Liyang Tang, BA, Hatim Alsulaim, MD, MPH, Megill Robin, MSPH, Michael A Schweitzer, MD, FACS, Thomas H Magnuson, MD, FACS, Kimberley Steele, MD, PhD, FACS. The Johns Hopkins University, School of Medicine
Introduction: As the vertical sleeve gastrectomy (VSG) becomes increasingly popular, its effect on postoperative micronutrients levels, such as thiamine, becomes more important. We previously found a 1.8% prevalence of thiamine deficiency in bariatric patients prior to surgery. The aim of the present study is to determine the prevalence of thiamine deficiency at our center following VSG and to explore possible predictors of postoperative thiamine levels.
Methods: A retrospective chart review was performed on 147 bariatric patients between 18 and 65 years old who underwent VSG between April 2011 and February 2015. Demographics, pre-operative body mass index (BMI), obesity associated co-morbidities, alcohol intake, smoking habits, insurance type, calendar year of the procedure, occurrence of post-operative complications, and compliance with post-operative nutrition and follow up appointment guidelines were extracted. We defined thiamine deficiency as < 78 nmol/L on any lab draw within one year after the VSG. A comparison of the above factors was made between the thiamine sufficient group and the thiamine deficient group after the groups had been matched using a propensity score. Propensity score matching and multivariate logistic regression models were created to analyze the factors associated with thiamine deficiency after bariatric surgery.
Results: Out of the 147 patients, 105 met inclusion criteria and were included in the analysis, of whom 27 (25.7%) had thiamine deficiency. Overall median age was 42 years (IQR: 36, 49). The majority of patients (92.4%) were African Americans or Caucasian (47.6% and 44.8%, respectively), female (77.1%), and compliant with vitamins (81.0%). The overall mean pre-operative BMI was 46.4 ± 7.3 kg/m2. Patients with thiamine deficiency were more likely to be African American (66.7% vs. 41.0%, p=0.02), and to report nausea (59.3% vs. 25.6%, p=0.002) and vomiting (44.4% vs. 14.1%, p=0.001) compared with those without thiamine deficiency. Compliance with vitamins did not differ between those with or without thiamine deficiency (70.4% vs. 84.6%, p=0.10). After controlling for all factors, African American race (OR 4.62, p=0.013), nausea (OR 4.04, p=0.025), and vomiting (OR 3.88, p=0.032) were independent risk factors for the development of thiamine deficiency. Similar differences were observed in the propensity score model.
Discussion: We found an alarmingly high prevalence of thiamine deficiency in postoperative sleeve gastrectomy patients. This disorder may have serious consequences including Wernicke encephalopathy. Hence, it is important to identify predictive factors including demographics, post-operative complications, and behaviors so that measures can be taken to prevent thiamine deficiency in VSG patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78608
Program Number: P566
Presentation Session: Poster (Non CME)
Presentation Type: Poster
