scholarly journals POS1383 THE ASSOCIATION BETWEEN BARIATRIC SURGERY AND DUPUYTREN DISEASE: A COHORT STUDY FROM SWEDISH NATIONWIDE HEALTHCARE REGISTRIES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 974.3-975
Author(s):  
T. Burkard ◽  
J. Lane ◽  
D. Holmberg ◽  
A. M. Burden ◽  
D. Furniss
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Weight Loss ◽  
Cohort Study ◽  
Secondary Care ◽  
High Body Mass Index ◽  
Null Result ◽  
Increased Risk ◽  
Dupuytren Disease

Background:Dupuytren disease (DD) is multifactorial, with several genetic and environmental risk factors contributing to disease susceptibility. High body mass index, however, was suggested to be protective of DD.1 The impact of weight loss among obese patients on DD has not been assessed to date.Objectives:To assess the association between bariatric surgery and DD in a secondary care setting.Methods:We performed a propensity score (PS)-matched cohort study using data from Swedish nationwide healthcare registries (patient registry [secondary care], causes of death registry, prescribed drug registry). Patients aged 30-79 years who underwent bariatric surgery between 2006 and 2019 were matched to up to 2 obese bariatric surgery-free patients (called unexposed patients) based on their PS. PS-matching was carried out in risk set sampling to reduce selection bias, within 4 sequential cohort entry blocks to account for time trend biases. The outcome DD was defined as a diagnosis of DD in secondary care or partial or total fasciotomy of wrist or hand. After a 1-year run-in period, patients were followed in an “as-treated” approach. We applied Cox proportional hazard regression to calculate hazard ratios (HR) with 95% confidence intervals (CIs) of incident DD among bariatric surgery patients when compared to obese unexposed patients overall, and in subgroups of age, sex, bariatric surgery type, and by duration of follow-up.Results:A total of 34 959 bariatric surgery patients were PS-matched to 54 769 obese unexposed patients. A total of 71.6% of bariatric surgery patients were women. Bariatric surgery patients had a mean age of 45.5 years and a mean follow-up of 6.9 years. All patient characteristics in obese unexposed patients were highly similar. We observed 126 and 136 severe DD cases among bariatric surgery and obese unexposed patients, respectively. The risk of DD was significantly increased in bariatric surgery patients compared to obese unexposed patients (HR = 1.30, 95% CI 1.02-1.65). The risk of DD was higher in women (HR = 1.36, 95% CI 1.00-1.84) than in men (HR = 1.05, 95% CI 0.70-1.58). Age did not modify the risk of DD among bariatric surgery patients compared to obese unexposed patients. Malabsorptive bariatric surgery yielded an increased risk of DD when compared to obese unexposed patients (HR = 1.33, 95% CI 1.04-1.71), while restrictive bariatric surgery yielded a null result. The risk of DD increased with duration of follow-up (>5 years of follow-up: HR = 1.63, 95% CI 1.14-2.34, null result in earlier follow-up).Conclusion:Our results suggest that substantial weight loss is associated with a latent increased risk of severe DD in an obese population. This observation further strengthens current evidence that high body mass index is protective against DD. The latency of risk increase of DD after bariatric surgery may suggest that slowly adapting metabolic changes may be part of the mechanism of DD emergence.References:[1]Hacquebord JH, Chiu VY, Harness NG. The Risk of Dupuytren Surgery in Obese Individuals. J Hand Surg Am. 2017, 42: 149–55.Acknowledgements:We thank Prof. Dr. Jesper Lagergren (Karolinksa Institutet, Stockholm, Sweden) for hosting Dr. Theresa Burkard for a research stay at the Upper Gastrointestinal Surgery Group and making the data available for use. Furthermore, we thank Dr. Giola Santoni (Karolinksa Institutet, Stockholm, Sweden) for her technical support.Disclosure of Interests:None declared

scholarly journals POS0011 THE ASSOCIATION BETWEEN BARIATRIC SURGERY AND CARPAL TUNNEL SYNDROME: A COHORT STUDY FROM SWEDISH NATIONWIDE HEALTHCARE REGISTRIES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 207.2-208
Author(s):  
J. Lane ◽  
D. Holmberg ◽  
A. M. Burden ◽  
D. Furniss ◽  
T. Burkard
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Cohort Study ◽  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Secondary Care ◽  
Observational Research ◽  
Tunnel Syndrome ◽  
Restrictive Bariatric Surgery

