The role of body mass index in determining clinical and quality of life outcomes after laparoscopic anti-reflux surgery

Zachary Sanford, Shyam Jayaraman, Adam S. Weltz, H. Reza Zahiri, Adrian Park

Research output: Contribution to journalArticle

Abstract

Background: Current literature is conflicted regarding the efficacy of laparoscopic anti-reflux surgery (LARS) among obese patients complaining of pathologic reflux or otherwise symptomatic hiatal hernias. Controlling for other factors, this study examined the influence of preoperative body mass index (BMI) on clinical and subjective quality of life (QOL) outcomes following LARS. Methods: Patients who underwent LARS between February 2012 and April 2018 were subdivided into four BMI stratified categories according to CDC definitions: normal (18.5 to < 25), overweight (25.0 to < 30), obese Class 1 (30 to < 35), and a combination of obese Class 2 (35 to < 40) and Class 3 (≥ 40). Patient demography, perioperative data, and QOL data were collected. QOL was assessed utilizing four validated survey instruments: the Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL), Laryngopharyngeal Reflux Health-Related Quality of Life (LPR-HRQL), and a modified Quality of Life in Swallowing Disorders (mSWAL-QOL) surveys. Results: In this study, 869 patients were identified (213 NL, 323 OW, 219 OC1, 114 OC23). The majority of patients in each subgroup were female (65% NL, 68% OW, 79% OC1, 74% OC23) with similar rates of underlying hypertension, hyperlipidemia, and diabetes mellitus. Coronary artery disease rates between groups were statistically significant (p =.021). Operative time, length of hospital stay, and rates of 30-day readmission and reoperation were similar between groups. Among postoperative complications, rates of arrhythmia and UTI were more commonly reported in OC1 and OC23 populations. When assessed utilizing the RSI, GERD-HRQL, LPR-HRQL, and mSWAL-QOL instruments, QOL was similar among all groups (mean follow-up 15 months) irrespective of BMI. Conclusion: These findings suggest LARS in the overweight, obese, and morbidly obese populations—when compared to normal-weight cohorts in short-term follow-up—may have similar value in addressing pathological reflux manifestations and conveying quality of life benefits without added morbidity or mortality.

Original languageEnglish (US)
JournalSurgical endoscopy
DOIs
StatePublished - Jan 1 2019

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Body Mass Index
Quality of Life
Laryngopharyngeal Reflux
Gastroesophageal Reflux
Length of Stay
Hiatal Hernia
Centers for Disease Control and Prevention (U.S.)
Operative Time
Deglutition Disorders
Hyperlipidemias
Reoperation
Cardiac Arrhythmias
Coronary Artery Disease
Diabetes Mellitus
Demography
Hypertension
Morbidity
Weights and Measures
Mortality

Keywords

  • BMI
  • Body mass index
  • Gastroesophageal reflux disease
  • GERD
  • Laparoscopic anti-reflux surgery
  • LARS
  • Obesity
  • QOL
  • Quality of life outcomes

ASJC Scopus subject areas

  • Surgery

Cite this

The role of body mass index in determining clinical and quality of life outcomes after laparoscopic anti-reflux surgery. / Sanford, Zachary; Jayaraman, Shyam; Weltz, Adam S.; Reza Zahiri, H.; Park, Adrian.

In: Surgical endoscopy, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Current literature is conflicted regarding the efficacy of laparoscopic anti-reflux surgery (LARS) among obese patients complaining of pathologic reflux or otherwise symptomatic hiatal hernias. Controlling for other factors, this study examined the influence of preoperative body mass index (BMI) on clinical and subjective quality of life (QOL) outcomes following LARS. Methods: Patients who underwent LARS between February 2012 and April 2018 were subdivided into four BMI stratified categories according to CDC definitions: normal (18.5 to < 25), overweight (25.0 to < 30), obese Class 1 (30 to < 35), and a combination of obese Class 2 (35 to < 40) and Class 3 (≥ 40). Patient demography, perioperative data, and QOL data were collected. QOL was assessed utilizing four validated survey instruments: the Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL), Laryngopharyngeal Reflux Health-Related Quality of Life (LPR-HRQL), and a modified Quality of Life in Swallowing Disorders (mSWAL-QOL) surveys. Results: In this study, 869 patients were identified (213 NL, 323 OW, 219 OC1, 114 OC23). The majority of patients in each subgroup were female (65{\%} NL, 68{\%} OW, 79{\%} OC1, 74{\%} OC23) with similar rates of underlying hypertension, hyperlipidemia, and diabetes mellitus. Coronary artery disease rates between groups were statistically significant (p =.021). Operative time, length of hospital stay, and rates of 30-day readmission and reoperation were similar between groups. Among postoperative complications, rates of arrhythmia and UTI were more commonly reported in OC1 and OC23 populations. When assessed utilizing the RSI, GERD-HRQL, LPR-HRQL, and mSWAL-QOL instruments, QOL was similar among all groups (mean follow-up 15 months) irrespective of BMI. Conclusion: These findings suggest LARS in the overweight, obese, and morbidly obese populations—when compared to normal-weight cohorts in short-term follow-up—may have similar value in addressing pathological reflux manifestations and conveying quality of life benefits without added morbidity or mortality.",
keywords = "BMI, Body mass index, Gastroesophageal reflux disease, GERD, Laparoscopic anti-reflux surgery, LARS, Obesity, QOL, Quality of life outcomes",
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AU - Sanford, Zachary

