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Specialist Follow-Up Mitigates Anemia Risk of Bariatric Surgery

by U.S. Medicine

December 15, 2017

Dan Eisenberg, MD, MS, of the Palo Alto VAMC and Stanford School of Medicine led the research.

PALO ALTO, CA—Roux-en-Y gastric bypass (RYGB) is the criterion standard operation for weight loss, but it also increases the risk of adverse outcomes such as mineral and/or vitamin deficiency.

Noting that few studies have described long-term outcomes in a veteran population, a research letter published in JAMA Surgery sought to evaluate the prevalence of anemia 10 years after RYGB and assesses whether postoperative bariatric follow-up affects that outcome.1

Researchers from the Palo Alto VA Healthcare System and Stanford University School of Medicine performed a retrospective review of a prospective, 10-year database of RYGB at a single VAMC. Patients who did not have follow-up with a bariatric specialist more than five years postoperatively were compared with patients who had at least one visit with a bariatric specialist after five years. For purposes of the study, anemia was defined as a hemoglobin concentration of less than 13.5 g/dL for men and less than 12.0 g/dL for women.

The study looked at 102 patients who underwent RYGB from 2002 through 2006, ultimately focusing on 74 patients, 78% male, with an average age of 51 and a preoperative body mass index of 46.2. After 10 years, the mean BMI was 33.7, representing 60% excess BMI loss.

With an initial mean rate of preoperative anemia of 20%, the rate increased after RYGB to 28% at one year, 31% at five years and 47% at 10 years. The rate varied based on bariatric specialist follow-up, according to the report. While, at 10 years after surgery, the anemia rate in the cohort without follow-up increased to 57% from 22% before surgery, the rate among participants with follow-up did not increase—19% vs. 13%.

“Compared with patients with bariatric specialist follow-up, patients without bariatric specialist follow-up had significantly higher odds of anemia at 10 years (odds ratio, 6.1; 95% CI, 1.4-27.6; P = .02) after adjusting for preoperative anemia,” study authors concluded.

“Long-term complications of RYGB, such as anemia, may go unrecognized by non-bariatric specialists,” the researchers pointed out. “Causes include iron, vitamin B12, and folate deficiency; less common causes include copper, vitamin A, and selenium deficiency and bleeding marginal ulcers. We found high anemia rates 10 years after RYGB; these rates may reflect a mixed vitamin and mineral deficiency, because patients had normocytic anemia.

“Our study suggests that follow-up with bariatric specialists more than 5 years after surgery, rather than with specialists with no bariatric expertise, can decrease long-term anemia risk. This finding may demonstrate the bariatric specialist’s specific understanding of the long-term risk for nutritional deficiency after RYGB and the importance of vitamin and mineral supplementation.”

Chen GL, Kubat E, Eisenberg D. Prevalence of Anemia 10 Years After Roux-en-Y Gastric Bypass in a Single Veterans Affairs Medical Center. JAMA Surg. 2017 Sep 20. doi: 10.1001/jamasurg.2017.3158. [Epub ahead of print] PubMed PMID: 28975250. Cancer. 2017 Apr 1;123(7):1174-1183. doi: 10.1002/cncr.30416. Epub 2016 Dec 2.


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