Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia
Background: Real-world data on long-term (> 5 years) weight loss and obesity-related complications after newer bariatric surgical procedures are currently limited. The aim of this longitudinal study was to examine the effectiveness and sustainability of bariatric surgery in a cohort with clinical...
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| Format: | Article |
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MDPI AG
2022-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/15/4466 |
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| author | Michelle M.C. Tan Xingzhong Jin Craig Taylor Adrian K. Low Philip Le Page David Martin Ang Li David Joseph Nic Kormas |
| author_facet | Michelle M.C. Tan Xingzhong Jin Craig Taylor Adrian K. Low Philip Le Page David Martin Ang Li David Joseph Nic Kormas |
| author_sort | Michelle M.C. Tan |
| collection | DOAJ |
| description | Background: Real-world data on long-term (> 5 years) weight loss and obesity-related complications after newer bariatric surgical procedures are currently limited. The aim of this longitudinal study was to examine the effectiveness and sustainability of bariatric surgery in a cohort with clinically severe obesity in a multidisciplinary publicly funded service in two teaching hospitals in New South Wales, Australia. Methods: Patients were adults with complex clinically severe obesity with a BMI ≥ 35 kg/m<sup>2</sup> and at least three significant obesity-related comorbidities, who underwent bariatric surgeries between 2009 and 2017. Detailed obesity-related health outcomes were reported from annual clinical data and assessments for up to 9 years of follow-up. Data were also linked with the national joint replacement registry. Results: A total of 65 eligible patients were included (mean, 7; range, 3–12 significant obesity-related comorbidities); 53.8% female; age 54.2 ± 11.2 years, with baseline BMI 52.2 ± 12.5 kg/m<sup>2</sup> and weight 149.2 ± 45.5 kg. Most underwent laparoscopic sleeve gastrectomy (80.0%), followed by laparoscopic adjustable gastric banding (10.8%) and one anastomosis gastric bypass (9.2%). Substantial weight loss was maintained over 9 years of follow-up (<i>p</i> < 0.001 versus baseline). Significant total weight loss (%TWL ± SE) was observed (13.2 ± 2.3%) following an initial 1-year preoperative intensive lifestyle intervention, and ranged from 26.5 ± 2.3% to 33.0 ± 2.0% between 1 and 8 years following surgery. Type 2 diabetes mellitus (T2DM), osteoarthritis-related joint pain and depression/severe anxiety were the most common metabolic, mechanical and mental health comorbidities, with a baseline prevalence of 81.5%, 75.4% and 55.4%, respectively. Clinically significant composite cumulative rates of remission and improvement occurred in T2DM (50.0–82.0%) and hypertension (73.7–82.9%) across 6 years. Dependence on continuous positive airway pressure treatment in patients with sleep-disordered breathing fell significantly from 63.1% to 41.2% in 6 years. Conclusion: Bariatric surgery using an intensive multidisciplinary approach led to significant long-term weight loss and improvement in obesity-related comorbidities among the population with clinically complex obesity. These findings have important implications in clinical care for the management of the highest severity of obesity and its medical consequences. Major challenges associated with successful outcomes of bariatric surgery in highly complex patients include improving mental health in the long run and reducing postoperative opioid use. Long-term follow-up with a higher volume of patients is needed in publicly funded bariatric surgery services to better monitor patient outcomes, enhance clinical data comparison between services, and improve multidisciplinary care delivery. |
| first_indexed | 2024-03-09T05:17:45Z |
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| language | English |
| last_indexed | 2024-03-09T05:17:45Z |
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| spelling | doaj.art-0b59d26c9b154f65b3b038c523b833672023-12-03T12:43:24ZengMDPI AGJournal of Clinical Medicine2077-03832022-07-011115446610.3390/jcm11154466Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in AustraliaMichelle M.C. Tan0Xingzhong Jin1Craig Taylor2Adrian K. Low3Philip Le Page4David Martin5Ang Li6David Joseph7Nic Kormas8Boden Initiative, Central Clinical School, Sydney School of Medicine, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, AustraliaCentre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, AustraliaUpper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, AustraliaDepartment of Orthopaedic Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney Adventist