Background
Since 2014, the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has produced an annual report of all bariatric surgery submitted to the Global Registry. ...We describe baseline demographics of international practice from the 4th report.
Methods
The IFSO Global Registry amalgamated data from 51 different countries, 14 of which provided data from their national registries. Data were available from 394,431 individual records, of which 190,177 were primary operations performed since 2014.
Results
Data were submitted on 72,645 Roux en Y gastric bypass operations (38.2%), 87,467 sleeve gastrectomy operations (46.0%), 14,516 one anastomosis gastric bypass procedures (7.6%) and 9534 gastric banding operations (5.0%) as the primary operation since 2014. The median patient body mass index (BMI) pre-surgery was 41.7 kg m
2
(inter-quartile range: 38.3–46.1 kg m
2
). Following gastric bypass, 84.1% of patients were discharged within 2 days of surgery; and 84.5% of sleeve gastrectomy patients were discharged within 3 days. Assessing operations performed between 2012 and 2016, at one year after surgery, the mean recorded percentage weight loss was 28.9% and 66.1% of those taking medication for type 2 diabetes were recorded as not using them. The proportion of patients no longer receiving treatment for diabetes was highly dependent on weight loss achieved. There was marked variation in access and practice.
Conclusions
A global description of patients undergoing bariatric surgery is emerging. Future iterations of the registry have the potential to describe the operated patients comprehensively.
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.
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.
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.
Do people classify nature in ways that can be described as archetypes? Could it be that these can be interpreted as health promotive? More and more researchers today suggest that archetypes can be ...used to analyze, describe, and develop green spaces. In parallel, an increasing number of research results since the 1980s have shown that human health and well-being are positively affected by stays in certain nature areas. The qualities in these nature areas which stand out to be most health-promoting are interpreted to be properties of nature that humans through evolution are prepared to perceive in a positive way. In this study, 547 respondents in southern Sweden answered a questionnaire on properties in natural areas. Through cluster analysis, these properties have been grouped into 10 types of nature and landscape. The 10 clusters are related to specific phenomena and places in Scandinavian nature, which could be described as archetypal. These natural phenomena and places are discussed, partly based on references to archaic Scandinavian mythology, Scandinavian lifestyle, and cultural canon, and partly on research on evolution, human preferences, and how nature can affect human health. We discuss how these nature archetypes evoke anxiety, fear, and distancing as well as calmness, tranquility, and connection. However, researchers have so far focused on how visits to natural environments have affected the sympathetic nervous system, and not realized the possibility of including the calm and connection system as well as the oxytocin in their explanatory models. In a follow-up article, we intend to develop a model for how the nature archetypes can interact with the calm and connection system.
Summary 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 offered 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 significantly 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. Funding Örebro County Council, Stockholm City Council, and the Erling-Persson Family Foundation.
Background
The impact of obesity on patient-reported outcome (PRO) after total knee arthroplasty (TKA) surgery has demonstrated varying results. We evaluated knee pain, Activity in Daily Life ...function (ADL), and satisfaction after TKA surgery in patients with and without prior bariatric surgery (BS).
Methods
Scandinavian Obesity Surgery Registry (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) were used to identify patients operated on with primary TKA for osteoarthritis (OA) between 2009 and 2019 that had a BS within 2 years before the TKA (BS group). These patients were compared to patients with TKA without prior BS (no BS group). The patients filled in the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and one year postoperatively as well as satisfaction with the surgery one year postoperatively. Multiple linear regression analysis was used to evaluate 1-year postoperative KOOS pain and ADL function between the 2 groups. Adjustments were made for sex, age, and preoperative KOOS pain and ADL function respectively.
Results
Forty-four patients were included in the BS group and 3,525 patients in the no BS group. We found no statistically or clinically significant difference in one-year postoperative KOOS pain and ADL function between the BS group and the no BS group. The majority of the patients in both groups were classified as satisfied or very satisfied one year postoperatively to the TKA.
