Browsing by Subject "bariatric surgery"
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Item Are Perceived Barriers to Exercise and Level of Interest in Fitness Programs Different Between Preoperative and Postoperative Bariatric Surgery Groups?(Liebert, 2020-12) Athanasiadis, Dimitrios; Hilgendorf, William; Kubicki, Natalia; Banerjee, Ambar; Surgery, School of MedicineBackground: Exercise following bariatric surgery is associated with better outcomes. We aimed to assess the level of interest in fitness programs, self-reported exercise duration, and perceived obstacles for exercising in bariatric patients. Materials and Methods: All patients who presented to our hospital for any bariatric clinic visit were administered a questionnaire, which explored their interest in a free 10-min DVD-based workout (DW) versus an internet-based workout (IW), average duration of exercise per week, and two perceived obstacles to exercise. Results: One hundred fifty-nine preoperative and 135 postoperative patients were surveyed. Overall, there was more interest in DW than in IW. The mean duration of exercise in the preop group was 89 ± 92.1 min/week, whereas the postop group reported 84.4 ± 103.7 min/week (p = 0.717). Time was the most frequent obstacle in both groups, whereas orthopedic discomfort was reported less frequently in the postoperative compared with the preoperative population (7% vs. 18.1%, respectively, p = 0.001). Conclusions: Despite the postoperative group reporting less orthopedic pain, mean exercise time per week was the same as the preoperative group. Time constraints were the most frequently reported barrier in both groups, suggesting a pathway for intervention.Item A behavioral rating system predicts weight loss and quality of life after bariatric surgery(Elsevier, 2018-08) Hilgendorf, William; Butler, Annabelle; Timsina, Lava; Choi, Jennifer; Banerjee, Ambar; Selzer, Don; Stefanidis, Dimitrios; Pediatrics, School of MedicineBackground Bariatric surgery represents the most effective intervention for severe obesity available today; however, significant variability in postoperative outcomes exists. Effective tools that predict postoperative outcomes are needed for decision-making and patient counseling. Objectives We hypothesized that a validated behavioral assessment tool, the Cleveland Clinic Behavioral Rating Scale (CCBRS), would predict excess weight loss, health-related quality of life, depression, anxiety, and alcohol use after bariatric surgery. Setting Hospital in the United States. Methods A prospective observational study with 2-year planned follow-up was conducted with patients who completed a psychological clinical interview, the Short Form 36 (SF-36) v.2 Health Survey and brief self-report questionnaires measuring depression (PHQ-9), anxiety (GAD-7), and alcohol use (AUDIT) preoperatively. At the conclusion of the preoperative psychological evaluation, the psychologist completed the CCBRS. All questionnaires were readministered at 6, 12, 18, and 24 months after surgery. Generalized estimating equations were used to assess whether any CCBRS ratings predicted surgery outcomes. Results One hundred seventy-nine patients (113 Roux-en-Y gastric bypass and 66 sleeve gastrectomy) were included in the analyses. SF-36 scores, PHQ-9 scores, and the AUDIT total scores improved significantly after surgery, while GAD-7 scores did not change appreciably. Higher preoperative CCBRS ratings predicted higher SF-36 scores, and lower PHQ-9, GAD-7 and AUDIT scores. The CCBRS social support rating predicted higher postoperative percent excess weight loss. Conclusion A behavioral rating scale (CCBRS) completed before bariatric surgery predicted postoperative weight loss, quality of life, depression, and anxiety. Therefore, this tool may prove useful in patient counseling and expectation management before surgery.Item Can a brief assessment of social support predict outcomes after bariatric surgery?(Wiley, 2021-02) Hilgendorf, William; Monfared, Sara; Hassan Beygi Monfared, Sina; Athanasiadis, Dimitrios I.; Selzer, Don; Choi, Jennifer N.; Banerjee, Ambar; Stefanidis, Dimitrios; Surgery, School of MedicineSocial support is important to optimize bariatric surgery outcomes, but limited tools exist for brief and effective assessment preoperatively. The aims of the study were to determine the extent to which two ratings of social support can predict bariatric surgery outcomes, and to examine any associations between these two methods.In this retrospective study, patients were included for whom the Cleveland clinic behavioral rating system (CCBRS) and Flanagan quality of life scale (FQoLS) scores were obtained as part of their preoperative psychosocial evaluation. They were followed up for 6 to 24 months after bariatric surgery. Linear and logistic regressions were performed with patients' CCBRS and FQoLS scores as independent variables, and percent excess weight loss (%EWL), length of stay (LOS), complications, readmissions and loss to follow-up as dependent variables. The prediction of CCBRS ratings from FQoLS social support items was also evaluated. A total of 415 patients were included in the analysis. There were significant associations between the CCBRS and three of the four relevant FQoLS self-ratings. As CCBRS and FQoLS scores increased, complications decreased significantly. The CCBRS alone additionally predicted decreased length of hospital stay and approached significance for predicting decreased readmission rates. There were no associations between %EWL and behavior ratings. The degree of patients' social support is associated with important bariatric surgery outcomes. It is possible to obtain this valuable information via the administration of brief assessments prior to bariatric surgery.Item Development of ASMBS Research Agenda for Bariatric Surgery Using the Delphi Methodology(Elsevier, 2019) Stefanidis, Dimitrios; King, Wendy C.; Puzziferri, Nancy; Butler, Annabelle R.; Hutter, Matthew; Sudan, Ranjan; Surgery, School of MedicineBackground While the number of research publications related to bariatric surgery have increased remarkably in the past decade, research efforts remain uncoordinated and have limited focus, and numerous important questions remain unanswered. Objective To generate a research agenda in bariatric surgery. Setting National survey. Methods The membership of the