Preoperative Depression Status and 5 Year Metabolic and Bariatric Surgery Outcomes in the PCORnet Bariatric Study Cohort

Janelle W Coughlin, Elizabeth Nauman, Robert Wellman, R Yates Coley, Kathleen M McTigue, Karen J Coleman, Daniel B Jones, Kristina H Lewis, Jonathan N Tobin, Christina C Wee, Stephanie L Fitzpatrick, Jay R Desai, Sameer Murali, Ellen H Morrow, Ann M Rogers, G Craig Wood, David G Schlundt, Caroline M Apovian, Meredith C Duke, James C McClay, Rohit Soans, Rabih Nemr, Neely Williams, Anita Courcoulas, John H Holmes, Jane Anau, Sengwee Toh, Jessica L Sturtevant, Casie E Horgan, Andrea J Cook, David E Arterburn, PCORnet Bariatric Study Collaborative, Janelle W Coughlin, Wendy L Bennett, Elizabeth Nauman, Robert Wellman, R Yates Coley, Jane Anau, Andrea J Cook, David Arterburn, Kathleen M McTigue, Anita Courcoulas, Sengwee Toh, Jessica L Sturtevant, Casie E Horgan, Jeffrey S Brown, Karen J Coleman, Daniel B Jones, Christina C Wee, Kristina H Lewis, Jonathan N Tobin, Stephanie L Fitzpatrick, Jay R Desai, Sameer Murali, Ellen H Morrow, Molly B Conroy, Ann M Rogers, Jennifer L Kraschnewski, G Craig Woods, Christopher D Still, David J Schlundt, James C McClay, Corrigan L McBride, Rohit Soans, Meredith C Duke, Cynthia Blalock, Rabih Nemr, Neely Williams, Ana B Emiliano, Stavra A Xanthakos, Thomas Inge, Timothy S Carey, Marc Michalsky, Matthew F Daley, Howard S Gordon, Kirk W Reichard, Caroline M Apovian, Ali Tavakkoli, William G Adams, John H Holmes, Janelle W Coughlin, Elizabeth Nauman, Robert Wellman, R Yates Coley, Kathleen M McTigue, Karen J Coleman, Daniel B Jones, Kristina H Lewis, Jonathan N Tobin, Christina C Wee, Stephanie L Fitzpatrick, Jay R Desai, Sameer Murali, Ellen H Morrow, Ann M Rogers, G Craig Wood, David G Schlundt, Caroline M Apovian, Meredith C Duke, James C McClay, Rohit Soans, Rabih Nemr, Neely Williams, Anita Courcoulas, John H Holmes, Jane Anau, Sengwee Toh, Jessica L Sturtevant, Casie E Horgan, Andrea J Cook, David E Arterburn, PCORnet Bariatric Study Collaborative, Janelle W Coughlin, Wendy L Bennett, Elizabeth Nauman, Robert Wellman, R Yates Coley, Jane Anau, Andrea J Cook, David Arterburn, Kathleen M McTigue, Anita Courcoulas, Sengwee Toh, Jessica L Sturtevant, Casie E Horgan, Jeffrey S Brown, Karen J Coleman, Daniel B Jones, Christina C Wee, Kristina H Lewis, Jonathan N Tobin, Stephanie L Fitzpatrick, Jay R Desai, Sameer Murali, Ellen H Morrow, Molly B Conroy, Ann M Rogers, Jennifer L Kraschnewski, G Craig Woods, Christopher D Still, David J Schlundt, James C McClay, Corrigan L McBride, Rohit Soans, Meredith C Duke, Cynthia Blalock, Rabih Nemr, Neely Williams, Ana B Emiliano, Stavra A Xanthakos, Thomas Inge, Timothy S Carey, Marc Michalsky, Matthew F Daley, Howard S Gordon, Kirk W Reichard, Caroline M Apovian, Ali Tavakkoli, William G Adams, John H Holmes

Abstract

Objective: To examine whether depression status before metabolic and bariatric surgery (MBS) influenced 5-year weight loss, diabetes, and safety/utilization outcomes in the PCORnet Bariatric Study.

Summary of background data: Research on the impact of depression on MBS outcomes is inconsistent with few large, long-term studies.

Methods: Data were extracted from 23 health systems on 36,871 patients who underwent sleeve gastrectomy (SG; n=16,158) or gastric bypass (RYGB; n=20,713) from 2005-2015. Patients with and without a depression diagnosis in the year before MBS were evaluated for % total weight loss (%TWL), diabetes outcomes, and postsurgical safety/utilization (reoperations, revisions, endoscopy, hospitalizations, mortality) at 1, 3, and 5 years after MBS.

