Skip to main content

Advertisement

SpringerLink
Log in

Anemia and Bariatric Surgery: Results of a National French Survey on Administrative Data of 306,298 Consecutive Patients Between 2008 and 2016

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

Bariatric surgery (BS) has grown exponentially in France, and long-term anemia due to micronutrient deficiencies has become common.

Objectives

The objective of this study was to assess the long-term risk of anemia after BS and to investigate the factors associated with the occurrence of this complication.

Materials and Methods

Data from the French National Health Service database on patients who had undergone gastric bypass (GB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB), between 2008 and 2016 were extracted. Only patients with a primary intervention were considered.

Results

Data from 306,298 patients (143.733 SG, 79.188 GB, and 36.413 AGB) were analyzed. Overall, 12.930 of them (5.0%) had a diagnosis of anemia due to micronutrient deficiencies as main diagnosis or related diagnosis at time of a hospital stay between 2008 and 2016. In multivariate analysis, GB surgery, female gender, age younger than 52 years, and 25-OH vitamin D deficiency were positively associated with the occurrence of anemia whereas hospital procedural volume was negatively associated. The risk to be diagnosed with anemia after BS was 13.0% after a GB, 5.6% after a SG and 4.0% after an AGB (Log-rank p < 0.0001). The hazard ratio for anemia after GB compared to SG was 2.0 (95% CI 1.9–2.1), adjusted for age and gender.

Conclusion

In France, between 2008 and 2016, 5% of patients had anemia after BS. The risk to develop anemia was 2-fold higher after a GB than after a SG. Young women should be particularly aware of this long-term risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.

    Article  PubMed  Google Scholar 

  2. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes—3-year outcomes. N Engl J Med. 2014;370(21):2002–13.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.

    Article  PubMed  CAS  Google Scholar 

  4. Lazzati A, Audureau E, Hemery F, et al. Reduction in early mortality outcomes after bariatric surgery in France between 2007 and 2012: a nationwide study of 133,000 obese patients. Surgery. 2016 Feb;159(2):467–74.

    Article  PubMed  Google Scholar 

  5. Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci. 2006;331(4):219–25.

    Article  PubMed  Google Scholar 

  6. Hammer HF. Medical complications of bariatric surgery: focus on malabsorption and dumping syndrome. Dig Dis Basel Switz. 2012;30(2):182–6.

    Article  Google Scholar 

  7. Haute Autorité de Santé. Obésité: prise en charge chirurgicale chez l’adulte. Recommandations de bonnes pratiques professionnelles. [Internet]. Available from: https://www.has-sante.fr//portail/jcms/c_765529/obesite-prise-en-charge-chirurgicale-chez-l-adulte.

  8. Thereaux J, Lesuffleur T, Païta M, et al. Long-term follow-up after bariatric surgery in a national cohort. Br J Surg. 2017;104(10):1362–71.

    Article  PubMed  CAS  Google Scholar 

  9. Kwon Y, Kim HJ, Lo Menzo E, et al. Anemia, iron and vitamin B12 deficiencies after sleeve gastrectomy compared to Roux-en-Y gastric bypass: a meta-analysis. Surg Obes Relat Dis. 2014;10(4):589–97.

    Article  PubMed  Google Scholar 

  10. Brolin RE, Gorman JH, Gorman RC, et al. Are vitamin B12 and folate deficiency clinically important after roux-en-Y gastric bypass? J Gastrointest Surg Off J Soc Surg Aliment Tract. 1998;2(5):436–42.

    Article  CAS  Google Scholar 

  11. Fulton C, Sheppard C, Birch D, et al. A comparison of revisional and primary bariatric surgery. Can J Surg. 2017;60(3):205–11.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–9.

    Article  PubMed  Google Scholar 

  13. Knight T, D’Sylva L, Moore B, et al. Burden of iron deficiency anemia in a bariatric surgery population in the United States. J Manag Care Spec Pharm. 2015;21(10):946–54.

