Causes of death after bariatric surgery: long-term study of 10 years

Background There is a lack of up-to-date research addressing the causes of death and predictors of long-term mortality after bariatric surgery. Methods This was a single-centre retrospective study. Trust records were used to identify deceased patients and their medical history. The demographic data, comorbidities, cause of death, and time since surgery were retrieved and tabulated. Data was recoded to allow for use in IBM SPSS. Results There were 39 deaths amongst 891 patients who underwent bariatric surgery between 15th June 2010 to 18th September 2022. The main cause of death was pneumonia and respiratory causes with 15.4% of the cohort. A history of asthma/COPD had an association with the cause of death (p = 0.021). A history of hypertension, ischaemic heart disease (IHD), and smoking were all associated with a higher age at death, whilst a history of IHD was associated with a higher number of days from operation to death. Age at operation and number of comorbidities both correlated with age at death, and multiple linear regression of age at death with age at operation and number of comorbidities as predictors was significant (p < 0.001). A Cox regression found age at operation to have a significant effect on survival, with a hazard ratio of 1.063 (95% CI:1.027 to 1.100, p < 0.001). Conclusion Pneumonia and respiratory causes are the largest causes of long-term mortality after bariatric surgery. The only factor found to have a detrimental effect on all-cause mortality was age at operation which reduced survival. Hypertension, IHD, and smoking are indirect factors that are associated with mortality

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients

30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data

Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusions: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts

Cutaneous Tuberculosis – A Profile of Cases 3 Years Cross Sectional Study

Background: Tuberculosis is an ancient disease known since pre-historic times and remains important infectious disease today in terms of morbidity, mortality and economic impact. Cutaneous tuberculosis makes up a small proportion (1.5%) of all cases of extra pulmonary tuberculosis. In a recent study from India cases of cutaneous tuberculosis make upto 0.15% of all skin outpatients. Irrespective of immunodeficiency status, cutaneous tuberculosis still contributes markedly in morbidity of developing countries and it remains at times a diagnostic challenge in dermatology clinic due to its varied clinical manifestations and varied histomorphology, hence proper clinical management with assisted histopathological diagnosis, the morbidity can be reduced. Aim and Objective: To study clinical and morphological variants of cutaneous tuberculosis with age and sex distribution. Materials and Methods: 3 years prospective study was done in the Department of Pathology, Shri Nijilingappa Medical College, Bagalkot from 2009 to 2011. Total 267 skin biopsies were received in the histopathology section. The biopsy tissue was processed as per routine procedure and stained with Hematoxylin and Eosin stains and special stains (ZN with 20% H2SO4). Microscopic features were studied and diagnosis of cutaneous tuberculosis made with sub typing and clinical co-relation. Results: Out of 267 skin biopsies, 37 were diagnosed as cutaneous tuberculosis based on clinical examination and morphology, Lupus vulgaris (62.16%) was a commonest variant affecting males (64.86%) predominantly. Most frequent age group affected was 21-40 years (59.45%). Face and neck were the usual sites for manifestation. Forty one percent of cases were mantoux test positive. All cases were HIV negative and free from active pulmonary tuberculosis. Conclusion: Lupus vulgaris remains most frequent form of cutaneous tuberculosis in dermatopathology irrespective of HIV status. Strong clinical suspicion, histopathological study and response to anti-tuberculosis treatment are sufficient for diagnosis and thus reducing the morbidity and mortality