1. |
- Axelsson, Kristian F, 1973, et al.
(författare)
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Fracture risk after gastric bypass surgery – a retrospective cohort study
- 2018
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Ingår i: Journal of Bone and Mineral Research. - : Wiley-Blackwell Publishing Inc.. - 0884-0431 .- 1523-4681. ; 33:12, s. 2122-2131
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Tidskriftsartikel (refereegranskat)abstract
- Gastric bypass surgery constitutes the most common and effective bariatric surgery to treat obesity. Gastric bypass leads to bone loss, but fracture risk following surgery has been insufficiently studied. Furthermore, the association between gastric bypass and fracture risk has not been studied in patients with diabetes, which is a risk factor for fracture and affected by surgery. In this retrospective cohort study using Swedish national databases, 38 971 obese patients undergoing gastric bypass were identified, 7758 with diabetes and 31 213 without. An equal amount of well-balanced controls were identified through multivariable 1:1 propensity score matching. The risk of fracture and fall injury was investigated using Cox proportional hazards and flexible parameter models. Fracture risk according to weight loss and degree of calcium and vitamin D supplementation one-year post- surgery was investigated. During a median follow-up time of 3.1 (IQR 1.7-4.6) years, gastric bypass was associated with increased risk of any fracture, in patients with and without diabetes using a multivariable Cox model (HR 1.26, 95% CI 1.05- 1.53 and HR 1.32, 95% CI 1.18-1.47, respectively). Using flexible parameter models, the fracture risk appeared to increase with time. The risk of fall injury without fracture was also increased after gastric bypass. Larger weight loss or poor calcium and vitamin D supplementation after surgery were not associated with increased fracture risk. In conclusion, gastric bypass surgery is associated with an increased fracture risk, which appears to be increasing with time and not associated with degree of weight loss or calcium and vitamin D supplementation following surgery. An increased risk of fall injury was seen after surgery, which could contribute to the increased fracture risk. This article is protected by copyright. All rights reserved.
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2. |
- Jans, Anders, 1981-, et al.
(författare)
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Reliability of the DSS-Swe Questionnaire
- 2023
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 33:11, s. 3487-3493
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Symptomatic postbariatric hypoglycemia (PBH) is a known complication that can occur a few years after Roux-en-Y gastric bypass (RYGB). There is currently no established rating scale for PBH-associated symptoms developed for use in Swedish populations. The aim of the study was to translate an already existing questionnaire into Swedish and to test its reliability.METHODS: The study included forward and backward translations of the original Dumping Severity Scale (DSS) questionnaire with 8 items regarding symptoms of early dumping and 6 items regarding hypoglycemia, with each item graded on a 4-point Likert scale. The reliability of the Swedish translated questionnaire (DSS-Swe) was estimated using internal consistency and test-retest methods.RESULTS: A total of 200 patients were included in the study. Good internal consistency was demonstrated regarding the items related to early dumping symptoms, with a Cronbach's alpha coefficient of 0.82, and very good agreement in terms of test-retest reliability, with an overall intraclass correlation coefficient (ICC) of 0.91 (95% CI 0.88-0.93). The items related to hypoglycemia yielded a good Cronbach's alpha coefficient of 0.76 and an ICC of 0.89 (95% CI 0.85-0.91).CONCLUSION: The DSS-Swe questionnaire shows good reliability regarding both internal consistency and test-retest performance for use in Swedish populations.
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4. |
- Raoof, Mustafa, 1966-, et al.
(författare)
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Bone Mineral Density, Parathyroid Hormone, and Vitamin D After Gastric Bypass Surgery : a 10-Year Longitudinal Follow-Up
- 2020
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 30:12, s. 4995-5000
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the present study was to study longitudinal changes in bone mineral density (BMD), vitamin D, and parathyroid hormone (PTH) levels in females over a 10-year period after laparoscopic Roux-en-Y gastric bypass (LRYGB).METHODS: at baseline, were included. BMD, BMI, S-calcium, S-25(OH)-vitamin D, and fP-PTH were measured preoperatively and 2, 5, and 10 years postoperatively.RESULTS: Ten years after surgery, BMD of the spine and femoral neck decreased by 20% and 25%, respectively. Changes in serum levels of vitamin D, PTH, and calcium over the same period were small.CONCLUSION: After LRYGB with subsequent massive weight loss, a large decrease in BMD of the spine and femoral neck was seen over a 10-year postoperative period. The fall in BMD largely occurred over the first 5 years after surgery.
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5. |
- Raoof, Mustafa, 1966-, et al.
(författare)
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Effect of Gastric Bypass on Bone Mineral Density, Parathyroid Hormone and Vitamin D : 5 Years Follow-up
- 2016
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Ingår i: Obesity Surgery. - New York, USA : Springer. - 0960-8923 .- 1708-0428. ; 26:5, s. 1141-1145
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of the present study was to see if there are longitudinal changes in bone mineral density (BMD), vitamin D or parathyroid hormone (PTH) in females 5 years after Laparoscopic Roux-en-Y Gastric Bypass (LRYGB).Methods: Thirty-two women with mean age 41.6 ± 9.3 years and mean body mass index (BMI) 44.5 ± 4.6 kg/m(2) were included. Preoperatively, 2 and 5 years postoperatively, BMD, weight, height, S-calcium, S-albumin, S-creatinine, S-25(OH)-vitamin D and fP-PTH were measured.Results: The mean decrease in BMI between baseline and 5 years after surgery was 29.4 %. BMD of the spine and femur measured as z- and t-scores, showed a linear, statistically significant declining trend over the years. The fall in BMD of the spine and femoral neck between baseline and 5 years after surgery was 19 and 25 %, respectively. The mean fP-PTH showed a significant increase over the study period (20.2 μg/L increase, 95 % CI:-31.99 to -8.41). S-calcium, both free and corrected for albumin, showed a decrease between baseline and 5 years after surgery. Eight patients developed osteopenia and one osteoporosis after a 5-year follow-up.Conclusion: LRYGB is an efficient method for sustained long-term body weight loss. There is, however, a concomitant decrease in BMD and S-calcium, and an increase in fP-PTH.
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6. |
- Raoof, Mustafa, 1966-, et al.
(författare)
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Health-Related Quality-of-Life (HRQoL) on an Average of 12 Years After Gastric Bypass Surgery
- 2015
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Ingår i: Obesity Surgery. - : Springer Science and Business Media LLC. - 0960-8923 .- 1708-0428. ; 25:7, s. 1119-1127
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Tidskriftsartikel (refereegranskat)abstract
- It is evident that morbidly obese patients have a low health-related quality-of-life (HRQoL), and this low HRQoL has become a common reason for them to seek bariatric surgery. Several HRQoL studies demonstrate a dramatic postoperative improvement, but most of these have had a short follow-up period.An observational, cross-sectional study for HRQoL was conducted to study 486 patients (average age of 50.7 +/- 10.0 years, with 84 % of them being female) operated with gastric bypass (GBP) in the period 1993 to 2003 at the University Hospitals of A-rebro and Uppsala. Mean follow-up after gastric bypass was 11.5 +/- 2.7 years (range 7-17). Two HRQoL instruments were used, SF-36 and the Obesity-related Problems scale (OP). The study group was compared with two control groups, both matched for age and gender, one from the general population and one containing morbidly obese patients evaluated and awaiting bariatric surgery.The study group scored better in the SF-36 domains (all four physical domains and the vitality subscore) and OP scale compared to obese controls, but their HRQoL scores were lower than those of the general population. HRQoL was better among younger patients and in the following subgroups: men, patients with satisfactory weight loss, satisfied with the procedure, free from co-morbidities and gastrointestinal symptoms, employment, good oral status and those not hospitalised or regularly followed up for non-bariatric reasons.Long-term follow-up after GBP for morbid obesity showed better scores in most aspects of HRQoL compared to obese controls but did not achieve the levels of the general population. Patients with better medical outcome after gastric bypass operation had better HRQoL.
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7. |
- Stenberg, Erik, 1979-, et al.
(författare)
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The Effect of Laparoscopic Gastric Bypass Surgery on Insulin Resistance and Glycosylated Hemoglobin A1c : a 2-Year Follow-up Study
- 2020
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 30:9, s. 3489-3495
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Tidskriftsartikel (refereegranskat)abstract
- Background: Bariatric surgery improves insulin sensitivity and secretion in patients with type 2 diabetes, but the effect on patients with prediabetes or even normal glucose tolerance deserves further consideration.Methods: Cohort study including patients operated with laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) between November 2012 and June 2017 at the orebro University Hospital (n = 813) with follow-up of 742 patients 2 years after surgery. Fasting insulin, glucose, glycosylated hemoglobin (HbA1c), and homeostatic model assessment of insulin resistance (HOMA-IR) were analyzed at baseline and 2 years after surgery for patients with overt type 2 diabetes, prediabetes, or non-diabetes.Results: Fasting insulin levels improved for all groups (diabetics baseline 25.5 mIU/L, IQR 17.5-38.0, 2 years 7.6 mIU/L, IQR 5.4-11.1, p < 0.001; prediabetics baseline 25.0 mIU/L, IQR 17.5-35.0, 2 years 6.7mIU/L, IQR 5.3-8.8, p < 0.001; non-diabetics baseline 20.0 mIU/L, IQR 14.0-30.0, 2 years 6.4 mIU/L, IQR 5.0-8.5, p < 0.001). HbA1c improved in all groups (diabetics baseline 56 mmol/mol, IQR 49-74 [7.3%, IQP 6.6-8.9], 2 years 38 mmol/mol, IQR 36-47 [5.6%, IQR 5.4-6.4], p < 0.001; prediabetics baseline 40 mmol/mol, IQR 39-42 [5.8%, IQR5.7-6.0], 2 years 36 mmol/mol, IQR 34-38 [5.5%, IQR 5.3-5.6], p < 0.001; non-diabetics baseline 35 mmol/mol, IQR 33-37 [5.4%, IQR 5.2-5.5]; 2 years 34 mmol/mol, IQR 31-36 [5.3%, IQR 5.0-5.4], p < 0.001). HOMA-IR improved in all groups (diabetics baseline 9.3 mmol/mol, IQR 5.4-12.9, 2 years 1.9 mmol/mol, IQR 1.4-2.7, p < 0.001; prediabetics baseline 7.0 mmol/mol, IQR 4.3-9.9, 2 years 1.6 mmol/mol, IQR 1.2-2.1, p < 0.001; non-diabetics 4.9 mmol/mol, IQR 3.4-7.3, 2 years 1.4 mmol/mol, IQR 1.1-1.9, p < 0.001).Conclusion: Insulin homeostasis and glucometabolic control improve in all patients after LRYGB, not only in diabetics but also in prediabetics and non-diabetic obese patients, and this improvement is sustained 2 years after surgery.
