Ten-year changes in health-related quality of life after biliopancreatic diversion with duodenal switch

doi:10.1016/j.soard.2016.04.030

Surgery for Obesity and Related Diseases

Volume 12, Issue 8, September–October 2016, Pages 1594-1600

https://doi.org/10.1016/j.soard.2016.04.030 Get rights and content

Abstract

Background

Long-term data on health-related quality of life (HRQL) after biliopancreatic diversion with duodenal switch (BPDDS) are scarce. The aim of this study was to evaluate changes in HRQL from baseline to 10 years in patients who had undergone BPDDS.

Methods

We included 50 patients who underwent BPDDS for severe obesity at Førde Central Hospital in a prospective cohort study. HRQL was measured with a self-report questionnaire, the Short-Form-36. Main outcomes were the physical component score and the mental component score. HRQL was assessed before surgery and after 1, 2, 5, and 10 years. Linear mixed-effect models were applied to evaluate changes over time.

Results

A total of 35 patients (70%) completed the 10-year follow-up of the HRQL study. The mean body mass index at baseline was 51.7 kg/m² (95 % CI, 50.0–53.5) and 34.3 kg/m² (95% CI, 32.4–36.2) at 10 years. The physical component score improved significantly from 32.6 (95% CI, 29.7–35.5) at baseline to 44.2 (95% CI, 40.9–47.5) at the 10-year follow-up (P<.001). Mental component scores also improved significantly, from 37.8 (95% CI, 34.2–41.3) at baseline to 46.0 (95% CI, 41.9–50.0) at the 10-year follow-up (P<.001). However, the scores at 10-year follow-up were significantly lower than the Norwegian norm data.

Conclusion

Ten years after BPDDS, patients’ HRQL was significantly improved from preoperative values, and approximately 60% of the improvements seen at 1-year follow-up were maintained.

Section snippets

Methods

The first 51 patients who were accepted for BPDDS at Førde Central Hospital in Norway were invited to participate in a prospective cohort study. The criteria for having surgery included body mass index (BMI)≥40.0 or 35.0–39.9 kg/m² with obesity-related co-morbidities, no active psychosis, no alcohol or drug problems, age 18 to 60 years, and failure to lose weight through other methods. Written informed consent was obtained from participants. Patients were included consecutively from 2001 to

Results

All 51 patients who were invited participated and gave written informed consent. One patient died 2 years after surgery and was excluded from the study. Seven patients were reoperated, 5 due to weight regain and 2 as a result of inadequate weight loss. Two of the 7 reoperated patients completed the 10-year follow-up. These 2 patients had a resection of the stomach 9 years after BPDDS due to weight regain after initial weight loss.

The characteristics of the patients are presented in Table 1. At

Discussion

This is, to the best of our knowledge, the first study that has prospectively evaluated 10-year changes in HRQL after BPDDS. We evaluated changes in HRQL among 35 patients with severe obesity and found statistically significant and clinically important long-term improvements from baseline. The improvements in HRQL from baseline to 2 years were dramatic, followed by moderate declines at 2 to 5 years. At 5 to 10 years the PCS score declined further, while the MCS remained stable. To date, the

Conclusion

Ten years after BPDDS. patients’ HRQL was significantly improved from preoperative values, and approximately 60% of the improvements seen at 1-year follow-up were maintained. Given the scarcity of long-term studies of HRQL after bariatric surgery, especially BPDDS, further studies should be performed to confirm these findings.

Disclosures

The authors have no financial associations that might be a conflict of interest in relation to this article.

Acknowledgments

We thank the staff that worked with the patients at Førde Central Hospital for assisting with data collection.