Background:Carpal tunnel syndrome (CTS) is a chronic compression neuropathy caused by entrapment of the median nerve in the wrist causing pain and sensory loss. Prior observational research suggested that obesity increased the risk of CTS. However, the impact of weight loss among obese patients on CTS has not been assessed to date.Objectives:To assess the association between bariatric surgery and CTS in a secondary care setting.Methods:We performed a propensity score (PS)-matched cohort study using data from Swedish nationwide healthcare registries (patient registry [secondary care], causes of death registry, prescribed drug registry). Patients aged 18-79 years who underwent bariatric surgery between 2006 and 2019 were matched to up to 2 obese bariatric surgery-free patients (called unexposed patients) based on their PS. PS-matching was carried out in risk set sampling to reduce selection bias, within 4 sequential cohort entry blocks to account for time trend biases. The outcome CTS was defined as a diagnosis of CTS in secondary care or carpal tunnel decompression surgery. After a 1-year run-in period, patients were followed in an “as-treated” approach. We applied Cox proportional hazard regression to calculate hazard ratios (HR) with 95% confidence intervals (CIs) of CTS among bariatric surgery patients when compared to obese unexposed patients overall, and in subgroups of age, sex, bariatric surgery type, and by duration of follow-up.Results:A total of 40 619 bariatric surgery patients were PS-matched to 63 540 obese unexposed patients. A total of 72.3% of bariatric surgery patients were women. Bariatric surgery patients had a mean age of 41.7 years and a mean follow-up of 6.8 years. All patient characteristics in obese unexposed patients were highly similar. We observed 1 356 and 1 938 severe CTS cases among bariatric surgery and obese unexposed patients, respectively. Bariatric surgery was not associated overall with CTS (HR of 0.98, 95% CI 0.91-1.05). However, the risk of CTS seemed to decrease with age at bariatric surgery – the lowest CTS risk was observed among bariatric surgery patients aged 18-34 years (HR of 0.87, 95% CI 0.74-1.01), when compared to obese unexposed patients. Sex did not modify the risk of CTS among bariatric surgery patients compared to obese unexposed patients. Restrictive bariatric surgery yielded lower risks of CTS (HRs of 0.81, 95% CI 0.69-0.88) than did malabsorptive bariatric surgery (HR of 0.95, 95% CI 0.88-1.02) when compared to obese unexposed patients. The risk of CTS increased with duration of follow-up. The lowest risk was observed 1-3 years after bariatric surgery (HR of 0.77, 95% CI 0.68-0.88) and the highest risk 6-13 years after bariatric surgery (HR of 1.20, 95% CI 1.05-1.36) when compared to obese unexposed patients.Conclusion:Our results suggest that substantial weight loss is not overall associated with severe CTS in an obese patient population. However, bariatric surgery was associated with an initial decreased risk of CTS after bariatric surgery followed by an increased risk in later follow-up. Furthermore, restrictive bariatric surgery but not malapsorptive bariatric surgery was associated with a decreased risk of CTS.Acknowledgements:We thank Prof. Dr. Jesper Lagergren (Karolinksa Institutet, Stockholm, Sweden) for hosting Dr. Theresa Burkard for a research stay at the Upper Gastrointestinal Surgery Group and making the data available for use. Furthermore, we thank Dr. Giola Santoni (Karolinksa Institutet, Stockholm, Sweden) for her technical support.Disclosure of Interests:None declared.

scholarly journals Physical activity modifies the risk of atrial fibrillation in obese individuals: The HUNT3 study

2018 ◽  
Vol 25 (15) ◽  
pp. 1646-1652 ◽  
Author(s):  
Lars E Garnvik ◽  
Vegard Malmo ◽  
Imre Janszky ◽  
Ulrik Wisløff ◽  
Jan P Loennechen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Confidence Interval ◽  
Body Mass ◽  
High Body Mass Index ◽  
Overweight And Obesity ◽  
Hazard Ratio ◽  
Increased Risk

