17.09 Readmission Following Laparoscopic Bariatric Surgery Using the MBSAQIP Database

Posted on January 18, 2018

K. Feng1, J. S. Richman1, B. L. Corey1, R. D. Stahl1, J. M. Grams1  1University Of Alabama at Birmingham,Division Of Gastrointestinal Surgery/Department Of Surgery,Birmingham, Alabama, USA

Introduction: Laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most common bariatric operations. As both have low reported morbidity and mortality rates, readmission rates are increasingly utilized as a measure of quality. Identifying patients at risk will allow for targeted interventions to decrease readmissions. The purpose of this study was to evaluate national readmission rates and the associated risk factors related to RYGB and SG.

Methods:  Data from patients undergoing SG or RYGB were identified from the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. Chi-square test and logistic regression were used to examine patient characteristics and 30-day readmission rates. Patients were also stratified by bariatric procedure. 

Results: A total of 144,459 patients were included RYGB (30.44%) and SG (69.56%). The overall 30-day readmission rate was 3.45% (n=4,991). SG patients had a lower readmission rate compared to RYGB (2.73% vs. 5.10%; p<0.001). The most common causes of readmission were nausea, vomiting, or dehydration (RYGB 26.83%, SG 32.32%); and abdominal pain (RYGB 14.55%, SG 11.71%). Unadjusted analyses showed that readmitted patients had higher body mass index (BMI), longer operation times, and more often had length of stay (LOS) >4 days (all p< 0.001). When stratified by operation, readmitted SG patients were more likely to have hypertension, hyperlipidemia, obstructive sleep apnea, and diabetes, while readmitted RYGB patients had longer operation time and more post-operative complications (all p< 0.001). Adjusted analyses (Table 1) showed that factors associated with readmission for both procedures included being African-American (SG OR=1.46, RYGB OR=1.24), LOS>4 (SG OR=3.63, RYGB OR=2.09), postoperative inpatient complications (SG OR=23.03, RYGB OR=9.21), all p<0.001. 

Conclusion: Readmission after bariatric surgery was associated with race, BMI, diabetes, LOS, and inpatient postoperative complications. Further studies should focus on understanding these risk factors to reduce readmission rates. 
 

17.08 Tipping the Scales: Results of Bariatric Surgery by Socioeconomic Status in Black Patients

Posted on January 18, 2018

S. Timberline7, M. S. Pichardo6,7, G. Ortega5, M. F. Nunez8, E. S. Bauer5, E. Smith7, J. Tordecilla7, T. M. Fullum10, D. D. Tran10  5Howard University College Of Medicine,Clive O. Callender Howard-Harvard Health Sciences Outcomes Research Center,Washington, DC, USA 6Yale University,New Haven, CT, USA 7Howard University College Of Medicine,Washington, DC, USA 8Howard University College Of Medicine,Department Of Medicine,Washington, DC, USA 10Howard University College Of Medicine,Department Of Surgery, Center For Wellness And Weight Loss Surgery,Washington, DC, USA

Introduction:
Research suggests that individuals of racial/ethnic minority groups and of low socioeconomic status (SES) experience worse outcomes after weight loss surgery compared to their White and higher SES counterparts, respectively. Our objective is to examine the association between socioeconomic characteristics and post-operative outcomes by 12 months in Black patients from a single academic center.

Methods:
A retrospective study of Black patients who underwent bariatric surgery from 2008 to 2013 was performed. Median Household Income (MHI), obtained from census-tract level neighborhood SES data, was a proxy for patients’ SES and categorized into tertiles: $42,595-$76,674, $76,969-$100,652, and $100,704-$205,980. Insurance status at time of surgery was defined as public or private insurance. Outcomes of interest included mean weight loss, body mass index (BMI) points loss, percent excess weight loss (%EWL), and resolution of comorbidities (hypertension, diabetes, hypercholesterolemia). Adjusted multivariable regression analysis was performed to assess the association between SES characteristics and the outcomes of interest.

