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Szabo, Eva
Publications (10 of 23) Show all publications
Stenberg, E., Rask, E., Szabo, E., Näslund, I. & Ottosson, J. (2020). The Effect of Laparoscopic Gastric Bypass Surgery on Insulin Resistance and Glycosylated Hemoglobin A1c: a 2-Year Follow-up Study. Obesity Surgery
Open this publication in new window or tab >>The Effect of Laparoscopic Gastric Bypass Surgery on Insulin Resistance and Glycosylated Hemoglobin A1c: a 2-Year Follow-up Study
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2020 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Bariatric surgery improves insulin sensitivity and secretion in patients with type 2 diabetes, but the effect on patients with prediabetes or even normal glucose tolerance deserves further consideration.

Methods: Cohort study including patients operated with laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) between November 2012 and June 2017 at the orebro University Hospital (n = 813) with follow-up of 742 patients 2 years after surgery. Fasting insulin, glucose, glycosylated hemoglobin (HbA1c), and homeostatic model assessment of insulin resistance (HOMA-IR) were analyzed at baseline and 2 years after surgery for patients with overt type 2 diabetes, prediabetes, or non-diabetes.

Results: Fasting insulin levels improved for all groups (diabetics baseline 25.5 mIU/L, IQR 17.5-38.0, 2 years 7.6 mIU/L, IQR 5.4-11.1, p < 0.001; prediabetics baseline 25.0 mIU/L, IQR 17.5-35.0, 2 years 6.7mIU/L, IQR 5.3-8.8, p < 0.001; non-diabetics baseline 20.0 mIU/L, IQR 14.0-30.0, 2 years 6.4 mIU/L, IQR 5.0-8.5, p < 0.001). HbA1c improved in all groups (diabetics baseline 56 mmol/mol, IQR 49-74 [7.3%, IQP 6.6-8.9], 2 years 38 mmol/mol, IQR 36-47 [5.6%, IQR 5.4-6.4], p < 0.001; prediabetics baseline 40 mmol/mol, IQR 39-42 [5.8%, IQR5.7-6.0], 2 years 36 mmol/mol, IQR 34-38 [5.5%, IQR 5.3-5.6], p < 0.001; non-diabetics baseline 35 mmol/mol, IQR 33-37 [5.4%, IQR 5.2-5.5]; 2 years 34 mmol/mol, IQR 31-36 [5.3%, IQR 5.0-5.4], p < 0.001). HOMA-IR improved in all groups (diabetics baseline 9.3 mmol/mol, IQR 5.4-12.9, 2 years 1.9 mmol/mol, IQR 1.4-2.7, p < 0.001; prediabetics baseline 7.0 mmol/mol, IQR 4.3-9.9, 2 years 1.6 mmol/mol, IQR 1.2-2.1, p < 0.001; non-diabetics 4.9 mmol/mol, IQR 3.4-7.3, 2 years 1.4 mmol/mol, IQR 1.1-1.9, p < 0.001).

Conclusion: Insulin homeostasis and glucometabolic control improve in all patients after LRYGB, not only in diabetics but also in prediabetics and non-diabetic obese patients, and this improvement is sustained 2 years after surgery.

Place, publisher, year, edition, pages
Springer, 2020
Keywords
Insulin, Insulin resistance, Gastric bypass, Bariatric surgery, Postoperative outcome
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-81568 (URN)10.1007/s11695-020-04599-w (DOI)000527899000006 ()32314253 (PubMedID)
Note

Funding Agencies:

Örebro University  

Örebro County Council  

Bengt Ihre Foundation 

Available from: 2020-05-06 Created: 2020-05-06 Last updated: 2020-05-08Bibliographically approved
Stenberg, E., Ottosson, J., Szabo, E. & Näslund, I. (2019). Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery: a Register-Based Cohort Study. Obesity Surgery, 29(4), 1229-1235
Open this publication in new window or tab >>Comparing Techniques for Mesenteric Defects Closure in Laparoscopic Gastric Bypass Surgery: a Register-Based Cohort Study
2019 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, no 4, p. 1229-1235Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Routine closure of mesenteric defects is generally considered standard part of laparoscopic gastric bypass surgery today. Controversy still exists regarding the optimal method for mesenteric defects closure. The objective was to compare different methods for mesenteric defects handling in laparoscopic gastric bypass surgery.

