Evidence-Based Classification for Post-bariatric Weight Regain from a Benchmark Registry Cohort of 18,403 Patients and Comparison with Current Criteria
Introduction There is a need for a standardized, evidence-based classification of post-bariatric weight-regain, to investigate and compare revision procedures and to advice and treat patients in an evidence-based way. Methods We used standard deviations (SD) of the highest (1–2 years) and latest (&g...
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| Veröffentlicht in: | Obesity surgery 2023-07, Vol.33 (7), p.2040-2048 |
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| creator | Franken, R. J. de Laar, A. W. Van |
| description | Introduction
There is a need for a standardized, evidence-based classification of post-bariatric weight-regain, to investigate and compare revision procedures and to advice and treat patients in an evidence-based way.
Methods
We used standard deviations (SD) of the highest (1–2 years) and latest (> 2 years) percentage total weight loss (%TWL) results after primary bariatric surgery from the Dutch Audit for Treatment of Obesity (DATO) bariatric registry as benchmarks for (above) average (≥ − 1SD), poor (− 1SD to − 2SD) and insufficient ( |
| doi_str_mv | 10.1007/s11695-023-06586-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2808588189</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2808588189</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-78dcc9b9f1b238166f311d469528ab63a09e8804cf025448f7fdcd289b4713763</originalsourceid><addsrcrecordid>eNp9kcuKFDEUhoMoTjv6Ai4k4MaF0Vyqclk6xXiBAQdRXIZUKunO2FVpk5QyT-LresYeFVy4CiTf-f5wfoQeM_qCUapeVsak6QnlglDZa0nEHbRhimpCO67vog01khJtuDhBD2q9opQzyfl9dCIU40Zps0E_zr-lKSw-kDNXw4SHvas1xeRdS3nBMRd8mWsjoyvJtZI8_hzSdtfwh7B1CYCSZ-zwGSh2sytfbu5TbeUaD3mXS8M5Yqafd1TgS1CGpVXsFsjJ8wGUFTK-p7bDw1oKPOKhpBYg6iG6F92-hke35yn69Pr84_CWXLx_8254dUG8UH0jSk_em9FENnKhmZRRMDZ1sBau3SiFoyZoTTsfKe-7TkcVJz9xbcZOMaGkOEXPjt5DyV_XUJudU_Vhv3dLyGu1XFPda820AfTpP-hVXssCvwMKlKrjlAHFj5QvudYSoj2UBJu5tozam9rssTYLtdlftVkBQ09u1es4h-nPyO-eABBHoMLTsg3lb_Z_tD8BklGijA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2828974201</pqid></control><display><type>article</type><title>Evidence-Based Classification for Post-bariatric Weight Regain from a Benchmark Registry Cohort of 18,403 Patients and Comparison with Current Criteria</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Franken, R. J. ; de Laar, A. W. Van</creator><creatorcontrib>Franken, R. J. ; de Laar, A. W. Van ; Dutch Audit for Treatment of Obesity Research Group</creatorcontrib><description>Introduction
There is a need for a standardized, evidence-based classification of post-bariatric weight-regain, to investigate and compare revision procedures and to advice and treat patients in an evidence-based way.
Methods
We used standard deviations (SD) of the highest (1–2 years) and latest (> 2 years) percentage total weight loss (%TWL) results after primary bariatric surgery from the Dutch Audit for Treatment of Obesity (DATO) bariatric registry as benchmarks for (above) average (≥ − 1SD), poor (− 1SD to − 2SD) and insufficient (< − 2SD) weight loss. Weight regain maintaining (above) average weight loss was called grade 1, weight regain towards poor weight loss grade 2, towards insufficient weight loss grade 3, with subgrades 2a/3a for below average weight loss from the start, and 2b/3b for weight regain from (above) average to below average weight loss. Patient characteristics and diabetes improvement/impairment were compared. Sensitivity and specificity of 14 existing weight regain criteria were calculated.
