Background
Laparoscopic cholecystectomy (LC) is one of the safest, most commonly performed surgical procedures, but postoperative complications including bile leak, retained stone, cholangitis, and ...gallstone pancreatitis following LC occur in up to 2.6% of cases and may require readmission with possible endoscopic retrograde cholangiopancreatography (ERCP) intervention. There is a paucity of literature on factors predictive of need for ERCP following LC. The goal of this study is to describe the prevalence and risk factors for readmission with indication for ERCP.
Methods
We queried the ACS/NSQIP 2012–2017 Participant User Files for patients who underwent LC. Patient demographics, comorbidities, operative characteristics, and postoperative outcomes were evaluated. Multivariate logistic regression was used to identify risk factors for readmission with indication for ERCP intervention.
Results
Of 275,570 patients, 11,010 (4.00%) were readmitted within the 30-day postoperative period. Among these, 930 (8.44%) were admitted with indication for ERCP intervention. On multivariate regression, readmissions were more likely in older patients, inpatients, and patients with baseline comorbidities, acute preoperative morbidity, and those discharged to care facilities. The use of intraoperative cholangiogram was associated with lower odds of readmission. Less than 10% of readmitted patients had an indication for ERCP. Those who were readmitted with an indication for ERCP were more likely to have undergone emergency surgery, experienced longer operative times, and had elevated preoperative LFTs or gallstone pancreatitis prior to surgery. The risk of 30-day mortality was significantly higher among patients who experienced any complications after their surgery (OR 13.03, 95% CI 10.57–16.07,
p
< 0.001).
Conclusions
Older patients, patients with greater preoperative morbidity, and those discharged to care facilities were more likely to be readmitted for any reason following laparoscopic cholecystectomy, whereas patients with evidence of complicated gallstone disease were more likely to be readmitted with an indication for ERCP, even when controlling for the use of intraoperative cholangiogram. Initiatives aimed at reducing readmission with indication for ERCP should focus on these patient subgroups.
Purpose
Energy and fatigue are thought to improve after bariatric surgery. Such improvements could be related to weight loss and/or increased engagement in day-to-day health behaviors, such as ...moderate-to-vigorous physical activity (MVPA). This study used ecological momentary assessment (EMA) to evaluate several aspects of energy/fatigue in real-time in patients’ natural environment during the first year after surgery and assessed the associations of percent total weight loss (%TWL) and daily MVPA with daily energy/fatigue levels.
Methods
Patients (n = 71) undergoing Roux-en-Y gastric bypass or sleeve gastrectomy rated their energy, alertness and attentiveness (averaged to create an “attentiveness” rating), and tiredness and sleepiness (averaged to create a “fatigue” rating) via smartphone-based EMA at 4 semi-random times daily for 10 days at pre-surgery and 3-, 6-, and 12 months post-surgery. Daily MVPA minutes were assessed via accelerometry. Weight was measured in clinic.
Results
Energy ratings initially increased from pre- to post-surgery, before leveling off/decreasing by 12 months (p < 0.001). Attentiveness and fatigue ratings did not change over time. %TWL was unrelated to any ratings, while MVPA related to both energy and attentiveness but not fatigue. Participants reported more energy on days with more total MVPA min (p = 0.03) and greater attentiveness on days with more total (p < 0.001) and bouted (p = 0.02) MVPA.
Conclusions
While more research is needed to confirm causality, results suggest that greater daily MVPA is associated with increased daily energy and attentiveness among bariatric surgery patients, independent of %TWL. Findings add to growing evidence of MVPA’s potential benefits beyond energy expenditure in the context of bariatric surgery.
Graphical abstract
Habitual physical activity (PA) may help to optimize bariatric surgery outcomes; however, objective PA measures show that most patients have low PA preoperatively and make only modest PA changes ...postoperatively. Patients require additional support to adopt habitual PA. The objective of this study was to test the efficacy of a preoperative PA intervention (PAI) versus standard presurgical care (SC) for increasing daily moderate-to-vigorous PA (MVPA) in bariatric surgery patients.
Outcomes analysis included 75 participants (86.7% women; 46.0±8.9 years; body mass index BMI=45.0±6.5 kg/m2) who were randomly assigned preoperatively to 6 weeks of PAI (n=40) or SC (n=35). PAI received weekly individual face-to-face sessions with tailored instruction in behavioral strategies (e.g., self-monitoring, goal-setting) to increase home-based walking exercise. The primary outcome, pre- to postintervention change in daily bout-related (≥10 min bouts) and total (≥1 min bouts) MVPA minutes, was assessed objectively via a multisensor monitor worn for 7 days at baseline- and postintervention.
