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Post-operative gastric bypass anemia rates are largely tied to specialist follow-up care, a new study found.

In a single-center, retrospective review of U.S. veterans, those who underwent Roux-en-Y gastric bypass and did not get follow-up with a bariatric specialist had significantly higher rates of anemia 10 years after surgery versus patients receiving post-op specialist care (adjusted OR 6.1, 95% CI 1.4-27.6; P=0.02), according to Gao Linda Chen, MD, of the Palo Alto (Calif.) VA Health Care System, and colleagues.

Their research letter in indicated that among the 58 patients who did not have post-surgical bariatric specialist follow-up, 57% (33 patients) showed anemia 10 years after surgery, compared to only 22% who were anemic prior to surgery (13 patients) (P<0.001).

Anemia was defined as hemoglobin less than 12.0 g/dL for women and 13.5 g/dL for men.

"All patients receiving iron supplements who still had anemia at 10 years were in the group without bariatric specialist follow-up (n=11)," Chen's group wrote, speculating that this finding suggests "an inappropriate choice of treatment or inadequate follow-up."

Only one patient among the 16 who did continue to follow-up with a bariatric specialist after surgery developed new-onset anemia within 10 years, suggesting that this was a vital and possibly protective factor for surgical patients.

Among the total remaining surgical cohort (n=74), mean rates of post-operative anemia steadily increased over the course of the 10-year follow-up period:

• Preoperative anemia: 20% (15 patients)
• 1-year post-operative: 28% (21 patients)
• 5-years post-operative: 31% (23 patients)
• 10-years post-operative: 47% (35 patients)

The research group suggested that these high rates of anemia "may reflect a mixed vitamin and mineral deficiency, because patients had normocytic anemia."

However, a large benefit for total body mass index reduction was seen among the total cohort, with a 60% excess loss reported 10-years after surgery (pre-op mean BMI 46.2 vs. 33.7).

Chen's group highlighted the importance of bariatric specialist follow-up beyond 5 years after surgery in order to mitigate long-term anemia risk, writing that "long-term complications of [Roux-en-Y gastric bypass], such as anemia, may go unrecognized by nonbariatric specialists," however they noted that their findings were limited due to the small cohort size.

"Long-term follow-up should be an integral part of bariatric programs, and additional studies are needed to identify potential barriers to successful follow-up," the group wrote, citing geographical distance and socioeconomic status as some of these barriers.

The researchers recommended a "hub-and-spoke" model for the care of bariatric patients involving a multidisciplinary team of providers in order to optimize outcomes prior to, and following surgery.

Click for the American Association of Clinical Endocrinologists comprehensive clinical practice guidelines for the medical care of obesity, including bariatric surgery.

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