1,721,010 research outputs found
Letter to the editor: Do not throw the band out with the bath water
No full textChiappetta and colleagues highlight some of the challenges of gastric banding surgery and propose a “gastric band removal schedule” for patients who develop long-term intolerance or device problems with their gastric bands. They do not suggest that patients with good weight loss and working bands should have them removed [1]. The authors are persuaded by the declining popularity of gastric banding worldwide [2], high reoperation rates for patients with technical problems, and high removal rates for patients developing obstructive symptoms, regurgitation, and insufficient weight loss. As the letter stimulates ongoing discussion about procedure choice between patients and their bariatric teams, the advantages of gastric banding are worth statin
What is the most effective operation for adults with severe and complex obesity?
No full textThere is no abstract of this work
Social Media Response to the Introduction of the Swallowable Gastric Balloon Treatment for Severe Obesity in the NHS: A Snapshot of Public Opinion.
No full textBackground
Swallowable gastric balloons are available in the UK to treat severe obesity. Our hospital introduced this treatment in 2023, the first to do so in the National Health Service (NHS). The event was featured by the British Broadcasting Corporation (BBC) on regional television, in multiple radio interviews, and online by numerous news outlets in February 2024. Obesity and the treatment of obesity are often subject to stigma, prejudice and bias. The event gave an opportunity to observe public opinion in response to a new publicly available obesity treatment.
Methods
Qualitative review of public comments in articles responding to the BBC story about the introduction of swallowable gastric balloon therapy in the NHS. Comments were categorized as positive, neutral, or negative.
Results
Out of 2364 comments reviewed from all sources, 16.6% were positive, 48.9% were neutral and 34.8% were negative. Obesity stigma was highly prevalent in the responses and included many derogatory and abusive comments, including towards the patients featured in the BBC articles.
Conclusions
Obesity stigma is highly prevalent in those responding by social media and on news websites to a new treatment within the NHS. Negative stereotypes may be a barrier to obesity treatment within the NHS and need to be addressed
Disparities in Complication Rates Among Ethnic Minorities Undergoing Bariatric Surgery in the UK.
No full textBackground: Ethnicity may play a significant role in determining surgical outcomes. This study examines the disease profiles across ethnic groups and investigates whether ethnicity influences the risk of complications following bariatric surgery.
Methods: Data from the United Kingdom's National Bariatric Surgery Registry (NBSR) were analysed, encompassing all adult patients undergoing bariatric procedures. Comparative analyses were performed, and a multivariable regression model was developed to identify factors associated with postoperative complications.
Results: A total of 77,710 (78.8% female) patients were included in the analysis, with a median age of 46 (IQR 37-55) years. Most patients were Caucasian (91.6%), followed by Asian (4.1%), Afro-Caribbean (2.5%), and African (1.7%) groups. Afro-Caribbean patients had the highest median BMI (44.5 kg/m2) and the highest prevalence of hypertension (43.2%), while Asian patients were younger (median age 41 years) and had a higher prevalence of diabetes mellitus (29.1%). African and Afro-Caribbean patients were less likely to self-fund their procedures (14.9% and 10.6%, respectively) compared to Caucasians (25.9%). Complication rates were the highest among Afro-Caribbean patients (5.8 vs 4.8%, p < 0.001) compared to Caucasians. Multivariable regression analysis identified ethnicity as an independent predictor of postoperative complications, with Afro-Caribbean (OR 1.47, 95% CI 1.22-1.87, p < 0.001) and African (OR 1.34, 95% CI 1.05-1.70, p = 0.019) patients demonstrating significantly increased risks.
Conclusions: This registry analysis identified ethnic disparities in disease profiles and postoperative outcomes among bariatric surgery patients in the UK, underscoring the need for targeted health policies to improve outcomes in these vulnerable populations.
Keywords: Bariatric Surgery; Ethnicity; Health Disparities / Healthcare Inequalities; National Bariatric Surgery Registry (NBSR); Obesity; Surgical Outcomes / Postoperative Complications
Weight loss surgery for non-morbidly obese populations with type 2 diabetes: is this an acceptable option for patients?
No full textAim To explore the views of non-morbidly obese people (BMI 30-40 kg/m2) with type 2 diabetes regarding: (a) the acceptability of bariatric surgery (BS) as a treatment for type 2 diabetes, and (b) willingness to participate in randomised controlled trials comparing BS versus non-surgical intervention. BACKGROUND: Despite weight management being a key therapeutic goal in type 2 diabetes, achieving and sustaining weight loss is problematic. BS is an effective treatment for people with morbid obesity and type 2 diabetes; it is less certain whether non-morbidly obese patients (BMI 30-39.9 kg/m2) with type 2 diabetes benefit from this treatment and whether this approach would be cost-effective. Before evaluating this issue by randomised trials, it is important to understand whether BS and such research are acceptable to this population. METHODS: Non-morbidly obese people with type 2 diabetes were purposively sampled from primary care and invited to participate in semi-structured interviews. Interviews explored participants' thoughts surrounding their diabetes and weight, the acceptability of BS and the willingness to participate in BS research. Data were analysed using Framework Analysi
Analysis of the effect of staple line reinforcement on leaking and bleeding after sleeve gastrectomy from the UK National Bariatric Surgery Registry.
