Patient Selection and Surgical Management of High-Risk Patients with Morbid Obesity

Guerrón, Alfredo D.; Portenier, Dana

doi:10.1016/j.suc.2016.03.009

Cited by 13 publications

(6 citation statements)

References 109 publications

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“…Although they have not been shown to be a significant predictor of EBWL at 1 year, they do predict increased length of stay in hospital. Using one of these systems in the preoperative assessment clinic may support clinicians in identifying patients who may benefit from admission to the PACU (Daniel Guerron and Portenier 2016 ) or more intensive after-care pathways, including physiotherapy and occupational therapy. Preoperative optimization of these patients, or pre-habilitation, may be also of benefit to this demographic as it can improve physical fitness, which can help to improve outcomes (West et al 2015 ; Bond et al 2015 ).…”

Section: Discussionmentioning

confidence: 99%

“…The OS-MRS uses a binary point scoring system based on five variables to stratify patients into three main groups (DeMaria et al 2007 ). It is currently the most commonly used risk stratification tool for bariatric surgery (Daniel Guerron and Portenier 2016 ) and has been shown to be a useful tool for morbidity prediction as well (Lorente et al 2014 ; Pinho et al 2015 ).…”

Section: Methodsmentioning

confidence: 99%

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The evaluation of risk prediction models in predicting outcomes after bariatric surgery: a prospective observational cohort pilot study

2018

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BackgroundAs the prevalence of obesity is increasing, the number of patients requiring surgical intervention for obesity-related illness is also rising. The aim of this pilot study was to explore predictors of short-term morbidity and longer-term poor weight loss after bariatric surgery.MethodsThis was a single-centre prospective observational cohort pilot study in patients undergoing bariatric surgery. We assessed the accuracy (discrimination and calibration) of two previously validated risk prediction models (the Physiological and Operative Severity Score for the enumeration of Morbidity and Mortality, POSSUM score, and the Obesity Surgical Mortality Risk Score, OS-MS) for postoperative outcome (postoperative morbidity defined using the Post Operative Morbidity Survey). We then tested the relationship between postoperative morbidity and longer-term weight loss outcome adjusting for known patient risk factors.ResultsComplete data were collected on 197 patients who underwent surgery for obesity or obesity-related illnesses between March 2010 and September 2013. Results showed POSSUM and OS-MRS were less accurate at predicting Post Operative Morbidity Survey (POMS)-defined morbidity on day 3 than defining prolonged length of stay due to poor mobility and/or POMS-defined morbidity. Having fewer than 28 days alive and out of hospital within 30 days of surgery was predictive of poor weight loss at 1 year, independent of POSSUM-defined risk (odds ratio 2.6; 95% confidence interval 1.28–5.24).ConclusionsPOSSUM may be used to predict patients who will have prolonged postoperative LOS after bariatric surgery due to morbidity or poor mobility. However, independent of POSSUM score, having less than 28 days alive and out of hospital predicted poor weight loss outcome at 1 year. This adds to the literature that postoperative complications are independently associated with poor longer-term surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

The evaluation of risk prediction models in predicting outcomes after bariatric surgery: a prospective observational cohort pilot study

2018

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“…An alternative approach to achieve weight loss is bariatric surgery which has been shown to result in potentially massive weight losses and is now advocated by some professional societies as a best practice option for the morbidly obese with comorbidities such as diabetes . However, the benefits of bariatric surgery are often unclear for women seeking fertility, since it is generally advised that pregnancy should be delayed for 18–24 months to allow for maximal weight loss .…”

Section: Critique Of the Arguments Supporting Restricting Access To Amentioning

confidence: 99%

“…Advocates of preconception bariatric surgery also need to consider the potential harms to mother and child. Mortality rates from complications of surgery are estimated as one in 500 in the metabolically healthy obese women, and may exceed 1% in the morbidly obese patient with co‐morbidities . Furthermore, bariatric surgery increases the risk of intra‐uterine growth restriction (IUGR), a disorder known to potentially produce fetal programing and adult‐onset disease, plus increase the risk of stillbirth and neonatal death .…”