Results
We analyzed 93,465 results from 38,830 patients (77.1% gastric bypass, 22.5% sleeve gastrectomy). The − 1SD thresholds for early and late weight loss approximated 25%TWL and 20%TWL, the − 2SD threshold for late weight loss 10%TWL. Weight regain could be analyzed for 18,403 patients (2.5–5.2 years follow-up). They regained mean 6.7 kg (5.4%TWL), with 66.8% grade 1 weight regain, 7.2% grade 2a, 7.4% grade 2b, 2.1% grade 3a, and 0.6% grade 3b. There were significant differences in comorbidities, gender, age, weight regain, diabetes impairment, and diabetes improvement across grades. Weight regain criteria from literature were extremely divers. None had high sensitivity.
Conclusion
The DATO classification for post-bariatric weight regain combines the extent of weight regain with evidence-based endpoints of weight loss. It differentiated weight regain maintaining (above) average weight loss, two intermediate grades, gradual weight regain with below average weight loss from the start (primary non-response) and steep weight regain towards insufficient weight loss (secondary non-response). The classification is superior to existing criteria and well supported by evidence.
Graphical Abstract</description><identifier>ISSN: 0960-8923</identifier><identifier>ISSN: 1708-0428</identifier><identifier>EISSN: 1708-0428</identifier><identifier>DOI: 10.1007/s11695-023-06586-3</identifier><identifier>PMID: 37129789</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Benchmarking ; Body mass index ; Classification ; Diabetes ; Diabetes Mellitus - surgery ; Gastrectomy - methods ; Gastric Bypass - methods ; Gastrointestinal surgery ; Humans ; Laparoscopy ; Medicine ; Medicine & Public Health ; Obesity ; Obesity - surgery ; Obesity, Morbid - surgery ; Original Contributions ; Patients ; Registries ; Retrospective Studies ; Standard deviation ; Surgery ; Treatment Outcome ; Weight control ; Weight Gain ; Weight Loss</subject><ispartof>Obesity surgery, 2023-07, Vol.33 (7), p.2040-2048</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-78dcc9b9f1b238166f311d469528ab63a09e8804cf025448f7fdcd289b4713763</citedby><cites>FETCH-LOGICAL-c375t-78dcc9b9f1b238166f311d469528ab63a09e8804cf025448f7fdcd289b4713763</cites><orcidid>0000-0002-3245-4141</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11695-023-06586-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11695-023-06586-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37129789$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Franken, R. J.</creatorcontrib><creatorcontrib>de Laar, A. W. Van</creatorcontrib><creatorcontrib>Dutch Audit for Treatment of Obesity Research Group</creatorcontrib><title>Evidence-Based Classification for Post-bariatric Weight Regain from a Benchmark Registry Cohort of 18,403 Patients and Comparison with Current Criteria</title><title>Obesity surgery</title><addtitle>OBES SURG</addtitle><addtitle>Obes Surg</addtitle><description>Introduction
There is a need for a standardized, evidence-based classification of post-bariatric weight-regain, to investigate and compare revision procedures and to advice and treat patients in an evidence-based way.
Methods
We used standard deviations (SD) of the highest (1–2 years) and latest (> 2 years) percentage total weight loss (%TWL) results after primary bariatric surgery from the Dutch Audit for Treatment of Obesity (DATO) bariatric registry as benchmarks for (above) average (≥ − 1SD), poor (− 1SD to − 2SD) and insufficient (< − 2SD) weight loss. Weight regain maintaining (above) average weight loss was called grade 1, weight regain towards poor weight loss grade 2, towards insufficient weight loss grade 3, with subgrades 2a/3a for below average weight loss from the start, and 2b/3b for weight regain from (above) average to below average weight loss. Patient characteristics and diabetes improvement/impairment were compared. Sensitivity and specificity of 14 existing weight regain criteria were calculated.