Background Atrial fibrillation is the most common heart rhythm disorder, and high body mass index is a well-established risk factor for atrial fibrillation. The objective of this study was to examine the associations of physical activity and body mass index and risk of atrial fibrillation, and the modifying role of physical activity on the association between body mass index and atrial fibrillation. Design The design was a prospective cohort study. Methods This study followed 43,602 men and women from the HUNT3 study in 2006–2008 until first atrial fibrillation diagnosis or end of follow-up in 2015. Atrial fibrillation diagnoses were collected from hospital registers and validated by medical doctors. Cox proportional hazard regression analysis was performed to assess the association between physical activity, body mass index and atrial fibrillation. Results During a mean follow-up of 8.1 years (352,770 person-years), 1459 cases of atrial fibrillation were detected (4.1 events per 1000 person-years). Increasing levels of physical activity were associated with gradually lower risk of atrial fibrillation ( p trend 0.069). Overweight and obesity were associated with an 18% (hazard ratio 1.18, 95% confidence interval 1.03–1.35) and 59% (hazard ratio 1.59, 95% confidence interval 1.37–1.84) increased risk of atrial fibrillation, respectively. High levels of physical activity attenuated some of the higher atrial fibrillation risk in obese individuals (hazard ratio 1.53, 95% confidence interval 1.03–2.28 in active and 1.96, 95% confidence interval 1.44–2.67 in inactive) compared to normal weight active individuals. Conclusion Overweight and obesity were associated with increased risk of atrial fibrillation. Physical activity offsets some, but not all, atrial fibrillation risk associated with obesity.

Associations of BMI and Serum Urate with Developing Dementia: A Prospective Cohort Study

2020 ◽  
Vol 105 (12) ◽  
pp. e4688-e4698
Author(s):  
Zhi Cao ◽  
Chenjie Xu ◽  
Hongxi Yang ◽  
Shu Li ◽  
Fusheng Xu ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cohort Study ◽  
Lower Risk ◽  
Serum Urate ◽  
Healthy Weight ◽  
Uk Biobank ◽  
Health Records ◽  
Increased Risk ◽  
The Uk

Abstract Context Recent studies have suggested that a higher body mass index (BMI) and serum urate levels were associated with a lower risk of developing dementia. However, these reverse relationships remain controversial, and whether serum urate and BMI confound each other is not well established. Objectives To investigate the independent associations of BMI and urate, as well as their interaction with the risk of developing dementia. Design and Settings We analyzed a cohort of 502 528 individuals derived from the UK Biobank that included people aged 37–73 years for whom BMI and urate were recorded between 2006 and 2010. Dementia was ascertained at follow-up using electronic health records. Results During a median of 8.1 years of follow-up, a total of 2138 participants developed dementia. People who were underweight had an increased risk of dementia (hazard ratio [HR] = 1.91, 95% confidence interval [CI]: 1.24–2.97) compared with people of a healthy weight. However, the risk of dementia continued to fall as weight increased, as those who were overweight and obese were 19% (HR = 0.81, 95%: 0.73–0.90) and 22% (HR = 0.78, 95% CI: 0.68–0.88) were less likely to develop dementia than people of a healthy weight. People in the highest quintile of urate were also associated with a 25% (HR = 0.75, 95% CI: 0.64–0.87) reduction in the risk of developing dementia compared with those who were in the lowest quintile. There was a significant multiplicative interaction between BMI and urate in relation to dementia (P for interaction = 0.004), and obesity strengthens the protective effect of serum urate on the risk of dementia. Conclusion Both BMI and urate are independent predictors of dementia, and there are inverse monotonic and dose-response associations of BMI and urate with dementia.

scholarly journals Association Between Body Mass Index, Its Change And Cognitive Impairment Among Chinese Older Adults: A Community-Based, 9-Year Prospective Cohort Study

2021 ◽  
Author(s):  
Shanshan Wu ◽  
Xiaozhen Lv ◽  
Jie Shen ◽  
Hui Chen ◽  
Yuan Ma ◽  
...  
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Weight Loss ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Prospective Cohort ◽  
Community Based ◽  
Chinese Older Adults ◽  
Large Weight Loss ◽  
Increased Risk

