Understanding the Impact of Preoperative Nutrition Counseling given by Registered Dietitians on Complication Rates among Bariatric Surgery Patients Open Access

Nwankwo, Ozodimma (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/tb09j571h?locale=en


Introduction Bariatric surgery is an obesity intervention which produces sustained weight loss and improvement in many obesity-related medical comorbidities. Understanding the results of preoperative nutrition counseling (PNC) in the bariatric population is essential given that they assume a substantial burden of the growing obesity epidemic and there is evidence supporting the need for weight loss surgery to address the obesity epidemic. This study aimed to explore the relationship between PNC given by registered dietitians (RD) and the incidence of complications within nine months after bariatric surgery.


Methods A retrospective study examined patients (N = 60) who underwent bariatric surgery at Johns Hopkins Center for Bariatric Surgery located in Baltimore, Marylandin 2017. The instrument used for data collection was an excel spreadsheet. Data were extracted from the clinical nutrition department’s database and EPIC, the Johns Hopkins Medicine’s electronic medical record (EMR) system, then analyzed using SPSS. Pearson’s Correlation and logistic regression were used to analyze data.


Results The mean age of the patient sample was 44 years old. There was no significant correlation found between bariatric patients who received PNC by an RD verses a counselor with unknown credentials and those that experienced complications post-bariatric surgery (Pearson's Correlation ρ = 0.193; P= .139). The results showed that surgery type is a protective factor from experiencing complications, (Point Estimate/Exp (B) = 0.848) suggesting that it lowers the risk of complications. After adjusting for surgery type and approach, the association between patients who received PNC by an RD and experiencing complications persisted (β = 1.039; 95% confidence interval, 0.807–9.904; P = 0.104).


Conclusion Ultimately, the hypothesis was accepted, and there was no statistical difference in the odds of experiencing complications within nine months of surgery for the cohort of bariatric patients who received PNC from an RD compared to those who received PNC from a counselor with unknown credentials. Further investigation of the impact of the RD role in the multidisciplinary team and subsequently, the effects of PNC facilitated by any other healthcare professional should be done as an extension of this study. 

Table of Contents

Table of Contents

Chapter 1 – Introduction 1

Introduction and Rationale 1

Problem Statement 1

Theoretical Framework 3

Key Determinants of Health 5

Purpose Statement 5

Research Question and Hypothesis 6

Significance Statement 7

Definition of Terms 7

Chapter 2 – Review of the Literature 10

Introduction 10

Current State of Knowledge 11

Bariatric Surgery 11

Roux-en-Y Gastric Bypass 11

Biliopancreatic Diversion with Duodenal Switch 12

Laparoscopic Adjustable Gastric Band 14

Sleeve Gastrectomy 15

Preoperative Assessment 16

Gaps in Research 17

Addressing the Gaps 18

Summary of Current Problem and Study Relevance 18

Chapter 3 – Methodology 20

Introduction 20

Population and sample 20

Population 20

Setting 21

Sample Selection Rationale 22

Research design 23

Procedures 26

Instruments 27

Assumptions 29

Data analysis methodology 29

Chapter 4 – Results 34

Introduction 34

Key findings 34

Correlations 34

Logistic Regression 35

Other findings 39

Summary 39

Chapter 5 – Conclusions, Implications, and Recommendations 41

Introduction 41

Summary of Study 41

Discussion of Key Results 42

Limitations 43

Implications 45

Recommendations 47

Conclusion 47

References 49

Appendix A 52



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