Understanding the Impact of Preoperative Nutrition Counseling given by Registered Dietitians on Complication Rates among Bariatric Surgery Patients Público
Nwankwo, Ozodimma (Spring 2018)
Abstract
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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