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Original Investigation |

Evaluation of the Association Between Preoperative Clinical Factors and Long-term Weight Loss After Roux-en-Y Gastric Bypass ONLINE FIRST

G. Craig Wood, MS1; Peter N. Benotti, MD1; Clare J. Lee, MD, MHS2; Tooraj Mirshahi, PhD1; Christopher D. Still, DO1; Glenn S. Gerhard, MD3; Michelle R. Lent, PhD1
[+] Author Affiliations
1Geisinger Obesity Institute, Geisinger Clinic, Danville, Pennsylvania
2Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
3Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
JAMA Surg. Published online August 10, 2016. doi:10.1001/jamasurg.2016.2334
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Importance  Weight loss after bariatric surgery varies, yet preoperative clinical factors associated with long-term suboptimal outcomes are not well understood.

Objective  To evaluate the association between preoperative clinical factors and long-term weight loss after Roux-en-Y gastric bypass (RYGB).

Design, Setting, and Participants  From June 2001 to September 2007, this retrospective cohort study followed up RYGB patients before surgery to 7 to 12 years after surgery. The setting was a large rural integrated health system. Of 1033 eligible RYGB patients who consented to participate in longitudinal research and completed surgery before October 2007, a total of 726 (70.3%) had a weight entered in the electronic medical record 7 or more years after surgery and were included in the analyses after exclusions for pregnancy and mortality. Date of the long-term weight measurement was recorded between August 2010 and January 2016.

Main Outcomes and Measures  The primary outcome was percentage weight loss (%WL) at 7 to 12 years after surgery. Preoperative clinical factors (>200) extracted from the electronic medical record included medications, comorbidities, laboratory test results, and demographics, among others.

Results  Among the 726 study participants, 83.1% (n = 603) were female and 97.4% (n = 707) were of white race, with a mean (SD) preoperative body mass index (calculated as weight in kilograms divided by height in meters squared) of 47.5 (7.4). From the time of surgery to long-term follow-up (median, 9.3 postoperative years), the mean (SD) %WL was 22.5% (13.1%). Preoperative insulin use, history of smoking, and use of 12 or more medications before surgery were associated with greater long-term postoperative %WL (6.8%, 2.8%, and 3.1%, respectively). Preoperative hyperlipidemia, older age, and higher body mass index were associated with poorer long-term postoperative %WL (−2.8%, −8.8%, and −4.1%, respectively).

Conclusions and Relevance  Few preoperative clinical factors associated with long-term weight loss after RYGB were identified. Preoperative insulin use was strongly associated with better long-term %WL, while preoperative hyperlipidemia, higher body mass index, and older age were associated with poorer %WL. Our findings provide additional insight into preoperative identification of RYGB patients at higher risk for long-term suboptimal outcomes.

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Figure 1.
Patient Flow in the Study

Patient exclusions are shown in the boxes on the right.

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Figure 2.
Distributions of Percentage Weight Loss (%WL) and Percentage Excess Weight Loss (%EWL) in 726 RYGB indicates Roux-en-Y gastric bypass (RYGB) Patients
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