Page 73 - When surgery alone won’t cut it - Valerie Maureen Monpellier

INTRODUCTION
Health-related quality of life (HRQoL) is currently considered a vital parameter after medical treatment worldwide 1. In obese patients HRQoL is significantly impaired, therefore HRQoL improvement is one of the primary outcome measurements after bariatric surgery 2-5. Common belief is that bariatric surgery positively affects HRQoL, however recent publications question this positive effect 5-8. These publications show great variance in the effect of bariatric surgery and address two possible causes for this. First, HRQoL is assessed with numerous questionnaires, since there is no specif- ic questionnaire to assess HRQoL in bariatric surgery patients 5,6. Second, weight loss might also influence HRQoL 7,8.
HRQoL questionnaires can be divided in two groups: obesity-specific questionnaires, like Impact of Weight on Quality of Life-lite (IWQOL-lite); and general questionnaires, like the RAND-36. In the obese population body weight was the main determinant of improvement of HRQoL when IWQOL-lite was used; outcome of a general question- naire was only partially dependent on body weight 2,9,10.
Strikingly the relationship between weight loss and HRQoL has been studied only sparsely in the bariatric population, and with conflicting results 8,11,12. Even fewer stud- ies have assessed the effect of bariatric surgery with a general and an obesity-specific questionnaire 8,13.
In total, HRQoL is an important outcome after bariatric surgery. However, there is still a knowledge gap regarding the effect of bariatric surgery on HRQoL and the influence of weight loss on HRQoL. This study evaluated HRQoL before and after primary lap- aroscopic Roux-en-Y gastric bypass (RYGB) by using the IWQOL-lite and the RAND- 36. Secondly, the relationship between HRQoL and weight loss was assessed.
METHODS
Patient selection and standard treatment
This is a retrospective analysis of prospectively collected data, data was collected up to July 2015. Patients were selected from the database of the Nederlandse Obesitas Kliniek (Dutch Obesity Clinic); the largest, outpatient clinic for treatment of bariatric patients in the Netherlands which provides the structured care for over 50% of the Dutch bariatric population. All patients were screened according to IFSO-criteria. In addition to bariatric surgery, the treatment program consists of pre- and postoperative group counselling by a multidisciplinary team (dietician, a psychologist, a physical therapist and a medical doctor).
Since 2012 HRQoL was routinely assessed in the treatment program; staring with the RAND-36 and later also adding IWQOL-lite. This treatment program was enrolled over the different clinics at several time points during 2012 and 2013. The questionnaires were administered at pre-operative screening and at 15 and 24 months after surgery.
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