Page 78 - When surgery alone won’t cut it - Valerie Maureen Monpellier

Chapter 4
ΔHRQoL24 ranged from 0.05 to 0.42 for RAND-36 scores and from 0.24 to 0.47 for IWQOL-lite scores. At 24 months, highest correlation with %TWL was found in the physical functioning scale (rs (1034) = 0.128, p<0.001) and general health perception scale (rs (1034) = 0.124, p<0.001) of RAND-36. In the IWQOL-lite the highest correlation was with self-esteem scale (rs (609) = 0.230, p=0.104).
ΔHRQoL24 of PHS, MHS and IWQOL-lite total score were all significantly associated with %TWL (p<0.001 in all). After adjusting for baseline BMI, gender, age and comorbidities (diabetes mellitus, hypertension, obstructive sleep apnoea syndrome, hypercholesterolemia and osteoarthritis), %TWL remained significantly related to ΔHRQoL24 for all total scores (Table 3).
Table 3:
Linear regression analysis for ΔHRQoL based on %TWL at both follow-up moments.
R2
15 months
RAND-36 PHS .024 RAND-36 MHS .004 IWQOL-lite total .055 24 months
RAND-36 PHS .038 RAND-36 MHS .026 IWQOL-lite total .079
* Adjusted for baseline BMI, gender, age and comorbidities (diabetes mellitus, hypertension, obstructive sleep apnoea syndrome, hypercholesterolemia and osteoarthritis) at baseline
ΔHRQoL = change in HRQoL from baseline to 15 and 24-month follow-up; TWL= total weight loss; PHS = physical health summary; MHS = mental health summary
DISCUSSION
The purpose of this study was to evaluate the effect of primary RYGB on HRQoL and assess the relationship between weight loss and HRQoL with two HRQoL question- naires. Our results show that HRQoL significantly improves after primary RYGB when assessed with both a generic (RAND-36) and an obesity-specific (IWQOL-lite) ques- tionnaire. A higher BMI is associated with a lower HRQoL before and after surgery. While more weight loss is associated with higher improvement of HRQoL and better HRQoL score at 15- and 24-months follow-up. The correlations between weight (loss) and HRQoL were higher with the IWQOL-lite compared to the RAND-36.
The effect of bariatric surgery on HRQoL was questioned in recent literature 6,8. This study shows that HRQoL significantly improves after RYGB. After 15 months fol- low-up there was a statistically significant decline for all RAND-36 scores. This effect was also observed up to 5 years post-surgery in the SOS-study 18. However, the re- duction was only clinically relevant for one scale, the health change scale. The mean score of this scale at 24 months was still higher than the mean score of the normal
β*
SE
95% CI
p-value
.002
.001
.001 - .004
< .001
.001
.001
.000 - .002
.169
.003
.001
.002 - .004
< .001
.003
.001
.002 - .005
< .001
.002
.001
.001- .004
.003
.004
.001
.003 - .006
< .001
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