique that was used in both primary and revision settings. Level of Evidence: Level IV, case series.

Download Full-text

THE USE OF CRANIAL HALO TRACTION VERSUS TEMPORARY INTERNAL DISTRACTION IN STAGED SURGERY FOR SEVERE SCOLIOSIS: A COMPARATIVE STUDY

Coluna/Columna ◽

10.1590/s1808-185120212004250449 ◽

2021 ◽

Vol 20 (4) ◽

pp. 254-259

Author(s):

José Alberto Alves Oliveira ◽

Antônio Cardoso Paiva ◽

Pedro Paschoal Cassapis Cardoso Afonso ◽

Paulo Cesar Almeida ◽

Rogério dos Reis Visconti ◽

...

Keyword(s):

Demographic Data ◽

Level Of Evidence ◽

Severe Scoliosis ◽

Halo Traction ◽

Definitive Surgery ◽

Student’S T ◽

Vertebral Resection ◽

Internal Distraction ◽

Student’S T Test

ABSTRACT Objective: To determine which method is more effective – cranial halo traction or temporary internal distraction – in staged surgeries for patients with severe (≥ 100°) and stiff (<25% flexibility) scoliosis. Methods: A sample of 12 patients with traction and 7 patients without traction, operated on between January 2013 and December 2017. The patients’ demographic data, the type of surgery performed, complications, and coronal and sagittal alignment parameters were recorded before surgery and in the final follow-up. The data were processed in SPSS 20.0. Comparisons were made between the means (Student's t-test) and the clinical and procedure-related characteristics (likelihood ratio and Fisher's Exact tests), at a confidence level of 0.05. Results: There were no significant intergroup differences for clinical characteristics, complications or degree of correction. However, more patients in the group submitted to temporary internal distraction required vertebral resection osteotomies during definitive surgery (p<0.05). Conclusions: Based on the results, it was not possible to establish which is the most effective method, but it is suggested that staged traction may be more effective, and safer, particularly when the surgeon is less experienced, during surgery on patients with severe and stiff scoliosis. Level of evidence IV; Vase series.

Download Full-text