The Risk of Post-operative Complications in Super-Super Obesity Compared to Super Obesity in Accredited Bariatric Surgery Centers

Abstract

Background The prevalence of super obesity (SO, BMI > 50.0 kg/m 2) and super-super obesity (SSO, BMI > 60 kg/m 2) is increasing. Current data are limited and discrepant on the relationship between SSO and post-bariatric surgery complication risk. We hypothesized there would be increased complications for both laparoscopic Roux-en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) in SSO compared to SO, but the relative risk (RR) would support the use of LSG in SSO patients. Methods Metabolic and Bariatric Surgery Accreditation and Quality Improvement 2016 data were queried for SO and SSO patients undergoing LRYGB or LSG. Thirty-day post-operative complications were calculated. Univariate analyses were performed with a χ 2 or Student's t test. Comparisons between multiple groups were performed using a one-way ANOVA. Statistical significance was defined as p < 0.05. Results A total of 5723 patients with SSO and 24,940 with SO were included for analysis. Patients with SSO had more comorbidities. Patients with SSO had a higher likelihood of complications compared to SO patients (15.2% vs 12.6%, p < 0.0005). SSO patients, and specifically SSO RYGB, were significantly more likely to experience an unplanned intubation, prolonged ventilation, and unplanned ICU admission. Compared to SO LRYGB, the RR for complications in SSO LRYGB and LGS were 1.19 and 0.76 respectively (p < 0.0005). Discussion We found SSO patients had increased 30-day post-operative complications after both LRYGB and LSG compared to SO patients. LSG may be the preferred procedure for this high-risk population.

The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons

“…This survey found that 72.2% of surgeons favored postoperative prophylactic anticoagulation for at least 2 weeks (up to 6 weeks). This practice is supported by published data by Wilkinson et al [75] and Nasser et al [76], who reported higher incidences of DVT/PTE among patients with BMI superior to 50 kg/m 2 . In addition, Stier et al demonstrated that patients with morbid obesity (at least those with BMI greater than 50 kg/m 2 ) treated with routine prophylactic enoxaparin did not achieve the defined target range for aFXa [77].…”

“…Both studies divided patients into BMI greater than 50 kg/m 2 and BMI greater than 60 kg/ m 2 . Wilkinson et al [75] analyzed the outcomes of over 30,000 patients with BMI over 50 kg/m 2 and Nasser et al [76] analyzed the outcomes of over 85,000 patients BMI over 50 kg/m 2 . Both studies confirmed that the frequency of unplanned ICU care was higher than for patients with severe obesity.…”

Clinical outcomes after one anastomosis gastric bypass versus sleeve gastrectomy in super-super-obese patients

“…Bariatric and metabolic surgery meets wide acceptance with an acceptable perioperative risk profile even in patients with higher perioperative risk profiles. Especially super-super obese (SSO) patients with a Body-Mass-Index (BMI) > 60 kg/m 2 are prone to operation risks and morbidity [1][2][3], caused by difficulties in exposure, a fatty liver, tension on the surgical instruments and co-existing comorbidities [4][5][6]. Therefore, operation time, length of hospital stay, and complication rates have been described to be higher in SSO patients in comparison to patients with a BMI < 60 kg/m 2 [1,3].…”

Current Views on the Use of Bariatric Surgery in Patients with Extreme Obesity

“…После проведения подготовительных мероприятий встаёт вопрос о выборе оптимального метода хирургического лечения. Возможно применение как рестриктивных, так и комбинированных операций, при этом сторонники первого типа вмешательств отмечают меньшие анестезиологические и операционные риски в сравнении с операциями с мальабсорбтивным компонентом [15]. Однако имеются данные, показывающие также меньшее влияние этого типа операций на снижение избыточной массы тела и регресс коморбидной патологии.…”