RPT-Algorithm Reduces Cost of Nutritional Screening After Bariatric Surgery

(Repeating story from Jan 10, with no changes, for clients who didn't receive it the first time.)

January 12, 2017

By Anne Harding

NEW YORK (Reuters Health) - Using algorithms to guide screening for nutrient deficiencies after bariatric surgery could lead to "substantial cost savings," according to new research.

"You do not have to screen for every nutritional deficiency in patients scheduled for bariatric surgery, and the same thing is true for the postoperative phase," Dr. Sjaak Pouwels of Catharina Hospital Eindhoven in the Netherlands, who worked on the study, told Reuters Health in a telephone interview.

There is currently no standard approach to screening patients for nutrient deficiencies after bariatric surgery, and no consensus in the medical literature on cutoff values for deficiency, Dr. Pouwels and his team note in their report, online December 14 in the European Journal of Clinical Nutrition.

However, they add, guidelines generally recommend that patients be monitored frequently using an extensive panel of tests. In the Netherlands, patients typically undergo screening up to seven times after surgery, for a total cost of nearly 600 euros.

To investigate whether an algorithm could help reduce costs, the researchers looked at more than 2,000 patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) at their hospital between 2009 and 2013.

They analyzed the most recent pre- and post-operative measurements for vitamins A, B1, B6, B12, D, folate, ferritin, zinc and magnesium in 561 LRYGB and 831 LSG patients. They defined measurements below lower reference limit as moderate deficiencies, and measurements below the supplementation limit as severe.

Vitamin D, zinc, ferritin, folate, and vitamin B12 were the most common deficiencies after surgery, and most deficiencies were already present before surgery. The researchers developed algorithms for screening for these deficiencies based on preoperative vitamin D and ferritin, and current folate, MCV, and hemoglobin.

Using the algorithms would cut screening costs by 14% without missing clinically important deficiencies, except for those in vitamin D, according to the researchers. Given the rarity of deficiency in vitamins A, B1 and B6, they add, these could be excluded, reducing costs by an additional 28%.

"The relative high preoperative prevalence of deficiencies and for some biochemical parameters the relative low percentage of newly developed deficiencies after surgery, suggest that the preoperative patient should be supplemented with higher doses of multivitamins," Dr. Pouwels and his team write.

Factors that complicate the study of nutrient deficiency after weight-loss surgery include the fact that deficiencies may vary by surgery type, Dr. Pouwels noted, as well as the difficulty of determining patient compliance with supplement use.

"It's a topic of interest in the bariatric and metabolic surgery field, but we still have a lot of work to do," he said.

SOURCE: http://bit.ly/2i8JWOf

Eur J Clin Nutr 2016.