AU - Jayaraman, Shyam

AU - Weltz, Adam S.

AU - Reza Zahiri, H.

AU - Park, Adrian

PY - 2019/1/1

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N2 - Background: Current literature is conflicted regarding the efficacy of laparoscopic anti-reflux surgery (LARS) among obese patients complaining of pathologic reflux or otherwise symptomatic hiatal hernias. Controlling for other factors, this study examined the influence of preoperative body mass index (BMI) on clinical and subjective quality of life (QOL) outcomes following LARS. Methods: Patients who underwent LARS between February 2012 and April 2018 were subdivided into four BMI stratified categories according to CDC definitions: normal (18.5 to < 25), overweight (25.0 to < 30), obese Class 1 (30 to < 35), and a combination of obese Class 2 (35 to < 40) and Class 3 (≥ 40). Patient demography, perioperative data, and QOL data were collected. QOL was assessed utilizing four validated survey instruments: the Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL), Laryngopharyngeal Reflux Health-Related Quality of Life (LPR-HRQL), and a modified Quality of Life in Swallowing Disorders (mSWAL-QOL) surveys. Results: In this study, 869 patients were identified (213 NL, 323 OW, 219 OC1, 114 OC23). The majority of patients in each subgroup were female (65% NL, 68% OW, 79% OC1, 74% OC23) with similar rates of underlying hypertension, hyperlipidemia, and diabetes mellitus. Coronary artery disease rates between groups were statistically significant (p =.021). Operative time, length of hospital stay, and rates of 30-day readmission and reoperation were similar between groups. Among postoperative complications, rates of arrhythmia and UTI were more commonly reported in OC1 and OC23 populations. When assessed utilizing the RSI, GERD-HRQL, LPR-HRQL, and mSWAL-QOL instruments, QOL was similar among all groups (mean follow-up 15 months) irrespective of BMI. Conclusion: These findings suggest LARS in the overweight, obese, and morbidly obese populations—when compared to normal-weight cohorts in short-term follow-up—may have similar value in addressing pathological reflux manifestations and conveying quality of life benefits without added morbidity or mortality.

AB - Background: Current literature is conflicted regarding the efficacy of laparoscopic anti-reflux surgery (LARS) among obese patients complaining of pathologic reflux or otherwise symptomatic hiatal hernias. Controlling for other factors, this study examined the influence of preoperative body mass index (BMI) on clinical and subjective quality of life (QOL) outcomes following LARS. Methods: Patients who underwent LARS between February 2012 and April 2018 were subdivided into four BMI stratified categories according to CDC definitions: normal (18.5 to < 25), overweight (25.0 to < 30), obese Class 1 (30 to < 35), and a combination of obese Class 2 (35 to < 40) and Class 3 (≥ 40). Patient demography, perioperative data, and QOL data were collected. QOL was assessed utilizing four validated survey instruments: the Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL), Laryngopharyngeal Reflux Health-Related Quality of Life (LPR-HRQL), and a modified Quality of Life in Swallowing Disorders (mSWAL-QOL) surveys. Results: In this study, 869 patients were identified (213 NL, 323 OW, 219 OC1, 114 OC23). The majority of patients in each subgroup were female (65% NL, 68% OW, 79% OC1, 74% OC23) with similar rates of underlying hypertension, hyperlipidemia, and diabetes mellitus. Coronary artery disease rates between groups were statistically significant (p =.021). Operative time, length of hospital stay, and rates of 30-day readmission and reoperation were similar between groups. Among postoperative complications, rates of arrhythmia and UTI were more commonly reported in OC1 and OC23 populations. When assessed utilizing the RSI, GERD-HRQL, LPR-HRQL, and mSWAL-QOL instruments, QOL was similar among all groups (mean follow-up 15 months) irrespective of BMI. Conclusion: These findings suggest LARS in the overweight, obese, and morbidly obese populations—when compared to normal-weight cohorts in short-term follow-up—may have similar value in addressing pathological reflux manifestations and conveying quality of life benefits without added morbidity or mortality.

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KW - Quality of life outcomes

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