    Article  PubMed  Google Scholar 

  14. Mckinlay SM, Brambilla DJ, Posner JG. “Reprint of” the normal menopause transition. Maturitas. 2008;61(1):4–16.

    Article  PubMed  Google Scholar 

  15. Caron M, Hould FS, Lescelleur O, et al. Long-term nutritional impact of sleeve gastrectomy. Surg Obes Relat Dis. 2017;13(10):1664–73.

    Article  PubMed  CAS  Google Scholar 

  16. Karefylakis C, Näslund I, Edholm D, et al. Prevalence of anemia and related deficiencies 10 years after gastric bypass—a retrospective study. Obes Surg. 2015;25(6):1019–23.

    Article  PubMed  Google Scholar 

  17. Smith EM, Tangpricha V. Vitamin D and anemia: insights into an emerging association. Curr Opin Endocrinol Diabetes Obes. 2015;22(6):432–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Salgado Jr W, Modotti C, Nonino CB, et al. Anemia and iron deficiency before and after bariatric surgery. Surg Obes Relat Dis. 2014;10(1):49–54.

    Article  PubMed  Google Scholar 

  19. Chen GL, Kubat E, Eisenberg D. Prevalence of anemia 10 years after roux-en-Y gastric bypass in a single veterans affairs medical center. JAMA Surg. 2017;153:86–7. https://doi.org/10.1001/jamasurg.2017.3158.

    Article  PubMed Central  Google Scholar 

  20. Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery Integrated Health Nutritional Guidelines for the Surgical Weight Loss Patient 2016 Update: Micronutrients. Surg Obes Relat Dis. 2017;13(5):727–41.

    Article  PubMed  Google Scholar 

  21. Keith CJ, Gullick AA, Feng K, et al. Predictive factors of weight regain following laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2017:1–7.

  22. Shantavasinkul PC, Omotosho P, Corsino L, et al. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2016;12(9):1640–5.

    Article  PubMed  Google Scholar 

  23. Baldridge AS, Pacheco JA, Aufox SA, et al. Factors associated with long-term weight loss following bariatric surgery using 2 methods for repeated measures analysis. Am J Epidemiol. 2015;182(3):235–43.

    Article  PubMed  PubMed Central  Google Scholar 

  24. DRESS (Direction de la recherche des etudes de l’evaluation et des statistiques). Redressements du Programme de Medicalisation des Systemes d’Information (PMSI). Available at: http://www.drees.sante.gouv.fr/redressements-du-programme-de-medicalisation-des-systemes-d-informations-pmsi,5334.html. Accessed 19 Oct 2014.)

  25. Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity. 2013;21(S1).

Download references

Author information

Author notes

  1. Laurent Bailly and Luigi Schiavo contributed equally to this work.

Authors and Affiliations

  1. Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), 06202, Nice, France

    Laurent Bailly, Roxane Fabre & Christian Pradier

  2. Université Côte d’Azur, LAMHESS, Nice, France

    Laurent Bailly, Roxane Fabre & Christian Pradier

  3. Department of Cardio-Thoracic and Respiratory Science, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Luigi Schiavo

  4. IX Division of General Surgery, Vascular Surgery, and Applied Biotechnology, Naples University Polyclinic, Naples, Italy

    Luigi Schiavo

  5. Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France

    Lionel Sebastianelli & Antonio Iannelli

  6. EA CoBTek, University of Nice Sophia-Antipolis, Nice, France

    Roxane Fabre

  7. Inserm, U1065, Team 8 “Hepatic Complications of Obesity”, 06204, Nice, France

    Antonio Iannelli

  8. University of Nice Sophia Antipolis, 06107, Nice, France

    Antonio Iannelli

Authors
  1. Laurent Bailly
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luigi Schiavo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lionel Sebastianelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roxane Fabre
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian Pradier
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Iannelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonio Iannelli.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Informed Consent

Written informed consent was obtained for each individual participant included in the study.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bailly, L., Schiavo, L., Sebastianelli, L. et al. Anemia and Bariatric Surgery: Results of a National French Survey on Administrative Data of 306,298 Consecutive Patients Between 2008 and 2016. OBES SURG 28, 2313–2320 (2018). https://doi.org/10.1007/s11695-018-3143-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-018-3143-x

Keywords

Search

Navigation