SLEEVE GASTRECTOMY IS ASSOCIATED WITH LONGITUDINAL IMPROVEMENTS IN LUNG FUNCTION AND PATIENT-REPORTED RESPIRATORY OUTCOMES
Vasundhara Mathur*, Mehran Karvar, Tammy Lo, Ali Tavakkoli, Eric G. Sheu
General/GI Surgery, Brigham and Women's Hospital, Boston, MA
Background: Obesity exerts negative effects on pulmonary function through proven mechanical and biochemical pathways. Multiple studies have suggested that bariatric surgery can improve lung function. However, the timing of bariatric surgery's effects on lung function and related inflammatory markers, as well as its association with patient reported outcomes is not known.
Methods: A prospective cohort study of laparoscopic sleeve gastrectomy (LSG) patients at a tertiary care hospital was undertaken between January 2017 and July 2019. Spirometry tests pre- and post- bronchodilator were performed, and questionnaires on asthma symptoms, asthma control test (ACT) and asthma control questionnaire (ACQ) were administered to assess patient-reported respiratory outcomes (PROMS). All data were recorded at baseline just before surgery (T0) and every 3 months post-operatively for 1 year (T3, T6, T9, T12). The variables of interest were compared to pre-surgical values using a mixed-models approach for repeated measures. The level of significance was set as P < 0.05.
Results: For the 23 study participants, mean age was 44.2 ±12.3 years, mean BMI was 45.2 ± 7.2 kg/m2, 18 (78%) were female, 9 (39%) self-reported as being non-white and 6 (26%) reported to have asthma. Following LSG, BMI decreased significantly (all follow-up points, P < 0.0001) as did fasting blood glucose (T3, T12, P = 0.001, 0.002 respectively). Objective lung function showed rapid improvement, with an increase in forced vital capacity (FVC and FVC % predicted) beginning at T3 (Figure 1), as well as an increase in forced expiratory volume in first second (FEV1) at T6 (P < 0.05). As reported previously, serum inflammatory markers, such as C-reactive protein, declined after surgery; however, allergen-related inflammatory markers, including FeNO and peripheral eosinophil count, were unchanged or increased. Patients also reported reduced frequency of many respiratory symptoms beginning at T3 (night time cough/wheeze, cough/wheeze unrelated to exercise, and loss of time out of work due to asthma) (Figure 2), though the overall ACQ and ACT score for the cohort remained within normal range. Shortness of breath was consistently reported to be under control and did not show any significant decrease over time.
Conclusion: Improvements in objective lung function assessments and respiratory PROMs begin as early as 3 months after sleeve gastrectomy. Further investigation is needed to define the mechanical, metabolic, and/or inflammatory changes that drive these changes in lung function.
Figure 1
Figure 2
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