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Show A STUDY OF MICRONUTRIENT DEFICIENCIES AFTER BARIATRIC SURGERY Alexa Nickel, RN, BSN Project Chair: Pamela Phares, PhD, APRN Content Expert: Steven Simper, MD, FACS Key Findings: A large majority of bariatric surgery patients had high adherence to the daily multivitamin recommendation. Current education process of patients in the practice are effective. Micronutrient deficiencies varied by procedure. Process improvements for data management and tracking of clinical outcomes are needed within the practice. Background Results • There are over 150,000 bariatric surgeries performed in the United States annually and the number of surgeries performed has increased each year from 2011 to 2015. • 47 MMAQ questionnaires were completed. A large majority of patients had high adherence to their daily multivitamin (97.9%). • Those with moderate adherence identified forgetting, traveling, and stopping due to weight loss being under control as reasons for inconsistency in taking the prescribed MVI. • Weight loss surgeries are known to impair absorption of vitamins A, B, C, D, E, and K, as well as iron, copper, and zinc, however the prevalence of nutritional deficiencies are understudied. • Patients who underwent a gastric bypass or sleeve gastrectomy had a reduction in B12 and D deficiencies, but had increases in B1 and folate deficiencies. • A daily MVI is recommended for all patients who have undergone bariatric surgery to prevent these deficiencies. Patient adherence to this recommendation is unknown. • Those who underwent a duodenal switch had no change in B12 deficiencies but had increases in deficiencies of B1, D, A, and folate. Methods • Participants were patients of Rocky Mountain Associated Physicians, who underwent a gastric bypass, sleeve gastrectomy, or duodenal switch in 2015 or 2016. • Retrospective chart review of micronutrients were analyzed for 125 patients prior to bariatric surgery and one year following surgery. Sample Population Demographic Age 23-35 36-50 51-72 N=125 12 55 58 Gender Female Male 92 33 Race • Vitamins B12, B1, D, and folate were assessed for sleeve gastrectomy and gastric bypass. Vitamins A, B12, B1, D, folate were assessed for duodenal switch. • A Morisky Medication Adherence Questionnaire (MMAQ) was given to all post surgical patients seen from December 2017 to January 2018, to assess adherence to MVI and the practice’s education processes. Caucasian Hispanic Pacific Islander Middle Eastern Refuse to Report Surgeon Mckinlay Simper Paulk Procedure Gastric Bypass Sleeve Gastrectomy Duodenal Switch 102 7 1 1 14 80 41 4 63 30 32 Conclusions • Adherence to the recommended MVI was high in the patients surveyed, indicating that the practice’s education process is effective. • Micronutrient deficiencies were similar in gastric bypass and sleeve gastrectomy procedures, but were different in duodenal switch procedures. • Gathering results of pre- and post-surgical labs was found to be problematic during data collection suggesting that data management for the bariatric practice needs improvement in order to monitor micronutrient status and clinical outcomes of patients. COLLEGE OF NURSING |
