Preoperative and early adjuvant weight loss medications in bariatric surgery patients with body mass index over 60 or suboptimal initial response to surgery.

BACKGROUND

Few studies have examined the adjuvant use of antiobesity medications with surgery, especially in the pre- and early postoperative periods.

OBJECTIVE

Evaluate the impact of adjuvant pharmacotherapy on bariatric surgery outcomes.

SETTING

University hospital, United States.

METHODS

A retrospective chart review of patients receiving adjuvant pharmacotherapy for obesity treatment and bariatric surgery. Patients received pharmacotherapy either preoperatively if their body mass index was >60, or in the first or second postoperative years for suboptimal weight loss. Outcome measures included percentage of total body weight loss as well as comparison with the expected weight loss curve as determined by the Metabolic and Bariatric Surgery Risk/Benefit Calculator.

RESULTS

A total of 98 patients were included in the study, with 93 (94.9%) undergoing sleeve gastrectomy and 5 (5.1%) undergoing Roux-en-Y gastric bypass surgery. During the study period, patients were prescribed phentermine and/or topiramate. At postoperative year 1, patients who received pharmacotherapy preoperatively lost 31.3% of their total body weight (TBW) compared with 25.3% TBW for patients with suboptimal weight loss who received medication in the first postoperative year, and 20.8% TBW for patients who did not receive any antiobesity medication in the first postoperative year. Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) curve for comparison, patients receiving medication preoperatively weighed 2.4% less than expected, whereas patients receiving medication during the first postoperative year weighed 4.8% higher than expected.

CONCLUSION

For patients having bariatric surgery who fall below the expected MBSAQIP weight loss curve, early initiation of antiobesity medications can improve the weight loss, with preoperative pharmacotherapy having the greatest effect.