Bariatric surgery associated with long-term improvements in pain, physical function and work productivity

Improvements in pain, physical function, and work productivity largely last for at least seven years after bariatric surgery, despite some setback from the high levels of improvement seen in the years immediately following surgery , report today epidemiologists at the University of Pittsburgh in JAMA network open.

The results – which show that the improvements persist even as participants age over the course of the study – may help inform doctors, health insurance providers and patients, many of whom undergo surgery to relieve joint pain. and improve mobility.

Adults with severe obesity are much more likely to experience significant joint pain and limitations to their physical abilities. Obesity leads to an earlier need for knee and hip replacement. However, adults with severe obesity may be denied joint surgery until they lose weight. And, if physical limitations and pain interfere with work performance, weight loss may be necessary to maintain employment.”

Wendy C. King, Ph.D., Associate Professor of Epidemiology, Pitt’s School of Public Health

For seven years, King and his colleagues followed 1,491 adults who, between 2006 and 2009, underwent either Roux-en-Y gastric bypass or sleeve gastrectomy, the two most common and effective surgical treatments. against severe obesity. At the time of surgery, study participants had a median age of 47 years and 80% were female.

Participants were enrolled in the National Institutes of Health-funded Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a prospective cohort study of US patients undergoing weight loss surgery.

The new research builds on a previous study by King and colleagues who found that within three years of bariatric surgery, 50-70% of study participants reported clinically important improvements in pain levels, physical function and usual walking speed.

“At the time, this research provided the largest and longest-running assessment of changes in pain and physical function after modern bariatric procedures,” King said. “Our new study more than doubles that time, giving patients and doctors a better understanding of the likelihood that bariatric surgery will yield lasting results.”

In their updated analysis, the researchers found that at seven years postoperatively, 43% of participants had clinically significant improvements in pain, 64% in physical function and 50% in 400-meter walking time. , all down 7 to 11 percentage points. of the three-year evaluation.

Among participants with symptoms indicative of osteoarthritis before undergoing bariatric surgery, seven years after surgery, 65% reported improvement in hip pain, while 72% reported improvement in knee function, versus 77% three years after surgery.

The small to moderate decreases in pain and improvements in physical function are not surprising, given that the participants also aged during the study to a median of 54 years, King said. Previous research shows that some aspects of physical function, such as balance and strength, begin to decline when people reach their 50s, and others, such as walking speed and aerobic endurance, typically decline. during the sixth decade of life.

“On average, participants experienced sustained improvements in walking speed, fitness, and nearly all measures of pain,” King said.

Additionally, participants reported that pain and health status interfered less with their ability to work post-surgery, with 43% of participants reporting work difficulties due to their condition seven years after surgery. operation, compared to 63% before the operation.

“Combined, our study provides great news about the lasting effects of bariatric surgery,” King said. “But clinicians should view patients as individuals and consider their full medical history, goals, and motivations for weight loss when providing preoperative counseling about potential outcomes.”

The other authors of this research are Amanda S. Hinerman, Ph.D., and Gretchen E. White, Ph.D., both of Pitt.

No funding was provided for this specific analysis, but LABS-2 was funded through a cooperative agreement by the National Institute of Diabetes and Digestive and Kidney Diseases.

Source:

Journal reference:

King, WC, et al. (2022) A 7-year study of the durability of improvements in pain, physical function, and work productivity after Roux-en-Y gastric bypass surgery and sleeve gastrectomy. JAMA network open. doi.org/10.1001/jamanetworkopen.2022.31593.

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