METHODS: Primary laparoscopic gastric bypass procedures from 2010 until 2015 reported to the Scandinavian Obesity Surgery Registry (SOReg), where the mesenteric defects closure method was identifiable, were included. Main outcome measures were serious postoperative complication within 30 days after surgery, and reoperation for small bowel obstruction within 5 years after surgery. Quality-of-life before and after surgery, duration of surgery, and risk factors for complication were also analyzed. Information on operation for small bowel obstruction was based on data from the SOReg, the Swedish National Patient Register and reviews of hospital charts.

RESULTS: In all, 34,707 patients were included. Serious postoperative complication occurred in 174 (2.9%) patients with sutures, in 592 (3.1%, adjusted p = 0.079) with clips, and 278 (3.1%; adjusted p = 0.658) in the non-closure group. Reoperation for small bowel obstruction within 5 years after surgery was lower with sutures (cumulative incidence 6.9%) and clips (cumulative incidence 7.3%; adjusted HR 1.16, 95% CI 1.02-1.32, p = 0.026), compared to non-closure (cumulative incidence 11.2%; adjusted HR 1.63, 95% CI 1.44-1.84, p < 0.0001).

CONCLUSION: Closure of the mesenteric defects using either non-absorbable metal clips or non-absorbable running sutures is a safe and effective measure to reduce the risk for small bowel obstruction after laparoscopic gastric bypass surgery. Sutures appear slightly more effective and should remain gold standard for mesenteric defects closure.

Place, publisher, year, edition, pages
Springer Science+Business Media B.V., 2019
Keywords
Bariatric surgery, Gastric bypass, Internal hernia, Postoperative complication, Prevention, Small bowel obstruction
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-71852 (URN)10.1007/s11695-018-03670-x (DOI)000467148300022 ()30675687 (PubMedID)2-s2.0-85060594258 (Scopus ID)
Note

Funding Agencies:

Örebro Region County Council  

Örebro University 

Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-06-18Bibliographically approved
Jans, A., Näslund, I., Ottosson, J., Szabo, E., Näslund, E. & Stenberg, E. (2019). Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007-2015: A registry-based cohort study. PLoS Medicine, 16(11), Article ID e1002985.
Open this publication in new window or tab >>Duration of type 2 diabetes and remission rates after bariatric surgery in Sweden 2007-2015: A registry-based cohort study
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2019 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 16, no 11, article id e1002985Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although bariatric surgery is an effective treatment for type 2 diabetes (T2D) in patients with morbid obesity, further studies are needed to evaluate factors influencing the chance of achieving diabetes remission. The objective of the present study was to investigate the association between T2D duration and the chance of achieving remission of T2D after bariatric surgery.

METHODS AND FINDINGS: We conducted a nationwide register-based cohort study including all adult patients with T2D and BMI ≥ 35 kg/m2 who received primary bariatric surgery in Sweden between 2007 and 2015 identified through the Scandinavian Obesity Surgery Registry. The main outcome was remission of T2D, defined as being free from diabetes medication or as complete remission (HbA1c < 42 mmol/mol without medication). In all, 8,546 patients with T2D were included. Mean age was 47.8 ± 10.1 years, mean BMI was 42.2 ± 5.8 kg/m2, 5,277 (61.7%) were women, and mean HbA1c was 58.9 ± 17.4 mmol/mol. The proportion of patients free from diabetes medication 2 years after surgery was 76.6% (n = 6,499), and 69.9% at 5 years (n = 3,765). The chance of being free from T2D medication was less in patients with longer preoperative duration of diabetes both at 2 years (odds ratio [OR] 0.80/year, 95% CI 0.79-0.81, p < 0.001) and 5 years after surgery (OR 0.76/year, 95% CI 0.75-0.78, p < 0.001). Complete remission of T2D was achieved in 58.2% (n = 2,090) at 2 years, and 46.6% at 5 years (n = 681). The chance of achieving complete remission correlated negatively with the duration of diabetes (adjusted OR 0.87/year, 95% CI 0.85-0.89, p < 0.001), insulin treatment (adjusted OR 0.25, 95% CI 0.20-0.31, p < 0.001), age (adjusted OR 0.94/year, 95% CI 0.93-0.95, p < 0.001), and HbA1c at baseline (adjusted OR 0.98/mmol/mol, 95% CI 0.97-0.98, p < 0.001), but was greater among males (adjusted OR 1.57, 95% CI 1.29-1.90, p < 0.001) and patients with higher BMI at baseline (adjusted OR 1.07/kg/m2, 95% CI 1.05-1.09, p < 0.001). The main limitations of the study lie in its retrospective nature and the low availability of HbA1c values at long-term follow-up.