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8. |
- Al-Tai, Saif, 1978-, et al.
(författare)
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The impact of the bougie size and the extent of antral resection on weight-loss and postoperative complications following sleeve gastrectomy : results from the Scandinavian Obesity Surgery Registry
- 2024
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 20:2, s. 139-145
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The optimal sleeve diameter and distance from the pylorus to the edge of the resection line in laparoscopic sleeve gastrectomy (LSG) remain controversial.OBJECTIVES: To evaluate the influence of bougie size and antral resection distance from the pylorus on postoperative complications and weight-loss results in LSG.SETTING: Nationwide registry-based study.METHODS: This study included all LSGs performed in Sweden between 2012 and 2019. Data were obtained from the Scandinavian Obesity Surgery Registry. Reference bougie size of 35-36 Fr and an antral resection distance of 5 cm from the pylorus were compared to narrower bougie size (30-32 Fr), shorter distances (1-4 cm), and extended distances (6-8 cm) from the pylorus in assessing postoperative complications and weight loss as the outcomes of LSG. RESULTS: The study included 9,360 patients with postoperative follow-up rates of 96%, 79%, and 50% at 30 days, 1 year, and 2 years, respectively. Narrow bougie and short antral resection distance from the pylorus were significantly associated with increased postoperative weight loss. Bougie size was not associated with increased early or late complications. However, short antral resection distance was associated with high risk of overall early complications [odds ratio: 1.46 (1.17-1.82, P = .001)], although no impact on late complications at 1 and 2 years was observed.CONCLUSIONS: Using a narrow bougie and initiating resection closer to the pylorus were associated with greater maximum weight loss. Although a closer resection to the pylorus was associated with an increased risk of early postoperative complications, no association was observed with the use of narrow bougie for LSG.
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9. |
- Al-Tai, Saif, 1978-, et al.
(författare)
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THE IMPACT OF THE BOUGIE SIZE AND THE EXTENT OF ANTRAL RESECTION ON WEIGHT-LOSS AND POSTOPERATIVE COMPLICATIONS FOLLOWING SLEEVE GASTRECTOMY : RESULTS FROM THE SCANDINAVIAN OBESITY SURGERY REGISTRY
- 2023
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 33:Suppl. 2, s. 332-332
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Laparoscopic sleeve gastrectomy (LSG) as a primary bariatric procedure has gained increasing popularity world-wide. However, controversies still exist regarding several operative aspects, such as the optimal diameter of thesleeve and the optimal distance from the pylorus to the edge of the resection line, and whether these aspects haveeffects on weight-loss results and the risk to develop postoperative complications.Objective: The aim of this study was to compare weight-loss results and the incidence of postoperative complications betweensleeve with different diameters measured in bougie size and with different distances from the pylorus to the edge ofthe resection line measured in centimeter.Setting: Nationwide registry-based study.Method: This study is an analysis of sleeve gastrectomy performed in Sweden between 2012 and 2019. Data were collectedfrom Scandinavian Obesity Surgery Registry (SOReg). Patients with bougie size 30-32 and 35-36 and patients withdistance from pylorus 1-4 cm, 5 cm, 6-8 cm were identified and compared regarding weight-loss results and the riskto develop postoperative complications.Results: 9,360 patients were included. Follow-up rate was 96% at day 30, 78.8% at one year and 50% at two years. Bothbougie size 30-32 compared to 35-36 and distance from the pylorus 1-4 cm compared to 5 cm were associated withsignificant higher weight-loss at one and two years. No difference in the risk for early or late complications was seenbetween bougie size groups 30-32 and 35-36. Resection starting 1-4 cm from the pylorus compared to 5 cm was as-sociated with higher risk for overall early postoperative complications (OR 1.46 (1.17-1.82, P=.001)), but there wasno significant difference in the risk to develop late complication at 1 and 2 years. No difference in the leak rate andin the risk to develop stricture was seen between different Bougie sizes, nor distances from the Pylorus.Conclusion: Using a smaller Bougie size and starting the resection closer to the pylorus was associated with better maximumweight-loss. Closer resection to the Pylorus, but not Bougie size was associated with increased risk for early postop-erative complications after sleeve gastrectomy.
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10. |
- Axelsson, K. F., et al.
(författare)
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Fracture Risk After Gastric Bypass Surgery : A Retrospective Cohort Study
- 2018
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Ingår i: Osteoporosis International. - : Springer London. - 0937-941X .- 1433-2965. ; 29:Suppl. 1, s. S491-S491
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: Gastric bypass surgery constitutes the most common and effective bariatric surgery to treat obesity. Gastric bypass leads to bone oss but fracture risk following surgery has been insufficiently studied. Our objective was to investigate if gastric bypass surgery in obese patients, with and without diabetes, was associated with fracture risk, and if the fracture risk was associated with post-surgery weight loss or insufficient calcium and vitamin D supplementation.Methods: Using large databases, 38 971 obese patients undergoing gastric bypass were identified, 7758 with diabetes and 31 213 without. Through multivariable 1:1 propensity score matching, well-balanced controls were identified. The risk of fracture and fall injury was investigated using Cox proportional hazards and flexible parameter models. Fracture risk according to weight loss and degree of calcium and vitamin D supplementation one year post-surgery was investigated.Results: 77 942 patients had a median and total follow-up time of 3.1 (IQR 1.7-4.6) and 251 310 person-years, respectively. Gastric bypass was associated with increased risk of any fracture, in patients with diabetes and without diabetes using a multivariable Cox model (HR 1.26, 95%CI 1.05-1.53 and HR 1.32, 95%CI 1.18-1.47, respectively). The risk of fall injury without fracture was also increased after gastric bypass, both in patients with (HR 1.26 95%CI 1.04-1.52) and without diabetes (HR 1.24 95%CI 1.12-1.38). Weight loss or degree of calcium and vitamin D supplementation after gastric bypass were not associated with fracture risk.Conclusions: Gastric bypass was associated with an increased risk of fracture and fall injury. Weight loss or calcium and vitamin D supplementation following surgery were not associated with fracture risk. These findings indicate that gastric bypass increases fracture risk, which could at least partly be due to increased susceptibility to falls.
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12. |
- Axer, Stephan, et al.
(författare)
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Non-response After Gastric Bypass and Sleeve Gastrectomy-the Theoretical Need for Revisional Bariatric Surgery : Results from the Scandinavian Obesity Surgery Registry
- 2023
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 33:10, s. 2973-2980
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Revisional surgery is a second-line treatment option after sleeve gastrectomy (SG) and gastric bypass (GBP) in patients with primary or secondary non-response. The aim was to analyze the theoretical need for revisional surgery after SG and GBP when applying four indication benchmarks. METHOD: Based on data from the Scandinavian Obesity Surgery Registry, SG and GBP were compared regarding four endpoints: 1. excess weight loss (%EWL) < 50%, 2. weight regain of more than 10 kg after nadir, 3. fulfillment of previous IFSO-guidelines, or 4. ADA criteria for bariatric metabolic surgery 2 years after primary surgery.RESULTS: A total of 60,426 individuals were included in the study (SG: n = 7856 and GBP: n = 52,570). Compared to patients in the GBP group, more SG patients failed to achieve a %EWL > 50% (23.0% versus 8.5%, p < .001), regained more than 10 kg after nadir (4.3% versus 2.5%, p < .001), and more often fulfilled the IFSO criteria (8.0% versus 4.5%, p < .001) or the ADA criteria (3.3% versus 1.8%, p < 001) at the 2-year follow-up.CONCLUSION: SG is associated with a higher risk for weight non-response compared to GBP. To offer revisional bariatric surgery to all non-responders exceeds the bounds of feasibility and operability. Hence, individual prioritization and intensified evaluation of alternative second-line treatments are necessary.
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13. |
- Axer, S., et al.
(författare)
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NON-RESPONSE AFTER GASTRIC BYPASS AND SLEEVE GASTRECTOMY - THE THEORETICAL NEED FOR REVISIONAL BARIATRIC SURGERY RESULTS FROM THE SCANDINAVIAN OBESITY SURGERY REGISTRY : Revisional surgery
- 2022
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 32:Suppl. 2, s. 381-381
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Revisional surgery is a second-line treatment option after sleeve gastrectomy (SG) and gastric bypass (GBP) in patients with primary or secondary non-response. This study is an analysis of the theoretical need for revisional surgery when applying four indication benchmarks.Objective: The aim was to analyze the risk for primary and secondary non-response after SG and GBP.Setting: 44 hospitals in Sweden.Methods: Based on data from the Scandinavian Obesity Surgery Registry, SG and GBP were compared regarding four endpoints: 1. Excess Weight Loss (%EWL) < 50%; 2. weight regain of more than 10 kg after nadir; 3. fulfillment of IFSO-guidelines; or 4. ADA-criteria for bariatric surgery two years after primary surgery.Results: 60 426 individuals were included in the study (SG: n=7856 and GBP: n=52 570). Compared to patients in the GBP-group, more SG patients failed to achieved a %EWL > 50% (23.0% versus 8.5%, p < .001), regained more than 10 kg after nadir (4.3% versus 2.5%, p < .001), more often fulfilled the IFSO-criteria (8.0% vs. 4.5%, p < .001) or the ADA criteria (3.3% vs. 1.8%, p < 001) for bariatric/metabolic surgery at the 2-year follow-up.Conclusions: SG is associated with a higher risk for primary and secondary non-response compared to gastric bypass. To offer revisional bariatric surgery to all non-responders exceeds the bounds of feasibility and operability. Hence, individual prioritization and intensified evaluation of alternative second-line treatments is necessary.
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14. |
- Axer, Stephan, 1971-, et al.
