Abstract
Background
Bariatric surgery offers patients short- and long-term benefits to their health and
quality of life. Currently, we see more patients with superior body mass index (BMI)
looking for these benefits. Evidence-based medicine is integral in the evaluation
of risks versus benefit; however, data are lacking in this high-risk population.
Objectives
To assess the morbidity and mortality of patients with BMI ≥70 undergoing bariatric
surgery.
Setting
University Hospital, Bronx, New York, United States using national database.
Methods
Using the American College of Surgeons-National Surgical Quality Improvement Project
(ACS-NSQIP) database for years 2005 to 2016, we identified patients who underwent
primary laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass.
Patients with BMI ≥70 were assigned to the BMI >70 (BMI70+) cohort and less obese
patients were assigned to the BMI <70 (U70) cohort. Length of stay and 30-day morbidity
and mortality were compared.
Results
A total of 163,413 patients underwent non-revisional bariatric surgery. Of those,
2322 had a BMI ≥70. BMI70+ was associated with increased mortality (.4% versus .1%,
P = .0001), deep vein thrombosis (.6% versus .3%, P = .007), pulmonary (1.9% versus .5%, P = .0001), renal (.9% versus .2%, P = .0001), and infectious complications (1.1% versus .4%, P = .0001). BMI70+ patients had longer mean length of stay (2.6 versus 2.1 d, P = .0001) and operative time (126.1 versus 114.5 min, P = .0001). There was no statistically significant difference in the number of myocardial
infarctions (.1% versus .1%, P = .319), pulmonary embolisms (.3% versus .2%, P = .596), and transfusion requirements (.1% versus .1%, P = .105) between groups.
Conclusions
Evaluation of risk and benefit is performed on a case-by-case basis, but evidence-based
medicine is critical in empowering surgeons and patients to make informed decisions.
The overall rate of morbidity and mortality for BMI70+ patients undergoing bariatric
surgery was increased over U70 patients but was still relatively low. Our study will
allow surgeons to incorporate objective data into their assessment of risk for super-obese
patients pursuing bariatric surgery.
Key words
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Article info
Publication history
Published online: April 02, 2020
Accepted:
March 15,
2020
Received:
November 25,
2019
Identification
Copyright
© 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