CONCLUSIONS: In this study, we found that remission of T2D after bariatric surgery was inversely associated with duration of diabetes and was highest among patients with recent onset and those without insulin treatment.

Place, publisher, year, edition, pages
Public Library of Science, 2019
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-78056 (URN)10.1371/journal.pmed.1002985 (DOI)000501333400007 ()31747392 (PubMedID)2-s2.0-85075326037 (Scopus ID)
Funder
Novo NordiskStockholm County Council
Note

Funding Agencies:

Örebro Region County Council  OLL-915571 OLL-884791

Bengt Ihre Foundation 

SRP Diabetes

Available from: 2019-11-25 Created: 2019-11-25 Last updated: 2020-01-14Bibliographically approved
Axer, S., Szabo, E., Agerskov, S. & Näslund, I. (2019). Predictive factors of complications in revisional gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry. Surgery for Obesity and Related Diseases, 15(12), 2094-2100
Open this publication in new window or tab >>Predictive factors of complications in revisional gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry
2019 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 15, no 12, p. 2094-2100Article in journal (Refereed) Published
Abstract [en]

Background: Roux-en-Y gastric bypass is the most common procedure for revisional bariatric surgery. This study is an analysis of revisional gastric bypass operations (rGBP) compared with primary gastric bypass (pGBP) performed in Sweden between 2007 and 2016.

Objective: The aim was to compare the incidence of adverse events in primary and revisional gastric bypass surgery and to identify predictive factors of intraoperative, early, and late complications in revisional gastric bypass surgery.

Setting: Forty-four hospitals.

Methods: Registered study from the Scandinavian Obesity Surgery Registry. The study group (rGBP) comprised 1795 patients, and the control group (pGBP) comprised 46,055 patients.

Results: Median follow-up time was 28 months. The rate of open procedures was significantly higher in the rGBP group (39.1% versus 2.4%; P < .001) decreasing from 70.8% in 2007 to 8.5% in 2016. Intraoperative complications (15.5% versus 3.0%, P < .001), early complications (24.6% versus 8.7%; P < .001), and late complications (17.7% versus 8.7%; P < .001) occurred more often in the rGBP group. Open access in revisional surgery was an independent risk factor for intraoperative complications (odds ratio 3.87; 95% confidence interval: 2.69-5.57, P < .001), early complications (odds ratio 2.08; 95% confidence interval: 1.53-2.83, P < .001), and late complications (odds ratio 1.91; 95% confidence interval: 1.31-2.78, P = .001). Indication for revision or type of index operation were not associated with complications.

Conclusion: RGBP was associated with a higher incidence of intraoperative, early, and late complications compared with pGBP. Open access in revisional surgery was predictive of complications regardless of the index operation or indication for revision.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Revision, Gastric bypass, Predictive factors, Complications, Bariatric surgery
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-79110 (URN)10.1016/j.soard.2019.09.071 (DOI)000504368600012 ()31640905 (PubMedID)2-s2.0-85073751563 (Scopus ID)
Note

Funding Agency:

Region Värmland Sweden

Available from: 2020-01-15 Created: 2020-01-15 Last updated: 2020-01-15Bibliographically approved
Stenberg, E., Persson, C., Näslund, E., Ottosson, J., Sundbom, M., Szabo, E. & Näslund, I. (2019). The impact of socioeconomic factors on the early postoperative complication rate after laparoscopic gastric bypass surgery: A register-based cohort study. Surgery for Obesity and Related Diseases, 15(4), 575-581
Open this publication in new window or tab >>The impact of socioeconomic factors on the early postoperative complication rate after laparoscopic gastric bypass surgery: A register-based cohort study
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2019 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 15, no 4, p. 575-581Article in journal (Refereed) Published
Abstract [en]

Background: Socioeconomic factors may influence the outcome of certain surgical procedures, but it is not known whether such factors influence the risk for postoperative complication after bariatric surgery.