(författare)
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Predictive factors of complications in revisional gastric bypass surgery : results from the Scandinavian Obesity Surgery Registry
- 2019
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 15:12, s. 2094-2100
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Tidskriftsartikel (refereegranskat)abstract
- Background: Roux-en-Y gastric bypass is the most common procedure for revisional bariatric surgery. This study is an analysis of revisional gastric bypass operations (rGBP) compared with primary gastric bypass (pGBP) performed in Sweden between 2007 and 2016.Objective: The aim was to compare the incidence of adverse events in primary and revisional gastric bypass surgery and to identify predictive factors of intraoperative, early, and late complications in revisional gastric bypass surgery.Setting: Forty-four hospitals.Methods: Registered study from the Scandinavian Obesity Surgery Registry. The study group (rGBP) comprised 1795 patients, and the control group (pGBP) comprised 46,055 patients.Results: Median follow-up time was 28 months. The rate of open procedures was significantly higher in the rGBP group (39.1% versus 2.4%; P < .001) decreasing from 70.8% in 2007 to 8.5% in 2016. Intraoperative complications (15.5% versus 3.0%, P < .001), early complications (24.6% versus 8.7%; P < .001), and late complications (17.7% versus 8.7%; P < .001) occurred more often in the rGBP group. Open access in revisional surgery was an independent risk factor for intraoperative complications (odds ratio 3.87; 95% confidence interval: 2.69-5.57, P < .001), early complications (odds ratio 2.08; 95% confidence interval: 1.53-2.83, P < .001), and late complications (odds ratio 1.91; 95% confidence interval: 1.31-2.78, P = .001). Indication for revision or type of index operation were not associated with complications.Conclusion: RGBP was associated with a higher incidence of intraoperative, early, and late complications compared with pGBP. Open access in revisional surgery was predictive of complications regardless of the index operation or indication for revision.
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15. |
- Axer, Stephan, 1971-
(författare)
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Revisional bariatric surgery : more than a moral obligation
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Growing awareness of biological, genetic, environmental, and behavioural factors contributed to the recognition of obesity as a chronic disease. Nowadays, obesity and its medical/surgical treatment is widely acknowledgedin the medical curriculum. Bariatric surgery has long been shown to provide superior induction and maintenance of weight loss, together with improvement or resolution of obesity-related diseases. The role of revisional bariatric surgery for treatment of procedure-related complications is accepted. However, its role as second-line treatment of patients with primary or secondary non-response is still a matter of debate. This prompted Dr Henry Buchwald in 2015 to publish his article “Revisional Metabolic/Bariatric Surgery: A Moral Obligation”. Studies I and II in this doctoral thesis covered issues that fuel the ongoing controversy, namely effects and risks of revisional surgery. Conversion to gastric bypass is the most common revisional procedure in Sweden. In Studies I and II, we found revisional gastric bypass to give inferior weight loss with a higher risk for perioperative complications compared to primary gastric bypass. However, the beneficial effects on obesity-related disease were similar (Papers I and II). In Study III, the theoretical need for revisional bariatric surgery in patients with primary or secondary weight non-response was evaluated. When applying four different indication criteria, more than 13% of patients met the criteria for second-line treatment, with a significant higher probability after sleeve gastrectomy compared to gastric bypass (Paper III). To gain a clearer picture, a systematic review of the literature on revisional bariatric surgery after sleeve gastrectomy was inevitable. However, an evidence-based treatment strategy for patients with primary or secondary weight non-response could not be deduced from the current literature (Paper IV).
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16. |
- Axer, Stephan, 1971-, et al.
(författare)
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Weight loss and alterations in co-morbidities after revisional gastric bypass : A case-matched study from the Scandinavian Obesity Surgery Registry
- 2017
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 13:5, s. 796-800
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Sweden, Roux-en-Y gastric bypass is the most common procedure when revising a previous bariatric procedure. This study is an analysis of all revisional gastric bypass operations (rGBP) compared with a matched group of primary gastric bypass (pGBP) operated between 2007 and 2012.Objective: The aim was to determine whether improvement of obesity-related co-morbidity and changes in weight after revisional gastric bypass surgery were comparable with those seen after primary surgery.Setting: 44 hospitals in SwedenMethods: Retrospective data were retrieved from the Scandinavian Obesity Surgery Registry. The study group (rGBP) comprised 1224 patients, and the control group (pGBP) comprised 3612 patients matched for age and gender.Results: The indication for revision was weight failure in 512 patients (42%), a late complication of the initial procedure in 330 patients (27%), and a combination of weight failure and complication in 303 patients (25%). A total of 66% of patients in the rGBP group and 67% in the pGBP group completed the 2-year follow-up in the Scandinavian Obesity Surgery Registry.The rGBP-group had significantly less excess BMI loss (%EBMIL, 59.4 +/- 147.0 versus 79.5 +/- 24.7, P < .001) and a lower dyslipidemia remission rate (42.9% versus 62.0%, P = .005) at the time of the 2-year follow-up. Remission rates of sleep apnea, hypertension, type 2 diabetes, and depression were similar. The effects on obesity-related co-morbidity were not related to the indication for revisional surgery or the initial bariatric procedure.Conclusion: Even if weight results might be inferior compared with primary bypass procedures, the improvement of co-morbidity is similar. (C) 2017 American Society for Metabolic and Bariatric Surgery. All right reserved
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17. |
- Axer, Stephan, et al.
(författare)
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Weight-Related Outcomes After Revisional Bariatric Surgery in Patients with Non-response After Sleeve Gastrectomy : a Systematic Review
- 2023
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 33:7, s. 2210-2218
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Forskningsöversikt (refereegranskat)abstract
- Weight non-response after sleeve gastrectomy is an emerging issue. This systematic review compared revisional procedures for weight-related outcomes. We searched several databases for relevant articles and included adult patients with revisional bariatric procedures after primary sleeve gastrectomy. Twelve trials with 1046 patients were included, covering five revisional procedures. There were no randomised controlled trials, and 10 studies had a critical risk of bias. Significant variations in inclusion criteria, therapy benchmarks, follow-up schemes, and outcome measurements were observed, preventing meaningful comparison of results. Evidence-based treatment strategies for weight non-response after sleeve gastrectomy cannot be deduced from the current literature. Prospective studies with well-defined indications, standardised techniques, and strict adherence to outcome measurements are needed.
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19. |
- Cao, Yang, Associate Professor, 1972-, et al.
(författare)
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Using Bayesian Networks to Predict Long-Term Health-Related Quality of Life and Comorbidity after Bariatric Surgery : A Study Based on the Scandinavian Obesity Surgery Registry
- 2020
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Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 9:6
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Tidskriftsartikel (refereegranskat)abstract
- Previously published literature has identified a few predictors of health-related quality of life (HRQoL) after bariatric surgery. However, performance of the predictive models was not evaluated rigorously using real world data. To find better methods for predicting prognosis in patients after bariatric surgery, we examined performance of the Bayesian networks (BN) method in predicting long-term postoperative HRQoL and compared it with the convolution neural network (CNN) and multivariable logistic regression (MLR). The patients registered in the Scandinavian Obesity Surgery Registry (SOReg) were used for the current study. In total, 6542 patients registered in the SOReg between 2008 and 2012 with complete demographic and preoperative comorbidity information, and preoperative and postoperative 5-year HROoL scores and comorbidities were included in the study. HRQoL was measured using the RAND-SF-36 and the obesity-related problems scale. Thirty-five variables were used for analyses, including 19 predictors and 16 outcome variables. The Gaussian BN (GBN), CNN, and a traditional linear regression model were used for predicting 5-year HRQoL scores, and multinomial discrete BN (DBN) and MLR were used for 5-year comorbidities. Eighty percent of the patients were randomly selected as a training dataset and 20% as a validation dataset. The GBN presented a better performance than the CNN and the linear regression model; it had smaller mean squared errors (MSEs) than those from the CNN and the linear regression model. The MSE of the summary physical scale was only 0.0196 for GBN compared to the 0.0333 seen in the CNN. The DBN showed excellent predictive ability for 5-year type 2 diabetes and dyslipidemia (area under curve (AUC) = 0.942 and 0.917, respectively), good ability for 5-year hypertension and sleep apnea syndrome (AUC = 0.891 and 0.834, respectively), and fair ability for 5-year depression (AUC = 0.750). Bayesian networks provide useful tools for predicting long-term HRQoL and comorbidities in patients after bariatric surgery. The hybrid network that may involve variables from different probability distribution families deserves investigation in the future.
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20. |
- Gerber, Peter, et al.
(författare)
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Impact of age on risk of complications after gastric bypass : A cohort study from the Scandinavian Obesity Surgery Registry (SOReg)
- 2018
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 14:4, s. 437-442
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: An increasing number of older patients undergo bariatric surgery.OBJECTIVE: To define the risk for complications and mortality in relation to age after gastric bypass.SETTING: A national registry-based study.METHODS: Patients (n = 47,660) undergoing gastric bypass between May 2007 and October 2016 and registered in the Scandinavian Obesity Register were included. Risk between age groups was compared by multivariate analysis.RESULTS: The 30-day follow-up rate was 98.1%. In the entire cohort of patients, any complication within 30 days was demonstrated in 8.4%. For patients aged 50 to 54, 55 to 59, and ≥60 years, this risk was significantly increased to 9.8%, 10.0%, and 10.2%, respectively. Rates of specific surgical complications, such as anastomotic leak, bleeding, and deep infections/abscesses were all significantly increased by 14% to 41% in patients aged 50 to 54 years, with a small additional, albeit not significant, increase in risk in patients of older age. The risk of medical complications (thromboembolic events, cardiovascular, and pulmonary complications) was significantly increased in patients aged ≥60 years. Mortality was .03% in all patients without differences between groups.CONCLUSIONS: In this large data set, rates of complications and mortality after 30 days were low. For many complications, an increased risk was encountered in patients aged ≥50 years. However, rates of complications and mortality were still acceptably low in these age groups. Taking the expected benefits in terms of weight loss and improvements of co-morbidities into consideration, our findings suggest that patients of older age should be considered for surgery after thorough individual risk assessment rather than denied bariatric surgery based solely on a predefined chronologic age limit.
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21. |
- Hedberg, Jakob, et al.
(författare)
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Randomized controlled trial of nasogastric tube use after esophagectomy : study protocol for the kinetic trial
- 2024
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Ingår i: Diseases of the esophagus. - : John Wiley & Sons. - 1120-8694 .- 1442-2050. ; 37:6
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Tidskriftsartikel (refereegranskat)abstract
- Esophagectomy is a complex and complication laden procedure. Despite centralization, variations in perioparative strategies reflect a paucity of evidence regarding optimal routines. The use of nasogastric (NG) tubes post esophagectomy is typically associated with significant discomfort for the patients. We hypothesize that immediate postoperative removal of the NG tube is non-inferior to current routines. All Nordic Upper Gastrointestinal Cancer centers were invited to participate in this open-label pragmatic randomized controlled trial (RCT). Inclusion criteria include resection for locally advanced esophageal cancer with gastric tube reconstruction. A pretrial survey was undertaken and was the foundation for a consensus process resulting in the Kinetic trial, an RCT allocating patients to either no use of a NG tube (intervention) or 5 days of postoperative NG tube use (control) with anastomotic leakage as primary endpoint. Secondary endpoints include pulmonary complications, overall complications, length of stay, health related quality of life. A sample size of 450 patients is planned (Kinetic trial: https://www.isrctn.com/ISRCTN39935085). Thirteen Nordic centers with a combined catchment area of 17 million inhabitants have entered the trial and ethical approval was granted in Sweden, Norway, Finland, and Denmark. All centers routinely use NG tube and all but one center use total or hybrid minimally invasive-surgical approach. Inclusion began in January 2022 and the first annual safety board assessment has deemed the trial safe and recommended continuation. We have launched the first adequately powered multi-center pragmatic controlled randomized clinical trial regarding NG tube use after esophagectomy with gastric conduit reconstruction.