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Cited by (23)

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.
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Citation Excerpt :
The patients in the study group were 2 years older and a 3% higher prevalence of hypertension (Supplement Table S1). This study confirmed the importance of weight loss for improvements in HRQoL after bariatric surgery, as shown previously by others [5–9,15,22,31,33]. TWL as well as weight maintenance/regain had a significant association with the magnitude of improvements.
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.
To examine whether there are factors besides weight loss that affect the improvement of HRQoL from before to 5 years after gastric bypass surgery.
Large, nationwide, observational study with national quality and research registry.
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.
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.
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.
Comments on: Early complications, long-term adverse event,s and quality of life after duodenal switch and gastric bypass in a matched national cohort
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Early complications, long-term adverse events, and quality of life after duodenal switch and gastric bypass in a matched national cohort
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Considering the results from the Swedish Obese Subjects study [30], where a close association of QoL and weight loss was found, the higher PCS for DS at 5 years is likely explained by the superior weight loss. A previous Norwegian study [31] of 35 DS patients with a BMI of 51.7 at baseline, found a significant improvement in both PCS and MCS at 10 years; however, baseline-MCS was lower in that study (37.8) compared with our DS group (49.2). Among the strengths of this study is the registry-based design that allows cross-matching 5 national registries, the high coverage of these registries, and the propensity score matching of baseline characteristics from these registries that minimizes possible confounding.
Insufficient weight loss is common in super-obese patients (body mass index >50) after Roux-en-Y gastric bypass (RYGB). Duodenal switch (DS) is more effective; however, it is considered to have an increased complication rate.
To compare early complications (≤30 d), long-term adverse events, and quality of life (QoL) between primary DS and RYGB.
Sweden.
National cohort-study of super-obese patients after primary DS or RYGB in Sweden 2007 to 2017. Propensity-score matching was used to reduce confounders. Five national registers were cross-matched.
The study population consisted of 333 DS and 1332 RYGB (body mass index 55 ± 5 kg/m², 38.5 ± 11 yr, and 60.7% females). Laparoscopic approach was used in 25% of DS and 91% of RYGB. Early complications were more common after DS (15.3% versus 8.1%, P < .01), mainly because of more open surgery and related surgical site infections. During 4.6 ± 2.3 years mean follow-up, hospital admission rate was 1.4 ± 2.3 versus 1.1 ± 3.3 (P = .18), with 6.7 ± 18.3 versus 7.0 ± 43.0 in-hospital days, for DS and RYGB, respectively. An increased risk of malnutrition/malabsorption requiring inpatient care (2.8% versus .2%, odds ratio 12.3 [3.3–45.7]) and greater need for additional abdominal surgery (25.8% versus 15.3%, odds ratio 2.0 [1.5–2.7]) was observed for DS. However, QoL was more improved after DS.
DS was associated with more early complications because of more open surgery, but long-term requirement of inpatient care was similar to RYGB. The increased risk of malnutrition/malabsorption and need for additional abdominal surgeries was contrasted with a greater improvement in QoL for DS.
Eating self-efficacy as predictor of long-term weight loss and obesity-specific quality of life after sleeve gastrectomy: A prospective cohort study
2019, Surgery for Obesity and Related Diseases
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Scores are transformed into a scale from 0 to 100, where high scores indicate high obesity-specific quality of life [24]. This measure holds strong psychometric properties, and has been validated for Norwegian bariatric surgery patients [26]. Continuous variables are presented as means ± standard deviation or 95% confidence intervals (CI).
A person's confidence to control eating, eating self-efficacy (ESE), has been identified as a target for long-term weight management in nonsurgical weight loss interventions, but has to a limited extent been studied after bariatric surgery.
We investigated the association between ESE, weight loss, and obesity-specific quality of life (QOL) after sleeve gastrectomy (SG).
A single-center longitudinal study.
Data from adult patients were collected before SG, and at mean 16 months (±standard deviation 4 mo) and 55 (±4) months postoperatively. ESE was measured by the Weight Efficacy Lifestyle Questionnaire Short-Form. Multiple regression analyses were performed with excess body mass index loss (%EBMIL) and obesity-specific QOL as dependent variables. Age, sex, and other preoperative values were covariates in all models.
Of 114 preoperative patients, 91 (80%) and 84 (74%) were available for follow-up 16 and 55 months after SG, respectively. Mean %EBMIL from baseline to 16 and 55 months was 76% (95% confidence interval: 71.9, 79.6) and 67% (95% confidence interval: 61.9, 72.2), respectively. Preoperative ESE scores improved significantly at both 16 and 55 months (P = .002) but did not predict postoperative %EBMIL or QOL at 55 months (β = −.08, P = .485). Greater change in ESE from 0 to 16 months predicted higher %EBMIL (β = .34, P = .013) at 55 months, and improvements in ESE from 0 to 55 months were significantly associated with higher %EBMIL (β = .46, P = .001) and obesity-specific QOL (β = .50, P < .001) 55 months after SG.
Significant improvements in ESE were seen at 16 months, and remained high at 55 months after SG in this cohort. Patients who improved their ESE the most also experienced the highest weight loss and obesity-specific QOL 5 years postoperatively. Future research should address whether enhancement of ESE corresponds to sustained improvements in eating behavior after bariatric surgery.
ASMBS Position Statement on medium- and long-term durability of weight loss and diabetic outcomes after conventional stapled bariatric procedures
2018, Surgery for Obesity and Related Diseases
12-year trajectory of health-related quality of life in gastric bypass patients versus comparison groups
2018, Surgery for Obesity and Related Diseases
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However, only 24% (of 275 patients) were available at 9 years. In the Aasprang, et al. study [23], 70% (of 50 patients) were available at 10 years. Although PCS and MCS improved significantly from baseline to 10 years, only 60% of improvements seen at 1 year were maintained at 10 years, and 10-year scores were significantly below Norwegian norms.
Few prospective studies compare long-term health-related quality of life (HRQOL) outcomes between bariatric surgery patients and individuals with severe obesity who do not undergo bariatric surgery.
This 12-year, prospective study evaluated the trajectory and durability of HRQOL changes in gastric bypass patients (surgery group; n = 418) and compared these changes to 2 nonsurgical groups. The nonsurgery group 1 (n = 417) sought but did not have surgery; nonsurgery group 2 (n = 321) had severe obesity but did not seek surgery.
Bariatric surgery center.
Weight-related (impact of weight on quality of life-lite [IWQOL-Lite]) and general (short-form health survey-36 [SF-36]) HRQOL questionnaires were administered at baseline and 2, 6, and 12 years postsurgery.
At 12 years, the surgery group showed greatly improved weight-related HRQOL (IWQOL-Lite) and physical HRQOL (physical component summary of short-form health survey-36) from baseline, and differences between the surgery group and both nonsurgery groups were significant for IWQOL-Lite and physical component summary. IWQOL-Lite and physical component summary scores peaked at 2 years, followed by declines from 2 to 6 and 6 to 12 years. Small improvements in mental/psychosocial aspects of HRQOL (mental component summary of short-form health survey-36) seen in the surgery group at 2 years were not maintained at either 6 or 12 years.
Gastric bypass patients demonstrated significantly higher weight-related and physical HRQOL at 12 years compared with their very low baseline scores, with the trajectory peaking at 2 years. Despite declining HRQOL between 2 and 12 years, the magnitude of improvement supports the clinical relevance of bariatric surgery for enhancing patients’ quality of life.

