Livskvalitet etter fedmekirurgi

Abstract

Background: Severe obesity is a chronic condition associated with a range of comorbidities and reduced quality of life. The only treatment documented to provide sustained weight loss in patients with severe obesity is bariatric surgery. Biliopancreatic diversion with duodenal switch (BPDDS) is the surgery that leads to the greatest weight loss. However, long-term data on quality of life after BPDDS are scarce. Aims: The primary aim of this thesis was to evaluate changes in quality of life from baseline to ten-year follow-up in patients who had undergone BPDDS. A secondary aim was to translate the Obesity-Related Problems Scale (OP), an obesity-specific measure of quality of life, into the Norwegian language and test its reliability, validity and responsiveness in a Norwegian sample. Methods: The sample consisted of 50 patients with severe obesity (mean BMI 51.7, ± 7.5) who underwent BPDDS in a prospective cohort study. Patients were included consecutively from 2001 to 2004. Their mean age was 37.8 (± 8.1), and 27 (54 %) of the patients were women. The inclusion criteria for this surgery were as follows: age between 18 and 60 years, body mass index (BMI) ≥ 40.0 or 35.0-39.9 with obesity- related comorbidities, no alcohol or drug problems, no active psychosis and previous failure to lose weight through other methods. Quality of life was measured with self- reported questionnaires (Short Form-36, OP, Cantril Ladder) before surgery and after one, two, five, and ten years. Data on symptoms of anxiety and depression were also collected from baseline to the five-year follow-up. For the primary aim, the main outcome was ten-year follow-up scores on the physical component summary (PCS) and the mental component summary (MCS) of the SF-36. We used linear mixed- effect models based on restricted maximum likelihood estimation with random intercept for patients to estimate changes over time. The SF-36 scores of the sample were compared with a Norwegian population norm, adjusted for age, gender and BMI. For the secondary aim, the OP questionnaire was translated from the original language (Swedish) into Norwegian. We included patients with severe obesity (mean BMI 45 ± 6.9, mean age 43.1 ± 12.5 years) who were accepted for Sleeve Gastrectomy. Baseline analyses were based on 181 patients (123 women), and follow-up analyses at one year were based on 130 patients. Internal consistency was evaluated using Cronbach’s α. Construct validity was tested by correlating the OP with the Cantril Ladder and the SF-36 using the Pearson correlation coefficient. We used exploratory and confirmatory factor analyses to test the unidimensionality of the OP. Paired sample t-tests were used to test the responsiveness of the OP by assessing changes in the OP from baseline to one-year follow-up. Written informed consent was obtained from the participants and ethical approval was obtained from the Regional Committee for Medical and Health Research Ethics for Western Norway (registration number 234.03 and 2009/2174). Results: Thirty-five patients completed the ten-year follow-up after BPDDS. We found no significant differences in demographic characteristics, BMI, or SF-36 scores at baseline or at five-year follow-up between those who submitted ten-year SF-36 data and those who did not. The mean BMI at ten years was 34.3 (95 % CI, 32.4, 36.2), the mean percent excess body mass index loss was 66.2 % (± 22.2) and the average percent total weight loss was 33.4 % (± 11.3) at ten-year follow-up. The PCS score improved significantly from 32.6 (95 % CI, 29.7, 35.5) at baseline to 44.2 (95 % CI, 40.9, 47.5) at the ten-year follow-up (p&lt 0.001). MCS also improved significantly from 37.8 (95 % CI, 34.2, 41.3) at baseline 46.0 (95 % CI, 41.9, 50.0) at the ten-year follow-up (p&lt 0.001). However, the scores were significantly lower than the normative data ten years after surgery. A total of 130 patients completed the OP at one-year follow-up after sleeve gastrectomy. Internal consistency was high at baseline (Cronbach’s α 0.91). Exploratory and confirmatory factor analyses identified a single factor which explained 62.2 percent of the variance. Correlations between OP at baseline, Cantril Ladder, SF-36 and BMI were statistically significant and in the predicted direction to support validity of the Norwegian version of the OP. After one year, correlations between the change in OP and the change in Cantril Ladder, SF-36 scores and BMI were also statistically significant, except for the change in Role Physical Scale. The OP showed greater responsiveness than either the Cantril Ladder or SF-36. Conclusion: Ten years after BPDDS the patients’ quality of life was significantly improved from preoperative values, with approximately 60 % of the improvements having been maintained from the one-year follow-up. Given the scarcity of long-term studies of quality of life after bariatric surgery, especially those studying BPDDS, further studies should be performed to confirm these findings. In addition, this Norwegian version of the OP is a valid and reliable instrument for measuring psychosocial functioning in a sample with clinically severe obesity.