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22. |
- Holmén, Anders, et al.
(författare)
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Nutritional jejunostomy in esophagectomy for cancer, a national register-based cohort study of associations with postoperative outcomes and survival
- 2021
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Ingår i: Langenbeck's archives of surgery (Print). - : Springer. - 1435-2443 .- 1435-2451. ; 406:5, s. 1415-1423
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Insertion of a nutritional jejunostomy in conjunction with esophagectomy is performed with the intention to decrease the risk for postoperative malnutrition and improve recovery without adding significant catheter-related complications. However, previous research has shown no clear benefit and there is currently no consensus of practice.METHODS: All patients treated with esophagectomy due to cancer during the period 2006-2017 reported in the Swedish National Register for Esophageal and Gastric Cancer were included in this register-based cohort study from a national database. Patients were stratified into two groups: esophagectomy alone and esophagectomy with jejunostomy.RESULTS: A total of 847 patients (45.27%) had no jejunostomy inserted while 1024 patients (54.73%) were treated with jejunostomy. The groups were comparable, but some differences were seen in histological tumor type and tumor stage between the groups. No significant differences in length of hospital stay, postoperative surgical complications, Clavien-Dindo score, or 90-day mortality rate were seen. There was no evidence of increased risk for significant jejunostomy-related complications. Patients in the jejunostomy group with anastomotic leaks had a statistically significant lower risk for severe morbidity defined as Clavien-Dindo score ≥ IIIb (adjusted odds ratio 0.19, 95% CI: 0.04-0.94, P = 0.041) compared to patients with anastomotic leaks and no jejunostomy.CONCLUSION: A nutritional jejunostomy is a safe method for early postoperative enteral nutrition which might decrease the risk for severe outcomes in patients with anastomotic leaks. Nutritional jejunostomy should be considered for patients undergoing curative intended surgery for esophageal and gastro-esophageal junction cancer.
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23. |
- Jans, Anders, et al.
(författare)
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Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007-2015 : A registry-based cohort study
- 2019
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Ingår i: PLoS Medicine. - : Public Library of Science. - 1549-1277 .- 1549-1676. ; 16:11
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although bariatric surgery is an effective treatment for type 2 diabetes (T2D) in patients with morbid obesity, further studies are needed to evaluate factors influencing the chance of achieving diabetes remission. The objective of the present study was to investigate the association between T2D duration and the chance of achieving remission of T2D after bariatric surgery.METHODS AND FINDINGS: We conducted a nationwide register-based cohort study including all adult patients with T2D and BMI ≥ 35 kg/m2 who received primary bariatric surgery in Sweden between 2007 and 2015 identified through the Scandinavian Obesity Surgery Registry. The main outcome was remission of T2D, defined as being free from diabetes medication or as complete remission (HbA1c < 42 mmol/mol without medication). In all, 8,546 patients with T2D were included. Mean age was 47.8 ± 10.1 years, mean BMI was 42.2 ± 5.8 kg/m2, 5,277 (61.7%) were women, and mean HbA1c was 58.9 ± 17.4 mmol/mol. The proportion of patients free from diabetes medication 2 years after surgery was 76.6% (n = 6,499), and 69.9% at 5 years (n = 3,765). The chance of being free from T2D medication was less in patients with longer preoperative duration of diabetes both at 2 years (odds ratio [OR] 0.80/year, 95% CI 0.79-0.81, p < 0.001) and 5 years after surgery (OR 0.76/year, 95% CI 0.75-0.78, p < 0.001). Complete remission of T2D was achieved in 58.2% (n = 2,090) at 2 years, and 46.6% at 5 years (n = 681). The chance of achieving complete remission correlated negatively with the duration of diabetes (adjusted OR 0.87/year, 95% CI 0.85-0.89, p < 0.001), insulin treatment (adjusted OR 0.25, 95% CI 0.20-0.31, p < 0.001), age (adjusted OR 0.94/year, 95% CI 0.93-0.95, p < 0.001), and HbA1c at baseline (adjusted OR 0.98/mmol/mol, 95% CI 0.97-0.98, p < 0.001), but was greater among males (adjusted OR 1.57, 95% CI 1.29-1.90, p < 0.001) and patients with higher BMI at baseline (adjusted OR 1.07/kg/m2, 95% CI 1.05-1.09, p < 0.001). The main limitations of the study lie in its retrospective nature and the low availability of HbA1c values at long-term follow-up.CONCLUSIONS: In this study, we found that remission of T2D after bariatric surgery was inversely associated with duration of diabetes and was highest among patients with recent onset and those without insulin treatment.
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24. |
- Jans, Anders, 1981-, et al.
(författare)
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Factors affecting relapse of type 2 diabetes after bariatric surgery in Sweden 2007-2015 : a registry-based cohort study
- 2022
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 18:3, s. 305-312
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Although a large proportion of patients with type 2 diabetes (T2DM) who have undergone metabolic surgery experience initial remission some patients later suffer from relapse. While several factors associated with T2D remission are known, less is known about factors that may influence relapse.OBJECTIVES: To identify possible risk factors for T2D relapse in patients who initially experienced remission.SETTING: Nationwide, registry-based study.METHODS: We conducted a nationwide registry-based retrospective cohort study including all adult patients with T2D and body mass index ≥35 kg/m2 who received primary metabolic surgery with Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) in Sweden between 2007 and 2015. Patients who achieved complete diabetes remission 2 years after surgery was identified and analyzed. Main outcome measure was postoperative relapse of T2D, defined as reintroduction of diabetes medication.RESULTS: In total, 2090 patients in complete remission at 2 years after surgery were followed for a median of 5.9 years (interquartile range [IQR] 4.3-7.2 years) after surgery. The cumulative T2D relapse rate was 20.1%. Duration of diabetes (hazard ratio [HR], 1.09; 95% confidence interval [CI], 1.05-1.14; P < .001), preoperative glycosylated hemoglobin A1C (HbA1C) level (HR, 1.01; 95% CI, 1.00-1.02; P = .013), and preoperative insulin treatment (HR, 2.67; 95% CI, 1.84-3.90; P < .001) were associated with higher rates for relapse, while postoperative weight loss (HR, .93; 95% CI, .91-.96; P < .001), and male sex (HR, .65; 95% CI, .46-.91; P = .012) were associated with lower rates.CONCLUSION: Longer duration of T2D, higher preoperative HbA1C level, less postoperative weight loss, female sex, and insulin treatment prior to surgery are risk factors for T2D relapse after initial remission.
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25. |
- Kanold, Philip, et al.
(författare)
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The Swedish Standardized Course of Care-Diagnostic Efficacy in Esophageal and Gastric Cancer
- 2023
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Ingår i: Diagnostics. - : MDPI. - 2075-4418. ; 13:23
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Tidskriftsartikel (refereegranskat)abstract
- Fast-track pathways for diagnosing esophageal or gastric cancer (EGC) have been implemented in several European countries. In Sweden, symptoms such as dysphagia, early satiety, and other alarm symptoms call for a referral for gastroscopy, according to the Swedish Standardized Course of Care (SCC). The aim of this study was to evaluate the diagnostic yield of the SCC criteria for EGC, to review all known EGC cases in Region Örebro County between March 2017 and February 2021, and to compare referral indication(s), waiting times, and tumor stage. In our material, EGC was found in 6.2% of the SCC referrals. Esophageal dysphagia had a positive predictive value (PPV) of 5.6%. The criterion with the highest PPV for EGC was suspicious radiological findings, with a PPV of 24.5%. A total of 139 EGCs were diagnosed, 99 (71%) through other pathways than via the SCC. Waiting times were approximately 14 days longer for patients evaluated via non-SCC pathways. There was no statistically significant association between referral pathway and primary tumor characteristics. The results show that a majority of the current SCC criteria are poor predictors of EGC, and some alarm symptoms lack a sufficiently specific definition, e.g., dysphagia. Referral through this fast track does not seem to have a positive impact on disease outcomes.
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26. |
- Nilsson, Klara, et al.
(författare)
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Surgical Morbidity and Mortality From the Multicenter Randomized Controlled NeoRes II Trial : Standard Versus Prolonged Time to Surgery After Neoadjuvant Chemoradiotherapy for Esophageal Cancer.
- 2020
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 272:5, s. 684-689
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate if prolonged TTS after completed nCRT improves postoperative outcomes for esophageal and esophagogastric junction cancer.SUMMARY OF BACKGROUND DATA: TTS has traditionally been 4-6 weeks after completed nCRT. However, the optimal timing is not known.METHODS: A multicenter clinical trial was performed with randomized allocation of TTS of 4-6 or 10-12 weeks. The primary endpoint of this sub-study was overall postoperative complications defined as Clavien-Dindo grade II-V. Secondary endpoints included complication severity according to Clavien-Dindo grade IIIb-V, postoperative 90-day mortality, and length of hospital stay. The study was registered in Clinicaltrials.gov (NCT02415101).RESULTS: In total 249 patients were randomized. There were no significant differences between standard TTS and prolonged TTS with regard to overall incidence of complications Clavien-Dindo grade II-V (63.2% vs 72.6%, P = 0.134) or regarding Clavien-Dindo grade IIIb-V complications (31.6% vs 34.9%, P = 0.603). There were no statistically significant differences between standard and prolonged TTS regarding anastomotic leak (P = 0.596), conduit necrosis (P = 0.524), chyle leak (P = 0.427), pneumonia (P = 0.548), and respiratory failure (P = 0.723). In the standard TTS arm 5 patients (4.3%) died within 90 days of surgery, compared to 4 patients (3.8%) in the prolonged TTS arm (P = 1.0). Median length of hospital stay was 15 days in the standard TTS arm and 17 days in the prolonged TTS arm (P = 0.234).CONCLUSION: The timing of surgery after completed nCRT for carcinoma of the esophagus or esophagogastric junction, is not of major importance with regard to short-term postoperative outcomes.