Results: 27.1% of SG and 33.0% of RYGB patients had preoperative depression, and they had more medical and psychiatric comorbidities than those without depression. At 5 years of follow-up, those with depression, versus those without depression, had slightly less %TWL after RYGB, but not after SG (between group difference = 0.42%TWL, P = 0.04). However, patients with depression had slightly larger HbA1c improvements after RYGB but not after SG (between group difference = - 0.19, P = 0.04). Baseline depression did not moderate diabetes remission or relapse, reoperations, revision, or mortality across operations; however, baseline depression did moderate the risk of endoscopy and repeat hospitalization across RYGB versus SG.

Conclusions: Patients with depression undergoing RYGB and SG had similar weight loss, diabetes, and safety/utilization outcomes to those without depression. The effects of depression were clinically small compared to the choice of operation.

Conflict of interest statement

The other authors report no conflicts of interest.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1
Figure 1
A. Estimated percentage of total weight loss through 5years after bariatric surgery for gastric bypass and sleeve gastrectomy in patients with and without depression at baseline. B. Estimated change in HbA1c level through 5 years after bariatric surgery for gastric bypass and sleeve gastrectomy patients with type 2 diabetes, with and without depression at baseline.
Figure 2
Figure 2
A. Cumulative incidence rates of T2DM remission across 5 years in the PBS diabetes cohort comparing gastric bypass and sleeve gastrectomy stratified by baseline depression status. B. Cumulative incidence rates of T2DM relapse (across 5 years in the PBS diabetes cohort comparing gastric bypass and sleeve gastrectomy stratified by baseline depression status. RYGB indicates Roux-en-Y gastric bypass;SG, sleeve gastrectomy.
Figure 3
Figure 3
Cumulative Incidence Rates of operation or Intervention (Figure A), Revision (Figure B), Endoscopy (Figure C), Hospitalization (Figure D) and Mortality (Figure E). RYGB indicates Roux-en-Y gastric bypass;SG, sleeve gastrectomy; Depr = Depression.

