title: Evaluation of the Association Between Preoperative Clinical Factors and Long-term Weight Loss After Roux-en-Y Gastric Bypass.
abstract: Weight loss after bariatric surgery varies, yet preoperative clinical factors associated with long-term suboptimal outcomes are not well understood.
  
  
  
  To evaluate the association between preoperative clinical factors and long-term weight loss after Roux-en-Y gastric bypass (RYGB).
  
  
  
  From June 2001 to September 2007, this retrospective cohort study followed up RYGB patients before surgery to 7 to 12 years after surgery. The setting was a large rural integrated health system. Of 1033 eligible RYGB patients who consented to participate in longitudinal research and completed surgery before October 2007, a total of 726 (70.3%) had a weight entered in the electronic medical record 7 or more years after surgery and were included in the analyses after exclusions for pregnancy and mortality. Date of the long-term weight measurement was recorded between August 2010 and January 2016.
  
  
  
  The primary outcome was percentage weight loss (%WL) at 7 to 12 years after surgery. Preoperative clinical factors (>200) extracted from the electronic medical record included medications, comorbidities, laboratory test results, and demographics, among others.
  
  
  
  Among the 726 study participants, 83.1% (n = 603) were female and 97.4% (n = 707) were of white race, with a mean (SD) preoperative body mass index (calculated as weight in kilograms divided by height in meters squared) of 47.5 (7.4). From the time of surgery to long-term follow-up (median, 9.3 postoperative years), the mean (SD) %WL was 22.5% (13.1%). Preoperative insulin use, history of smoking, and use of 12 or more medications before surgery were associated with greater long-term postoperative %WL (6.8%, 2.8%, and 3.1%, respectively). Preoperative hyperlipidemia, older age, and higher body mass index were associated with poorer long-term postoperative %WL (-2.8%, -8.8%, and -4.1%, respectively).
  
  
  
  Few preoperative clinical factors associated with long-term weight loss after RYGB were identified. Preoperative insulin use was strongly associated with better long-term %WL, while preoperative hyperlipidemia, higher body mass index, and older age were associated with poorer %WL. Our findings provide additional insight into preoperative identification of RYGB patients at higher risk for long-term suboptimal outcomes.
authors.affiliation: Geisinger Obesity Institute, Geisinger Clinic, Danville, Pennsylvania.
authors.forename: G Craig
authors.initials: GC
authors.lastname: Wood
authors.affiliation: Geisinger Obesity Institute, Geisinger Clinic, Danville, Pennsylvania.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Benotti
authors.affiliation: Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland.
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Lee
authors.affiliation: Geisinger Obesity Institute, Geisinger Clinic, Danville, Pennsylvania.
authors.forename: Tooraj
authors.initials: T
authors.lastname: Mirshahi
authors.affiliation: Geisinger Obesity Institute, Geisinger Clinic, Danville, Pennsylvania.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Still
authors.affiliation: Department of Medical Genetics and Molecular Biochemistry, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Gerhard
authors.affiliation: Geisinger Obesity Institute, Geisinger Clinic, Danville, Pennsylvania.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Lent
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000601:surgery*; D057234:Preoperative Period; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology*; D013997:Time Factors; D015431:Weight Loss; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin