Prabin Sharma1,2, Thomas R McCarty1, Siddhartha Yadav3, Julius N Ngu4, Basile Njei5. 1. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. 2. Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA. 3. Hematology-Oncology Fellowship Program, Mayo Clinic, Rochester, MN, USA. 4. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA. 5. Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA. basile.njei@yale.edu.
Abstract
BACKGROUND: With advances in disease-specific treatments and improved overall survival, obesity rates are rising among patients with sickle cell disease (SCD). The primary aim of this study was to evaluate the role of bariatric surgery on clinical outcomes among hospitalized obese patients with SCD. METHODS: The United States Nationwide Inpatient Sample database was queried between 2004 and 2014 for discharges with co-diagnoses of morbid obesity and SCD. The primary outcome was in-hospital mortality. Secondary outcomes included vaso-occlusive crisis, acute chest syndrome, biliary-pancreatic complications, renal failure, urinary tract infection, malnutrition, sepsis, pneumonia, respiratory failure, thromboembolic events, strictures, wound infection, length of stay, and hospitalization costs. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior-bariatric surgery compared to those without bariatric surgery. RESULTS: Among 2549 patients with a discharge diagnosis of SCD and morbid obesity, only 42 patients (1.7%) had bariatric surgery. On multivariable analysis, bariatric surgery did not influence mortality (P = 0.98). Bariatric surgery was not associated with increased risk for acute chest syndrome, sepsis, multi-organ failure, biliary-pancreatic, or surgery-related complications (all P > 0.05). Interestingly, bariatric surgery decreased risk of vaso-occlusive crises (IRR 0.21; 95% CI, 0.07-0.69; P = 0.01) in these patients and was associated with a shorter length of stay (P < 0.001) but higher hospitalization costs (P < 0.001). CONCLUSIONS: Bariatric surgery may lower rates of vaso-occlusive crises in morbidly obese sickle cell patients without significantly affecting mortality and other adverse outcomes. In spite of this, these weight loss surgeries are underutilized in this select population.
BACKGROUND: With advances in disease-specific treatments and improved overall survival, obesity rates are rising among patients with sickle cell disease (SCD). The primary aim of this study was to evaluate the role of bariatric surgery on clinical outcomes among hospitalized obesepatients with SCD. METHODS: The United States Nationwide Inpatient Sample database was queried between 2004 and 2014 for discharges with co-diagnoses of morbid obesity and SCD. The primary outcome was in-hospital mortality. Secondary outcomes included vaso-occlusive crisis, acute chest syndrome, biliary-pancreatic complications, renal failure, urinary tract infection, malnutrition, sepsis, pneumonia, respiratory failure, thromboembolic events, strictures, wound infection, length of stay, and hospitalization costs. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior-bariatric surgery compared to those without bariatric surgery. RESULTS: Among 2549 patients with a discharge diagnosis of SCD and morbid obesity, only 42 patients (1.7%) had bariatric surgery. On multivariable analysis, bariatric surgery did not influence mortality (P = 0.98). Bariatric surgery was not associated with increased risk for acute chest syndrome, sepsis, multi-organ failure, biliary-pancreatic, or surgery-related complications (all P > 0.05). Interestingly, bariatric surgery decreased risk of vaso-occlusive crises (IRR 0.21; 95% CI, 0.07-0.69; P = 0.01) in these patients and was associated with a shorter length of stay (P < 0.001) but higher hospitalization costs (P < 0.001). CONCLUSIONS: Bariatric surgery may lower rates of vaso-occlusive crises in morbidly obese sickle cell patients without significantly affecting mortality and other adverse outcomes. In spite of this, these weight loss surgeries are underutilized in this select population.
Authors: Lars Sjöström; Kristina Narbro; C David Sjöström; Kristjan Karason; Bo Larsson; Hans Wedel; Ted Lystig; Marianne Sullivan; Claude Bouchard; Björn Carlsson; Calle Bengtsson; Sven Dahlgren; Anders Gummesson; Peter Jacobson; Jan Karlsson; Anna-Karin Lindroos; Hans Lönroth; Ingmar Näslund; Torsten Olbers; Kaj Stenlöf; Jarl Torgerson; Göran Agren; Lena M S Carlsson Journal: N Engl J Med Date: 2007-08-23 Impact factor: 91.245