Objectives: Determining whether different socioeconomic factors influence the risk for postoperative complication after laparoscopic gastric bypass surgery.

Setting: Nationwide in Sweden.

Methods: Retrospective register-based cohort study that includes all primary laparoscopic gastric bypass procedures in Sweden between 2010 and 2016, using data from the Scandinavian Obesity Surgery Registry, Statistics Sweden, and the Swedish Population Register. Main outcome measures were occurrence and severity of early postoperative complications.

Results: Included in this study were 41,537 patients with 30-day follow-up percentage of 96.7%. Study groups with increased risk for postoperative complication (age, sex, body mass index, and co-morbidity adjusted odds ratio with 95% confidence intervals) were as follows: being divorced, a widow, or a widower (1.14 [1.03-1.23]); receiving disability pension (1.37 [1.23-1.53]) or social assistance (1.22 [1.07-1.401); and being first- (1.22 [1.04-1.44]) or second-generation (1.20 [1.09-1.32]) immigrant. In contrast, being single (.90 [.83.991), having higher disposable income (50th-80th percentile:.84 [.76.93]; >80th percentile:.84 [72.98]), and living in a medium (.90 [.83.98]) or small (.84 [.76.92]) town were associated with lower risk. Increased risk for severe postoperative complication was seen for divorced, widowm, or widower (1.30 [1.12-1.521) and those receiving disability pension (1.37 [1.16-1.611) or social assistance (1.32 [1.08-1.62]), while higher disposable income (50th-80th percentile:.79 [.68.92]; >80th percentile .57 [.46.72]) was associated with lower risk.

Conclusion: Socioeconomic factors influence the risk for early postoperative complication after laparoscopic gastric bypass surgery. The impact is not enough to exclude patients from surgery, but they must be taken into account in preoperative risk assessment.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Laparoscopy, Gastric bypass, Postoperative complication, Risk factor, Socioeconomic
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-75276 (URN)10.1016/j.soard.2019.01.025 (DOI)000471741000006 ()30826242 (PubMedID)2-s2.0-85062107978 (Scopus ID)
Funder
Stockholm County CouncilNovo Nordisk
Note

Funding Agencies:

Örebro Region county council

Örebro University  

SRP Diabetes 

Available from: 2019-07-24 Created: 2019-07-24 Last updated: 2019-07-24Bibliographically approved
Sellberg, F., Possmark, S., Ghaderi, A., Näslund, E., Willmer, M., Tynelius, P., . . . Berglind, D. (2018). A dissonance-based intervention for women post roux-en-Y gastric bypass surgery aiming at improving quality of life and physical activity 24 months after surgery: study protocol for a randomized controlled trial. BMC Surgery, 18, Article ID 25.
Open this publication in new window or tab >>A dissonance-based intervention for women post roux-en-Y gastric bypass surgery aiming at improving quality of life and physical activity 24 months after surgery: study protocol for a randomized controlled trial
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2018 (English)In: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 18, article id 25Article in journal (Refereed) Published
Abstract [en]

Background: Roux-en-Y gastric bypass (RYGB) surgery is the most common bariatric procedure in Sweden and results in substantial weight loss. Approximately one year post-surgery weight regain for these patient are common, followed by a decrease in health related quality of life (HRQoL) and physical activity (PA). Our aim is to investigate the effects of a dissonance-based intervention on HRQoL, PA and other health-related behaviors in female RYGB patients 24 months after surgery. We are not aware of any previous RCT that has investigated the effects of a similar intervention targeting health behaviors after RYGB.