Conclusions
Our results indicate that patients without BS prior to the TKA gain similar 1-year outcome in pain, ADL function and satisfaction as patients with prior BS.
Graphical abstract
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.
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.
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.
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.
Ever more research results demonstrate that human health and wellbeing are positively affected by stays in and/or exposure to natural areas, which leads, among other things, to a reduction in high ...stress levels. However, according to the studies, these natural areas must meet certain qualities. The qualities that are considered to be most health promoting are those that humans perceive in a positive way. Theories about how natural areas can reduce people's stress levels and improve their coping skills have mainly focused on how certain natural areas that are perceived as safe reduce the activity of the hypothalamic-pituitary-adrenal axis and consequent reduction of cortisol levels. This article discusses studies containing descriptions of how participants in rehabilitation perceive and react to natural phenomena. The common core variable in the analyzed studies was the experience of calm and connection, and this experience was associated with a reduction in stress levels and with being able to develop health and coping skills. We suggest that this experience provides a possible role for the oxytocinergic system to act as a physiological mediator for the positive and health-promoting effects in humans caused by nature. The theory is mainly based on analogies framed by theories and data from the fields of environmental psychology, horticulture, landscape architecture, medicine, and neuroscience. Oxytocin promotes different kinds of social interaction and bonding and exerts stress-reducing and healing effects. We propose that oxytocin is released by certain natural phenomena experienced as positive to decrease the levels of fear and stress, increase levels of trust and wellbeing, and possibly develop attachment or bonding to nature. By these effects, oxytocin will induce health-promoting effects. In situations characterized by low levels of fear and stress in response to release of oxytocin, the capacity for "growth" or psychological development might also be promoted. Such an instorative effect of nature, i.e., the capacity of nature to promote reorientation and the creation of new coping strategies, might hence represent an additional aspect of the oxytocin-linked effect profile, triggered in connection with certain nature phenomena. We conclude by proposing that the stress-relieving, health-promoting, restorative, and instorative effects of nature may involve activation of the oxytocinergic system.
Background
Five International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) surveys since 1998 have estimated the volume and type of bariatric surgery being done in constituent ...member countries. These reports did not include baseline demographic descriptions.
Methods
An IFSO Global Registry pilot project in 2014 demonstrated that it was possible to amalgamate large numbers of individual patient data from different local and national database systems. Here we describe demographic data from the second report for 54,490 patients from 31 countries operated in the 3 calendar years 2013–2015 and follow up data from 66,560 of 112,544 patients in 2009–2015.
Results
Most procedures (97.8%) were performed laparoscopically and 73.3% (95% CI: 73.0–73.7%, range 54.2 to 80.3%) were female. The average age was 42.0 years (95% CI 41.9–42.1, inter-quartile range 33.0–51.0 years) and the median body mass index was 43.3 kg/m
2
(inter-quartile range 39.4–48.8 kg/m
2
). Before surgery, 22.0% patients had type 2 diabetes (inter-country variation 7.4–63.2%); 31.9% were hypertensive (15.8–92.7%); 17.6% had depression (0.0–46.3%); 27.8% took medication for musculoskeletal pain (0.0–58.9%); 18.9% had sleep apnea (0.0–63.2%); and 29.6% of patients had gastro-esophageal reflux disease (9.1–90.9%). Gastric bypass was the most prevalent operation (49.4%), followed by sleeve gastrectomy (40.7%) and gastric banding (5.5%). The 1-year total weight loss for patients with available data was 30.53% (95% CI: 30.22–30.84%) and in the cohort 2009–15 was 30.4% with a follow-up rate of 59.14%. In the 2009–2015 cohort, 64.7% of patients on treatment for diabetes preoperatively were not on treatment postoperatively.
Conclusions
There is widespread variation in access to surgery and in baseline patient characteristics in the countries submitting data to the IFSO Global Registry.
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 Örebro 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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