Preoperative weight loss is linked to improved mortality and leaks following elective bariatric surgery: an analysis of 548,597 patients from 2015-2018.
Bariatric surgery
Gastric bypass
Preoperative weight loss
Sleeve gastrectomy
Surgical outcomes
Journal
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
ISSN: 1878-7533
Titre abrégé: Surg Obes Relat Dis
Pays: United States
ID NLM: 101233161
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
02
03
2021
revised:
30
05
2021
accepted:
29
06
2021
pubmed:
1
8
2021
medline:
3
11
2021
entrez:
31
7
2021
Statut:
ppublish
Résumé
The effects of preoperative weight loss on bariatric surgery outcomes are still unclear, despite the practice being adopted by bariatric centers worldwide. Ongoing studies are needed for routine adoption of this practice given the multiple issues patients face with following difficult preoperative weight loss protocols. The aim of this study was to characterize the prevalence of preoperative weight loss and evaluate its impact on outcomes following elective bariatric surgery. This retrospective study was conducted using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015-2018. All primary Roux-en-Y (RYGB) and sleeve gastrectomy (SG) procedures were included, whereas prior revisional surgeries and emergency surgeries were excluded. Cases were then divided into preoperative weight loss (PWL) and control cohorts. PWL was defined categorically if the highest 30-day preoperative weight was greater than the closest recorded weight before surgery. Primary outcomes included identifying the impact of PWL on postoperative complications. Multivariable logistic regression modelling was used to examine the influence of PWL on serious complications and mortality after adjusting for patient co-morbidities and procedure type. A total of 548,597 patients were identified with the majority experiencing preoperative weight loss (n= 459,500; 83.8%). The PWL cohort was older (44.8 ± 12.0 versus 43.2 ± 11.9 yr), had a reduced body mass index (BMI) (45.0 ± 7.4 versus 46.1 ± 7.6 kg/m Preoperative weight loss before bariatric surgery is common, occurring in >80% of elective cases. Our findings suggest that preoperative weight loss is associated with improved odds of 30-day mortality and leaks but no differences in bleeds or overall serious complications. Additional prospective trials are needed to further evaluate the role of routine PWL in addition to ongoing development of tolerable preoperative weight-loss protocols.
Sections du résumé
BACKGROUND
The effects of preoperative weight loss on bariatric surgery outcomes are still unclear, despite the practice being adopted by bariatric centers worldwide. Ongoing studies are needed for routine adoption of this practice given the multiple issues patients face with following difficult preoperative weight loss protocols.
OBJECTIVES
The aim of this study was to characterize the prevalence of preoperative weight loss and evaluate its impact on outcomes following elective bariatric surgery.
SETTING
This retrospective study was conducted using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data registry from 2015-2018.
METHODS
All primary Roux-en-Y (RYGB) and sleeve gastrectomy (SG) procedures were included, whereas prior revisional surgeries and emergency surgeries were excluded. Cases were then divided into preoperative weight loss (PWL) and control cohorts. PWL was defined categorically if the highest 30-day preoperative weight was greater than the closest recorded weight before surgery. Primary outcomes included identifying the impact of PWL on postoperative complications. Multivariable logistic regression modelling was used to examine the influence of PWL on serious complications and mortality after adjusting for patient co-morbidities and procedure type.
RESULTS
A total of 548,597 patients were identified with the majority experiencing preoperative weight loss (n= 459,500; 83.8%). The PWL cohort was older (44.8 ± 12.0 versus 43.2 ± 11.9 yr), had a reduced body mass index (BMI) (45.0 ± 7.4 versus 46.1 ± 7.6 kg/m
CONCLUSION
Preoperative weight loss before bariatric surgery is common, occurring in >80% of elective cases. Our findings suggest that preoperative weight loss is associated with improved odds of 30-day mortality and leaks but no differences in bleeds or overall serious complications. Additional prospective trials are needed to further evaluate the role of routine PWL in addition to ongoing development of tolerable preoperative weight-loss protocols.
Identifiants
pubmed: 34330621
pii: S1550-7289(21)00334-8
doi: 10.1016/j.soard.2021.06.021
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1846-1853Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2021 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.