Results:
Of 422 Black patients, most were female (82%) and had private insurance (73.9%). The mean preoperative BMI was 48.9 kg/m2. At baseline, about half of the patients had hypertension (51.1%), and one third had diabetes (34.4%) and hypercholesterolemia (28.2%). Postoperatively, there were no statistical significant differences in %EWL (β= 0.17, 95%CI= -1.95 – 2.28), mean weight loss (β= 5.37, 95%CI=-3.88 – 14.62), BMI point difference (β= 5.39, 95%CI= -13.47 – 24.24), resolution of hypertension (OR= 1.57, 95%CI= 0.88 – 2.80), diabetes (OR= 1.29, 95%CI= 0.63 – 2.62), and hypercholesterolemia (OR= 0.81, 95%CI= 0.36 – 1.81) by insurance status. Median household income categories did not statistically differ in %EWL, mean weight loss, BMI point difference, or resolution of co-morbidities (Table 1).

Conclusion:
Among Black patients who underwent bariatric surgery, median household income level and type of insurance used was not associated with a difference in weight loss or resolution co-morbidity outcomes by 12 months post-operatively.

17.07 Type of Fundoplication Is Not Associated with Persistent Dysphagia Following Antireflux Surgery

Posted on January 18, 2018

K. Vande Walle1, L. M. Funk1, Y. Xu1, J. Greenberg1, A. Shada1, A. Lidor1  1University Of Wisconsin,Department Of Surgery,Madison, WI, USA

Introduction:  Laparoscopic fundoplication is the gold standard operation for control of gastroesophageal reflux disease. It has been suggested that persistent postoperative dysphagia is increased in Nissen fundoplication compared to partial fundoplication (Toupet, Dor). We aimed to determine risk factors for persistent postoperative dysphagia, specifically examining type of fundoplication, to inform operative planning. 

Methods:  Patients experiencing gastroesophageal reflux symptoms who underwent laparoscopic Nissen, Toupet, or Dor fundoplication between January 2009 and July 2016 were identified from our single academic institutional foregut surgery database. A dysphagia score was obtained by administering a standardized quality of life survey in clinic or by telephone. Persistent dysphagia was defined as a difficulty swallowing score ≥ 1 (noticeable) on a scale from 0 (no symptoms) to 5 (incapacitating) at least one year postoperatively. Adjusted odds ratios (OR) of persistent dysphagia among those who underwent Nissen compared to partial fundoplication with 95% confidence intervals (CI) were calculated in multivariate logistic regression models. The multivariate logistic regression model was adjusted for sex, age, body mass index (BMI), and redo operation.

Results: Of 441 patients in the database who met the inclusion criteria, 255 had at least one year of follow-up (response rate = 57.8%). The median follow-up interval was 3 years. 45.1% of patients underwent Nissen fundoplication and 54.9% underwent partial fundoplication. Persistent postoperative dysphagia was present in 25.9% (n=66) of patients. On adjusted analysis, there was no statistically significant association between the type of fundoplication (Nissen vs. partial) and the likelihood of dysphagia (Table 1).

Conclusion: The likelihood of persistent dysphagia was not associated with the type of fundoplication (Nissen vs. partial). While many surgeons believe partial fundoplication decreases the risk of persistent postoperative dysphagia compared to Nissen fundoplication, our study demonstrated equivalent rates of persistent postoperative dysphagia. This suggests that in patients who are equivalent candidates for either a Nissen or partial fundoplication, Nissen fundoplication is a sound choice for an antireflux operation.
 

17.06 Pre-Operative Weight-loss on a Liver Shrink Diet Predicts Early Weight-loss after Bariatric Surgery

Posted on January 18, 2018

A. D. Jalilvand1, J. Sojka1, K. Shah1, B. J. Needleman1, S. F. Noria1  1Ohio State University,General And Gastrointestinal Surgery,Columbus, OH, USA

Introduction:  The surgical weight loss program at our institution requires patients to comply with a liver-shrink diet (LSD) 1-3 weeks prior to bariatric surgery (BS) in order to facilitate liver retraction during surgery. However, the effect of LDS-induced weight-loss on weight-loss after BS is unclear. The primary objective of this study was to examine the correlation between LSD-induced weight-loss and post-operative weight loss outcomes. Secondary objectives included identifying other factors that correlated to improved weight-loss after surgery.

Methods:  All patients who underwent primary laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (LRNYGB) between July 2014 and June 2016 were retrospectively reviewed at a single academic institution. Baseline demographic and operative data was obtained using the electronic medical record. The LSD consisted of a partial-liquid, low carbohydrate, high protein diet that utilized 4 protein shakes and 1 low carbohydrate meal/day. Percent excess body weight-loss (EBWL) was calculated for each patient on LSD (EBWL-LSD), as well as at 2, 8, and 24 weeks after BS. Student’s t-test, Mann-Whitney-U, Chi squared, and Fisher’s Exact were utilized to calculate significance. Multivariate linear regressions were conducted to determine independent predictors of weight-loss. A p-value of <0.05 was considered significant. 

