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Show An Expanded Examination of Outcomes from Revisional Bariatric Surgery: A Needs Assessment Lauren Reynolds, BSN, RN, DNP-FNP Student; Nicholas Paulk MD, FACS, FASMBS; Nancy A. Allen PhD, ANP-BC; Sara Simonsen PhD, CNM, MSPH Key Take Away: After assessing patient data following revisional bariatric surgery, a treatment for chronic relapsing obesity, results show more than half of the cases were associated with at least one complication but a substantial decrease in BMI and improvement of major comorbidities. These data will help . surgeons and patients determine risk versus benefit of revisional surgery. Background Complication Rate Revisional bariatric surgery: surgery following a failed or complicated primary bariatric procedure (weight regain responsible for >50%) Major Complication 34% As bariatric surgery becomes more common so does revisional surgery (7%-15% of total bariatric surgeries); Safety and efficacy of revisions are controversial Methods Follow-up phone calls were made to 120 patients who are now 2-5 years post revisional surgery to assess current BMI and comorbidity improvement Outcomes and recommendations developed from the literature were presented to the surgeons, followed by a survey to determine usability and satisfaction with findings 54% (n=87) of revisional surgeries had ≥1 complication; 20% (n=32) minor complications; 34% (n=55) major complications; 1.9% mortality rate Median decrease in BMI at one year follow-up was 13.14 kg/𝑚𝑚2 (-0.23-27.26) No Complications 46% Comorbidity improvement noted for 21% (n=33) at 1 year Minor Complication Only 20% Previous needs assessment at St. Mark’s Hospital showed a complication rate of 58%, mortality rate of 2.5%, and lack of evidence demonstrating benefits of revisional surgery A checklist was derived from the literature to guide the chart review at St. Mark’s Hospital; 160 patient records were reviewed to assess complications, timing of complications, and benefits following revisional surgery Results 2-5 years post revision, 50% (n=79) of comorbidities were described as “much better” or “somewhat better” 100% of SMWTC team reported being “very likely” to implement recommendations into practice, and “very satisfied” with the findings and report Comorbidity Improvement 2-5 Years Post-Revision Improved 16 15 1010 11 18 Same Worse 12 11 Conclusions 10 6 6 2 0 1 2 While there was a 54% complication rate, there was substantial weight loss seen among all types of revisions; Information from this project can help surgical decision making and counseling patients pursuing revisional bariatric surgery Recommendations included: • Multidisciplinary evaluation, including social workers/psychiatry, pre- and post-surgery • Processes to improve patient follow-up and improve documentation of comorbidity improvement @uofunursing @utnurseresearch |
