Bariatric Surgery App Helps Physicians Reduce Risks, Choose Best Procedure

A team of researchers from Cleveland Clinic has created the first mobile app that will help physicians and patients make decisions around three important clinical questions in the field of bariatric surgery.

The Bariatric Surgery Calculator includes a sleeve gastrectomy risk calculator, a post-discharge venous thromboembolism (VTE) risk calculator, and a scoring system for evidence-based selection of surgery so physicians can better choose between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) for their patients.

“These are validated tools that operate on smart phones and mobile devices which can potentially lead to better patient selection and improved outcomes,” says bariatric surgeon Ali Aminian, MD, who presented the app today at ObesityWeek 2017, the national conference of the American Society of Metabolic and Bariatric Surgeons.

Sleeve gastrectomy risk calculator

Dr. Aminian and colleagues took data of 5,871 SG patients from the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP).

Out of 52 baseline variables, they identified seven risk factors associated with early postoperative morbidity and mortality after SG: congestive heart failure, chronic steroid use, male gender, diabetes, high BMI, elevated preoperative serum bilirubin level and low hematocrit.

The researchers incorporated these factors into the scoring system so that physicians could enter individual’s data and receive an estimate of a particular patient’s chance of developing a serious post-operative adverse event after SG.

The Bariatric Surgery Calculator is now available on the App Store for iOS devices.

Post-discharge venous thromboembolism risk calculator

Venous thromboembolism is the most common cause of mortality after bariatric surgery. Once again, Dr. Aminian and colleagues used data from the ACS-NSQIP. They identified almost 100,000 patients who underwent bariatric surgery between 2007 and 2012 and identified 269 patients who suffered from post-discharge VTE.

Of the 45 examined variables, they uncovered 10 that were most associated with post-discharge VTE: congestive heart failure, paraplegia, return to operating room, dyspnea at rest, non-gastric band surgery, male sex, 60 years or older, very high BMI, postoperative hospital stay of three days or more, and an operative time of three hours or more.

The investigators incorporated these predictors of post-discharge VTE into the risk calculator so that physicians could input individual’s data and receive an estimate of a particular patient’s risk for developing VTE post bariatric surgery and thus make an evidence-based decision on whether to prescribe extended thromboprophylaxis.

Evidence-based selection of metabolic surgery

For this calculator, Dr. Aminian and colleagues looked at medical records of 659 patients with type 2 diabetes mellitus who underwent RYGB or SG at Cleveland Clinic between 2004 and 2011 and had at least five years of postoperative follow-up. They externally validated their findings by comparing the model to 241 patients with similar criteria from Hospital Clínic Universitari, Barcelona, Spain.

Their analysis revealed four predictors of long-term diabetes remission: preoperative duration of diabetes, preoperative number of diabetes medications, insulin use and glycemic control. Using these parameters, they then developed an Individualized Metabolic Surgery (IMS) scoring system that led to three patient categories based on diabetes severity.

Physicians can enter individual’s data into the calculator and receive an IMS score for a particular patient that indicates which type of procedure is best for that patient — either RYGB or SG.

Three important questions

Over the past five years there has been tremendous growth in the development of medical-focused mobile apps, says Dr. Aminian. “We saw value in developing one that incorporates three scoring systems to answer important clinical questions in the field of bariatric surgery.”

Visit us at ObesityWeek 2017 at Booth #843. Follow Dr. Aminian on Twitter at @Ali_Aminian_MD.