Nine Key Outcomes for Metabolic Surgery

The noise coming at a person considering metabolic and bariatric surgery can be deafening. Intense emotions about these procedures can influence personal decision making and even the scientific literature. The best antidote is to focus on the facts. A new study in PLOS Medicine provides a well-validated set of nine key outcomes for metabolic surgery.

The focus of the study was on outcomes that should be reported in research studies. But these core outcomes provide a good reference point for anyone thinking about metabolic and bariatric surgery. These are facts that make a difference.

  1. Weight. OK, this one was easy. How much weight do people lose over time?
  2. Diabetes Status. Ever more data shows that metabolic and bariatric surgery can be the most effective means to put type 2 diabetes into remission for people with obesity. This outcome is growing ever more important.
  3. Cardiovascular Risk. Risk factors such as blood pressure, cholesterol, and multiple measures of heart function can be greatly improved or completely controlled after metabolic surgery. These factors play a big role in better prospects for a longer life.
  4. Quality of Life. Living with obesity is hard. It affects how you function, how you feel, your confidence, and your outlook on life. These are important dimensions of life that can be improved with surgery. Measuring and reporting them is critical.
  5. Survival. Every surgery carries a risk of death. For metabolic surgery, this risk low and comparable to other routine surgeries. And overall, people who choose to have bariatric surgery live longer than those who don’t. Make no mistake about it. This measure is critical.
  6. Technical Complications. Any bariatric surgery, whether it’s a bypass or a sleeve or something else, presents technical challenges with the possibility for complications at the time of surgery. The nature and rates of these complications are key measures.
  7. Re-operations. One and done is what everyone would like their outcome to be. But complications can require re-operations. Having reliable numbers on the need for subsequent operations is critical.
  8. Swallowing. Difficulty swallowing and regurgitation is a common problem after metabolic surgery and therefore an important outcome to measure.
  9. Nutrition. Getting enough of the right nutrients after surgery can be a challenge. The most common deficiencies are vitamin B12, folate, zinc, iron, copper, calcium, and vitamin D. These problems may be different for different procedures, so reporting the outcomes is important.

The Bariact project completed a careful process of evaluating thousands of potential outcome measures. Both patients and medical professionals evaluated them. The final list represents a core set of measures that should be a minimum for reporting outcomes for metabolic surgery.

These core outcomes have potential to improve the quality of information for everyone concerned about bariatric surgery. The work to produce this core set of measures was completed with UK patients and medical professionals, so international validation work will be the next step.

Despite the need for more work on these core outcome measures, having a solid starting point is a great step in the right direction.

Click here for the study and here for more from MedPage Today.

Nine, photograph © Yvonne Larsson / flickr

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December 8, 2016