Results
We analyzed 93,465 results from 38,830 patients (77.1% gastric bypass, 22.5% sleeve gastrectomy). The − 1SD thresholds for early and late weight loss approximated 25%TWL and 20%TWL, the − 2SD threshold for late weight loss 10%TWL. Weight regain could be analyzed for 18,403 patients (2.5–5.2 years follow-up). They regained mean 6.7 kg (5.4%TWL), with 66.8% grade 1 weight regain, 7.2% grade 2a, 7.4% grade 2b, 2.1% grade 3a, and 0.6% grade 3b. There were significant differences in comorbidities, gender, age, weight regain, diabetes impairment, and diabetes improvement across grades. Weight regain criteria from literature were extremely divers. None had high sensitivity.
Conclusion
The DATO classification for post-bariatric weight regain combines the extent of weight regain with evidence-based endpoints of weight loss. It differentiated weight regain maintaining (above) average weight loss, two intermediate grades, gradual weight regain with below average weight loss from the start (primary non-response) and steep weight regain towards insufficient weight loss (secondary non-response). The classification is superior to existing criteria and well supported by evidence.
Graphical Abstract</description><subject>Benchmarking</subject><subject>Body mass index</subject><subject>Classification</subject><subject>Diabetes</subject><subject>Diabetes Mellitus - surgery</subject><subject>Gastrectomy - methods</subject><subject>Gastric Bypass - methods</subject><subject>Gastrointestinal surgery</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Obesity</subject><subject>Obesity - surgery</subject><subject>Obesity, Morbid - surgery</subject><subject>Original Contributions</subject><subject>Patients</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Standard deviation</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Weight control</subject><subject>Weight Gain</subject><subject>Weight Loss</subject><issn>0960-8923</issn><issn>1708-0428</issn><issn>1708-0428</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kcuKFDEUhoMoTjv6Ai4k4MaF0Vyqclk6xXiBAQdRXIZUKunO2FVpk5QyT-LresYeFVy4CiTf-f5wfoQeM_qCUapeVsak6QnlglDZa0nEHbRhimpCO67vog01khJtuDhBD2q9opQzyfl9dCIU40Zps0E_zr-lKSw-kDNXw4SHvas1xeRdS3nBMRd8mWsjoyvJtZI8_hzSdtfwh7B1CYCSZ-zwGSh2sytfbu5TbeUaD3mXS8M5Yqafd1TgS1CGpVXsFsjJ8wGUFTK-p7bDw1oKPOKhpBYg6iG6F92-hke35yn69Pr84_CWXLx_8254dUG8UH0jSk_em9FENnKhmZRRMDZ1sBau3SiFoyZoTTsfKe-7TkcVJz9xbcZOMaGkOEXPjt5DyV_XUJudU_Vhv3dLyGu1XFPda820AfTpP-hVXssCvwMKlKrjlAHFj5QvudYSoj2UBJu5tozam9rssTYLtdlftVkBQ09u1es4h-nPyO-eABBHoMLTsg3lb_Z_tD8BklGijA</recordid><startdate>20230701</startdate><enddate>20230701</enddate><creator>Franken, R. J.</creator><creator>de Laar, A. W. Van</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3245-4141</orcidid></search><sort><creationdate>20230701</creationdate><title>Evidence-Based Classification for Post-bariatric Weight Regain from a Benchmark Registry Cohort of 18,403 Patients and Comparison with Current Criteria</title><author>Franken, R. J. ; de Laar, A. W. Van</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-78dcc9b9f1b238166f311d469528ab63a09e8804cf025448f7fdcd289b4713763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Benchmarking</topic><topic>Body mass index</topic><topic>Classification</topic><topic>Diabetes</topic><topic>Diabetes Mellitus - surgery</topic><topic>Gastrectomy - methods</topic><topic>Gastric Bypass - methods</topic><topic>Gastrointestinal surgery</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Obesity</topic><topic>Obesity - surgery</topic><topic>Obesity, Morbid - surgery</topic><topic>Original Contributions</topic><topic>Patients</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Standard deviation</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Weight control</topic><topic>Weight Gain</topic><topic>Weight Loss</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Franken, R. J.