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Preoperative functional health status is a predictor of short-term postoperative morbidity and mortality after bariatric surgery

Published:February 15, 2019DOI:https://doi.org/10.1016/j.soard.2019.02.004

      Highlights

      • FHS is a predictor of increased morbidity and mortality after bariatric surgery.
      • Quality initiatives are needed to improve outcomes in this patient group.

      Abstract

      Background

      Functional health status (FHS) is the ability to perform activities of daily living without caregiver assistance.

      Objectives

      The primary aim of this study was to determine the impact of impaired preoperative FHS on morbidity and mortality within 30 days of bariatric surgery.

      Setting

      Academic medical center in the United States.

      Methods

      The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 data set was queried for primary minimally invasive bariatric procedures. The demographic characteristics and perioperative details of patients who were functionally independent were compared with patients with impaired FHS. Multivariable logistic regression analysis was performed to determine the odds of developing a perioperative complication or death for patients with impaired functional health.

      Results

      Of patients, 1515 (1.0%) were reported as having impaired FHS and 147,195 patients (99.0%) were independent before surgery. Patients with impaired FHS experienced significantly longer length of hospital stays (2.4 versus 1.8 d; P < .0001), a higher morbidity (adjusted odds ratio 1.5; P <0.0001), and higher mortality (adjusted odds ratio 2.1; P < .0001). Impaired FHS resulted in significantly increased rate of unplanned admissions to the intensive care unit, interventions, reoperations, and readmissions within 30 days of surgery.

      Conclusions

      Patients with impaired FHS preoperatively have a significantly increased risk of short-term morbidity and mortality after bariatric surgery. The results of this study highlight the importance of establishing quality initiatives focused on improving short-term outcomes for patients with impaired functional health status.

      Graphical abstract

      Keywords

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      Linked Article

      • Comment on: Preoperative functional health status as a predictor of short-term postoperative morbidity and mortality following bariatric surgery
        Surgery for Obesity and Related DiseasesVol. 15Issue 5
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          Kathleen L et al. published a comprehensive study regarding functional health status as a better predictor of postoperative morbidity and mortality of bariatric surgery than age alone. Age is a suboptimal predictor for bariatric surgery outcomes, making it important to look for another predictor to carefully select the most optimal candidates for the surgery [1]. Impaired functional status is associated with increased postoperative morbidities including venous thromboembolism and gastrointestinal leak [2–4], urging the development of customized advice for people with functional status impairment as they need to be warned about potential adverse outcomes and additional risks.
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