Oliver A Varban1, Aaron J Bonham2, Jonathan F Finks3, Dana A Telem4, Nabeel R Obeid3, Amir A Ghaferi4. 1. Department of Surgery, Michigan Medicine, University of Michigan Hospital, Ann Arbor, Michigan. Electronic address: ovarban@med.umich.edu. 2. Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan. 3. Department of Surgery, Michigan Medicine, University of Michigan Hospital, Ann Arbor, Michigan. 4. Department of Surgery, Michigan Medicine, University of Michigan Hospital, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
Abstract
BACKGROUND: Criteria for undergoing sleeve gastrectomy (SG) is restricted among patients with a body mass index (BMI) <35 kg/m2. OBJECTIVES: To determine if low-BMI patients experience similar health benefits after SG compared with patients with a BMI ≥35 kg/m2. SETTING: Teaching and nonteaching hospitals in Michigan. METHODS: Patients with a BMI <35 kg/m2 at the time of primary SG were identified between 2006 and 2018 (n = 1073, 2.4%). Patient characteristics, 30-day risk-adjusted complication rates, and patient reported outcomes were compared with all patients who underwent SG with a BMI ≥35 kg/m2 (n = 44,511, mean BMI 46.7 kg/m2). RESULTS: Low-BMI patients were more likely to be older (50.7 versus 45.4 yr, P < .0001), have diabetes (36.7 versus 30.9%, P < .0001), hypertension (54.2% versus 51.0%, P = .0372), and hyperlipidemia (57.1% versus 44.8%, P < .0001). Both groups had comparable rates of discontinuation of medications for hypertension (59.7% versus 54.1%, P = .0570), hyperlipidemia (54.3% versus 52.2%, P = .5537), and diabetes (oral, 79.2% versus 78.1%, P = .7294; insulin, 64.2% versus 62.2%, P = .7438). However, low-BMI patients were more likely to achieve a healthy BMI (i.e., BMI ≤25 kg/m2; 36.3% versus 6.01%, P < .0001), and had higher body image scores (50.6 versus 42.4, P < .0001). CONCLUSIONS: Despite being older and with higher rates of metabolic disease, low-BMI patients reported high-resolution rates for diabetes, hypertension, and hyperlipidemia (>50%) and were more likely to achieve a healthy weight after SG. Abolishing the BMI threshold for SG among patients with metabolic disease should be considered.
BACKGROUND: Criteria for undergoing sleeve gastrectomy (SG) is restricted among patients with a body mass index (BMI) <35 kg/m2. OBJECTIVES: To determine if low-BMI patients experience similar health benefits after SG compared with patients with a BMI ≥35 kg/m2. SETTING: Teaching and nonteaching hospitals in Michigan. METHODS:Patients with a BMI <35 kg/m2 at the time of primary SG were identified between 2006 and 2018 (n = 1073, 2.4%). Patient characteristics, 30-day risk-adjusted complication rates, and patient reported outcomes were compared with all patients who underwent SG with a BMI ≥35 kg/m2 (n = 44,511, mean BMI 46.7 kg/m2). RESULTS: Low-BMI patients were more likely to be older (50.7 versus 45.4 yr, P < .0001), have diabetes (36.7 versus 30.9%, P < .0001), hypertension (54.2% versus 51.0%, P = .0372), and hyperlipidemia (57.1% versus 44.8%, P < .0001). Both groups had comparable rates of discontinuation of medications for hypertension (59.7% versus 54.1%, P = .0570), hyperlipidemia (54.3% versus 52.2%, P = .5537), and diabetes (oral, 79.2% versus 78.1%, P = .7294; insulin, 64.2% versus 62.2%, P = .7438). However, low-BMI patients were more likely to achieve a healthy BMI (i.e., BMI ≤25 kg/m2; 36.3% versus 6.01%, P < .0001), and had higher body image scores (50.6 versus 42.4, P < .0001). CONCLUSIONS: Despite being older and with higher rates of metabolic disease, low-BMI patients reported high-resolution rates for diabetes, hypertension, and hyperlipidemia (>50%) and were more likely to achieve a healthy weight after SG. Abolishing the BMI threshold for SG among patients with metabolic disease should be considered.