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Constructing and Validating a Dynamic Nomogram to Predict Response to Bariatric Surgery: A Multicenter Retrospective Study

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Abstract

Purpose

Suboptimal response is one of the major problems for bariatric surgery, and constructing an individualized model for predicting outcomes of bariatric surgery is essential. Thus, the aim of this study is to develop a nomogram to predict the response to bariatric surgery.

Materials and Methods

509 patients who underwent bariatric surgery between 2019 to 2020 from 6 centers were retrieved and assessed. Multiple Imputation was used to replace missing data. Patients with %TWL ≥ 20% 1 year after bariatric surgery were classified as patients with optimal response, while the others were patients with suboptimal response. A web-based nomogram was constructed and validated. ROC curve and calibration curve were used to determine the predictive ability of our model.

Results

56 (11.0%) patients were classified as patients with suboptimal response, and they showed advanced age, lower pre-operative BMI, smaller waist circumference, higher fasting glucose, higher HbA1c and lower fasting insulin compared to patients with optimal response. A forward likelihood ratio logistic regression analysis indicated that age (OR = 0.943, 95% CI: 0.915–0.971, p < 0.001), pre-operative BMI (OR = 1.109, 95% CI: 1.002–1.228, p = 0.046) and waist circumference (OR = 1.043, 95% CI: 1.000–1.088, p = 0.048) were essential factors contributing to the response to bariatric surgery. Lastly, a web-based nomogram was constructed to predict the response to bariatric surgery and demonstrated an AUC of 0.829 and 0.798 upon internal and external validation.

Conclusion

Age, BMI and fasting glucose were proved to be essential factors influencing the response to bariatric surgery. The nomogram constructed in this study demonstrated good adaptivity.

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Data Availability

The data that support the findings of this study are available from the corresponding author, Prof. Junjiang Wang, upon reasonable request.

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Funding

This study was funded by National key Clinical Specialty Construction Project (2021–2024, No. 2022YW030009) and Bethune-Merck Research Fund for young surgeons (2021).

Author information

Author notes

  1. Wenfei Diao, Yongquan Chen, Luansheng Liang, Shaowei Xiong, Liangping Wu and Shibo Lin contributed equally to this work.

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Department of General Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People’s Republic of China

    Wenfei Diao, Yongquan Chen, Yong Li & Junjiang Wang

  2. Shantou University Medical College, Shantou, People’s Republic of China

    Wenfei Diao

  3. Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China

    Yongquan Chen

  4. Bariatric Surgery Department, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, People’s Republic of China

    Luansheng Liang & Xiangwen Zhao

  5. Department of Gastrointestinal Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China

    Shaowei Xiong

  6. Abdominal Surgery, Jinshazhou Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, People’s Republic of China

    Liangping Wu

  7. Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China

    Shibo Lin & Hui Liang

  8. The Center for Obesity and Metabolic Health Department of General Surgery, The Third People’s Hospital of Chengdu & The Affiliated Hospital of Southwest Jiaotong University, Chengdu, People’s Republic of China

    Huawu Yang

Authors
  1. Wenfei Diao
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  2. Yongquan Chen
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  3. Luansheng Liang
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  5. Liangping Wu
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  6. Shibo Lin
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  7. Huawu Yang
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  8. Hui Liang
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  9. Xiangwen Zhao
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  10. Yong Li
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  11. Junjiang Wang
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Corresponding authors

Correspondence to Xiangwen Zhao, Yong Li or Junjiang Wang.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national ethics committee (KY2023-123–02) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Key Points

1. Patients with suboptimal response showed advanced age, lower BMI, smaller waist circumference, lower fasting insulin and higher fasting glucose and HbA1c before receiving bariatric surgery, compared to those patients with great response.

2. Age, pre-operative BMI and waist circumference were important characters that may contribute to the response after receiving bariatric surgery.

3. A web-based dynamic nomogram, which could help make clinical decisions, were constructed and showed predictive accuracy and discriminative ability.

Supplementary Information

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Diao, W., Chen, Y., Liang, L. et al. Constructing and Validating a Dynamic Nomogram to Predict Response to Bariatric Surgery: A Multicenter Retrospective Study. OBES SURG 33, 2898–2905 (2023). https://doi.org/10.1007/s11695-023-06729-6

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  • DOI: https://doi.org/10.1007/s11695-023-06729-6

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