Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy in the Super-Obese and Super-Super-Obese: An Analysis of the Metabloic and Bariatric Surgery Accreditation and Quality Improvement Program Database
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Resident PGY 3
Henry Ford Hospital
Background: With the increase in the prevalence of obesity and the need for bariatric surgery, there continues to be contradictory evidence for the perioperative outcomes of super-obese (SO) and super-super-obese (SSO) patients. The purpose of this is study is to investigate 30-day morbidity and mortality following laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in SO and SSO patients using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.
Methods: All patients undergoing LSG and LRYGB between the years 2015 and 2017 in the MBSAQIP database were identified. Patients were divided into three groups based on body mass index (BMI): obese (BMI 35 – 50 kg/m2), SO (BMI 50 – 60 kg/m2), and SSO (BMI ≥ 60 kg/m2). Primary outcomes included the occurrence of any complication or mortality. Secondary outcomes included readmission, reoperation, renal events, cardiac events, respiratory events, unplanned intensive care admission, surgical site infections, venous thromboembolic events, transfusion, and reintervention. These were compared between the BMI groups using Pearson X2 test or Fischer’s exact test. Multivariate logistic regression was then used to adjust for demographics, co-morbidities, and operative variables and adjusted odds ratio (AOR) was reported for each outcome.
Results: A total of 356,621 patients met inclusion criteria: 71.6% LSG and 28.4% LRYGB. SSO and SO groups was associated with marginally longer operative times and conversion to open. Higher BMI was associated with increased overall morbidity and mortality. The overall complication rate was significantly higher for the SO group (AOR = 1.20 for LSG; AOR = 1.08 for LRYGB) and SSO group (AOR = 1.44 for LSG; AOR = 1.31 for LRYGB). Mortality rate was also significantly higher for the SO group (AOR = 1.65 for LSG; AOR = 1.85 for LRYGB) and SSO group (AOR = 3.30 for LSG; AOR = 3.32 for LRYGB).
Conclusion: SO and SSO patients are at increased risk of 30-day morbidity and mortality compared to patients with BMI ≤ 50 kg/m2. Despite this statistically significant increase, the risks remain low and acceptable especially that bariatric surgery is the only reliable treatment option for obesity.
Nasser, Hassan; Ivanics, Tommy; Leonard-Murali, Shravan; Shakaroun, Dania; and Genaw, Jeffrey A., "Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy in the Super-Obese and Super-Super-Obese: An Analysis of the Metabloic and Bariatric Surgery Accreditation and Quality Improvement Program Database" (2019). Clinical Research. 50.