Psychosocial Effects of Complications After Bariatric Surgery

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Psychosocial Effects of Complications After Bariatric Surgery

More than one-third of American adults and one-quarter of Canadian adults are clinically obese (body mass index ≥ 30 kg/m). And their numbers are rising. According to the World Health Organization, the worldwide prevalence of obesity nearly tripled between 1975 and 2016.

This upward trend is a serious health concern, as excessive body fat increases the risk of developing numerous medical conditions, such as type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular disease, osteoarthritis, and some malignancies.

Furthermore, patients who are clinically obese often suffer from significant psychosocial burdens including social stigma, low self-esteem, and mental illnesses, such as depression and anxiety.

Bariatric surgery has been shown to be an effective weight-loss intervention that results in sustained weight loss, improvement in obesity-related comorbidities, and positive psychosocial outcomes. However, bariatric procedures come with risks—surgical complications are not uncommon.

“The long-term effects of postoperative complications on patients’ psychosocial functioning is not well understood.”

A study by Karen Ho, BA, Raed Hawa, MD, Susan Wnuk, PhD, Allan Okrainec, MD, MHPE, Timothy Jackson, MD, MPH, and Sanjeev Sockalingam, MD, FACLP, MHPE, described in the September-October issue of Psychosomatics, aims to better understand the effect of postoperative complications from bariatric surgery on patients’ psychosocial well-being.

Core findings

As has been found in previous research, patients who experience complications after bariatric surgery do, nevertheless, show significant improvement in most psychosocial outcomes, say the researchers.

But complications can hinder improvements in the psychosocial well-being and quality of life patients might expect when pursuing the surgery at the outset.

Moreover, “the long-term effects of postoperative complications on patients’ psychosocial functioning is not well understood,” say the researchers.

Obesity, depression, and anxiety often coexist in the bariatric population. Obese patients who undergo bariatric surgery show higher depression and anxiety scores, and poorer health-related quality of life, compared to those pursuing non-surgical weight loss treatments.

In this study, different types of complications were observed in the early and late postoperative stages. Early complications most frequently involved gastrointestinal bleeds, bowel obstructions, and infections. The most common late complication was the development of ulcers.

Relevance of timing

Previous studies have described a “honeymoon phase” after bariatric surgery, during which dramatic improvement is observed in the first year post-surgery, followed by a relapse.

This pattern, of initial improvement and subsequent deterioration, has been noted in a significant number of bariatric surgery outcomes. Deterioration outcomes include unplanned weight loss, depression, anxiety, and reduced quality of life.

Burgmer et al1 postulated that once the excitement of the initial rapid weight loss wears off, issues unrelated to obesity become more relevant and can have a negative effect on patients’ mental quality of life.

Some studies have also found short-term improvements in quality of life that exceed levels of healthy controls and have attributed these to the patients’ need to reassure themselves that they have made the right decision to pursue surgery.

It may be that when a patient undergoing bariatric surgery experiences a postoperative complication, daily challenges and hassles can set in sooner and there may not be a ‘honeymoon phase’,” researchers say.

But, in this latest study, the timing of complications, early or late, was not found to be significant in terms of the key intended outcome—weight loss: “Timing of the complications did not affect the magnitude of weight loss.”

This study instead focuses more on its key conclusion: that complications following bariatric surgery can hinder improvements in patient’s psychological well-being and quality of life. “Bariatric centers should provide more support for patients who have experienced complications,” say the researchers.

Psychosomatics journal cover

The full paper, “The Psychosocial Effects of Perioperative Complications After Bariatric Surgery”, published in Psychosomatics, is here.

The statistics

  • Of the 365 patients in the research, the complications rate was 15.3%.
  • 31 of them (8.5%) experienced complications within 30 days of surgery.
  • 25 (6.8%) experienced late complications.
  • All patients achieved significant weight loss at 1-year postoperatively.
  • Patients with uncomplicated recoveries showed significant improvement in depression (P < 0.001), anxiety (P < 0.001), mental QOL (P < 0.001), and physical QOL (P <0.001) at 1-year post-surgery.
  • Patients who experienced postoperative complications showed significant improvement in depression (P < 0.001), anxiety (P = 0.04) and physical QOL (P < 0.001), but not in mental QOL (P = 0.210).
  • Despite improved psychosocial outcomes from baseline, patients experiencing complications showed higher postoperative depression scores (P < 0.01) and lower physical QOL (P < 0.01) than patients without complication.
  • Comparison between those with early and late complications did not show significant difference in outcomes.

1 Burgmer R, Legenbauer T, Müller A, de Zwaan M, Fischer C, Herpertz S: Psychological outcome 4 years after restrictive bariatric surgery. Obes Surg 2014; 24(10):1670–1678

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