Abstract Objective To examine the association of baseline body mass index (BMI) and BMI change with cognitive impairment among older adults in China. Methods The study included data from the Chinese Longitudinal Healthy Longevity Study, a national community-based prospective cohort study from 2002-2018. Baseline BMI and BMI change measurements were available for 12,027 adults aged older than 65 years. Cognitive impairment was defined as Chinese version of the Mini Mental State Examination score less than 18. Multivariable Cox proportional hazard model was used.Results Among 12027 participants (mean age was 81.23 years old and 47.48% were male), the proportion of underweight, normal, overweight and obese at baseline was 33.87%, 51.39%, 11.39% and 3.34%, respectively. During an average of 5.9 years’ follow-up, 3086 participants (4.35 per 100 person-years) with incident cognitive impairment were identified. Compared with normal weight group, adjusted hazard ratio (AHR) for cognitive impairment was 0.86 (95% CI 0.75-0.99) among overweight group, whereas corresponding AHR was 1.02 (95% CI 0.94-1.10) in underweight and 1.01 (95% CI 0.80-1.28) in obese. Large weight loss (<-10%) was significantly associated with an increased risk of cognitive impairment (AHR, 1.42, 95% CI 1.29-1.56), compared to stable weight status group (-5%~5%). In the restricted cubic spline models, BMI change showed a L-shaped association with cognitive impairment. Conclusions BMI-defined overweight is associated with a reduced risk of cognitive impairment among Chinese older adults, while large weight loss is associated with increased risk. More attention should be paid to older adults with significant weight loss.

Association of body mass index changes from childhood to adulthood with dyslipidemia in adults: Hanzhong adolescent cohort study

2020 ◽  
Author(s):  
Yue-Yuan Liao ◽  
Chao Chu ◽  
Yang Wang ◽  
Wen-Ling Zheng ◽  
Qiong Ma ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Body Mass ◽  
Rural Areas ◽  
Normal Weight ◽  
Increased Risk ◽  
And Control ◽  
Early Weight Loss

Abstract Background Dyslipidemia is a disorder of lipid metabolism and associated with insulin resistance. The relationship between longitudinal body mass index (BMI) changes from childhood to adulthood and long-term dyslipidemia was explored in this study. Methods We assessed the longitudinal relationship between BMI changes since childhood and dyslipidemia among 1738 participants in rural areas of Hanzhong City, Shaanxi. All participants were initially examined between the ages of 6 and 15 years in 1987 and were reexamined in 1995, 2013 and 2017; the total follow-up duration was 30 years. Anthropometric measurements and blood biochemistry indexes were measured. Results We found that gradual progression of normal weight to overweight (OR = 1.65; 95% CI = 1.27, 2.15) or persistent overweight (OR = 2.45; 95% CI = 1.52, 3.96) from childhood to adulthood was associated with an increased risk of dyslipidemia in adulthood. And these risks were largely disappeared if the overweight or obesity during childhood was resolved by adulthood. The higher the BMI in adulthood and the younger the age at which overweight begins, the higher the risk of dyslipidemia. Conclusions Early weight loss and any degree of weight loss from childhood to adulthood can help improve dyslipidemia in adulthood. We further emphasize the importance of weight management and control in public health primary prevention.

scholarly journals High prevalence of cardiac dysfunction or overt heart failure in 71-year-old men: A 21-year follow-up of “The Study of men born in 1943”

2019 ◽  
Vol 27 (7) ◽  
pp. 717-725 ◽  
Author(s):  
Xiaojing Chen ◽  
Erik Thunström ◽  
Per-Olof Hansson ◽  
Annika Rosengren ◽  
Zacharias Mandalenakis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Body Mass Index ◽  
Random Sample ◽  
Body Mass ◽  
Cardiac Dysfunction ◽  
High Body Mass Index ◽  
Increased Risk ◽  
Old Men

