Factors associated with different patterns of weight change after bariatric surgery : a longitudinal study

Q4Q2Pacientes con Cirugía bariátricaBackground: The mean weight loss (WL) after successful bariatric surgery is approximately one third of the initial body weight, which is mainly achieved between the first 2 years of follow-up. However, 15%–35% of patients do not achieve a significant percentage of total WL (%TWL). Information on factors associated with a higher or lower WL after bariatric surgery is limited. This study aimed to assess the change in %TWL and describe the factors associated with greater or lesser WL over time. Methods: This prospective longitudinal study included patients treated with laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. Baseline data were recorded before surgery. Follow-up was performed at 3 (n = 141), 6 (n = 208), 9 (n = 115), 12 (n = 216), 24 (n = 166), and 36 months (n = 99). Generalized estimating equation analysis was performed to assess the changes in %TWL over time and factors associated with different patterns of WL. Results: In total, 231 patients were included (women, 82.2%; basal body mass index (BMI) 41.4 ± 5.1 kg/m2). The tendencies to increase %TWL (32 ± 6.5) were evident in the first year and stabilized thereafter. Sustained nutritionist follow-up (2.3%, p = 0.004), baseline BMI >40 kg/m2 (0.4%, p 30 min/day after surgery reduced their %TWL by 0.6% (p = 0.002). Conclusions: Modifiable factors such as nutritional monitoring and WL before surgery are associated with a significant increase in %TWL over time. Basal BMI was associated with a significant decrease in %TWL.https://orcid.org/0000-0002-1353-148Xhttps://orcid.org/0000-0002-8907-3470https://orcid.org/0000-0001-5401-0018https://orcid.org/0000-0003-2863-8607https://orcid.org/0000-0002-1056-8906https://orcid.org/0000-0002-7935-2396https://orcid.org/0000-0003-1982-9161Revista Internacional - IndexadaA2N

Cost-effective of laparoscopic versus open groin hernia surgery in Colombia : an institutional perspective

Q3Q1Resumen289Introduction: Laparoscopic repair (LR) reveal clinical benefits above open repair (OR) of the groin hernia (QALY: LR: 0.84; OR: 0.83); however their cost-effectiveness is controversial. In both techniques, lightweight meshes (LWM) provide less postoperative pain, earlier labor return and QoL that heavyweight meshes (HWM). In Colombia, the OR+HWM has been currently performed, but LR (TAPP and TEP) is increasing. As well, there is not available information in Colombia of the cost-effectiveness of LR versus OR and available LWM. the aim of this study is to perform a comparison of four scenarios for treatment, based on technique and meshes, to identify the economic impact of the intervention through a cost-effective analysis. Methods: Retrospective analysis of economically active patients with primary unilateral hernia, submitted to OR+HWM from 2005-2010. Three economical scenarios were simulated (OR+LWM, TAPP+LWM and TAPP+HWM) and compared with OR+HWM, by the use of institutional costs. Direct and indirect costs, cost per QALY gained and incremental cost-effectiveness radio (ICER) were determinate for interventions. Work return in LR was assumed five days less than OR according to literature. the intervention was considered cost-effective if QALY value was less than three annual GNP per capita (29.000 USD). Results: 503 patients were submitted to OR+HWM. A mean of 12.3 days of labor return was identified. Total cost of treatment per patient was 564 USD (direct: 344; indirect: 220). Cost of treatment per patient on simulated scenarios was: OR+LWM: 607 USD (direct: 387; indirect: 220); TAPP+HWM: 1242 USD (direct: 1099; indirect: 143); and TAPP+LWM: 1285 USD (direct: 1142; indirect: 143). Main direct cost of treatment in LR was associated to surgical devices (fixation and harmonic scalpel). ICER for LR groups per QALY gained was highest that reference value (TAPP+HWM: 75.500 USD; TAPP+LWM:79.743 USD). The optimal ICER for LR (TAPP) is 638 USD. Conclusions: LR (TAPP) in Colombia is not a cost-effective treatment for groin hernia. Based in clinical advantages for the patient and face to the advances of LR, significant adjustments in direct cost by industry and negotiation policies among health system stakeholders are indispensable. Continuous training among surgeons is critical for develop of the LR. Further studies are necessary to evaluate the cost-effectiveness of other techniques as TEP in Colombia