Literature selections curated by Lewis Flint, MD, FACS, and reviewed by the Bulletin Brief editorial board.
Can Gut Microbiota Play a Predictive Role in Weight Loss after Bariatric Surgery?
Gutierrez-Repiso C, Garrido-Sanchez L, Aleaide-Torres J, et al. Predictive Role of Gut Microbiota in Weight Loss Achievement after Bariatric Surgery. J Am Coll Surg 2022, in press.
Several studies suggest that gut microbiota characteristics and changes in therein during weight-loss programs may predict successful weight loss. Studies of patients after bariatric surgery show that weight loss is associated with specific gut microbiota patterns. This study sought to determine whether certain gut microbiota compositions could predict the desired degree of weight loss.
A total of 76 patients were enrolled in the study and underwent sleeve gastrectomy; all patients provided preoperative fecal samples for analysis, and 40 patients provided fecal samples 3 months after surgery. Evaluations at 3 months and 1 year after surgery showed that 50 patients had lost 50% of excess weight (responder group), and 26 had not (non-responder group). Preoperative clinical characteristics were similar in both groups.
Examination of gut microbiota patterns showed that the preoperative prevotella to bacteroides(P/B) ratio was significantly lower in non-responders, and microbiota patterns in non-responders at 3 months showed a pattern of lipopolysaccharide enrichment that could contribute to a persistent enteric inflammatory response that prevented weight loss. The authors acknowledged the small sample size in the study and recommended additional research to determine the value of preoperative P/B ratio assessment to predict postoperative weight loss, as well as the potential benefits of efforts to alter microbiota-associated lipopolysaccharide production.
MBSAQIP Addresses Complications in Metabolic and Bariatric Surgery
Clapp B, Janik MR, El Badaoui J, et al. Five-Year Analysis of the MBSAQIP Database: Are We Getting Better? J Am Coll Surg 2022, in press.
The ACS Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database evaluates and predicts outcomes of bariatric surgery procedures. The data have been used to identify the most important postoperative complications and implement quality improvement initiatives to minimize these events. Benjamin Clapp, MD, FACS, and colleagues used MBSAQIP data from 2015 to 2019 to determine time-related changes in postoperative complications following roux-y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures.
A total of 690,770 observations were available for analysis. Mean age of included patients was 44.5 years and mean preoperative BMI was 45.2 kg/m². Sleeve gastrectomy accounted for 73.45% of all observations. A significant reduction in readmissions, organ dysfunction, and overall mortality was observed for the SG group. Readmissions, ICU admissions, and organ dysfunction were reduced in the RYGB group, but mortality remained stable. Complications such as pneumonia, stroke, and bleeding significantly declined in the RYGB group, but bleeding only was reduced in the SG group.
The authors noted that prior data have confirmed mortality risk following RYGB or SG in the range of 0.9%–2.0%. These observations resulted in classification of obesity procedures as “dangerous”, serving as a stimulus for the quality improvement interventions that were expected to result from analyses of MBSAQIP data. The authors concluded that notable improvements have occurred in some but not all areas, and efforts to reduce complications such as bleeding and pneumonia are warranted to reduce overall mortality.
Supervised Exercise after Non-Reconstructive Breast Cancer Surgery Improves QoL and Reduces Costs
Bruce J, Mazuquin B, Canaway A, et al. Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation. BMJ. Nov 10 2021;375:e066542. doi:10.1136/bmj-2021-066542
The PROSPER trial was designed to compare functional and quality of life (QoL) outcomes in patients at high risk for upper limb disability (pain, limitation of motion, lymphedema) after breast cancer surgery that involved the axilla. The prospective randomized trial was conducted in 17 UK cancer centers and included 392 patients who were randomized to receive usual care (exercise information leaflets and selective physical therapy) or a supervised exercise program administered by physical therapists. The exercise program incorporated stretching, strengthening exercises, scheduled physical activity, and behavioral change interventions to ensure exercise adherence. The exercise program began 7−10 days postoperatively and continued for 3 months. Assessments with standard disability and QoL scales were made 12 months postoperatively.
The data analysis showed that upper extremity function improved significantly in the exercise group and pain scores were significantly reduced. QoL also improved in the exercise group. Notably, no increase in rates of lymphedema or wound complications was observed in the exercise group. Overall healthcare costs were significantly reduced in the exercise group. The authors concluded that the supervised exercise program was a clinically cost-effective intervention.