Running Head: HEALTH OUTCOMES OF BARIATRIC SURGERY
The use of Bariatric Surgery to Improve Health Outcomes among the Obese Population
Maria A. Hall
Ferris State University
NURS 240
HEALTH OUTCOMES OF BARIATRIC SURGERY
2
The use of Bariatric Surgery to Improve Health Outcomes among the Obese Population
The goal of this paper is to look at the use of bariatric surgery in improved health
outcomes. The purpose of bariatric surgery is to attain weight loss. As with any surgeries, there
are risks associated with them. Many different types of bariatric surgeries are now performed. In
this paper, laparoscopic adjustable gastric band insertion (LAGB) will be examined. A few
studies were reviewed to look at the complications of this type of surgery as well as the health
outcomes associated with it.
Obesity is a growing epidemic in the United States and the world. Obesity shortens the
lifespan by 10 years and also attributes to many other diseases or co-morbidities. According to
the World Health Organization’s website, worldwide “35% of adults aged 20 and over were
overweight in 2008, and 11% were obese. Overweight and obesity are the fifth leading risk for
global deaths. At least 2.8 million adults die each year as a result of being overweight or obese.
In addition, 44% of the diabetes burden, 23% of the ischemic heart disease burden and between
7% and 41% of certain cancer burdens are attributable to overweight and obesity.”
Obesity is defined through a height to weight ratio known as a BMI or body mass index.
People having a BMI ≥ 25 kg/m2 are considered overweight, BMI ≥ 30 kg/m2 obese, and BMI ≥
40 kg/m2 extremely or morbidly obese (Barbee 2010 p. 289). In cases where the BMI reaches 40
kg/m2, diet and exercise programs have been shown to be ineffective to reduce the weight. For
the population having a 40 or greater BMI, bariatric surgery is suggested to improve health
outcomes.
Co-Morbidities
HEALTH OUTCOMES OF BARIATRIC SURGERY
3
Obesity is also may cause a whole host of other diseases such as: type 2 diabetes mellitus,
hypertension, coronary heart disease, dyslipidemia, nonalcoholic fatty liver disease,
cholelithiasis, gastroesophageal reflux disease, stress urinary incontinence, gout, osteoarthritis,
pulmonary embolism, obstructive sleep apnea, depression, back pain, chronic venous
insufficiency, asthma, and obesity hypoventilation syndrome (Dunham 2013).
Patients having a BMI of 35 or greater that have co-morbities are also considered
candidates for bariatric surgery. These patients have seen a reduction of not only weight, but of
some these associated diseases. Most notably type 2 diabetes mellitus have had the best result
from bariatric surgery. Diabetes has been regulated without the use of medicine in some cases.
In fact,” In 2009 the American Diabetes Association issued a recommendation that bariatric
surgery be considered as a viable treatment option for obese patients with type 2
diabetes.”(Dunham 2013 p.46) Another study from Khwaja and Bonanomi (2010) reported of
patients undergoing Laparoscopic adjustable gastric band insertion (LAGB), “55% had
resolution of their diabetes mellitus (DM) at less than 24 months and 66% of patients with preexisting type II diabetes mellitus developed resolution or remission of their disease with
improvement in glycemic control in the remainder of the patients”. Hypertension was also found
to be controlled in 55% of bariatric patients without medication within 12 months (p. 33).
Complications
Complications from bariatric surgery depend on the type of surgery performed.
Specifically LAGB will be examined. LAGB procedures results in the least amount of
complications of all types of bariatric surgeries. Hamdan, Somers, and Chand (2011) reviewed
the percentages of patients having certain complications after this type of surgery. Slippage of
HEALTH OUTCOMES OF BARIATRIC SURGERY
4
the inserted band occurs in up to 15-20% of patients. Erosion of the tissue surrounding the band
is 4%. Megaesophagus is less than 0.5%. An additional surgery for revision or removal of the
band is required to address these complications.
As a part of the generalized bariatric surgery as a whole, cholesterol gallstones may be a
result of a high level of weight loss in a short time frame <6 months, occurs in 13-36% of
bariatric patients. In this instance, an additional surgery is needed to remove the gall bladder.
(Hamdan, Somers, and Chand. 2011) Venous thrombo-embolism is also the highest contributing
factor of mortality in gastric banding procedures. (Khwaja and Bonanomi 2010)
Surgeon/Facility Volume in Relation to Outcomes
Another factor of success regarding bariatric surgery is related to the location of the
surgery and the surgeon performing the procedure. In a study by Padwal et.al(2011) found a
correlation between surgery volume and effectiveness of the surgery. If the facility performs the
procedure with enough frequency, surgical complications are reduced. Padwal et.al suggests the
hospital volume of surgeries be 125 or greater per year to minimize post-op complications. The
same study also reviewed the surgeon’s quantity of surgeries and the health outcomes of the
patient. It was found that there was a certain number of surgeries performed annually by the
particular surgeon then the outcome would be improved. Padwal et. al found dramatically higher
patient mortality rates among surgeons performing 25 or less surgeries per year. The lowest
number of deaths occurs from surgeons performing 100 or more surgeries per year. The evidence
suggests that for higher success rates, bariatric surgeries are to be performed with great
frequency of the surgeon as well as the hospital they are performed in.
Correlations
HEALTH OUTCOMES OF BARIATRIC SURGERY
5
The WHO states that” Overweight and obesity are linked to more deaths worldwide than
underweight. For example, 65% of the world's population live in countries where overweight and
obesity kill more people than underweight (this includes all high-income and most middleincome countries).” In an effort to control the obesity epidemic, the volume of bariatric surgeries
is increasing exponentially. The surgical success rates will improve as does the frequency. The
correlation of the evidence shows that for obese patients with co-morbidities or a BMI above 40,
surgery is the best option to improve the health outcomes of patients despite the possible
complications involved.
HEALTH OUTCOMES OF BARIATRIC SURGERY
6
References
Barbee, K. G. (2010). Application of an integrated model to predict behavior in the bariatric surgery
population. Bariatric Nursing and Surgical Patient Care, 5(4), 289+. Retrieved from
http://go.galegroup.com/ps/i.do?id=GALE%7CA245661404&v=2.1&u=lom_ferrissu&it=r&p=
AONE&sw=w&asid=bf9d2722b777d298fbb9024d012890d6
Dunham, Marguerite MSN, CRNP (2013) Caring for patients undergoing bariatric surgery. Nursing
2013,43,44-50,DOI: 10.1097/01.NURSE.0000432118.12880.ff
Hamdan, K., Somers, S. and Chand, M. (2011), Management of late postoperative complications of
bariatric surgery. Br J Surg, 98: 1345–1355. doi: 10.1002/bjs.7568
Haris A. Khwaja, Gianluca Bonanomi (2010) Bariatric surgery: techniques, outcomes and complications
Current Anaesthesia & Critical Care, 21(1), 31–38 Retrieved from
http://dx.doi.org/10.1016/j.cacc.2009.10.005
Padwal, Raj, Scott Klarenbach, Natasha Wiebe, Maureen Hazel, Daniel Birch, Shahzeer Karmali, Arya
M. Sharma, Braden Manns, Marcello Tonelli (2011) Bariatric Surgery: A Systematic Review of
the Clinical and Economic Evidence. J Gen Intern Med, 26(10): 1183–1194.
doi: 10.1007/s11606-011-1721-x
World Health Organization. (n.d.). Retrieved from
http://www.who.int/mediacentre/factsheets/fs311/en/index.html