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27. |
- Raoof, Mustafa, 1966-, et al.
(författare)
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Improvements of health-related quality of life 5 years after gastric bypass. What is important besides weight loss? A study from Scandinavian Obesity Surgery Register
- 2020
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 16:9, s. 1249-1257
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Obesity continues to increase in the world. It is strongly associated with morbidity, mortality, and decrease of health-related quality of life (HRQoL). Surgery is the most effective treatment for obesity, resulting in sustained weight loss and improvements of HRQoL. The aim of this study was to examine whether other factors, apart from weight loss, are associated with improvement in HRQoL scores between the preoperative visit and the 5-year follow-up.OBJECTIVES: To examine whether there are factors besides weight loss that affect the improvement of HRQoL from before to 5 years after gastric bypass surgery.SETTING: Large, nationwide, observational study with national quality and research registry.METHODS: Patients operated with a primary gastric bypass in Sweden between January 2008 and December 2012 were identified in the Scandinavian Obesity Surgery Register. Patients with HRQoL data available at both baseline and 5 years after surgery were included. Two HRQoL instruments, the RAND Short form-36 and the obesity-related problems scale, were used in the study.RESULTS: The study sample comprised 6998 patients (21% men). Differences in HRQoL change according to sex were minor. Younger patients showed greater improvements in physical health scales. In general linear regression model analyses, age and weight loss correlated significantly with improvement in HRQoL after 5 years. Patients treated medically for depression preoperatively (13%) experienced less improvement in HRQoL than patients without such treatment. Patients with postoperative complications (26%) had significantly less improvements in all aspects of HRQoL compared with those without any form of postoperative complication.CONCLUSION: The study confirmed the importance of weight loss for improvement in HRQoL after bariatric surgery. Preoperative medication for depression and suffering a complication during the 5-year follow-up period were associated with less improvement in HRQoL.
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28. |
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29. |
- Raoof, Mustafa, 1966-
(författare)
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Long term effects of gastric bypass on quality of life and bone mineral density
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Obesity is a worldwide disease. Surgery is currently the only available management option which offers an adequate long-term effect on comorbidity, quality-of-life and weight loss. It is evident that overweight and obesity are associated with low health-related quality-of life (HRQoL) and multiple comorbidities. The aim of this thesis has been to explore the long-term effect of gastric bypass surgery on HRQoL and bone mineral density.In study 1: 486 patients (average age 50.7±10.0 years, 84 % female) operated with gastric bypass (GBP) from 1993 to 2003 at the University Hospitals of Örebro and Uppsala. Mean follow-up after GBP was 11.5±2.7 years (range 7–17). The study group was compared with two control groups. The study group scored better in the SF-36 domains and OP scale compared to obese controls, but their HRQoL scores were lower than those of the general population. HRQoL was better among younger patients and in the following subgroups: men; patients with satisfactory weight loss; those satisfied with the procedure; those free from comorbidity and gastrointestinal symptoms; employed; good oral status; and those not hospitalised or regularly followed up for non-bariatric reasons.In study 3: Patients operated with a primary GBP between January 2008 and December 2012 were identified in the Scandinavian Obesity Surgery Register (SOReg). Patients with HRQoL data available at both baseline and 5 years after surgery were included. The study sample comprised 6998 patients (21% men). Gender differences in change in HRQoL were minor. Younger patients showed greater improvements in physical health scales. In general linear regression model analyses, age and weight loss correlated significantly with improvement in HRQoL after 5 years. Patients treated medically for depression preoperatively (13%) experienced less improvement in HRQoL than patients without such treatment. Patients with a postoperative complications (26%) had significantly less improvement in all aspects of HRQoL compared to those without any form of postoperative complication.This study confirmed the importance of weight loss for improvement in HRQoL after bariatric surgery. Preoperative medication for depression and suffering a complication during the five-year follow-up period were associated with less improvement in HRQoL.Studies 2 and 4: Included patients operated with laparoscopic gastric bypass at the department of surgery at the Örebro University Hospital between January 2004 and December 2005. Thirty-two females were prospectively recruited for this longitudinal study. In both studies, the following were measured at baseline, 2, 5 and 10 years postoperatively: bone mineral density (BMD); weight; height; S-calcium; S-albumin; S-creatinine; S-25(OH)-vitamin D; and fP-PTH. In study 4: Nine of the patients declined follow-up. BMD showed a statistically significant decline over the study period. The fall in BMD of the spine and femoral neck between baseline and 5 years after surgery was 19% and 25%,respectively. During the next five years period BMD continued to decline but at a lower rate. At 5 years 58 % had elevated PTH, this number declined at the next 5 years.
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30. |
- Reda, Souheil, 1988-, et al.
(författare)
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Pre-operative beta-blocker therapy does not affect short-term mortality after esophageal resection for cancer
- 2020
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Ingår i: BMC Surgery. - : BioMed Central. - 1471-2482. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: It has been postulated that the hyperadrenergic state caused by surgical trauma is associated with worse outcomes and that β-blockade may improve overall outcome by downregulation of adrenergic activity. Esophageal resection is a surgical procedure with substantial risk for postoperative mortality. There is insufficient data to extrapolate the existing association between preoperative β-blockade and postoperative mortality to esophageal cancer surgery. This study assessed whether preoperative β-blocker therapy affects short-term postoperative mortality for patients undergoing esophageal cancer surgery.METHODS: All patients with an esophageal cancer diagnosis that underwent surgical resection with curative intent from 2007 to 2017 were retrospectively identified from the Swedish National Register for Esophagus and Gastric Cancers (NREV). Patients were subdivided into β-blocker exposed and unexposed groups. Propensity score matching was carried out in a 1:1 ratio. The outcome of interest was 90-day postoperative mortality.RESULTS: A total of 1466 patients met inclusion criteria, of whom 35% (n = 513) were on regular preoperative β-blocker therapy. Patients on β-blockers were significantly older, more comorbid and less fit for surgery based on their ASA score. After propensity score matching, 513 matched pairs were available for analysis. No difference in 90-day mortality was detected between β-blocker exposed and unexposed patients (6.0% vs. 6.6%, p = 0.798).CONCLUSION: Preoperative β-blocker therapy is not associated with better short-term survival in patients subjected to curative esophageal tumor resection.
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31. |
- Sellberg, Fanny, et al.
(författare)
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A dissonance-based intervention for women post roux-en-Y gastric bypass surgery aiming at improving quality of life and physical activity 24 months after surgery : study protocol for a randomized controlled trial
- 2018
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Ingår i: BMC Surgery. - : BioMed Central. - 1471-2482. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery is the most common bariatric procedure in Sweden and results in substantial weight loss. Approximately one year post-surgery weight regain for these patient are common, followed by a decrease in health related quality of life (HRQoL) and physical activity (PA). Our aim is to investigate the effects of a dissonance-based intervention on HRQoL, PA and other health-related behaviors in female RYGB patients 24 months after surgery. We are not aware of any previous RCT that has investigated the effects of a similar intervention targeting health behaviors after RYGB.METHODS: The ongoing RCT, the "WELL-GBP"-trial (wellbeing after gastric bypass), is a dissonance-based intervention for female RYGB patients conducted at five hospitals in Sweden. The participants are randomized to either control group receiving usual follow-up care, or to receive an intervention consisting of four group sessions three months post-surgery during which a modified version of the Stice dissonance-based intervention model is used. The sessions are held at the hospitals, and topics discussed are PA, eating behavior, social and intimate relationships. All participants are asked to complete questionnaires measuring HRQoL and other health-related behaviors and wear an accelerometer for seven days before surgery and at six months, one year and two years after surgery. The intention to treat and per protocol analysis will focus on differences between the intervention and control group from pre-surgery assessments to follow-up assessments at 24 months after RYGB. Patients' baseline characteristics are presented in this protocol paper.DISCUSSION: A total of 259 RYGB female patients has been enrolled in the "WELL-GBP"-trial, of which 156 women have been randomized to receive the intervention and 103 women to control group. The trial is conducted within a Swedish health care setting where female RYGB patients from diverse geographical areas are represented. Our results may, therefore, be representative for female RYGB patients in the country as a whole. If the intervention is effective, implementation within the Swedish health care system is possible within the near future.TRIAL REGISTRATION: The trial was registered on February 23th 2015 with registration number ISRCTN16417174.
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32. |
- Stenberg, Erik, 1979-, et al.
(författare)
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Bleeding during laparoscopic gastric bypass surgery as a risk factor for less favorable outcome : A cohort study from the Scandinavian Obesity Surgery Registry
- 2017
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 13:10, s. 1735-1740
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Intraoperative adverse events are known to be associated with postoperative complications; however, little is known about whether or not blood loss during laparoscopic gastric bypass surgery affects the outcome.OBJECTIVE: To see if intraoperative bleeding was associated with a less favorable outcome, and to identify patient-specific risk factors for intraoperative bleeding.SETTING: Nationwide, Sweden.METHODS: Patients who underwent laparoscopic gastric bypass surgery between January 8, 2007, and September 15, 2015, were included in the study. The volume of intraoperative blood loss was compared with data from follow-up at day 30 and 1 and 2 years after surgery. Patient-specific factors were analyzed as potential risk factors for intraoperative bleeding.RESULTS: The study included 43,157 patients. Intraoperative bleeding was associated with an increased risk for postoperative complication (100-499 mL, odds ratio [OR] 2.97, 95% confidence interval [95%CI] 2.53-3.50;>500 mL OR 3.34, 95%CI 2.05-5.44), lower weight loss (<100 mL, 82.4±24.19% excess body mass index-loss [%EBMIL]; 100-499 mL, 76.9±24.24 %EBMIL, P<.0001;>500 mL 76.9±23.89 %EBMIL, P = .063) and lower reported quality-of-life 2 years after surgery (<100 mL, Obesity-related Problem scale (OP) 21.1±24.46; 100-499 mL, OP 25.0±26.62, P = .008;>500 mL, OP 25.2±24.46, P = .272). Diabetes (OR 1.30, 95%CI 1.08-1.58), age (OR 1.02, 95%CI 1.02-1.03), and body mass index (OR 1.03, 95%CI 1.02-1.05) were patient-specific risk factors for intraoperative bleeding≥100 mL, whereas intentional preoperative weight loss was associated with a lower risk (OR .50, 95%CI .43-.57).CONCLUSION: Intraoperative bleeding was associated with less favorable outcome after laparoscopic gastric bypass surgery. Age, body mass index, and diabetes were risk factors for intraoperative bleeding, while preoperative weight reduction seems to be protective.
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33. |
- Stenberg, Erik, 1979-, et al.
