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. 2023 Apr 1;277(4):637-646.
doi: 10.1097/SLA.0000000000005364. Epub 2022 Jan 19.

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

Janelle W Coughlin  1 , Elizabeth Nauman  2 , Robert Wellman  3 , R Yates Coley  3 , Kathleen M McTigue  4 , Karen J Coleman  5 , Daniel B Jones  6 , Kristina H Lewis  7 , Jonathan N Tobin  8 , Christina C Wee  6 , Stephanie L Fitzpatrick  9 , Jay R Desai  10 , Sameer Murali  11 , Ellen H Morrow  12 , Ann M Rogers  13 , G Craig Wood  14 , David G Schlundt  15 , Caroline M Apovian  16 , Meredith C Duke  17 , James C McClay  18 , Rohit Soans  19 , Rabih Nemr  20 , Neely Williams  21 , Anita Courcoulas  22 , John H Holmes  23 , Jane Anau  2 , Sengwee Toh  24 , Jessica L Sturtevant  24 , Casie E Horgan  24 , Andrea J Cook  3 , David E Arterburn  3 ; PCORnet Bariatric Study Collaborative
Collaborators, Affiliations

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

Janelle W Coughlin et al. Ann Surg. .

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.

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Conflict of interest statement

The other authors report no conflicts of interest.

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.
See this image and copyright information in PMC

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