RESUMEN
BACKGROUND: It is well documented that bariatric surgery is an effective weight loss intervention, and bariatric procedure rates have increased over time. However, there was a period of plateau in procedure rates in the mid to late 2000s. Recent literature has not identified current trends in procedure rates or associations between bariatric surgery and population factors, such as obesity and diabetes. OBJECTIVES: The purpose of this study was to determine trends in statewide rates of bariatric operations, obesity, and diabetes over an 11-year period and to determine if population factors are associated with procedure rates. SETTING: Data from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) were utilized to identify a study sample population of patients who underwent bariatric procedures from 2002-2012. METHODS: State level population characteristics were obtained from the Behavioral Risk Factor Surveillance System and Census Bureau Data for the 11-year period. Statistical analyses determined rates of surgery, obesity, and diabetes over time, as well as associations between surgery rates and population factors. RESULTS: From 2002-2012, bariatric procedure rates increased, with an exponential rise in laparoscopic surgical methods. Procedure rates reached a peak value in 2009 and then plateaued. Statewide obesity and diabetes rates increased over time, although there was no association between these population factors and procedure rates. Women had consistently higher rates of bariatric operations. CONCLUSION: Although bariatric procedures are an evidenced-based effective treatment for obesity, procedure rates were not associated with the increasing obesity and diabetes rates in the United States. Further research is needed to identify factors that affect the adoption and diffusion of bariatric operations to increase diffusion of beneficial innovations and improve overall quality of care and health outcomes.
Asunto(s)
Cirugía Bariátrica/tendencias , Predicción , Obesidad Mórbida/cirugía , Mejoramiento de la Calidad , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Obesidad Mórbida/epidemiología , Pronóstico , Estudios Retrospectivos , South Carolina/epidemiologíaRESUMEN
OBJECTIVE: Depression among weight loss surgery (WLS) candidates is common. Anxiety in this population is less studied. Untreated anxiety persists post-surgery and is associated with poor surgical outcomes. The current study sought to explore the nature of anxiety in WLS candidates. Given shared symptoms of anxiety and obesity, we hypothesized that physiological symptoms of anxiety would be most common. METHODS: In this retrospective study, the medical records of 174 pre-WLS candidates at a large medical center were reviewed. Each completed a comprehensive medical, surgical, and psychological evaluation as part of standard of care. Data from these evaluations were abstracted. One hundred forty-three candidates completed the Beck Anxiety Inventory (BAI). A Principal Components Analysis (PCA) with varimax rotation was used to identify the factor structure of the BAI. RESULTS: The sample consisted of primarily middle-aged (46.0 ± 13.24 years), married (60.8%), Caucasian (65.7%), females (79%) with Class III obesity (Body Mass Index = 50.1 ± 10.68) and mild anxiety (8.86 ± 8.70). Forty-four percent of the sample endorsed clinically significant anxiety. PCA revealed a four-factor structure that explained 56.28% of the variance in the BAI. The four factors were: 1) cognitive-emotional distress, 2) autonomic hyperarousal, 3) neurophysiologic concerns, and 4) body temperature. CONCLUSIONS: Clinically significant anxiety is common among WLS candidates. Cognitive-emotional clustering of anxiety symptoms was more common than hypothesized. This is notable given the overlap of physiological symptoms of anxiety and obesity. Findings lend support for the utility of psychotherapeutic approaches tailored to address maladaptive thoughts to address anxiety and potentially improve WLS outcomes.
Asunto(s)
Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Cirugía Bariátrica/psicología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/psicología , Adulto , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Inventario de Personalidad/estadística & datos numéricos , Psicometría , Estudios Retrospectivos , Trastornos Somatomorfos/diagnóstico , Trastornos Somatomorfos/psicologíaRESUMEN
BACKGROUND: In a recent preliminary trial in 20 patients after gastric bypass surgery, 20 minutes of repetitive transcranial magnetic stimulation (TMS) over the left prefrontal cortex was associated with a 40% reduction in postoperative patient-controlled morphine use. As is the case with all novel scientific findings, and especially those that might have an impact on clinical practice, replicability is paramount. This study sought to test this finding for replication and to more accurately estimate the effect size of this brief intervention on postoperative morphine use and postoperative pain and mood ratings. METHODS: Twenty participants who underwent gastric bypass surgery completed this replication and extension study. Beck Depression Inventory and Center for Epidemiological Studies Depression scale scores were collected before surgery and at the time of discharge from the hospital. Immediately after surgery, participants were randomly assigned to receive 20 minutes of real or sham repetitive TMS (rTMS) (10 Hz, 10 seconds-ON, 20 seconds-OFF for a total of 4000 pulses). Patient-controlled morphine pump usage was tracked throughout each participant's postoperative hospital stay. In addition, pain and mood ratings were collected via visual analogue scales twice per day. RESULTS: Findings from the original postoperative TMS trial were replicated, as cumulative morphine usage curves were significantly steeper among patients receiving sham TMS, and participants receiving real TMS had used 35% less morphine at the time of discharge than participants receiving sham TMS. At the time of discharge, subjects who had received real TMS had used 42.50 mg of morphine, whereas subjects receiving sham TMS had used an average of 64.88 mg. When the data from the original preliminary trial were combined with the data from this replication trial, a significant difference in cumulative morphine usage was observed between subjects receiving real and sham TMS. Overall, participants who received real TMS used 36% less morphine and had significantly lower ratings of postoperative pain-on-average, and pain-at-its-worst than participants receiving sham. In addition, participants who received real TMS rated their mood-at-its-worst as significantly better than participants receiving sham. The effect of a single 20-minute session of TMS on postoperative pain and morphine use appears to be large (Cohen's d = 0.70) and clinically meaningful. Lastly, cross-lag correlational analyses indicate that improvements in mood follow improvements in pain by approximately 12 hours, supporting the notion that postoperative analgesic TMS effects are not driven by antidepressant effects. CONCLUSIONS: Although more research is needed to verify these observed effects independently, findings from the original postoperative TMS trial were replicated. TMS may have the potential to significantly improve current standards of postoperative care among gastric bypass patients, and further studies may be warranted on other surgical populations. Future investigations should use methodology that permits more definitive conclusions about causal effects of TMS on postoperative pain (for example, double-blinding, sham stimulation that is matched with real TMS with respect to scalp discomfort).