Evaluation of risk factors in superobese patients submitted to conventional Fobi-Capella surgery

Abstract

-Background -Obesity is one of the world's greatest health problems. The Roux-en-Y gastric bypass is the gold standard treatment for severe obesity. Surgery in obese patients has an acceptable level of morbidity and mortality. The superobese patient, a subcategory of severe obese patients with a high surgical risk has not yet been analyzed as a group. Methods -A retrospective and prospective cohort study was conducted enrolling 135 patients submitted to Roux-en-Y gastric bypass for treatment of severe obesity at the "Hospital das Clínicas", Federal University of Pernambuco, Recife, PE, Brazil, between November 1997 and September 2003. The independent variables were possible risk factors of adverse outcomes: age, gender, weight, body mass index, diabetes, hypertension, hypercholesterolemia, sleep apnea, cardiopathy/coronariopathy, pneumopathy or any other co-morbidity. The dependent variables were major complications, minor complications and death. Results -Diabetes (RR = 1.6 and CI = 1.02-2.40) and sleep apnea (RR = 1.8 and CI = 1.18-2.64) were associated to minor complications. Cardiopathy/coronariopathy were associated with major complications (RR = 5.42 and CI = 1.22-2.40) and death (RR = 16.25 and CI = 3.00-87.95). BMI ≥55 kg/m 2 was associated with minor complications (RR = 1.58 and CI = 1.04-2.40), major complications (RR = 3.17 and CI = 1.03-9.80) and death (P = 0.007). After logistic regression, the body mass index ≥55 kg/m 2 remained as a strong risk factor of death (OR = 3.6 and CI = 1.05-12.32). Conclusions -The body mass index ≥55 kg/m 2 was the main risk factor for severe complications and death. Other risk factors affecting the outcome were diabetes, obstructive sleep apnea and cardiopathy/coronariopathy.

Early Complications in Bariatric Surgery:

“…While the routine use of gastrostomy is questionable, its presence can be of great value in maintaining a nutritional route in cases involving fistulas and as a means of decompression in cases of intestinal obstruction, especially when there is a high prevalence of comorbidities and therefore a greater risk for complications. The deep surgical wound infections had a similar incidence to that reported in the literature for open or conventional surgery (10,13) . Given the increasing trend of performing bariatric surgery through videolaparoscopy, the incidence of this complication is currently decreasing.…”

“…The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities (such as diabetes, arterial hypertension, and sleep apnea), as well as the difficulty in making an early diagnosis of the complications (due to limitations of the clinical abdominal workup and imaging methods, such as ultrasonography and computed tomography, particularly in highly obese patients with body mass indices >50 kg/m²), these patients require special attention in the early post-operative follow-up (3,10) . Pulmonary thromboembolism, a complication associated with bariatric surgery, also requires greater attention from the medical team given the high mortality rate associated with this condition (14) .…”

Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by american association of clinical endocrinologists, The obesity society, and american society for metabolic & bariatric surgery*

“…More liberal targets may be used based on clinical judgment. Risk factors contributing to complications and death after RYGB include T2D, in addition to BMI ≥55 kg/m 2 (main factor), obstructive sleep apnea, and cardiomyopathy (155 EL 2, PCS). Among 468 patients undergoing RYGB, elevated preoperative A 1c was associated with elevated postoperative hyperglycemia.…”

Obesidade mórbida: controle dos riscos

“…No artigo publicado neste número dos ARQUIVOS de GASTROENTEROLOGIA (4) , oriundo de um dos principais centros de cirurgia bariátrica do país, objetiva-se a identificação de fatores de risco para complicações pós-operatórias. Destacase a maior relevância do trabalho se considerarmos, ainda, a alta prevalência da obesidade em níveis mais elevados, super-obesidade, nos serviços públicos de atendimento.…”