Comorbidity as a Prognostic Criterion for Clinical Outcomes after Sleeve Gastrectomy in Patients with Obesity | Ukrainian Medical Journal

Aim: to assess the prognostic value of comorbid conditions in patients with obesity for predicting clinical outcomes following sleeve gastrectomy in the long-term postoperative period.

Materials and methods. Clinical outcomes were analyzed in 93 patients with obesity (69 women (74.19%) and 24 men (25.81%)) who underwent sleeve gastrectomy. The mean age was 42.20±11.09 years. Clinical outcomes were evaluated using the SF-BARI Score QoL scale. Comorbid conditions were assessed using the Charlson Comorbidity Index.

Results. Predictive factors for satisfactory outcomes after sleeve gastrectomy included the presence of heart failure (OR 10.43, 95% CI 1.70–64.06; p=0.008), peripheral vascular disease (OR 9.88, 95% CI 1.66–58.64; p=0.02), chronic non-specific pulmonary disease (OR 14.00, 95% CI 1.75–111.93; p=0.02), and a Charlson Comorbidity Index ≥6 (OR 28.00, 95% CI 3.80–206.53; p=0.002). A higher probability of favorable clinical outcomes was observed in patients with liver cirrhosis without portal hypertension (OR 11.83, 95% CI 1.13–124.44; p=0.02) and in those with a Charlson Index 3–5 (OR 2.94, 95% CI 1.05–8.22; p=0.04). Significantly poorer outcomes were associated with a history of stroke (τ=–0.20, p=0.005), dementia (τ=–0.15; p=0.03), diabetes mellitus with peripheral complications (τ=–0.18; p=0.01). A Charlson Index 0–2 was significantly associated with very good surgical outcomes (OR 3.13, 95% CI 1.20–8.13; p=0.01).

Conclusion. This study confirms the high prognostic value of comorbid conditions in predicting clinical outcomes of sleeve gastrectomy in patients with obesity.

References

1. Sockalingam S., Leung S.E., Ma C. et al. (2023) Efficacy of telephone-based cognitive behavioral therapy for weight loss, disordered eating, and psychological distress after bariatric surgery: a randomized clinical trial. JAMA Netw. Open, 6(8): e2327099. DOI: 10.1001/jamanetworkopen.2023.27099.
2. Martinelli V., Chiappedi M. (2022) Bariatric surgery: psychosocial aspects and quality of life. Int. J. Environ. Res. Public Health, 19(24): 16516. DOI: 10.3390/ijerph192416516.
3. Coulman K.D., Blazeby J.M. (2020) Health-related quality of life in bariatric and metabolic surgery. Curr. Obes. Rep., 9(3): 307–314. DOI: 10.1007/s13679-020-00392-z.
4. Sierżantowicz R., Ładny J.R., Lewko J. (2022) Quality of life after bariatric surgery—a systematic review. Int. J. Environ. Res. Public Health, 19(15): 9078. DOI: 10.3390/ijerph19159078.
5. Raman J., Spirou D., Jahren L., Eik-Nes T.T. (2020) The Clinical Obesity Maintenance Model: a theoretical framework for bariatric psychology. Front. Endocrinol., 11: 563. DOI: 10.3389/fendo.2020.00563.
6. Belligoli A., Bettini S., Segato G., Busetto L. (2020) Predicting responses to bariatric and metabolic surgery. Curr. Obes. Rep., 9(3): 373–379. DOI: 10.1007/s13679-020-00390-1.
7. Stenberg E., Cao Y., Marsk R. et al. (2020) Association between metabolic surgery and cardiovascular outcome in patients with hypertension: a nationwide matched cohort study. PLoS Med., 17(9): e1003307. DOI: 10.1371/journal.pmed.1003307.
8. Chen T.H., Huang W.W., Lu L.C. et al. (2024) Factors associated with postoperative efficacy evaluation in patients with morbid obesity. Sci. Rep., 14: 12255. DOI: 10.1038/s41598-024-63099-4.
9. Arishi A.A., Gosadi I.M., Hakami I.A. et al. (2023) Bariatric surgery reduces weight loss, comorbidities prevalence, and improves quality of life in the Southern Region of Saudi Arabia. Medicina (Kaunas), 59(10): 1695. DOI: 10.3390/medicina59101695.
10. Crozet J., Pasquer A., Pelascini E., Robert M. (2023) Factors influencing bariatric surgery outcomes. J. Visc. Surg., 160(2S): S7–S11. DOI: 10.1016/j.jviscsurg.2022.12.001.
11. Peterli R., Hurme S., Bueter M. et al. (2023) Standardized assessment of metabolic bariatric surgery outcomes: secondary analysis of 2 randomized clinical trials. JAMA Surg., 158(1): e234567. DOI: 10.1001/jamasurg.2023.6254.
12. Moorehead M.K., Ardelt-Gattinger E., Lechner H., Oria H.E. (2003) The validation of the Moorehead-Ardelt Quality of Life Questionnaire II. Obes. Surg., 13(5): 684–692. DOI: 10.1381/096089203322509237.
13. Charlson M.E., Pompei P., Ales K.L., MacKenzie C.R. (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chronic Dis., 40(5): 373–383. DOI: 10.1016/0021-9681(87)90171-8.
14. Boutouyrie P., Chowienczyk P., Humphrey J.D., Mitchell G.F. (2021) Arterial stiffness and cardiovascular risk in hypertension. Circ. Res., 128(7): 864–886.