View all citing articles on Scopus

^☆: This study was supported by a grant from Sogn og Fjordane University, Norway.

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Original articleTen-year changes in health-related quality of life after biliopancreatic diversion with duodenal switch☆

Abstract

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

Disclosures

Acknowledgments

Surg Obes Relat Dis

Surg Obes Relat Dis

Surg Obes Relat Dis

Report of a WHO consultation

World Health Organ Tech Rep Ser

Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies

Lancet

Quality of life and obesity

Obes Rev

Criteria for selection of patients for bariatric surgery

Obesity surgery. Stories of altered lives

Why patients seek bariatric surgery: a qualitative and quantitative analysis of patient motivation

Obes Surg

Five-year changes in health-related quality of life after biliopancreatic diversion with duodenal switch

Obes Surg

Health-related quality of life and paid work participation after duodenal switch

Obes Surg

Anxiety and depression in association with morbid obesity: changes with improved physical health after duodenal switch

Health Qual Life Outcomes

Bariatric surgery: a systematic review and meta-analysis

JAMA

Ten-year trends in health-related quality of life after surgical and conventional treatment for severe obesity: the SOS intervention study

Int J Obes

The biliopancreatic diversion with a duodenal switch (BPDDS): how is it optimally performed?

Obes Surg

The biliopancreatic diversion with the duodenal switch: results beyond 10 years

Obes Surg

Original article
Ten-year changes in health-related quality of life after biliopancreatic diversion with duodenal switch☆