Abstract 15673: Racial Disparities in Referral for Pre-operative Cardiovascular Evaluation, Surgical Wait Time, and Weight Loss in Patients Undergoing Bariatric Surgery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lauren Tragesser ◽  
Kaitlyn Ibrahim ◽  
Rohit Soans ◽  
Abdullah Haddad ◽  
Raj K Dalsania ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Racial Disparities ◽  
Wait Time ◽  
Similar Proportion ◽  
Postoperative Weight Loss ◽  
Cardiovascular Evaluation ◽  
Cardiac Testing ◽  
Surgical Wait Time ◽  
White Patients

Introduction: White patients undergo bariatric surgery more frequently and with fewer complications compared to non-white patients. Yet, racial disparities in referral pattern for preoperative cardiovascular evaluation (CVE) are unexplored. We hypothesized that racial disparities exist in preoperative CVE in white vs. non-white patients undergoing bariatric surgery. Methods: We identified consecutive patients undergoing bariatric surgery at our institution from 2014-2018. The association of white vs. non-white race with referral for CVE, cardiac testing, surgical wait time, and postoperative weight loss was determined in a multivariate model adjusting for baseline demographic comorbidities and income. Additional adjustment for insurance provider was made for surgical wait time. Results: Of the 797 patients undergoing bariatric surgery during the study period, 86% (n=682) were non-white. White vs. non-white patients had similar age, gender distribution, and prevalence of hypertension, hyperlipidemia, Type 2 diabetes, and heart failure. A similar proportion of whites vs. non-whites were referred to cardiology for pre-operative evaluation (65% vs. 68%, p=0.52), while whites were more likely to undergo further preoperative cardiac testing after adjustment (68% vs. 55%, p=0.04; adjusted, OR 0.6, 95%CI 0.35-1.0, p=0.05). Despite less cardiac testing, non-white patients referred to cardiology waited longer for surgery (9.9 months vs. 12.1 months, p=0.008), including after adjustment (HR 0.7, 95%CI 0.53-0.91, p= 0.008. Weight loss at 6 months was higher in whites (12.9 kg/m 2 vs. 11.95 kg/m 2 , p=0.03), but equivalent at 1 year (whites 14.9 kg/m 2 vs. non-whites 14.3 kg/m 2 , p=0.33). Conclusions: In a bariatric surgery population, white vs. non-white patients were referred for CVE in similar proportion. However, white patients underwent more subsequent cardiac testing pre-operatively when compared to non-whites yet had a shorter wait time for surgery. Early weight loss was greater in whites, but equivalent between groups at 1 year.

Responsiveness of virtual beverage portion size tasks and prediction of postoperative weight loss in bariatric surgery patients.

Appetite ◽  
2021 ◽  
pp. 105574
Author(s):  
Tamima Sultana ◽  
Jeon D. Hamm ◽  
Jany Dotel ◽  
Jeanine Albu ◽  
Subhash Kini ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Portion Size ◽  
Postoperative Weight Loss

scholarly journals The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery

2020 ◽  
Vol 44 (11) ◽  
pp. 2279-2290
Author(s):  
Erik Stenberg ◽  
Ingmar Näslund ◽  
Carina Persson ◽  
Eva Szabo ◽  
Magnus Sundbom ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Socioeconomic Status ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Socioeconomic Factors ◽  
First Generation ◽  
First Generation Immigrants ◽  
Preoperative Body Mass Index ◽  
Postoperative Weight Loss ◽  
The Mean

Abstract Introduction Patients with low socioeconomic status have been reported to have poorer outcome than those with a high socioeconomic status after several types of surgery. The influence of socioeconomic factors on weight loss after bariatric surgery remains unclear. The aim of the present study was to evaluate the association between socioeconomic factors and postoperative weight loss. Materials and methods This was a retrospective, nationwide cohort study with 5-year follow-up data for 13,275 patients operated with primary gastric bypass in Sweden between January 2007 and December 2012 (n = 13,275), linking data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, the Swedish National Patient Register, and the Swedish Prescribed Drugs Register. The assessed socioeconomic variables were education, profession, disposable income, place of residence, marital status, financial aid and heritage. The main outcome was weight loss 5 years after surgery, measured as total weight loss (TWL). Linear regression models, adjusted for age, preoperative body mass index (BMI), sex and comorbid diseases were constructed. Results The mean TWL 5 years after surgery was 28.3 ± 9.86%. In the adjusted model, first-generation immigrants (%TWL, B −2.4 [95% CI −2.9 to −1.9], p < 0.0001) lost significantly less weight than the mean, while residents in medium-sized (B 0.8 [95% CI 0.4–1.2], p = 0.0001) or small towns (B 0.8 [95% CI 0.4–1.2], p < 0.0001) lost significantly more weight. Conclusions All socioeconomic groups experienced improvements in weight after bariatric surgery. However, as first-generation immigrants and patients residing in larger towns (>200,000 inhabitants) tend to have inferior weight loss compared to other groups, increased support in the pre- and postoperative setting for these two groups could be of value. The remaining socioeconomic factors appear to have a weaker association with postoperative weight loss.