No full textIntroduction: Sleeve gastrectomy (SG) is currently the most frequently performed procedure for obesity worldwide. Staple line reinforcement (SLR) has been suggested as a strategy to reduce the risk of staple line leak or bleeding; however, its use for SG in the United Kingdom (UK) is unknown. This study examined the effect of SLR on the development of postoperative complications from SG using a large national dataset from the UK.
Methods: Patients undergoing either primary or revision SG over 10 years from Jan 2012 to Dec 2021 were identified by the National Bariatric Surgery Registry. Comparative and logistic regression analyses were undertaken to determine the effect of SLR on staple line leak and bleeding.
Results: During this time, 14,231 patients underwent SG for whom there were complete data. Of these, 76.5% were female and the median age was 46 years (IQR: 36-53). The rate of surgical complications was 2.3% (n = 219/14,231). The incidence of bleeding was 1.3% (n = 179/14,231) and leak was 1.0% (n = 140/14,231). Over time, the use of SLR of any variety declined significantly from 99.7% in 2012 to 57.3% in 2021 (p < 0.001). Multivariable (adjusted) regression analysis demonstrated that neither the use of nor the type of reinforcement had any effect on the rate of bleeding or leaking.
Conclusion: SLR for SG has declined in the UK since 2012. There were no differences in staple line leak or bleed with or without reinforcement
Assessing economic investment required to scale up bariatric surgery capacity in England:a health economic modelling analysis
Full text linkObjectives: To quantify the economic investment required to increase bariatric surgery (BaS) capacity in National Health Service (NHS) England considering the growing obesity prevalence and low provision of BaS in England despite its high clinical effectiveness. Design: Data were included for the patients with obesity who were eligible for BaS. We used a decision-tree approach including four distinct steps of the patient pathway to capture all associated resource use. We estimated total costs according to the current capacity (current scenario) and three BaS scaling up strategies over a time horizon of 20 years (projected scenario): maximising NHS capacity (strategy 1), maximising NHS and private sector capacity (strategy 2) and adding infrastructure to NHS capacity to cover the entire prevalent and incident obesity populations (strategy 3). Setting: BaS centres based in NHS and private sector hospitals in England. Main outcome measures: Number of BaS procedures (including revision surgery), cost (GBP) and resource utilisation over 20 years. Results: At current capacity, the number of BaS procedures and the total cost over 20 years were estimated to be 140 220 and £1.4 billion, respectively. For strategy 1, these values were projected to increase to 157 760 and £1.7 billion, respectively. For strategy 2, the values were projected to increase to 232 760 and £2.5 billion, respectively. Strategy 3 showed the highest increase to 564 784 and £6.4 billion, respectively, with an additional 4081 personnel and 49 facilities required over 20 years. Conclusions: The expansion of BaS capacity in England beyond a small proportion of the eligible population will likely be challenging given the significant upfront economic investment and additional requirement of personnel and infrastructure
Multi-centre micro-costing of Roux-En-Y Gastric bypass, sleeve gastrectomy and adjustable gastric banding procedures for the treatment of severe, complex obesity
No full textBackground: There is a growing interest in comparing the effectiveness and costs of alternative forms of bariatric surgery. We aimed to examine the per-patient, procedural costs of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and adjustable gastric banding (AGB) in the United Kingdom.Methods: Multi-centre (two National Health Service; NHS and one private hospital) micro-costing, using a time-and-motion study. Prospective collection of surgery times, staff quantities, equipment, instruments and consumables for 12 patients (four RYGB, five SG, three AGB) from patients’ first surgeon interaction on the day of surgery to departure from the theatre recovery area. Costs were attached to quantities and mean costs compared. Sensitivity and scenario analyses assessed the impact of varying surgery inputs and consideration of additional plausible factors respectively on total costs.Results: Mean procedural costs were £5002 for RYGB, £4306 for SG and £2527 for AGB. Varying staff seniority or altering procedure times had small impacts on costs (± 4–6%). Reducing prices of consumables by 20% reduced costs by 10–13%. Accounting for differences in surgical technique by altering the number of staple reloads used impacted costs by ± 7–10%. Adjusted total costs from scenario analyses were similar to NHS tariffs for RYGB and SG (difference of £51 and -£119 respectively) but were much lower for AGB (difference of £1982).Conclusions: These detailed costs will allow for more precise reimbursement of bariatric surgery and support comprehensive assessments of cost-effectiveness. Additional work to investigate costs of post-surgical care, re-operations and life-long support received by patients following surgery is required
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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