Recent Submissions

  • Remission of diabetes mellitus after bariatric surgery: the putative link with worsening diabetic retinopathy and a need for ongoing postoperative follow-up retinal screening

    Jacob, Sarita; Varughese, George I; Jacob, Sarita; Ophthalmology; Medical and Dental; University Hospitals of North Midlands NHS Trust; University Hospitals Birmingham NHS Foundation Trust (Elsevier, 2023-12-19)
    No abstract available.
  • How safe bariatric surgery is-an update on perioperative mortality for clinicians and patients.

    Huppler, Lucy; Robertson, Andrew G; Wiggins, Tom; Hollyman, Marianne; Welbourn, Richard; Wiggins, Tom; Surgery; Medical and Dental (Wiley-Blackwell, 2022-03-09)
    Bariatric, metabolic or weight loss surgery produces sustained weight loss and imporovement in obesity related diseases. Bariatric surgery has existed for decades but there is limited reliable data on the risk of perioperative mortality following the procedures. This commentary focuses on a recent meta-analysis which has produced contemporaneous mortality data, and the findings are significant. Utilising data from 3.6 million patients the study has shown an overall pooled perioperative mortality of 0.08%, a significantly reduced risk compared to previous, smaller studies. This finding increases our knowledge of surgical risk for these procedures and should now equip health care groups to challenge barriers to uptake of bariatric surgery. Barriers currently include a worldwide lack of focus on treating obesity, lack of funding and resource from commissioners, and a general public and professional view that bariatric surgery may be high risk. In reality, this figure equates to mortality risk for procedures generally considered 'safe' such as laparoscopic cholecystectomy and knee arthroplasty. Bariatric surgery is a safe option for achieving sustained weight-loss and the treatment of obesity related diseases, and refusing access to surgery on the grounds of perioperative safety should now be an outdated premise.
  • Cost-effectiveness of bariatric surgery versus community weight management to treat obesity-related idiopathic intracranial hypertension: evidence from a single-payer healthcare system.

    Elliot, Laura; Frew, Emma; Mollan, Susan P; Mitchell, James L; Yiangou, Andreas; Alimajstorovic, Zerin; Ottridge, Ryan S; Wakerley, Ben R; Thaller, Mark; Grech, Olivia; et al. (Elsevier, 2021-03-30)
    Background: Idiopathic intracranial hypertension (IIH) is associated with significant morbidity, predominantly affecting women of childbearing age living with obesity. Weight loss has demonstrated successful disease-modifying effects; however, the long-term cost-effectiveness of weight loss interventions for the treatment of IIH has not yet been established. Objectives: To estimate the cost-effectiveness of weight-loss treatments for IIH. Setting: Single-payer healthcare system (National Health Service, England). Methods: A Markov model was developed comparing bariatric surgery with a community weight management intervention over 5-, 10-, and 20-year time horizons. Transition probabilities, utilities, and resource use were informed by the IIH Weight Trial (IIH:WT), alongside the published literature. A probabilistic sensitivity analysis was conducted to characterize uncertainty within the model. Results: In the base case analysis, over a 20-year time horizon, bariatric surgery was "dominant," led to cost savings of £49,500, and generated an additional 1.16 quality-adjusted life years in comparison to the community weight management intervention. The probabilistic sensitivity analysis indicated a probability of 98% that bariatric surgery is the dominant option in terms of cost-effectiveness. Conclusion: This economic modeling study has shown that when compared to community weight management, bariatric surgery is a highly cost-effective treatment option for IIH in women living with obesity. The model shows that surgery leads to long-term cost savings and health benefits, but that these do not occur until after 5 years post surgery, and then gradually increase over time.
  • Global variations in preoperative practices concerning patients seeking primary bariatric and metabolic surgery (PACT Study): A survey of 634 bariatric healthcare professionals.

    Yang, Wah; Abbott, Sally; Borg, Cynthia-Michelle; Chesworth, Paul; Graham, Yitka; Logue, Jennifer; Ogden, Jane; O'Kane, Mary; Ratcliffe, Denise; Sherf-Dagan, Shiri; et al. (Nature Publishing Group, 2022-04-11)
    Background: Bariatric and Metabolic Surgery (BMS) is a popular weight loss intervention worldwide, yet few scientific studies have examined variations in preoperative practices globally. This study aimed to capture global variations in preoperative practices concerning patients planned for BMS. Methods: A 41-item questionnaire-based survey was designed and the survey link was freely distributed on social and scientific media platforms, email groups and circulated through personal connections of authors. The survey included eight parts: basic information; criteria for BMS; preoperative nutritional screening; preoperative weight loss; preoperative diets for liver size reduction; preoperative glycemic control; other laboratory investigations and preparations; decision making, education, and consents. Descriptive statistics were used to analyse data and graphs were used for representation where applicable. Results: Six hundred thirty-four bariatric healthcare professionals from 76 countries/regions completed the survey. Of these, n = 310 (48.9%) were from public hospitals, n = 466 (73.5%) were surgeons, and the rest were multidisciplinary professionals. More than half of respondents reported using local society/association guidelines in their practice (n = 310, 61.6%). The great majority of respondents routinely recommend nutritional screening preoperatively (n = 385, 77.5%), mandatory preoperative diets for liver size reduction (n = 220, 53.1%), routine screening for T2DM (n = 371, 90.7%), and mandate a glycemic control target before BMS in patients with T2DM (n = 203, 55.6%). However, less than half (n = 183, 43.9%) recommend mandatory preoperative weight loss to all patients. Most respondents (n = 296, 77.1%) recommend psychological intervention before surgery for patients diagnosed with psychological conditions. Variations were also identified in laboratory investigations and optimisation; and in the aspects of decision making, education and consent. Conclusions: This survey identified significant global variations in preoperative practices concerning patients seeking primary BMS. Our findings could facilitate future research for the determination of best practice in these areas of variations, and consensus-building to guide clinical practice while we wait for that evidence to emerge.