Methods: The ongoing RCT, the "WELL-GBP"-trial (wellbeing after gastric bypass), is a dissonance-based intervention for female RYGB patients conducted at five hospitals in Sweden. The participants are randomized to either control group receiving usual follow-up care, or to receive an intervention consisting of four group sessions three months post-surgery during which a modified version of the Stice dissonance-based intervention model is used. The sessions are held at the hospitals, and topics discussed are PA, eating behavior, social and intimate relationships. All participants are asked to complete questionnaires measuring HRQoL and other health-related behaviors and wear an accelerometer for seven days before surgery and at six months, one year and two years after surgery. The intention to treat and per protocol analysis will focus on differences between the intervention and control group from pre-surgery assessments to follow-up assessments at 24 months after RYGB. Patients' baseline characteristics are presented in this protocol paper.

Discussion: A total of 259 RYGB female patients has been enrolled in the "WELL-GBP"-trial, of which 156 women have been randomized to receive the intervention and 103 women to control group. The trial is conducted within a Swedish health care setting where female RYGB patients from diverse geographical areas are represented. Our results may, therefore, be representative for female RYGB patients in the country as a whole. If the intervention is effective, implementation within the Swedish health care system is possible within the near future.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Bariatric surgery, Roux-en-Y gastric bypass, Dissonance-based, Intervention, RCT, Quality of life, Physical activity
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-67078 (URN)10.1186/s12893-018-0358-7 (DOI)000431879900001 ()29743040 (PubMedID)2-s2.0-85046686474 (Scopus ID)
Funder
Swedish Research Council
Note

Funding Agencies:

Erling-Persson Family Foundation  

Research School of Caring Sciences Karolinska Institutet  

Available from: 2018-05-24 Created: 2018-05-24 Last updated: 2018-09-13Bibliographically approved
Axelsson, K. F., Werling, M., Eliasson, B., Szabo, E., Näslund, I., Wedel, H., . . . Lorentzon, M. (2018). Fracture Risk After Gastric Bypass Surgery: A Retrospective Cohort Study. Paper presented at World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO 2018), Krakow, Poland, April 19-22, 2018. Osteoporosis International, 29(Suppl. 1), S491-S491
Open this publication in new window or tab >>Fracture Risk After Gastric Bypass Surgery: A Retrospective Cohort Study
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2018 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, no Suppl. 1, p. S491-S491Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Objectives: Gastric bypass surgery constitutes the most common and effective bariatric surgery to treat obesity. Gastric bypass leads to bone oss but fracture risk following surgery has been insufficiently studied. Our objective was to investigate if gastric bypass surgery in obese patients, with and without diabetes, was associated with fracture risk, and if the fracture risk was associated with post-surgery weight loss or insufficient calcium and vitamin D supplementation.

Methods: Using large databases, 38 971 obese patients undergoing gastric bypass were identified, 7758 with diabetes and 31 213 without. Through multivariable 1:1 propensity score matching, well-balanced controls were identified. The risk of fracture and fall injury was investigated using Cox proportional hazards and flexible parameter models. Fracture risk according to weight loss and degree of calcium and vitamin D supplementation one year post-surgery was investigated.

Results: 77 942 patients had a median and total follow-up time of 3.1 (IQR 1.7-4.6) and 251 310 person-years, respectively. Gastric bypass was associated with increased risk of any fracture, in patients with diabetes and without diabetes using a multivariable Cox model (HR 1.26, 95%CI 1.05-1.53 and HR 1.32, 95%CI 1.18-1.47, respectively). The risk of fall injury without fracture was also increased after gastric bypass, both in patients with (HR 1.26 95%CI 1.04-1.52) and without diabetes (HR 1.24 95%CI 1.12-1.38). Weight loss or degree of calcium and vitamin D supplementation after gastric bypass were not associated with fracture risk.

Conclusions: Gastric bypass was associated with an increased risk of fracture and fall injury. Weight loss or calcium and vitamin D supplementation following surgery were not associated with fracture risk. These findings indicate that gastric bypass increases fracture risk, which could at least partly be due to increased susceptibility to falls.