Results: During the study period, 588 patients underwent primary BS, of which 57.14% had LSG and 42.86% underwent LRNYGB. Of these, 78.91% (464) were female, and the mean preoperative BMI was 48.8 ± 8.95 kg/m2. The mean time spent on the LSD was 18.21 ± 7.32 days, and median EBWL-LSD was 4.7% (1.73-7.61). Greater EBWL-LSD was observed in patients who were on the LSD for > 2 weeks (5.35% vs 3.09%, p<0.0005), and in men (median of 6.2% vs 4.23%, p=0.0001). Significant independent predictors of EBWL 2 weeks post-operatively included EBWL-LSD (p<0.0005) and male sex (p<0.0005), when adjusting for surgery type, baseline EBW, and age. Patients who achieved at least the median EBWL at 2 weeks (15.4%) had greater EBWL-LSD than those who did not (5.7% vs 4%, p<0.0005). The only significant predictor of EBWL at 2 months was 2-week EBWL (p <0.0005), when adjusting for EBWL-LSD, surgery type, and gender. At 24 weeks, significant independent predictors for EBWL included EBWL at 2 and 8 weeks (p=0.001, p<0.0005), and LRNYGB (p=0.002).

Conclusion: Greater EBWL-LSD is associated with male gender and longer duration on the LSD. EBWL-LSD was a significant independent predictor of EBWL at 2 weeks, while EBWL at 2 and 8 weeks were independent predictors for weight loss at 24 weeks. Patients who reached at least 5.7% EBWL-LSD were in the 50th percentile of EBWL at 2 weeks. This suggests that EBWL-LSD can predict optimal early weight loss outcomes after BS and be used to guide expectations both in preparation for, and after bariatric surgery. 

 

17.05 Stratification by Age Improves Accuracy of ACS Risk Calculator for Paraesophageal Hernia Repair

Posted on January 18, 2018

A. D. Jalilvand1, M. Al-Mansour1, K. A. Perry1  1Ohio State University,General And Gastrointestinal Surgery,Columbus, OH, USA

Introduction: The ACS-NSQIP Surgical Risk Calculator (ANS-RC) predicts 30-day complication rates for specific surgical procedures. The goal of this study was to assess the accuracy of the ANS-RC for predicting 30-day complication rates in a cohort of patients undergoing laparoscopic paraesophageal hernia repair (LPEHR) in a large academic medical center.

Methods: One hundred seventy-seven patients underwent primary LPEHR between 2011 and 2016 and were included in the study. Using the definitions in the ANS-RC, risk factors and 30-day post-operative complications were obtained for all patients from the electronic medical record. Predicted complication rates were calculated for each patient. Data are presented as incidence (%), mean ± SD, or median (IQ range). Comparisons between predicted and observed complication rates were made using one sample proportion or Wilcoxan paired signed rank tests. A p-value of <0.05 was considered statistically significant.

Results: During the study period, LPEHR was performed for 177 patients with a mean age of 66.2 ± 14.0 years and BMI of 30.2± 6.1 kg/m2. Seventy-three percent (n=156) were female and most patients had an ASA score of 2 (n=47, 26.6%) or 3 (n=122, 68.9%). Compared to the ANS-RC general population, this cohort had higher risks for serious complications (7.0% vs 5.7%), cardiac complication (0.4% vs 0.2%), reoperation (2.3% vs 2.1%), and readmission (6.5% vs 5.2%). Overall, the observed complication rates for any complication (13.6% vs 7.7%, p<0.01), serious complication (11.4% vs 7%, p=0.02), death (1.7% vs 0.3%, p<0.01), reoperation (6.8% vs 2.3%, p<0.01), and readmission (11.3% vs 6.5%, p<0.01) were higher than those predicted by the ANS-RC. The median hospital length of stay (LOS) was significantly shorter than predicted (2 vs 2.5, p<0.01). When stratified for patients with ASA scores of 2 or 3, the calculator more accurately predicted the observed complication rates, although reoperation (p=0.02) for ASA 2, and reoperation (p=0.04), SNF placement (p=0.03) and readmission rates (p=0.04) for ASA 3 were higher than predicted by the ANS-RC. The calculator most accurately predicted complication rates when patients were stratified by age group (<65, 65-79, 80+). Predicted values were lower than observed rates for reoperation in patients <65 (p=0.01) and 65-79 (p<0.01), readmission for patients <65 (p<0.01), and any or serious complications for patients >80 years of age (p=0.01). ANS-RC significantly overestimated LOS for patients <65 (p<0.01) and 65-79 years (p<0.01).