Hospital, Wahroonga, NSW 2076, AustraliaUpper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, AustraliaUpper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, AustraliaBoden Initiative, Central Clinical School, Sydney School of Medicine, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, AustraliaUpper GI Surgery Department, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, AustraliaDepartment of Endocrinology & Metabolism, Concord Repatriation General Hospital, Sydney Local Health District, Concord, NSW 2139, AustraliaBackground: Real-world data on long-term (> 5 years) weight loss and obesity-related complications after newer bariatric surgical procedures are currently limited. The aim of this longitudinal study was to examine the effectiveness and sustainability of bariatric surgery in a cohort with clinically severe obesity in a multidisciplinary publicly funded service in two teaching hospitals in New South Wales, Australia. Methods: Patients were adults with complex clinically severe obesity with a BMI ≥ 35 kg/m<sup>2</sup> and at least three significant obesity-related comorbidities, who underwent bariatric surgeries between 2009 and 2017. Detailed obesity-related health outcomes were reported from annual clinical data and assessments for up to 9 years of follow-up. Data were also linked with the national joint replacement registry. Results: A total of 65 eligible patients were included (mean, 7; range, 3–12 significant obesity-related comorbidities); 53.8% female; age 54.2 ± 11.2 years, with baseline BMI 52.2 ± 12.5 kg/m<sup>2</sup> and weight 149.2 ± 45.5 kg. Most underwent laparoscopic sleeve gastrectomy (80.0%), followed by laparoscopic adjustable gastric banding (10.8%) and one anastomosis gastric bypass (9.2%). Substantial weight loss was maintained over 9 years of follow-up (<i>p</i> < 0.001 versus baseline). Significant total weight loss (%TWL ± SE) was observed (13.2 ± 2.3%) following an initial 1-year preoperative intensive lifestyle intervention, and ranged from 26.5 ± 2.3% to 33.0 ± 2.0% between 1 and 8 years following surgery. Type 2 diabetes mellitus (T2DM), osteoarthritis-related joint pain and depression/severe anxiety were the most common metabolic, mechanical and mental health comorbidities, with a baseline prevalence of 81.5%, 75.4% and 55.4%, respectively. Clinically significant composite cumulative rates of remission and improvement occurred in T2DM (50.0–82.0%) and hypertension (73.7–82.9%) across 6 years. Dependence on continuous positive airway pressure treatment in patients with sleep-disordered breathing fell significantly from 63.1% to 41.2% in 6 years. Conclusion: Bariatric surgery using an intensive multidisciplinary approach led to significant long-term weight loss and improvement in obesity-related comorbidities among the population with clinically complex obesity. These findings have important implications in clinical care for the management of the highest severity of obesity and its medical consequences. Major challenges associated with successful outcomes of bariatric surgery in highly complex patients include improving mental health in the long run and reducing postoperative opioid use. Long-term follow-up with a higher volume of patients is needed in publicly funded bariatric surgery services to better monitor patient outcomes, enhance clinical data comparison between services, and improve multidisciplinary care delivery.https://www.mdpi.com/2077-0383/11/15/4466bariatric surgerylong-term outcomespublicly fundedmultidisciplinary managementclinically severe obesity |
| spellingShingle | Michelle M.C. Tan Xingzhong Jin Craig Taylor Adrian K. Low Philip Le Page David Martin Ang Li David Joseph Nic Kormas Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia Journal of Clinical Medicine bariatric surgery long-term outcomes publicly funded multidisciplinary management clinically severe obesity |
| title | Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia |
| title_full | Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia |
| title_fullStr | Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia |
| title_full_unstemmed | Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia |
| title_short | Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia |
| title_sort | long term trajectories in weight and health outcomes following multidisciplinary publicly funded bariatric surgery in patients with clinically severe obesity ≥ 3 associated comorbidities a nine year prospective cohort study in australia |
| topic | bariatric surgery long-term outcomes publicly funded multidisciplinary management clinically severe obesity |
| url | https://www.mdpi.com/2077-0383/11/15/4466 |
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