Background Knowledge about long-term risk factors and the prevalence of heart failure stages in general population is limited. We aimed to study the prevalence of cardiac dysfunction and heart failure in 71-year-old men and potential risk factors in the past two decades. Design This research was based on a randomized selected population study with longitudinal follow-up. Methods A random sample of men born in 1943 in Gothenburg, Sweden were examined in 1993 (at 50 years of age) and re-examined 21 years later in 2014 (at 71 years of age). Cardiac dysfunction or heart failure was classified into four stages (A–D) according to American Heart Association/American College of Cardiology guidelines on heart failure. Results Of the 798 men examined in 1993 (overall cohort), 535 (67%) were re-examined in 2014 (echo cohort). In the echo cohort 122 (23%) men had normal cardiac function, 135 (25%) were at stage A, 207 (39%) men were at stage B, 66 (12%) men were at stage C, and five (1%) men were at stage D. Multivariable logistic regression demonstrated that elevated body mass index at 50 years old was the only independent risk factor for developing heart failure/cardiac dysfunction during the subsequent 21 years. For each unit (1 kg/m2) of increased body mass index, the odds ratio for stages C/D heart failure vs no heart failure/stage A increased by 1.20 (95% confidence interval, 1.11–1.31, p < 0.001), after adjustment for smoking, sedentary life style, systolic blood pressure, diabetes, and hyperlipidemia. Conclusion In a random sample of men at 71 years of age, half presented with either cardiac dysfunction or clinical heart failure. High body mass index was associated with an increased risk for developing cardiac dysfunction or heart failure over a 21-year period.

scholarly journals Clinical Outcomes of Bariatric Surgery Among Military Retirees and Beneficiaries: A Retrospective Cohort Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1677-1677
Author(s):  
Joshua Roe ◽  
Brenda Bustillos ◽  
Adam Kieffer
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Cohort Study ◽  
Clinical Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Military Retirees ◽  
Student’S T ◽  
One Year

Abstract Objectives Obesity prevalence is estimated at 34% in U.S. military retirees and 28% in beneficiaries of military healthcare, with common comorbidities being type 2 diabetes (T2D), hypertension, and hyperlipidemia. Stressors experienced during active duty service result in higher risk for disabling musculoskeletal injuries, psychological trauma, and alcohol abuse; all of which debilitate healthy weight loss efforts. No literature exists on the demographics and clinical outcomes of military retirees who elect bariatric surgery. The purpose of this study was to assess demographics and determine clinical outcomes of retirees and beneficiaries following bariatric surgery. It was hypothesized that pre-operative weights and comorbidity remission would be higher in the military retiree group. Methods A retrospective cohort study assessed military retirees and beneficiaries who underwent sleeve gastrectomy or gastric bypass surgery at a military treatment facility in 2014. Percent total weight loss (%TWL) and remission of pre-existing comorbidities (T2D, hypertension, and hyperlipidemia) at one year follow-up were primary outcomes and compared using Student's T tests and chi-squared contingency analysis. Additional statistical analyses included a Wilcoxon-Mann-Whitney test and backwards stepwise regression. Results Ninety-eight patients (64 beneficiaries and 34 retirees) were included with mean ages of 48 and 52 years, respectively. Student's T test and Wilcoxon-Mann-Whitney test confirmed that beneficiaries achieved greater %TWL at one year follow-up, 30.2% vs. 25.8% (p &lt; 0.05) and 55.5 vs. 38.2 mean rank (p &lt; 0.01), respectively. Beneficiaries and retirees achieved similar remission of T2D, hypertension, and hyperlipidemia. Patient's sex and surgery type were significant predictors of %TWL variation between groups at one year follow-up. These variables accounted for 9% of the %TWL variance. Conclusions Retirees who elect bariatric surgery lose less weight than their beneficiary counterparts. Etiology of this poorer outcome remains unclear, but further research may demonstrate need for improving healthcare resources provided to military retirees. Funding Sources No funding was received to support this study.

scholarly journals Use of Pharmacotherapy in Obesity Management

2021 ◽  
Vol 47 (5) ◽  
Author(s):  
Kwang Wei Tham
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Weight Loss ◽  
Weight Regain ◽  
Energy Homeostasis ◽  
Weight Maintenance ◽  
High Body Mass Index ◽  
Obesity Management ◽  
Behavioural Modification ◽  
Successful Weight Loss

Obesity is a chronic disease which is often relapsing and progressive due in part to the physiology of energy homeostasis in people with obesity, rendering them with the challenge of attaining adequate weight loss and weight maintenance after successful weight loss. Depending on the presence, types and severity of the obesity-related comorbidities (ORCs), some patients will require an amount of weight loss beyond what lifestyle and behavioural modification can achieve. Even after bariatric surgery, patients may not lose the expected amount of weight or experience weight regain. Anti-obesity medications may be required to support them further. Hence, the use of pharmacotherapy in obesity management remains an important adjunct to lifestyle and behavioural modifications and even to bariatric surgery, particularly in those with more severe ORCs and with a high body mass index. This article discusses the general approach to the use of pharmacotherapy in obesity management and the various anti-obesity medications currently approved.