Retention was 84% at the postintervention primary endpoint. In intent-to-treat analyses with baseline value carried forward for missing data and adjusted for baseline MVPA, PAI achieved a mean increase of 16.6±20.6 min/d in bout-related MVPA (baseline: 4.4±5.5 to postintervention: 21.0±21.4 min/d) compared to no change (-0.3±12.7 min/d; baseline: 7.9±16.6 to postintervention: 7.6±11.5 min/d) for SC (P=.001). Similarly, PAI achieved a mean increase of 21.0±26.9 min/d in total MVPA (baseline: 30.9±21.2 to postintervention: 51.9±30.0 min/d), whereas SC demonstrated no change (-0.1±16.3 min/d; baseline: 33.7±33.2 to postintervention: 33.6±28.5 minutes/d) (P=.001).
With behavioral intervention, patients can significantly increase MVPA before bariatric surgery compared to SC. Future studies should determine whether preoperative increases in PA can be maintained postoperatively and contribute to improved surgical outcomes.
Objective
Greater perceived social support (PSS) is associated with more favorable changes in weight loss, activity behaviors, and eating regulation after metabolic and bariatric surgery (MBS). ...However, studies have relied on generic, retrospective PSS measures, and stability of PSS levels and relations with weight loss and weight‐related behaviors over time is unknown. Using smartphone‐based Ecological Momentary Assessment, this study evaluated pre‐to 1‐year post‐MBS changes in daily weight management‐focused PSS and associations with weight loss, device‐measured activity behaviors, and eating regulation before and during the initial year after MBS.
Method
Adult MBS patients (n = 71) received (1) an accelerometer to measure daily moderate‐to‐vigorous intensity physical activity (MVPA) and sedentary time (ST) minutes/day, and (2) a smartphone to complete morning weight‐focused PSS ratings and eating regulation (dietary restraint/disinhibition) ratings at four semi‐random times daily for 10 days at pre‐ and 3, 6, and 12‐month postoperative. Generalized linear mixed models analyzed the associations of PSS with total weight loss (%TWL) and activity/eating outcomes.
Results
Participants on average reported relatively stable moderate‐to‐high PSS (3.98 on one to five scale) across assessments. Perceived social support was not related to %TWL, MVPA, or ST. Participants with higher PSS reported lower disinhibition and higher restraint than those with lower PSS (ps < 0.05); however, participants reported higher restraint on days that PSS was lower than their usual levels (p = 0.009).
Conclusions
MBS patients on average had stable PSS levels across time. Higher PSS levels were associated with greater resistance to overeating cues (disinhibition) and cognitive control to restrict food intake (restraint) over time. Additionally, participants reported higher restraint when PSS levels were lower than usual. Overall, weight‐focused PSS appeared to hold greater importance in relation to regulating eating behavior than engaging in activity behaviors or weight loss among MBS patients during the initial postoperative year.
Clinical Trial Registration
NCT02777177.
Background
Bariatric surgery produces weight loss in part by impacting appetite and eating behavior. Research suggests physical activity (PA) assists with regulation of appetite and eating during ...non‐surgical weight loss, although whether PA carries similar benefits in the context of bariatric surgery is unknown.
Objective
Evaluate associations of moderate‐to‐vigorous intensity PA (MVPA) and sedentary time (ST) with appetite sensations (hunger homeostatic/hedonic, satiety) and eating regulation behaviors (restraint, disinhibition) before and during the initial year following bariatric surgery.
Method
Adult bariatric patients received an accelerometer to measure MVPA/ST and a smartphone to complete appetite/eating ratings at four semi‐random times daily for 10 days at pre‐ and 3‐, 6‐, and 12‐months post‐surgery. Data were analyzed using generalized linear mixed models.
Results
Higher MVPA levels related to more satiety across time (p = 0.045) and more restraint at 3‐months post‐surgery (p < 0.001). At pre‐surgery, higher MVPA levels also related to more disinhibition (p's < 0.01), although participants reported more disinhibition on days they performed less MVPA than usual (p = 0.017). MVPA did not relate to hunger. Lower ST levels related to more hedonic hunger (p = 0.003), especially at 12‐months post‐surgery (p < 0.001), and participants reported more homeostatic hunger on days they accumulated more ST than usual (p = 0.044). Additionally, higher ST levels related to more disinhibition at 3‐months post‐surgery (p's < 0.01) and lower restraint at pre‐surgery (p's < 0.05). ST did not relate to satiety.
Conclusions
This study is the first to show that MVPA and ST each associate with appetite and eating regulation in daily life before and during post‐surgical weight loss. Results, while preliminary and requiring experimental confirmation, highlight potential for targeting bariatric patients' activity behaviors to enhance modulation of appetite, control of food intake, and resistance to overeating.
We have previously reported that most women seeking bariatric surgery have had female sexual dysfunction (FSD) as defined by the validated Female Sexual Function Index (FSFI). The present study ...examined whether FSD resolves after bariatric surgery.
