Anastasios T Mitsakos1,2, William Irish3, Eric J DeMaria4, Walter J Pories3, Maria S Altieri5. 1. Division of Metabolic and Minimally Invasive Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA. mitsakosa17@ecu.edu. 2. Department of Surgery, Vidant Medical Center, East Carolina University Brody School of Medicine, 2100 Stantonsburg Road, Greenville, NC, 27834, USA. mitsakosa17@ecu.edu. 3. Division of Surgical Research, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA. 4. Division of Metabolic and Minimally Invasive Surgery, Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA. 5. Department of Surgery, Section of GI Surgery, Pennsylvania Hospital/University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: Prior literature has demonstrated that bariatric surgery is a safe approach for patients with morbid obesity. However, the relationship between body mass index (BMI) and risk of mortality in these patients has not been fully elucidated. Primary objective of this study was to evaluate the relationship between BMI and risk of mortality using data obtained from a national database, with a special focus on patients with BMI ≥ 70.0 kg/m2. METHODS: A retrospective cohort study of patients with morbid obesity (BMI ≥ 40 kg/m2) undergoing first-time bariatric surgery between 2015 and 2018 was performed using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Primary outcome was intra-operative death or death within 30 days post-operatively. Patients were categorized into quartiles according to BMI. Multivariable analysis was performed to evaluate the association of BMI with risk of mortality. Relative risk (RR) and 95% confidence interval (CI) are provided as measures of strength of association and precision, respectively. RESULTS: A total of 463, 436 patients were included with a 30-day mortality rate of 0.11%. Mean BMI (SD) was 48.2 (7.3) kg/m2; 1.5% of patients had BMI ≥ 70.0 kg/m2. On multivariable analysis, highest quartile patients had a significantly higher risk of mortality than lowest quartile patients. For patients with BMI ≥ 70.0 kg/m2, the risk of mortality was more pronounced with an eightfold increase compared to the lowest quartile. In patients with BMI ≥ 70.0 kg/m2, although sleeve gastrectomy (SG) was the most common procedure, the risk of mortality was significantly higher in patients undergoing Roux-en-Y gastric bypass (RYGB). CONCLUSIONS: BMI is associated with increased risk of 30-day mortality. The effect of BMI is more pronounced in patients with BMI ≥ 70.0 kg/m2. In these patients, RYGB is associated with increased risk of mortality compared to SG.
BACKGROUND: Prior literature has demonstrated that bariatric surgery is a safe approach for patients with morbid obesity. However, the relationship between body mass index (BMI) and risk of mortality in these patients has not been fully elucidated. Primary objective of this study was to evaluate the relationship between BMI and risk of mortality using data obtained from a national database, with a special focus on patients with BMI ≥ 70.0 kg/m2. METHODS: A retrospective cohort study of patients with morbid obesity (BMI ≥ 40 kg/m2) undergoing first-time bariatric surgery between 2015 and 2018 was performed using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Primary outcome was intra-operative death or death within 30 days post-operatively. Patients were categorized into quartiles according to BMI. Multivariable analysis was performed to evaluate the association of BMI with risk of mortality. Relative risk (RR) and 95% confidence interval (CI) are provided as measures of strength of association and precision, respectively. RESULTS: A total of 463, 436 patients were included with a 30-day mortality rate of 0.11%. Mean BMI (SD) was 48.2 (7.3) kg/m2; 1.5% of patients had BMI ≥ 70.0 kg/m2. On multivariable analysis, highest quartile patients had a significantly higher risk of mortality than lowest quartile patients. For patients with BMI ≥ 70.0 kg/m2, the risk of mortality was more pronounced with an eightfold increase compared to the lowest quartile. In patients with BMI ≥ 70.0 kg/m2, although sleeve gastrectomy (SG) was the most common procedure, the risk of mortality was significantly higher in patients undergoing Roux-en-Y gastric bypass (RYGB). CONCLUSIONS: BMI is associated with increased risk of 30-day mortality. The effect of BMI is more pronounced in patients with BMI ≥ 70.0 kg/m2. In these patients, RYGB is associated with increased risk of mortality compared to SG.
Authors: Hamlet Gasoyan; Rohit S Soans; Jennifer K Ibrahim; William E Aaronson; David B Sarwer Journal: Surg Obes Relat Dis Date: 2021-10-15 Impact factor: 4.734
Authors: Anita P Courcoulas; Eric Johnson; David E Arterburn; Sebastien Haneuse; Lisa J Herrinton; David P Fisher; Robert A Li; Mary Kay Theis; Liyan Liu; Brianna Taylor; Julie Cooper; Philip L Chin; Gary G Grinberg; Anirban Gupta; Shireesh Saurabh; Scott S Um; Panduranga R Yenumula; Jorge L Zelada; Karen J Coleman Journal: Ann Surg Date: 2021-08-13 Impact factor: 12.969