Page 79 - When surgery alone won’t cut it - Valerie Maureen Monpellier

population sample 19. For the IWQOL-lite, there was also a slight decline, but none of the differences were statistically significant or clinically relevant. It seems that HRQoL stabilized 15 months post-surgery. This might be explained by the fact that patients experience an enormous improvement in HRQoL in the first 15 months. But after 12 - 15 months, in most patients weight stabilizes and thereby the additional changes that the patients experience in the months afterwards seem only small. Moreover, the HRQoL scores at 15 months are higher than the normal population scores; maybe there is no room left for further improvement.
Patients with a lower BMI before and after RYGB surgery generally had a better HRQoL. Total IWQOL-lite was related to presurgical BMI and BMI at both follow-up moments. In the obese population it was shown before that BMI was the more related to the IWQOL-lite scores compared to RAND-36 scores 9, 10. This study is the first to show that this also applies in the pre- and post-bariatric population.
For the generic questionnaire, BMI was associated physical health. This is in concor- dance with more studies assessing RAND-36 scores in post-bariatric patients 8. It is likely that the physical effects of morbid obesity are substantial and thereby also influ- ence general HRQoL. Mental health of the RAND-36 was only negatively associated with BMI at 24 months post-surgery.
Patients with a higher weight loss had a better HRQoL; total scores of RAND-36 and IWQOL-lite were all significantly positively associated with %TWL. The effect of weight loss on HRQoL has been evaluated in several studies with various question- naires, however the expected outcome had not been as clear as in our study 11, 12, 20-23. In addition, TWL was 31.1% at 24 months in our population, which might explain the greater association of weight loss and HRQoL. Other studies had much smaller populations and generally used percentage excess weight loss as a weight loss pa- rameter. The higher number of patients in our study, and the use of %TWL might have influenced the results.
Our results show that the variation in effect of bariatric surgery on HRQoL which was described recently, can at least in part be explained by the diversity in questionnaires used to assess HRQoL 6. Change in HRQoL was highest in the IWQOL-lite scales, ranging from 23-47%. For RAND-36, mean change ranged from 5-57%. The cor- relations between %TWL and ΔHRQoL were also highest in the IWQOL-lite scales at 15 and 24-month follow-up. And RAND-36 MHS was not significantly associated with ΔHRQoL at 15 months. To avoid influence of baseline HRQoL on outcome we calculated a ΔHRQoL.
In our study population maximum weight loss was achieved at an average of 15 months, therefore we chose to use 15 and 24 months to evaluate HRQoL. The large sample size enabled us to identify even small effects of weight loss on HRQoL. In previous research there was deterioration in HRQoL seen, which was explained by
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