Place, publisher, year, edition, pages
Springer London, 2018
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-68592 (URN)10.1007/s00198-018-4465-1 (DOI)000440102404082 ()
Conference
World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO-IOF-ESCEO 2018), Krakow, Poland, April 19-22, 2018
Available from: 2018-08-27 Created: 2018-08-27 Last updated: 2018-08-27Bibliographically approved
Axelsson, K. F., Werling, M., Eliasson, B., Szabo, E., Näslund, I., Wedel, H., . . . Lorentzon, M. (2018). Fracture Risk After Gastric Bypass Surgery: A Retrospective Cohort Study. Journal of Bone and Mineral Research, 33(12), 2122-2131
Open this publication in new window or tab >>Fracture Risk After Gastric Bypass Surgery: A Retrospective Cohort Study
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2018 (English)In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 33, no 12, p. 2122-2131Article in journal (Refereed) Published
Abstract [en]

Gastric bypass surgery constitutes the most common and effective bariatric surgery to treat obesity. Gastric bypass leads to bone loss, but fracture risk following surgery has been insufficiently studied. Furthermore, the association between gastric bypass and fracture risk has not been studied in patients with diabetes, which is a risk factor for fracture and affected by surgery. In this retrospective cohort study using Swedish national databases, 38,971 obese patients undergoing gastric bypass were identified, 7758 with diabetes and 31,213 without. An equal amount of well-balanced controls were identified through multivariable 1:1 propensity score matching. The risk of fracture and fall injury was investigated using Cox proportional hazards and flexible parameter models. Fracture risk according to weight loss and degree of calcium and vitamin D supplementation 1-year postsurgery was investigated. During a median follow-up time of 3.1 (interquartile range [IQR], 1.7 to 4.6) years, gastric bypass was associated with increased risk of any fracture, in patients with and without diabetes using a multivariable Cox model (hazard ratio [HR] 1.26; 95% CI, 1.05 to 1.53; and HR 1.32; 95% CI, 1.18 to 1.47; respectively). Using flexible parameter models, the fracture risk appeared to increase with time. The risk of fall injury without fracture was also increased after gastric bypass. Larger weight loss or poor calcium and vitamin D supplementation after surgery were not associated with increased fracture risk. In conclusion, gastric bypass surgery is associated with an increased fracture risk, which appears to be increasing with time and not associated with degree of weight loss or calcium and vitamin D supplementation following surgery. An increased risk of fall injury was seen after surgery, which could contribute to the increased fracture risk.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
OSTEOPOROSIS, FRACTURE RISK ASSESSMENT, GENERAL POPULATION STUDIES
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-70861 (URN)10.1002/jbmr.3553 (DOI)000452301800005 ()30011091 (PubMedID)2-s2.0-85052618842 (Scopus ID)
Funder
Swedish Research Council
Note

Funding Agencies:

Research fund at Skaraborg Hospital Skövde, Sweden  

Sahlgrenska University Hospital  

Gustaf V:s och Drottning Victorias Frimurarstiftelse 

Available from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved
Stenberg, E., Szabo, E., Ottosson, J., Thorell, A. & Näslund, I. (2018). Health-Related Quality-of-Life after Laparoscopic Gastric Bypass Surgery with or Without Closure of the Mesenteric Defects: a Post-hoc Analysis of Data from a Randomized Clinical Trial. Obesity Surgery, 28(1), 31-36
Open this publication in new window or tab >>Health-Related Quality-of-Life after Laparoscopic Gastric Bypass Surgery with or Without Closure of the Mesenteric Defects: a Post-hoc Analysis of Data from a Randomized Clinical Trial
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2018 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 28, no 1, p. 31-36Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Mesenteric defect closure in laparoscopic gastric bypass surgery has been reported to reduce the risk for small bowel obstruction. Little is known, however, about the effect of mesenteric defect closure on patient-reported outcome. The aim of the present study was to see if mesenteric defect closure affects health-related quality-of-life (HRQoL) after laparoscopic gastric bypass.

