Abandono de la terapia nutricional y pérdida de peso en pacientes bariátricos: cohorte retrospectiva en Lima, Perú
2017
Giacchetti-Vega, Monica | Baquerizo-vonBerswordts, Pamela | Carbone-Moane, Camila | Bernabé-Ortiz, Antonio
English. ABSTRACT Introduction: The aims of this study were to determine the proportion of patients who meet international recommendations for bariatric surgery and to assess the association between weight loss and dropout rate during diet therapy. Material and Methods: Retrospective cohort study performed using data from clinical records of patients who underwent sleeve gastrectomy in a private clinic of Lima, Peru. Two outcomes were evaluated, eligibility for bariatric surgery according to international recommendations (BMI≥40kg/m2 or ≥35kg/m2 with comorbidities) and abandonment before and after starting nutritional management (no nutritional assessment after 60 days from the previous visit without achieving ideal BMI). The exposure was the percentage of weight lost in the first five weeks after surgery split into <10% and ≥10%. Poisson regression was used and relative risks and 95% confidence intervals (95%CI) were calculated. Results: Data from 423 medical records of bariatric patients, mean age 39.2 years (±12.3), 294 (69.5%) women, were analyzed. Only 117 (27.7%) patients met international recommendations for bariatric surgery. Before starting nutritional management, 48/117 (41%) abandoned treatment, whereas an additional 29/69 (42.0%) abandoned before six months of nutritional management. Patient losing ≥10% of weight in the first month had 90% lower risk (RR=0.10; 95%CI:0.01-0.68) of nutritional therapy dropout compared to those who lost <10% of weight, controlling for sex and age. Conclusions: A great proportion of patients undergoing bariatric surgery did not meet the international criteria. A greater loss of weight during the first month was associated a lower dropout rate during nutritional therapy.
Show more [+] Less [-]Spanish; Castilian. RESUMEN Introducción: El objetivo de este trabajo fue determinar la proporcion de pacientes que cumplen criterios internacionales de gastrectomia en manga, asi como estimar la asociacion entre porcentaje de perdida de peso con tasa de abandono del tratamiento nutricional. Material y Métodos: Cohorte retrospectiva realizada con historias clinicas de pacientes con gastrectomia en manga entre 2008-2014 en una clinica privada. Hubo dos variables resultado de interes: los criterios de inclusion para cirugia bariatrica segun criterios internacionales (IMC≥40kg/m2 o ≥35kg/m2 con comorbilidades) y el abandono antes o durante (inasistencia ≥60 dias desde la consulta previa sin recibir alta [IMC<25]) del tratamiento nutricional. La exposicion fue el porcentaje de peso perdido en las primeras cinco semanas despues de la cirugia (<10% vs. ≥10%). Se utilizaron modelos de regresion de Poisson. Se calcularon riesgos relativos e intervalos de confianza al 95% (IC95%). Resultados: La muestra incluyo 423 historias clinicas, 294 (69,5%) mujeres, edad media 39,2 (±12,3) anos. 117 (27,7%) cumplieron requisitos para cirugia y 48 de esos 117 (41%) abandonaron el tratamiento nutricional antes de iniciarlo. Los pacientes que perdieron ≥10% de peso en el primer mes tuvieron un 90% menos de riesgo de abandonar la terapia nutricional que los que perdieron <10% del peso (RR=0,10; IC95%:0,01-0,68), ajustando por sexo y edad. Conclusiones: La mayoria de pacientes bariatricos no cumple los requisitos internacionales. Una mayor perdida de peso en el primer mes se asocio a un menor abandono del tratamiento nutricional.
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