</creatorcontrib><creatorcontrib>de Laar, A. W. Van</creatorcontrib><creatorcontrib>Dutch Audit for Treatment of Obesity Research Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Obesity surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Franken, R. J.</au><au>de Laar, A. W. Van</au><aucorp>Dutch Audit for Treatment of Obesity Research Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evidence-Based Classification for Post-bariatric Weight Regain from a Benchmark Registry Cohort of 18,403 Patients and Comparison with Current Criteria</atitle><jtitle>Obesity surgery</jtitle><stitle>OBES SURG</stitle><addtitle>Obes Surg</addtitle><date>2023-07-01</date><risdate>2023</risdate><volume>33</volume><issue>7</issue><spage>2040</spage><epage>2048</epage><pages>2040-2048</pages><issn>0960-8923</issn><issn>1708-0428</issn><eissn>1708-0428</eissn><abstract>Introduction
There is a need for a standardized, evidence-based classification of post-bariatric weight-regain, to investigate and compare revision procedures and to advice and treat patients in an evidence-based way.
Methods
We used standard deviations (SD) of the highest (1–2 years) and latest (> 2 years) percentage total weight loss (%TWL) results after primary bariatric surgery from the Dutch Audit for Treatment of Obesity (DATO) bariatric registry as benchmarks for (above) average (≥ − 1SD), poor (− 1SD to − 2SD) and insufficient (< − 2SD) weight loss. Weight regain maintaining (above) average weight loss was called grade 1, weight regain towards poor weight loss grade 2, towards insufficient weight loss grade 3, with subgrades 2a/3a for below average weight loss from the start, and 2b/3b for weight regain from (above) average to below average weight loss. Patient characteristics and diabetes improvement/impairment were compared. Sensitivity and specificity of 14 existing weight regain criteria were calculated.
Results
We analyzed 93,465 results from 38,830 patients (77.1% gastric bypass, 22.5% sleeve gastrectomy). The − 1SD thresholds for early and late weight loss approximated 25%TWL and 20%TWL, the − 2SD threshold for late weight loss 10%TWL. Weight regain could be analyzed for 18,403 patients (2.5–5.2 years follow-up). They regained mean 6.7 kg (5.4%TWL), with 66.8% grade 1 weight regain, 7.2% grade 2a, 7.4% grade 2b, 2.1% grade 3a, and 0.6% grade 3b. There were significant differences in comorbidities, gender, age, weight regain, diabetes impairment, and diabetes improvement across grades. Weight regain criteria from literature were extremely divers. None had high sensitivity.
Conclusion
The DATO classification for post-bariatric weight regain combines the extent of weight regain with evidence-based endpoints of weight loss. It differentiated weight regain maintaining (above) average weight loss, two intermediate grades, gradual weight regain with below average weight loss from the start (primary non-response) and steep weight regain towards insufficient weight loss (secondary non-response). The classification is superior to existing criteria and well supported by evidence.
Graphical Abstract</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37129789</pmid><doi>10.1007/s11695-023-06586-3</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-3245-4141</orcidid></addata></record> |
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| subjects | Benchmarking Body mass index Classification Diabetes Diabetes Mellitus - surgery Gastrectomy - methods Gastric Bypass - methods Gastrointestinal surgery Humans Laparoscopy Medicine Medicine & Public Health Obesity Obesity - surgery Obesity, Morbid - surgery Original Contributions Patients Registries Retrospective Studies Standard deviation Surgery Treatment Outcome Weight control Weight Gain Weight Loss |
| title | Evidence-Based Classification for Post-bariatric Weight Regain from a Benchmark Registry Cohort of 18,403 Patients and Comparison with Current Criteria |
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