scholarly journals Effectiveness of Gastric Bypass Versus Gastric Sleeve for Cardiovascular Disease: Protocol and Baseline Results for a Comparative Effectiveness Study

10.2196/14936 ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. e14936
Author(s):  
Karen J Coleman ◽  
Heidi Fischer ◽  
David E Arterburn ◽  
Douglas Barthold ◽  
Lee J Barton ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Bariatric Surgery ◽  
Health Care ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Cohort Study ◽  
Health Care System ◽  
Comparative Effectiveness ◽  
Gastric Sleeve

Background When compared with conventional weight loss strategies, bariatric surgery results in substantially greater durable weight loss and rates of disease remission. Objective The ENGAGE CVD (Effectiveness of Gastric Bypass versus Gastric Sleeve for Cardiovascular Disease) cohort study aimed to provide population-based, comprehensive, rigorous evidence for clinical and policy decision making regarding the choice between gastric bypass and gastric sleeve for overall cardiovascular disease (CVD) risk reduction, risk factor remission, and safety. Methods The cohort had 22,095 weight loss surgery patients from a large integrated health care system in Southern California assembled from 2009 to 2016 who were followed up through 2018. Bariatric surgery patients were followed up for the length of their membership in the health care system. Of the patients who had at least five years of follow-up (surgery between 2009 and 2013), 85.86% (13,774/16,043) could contribute to the outcome analyses for the ENGAGE CVD cohort. Results Patients in the ENGAGE CVD cohort were 44.6 (SD 11.4) years old, mostly women (17,718/22,095; 80.19%), with 18.94% (4185/22,095) non-Hispanic black and 41.80% (9235/22,095) Hispanic, and had an average BMI of 44.3 (SD 6.9) kg/m2 at the time of surgery. When compared with patients who did not contribute data to the 5-year outcome analysis for the ENGAGE CVD cohort (2269/16,043; 14.14%), patients who contributed data (13,774/16,043; 85.86%) were older (P=.002), more likely to be women (P=.02), more likely to be non-Hispanic white (P<.001), more likely to have had an emergency department visit in the year before surgery (P=.006), less likely to have a mental illness before surgery (P<.001), and more likely to have had a CVD event at any time before surgery (P<.001). Conclusions This study had one of the largest populations of gastric sleeve patients (n=13,459). The 5-year follow-up for those patients who had surgery between 2009 and 2013 was excellent for a retrospective cohort study at 85.86% (13,774/16,043). Unlike almost any study in the literature, the majority of the ENGAGE CVD cohort was racial and ethnic minority, providing a rare opportunity to study the effects of bariatric surgery for different racial and ethnic groups, some of whom have the highest rates of severe obesity in the United States. Finally, it also used state-of-the-art statistical and econometric comparative effectiveness methods to mimic the effect of random assignment and control for sources of confounding inherent in large observational studies. International Registered Report Identifier (IRRID) RR1-10.2196/14936

scholarly journals OP0106 THE ASSOCIATIONS BETWEEN BARIATRIC SURGERY AND HIP OR KNEE ARTHROPLASTY, AND HIP OR KNEE OSTEOARTHRITIS: A COHORT STUDY FROM SWEDISH NATIONWIDE HEALTHCARE REGISTRIES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 59.2-59
Author(s):  
T. Burkard ◽  
D. Holmberg ◽  
T. Hügle ◽  
A. M. Burden
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Body Weight ◽  
Knee Arthroplasty ◽  
Secondary Care ◽  
Obese Patients ◽  
Knee Oa ◽  
Hip And Knee Arthroplasty ◽  
Post Bariatric Surgery

