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Improvements of health-related quality of life five years after gastric bypass. What is important besides weight loss? A study from Scandinavian Obesity Surgery Register
Örebro University, School of Medical Sciences. Department of Surgery.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery.
University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Clinical Sciences, Danderyd Hospital Karolinska Institutet, Stockholm, Sweden.
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-81372OAI: oai:DiVA.org:oru-81372DiVA, id: diva2:1426692
Available from: 2020-04-27 Created: 2020-04-27 Last updated: 2020-04-27Bibliographically approved
In thesis
1. Long term effects of gastric bypass on quality of life and bone mineral density
Open this publication in new window or tab >>Long term effects of gastric bypass on quality of life and bone mineral density
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obesity is a worldwide disease. Surgery is currently the only available management option which offers an adequate long-term effect on comorbidity, quality-of-life and weight loss. It is evident that overweight and obesity are associated with low health-related quality-of life (HRQoL) and multiple comorbidities. The aim of this thesis has been to explore the long-term effect of gastric bypass surgery on HRQoL and bone mineral density.

In study 1: 486 patients (average age 50.7±10.0 years, 84 % female) operated with gastric bypass (GBP) from 1993 to 2003 at the University Hospitals of Örebro and Uppsala. Mean follow-up after GBP was 11.5±2.7 years (range 7–17). The study group was compared with two control groups. The study group scored better in the SF-36 domains and OP scale compared to obese controls, but their HRQoL scores were lower than those of the general population. HRQoL was better among younger patients and in the following subgroups: men; patients with satisfactory weight loss; those satisfied with the procedure; those free from comorbidity and gastrointestinal symptoms; employed; good oral status; and those not hospitalised or regularly followed up for non-bariatric reasons.

In study 3: Patients operated with a primary GBP between January 2008 and December 2012 were identified in the Scandinavian Obesity Surgery Register (SOReg). Patients with HRQoL data available at both baseline and 5 years after surgery were included. The study sample comprised 6998 patients (21% men). Gender differences in change in HRQoL were minor. Younger patients showed greater improvements in physical health scales. In general linear regression model analyses, age and weight loss correlated significantly with improvement in HRQoL after 5 years. Patients treated medically for depression preoperatively (13%) experienced less improvement in HRQoL than patients without such treatment. Patients with a postoperative complications (26%) had significantly less improvement in all aspects of HRQoL compared to those without any form of postoperative complication.This study confirmed the importance of weight loss for improvement in HRQoL after bariatric surgery. Preoperative medication for depression and suffering a complication during the five-year follow-up period were associated with less improvement in HRQoL.

Studies 2 and 4: Included patients operated with laparoscopic gastric bypass at the department of surgery at the Örebro University Hospital between January 2004 and December 2005. Thirty-two females were prospectively recruited for this longitudinal study. In both studies, the following were measured at baseline, 2, 5 and 10 years postoperatively: bone mineral density (BMD); weight; height; S-calcium; S-albumin; S-creatinine; S-25(OH)-vitamin D; and fP-PTH. In study 4: Nine of the patients declined follow-up. BMD showed a statistically significant decline over the study period. The fall in BMD of the spine and femoral neck between baseline and 5 years after surgery was 19% and 25%,respectively. During the next five years period BMD continued to decline but at a lower rate. At 5 years 58 % had elevated PTH, this number declined at the next 5 years.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2020. p. 70
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 2010
Keywords
Gastric bypass, health related quality of life, RAND SF-36, obesity-related problems scale, bone mineral density, BMI, parathyroid hormone, obesity, vitamin D
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-80487 (URN)978-91-7529-333-2 (ISBN)
Public defence
2020-05-29, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2020-03-09 Created: 2020-03-09 Last updated: 2020-04-28Bibliographically approved

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Raoof, MustafaSzabo, EvaCao, Yang

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