Conclusion: While the ANS-RC provides a useful tool for guiding preoperative discussions, this cohort comprised primarily of elderly patients with significant medical comorbidities had significantly higher than predicted complication rates compared to the general NSQIP population. However, stratifying patients by age and ASA improves the accuracy of the ANS-RC for LPEHR.

17.04 National evaluation of adherence to quality measures in esophageal cancer

Posted on January 18, 2018

A. Adhia1, J. Feinglass1, K. Engelhardt1, M. DeCamp1, D. Odell1  1Northwestern University,Chicago, IL, USA

Introduction: Esophageal cancer is the leading cause of death among GI malignancies and the incidence of the disease is rising faster than any other solid organ tumor. Patients frequently present with locally advanced disease (stage III), contributing to challenges in treatment decision making.  Our objective was to assess adherence to four novel quality measures in patients with stage III esophageal cancer.

Methods:  18,555 patients diagnosed with stage III esophageal cancer were identified from the National Cancer Database (NCDB) between 2004 and 2014.  Four quality measures were defined from NCCN guidelines: administration of induction therapy, >15 lymph nodes sampled at resection, surgery within 120 days of neoadjuvant treatment, and R0 resection.  The association of patient demographic and treatment variables (age, sex, location of lesion, histology, income, education, race and ethnicity and year of diagnosis) with measure adherence was assessed using logistic regression. Risk of all-cause mortality was assessed comparing adherent and non-adherent cases using Cox modeling.  Kaplan-Meier survival estimates of groups that adhered to none, one of four, two of four etc. quality measures were performed.

Results: Adherence was high for three of the quality measures: neoadjuvant treatment (92.7%), timing of surgery (82.5%) and completeness of resection (91.5%).  However, nodal evaluation was adequate in only a minority of patients (20.0%). Advanced age, Medicaid insurance status, lower level of education and Black or Hispanic ethnicity were all associated with statistically significant increased odds of non-adherence for all measures.  Adherence improved in the more recent time period, with cases after 2008 having improved adherence in administration of induction therapy (OR = 2.58 in 2012-2014 period) and adequate nodal staging (OR = 2.49 in 2012-2014).  Achieving adherence was associated with a statistically significant decrease in all-cause mortality for administration of induction therapy (HR = 0.70 [0.62, 0.78]), nodal staging (HR = 0.67 [0.63, 0.70]), and R0 resection (HR = 0.48 [0.43, 0.53]), but not for timing of surgery (HR = 0.93 [0.85, 1.02]).  Survival improved as the number of quality measures an individual patient adhered to increased (Figure).

Conclusion: Adherence to quality measures in the care of patients with stage III esophageal cancer is associated with improved survival.  Understanding variability in measure adherence may identify potential targets for cancer quality improvement initiatives.

17.03 Discrepancies Between Physician and Midlevel Provider Attitudes on Bariatric Surgery

Posted on January 18, 2018

S. M. Wrenn1, V. Shah1, P. W. Callas1, W. Abu-Jaish1  1University Of Vermont College Of Medicine / Fletcher Allen Health Care,Burlington, VT, USA

Introduction: Bariatric surgery (BS) remains a mainstay of treatment for severe obesity and/or diabetes mellitus. Referral for BS is predominantly dictated by primary care practitioners consisting of physicians and midlevel providers. Provider perceptions and knowledge related to these procedures influences treatment decisions, surgical volume, and ultimately patient outcomes.