(författare)
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Closure of mesenteric defects in laparoscopic gastric bypass : a multicentre, randomised, parallel, open-label trial
- 2016
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Ingår i: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 387:10026, s. 1397-1404
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Tidskriftsartikel (refereegranskat)abstract
- Background: Small bowel obstruction due to internal hernia is a common and potentially serious complication after laparoscopic gastric bypass surgery. Whether closure of surgically created mesenteric defects might reduce the incidence is unknown, so we did a large randomised trial to investigate.Method: This study was a multicentre, randomised trial with a two-arm, parallel design done at 12 centres for bariatric surgery in Sweden. Patients planned for laparoscopic gastric bypass surgery at any of the participating centres were off ered inclusion. During the operation, a concealed envelope was opened and the patient was randomly assigned to either closure of mesenteric defects beneath the jejunojejunostomy and at Petersen's space or non-closure. After surgery, assignment was open label. The main outcomes were reoperation for small bowel obstruction and severe postoperative complications. Outcome data and safety were analysed in the intention-to-treat population. This trial is registered with ClinicalTrials. gov, number NCT01137201.Findings: Between May 1, 2010, and Nov 14, 2011, 2507 patients were recruited to the study and randomly assigned to closure of the mesenteric defects (n= 1259) or non-closure (n= 1248). 2503 (99.8%) patients had follow-up for severe postoperative complications at day 30 and 2482 (99.0%) patients had follow-up for reoperation due to small bowel obstruction at 25 months. At 3 years after surgery, the cumulative incidence of reoperation because of small bowel obstruction was signifi cantly reduced in the closure group (cumulative probability 0.055 for closure vs 0.102 for non-closure, hazard ratio 0.56, 95% CI 0.41-0.76, p= 0.0002). Closure of mesenteric defects increased the risk for severe postoperative complications (54 [4.3%] for closure vs 35 [2.8%] for non-closure, odds ratio 1.55, 95% CI 1.01-2.39, p= 0.044), mainly because of kinking of the jejunojejunostomy.Interpretation: The results of our study support the routine closure of the mesenteric defects in laparoscopic gastric bypass surgery. However, closure of the mesenteric defects might be associated with increased risk of early small bowel obstruction caused by kinking of the jejunojejunostomy.
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34. |
- Stenberg, Erik, 1979-, et al.
(författare)
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Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery : a Register-Based Cohort Study
- 2019
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Ingår i: Obesity Surgery. - : Springer Science+Business Media B.V.. - 0960-8923 .- 1708-0428. ; 29:4, s. 1229-1235
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Routine closure of mesenteric defects is generally considered standard part of laparoscopic gastric bypass surgery today. Controversy still exists regarding the optimal method for mesenteric defects closure. The objective was to compare different methods for mesenteric defects handling in laparoscopic gastric bypass surgery.METHODS: Primary laparoscopic gastric bypass procedures from 2010 until 2015 reported to the Scandinavian Obesity Surgery Registry (SOReg), where the mesenteric defects closure method was identifiable, were included. Main outcome measures were serious postoperative complication within 30 days after surgery, and reoperation for small bowel obstruction within 5 years after surgery. Quality-of-life before and after surgery, duration of surgery, and risk factors for complication were also analyzed. Information on operation for small bowel obstruction was based on data from the SOReg, the Swedish National Patient Register and reviews of hospital charts.RESULTS: In all, 34,707 patients were included. Serious postoperative complication occurred in 174 (2.9%) patients with sutures, in 592 (3.1%, adjusted p = 0.079) with clips, and 278 (3.1%; adjusted p = 0.658) in the non-closure group. Reoperation for small bowel obstruction within 5 years after surgery was lower with sutures (cumulative incidence 6.9%) and clips (cumulative incidence 7.3%; adjusted HR 1.16, 95% CI 1.02-1.32, p = 0.026), compared to non-closure (cumulative incidence 11.2%; adjusted HR 1.63, 95% CI 1.44-1.84, p < 0.0001).CONCLUSION: Closure of the mesenteric defects using either non-absorbable metal clips or non-absorbable running sutures is a safe and effective measure to reduce the risk for small bowel obstruction after laparoscopic gastric bypass surgery. Sutures appear slightly more effective and should remain gold standard for mesenteric defects closure.
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35. |
- Stenberg, Erik, 1979-, et al.
(författare)
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Early complications after laparoscopic gastric bypass surgery : results from the Scandinavian Obesity Surgery Registry
- 2014
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 260:6, s. 1040-1047
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To identify risk factors for serious and specific early complications of laparoscopic gastric bypass surgery using a large national cohort of patients.BACKGROUND: Bariatric procedures are among the most common surgical procedures today. There is, however, still a need to identify preoperative and intraoperative risk factors for serious complications.METHODS: From the Scandinavian Obesity Surgery Registry database, we identified 26,173 patients undergoing primary laparoscopic gastric bypass operation for morbid obesity between May 1, 2007, and September 30, 2012. Follow-up on day 30 was 95.7%. Preoperative data and data from the operation were analyzed against serious postoperative complications and specific complications.RESULTS: The overall risk of serious postoperative complications was 3.4%. Age (adjusted P = 0.028), other additional operation [odds ratio (OR) = 1.50; confidence interval (CI): 1.04-2.18], intraoperative adverse event (OR = 2.63; 1.89-3.66), and conversion to open surgery (OR = 4.12; CI: 2.47-6.89) were all risk factors for serious postoperative complications. Annual hospital volume affected the rate of serious postoperative complications. If the hospital was in a learning curve at the time of the operation, the risk for serious postoperative complications was higher (OR = 1.45; CI: 1.22-1.71). The 90-day mortality rate was 0.04%.CONCLUSIONS: Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.
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36. |
- Stenberg, Erik, 1979-, et al.
(författare)
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Health-Related Quality-of-Life after Laparoscopic Gastric Bypass Surgery with or Without Closure of the Mesenteric Defects : a Post-hoc Analysis of Data from a Randomized Clinical Trial
- 2018
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Ingår i: Obesity Surgery. - : Springer-Verlag New York. - 0960-8923 .- 1708-0428. ; 28:1, s. 31-36
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mesenteric defect closure in laparoscopic gastric bypass surgery has been reported to reduce the risk for small bowel obstruction. Little is known, however, about the effect of mesenteric defect closure on patient-reported outcome. The aim of the present study was to see if mesenteric defect closure affects health-related quality-of-life (HRQoL) after laparoscopic gastric bypass.METHODS: Patients operated at 12 centers for bariatric surgery participated in this randomized two-arm parallel study. During the operation, patients were randomized to closure of the mesenteric defects or non-closure. This study was a post-hoc analysis comparing HRQoL of the two groups before surgery, at 1 and 2 years after the operation. HRQoL was estimated using the short form 36 (SF-36-RAND) and the obesity problems (OP) scale.RESULTS: Between May 1, 2010, and November 14, 2011, 2507 patients were included in the study and randomly assigned to mesenteric defect closure (n = 1259) or non-closure (n = 1248). In total, 1619 patients (64.6%) reported on their HRQoL at the 2-year follow-up. Mesenteric defect closure was associated with slightly higher rating of social functioning (87 ± 22.1 vs. 85 ± 24.2, p = 0.047) and role emotional (85 ± 31.5 vs. 82 ± 35.0, p = 0.027). No difference was seen on the OP scale (open defects 22 ± 24.8 vs. closed defects 20 ± 23.8, p = 0.125).CONCLUSION: When comparing mesenteric defect closure with non-closure, there is no clinically relevant difference in HRQoL after laparoscopic gastric bypass surgery.
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37. |
- Stenberg, Erik, 1979-, et al.
(författare)
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Impact of mesenteric defect closure technique on complications after gastric bypass
- 2018
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Ingår i: Langenbeck's archives of surgery (Print). - : Springer. - 1435-2443 .- 1435-2451. ; 403:4, s. 481-486
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Closure of mesenteric defects during laparoscopic gastric bypass surgery markedly reduces the risk for small bowel obstruction due to internal hernia. However, this procedure is associated with an increased risk for early small bowel obstruction and pulmonary complication. The purpose of the present study was to evaluate whether the learning curve and subsequent adaptions made to the technique have had an effect on the risk for complications.METHODS: The results of patients operated with a primary laparoscopic gastric bypass procedure, including closure of the mesenteric defects with sutures, during a period soon after introduction (January 1, 2010-December 31, 2011) were compared to those of patients operated recently (January 1, 2014-June 30, 2017). Data were retrieved from the Scandinavian Obesity Surgery Registry (SOReg). The main outcome was reoperation for small bowel obstruction within 30 days after surgery.RESULTS: A total of 5444 patients were included in the first group (period 1), and 1908 in the second group (period 2). Thirty-day follow-up rates were 97.1 and 97.5% respectively. The risk for early (within 30 days) small bowel obstruction was lower in period 2 than in period 1 (13/1860, 0.7% vs. 67/5285, 1.3%, OR 0.55 (0.30-0.99), p = 0.045). The risk for pulmonary complication was also reduced (5/1860, 0.3%, vs. 41/5285, 0.8%, OR 0.34 (0.14-0.87), p = 0.019).CONCLUSION: Closure of mesenteric defects during laparoscopic gastric bypass surgery can be performed safely and should be viewed as a routine part of that operation.
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38. |
- Stenberg, Erik, 1979-, et al.
(författare)
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Is glycosylated hemoglobin A1c associated with increased risk for severe early postoperative complications in nondiabetics after laparoscopic gastric bypass?
- 2014
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 10:5, s. 801-805
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Glycosylated hemoglobin A1 c (HbA1 c) has been described as a risk factor for adverse outcome after cardiovascular and colorectal surgery, but not for obese patients undergoing bariatric surgery. The objective of this study was to see if there is an association between HbA1 c and adverse outcome in laparoscopic gastric bypass surgery.METHODS: From the Scandinavian Obesity Surgery Registry we identified 12,850 patients, without treatment for diabetes and operated with laparoscopic gastric bypass between January 1, 2010 and September 30, 2012, and where a baseline HbA1 c value was registered. Preoperative data were compared with data from a 30-day follow-up. Severe complications were defined according to the Clavien-Dindo-Scale as Grade 3 b or higher.RESULTS: HbA1 c levels below 5.7 % were associated with a lower incidence of severe complications (2.7 %) than higher levels (HbA1 c 5.7-6.49% incidence 3.5%, P = .015; HbA1 c>6.5%, incidence 4.5%, P = .012). After multivariate analysis with patient-specific confounders the difference remained significant (HbA1 c 5.7-6.49% adjusted P = .046; HbA1 c>6.5% adjusted P = .023) CONCLUSION: Elevated HbA1 c levels in patients without pharmacologic treatment for diabetes undergoing laparoscopic gastric bypass surgery is associated with an increased risk for severe complications during the first 30 postoperative days. This is the case, even at levels not regarded as diagnostic for diabetes.