METHODS: Patients operated at 12 centers for bariatric surgery participated in this randomized two-arm parallel study. During the operation, patients were randomized to closure of the mesenteric defects or non-closure. This study was a post-hoc analysis comparing HRQoL of the two groups before surgery, at 1 and 2 years after the operation. HRQoL was estimated using the short form 36 (SF-36-RAND) and the obesity problems (OP) scale.

RESULTS: Between May 1, 2010, and November 14, 2011, 2507 patients were included in the study and randomly assigned to mesenteric defect closure (n = 1259) or non-closure (n = 1248). In total, 1619 patients (64.6%) reported on their HRQoL at the 2-year follow-up. Mesenteric defect closure was associated with slightly higher rating of social functioning (87 ± 22.1 vs. 85 ± 24.2, p = 0.047) and role emotional (85 ± 31.5 vs. 82 ± 35.0, p = 0.027). No difference was seen on the OP scale (open defects 22 ± 24.8 vs. closed defects 20 ± 23.8, p = 0.125).

CONCLUSION: When comparing mesenteric defect closure with non-closure, there is no clinically relevant difference in HRQoL after laparoscopic gastric bypass surgery.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2018
Keywords
Bariatric surgery, Laparoscopic gastric bypass, Small bowel obstruction, Internal hernia, Health-related quality-of-life, Randomized clinical trial
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:oru:diva-61780 (URN)10.1007/s11695-017-2798-z (DOI)000418304500005 ()28676957 (PubMedID)2-s2.0-85021846101 (Scopus ID)
Note

Funding Agencies:

Örebro County Council, Örebro University  

Erling-Persson Family Foundation 

Available from: 2017-10-24 Created: 2017-10-24 Last updated: 2018-08-16Bibliographically approved
Gerber, P., Anderin, C., Szabo, E., Näslund, I. & Thorell, A. (2018). Impact of age on risk of complications after gastric bypass: A cohort study from the Scandinavian Obesity Surgery Registry (SOReg). Surgery for Obesity and Related Diseases, 14(4), 437-442
Open this publication in new window or tab >>Impact of age on risk of complications after gastric bypass: A cohort study from the Scandinavian Obesity Surgery Registry (SOReg)
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2018 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 14, no 4, p. 437-442Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: An increasing number of older patients undergo bariatric surgery.

OBJECTIVE: To define the risk for complications and mortality in relation to age after gastric bypass.

SETTING: A national registry-based study.

METHODS: Patients (n = 47,660) undergoing gastric bypass between May 2007 and October 2016 and registered in the Scandinavian Obesity Register were included. Risk between age groups was compared by multivariate analysis.

RESULTS: The 30-day follow-up rate was 98.1%. In the entire cohort of patients, any complication within 30 days was demonstrated in 8.4%. For patients aged 50 to 54, 55 to 59, and ≥60 years, this risk was significantly increased to 9.8%, 10.0%, and 10.2%, respectively. Rates of specific surgical complications, such as anastomotic leak, bleeding, and deep infections/abscesses were all significantly increased by 14% to 41% in patients aged 50 to 54 years, with a small additional, albeit not significant, increase in risk in patients of older age. The risk of medical complications (thromboembolic events, cardiovascular, and pulmonary complications) was significantly increased in patients aged ≥60 years. Mortality was .03% in all patients without differences between groups.

CONCLUSIONS: In this large data set, rates of complications and mortality after 30 days were low. For many complications, an increased risk was encountered in patients aged ≥50 years. However, rates of complications and mortality were still acceptably low in these age groups. Taking the expected benefits in terms of weight loss and improvements of co-morbidities into consideration, our findings suggest that patients of older age should be considered for surgery after thorough individual risk assessment rather than denied bariatric surgery based solely on a predefined chronologic age limit.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Gastric bypass; age; elderly; complications; mortality
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-66467 (URN)10.1016/j.soard.2017.12.024 (DOI)000428971300001 ()29428689 (PubMedID)2-s2.0-85043981241 (Scopus ID)
Note

Funding Agency:

Erling-Persson Family Foundation

Available from: 2018-04-13 Created: 2018-04-13 Last updated: 2018-08-31Bibliographically approved
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