Section: Critique Of the Arguments Supporting Restricting Access To Amentioning

confidence: 99%

Should obese women's access to assisted fertility treatment be limited? A scientific and ethical analysis

Tremellen

Wilkinson

Savulescu

2017

Aust NZ J Obst Gynaeco

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Obesity is associated with a reduction in fertility treatment success and increased risks to mother and child. Therefore guidelines of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) suggest that a body mass index exceeding 35 kg/m should be an absolute contraindication to assisted fertility treatment such as in vitro fertilisation IVF. In this paper we challenge the ethical and scientific basis for such a ban. Livebirth rates for severely obese women are reduced by up to 30%, but this result is still far better than that observed for many older women who are allowed access to IVF. This prohibition is particularly unjust when IVF is the only treatment capable of producing a pregnancy, such as bilateral tubal blockage or severe male factor infertility. Furthermore, the absolute magnitude of risks to mother or child is relatively small, and while a woman has a right to be educated about these risks, she alone should be allowed to make a decision on proceeding with treatment. We do not prohibit adults from engaging in dangerous sports, nor do we force parents to vaccinate their children, despite the risks. Similarly, we should not prohibit obese women from becoming parents because of increased risk to themselves or their child. Finally, prohibiting obese women's access to IVF to prevent potential harms such as 'fetal programing' is questionable, especially when compared to that child never being born at all. As such, we believe the RANZCOG ban on severely obese women's access to assisted reproductive treatment is unwarranted and should be revised.

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“…Additionally, they undergo standardized physiologic and psychologic preoperative evaluations to increase the likelihood of successful weight loss and maintenance and to minimize perioperative complications. 12 13 14 Bariatric operations are well structured, with established maneuvers and expectations. 15 The high demand of such surgery combined with the relatively low perioperative complication rates are features that might favor their being performed concurrently or in an overlapping fashion.…”

Section: Introductionmentioning

confidence: 99%

Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study

Liu

Ban

Berian

et al. 2017

BMJ

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Objective To determine whether perioperative outcomes differ between patients undergoing concurrent compared with non-concurrent bariatric operations in the USA. Design Retrospective, propensity score matched cohort study. Setting Hospitals in the US accredited by the American College of Surgeons’ metabolic and bariatric surgery accreditation and quality improvement program. Participants 513 167 patients undergoing bariatric operations between 1 January 2014 and 31 December 2016. Main outcome measures The primary outcome measure was a composite of 30 day death, morbidity, readmission, reoperation, anastomotic or staple line leak, and bleeding events. Operative duration and lengths of stay were also assessed. Operations were defined as concurrent if they overlapped by 60 or more minutes or in their entirety. Results In this study of 513 167 operations, 739 (29.5%) surgeons at 483 (57.8%) hospitals performed 6087 (1.2%) concurrent operations. The most frequently performed concurrent bariatric operations were sleeve gastrectomy (n=3250, 53.4%) and Roux-en-Y gastric bypass (n=1601, 26.3%). Concurrent operations were more often performed at large academic medical centers with higher operative volumes and numbers of trainees and by higher volume surgeons. Compared with non-concurrent operations, concurrent operations lasted a median of 34 minutes longer (P<0.001) and resulted in 0.3 days longer average length of stay (P<0.001). Perioperative adverse events were not observed to more likely occur in concurrent compared with non-concurrent operations (7.5% v 7.4%; relative risk 1.02, 95% confidence interval 0.90 to 1.15; P=0.84). Conclusions Concurrent bariatric operations occurred infrequently, but when they did, there was no observable increased risk for adverse perioperative outcomes compared with non-concurrent operations. These results, however, do not argue against improved and more meaningful disclosure of concurrent surgery practices.

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Patient Selection and Surgical Management of High-Risk Patients with Morbid Obesity

Cited by 13 publications

References 109 publications

The evaluation of risk prediction models in predicting outcomes after bariatric surgery: a prospective observational cohort pilot study

The evaluation of risk prediction models in predicting outcomes after bariatric surgery: a prospective observational cohort pilot study

Should obese women's access to assisted fertility treatment be limited? A scientific and ethical analysis

Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study

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