 

Methods: We constructed a novel electronic survey and dispersed it to all physician and midlevel providers (n=1169) at a single academic medical center and its affiliated external sites.  Responders were queried for demographic information, baseline perception regarding BS, and given the option to view short informational surgical videos on four procedures (sleeve gastrectomy, roux-en-y gastric bypass, laparoscopic gastric band, and duodenal switch). Their perceptions were reassessed following the viewing of these videos. Responses were given on a Likert scale (1=very positive/very likely, 5=very negative/very unlikely) or multiple-choice response. Statistical analysis was performed with two sample t-test and Fisher’s exact test. Multivariate analysis adjusted for gender, specialty (primary care vs. specialist), practice, and education level (MD/DO vs. midlevel).

 

Results: Total respondents (n) included 114 physicians and 26 midlevel providers (12% response rate). Midlevel providers preferred weight loss medication (mean 3.3 vs 2.6, p =.005) for the treatment of diabetes and were less likely to recommend a randomized trial of weight loss surgery (mean 2.1 vs. 1.6, p=0.003). Midlevel providers also had a less favorable opinion overall of BS than physicians (mean likert scale response 2.4 vs. 1.9, p=0.003), including its ability to treat diabetes mellitus (mean 2.4 vs 2.0, p=0.02). Midlevel providers believed there was an increased likelihood of death from all 4 surgeries. Providers who watched an educational video on sleeve gastrectomy trended towards more likely to recommend the procedure (p=.07) than those who had not. After adjustment, there was no difference between genders or between specialists and generalists. After reviewing the educational material, 60% of all providers stated they had a more favorable opinion of BS and midlevel providers were just as likely to recommend BS (1.7 vs. 1.9, p=0.26).

 

Conclusions: Midlevel providers overall had significantly more negative perceptions of BS than physicians and perceived it to be of higher risk. This was at least partially alleviated by viewing educational videos.  More continued educational interventions geared toward primary care practitioners, particularly midlevel providers, may improve perceptions and increase referrals. 

17.02 New Onset Alcohol Use Disorder Following Bariatric Surgery

Posted on January 18, 2018

C. Holliday1, M. Sessine1, N. Ibrahim1, M. Alameddine1, J. Brennan1, A. A. Ghaferi1  1University Of Michigan,Ann Arbor, MI, USA

Introduction:

Bariatric surgery is the most effective treatment for morbid obesity; however, there may be significant unanticipated psychosocial effects after surgery. Prior work identified a three-fold increase in the incidence of alcohol use disorder (AUD) after surgery in patients who underwent Roux-en-Y gastric bypass (RYGB). The landscape of bariatric surgery has changed, with sleeve gastrectomy (SG) now comprising over 50% of primary bariatric operations. However, the degree to which patients who undergo SG develop AUD remains unknown. Therefore, we sought to characterize the incidence of AUD in patients who have undergone SG compared to RYGB and potential predisposing patient factors.

Methods:

This study used prospectively collected, patient-reported data from a state-wide quality collaborative. Presence of AUD was determined using the validated Alcohol Use Disorders Identification Test for Consumption (AUDIT-C), with a score ≥4 in men and ≥3 in women suggestive of AUD. We used bivariate chi-square tests for categorical variables and independent samples t-tests for continuous variables. We used multivariable logistic regression to identify patient characteristics that may predispose patients to development of AUD at 1 and 2 years after surgery.

Results:

The prevalence of AUD in all patients who underwent bariatric surgery in our population was 9.6% preoperatively (n=5724), 8.5% at 1 year postoperatively (n=5724), and 14.0% at 2 years postoperatively (n=1381). The preoperative, 1 year, and 2 year prevalence of AUD for SG were 10.1%, 9.0%, and 14.4%, respectively. The preoperative, one year, and two year postoperative prevalence of AUD for RYGB were 7.6%, 6.3%, and 11.9%, respectively. The rate of new onset AUD in the first year following SG and RYGB were 0.75% and 0.54%, respectively. However, in year two, there was a significant increase in the incidence of new onset AUD—8.5% for SG and 7.2% for RYGB (Figure). Predisposing patient factors to AUD development included higher educational level (p<0.01) and higher household income (p<0.01).

Conclusions:

This is the first large, multi-institutional study of AUD in sleeve gastrectomy patients. The prevalence of alcohol use disorder in patients undergoing SG and RYGB was similar pre- and post-operatively. While there was only a slight increase in the incidence of new onset AUD in the first postoperative year, there was a marked increase in new onset AUD in the second year after both SG and RYGB. Understanding the timing and incidence of alcohol use disorder in patients undergoing sleeve gastrectomy—the most commonly performed bariatric operation in the United States—is critical to providing appropriate counseling and treatment. 