References

    1. Pareek M, Schauer PR, Kaplan LM, et al. . Metabolic surgery: weight loss, diabetes, and beyond. J Am Coll Cardiol. 2018;71:670–687.
    1. Ahmed B, King WC, Gourash W, et al. . Long-term weight change and health outcomes for sleeve gastrectomy (SG) and matched Roux-en-Y gastric bypass (RYGB) participants in the Longitudinal Assessment of Bariatric Surgery (LABS) study. Surgery. 2018;164:774–783.
    1. Schauer PR, Bhatt DL, Kirwan JP, et al. . Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376:641–651.
    1. Welbourn R, Hollyman M, Kinsman R, et al. . Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO Global registry report 2018. Obes Surg. 2019;29:782–795.
    1. O’Brien PE, Hindle A, Brennan L, et al. . Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg. 2019;29:3–14.
    1. Courcoulas AP, King WC, Belle SH, et al. . Seven-year weight trajectories and health outcomes in the longitudinal assessment of bariatric surgery (LABS) study. JAMA Surg. 2018;153:427–434.
    1. Courcoulas AP, Christian NJ, Belle SH, et al. . Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310:2416–2425.
    1. Arterburn D, Wellman R, Emiliano A, et al. . Comparative effectiveness and safety of bariatric procedures for weight loss: a PCORnet cohort study. Ann Intern Med. 2018;169:741–750.
    1. McTigue KM, Wellman R, Nauman E, et al. . Comparing the 5-year diabetes outcomes of sleeve gastrectomy and gastric bypass: the national patientcentered clinical research network (PCORNet) bariatric study. JAMA Surg. 2020;155:e200087.
    1. Kalarchian MA, Marcus MD, Levine MD, et al. . Relationship of psychiatric disorders to 6-month outcomes after gastric bypass. Surg Obes Relat Dis. 2008;4:544–549.
    1. Pedro J, Neves JS, Ferreira MJ, et al. . Impact of depression on weight variation after bariatric surgery: a three-year observational study. Obesity facts. 2020;13:213–220.
    1. de Zwaan M, Enderle J, Wagner S, et al. . Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Disord. 2011;133:61–68.
    1. White MA, Kalarchian MA, Levine MD, et al. . Prognostic significance of depressive symptoms on weight loss and psychosocial outcomes following gastric bypass surgery: a prospective 24-month follow-up study. Obes Surg. 2015;25:1909–1916.
    1. Sheets CS, Peat CM, Berg KC, et al. . Post-operative psychosocial predictors of outcome in bariatric surgery. Obes Surg. 2015;25:330–345.
    1. Smith CE, Hawkins MAW, Williams-Kerver GA, et al. . Depression subtypes, binge eating, and weight loss in bariatric surgery candidates. Surg Obes Relat Dis. 2020;16:690–697.
    1. Kalarchian MA, King WC, Devlin MJ, et al. . Psychiatric disorders and weight change in a prospective study of bariatric surgery patients: a 3-year follow-up. Psychosom Med. 2016;78:373–381.
    1. Mitchell JE, Selzer F, Kalarchian MA, et al. . Psychopathology before surgery in the longitudinal assessment of bariatric surgery-3 (LABS-3) psychosocial study. Surg Obes Relat Dis. 2012;8:533–541.
    1. Courcoulas A, Coley RY, Clark JM, et al. . Interventions and operations 5 years after bariatric surgery in a cohort from the US National Patient-Centered Clinical Research Network Bariatric Study. JAMA Surg. 2020;155:194–204.
    1. Toh S, Rasmussen-Torvik LJ, Harmata EE, et al. . The national patient-centered clinical research network (PCORnet) bariatric study cohort: rationale, methods, and baseline characteristics. JMIR Res Protoc. 2017;6:e222.
    1. Forrest CB, McTigue KM, Hernandez AF, et al. . PCORnet® 2020: current state, accomplishments, and future directions. J Clin Epidemiol. 2021;129:60–67.
    1. Fleurence RL, Curtis LH, Califf RM, et al. . Launching PCORnet, a national patientcentered clinical research network. J Am Med Inform Assoc. 2014;21:578–582.
    1. Qualls LG, Phillips TA, Hammill BG, et al. . Evaluating foundational data quality in the National Patient-Centered Clinical Research Network (PCOR-net®). EGEMS (Washington DC). 2018;6:3.
    1. Gagne F, Glynn RJ, Avorn J, et al. . A combined comorbidity score predicted mortality in elderly patients better than existing scores. J Clin Epidemiol. 2011;64:749–759.
    1. Fiest KM, Jette N, Quan H, et al. . Systematic review and assessment of validated case definitions for depression in administrative data. BMC Psychiatry. 2014;14:289.
    1. Sogg S, Lauretti J, West-Smith L. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis. 2016;12:731–749.
    1. Brethauer SA, Kim J, el Chaar M, et al. , ASMBS Clinical Issues Committee. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11:489–506.
    1. Flum DR, Belle SH, King WC, et al. . Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445–454.
    1. Laird NM, Ware JH. Random-effects models for longitudinal data. Biometrics. 1982;38:963–974.
    1. Chambers JM, Hastie TJ. (Ed.). Statistical Models in S (1st ed.). First ed: Routledge; 1992. .
    1. Efron B. The efficiency of cox’s likelihood function for censored data. J Am Stat Ass. 1977;72:557–565.
    1. Dawes AJ, Maggard-Gibbons M, Maher AR, et al. . Mental health conditions among patients seeking and undergoing bariatric surgery: a meta-analysis. JAMA. 2016;315:150–163.
    1. Legenbauer T, De Zwaan M, Benecke A, et al. . Depression and anxiety: their predictive function for weight loss in obese individuals. Obesity facts. 2009;2:227–234.
    1. Fisher D, Coleman KJ, Arterburn DE, et al. . Mental illness in bariatric surgery: a cohort study from the PORTAL network. Obesity (Silver Spring). 2017;25:850–856.
    1. Mitchell JE, King WC, Chen JY, et al. . Course of depressive symptoms and treatment in the longitudinal assessment of bariatric surgery (LABS-2) study. Obesity (Silver Spring). 2014;22:1799–1806.
    1. Smith KE, Mason TB, Cao L, et al. . Trajectories of depressive symptoms and relationships with weight loss in the seven years after bariatric surgery. Obes Res Clin Pract. 2020;14:456–461.
    1. Brethauer SA, Kothari S, Sudan R, et al. . Systematic review on reoperative bariatric surgery: American Society for Metabolic and Bariatric Surgery Revision Task Force. Surg Obes Relat Dis. 2014;10:952–972.
    1. Altieri MS, Yang J, Nie L, et al. . Rate of revisions or conversion after bariatric surgery over 10 years in the state of New York. Surg Obes Relat Dis. 2018;14:500–507.
    1. Kalarchian MA, Marcus MD. Psychosocial concerns following bariatric surgery: current status. Curr Obes Rep. 2019;8:1–9.
    1. Brode CS, Mitchell JE. Problematic eating behaviors and eating disorders associated with bariatric surgery. Psychiatr Clin North Am. 2019;42:287–297.

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