Zhongguo quanke yixue (Dec 2022)
Association of Therapeutic Effects on Psychological Status of Post-bariatric Patients One Year after Surgery
Abstract
Background Bariatric surgery is the effective treatment for obesity, however, the effect of surgery on patients' psychological status is still unclear. Objective To investigate the treatment effects of bariatric surgery on patients' psychological status one year after the surgery. Methods This is a retrospective cross-sectional study. This study selected 172 patients who underwent bariatric surgery in the department of general surgery, First Affiliated Hospital of Nanjing Medical University during June 2019 to June 2020, and collected their clinical data. The indicators of the treatment effects of bariatric surgery include body composition indicators〔Weight, Body mass index (BMI) , Percentage of excess weight loss (EWL%) , Body muscle mass (BM) , Body fat mass (BF) , Visceral fat (VSF) , metabolism-related biochemical indexes〔Alanine aminotransferase (ALT) , Aspartate aminotransferase (AST) , Total protein (TP) , Albumin (ALB) 〕, preoperative comorbidities, relief of comorbidities after surgery, postoperative complications, postoperative complaints, surgery methods; Indicators of the postoperative psychological status include quality of life, perceived stress, general well-being and satisfaction degree of surgery. This study used the12-item Short Form Survey (SF-12) , Chinese version of the Perceived Stress Scale (CPSS) , General Well-being Schedule (GWS) , Questionnaire of Bariatric Surgery Patient' Satisfaction Survey to investigate the psychological status. This study used the Pearson correlation analysis and Spearman rank correlation analysis to explore the correlation between body composition indicators and metabolic-related biochemical indexes and postoperative psychological status, used the multivariate linear regression analysis to explore the factors that affect postoperative psychological status. Results One year after surgery, EWL% was (82.7±31.7) %, and BMI decreased by (10.3±4.3) kg/m2. 96 patients (55.8%) had metabolic-related comorbidities such as type 2 diabetes mellitus, hypertension, fatty liver before surgery, 48 patients (27.9%) achieved complete remission, 30 patients (17.4%) achieved partial remission, and 18 patients (10.5%) had no remission after surgery. Patients'weight, BMI, BM, BF, VSF, ALT, AST were lower than those before surgery, the TP and ALB were higher than those before surgery (P<0.05) .The correlation analysis showed that patients' MCS scores were negatively correlated with ΔALT (rs=-0.160, P=0.036) ; the CPSS scores were negatively correlated with EWL% (r=-0.181, P=0.017) and ΔBM% (rs=-0.174, P=0.022) but positively correlated with ΔALT (rs=-0.236, P=0.002) ; the GWS scores were negatively correlated with ΔALT (rs=-0.228, P=0.003) and ΔAST (rs=-0.216, P=0.004) ; the satisfaction of surgery were negatively correlated with ΔBMI (r=-0.171, P=0.025) , ΔBF% (r=-0.174, P=0.022) and ΔVSF (r=-0.154, P=0.043) but positively correlated with EWL% (r=0.284, P<0.001) . The multivariate linear regression analysis showed that postoperative stomachache (β=-0.239, P=0.002) and postoperative fatigue (β=-0.169, P=0.025) were factors that affect PCS scores; ΔALT (β=-0.181, P=0.017) and postoperative fatigue (β=0.171, P=0.024) were factors that affect MCS scores; EWL% (β=-0.188, P=0.010) , ΔBM% (β=-0.146, P=0.047) , ΔALT (β=0.219, P=0.003) and postoperative fatigue (β=0.169, P=0.022) were factors that affect CPSS scores; ΔALT (β=-0.254, P=0.001) and acid reflux (β=-0.251, P=0.001) were factors that affect GWS scores; ΔBMI (β=-0.245, P=0.010) , EWL% (β=0.247, P=0.003) and ΔBF% (β=-0.366, P<0.001) were factors that affect satisfaction of surgery. Among the 96 patients with preoperative comorbidities, multiple linear regression analysis showed that postoperative relief of comorbidities (β=0.411, P<0.001) and stomachache (β=-0.192, P=0.040) were factors that affect PCS scores; ΔALT (β=-0.273, P=0.006) and acid reflux (β=-0.263, P=0.008) were factors that affect MCS scores; postoperative relief of comorbidities (β=-0.220, P=0.024) , ΔALT (β=0.301, P=0.002) , stomachache (β=0.214, P=0.023) and ΔVSF (β=0.212, P=0.031) were factors that affect CPSS scores; postoperative relief of comorbidities (β=0.290, P=0.002) , ΔALT (β=-0.310, P=0.001) and stomachache (β=-0.271, P=0.004) were factors that affect GWS scores; postoperative relief of comorbidities (β=0.402, P<0.001) , ΔBF% (β=-0.452, P<0.001) and ΔBMI (β=-0.364, P<0.001) were factors that affect satisfaction of surgery. Conclusion Patients' BMI decreased significantly one year after bariatric surgery. The postoperative acid reflux, stomachache, fatigue and the increase of ΔBF% and ΔALT negatively affect patients'psychological status; the increase of EWL% and ΔBM% positively affect patients'psychological status. For patients with comorbidities, the higher the degree of postoperative comorbidity remission, the greater the positive impact on the patient's psychological status.
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