Original article| Volume 14, ISSUE 6, P842-848, June 2018

Preoperative immobility significantly impacts the risk of postoperative complications in bariatric surgery patients



      Preoperative immobility in general surgery patients has been associated with an increased risk of postoperative complications. It is unknown if immobility affects bariatric surgery outcomes.


      The aim of this study was to determine the impact of immobility on 30-day postoperative bariatric surgery outcomes.


      This study took place at a university hospital in the United States.


      The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 data set was queried for primary minimally invasive bariatric procedures. Preoperative immobility was defined as limited ambulation most or all the time. Logistic regression analysis was performed to determine if immobile patients are at increased risk (odds ratio [OR]) for 30-day complications.


      There were 148,710 primary minimally invasive bariatric procedures in 2015. Immobile patients had an increased risk of mortality (OR 4.59, P<.001) and greater operative times, length of stay, reoperation rates, and readmissions. Immobile patients had a greater risk of multiple complications, including acute renal failure (OR 6.42, P<.001), pulmonary embolism (OR 2.44, P = .01), cardiac arrest (OR 2.81, P = .05), and septic shock (OR 2.78, P = .02). Regardless of procedure type, immobile patients had a higher incidence of perioperative morbidity compared with ambulatory patients.


      This study is the first to specifically assess the impact of immobility on 30-day bariatric surgery outcomes. Immobile patients have a significantly increased risk of morbidity and mortality. This study provides an opportunity for the development of multiple quality initiatives to improve the safety and perioperative complication profile for immobile patients undergoing bariatric surgery.


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        • Pashikanti L.
        • Von Ah D.
        Impact of early mobilization protocol on the medical-surgical inpatient population.
        Clin Nurse Spec. 2012; 26: 87-94
        • Scarborough J.E.
        • Bennett K.M.
        • Englum B.R.
        • et al.
        The impact of functional dependency on outcomes after complex general and vascular surgery.
        Ann Surg. 2015; 261: 432-437
        • Gupta P.K.
        • Franck C.
        • Miller W.J.
        • et al.
        Development and validation of a bariatric surgery morbidity risk calculator using the prospective, multicenter NSQIP dataset.
        J Am Coll Surg. 2011; 212: 301-309
      1. American College of Surgeons National Surgical Quality Improvement Program 2014 Participant Data Use File (PUF). Available from: [Accessed September 5, 2017].

        • Blackstone R.P.
        • Cortes M.C.
        Metabolic acuity score: effect on major complications after bariatric surgery.
        Surg Obes Relat Dis. 2010; 6: 267-273
        • DeMaria E.J.
        • Portenier D.
        • Wolfe L.
        Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass.
        Surg Obes Relat Dis. 2007; 3: 134-140
        • Arterburn D.
        • Johnson E.S.
        • Butler M.G.
        • et al.
        Predicting 90-day mortality after bariatric surgery: an independent, external validation of the OS-MRS prognostic risk score.
        Surg Obes Relat Dis. 2014; 10: 774-779
        • DeMaria E.J.
        • Murr M.
        • Byrne T.K.
        • et al.
        Validation of the obesity surgery mortality risk score in a multicenter study proves it stratifies mortality risk in patients undergoing gastric bypass for morbid obesity.
        Ann Surg. 2007; 246: 235-241
        • Wynter-Blythe V.
        • Moorthy K.
        Prehabilitation: preparing patients for surgery.
        BMJ. 2017; 358: j3702
        • Shanahan J.L.
        • Leissner K.B.
        Prehabilitation for the ERAS patient.
        J Laparoendosc Adv Surg Tech A. 2017; 27: 880-882
        • Garcia R.S.
        • Yanez-Brage M.I.
        • Moolhuyzen E.G.
        • et al.
        Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial.
        Clinc Rehabil. 2016; 31: 1057-1067
        • Turk Y.
        • van Huisstede A.
        • Hiemstra P.S.
        • et al.
        Pre-surgical pulmonary rehabilitation in asthma patients undergoing bariatric surgery.
        Obes Surg. 2017; 27: 3055-3060
        • Valkenet K.
        • van de Port I.G.
        • Dronkers J.J.
        • et al.
        The effects of preoperative exercise therapy on postoperative outcome: a systematic review.
        Clinc Rehabil. 2011; 25: 99-111
        • Barberan-Garcia A.
        • Ubre M.
        • Roca J.
        • et al.
        Personalized prehabilitation in high-risk patients undergoing elective major abdominal surgery.
        Ann Surg. 2017; 67: 50-56
        • Gillis C.
        • Li C.
        • Lee L.
        • et al.
        Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer.
        Anesthesiology. 2014; 121: 937-947
        • Baillot A.
        • Mampuya W.M.
        • Comeau E.
        • et al.
        Feasibility and impacts of supervised exercise training on subjects with obesity awaiting bariatric surgery: a pilot study.
        Obes Surg. 2013; 23: 882-891
        • Baillot A.
        • Mampuya W.M.
        • Comeau E.
        • et al.
        Impacts of supervised exercise training in addition to interdisciplinary lifestyle management in subjects awaiting bariatric surgery: a randomized controlled study.
        Obes Surg. 2016; 26: 2602-2610
        • Aminian A.
        • Andalib A.
        • Khorgami Z.
        • et al.
        Who should get extended thromboprophylaxis after bariatric surgery?.
        Ann Surg. 2017; 265: 143-150
        • Raftopoulos I.
        • Martindale C.
        • Cronin A.
        • Steinberg J.
        The effect of extended post-discharge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial.
        Surg Endosc. 2008; 22: 2384-2391