Background:Osteoarthritis (OA) is a slowly developing chronic joint disease mainly characterized by joint pain which may lead to physical disability. OA in weight bearing joints, such as the hip and knee, was suggested to be susceptible to high body weight. In end-stage disease, hip and knee OA are often treated with arthroplasty. The impact of weight loss among obese patients on hip and knee arthroplasty has not been assessed to date.Objectives:To assess the association between bariatric surgery and hip or knee arthroplasty. As a secondary aim, we assessed the association between bariatric surgery and hip or knee OA in a secondary care setting.Methods:We performed a propensity score (PS)-matched cohort study using data from Swedish nationwide healthcare registries (patient registry [secondary care], causes of death registry, prescribed drug registry). Patients aged 18-79 years who underwent bariatric surgery between 2006 and 2019 were matched to up to 2 obese bariatric surgery free patients (called unexposed patients) based on their PS. PS-matching was carried out in risk set sampling to reduce selection bias, within 4 sequential cohort entry blocks to account for time trend biases. The primary outcome was hip or knee arthroplasty. The secondary outcome was a diagnosis of hip or knee OA in secondary care. We excluded patients with differential indications for arthroplasty or OA (e.g. rheumatoid arthritis, septic arthritis). After a 1-year run-in period, patients were followed in an “as-treated” approach until the outcome or censoring due to onset of an exclusion criterion, change of exposure status, or end of study period. We applied Cox proportional hazard regression to calculate hazard ratios (HR) with 95% confidence intervals (CIs) of hip or knee arthroplasty, and separately of hip or knee OA, among bariatric surgery patients when compared to obese unexposed patients. Additionally, we performed analyses in subgroups of age, sex, joint location, bariatric surgery type, and by duration of follow-up.Results:A total of 39 392 bariatric surgery patients were PS-matched to 61 085 obese unexposed patients. The study population had a mean age of 42 years, a mean follow-up of 6.5 years, and 72.5% of patients were women. We observed 1138 and 1108 hip or knee arthroplasties among bariatric surgery and obese unexposed patients, respectively. We observed an overall increased risk of hip or knee arthroplasty among bariatric surgery patients (HR of 1.43, 95% CI 1.32-1.55), compared to obese unexposed patients. The risk for knee arthroplasty was higher than that for hip arthroplasty among bariatric surgery patients (HR of 1.58, 95% CI 1.42-1.76, and HR of 1.21, 95% CI 1.06-1.39, respectively). Patients who underwent combined malabsorptive and restrictive bariatric surgery yielded highest risks of hip or knee arthroplasty (HR of 3.58, 95% CI 1.34-9.54). Risks of hip or knee arthroplasty decreased with duration of follow-up (highest risks 1-3 years post-bariatric surgery, HR of 1.79, 95% CI 1.56-2.07). In secondary analyses, risks of secondary care hip or knee OA were decreased among bariatric surgery versus obese unexposed patients (HR of 0.84, 95% CI 0.79-0.90). We observed lower risks for knee OA (HR of 0.82, 95% CI 0.76-0.88) than for hip OA (HR of 0.90, 95% CI 0.79-1.01) and observed lowest risks of hip or knee OA in early follow-up (1-3 years post-bariatric surgery) with a HR of 0.79, 95% CI 0.71-0.88, stable thereafter at a HR of 0.87, 95% CI 0.78-0.97.Conclusion:Our results suggest that substantial weight loss among obese patients is associated with decreased risks of secondary care hip and knee OA. Increased risks of hip and knee arthroplasty after bariatric surgery are likely the result of increased operability of patients who have lost a substantial amount of excess body weight. Stronger associations for the knee than for the hip in both arthroplasty and OA are consistent with existing literature suggesting a stronger impact of body weight on knee than on hip joints.Acknowledgements:We thank Prof. Dr. Jesper Lagergren (Karolinksa Institutet, Stockholm, Sweden) for hosting Dr. Theresa Burkard for a research stay at the Upper Gastrointestinal Surgery Group and making the data available for use. Furthermore, we thank Dr. Giola Santoni (Karolinksa Institutet, Stockholm, Sweden) for her technical support.Disclosure of Interests:Theresa Burkard: None declared, Dag Holmberg: None declared, Thomas Hügle Consultant of: Pfizer, Abbvie, Novartis, Grant/research support from: GSK, Jansen, Pfizer, Abbvie, Novartis, Roche, MSD, Sanofi, BMS, Eli Lilly, UCB, Andrea Michelle Burden: None declared

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