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Symptomatic Knee OA on the Rise

Symptomatic Knee OA on the Rise

Throughout the United States, the rate of knee replacement operations has surged in recent years. Experts have speculated that the increased prevalence of knee pain or of symptomatic knee osteoarthritis (OA) is due to an aging and increasingly obese U.S. population, which in turn may be the cause for the increase in knee surgeries. However, formal assessments of the secular trend of knee pain and symptomatic knee OA have been lacking. In the Annals of Internal Medicine, David T. Felson, MD, MPH, and colleagues addressed this void when they conducted a study examining whether a change in the prevalence of knee pain and symptomatic OA could be attributed to age, BMI, and radiographic knee OA. “It’s largely unknown if the increase in knee replacements was due to patients seeking the procedure more often,” explains Dr. Felson. “We also don’t have a great deal of data on the trends in knee OA.” Key Findings For their study, Dr. Felson and colleagues collected data from six National Health and Nutrition Examination Surveys (NHANES) conducted between 1971 and 2004 and from three examination periods in the Framingham Osteoarthritis (FOA) study between 1983 and 2005. “We wanted to see if the prevalence of knee OA had increased over time,” Dr. Felson says. In all samples studied, the age-adjusted prevalence of knee pain and symptomatic knee OA increased substantially over time. Between 1974 and 1994, the prevalence of knee pain—with adjustment for age and BMI—increased by about 65% among Caucasian and Mexican men and women and among African-American women in NHANES (Figure 1). In FOA, the age and BMI-adjusted prevalence of knee pain and...
Sexual Function in Women After Bariatric Surgery

Sexual Function in Women After Bariatric Surgery

Published reports have consistently shown that obesity impairs quality of life (QOL) and can contribute to depression as well as body image dissatisfaction. “Weight loss typically improves most aspects of QOL, but one aspect that is often overlooked in clinical research is sexual health,” says David B. Sarwer, PhD. Some reports have found that more than half of obese women considering bariatric surgery have sexual dysfunction that is accompanied by significant psychosocial distress. Exploring the Issue Few studies have investigated changes in sexual function, sex hormone levels, and psychosocial variables in women who undergo bariatric surgery. Recently, Dr. Sarwer and colleagues had a study published in JAMA Surgery that sought to address this research need. The analysis involved 106 women who received bariatric surgery. Overall, women lost an average of 32.7% of their initial body weight in the first year after surgery and 33.5% when assessed at the end of the second postoperative year. Women reported significant improvements in overall sexual function and satisfaction at 2 years after surgery. They also experienced significant changes in all hormones assessed in the study. Women also reported improvements in most domains of QOL—in addition to body image and depressive symptoms—1 and 2 years after surgery. “Importantly,” says Dr. Sarwer, “women who reported having the poorest quality of sexual functioning before bariatric surgery had the greatest improvements in functioning after surgery. Their functioning was comparable to women who reported the highest quality of sexual functioning before surgery.” These improvements occurred within the first postoperative year—when patients lost the largest percentage of their weight—but persisted even when the rate of weight loss had slowed....

Should All Surgeons Undergo Video Assessment?

A superb study by the Michigan Bariatric Surgery Collaborative showed that the more skilled surgeons were, the better were their outcomes. Surgeons submitted a video of their choice depicting their performance of a laparoscopic gastric bypass. Since it was self-selected, it was presumably their best work. At least 10 of their peers, blinded as to the name of the surgeon, rated skills on the video, which had been edited to include only the key portions of the case. Surgeons in the lowest quartile of ratings for surgical skill had significantly more postoperative complications, readmissions, reoperations, and deaths. A New York Times article about the paper featured a couple of short video clips—one from a not-so-skilled surgeon and one from a very skilled surgeon. The differences are obvious and dramatic. According to the discussion section of the paper, the Michigan bariatric surgeons are now watching each other operate and will soon be receiving anonymous feedback about their technique from their peers. It is not clear whether this will improve the skills of the lower-rated surgeons or have any effect on outcomes. Many people rightfully praised the research. Some suggested that all surgeons should be scrutinized in this same fashion. I agree that the study was well done and shows that better surgeons have better outcomes. But there are some problems with generalizing this to all surgeons. The American Board of Surgery recently noted that there are about 30,000 board-certified general surgeons in the United States. This raises a number of logistical issues. Let’s say we focus on the most common major surgical procedure: laparoscopic cholecystectomy. Ten surgeon raters would have to...
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