17.01 Effect of preoperative liquid diet on liver volume and MRI estimated proton density fat fraction

Posted on January 18, 2018

T. SUZUKI1, R. B. Luo1, J. C. Hooker2, Y. Covarrubias2, T. Wolfson2, A. Schlein2, S. Liu1, J. B. Schwimmer3, L. M. Funk5, J. A. Greenberg5, G. M. Campos6, B. J. Sandler1, S. Horgan1, S. B. Reeder4, C. B. Sirlin2, G. R. Jacobsen1  1University Of California – San Diego,Division Of Minimally Invasive Surgery, Department Of Surgery,San Diego, CA, USA 2University Of California – San Diego,Liver Imaging Group, Department Of Radiology,San Diego, CA, USA 3University Of California – San Diego,Division Of Gastroenterology, Hepatology, And Nutrition, Department Of Pediatrics,San Diego, CA, USA 4University Of Wisconsin,Departments Of Radiology, Medical Physics, Biomedical Engineering, Medicine And Emergency Medicine,Madison, WI, USA 5University Of Wisconsin,Department Of Surgery,Madison, WI, USA 6Virginia Commonwealth University,Division Of Bariatric And GI Surgery,Richmond, VA, USA

Introduction: Liver volume (LV) and fat content are important considerations during bariatric procedures as increased liver volume not only increases the difficulty of intra-operative visualization but also elevates the risk of bleeding complications. The aim of this study was to evaluate the impact of a preoperative liquid diet (PLD) on LV and magnetic resonance imaging (MRI) estimated proton density fat fraction (PDFF) as a measure of liver fat content, in morbidly obese patients undergoing bariatric surgery (BS). 

Methods: This prospective multi-institutional study was approved by an institutional review board (IRB) and was Health Insurance Portability and Accountability Act (HIPAA) compliant. After providing informed consent, patients meeting National Institutes of Health (NIH) criteria for BS underwent MRI at baseline and post PLD. LV and PDFF were estimated from 3D chemical shift encoded MRI (CSE-MRI) anatomical images and PDFF maps, using the OsiriX (Pixmeo SARL, Bernex, Switzerland) imaging software. Primary outcomes were patient weight, body mass index (BMI), LV and PDFF. Secondary outcomes were relationships between the changes in BMI, LV and PDFF. Data were analyzed with paired t-test and Wilcoxon-Mann-Whitney tests. Pearson correlation was used to assess the relationships between measures. Relative reduction rate of BMI was defined as: (baseline BMI – post BMI) / baseline BMI ×100 (%). Relative reduction rate of LV was defined as: (baseline LV – post LV) / baseline LV ×100 (%). The absolute reduction rate of PDFF was defined as: baseline PDFF ?post PDFF  (%).

Results:One-hundred-twenty-four patients scheduled for BS were recruited to be part of the study between October 2010 and June 2015. 102 patients (87 females, 85.3%, mean age 48.0 ± 12.8 years) underwent MRI at baseline and post PLD. The mean liquid diet duration was 17.1 ± 8.8 days. Post PLD, mean weight decreased from 119.6 ± 19.1 kg/m2 to 114.8 ± 18.7 kg/m2 (p<0.0001). BMI decreased  from 43.6 ± 6.4 kg/m2 to 41.9 ± 6.3 kg/m2 (p<0.0001) with a mean relative reduction of 4.1 ± 2.2 %. LV decreased from 2277.2 ± 578.0 cm3 to 1985.0 ± 510.6 cm3 (p<0.0001) with a mean relative reduction of 12.3 ± 10.1 %. PDFF decreased from 13.6 ± 9.4 % to 10.4 ± 7.8 % (p<0.0001) with a mean absolute reduction of 3.2 ± 4.3 %. Pearson correlations analyses revealed statistically significant relationships between the relative reductions in LV and BMI (r=0.5253, p≤0.0001), between the absolute reduction in PDFF and relative reduction in BMI (r=0.2451, p=0.0140), and between the absolute reduction in PDFF and relative reduction in LV (r=0.3861, p=0.0001).

Conclusion:PLD significantly reduced LV and PDFF. This highlights the importance of PLD in the improvement of LV and PDFF in morbidly obese patients and underscores the reason why PLD is routinely performed at our institutions.

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