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39. |
- Stenberg, Erik, 1979-, et al.
(författare)
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Long-term Safety and Efficacy of Closure of Mesenteric Defects in Laparoscopic Gastric Bypass Surgery : A Randomized Clinical Trial
- 2023
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Ingår i: JAMA Surgery. - : American Medical Association (AMA). - 2168-6254 .- 2168-6262. ; 158:7, s. 709-717
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: Short-term and midterm data suggest that mesenteric defects closure during laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery reduces the risk of internal herniation with small bowel obstruction (SBO) but may increase risk of kinking of the jejunojejunostomy in the early postoperative period. However, to our knowledge, there are no clinical trials reporting long-term results from this intervention in terms of risk for SBO or opioid use.OBJECTIVE: To evaluate long-term safety and efficacy outcomes of closure of mesenteric defects during LRYGB.DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial with a 2-arm, parallel, open-label design included patients with severe obesity scheduled for LRYGB bariatric surgery at 12 centers in Sweden from May 1, 2010, through November 14, 2011, with 10 years of follow-up after the intervention. INTERVENTIONS: During the operation, patients were randomly assigned 1:1 to closure of mesenteric defects beneath the jejunojejunostomy and at the Petersen space using nonabsorbable running sutures during LRYGB or to nonclosure.MAIN OUTCOME AND MEASURES: The primary outcome was reoperation for SBO. New incident, chronic opioid use was a secondary end point as a measure of harm.RESULTS: A total of 2507 patients (mean [SD] age, 41.7 [10.7] years; 1863 female [74.3%]) were randomly assigned to closure of mesenteric defects (n = 1259) or nonclosure (n = 1248). After censoring for death and emigration, 1193 patients in the closure group (94.8%) and 1198 in the nonclosure group (96.0%) were followed up until the study closed. Over a median follow-up of 10 years (IQR, 10.0-10.0 years), a reoperation for SBO from day 31 to 10 years after surgery was performed in 185 patients with nonclosure (10-year cumulative incidence, 14.9%; 95% CI, 13.0%-16.9%) and in 98 patients with closure (10-year cumulative incidence, 7.8%; 95% CI, 6.4%-9.4%) (subhazard ratio [SHR], 0.42; 95% CI, 0.32-0.55). New incident chronic opioid use was seen among 175 of 863 opioid-naive patients with nonclosure (10-year cumulative incidence, 20.4%; 95% CI, 17.7%-23.0%) and 166 of 895 opioid-naive patients with closure (10-year cumulative incidence, 18.7%; 95% CI, 16.2%-21.3%) (SHR, 0.90; 95% CI, 0.73-1.11).CONCLUSIONS AND RELEVANCE: This randomized clinical trial found long-term reduced risk of SBO after mesenteric defects closure in LRYGB. The findings suggest that routine use of this procedure during LRYGB should be considered.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01137201.
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40. |
- Stenberg, Erik, 1979-, et al.
(författare)
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Outcomes of laparoscopic gastric bypass in a randomized clinical trial compared with a concurrent national database
- 2017
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Ingår i: British Journal of Surgery. - : John Wiley & Sons. - 0007-1323 .- 1365-2168. ; 104:5, s. 562-569
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: RCTs are the standard for assessing medical interventions, but they may not be feasible and their external validity is sometimes questioned. This study aimed to compare results from an RCT on mesenteric defect closure during laparoscopic gastric bypass with those from a national database containing data on the same procedure, to shed light on the external validity of the RCT.METHODS: Patients undergoing laparoscopic gastric bypass surgery within an RCT conducted between 1 May 2010 and 14 November 2011 were compared with those who underwent the same procedure in Sweden outside the RCT over the same time interval. Primary endpoints were severe complications within 30 days and surgery for small bowel obstruction within 4 years.RESULTS: Some 2507 patients in the RCT were compared with 8485 patients in the non-RCT group. There were no differences in severe complications within 30 days in the group without closure of the mesenteric defect (odds ratio (OR) for RCT versus non-RCT 0·94, 95 per cent c.i. 0·64 to 1·36; P = 0·728) or in the group with closure of the defect (OR 1·34, 0·96 to 1·86; P = 0·087). There were no differences between the RCT and non-RCT cohorts in reoperation rates for small bowel obstruction in the mesenteric defect non-closure (cumulative incidence 10·9 versus 9·4 per cent respectively; hazard ratio (HR) 1·20, 95 per cent c.i. 0·99 to 1·46; P = 0·065) and closure (cumulative incidence 5·7 versus 7·0 per cent; HR 0·82, 0·62 to 1·07; P = 0·137) groups. The relative risk for small bowel obstruction without mesenteric defect closure compared with closure was 1·91 in the RCT group and 1·39 in the non-RCT group.CONCLUSION: The efficacy of mesenteric defect closure was similar in the RCT and national registry, providing evidence for the external validity of the RCT.
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41. |
- Stenberg, Erik, 1979-, et al.
(författare)
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Risk Prediction Model for Severe Postoperative Complication in Bariatric Surgery
- 2018
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 28:7, s. 1869-1875
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Factors associated with risk for adverse outcome are important considerations in the preoperative assessment of patients for bariatric surgery. As yet, prediction models based on preoperative risk factors have not been able to predict adverse outcome sufficiently.OBJECTIVE: This study aimed to identify preoperative risk factors and to construct a risk prediction model based on these.METHODS: Patients who underwent a bariatric surgical procedure in Sweden between 2010 and 2014 were identified from the Scandinavian Obesity Surgery Registry (SOReg). Associations between preoperative potential risk factors and severe postoperative complications were analysed using a logistic regression model. A multivariate model for risk prediction was created and validated in the SOReg for patients who underwent bariatric surgery in Sweden, 2015.RESULTS: Revision surgery (standardized OR 1.19, 95% confidence interval (CI) 1.14-0.24, p < 0.001), age (standardized OR 1.10, 95%CI 1.03-1.17, p = 0.007), low body mass index (standardized OR 0.89, 95%CI 0.82-0.98, p = 0.012), operation year (standardized OR 0.91, 95%CI 0.85-0.97, p = 0.003), waist circumference (standardized OR 1.09, 95%CI 1.00-1.19, p = 0.059), and dyspepsia/GERD (standardized OR 1.08, 95%CI 1.02-1.15, p = 0.007) were all associated with risk for severe postoperative complication and were included in the risk prediction model. Despite high specificity, the sensitivity of the model was low.CONCLUSION: Revision surgery, high age, low BMI, large waist circumference, and dyspepsia/GERD were associated with an increased risk for severe postoperative complication. The prediction model based on these factors, however, had a sensitivity that was too low to predict risk in the individual patient case.
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42. |
- Stenberg, Erik, 1979-, et al.
(författare)
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The association between socioeconomic factors and weight loss 5 years after gastric bypass surgery
- 2020
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Ingår i: International Journal of Obesity. - : Nature Publishing Group. - 0307-0565 .- 1476-5497. ; 44:11, s. 2279-2290
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Tidskriftsartikel (refereegranskat)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.
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43. |
- Stenberg, Erik, 1979-, et al.
(författare)
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The impact of socioeconomic factors on the early postoperative complication rate after laparoscopic gastric bypass surgery : A register-based cohort study
- 2019
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 15:4, s. 575-581
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Tidskriftsartikel (refereegranskat)abstract
- Background: Socioeconomic factors may influence the outcome of certain surgical procedures, but it is not known whether such factors influence the risk for postoperative complication after bariatric surgery.Objectives: Determining whether different socioeconomic factors influence the risk for postoperative complication after laparoscopic gastric bypass surgery.Setting: Nationwide in Sweden.Methods: Retrospective register-based cohort study that includes all primary laparoscopic gastric bypass procedures in Sweden between 2010 and 2016, using data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, and the Swedish Population Register. Main outcome measures were occurrence and severity of early postoperative complications.Results: Included in this study were 41,537 patients with 30-day follow-up percentage of 96.7%. Study groups with increased risk for postoperative complication (age, sex, body mass index, and co-morbidity adjusted odds ratio with 95% confidence intervals) were as follows: being divorced, a widow, or a widower (1.14 [1.03-1.23]); receiving disability pension (1.37 [1.23-1.53]) or social assistance (1.22 [1.07-1.401); and being first- (1.22 [1.04-1.44]) or second-generation (1.20 [1.09-1.32]) immigrant. In contrast, being single (.90 [.83.991), having higher disposable income (50th-80th percentile:.84 [.76.93]; >80th percentile:.84 [72.98]), and living in a medium (.90 [.83.98]) or small (.84 [.76.92]) town were associated with lower risk. Increased risk for severe postoperative complication was seen for divorced, widowm, or widower (1.30 [1.12-1.521) and those receiving disability pension (1.37 [1.16-1.611) or social assistance (1.32 [1.08-1.62]), while higher disposable income (50th-80th percentile:.79 [.68.92]; >80th percentile .57 [.46.72]) was associated with lower risk.Conclusion: Socioeconomic factors influence the risk for early postoperative complication after laparoscopic gastric bypass surgery. The impact is not enough to exclude patients from surgery, but they must be taken into account in preoperative risk assessment.
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44. |
- Szabo, Eva, 1973-
(författare)
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Molecular and clinical genetic studies of a novel variant of familial hypercalcemia
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Familial primary hyperparathyroidism (HPT) is a rare disorder that is treated surgically and mostly occurs in association with tumor-susceptibility syndromes, like multiple endocrine neoplasia and the hyperparathyroidism-jaw tumor syndrome. Familial hypercalciuric hypercalcemia (FHH) is another cause of hereditary hypercalcemia that generally is considered to require no treatment and is genetically and pathophysiologically distinct from HPT. Inactivating mutations in the calcium receptor gene cause FHH, whereas the down-regulated expression of the CaR in HPT never has been coupled to CaR gene mutations.Family screening revealed a hitherto unknown familial condition with characteristics of both FHH and HPT. The hypercalcemia was mapped to a point mutation in the intracellular domain of the CaR gene that was coupled to relative calcium resistance of the PTH release by transient expression in HEK 294 cells. Unusually radical excision of parathyroid glands was required to normalise the hypercalcemia. The mildly enlarged parathyroid glands displayed hyperplasia with nodular components. Frequent allelic loss on especially 12q was found and contrasts to findings in HPT. Allelic loss was also seen in loci typical for primary HPT like 1p, 6q and 15q, but not 11q13. Quantitative mRNA analysis showed that the glands had mild increase in a proliferation index (PCNA/GAPDH mRNA ratio) and mild reduction in genes important to parathyroid cell function, like CaR, PTH, VDR and LRP2.A previously unrecognized variant of hypercalcemia is explored that could be one explanation for persistent hypercalcemia after apparently typical routine operations for HPT. It also raises the issue of possibilities to treat FHH with parathyroidectomy provided it is radical enough.
