Surgery for Obesity and Related Diseases
Volume 8, Issue 1 , Pages 130-131, January 2012

How to use the Bariatric Analysis and Reporting Outcome System

Houston, Texas

published online 07 October 2011.

Article Outline

 

To the editor:

The Bariatric Analysis and Reporting Outcome System (BAROS) is a simple, 1-page scoring instrument developed to evaluate and present the results from obesity surgery [1]. It analyzes 3 domains: weight loss, changes in co-morbidities, and changes in quality of life, assigning a maximum of 3 points to each of the domains. Complications and reoperations deduct points from the subtotal, leading to a final score. This is used to objectively classify the results in 5 outcomes groups.

A frequent misconception in published studies is to confuse the BAROS with a quality of life questionnaire [2], [3], [4]. It is not, as I have written years ago in regards to other publications [5]. The system incorporates the specifically created Moorehead-Ardelt Quality of Life Questionnaire to evaluate changes perceived by the patients after surgery. Originally, this instrument contained 5 questions, with a full point assigned to the first (self-esteem), presuming that this was more important than the other items. After clinical trials, however, this assumption was found inaccurate. Consequently, the questionnaire was modified by the addition of a sixth question assessing the patient's approach to food, by slightly modifying the colored drawings, and by adopting a 10-point visual analog scale, which prompted changes in the instrument's scoring. The new Moorehead-Ardelt quality of life questionnaire was validated in studies in the United States and Austria [6]. Based mostly on these modifications, an update of the BAROS was published in the Journal [7]. Understandably, most of the studies that used the system had used the older version, now obsolete. The updated BAROS should be the 1 used, with the first quality of life questionnaire administered before the surgery and subsequently at least yearly thereafter.

Another problem encountered in publications is the reporting of the average final point score and then the outcome categories, without individually presenting the subtotals for each domain and the deductions for complications and reoperations [8], [9], [10]. Without this information, the reader is not able to discern the effects of the operation and the consequences it might cause. For example, a very invasive technique might produce good results in weight loss and the control of medical conditions, but at the expense of a diminished quality of life and with a significant number of complications or reinterventions, such as was shown by Marinari et al. [11]. Good studies using the BAROS do exist, although some of them have a short follow-up [12], [13], [14], [15], [16], [17].

As a reminder, the BAROS includes a modified scoring key to define the outcomes in patients without co-morbidities, or in whom the quality of life was not studied [1]. In addition, patients lost to follow-up and patients who have died should be excluded from the analysis, and the percentage of patients followed up should be stated for each period. Moreover, surveillance longer than 3–5 years is recommended before publishing the results of bariatric surgery, because of the possible weight regain and the subsequent negative changes in obesity-related diseases and quality of life in this population [18].

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References 

  1. Oria HE , Moorehead MK . Bariatric analysis and reporting outcome system (BAROS) . Obes Surg . 1998;8:487–499
  2. Himpens J , Cadière G-B , Bazi M , Vouche M , Cadière B , Dapri G . Long-term outcomes of laparoscopic adjustable gastric banding . Arch Surg . 2011;146:802–807
  3. Blanco-Engert R , Weiner S , Pomhoff I , Matkowitz R , Weiner RA . Outcome after laparoscopic adjustable gastric banding, using the Lap-BandR and the HeliogastR band: a prospective randomized study . Obes Surg . 2003;13:776–779
  4. Lanthaler M , Sieb M , Strasser S , Weiss H , Aigner F , Nehoda H . Disappointing mid-term results after laparoscopic gastric banding in young patients . Surg Obes Relat Dis . 2009;5:218–223
  5. Oria HE . The BAROS and the Moorehead-Ardelt Quality of Life Questionnaire II . Obes Surg . 2003;13:965
  6. Moorehead MK , Ardelt-Gattinger E , Lechner E , Oria HE . The validation of the Moorehead-Ardelt Quality of Life Questionnaire . Obes Surg . 2003;13:684–692
  7. Oria HE , Moorehead MK . Updated Bariatric Analysis and Reporting Outcome System (BAROS) . Surg Obes Relat Dis . 2009;5:60–66
  8. Collins J , Mattar S , Qureshi F , et al.  Initial outcomes of laparoscopic Roux-en-Y gastric bypass in morbidly obese adolescents . Surg Obes Relat Dis . 2007;3:147–152
  9. Al Harakeh AB , Larson CJ , Mathiason MA , Kallies KJ , Kothari SN . BAROS results in 700 patients after laparoscopic Roux-en-Y gastric bypass with subset analysis of age, gender and initial body mass index . Surg Obes Relat Dis . 2011;7:94–98
  10. Campos GM , Rabl C , Roll GR , et al.  Better weight loss, resolution of diabetes and quality of life for laparoscopic gastric bypass vs. banding . Arch Surg . 2011;146:149–153
  11. Marinari GM , Murelli F , Camerini G , et al.  A 15-year evaluation of biliopancreatic diversion according to the Bariatric Analysis Reporting Outcome System (BAROS) . Obes Surg . 2004;14:325–328
  12. Martikainen T , Pirinen E , Alhava E , et al.  Long-term results, late complications and quality of life in a series of adjustable gastric banding . Obes Surg . 2004;14:648–654
  13. Farkas DT , Vemulapalli P , Haider A , Lopes JM , Gibbs KE , Teixeira JA . Laparoscopic Roux-en-Y gastric bypass is safe and effective in patients with a BMI >60 . Obes Surg . 2005;15:486–493
  14. Branson R , Potoczna N , Brunotte R , et al.  Impact of age, sex and body mass index on outcomes at four years after gastric banding . Obes Surg . 2005;15:834–842
  15. Brounts LR , Lesperance K , Lehmann R , et al.  Resectional gastric bypass outcomes in active duty soldiers: a retrospective review . Surg Obes Relat Dis . 2009;5:657–661
  16. Steffen R , Potoczna N , Bieri N , Horber FF . Successful multi-intervention treatment of severe obesity: a 7-year prospective study with 96% follow-up . Obes Surg . 2009;19:3–12
  17. Todkar JS , Shah SS , Shah PS , Gangwani J . Long-term effects of laparoscopic sleeve gastrectomy in morbidly obese subjects with type 2 diabetes mellitus . Surg Obes Relat Dis . 2010;6:142–145
  18. Oria HE . Long-term follow-up and evaluation of results in bariatric surgery . In:  Buchwald H ,  Cowan GSM ,  Pories W editor. Surgical Management of Obesity . Philadelphia: WB Saunders-Elsevier; 2006;p. 345–356

PII: S1550-7289(11)00702-7

doi:10.1016/j.soard.2011.09.018

Surgery for Obesity and Related Diseases
Volume 8, Issue 1 , Pages 130-131, January 2012

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