A total of 54 reportedly sexually active women (43.3 ± 9.5 years) completed the FSFI preoperatively and 6 months postoperatively after a mean percentage of excess weight loss of 42.3% (laparoscopic adjustable gastric banding n = 38, percentage of excess weight loss, 34.6% ± 15.7%; Roux-en-Y gastric bypass n = 16, percentage of excess weight loss 60.0% ± 21.2%). The FSFI assesses sexual function across 6 domains, with higher scores indicating better sexual function. The summing of these scores yields a FSFI total score (range 2-36, with a score of ≤ 26.55 indicating FSD).
Before surgery, 34 women (63%) had scores indicative of FSD. By 6 months postoperatively, the FSD had resolved in 23 (68%) of these 34 women, and only 1 woman had developed FSD postoperatively. In the entire sample, significant (P < .05) improvements occurred from before to after surgery on all FSFI domains. The FSFI total scores improved after laparoscopic adjustable gastric banding (from 24.2 ± 5.9 to 29.1 ± 4.1, P < .001) and Roux-en-Y gastric bypass (from 23.7 ± 7.7 to 30.0 ± 4.7, P < .001). In regression analyses, being married, younger age, and worse preoperative sexual function were related to greater sexual function improvements. Postoperatively, the participants' FSFI total scores were indistinguishable from those of published normative controls (29.4 ± 4.3 versus 30.5 ± 5.3, P = .18).
FSD resolved in a large percentage of women after bariatric surgery. Sexual functioning in the entire sample improved to levels consistent with those of normative controls. This improvement in sexual function did not depend on surgery type or weight loss amount and appears to be an additional benefit for women undergoing bariatric surgery.
Background
Objective quantification of physical activity (PA) is needed to understand PA and sedentary behaviors in bariatric surgery patients, yet it is unclear whether PA estimates produced by ...different monitors are comparable and can be interpreted similarly across studies.
Methods
We compared PA estimates from the Stayhealthy RT3 triaxial accelerometer (RT3) and the Sensewear Pro
2
Armband (SWA) at both the group and individual participant level. Bariatric surgery candidates were instructed to wear the RT3 and SWA during waking hours for 7 days. Participants meeting valid wear time requirements (≥4 days of ≥8 h/day) for both monitors were included in the analyses. Time spent in sedentary (<1.5 METs), light (1.5–2.9 METs), moderate-to-vigorous (MVPA; ≥3.0 METs), and total PA (TPA; ≥1.5 METs) according to each monitor was compared.
Results
Fifty-five participants (BMI 48.4 ± 8.2 kg/m
2
) met wear time requirements. Daily time spent in sedentary (RT3 582.9 ± 94.3; SWA 602.3 ± 128.6 min), light (RT3 131.9 ± 60.0; SWA 120.6 ± 65.7 min), MVPA (RT3 25.9 ± 20.9; SWA 29.9 ± 19.5 min), and TPA (RT3 157.8 ± 74.5; SWA 150.6 ± 80.7 min) was similar between monitors (
p
> 0.05). While the average difference in TPA between the two monitors at the group level was 7.2 ± 64.2 min; the average difference between the two monitors for each participant was 45.6 ± 45.4 min. At the group level, the RT3 and SWA provide similar estimates of PA and sedentary behaviors; however, concordance between monitors may be compromised at the individual level.
Conclusions
Findings related to PA and sedentary behaviors at the group level can be interpreted similarly across studies when either monitor is used.
Sedentary behavior (SB), independent of physical activity, represents a significant health risk. We previously used objective measures to demonstrate that bariatric surgery candidates engage in high ...levels of SB overall, but supplementing these measures with subjective reports would provide information about time allocated to different forms of SB. The aim of this study was to examine self-reported time spent performing specific types of SB and discrepancy between self-reported and objectively measured estimates of total sedentary time in bariatric surgery candidates.
A total of 52 bariatric surgery candidates (87% female; age = 46.2 ± 9.1 years; body mass index BMI = 45.3 ± 6.7) completed the 9-item Sedentary Behavior Questionnaire (SBQ) as a subjective measure of SB and wore the SenseWear Armband (SWA; SenseWear, Pittsburgh, PA) as an objective measure. Paired samples t tests and the intraclass correlation coefficient (ICC) assessed measurement discrepancy.
Television-viewing was the most frequently performed type of SB (2.7 ± 1.6 hours per day), followed by paper/computer work (1.9 ± 1.8 hours per day), driving/riding in automobile (1.2 ± 1.1 hours per day), and sitting/talking on telephone (1.1 ± 1.2 hours per day). On average, the SBQ and SWA produced similar estimates of daily sedentary time (hours per day) at the group level (9.6 ± 4.8 versus 9.3 ± 1.9; mean difference = -.34 ± 4.6; P = .59), although agreement between the measures at the individual level was poor (mean absolute value of difference = 3.8 ± 2.8 hours per day; ICC = .22; P = .06).
Television-viewing was the single SB in which participants most frequently engaged and thus may be an important modifiable target for reducing total sedentary time in bariatric surgery candidates. The SBQ and SWA can be used similarly to describe SB levels in this patient population at the group level; however, ability of these measures to produce comparable estimates of sedentary time for any individual patient is limited.
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