Qualifying for bariatric surgery: is preoperative weight loss a reliable predictor of postoperative weight loss?

2018 ◽  
Vol 14 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Raman D. Krimpuri ◽  
James M. Yokley ◽  
Eileen L. Seeholzer ◽  
Ewald L. Horwath ◽  
Charles L. Thomas ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Preoperative Weight Loss ◽  
Postoperative Weight Loss ◽  
Reliable Predictor ◽  
Preoperative Weight

Preoperative Hemoglobin A1c Predicts Postoperative Weight Loss following Bariatric Surgery in Patients with Diabetes

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 2045-P ◽  
Author(s):  
CAMILA B. ORTEGA ◽  
HUI-JIE LEE ◽  
DANA PORTENIER ◽  
ALFREDO D. GUERRON ◽  
JENNY TONG
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Hemoglobin A1c ◽  
Postoperative Weight Loss ◽  
Preoperative Hemoglobin ◽  
Patients With Diabetes

Abstract 15340: Reducing Unnecessary Preoperative Cardiology Referral and Cost in Patients Undergoing Bariatric Surgery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kaitlyn Ibrahim ◽  
Rohit Soans ◽  
Lauren Tragesser ◽  
Abdullah Haddad ◽  
Raj Dalsania ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Risk Index ◽  
Cost Savings ◽  
Patient Characteristics ◽  
Cardiac Risk ◽  
Smoking History ◽  
Surgical Risk ◽  
Increased Risk ◽  
Cardiovascular Evaluation ◽  
Cardiac Testing

Introduction: Candidates for bariatric surgery are at increased risk for cardiovascular disease, which may increase surgical risk. Currently, there are no society guidelines indicating which patients are appropriate for preoperative cardiovascular evaluation and risk stratification. Hypothesis: We hypothesized that applying a standardized surgical risk calculator with a novel multidisciplinary internal referral algorithm to stratify patients for preoperative cardiovascular evaluation would decrease unnecessary referrals and cost. Methods: All patients undergoing bariatric surgery at our institution between 2014-2018 were identified. After assessing baseline patient characteristics, referral patterns to cardiology, prevalence of cardiac testing ordered, and surgical outcomes were measured. The Revised Cardiac Risk Index (RCRI) score was retrospectively calculated for each patient and grouped as low versus increased risk (RCRI score of 0 versus ≥ 1). Imputing a post hoc referral algorithm requiring an RCRI ≥ 1, age ≥ 65, METS ≤ 4, and/or ever smoking history for cardiology referral, we calculated how referral pattern would be affected and the resultant change in referral costs. Results: A total of 797 patients underwent bariatric surgery during the study period, of which 68% (n=540) were referred to cardiology preoperatively. Those referred had more hypertension, hyperlipidemia, diabetes, smoking history, and were more likely to have BMI >50 kg/m 2 . Of those referred, 81% (n=438), 15% (n=81), 3% (n=17), and 1% (n=4) had RCRI scores of 0, 1, 2, and ≥ 3, respectively. Of those patients with an RCRI score of 0, 53% (n=234) underwent further cardiac testing. Strictly applying our standardized internal referral algorithm, of the 540 patients referred to cardiology, only 45% (n=199) were appropriately referred. Based on Medicare reimbursement for Level 4 outpatient consults, this would have resulted in a savings of approximately $86,000. Conclusions: Among candidates for bariatric surgery, a novel referral algorithm based on RCRI and other cardiovascular risk factors may reduce unnecessary preoperative cardiology referrals, with resultant reduction in resource utilization and overall cost savings.

scholarly journals The Role of Hormonal Factors in Weight Loss and Recidivism after Bariatric Surgery

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
S. D. Pedersen
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Explanatory Power ◽  
Future Research ◽  
Hormonal Factors ◽  
Weight Loss Failure ◽  
Postoperative Weight Loss ◽  
Interdisciplinary Approaches ◽  
Hormonal Milieu ◽  
Weight Loss Success

Substantial heterogeneity exists in weight loss trajectories amongst patients following bariatric surgery. Hormonal factors are postulated to be amongst the contributors to the variation seen. Several hormones involved in hunger, satiety, and energy balance are affected by bariatric surgery, with the alteration in hormonal milieu varying by procedure. Limited research has been conducted to examine potential hormonal mediators of weight loss failure or recidivism following bariatric surgery. While hormonal factors that influence weight loss success following gastric banding have not been identified, data suggest that hormonal factors may be involved in modulating weight loss success following gastric bypass. There may be hormonal mediators involved in determining the weight trajectory following sleeve gastrectomy, though the extremely limited data currently available prohibits definitive conclusions from being drawn. There is great need for future research studies to explore this knowledge gap, as improving this knowledge base could be of benefit to guide clinicians toward understanding the hormonal contributors to a patient’s postoperative weight loss failure or recidivism or perhaps be of value in selecting the most appropriate bariatric procedure based on the preoperative hormone milieu. Integrative interdisciplinary approaches exploring these complex interrelationships could potentially increase the explanatory power of such investigations.

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