Pain, disability improvements endure 7 years after bariatric surgery
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Two-thirds of patients who underwent Roux-en-Y gastric bypass and sleeve gastrectomy experienced clinically important improvements in pain and physical function 7 years after surgery, according to research published in JAMA Network Open.
“Previous studies had provided evidence that bariatric surgical procedures are associated with improvements in pain, physical function and work productivity. However, most prior studies only followed participants 1 to 2 years, at which point participants were at the peak of their weight loss,” Wendy C. King, PhD, associate professor of epidemiology at the University of Pittsburgh, told Healio. “Among a large cohort of U.S. adults, we wanted to evaluate how much initial improvements in pain, physical function and work productivity declined during long-term follow-up, when some degree of weight regain is not uncommon.”
King and colleagues limited their study to adults who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG), the two most common bariatric surgical procedures done today, according to King. They analyzed 1,491 patients (80% women) with severe obesity (BMI ≥ 35) who underwent first-time bariatric surgery and were part of the multicenter Longitudinal Assessment for Bariatric Surgery-2 (LABS-2) cohort study.
Researchers assessed preoperative to postoperative clinically important improvements (CIIs) in bodily and joint-specific pain, physical function and work productivity among participants, focusing on changes between 3 and 7 years after surgery and beyond. They used the 36-item Short Form Health Survey and Western Ontario McMaster Osteoarthritis Index as well as 400-meter walk time.
According to results, the preoperative median age of participants was 47 years, and the preoperative BMI was 47. Researchers further reported that 43% of patients had a mobility deficit, 42% had symptoms indicative of osteoarthritis of the knee and 32% had symptoms indicative of osteoarthritis of the hip.
From 3 to 7 years after the surgical procedure, the percentage of participants with CIIs in pain decreased from 50% (95% CI, 48-53) to 43% (95% CI, 40-46), in physical function from 75% (95% CI, 73-77) to 64% (95% CI, 61-68) and in 400-meter walk time from 61% (95% CI, 56-65) to 50% (95% CI, 45-55).
Researchers also reported that although absenteeism, or missed work due to health, initially decreased after surgery, it rose by year 3 and at year 7 was not better than before surgery. Presenteeism, or impaired work due to health, increased in the 3 to 7 years following surgery but remained lower than preoperative values.
“Declines in pre- to postoperative improvements across follow-up were relatively small. As a result, clinically important improvements in bodily and joint-specific pain and physical function were common 7 years after undergoing RYGB or SG,” King added. “Additionally, work presenteeism decreased. These results are particularly impressive considering the cohort aged 7 years across follow-up, such that many of them were in age groups in which declines in these measures are common.”
Among patients with a preoperative mobility deficit, remission decreased from 50% (95% CI, 42-57) to 41% (95% CI, 32-49), according to results. This decrease was also evident among patients with severe pain or disability affecting the hip (77% [95% CI, 72-82] to 65% [95% CI, 58-72]) or knee (77% [95% CI, 73-82] to 72% [95% CI, 67-77]).
“While this study provides strong evidence for the beneficial effects of RYGB and SG on pain and physical function, it also demonstrates that not all patients maintain clinically important improvements over long-term follow-up,” King concluded. “Some postoperative patients likely experience levels of pain and disability that affect their quality of life and interfere with adopting or maintaining an active lifestyle, especially as time from surgery increases.
“Thus, there is a need to test and identify effective interventions for postoperative patients who require additional interventions to improve pain and physical function outcomes.”
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