INVASIVE PAIN MANAGEMENT NEED IN SEVERELY OBESE SUBJECTS WITH OSTEOARTHRITIS UNDERGOING BARIATRIC SURGERY

Maria C Fonseca, MD, Cristian Milla Matute, MD, Mauricio Sarmiento-Cobos, MD, Francisco Ferri, MD, Emanuele Lo Menzo, MD, PhD, FACS, FAS, Samuel Szomstein, MD, FACS, FASMBS, Raul J Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida

Background: Osteoarthritis (OA) affects 56 Million of Americans, 30% of which are obese. The risk of the developing OA in the obese population is 5 times higher. With each extra kilogram, the risk increases up to 13%. The aim of this study is to describe OA in our population and the outcomes after undergoing Bariatric Surgery.

Methods: After IRB approval, we conducted a retrospective analysis of all severely obese patients with a BMI above 35 kg/m2 and Osteoarthritis who underwent Laparoscopic Adjustable Gastric Banding (LAGB), Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) procedures from January 2004 to February 2018 at Cleveland Clinic Florida. Remission was assessed based on the requirement of invasive pain management (IPM) at 12 and 24 months. IPM was defined as the need for surgical drainage, articular injection, meniscectomy, Total Hip Replacement (THR), Total Knee Replacement (TKR).

Results: Of the 4,226 patients reviewed, 11.52%(N=487) had OA diagnosed prior to Bariatric Surgery (BS). Female gender was predominant (N=338; 69.5%). Average BMI was 43.93?8.8kg/m2. LSG was the predominant procedure 43.8%(N=213), followed by RYGB in 39.9%(N=194), and AGB in 16.5%(N=79). The most common location of OA was unilateral hip 31.1%(N=151), followed by bilateral knee by, 20.4%(N=99) (Table1). Overall 68.1%(N=332) patients did not require IPM within the first 24 months after BS, particularly, but not statistically significantly after LSG compared to other procedures (45.7%; n=152). Patients difference in BMI of 15.97±15 where 1.029 times more likely of not requiring invasive intervention (p=0.009; 95%CI 1.007-1.05), additionally with patients with Baseline BMI of 44.70 ±8.22 vs 43.16±7.36 (p= 0.0496 ), and TWL% of 14.29±13 (P=0.05; 95%CI 0.96-1.00) at 12 months and 2.43±6 (P=0.003; 95%CI 1.04-1.25) at 24 months were also related to this outcome. (Table2 ). Surgical drainage was the most common intervention seen in 67.5%(N=104) of the patients overall, being more prevalent after LAGB in 78.8%(N=26) of the patients, although not statically significant was found when compared to the other procedures (P=0.3), Pain medications at 12 months were reduced by 97%. (Table 3 ).

Conclusion: According to our data, bariatric surgery reduces the need for invasive interventions in patients with OA. The effect seems to be related to the amount of weight loss. Patients who undergo LAGB have higher rates of requiring surgical drainage after VGB. Thus, BS has proven to reduce the requirements of invasive management and use of medications to reduce pain in patients with OA.