American Society of Metabolic and Bariatric Surgery (ASMBS) was asked to submit research questions needed to advance the field of bariatric surgery. An expert panel grouped and collated submitted questions and redistributed them back to the membership to rate their importance on a 5-point Likert scale using a 3-round modified Delphi methodology. The top research questions were determined based on provided rankings. Results Two hundred ninety-two research questions were initially submitted that were collapsed to 59 unique questions. The ratings for the top 40 questions ranged from 2.67–4.33 (overall mean, 3.46). The highest-ranked questions centered on the mechanisms of effectiveness of bariatric surgery for weight loss and diabetes resolution, the underlying etiology of weight recidivism, and predictors of success. Conclusions A research agenda for bariatric surgery was developed using the Delphi methodology. This research agenda may enhance the ability of investigators and funding organizations, including the ASMBS, to focus attention to areas most likely to advance the field, and by editors and reviewers to assess the merit and relevance of scientific contributions.Item How are Bariatric Patients Coping During the COVID-19 Pandemic? Analysis of Factors Known to Cause Weight Regain Among Postoperative Bariatric Patients(Elsevier, 2020) Athanasiadis, Dimitrios I.; Hernandez, Edward; Hilgendorf, William; Roper, Alexandra; Embry, Marisa; Selzer, Don; Stefanidis, Dimitrios; Surgery, School of MedicineBackground The global coronavirus disease 2019 (COVID-19) pandemic is wreaking havoc on society. Bariatric patients are more prone to severe infection due to their high body mass index (BMI) and are more vulnerable to the effects of isolation, such as depression or disruption of their health habits. Objectives To quantify the impact of self-quarantine on bariatric patients and self-quarantine’s relationship with weight gain. Setting Academic hospital, United States. Methods A 30-item survey examining several known contributors to weight regain was distributed among the postoperative bariatric patients of our clinic. Changes in eating habits, exercise, depression, social support, loneliness, and anxiety were studied, among others. Results A total of 208 patients completed the survey (29.3% response rate). A large percentage of patients reported increases in their depression (44.2%), loneliness (36.2%), nervousness (54.7%), snacking (62.6%), loss of control when eating (48.2%), and binge eating (19.5%) and decreases in their social support (23.2%), healthy food eating (45.5%), and activity (55.2%). Difficulty in accessing vitamins was reported by 13%. Patients more than 18 months out of surgery regained more than 2 kg during an average of 47 days. Risk factors for weight regain were found to be loss of control when eating, increases in snacking and binge eating, reduced consumption of healthy food, and reduced physical activity. Conclusion Bariatric patients are negatively affected by the COVID-19 pandemic and subsequent social isolation on many levels. This patient population is vulnerable to crisis situations; thus, additional intervention is needed to address behaviors that lead to weight regain.Item Prevention and management of internal hernias after bariatric surgery: an expert review(OAE Publishing, 2022-04-21) Pokala , Bhavani; Giannopoulos, Spyridon; Stefanidis, Dimitrios; Surgery, School of MedicineInternal hernia formation is a feared complication following bariatric surgery. Protrusion of the small bowel through mesenteric defects can result in volvulus presenting with symptoms of bowel obstruction. If left untreated, patients may go on to develop bowel ischemia with possible perforation or necrosis necessitating emergent surgical exploration with resection. In severe cases, extensive bowel resection is required, leading to short-gut syndrome, which can have devastating consequences for the already nutritionally vulnerable bariatric patient. This review presents a comprehensive summary of various surgical techniques and technical factors implicated in the formation of internal hernias. The clinical presentation of patients with internal hernias, appropriate diagnostic work-up, and effective management and treatment strategies are discussed based on the established literature.Item Skills training in bariatric surgery(Elsevier, 2017-05) Stefanidis, Dimitrios; Surgery, School of MedicineItem Web-Based Educational Seminars Compare Favorably with In-House Seminars for Bariatric Surgery Patients(Springer, 2019-03) Monfared, Sara; Martin, Anna; Gupta, Kamna; Stefanidis, Dimitrios; Selzer, Don; Choi, Jennifer; Butler, Annabelle; Banerjee, Ambar; Surgery, School of MedicineBackground Comprehensive preparative patient education is a key element in bariatric patient success. The primary objective of this study was to compare attrition rates, demographics, and surgery outcomes between patients who participated in the online vs in-house preparative seminars. Methods A retrospective chart review was performed involving patients who chose to participate in online vs in-house educational seminar between July of 2014 and December of 2016. The patients were divided into two groups based on their choice of educational seminar and tracked to see how many made it to an initial visit and to surgery. In those who had bariatric surgery, data was collected on age, type of insurance, length of stay (LOS), longest follow-up, and change in body mass index. Results Total of 1230 patients were included in this study. There was no difference in attrition rate to initial consultation visit (29.1% vs 29.9%), but there was a statistically higher attrition to surgery in the in-house seminar attendees (72.9%) compared to online participants (66.6%, p < 0.05). Between January 2015 and December 2016, 291 patients underwent primary bariatric surgery. The online group was on average 3 years younger which was statistically significant. There were no differences in LOS, longest follow-up, and weight loss at 12 months between the groups. Conclusion When comparing attrition rates and bariatric surgery outcomes, no overall difference was noted between patients who received web- or hospital-based preparative education. Bariatric programs should provide access to online seminars to attract younger population and save resources and cost.