Lily Koffman1, Alexander W Levis2, Sebastien Haneuse2, Eric Johnson3, Steven Bock4, Debie McSperitt5, Anirban Gupta6, David Arterburn3. 1. Department of Biostatistics, Harvard T. H. Chan School of Public Health, 655 Huntington Ave Building 2, Boston, MA, 02115, USA. lkoffman@hsph.harvard.edu. 2. Department of Biostatistics, Harvard T. H. Chan School of Public Health, 655 Huntington Ave Building 2, Boston, MA, 02115, USA. 3. Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA. 4. Department of Surgery, University of New Mexico, Albuquerque, NM, 87106, USA. 5. Transform Weight Loss Lynwood, Lynwood, WA, 98036, USA. 6. Washington Permanente Medical Group, Seattle, WA, 98109, USA.
Abstract
BACKGROUND: To determine the impact of an intensive perioperative nutritional and lifestyle support protocol on long-term outcomes of bariatric surgery. METHODS: A retrospective observational study was conducted of 955 patients who underwent gastric bypass surgery between 2005 and 2015. Patients were divided into two cohorts: (1) 2005 through August 2013: these 767 patients were required to participate in the intensive telephone-based nutritional support program from 8 weeks preoperative through 44 weeks postoperative; (2) after August 2013, the program was discontinued and 188 patients did not have intensive telephonic nutritional support. Inverse probability weighting was used to obtain weight loss estimates at 1 and 3 years postoperative. Time-to-event analyses were used to investigate hospitalization rates postoperative. Poisson models were used to investigate healthcare utilization. RESULTS: Patients who participated in the program exhibited 1.97% (95% CI 0.7, 3.3) greater %TWL at 1 year and 2.2% (95% CI -0.3, 4.1) greater %TWL at 3 years postoperative than patients who did not participate. Secondary analyses indicated participation in the program was associated with 44% shorter time to first hospitalization postoperative (p < 0.001). CONCLUSIONS: In this health system, intensive nutritional support was associated with greater weight loss at 1 and 3 years postoperative and higher hospitalization rates.
BACKGROUND: To determine the impact of an intensive perioperative nutritional and lifestyle support protocol on long-term outcomes of bariatric surgery. METHODS: A retrospective observational study was conducted of 955 patients who underwent gastric bypass surgery between 2005 and 2015. Patients were divided into two cohorts: (1) 2005 through August 2013: these 767 patients were required to participate in the intensive telephone-based nutritional support program from 8 weeks preoperative through 44 weeks postoperative; (2) after August 2013, the program was discontinued and 188 patients did not have intensive telephonic nutritional support. Inverse probability weighting was used to obtain weight loss estimates at 1 and 3 years postoperative. Time-to-event analyses were used to investigate hospitalization rates postoperative. Poisson models were used to investigate healthcare utilization. RESULTS: Patients who participated in the program exhibited 1.97% (95% CI 0.7, 3.3) greater %TWL at 1 year and 2.2% (95% CI -0.3, 4.1) greater %TWL at 3 years postoperative than patients who did not participate. Secondary analyses indicated participation in the program was associated with 44% shorter time to first hospitalization postoperative (p < 0.001). CONCLUSIONS: In this health system, intensive nutritional support was associated with greater weight loss at 1 and 3 years postoperative and higher hospitalization rates.