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45. |
- Wallén, Stefan, 1978-, et al.
(författare)
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Impact of socioeconomic status on new chronic opioid use after gastric bypass surgery
- 2023
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Ingår i: Surgery for Obesity and Related Diseases. - : Elsevier. - 1550-7289 .- 1878-7533. ; 19:12, s. 1375-1381
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Socioeconomic status may influence weight loss, postoperative complications, and health-related quality of life after bariatric surgery. Chronic use of opioid analgesics is a known risk after bariatric surgery, but whether socioeconomic factors are associated with new chronic use of opioid analgesics has not been investigated in depth.OBJECTIVES: The aim of this study was to identify socioeconomic factors associated with the development of new chronic use of opioid analgesics after gastric bypass surgery.SETTING: All hospitals performing bariatric surgery in Sweden.METHODS: This was a retrospective cohort study with prospectively collected data including all primary gastric bypass procedures in Sweden between 2007 and 2015. Data were collected from the Scandinavian Obesity Surgery Registry, the Swedish Prescribed Drug Register, and Statistics Sweden. The primary outcome was new chronic opioid use.RESULTS: Of the 44,671 participants, 1438 patients became new chronic opioid users. Longer education (secondary education; odds ratio [OR] = .71; 95% CI, .62-.81) or higher education (OR = .45; 95% CI, .38-.53), higher disposable income (20th-50th percentile: OR = .75; 95% CI, .66-.85; 50th-80th percentile: OR = .50; 95% CI, .43-.58; and the highest 80th percentile: OR = .40; 95% CI, .32-.51) were significantly associated with lower risk for new chronic opioid use. Being a second-generation immigrant (OR = 1.54; 95% CI, 1.24-1.90), being on a disability pension or early retirement (OR = 3.04; 95% CI, 2.67-3.45), receiving social benefits (OR = 1.88; 95% CI, 1.59-2.22), being unemployed for <100 days (OR = 1.25; 95% CI, 1.08-1.45), being unemployed for >100 days (OR = 1.41; 95% CI, 1.16-1.71), and being divorced or a widow or widower (OR = 1.35; 95% CI, 1.17-1.55) were significantly associated with a higher risk for chronic opioid use.CONCLUSION: Given that long-term opioid use has detrimental effects after bariatric surgery, it is important that information and follow-up are optimized for patients with shorter education, lower income, and disability pension or early retirement because they are at an increased risk of new chronic opioid analgesics use.
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46. |
- Wallén, Stefan, 1978-, et al.
(författare)
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Opioid Use After Gastric Bypass, Sleeve Gastrectomy or Intensive Lifestyle Intervention
- 2023
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 277:3, s. e552-e560
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare opioid use in patients with obesity treated with bariatric surgery versus adults with obesity who underwent intensive lifestyle modification. SUMMARY OFBACKGROUND DATA: Previous studies of opioid use after bariatric surgery have been limited by small sample sizes, short follow-up, and lack of control groups.METHODS: Nationwide matched cohort study including individuals from the Scandinavian Obesity Surgery Registry and the Itrim health database with individuals undergoing structured intensive lifestyle modification, between August 1, 2007 and September 30, 2015. Participants were matched on Body Mass Index, age, sex, education, previous opioid use, diabetes, cardiovascular disease, and psychiatric status (n = 30,359:21,356). Dispensed opioids were retrieved from the Swedish Prescribed Drug Register from 2 years before to up to 8 years after intervention.RESULTS: During the 2-year period before treatment, prevalence of individuals receiving ≥1 opioid prescription was identical in the surgery and lifestyle group. At 3 years, the prevalence of opioid prescriptions was 14.7% versus 8.9% in the surgery and lifestyle groups (mean difference 5.9%, 95% confidence interval 5.3-6.4) and at 8 years 16.9% versus 9.0% (7.9%, 6.8-9.0). The difference in mean daily dose also increased over time and was 3.55 mg in the surgery group versus 1.17 mg in the lifestyle group at 8 years (mean difference [adjusted for baseline dose] 2.30 mg, 95% confidence interval 1.61-2.98).CONCLUSIONS: Bariatric surgery was associated with a higher proportion of opioid users and larger total opioid dose, compared to actively treated obese individuals. These trends were especially evident in patients who received additional surgery during follow-up.
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47. |
- Wallén, Stefan, 1978-, et al.
(författare)
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Use of Opioid Analgesics Before and After Gastric Bypass Surgery in Sweden : a Population-Based Study
- 2018
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 28:11, s. 3518-3523
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Tidskriftsartikel (refereegranskat)abstract
- Background: Little is known regarding the use of opioid analgesics among patients who have undergone bariatric surgery. The Roux-en-Y gastric bypass (RYGB) procedure has been shown to significantly increase the rate of absorption of and exposure to morphine, raising concerns regarding the potentially increased risk of side-effects and the development of substance-use disorder.Objectives: The aim of this study was to describe the pattern of opioid use over time following RYGB and to see if the pattern differs between patients with a high opioid consumption (HOC) prior to surgery and those with a low consumption (LOC).Setting: University Hospital of Örebro, Sweden.Methods: The study was a descriptive retrospective population-based cohort study where two registers with complete coverage were cross-matched.Results: The study population comprised 35,612 persons (1628 HOC, and 33,984 LOC). After surgery, the number of HOC patients increased to 2218. Mean daily opioid consumption in the total population and the LOC group increased after surgery (p <.0005). In the HOC group, there was no difference between mean daily consumption before and after surgery.Conclusion: In this nationwide study, we have showed that there is an increase in consumption of opioid analgesics after gastric bypass surgery in Sweden. The increase in the number of individuals with high opioid consumption in the total population was mainly due to an increase in the group of patients with a low consumption prior to surgery.
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48. |
- Wallhuss, Andreas, et al.
(författare)
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Outcomes of bariatric surgery for patients with prevalent inflammatory bowel disease: A nationwide registry-based cohort study
- 2023
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Ingår i: Surgery. - : MOSBY-ELSEVIER. - 0039-6060 .- 1532-7361. ; 174:2, s. 144-151
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Tidskriftsartikel (refereegranskat)abstract
- Background: Obesity is becoming more prevalent in patients with inflammatory bowel disease. Although bariatric surgery is an effective treatment for obesity, questions remain regarding its safety and effec-tiveness for patients with inflammatory bowel disease. The aim of this study was to evaluate the safety and effectiveness of bariatric surgery in patients with inflammatory bowel disease. Method: This registry-based, propensity-matched cohort study included all patients who had primary Roux-en-Y gastric bypass or sleeve gastrectomy in Sweden from January 2007 to June 2020 who had an inflammatory bowel disease diagnosis and matched control patients without an inflammatory bowel disease diagnosis. The study included data from the Scandinavian Obesity Surgery Registry, the National Patient Register, the Swedish Prescribed Drugs Register, the Total Population Register, and the Education Register from Statistics Sweden.Results: In total, 71,093 patients who underwent bariatric surgery, including 194 with Crohns disease and 306 with ulcerative colitis, were 1:5 matched to non-inflammatory bowel disease control patients. The patients with Crohns disease had a higher readmission rate within 30 days (10.7% vs 6.1%, odds ratio = 1.84, 95% confidence interval 1.02-3.31) than the control patients, with no significant difference between the surgical methods. The patients with ulcerative colitis had a higher risk for serious post-operative complications after Roux-en-Y gastric bypass (8.0% vs 3.7%, odds ratio = 2.64, 95% confidence interval 1.15-6.05) but not after sleeve gastrectomy compared to control patients (0.8% vs 2.3%). No difference was observed in postoperative weight loss or postoperative health-related quality of life.Conclusion: Sleeve gastrectomy appears to be a safe and effective treatment for obesity in patients with inflammatory bowel disease, whereas Roux-en-Y gastric bypass was associated with a higher risk for postoperative complications in patients with ulcerative colitis.& COPY; 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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49. |
- Wanjura, Viktor, 1975-, et al.
(författare)
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Cholecystectomy after gastric bypass-incidence and complications
- 2017
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Ingår i: Surgery for Obesity and Related Diseases. - New York : Elsevier. - 1550-7289 .- 1878-7533. ; 13:6, s. 979-987
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Tidskriftsartikel (refereegranskat)abstract
- Background: Although cholecystectomy incidence is known to be high after Roux-en-Y gastric bypass (RYGB) surgery, the actual increase in incidence is not known. Furthermore, the outcome of cholecystectomy after RYGB is not known.Objectives: To estimate cholecystectomy incidence before and after RYGB and to compare the outcome of post-RYGB cholecystectomy with the cholecystectomy outcome in the background population.Setting: Nationwide Swedish multiregister study.Methods: The Swedish Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (n = 79,386) and the Scandinavian Obesity Surgery Registry (n = 36,098) were cross-matched for the years 2007 through 2013 and compared with the National Patient Register.Results: The standardized incidence ratio for cholecystectomy before RYGB was 3.42 (2.75-4.26, P < .001); the ratio peaked at 11.4 (10.2-12.6, P < .001) 6-12 months after RYGB, which was 3.54 times the baseline level (2.78-4.49, P < .001). After 36 months, the incidence ratio had returned to baseline. The post-RYGB group demonstrated an increased risk of 30-day postoperative complications after cholecystectomy (odds ratio 2.13, 1.78-2.56; P < .001), including reoperation (odds ratio 3.84, 2.76-5.36; P < .001), compared with the background population. The post-RYGB group also demonstrated a higher risk of conversion, acute cholecystectomy, and complicated gallstone disease and a slightly prolonged operative time, adjusted for age, sex, American Society of Anesthesiologists class, and previous open RYGB.Conclusion: Compared with the background population, the incidence of cholecystectomy was substantially elevated already before RYGB and increased further 6-36 months after RYGB. Previous RYGB doubled the risk of postoperative complications after cholecystectomy and almost quadrupled the risk of reoperation, even when intraoperative cholangiography was normal. (C) 2017 American Society for Metabolic and Bariatric Surgery.
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