A nationwide safety analysis of bariatric surgery in nonseverely obese patients with type 2 diabetes

Abstract

BackgroundBariatric surgery is more effective than medical therapy in treatment of type 2 diabetes (T2D) in patients with severe obesity. However, surgery is often not advocated for patients with T2D who are overweight or have mild obesity. ObjectiveTo assess the safety profile of bariatric surgery in patients with T2D and mild obesity. SettingDatabase of the American College of Surgeons–National Surgical Quality Improvement Program. MethodsData of 1300 patients with T2D and a body mass index≥25 but<35 kg/m2 who underwent bariatric surgery were retrieved from the American College of Surgeons–National Surgical Quality Improvement Program data set (2005–2014) to assess safety profile. Further stratified analyses were carried out between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). ResultsThe mean operative time and length of hospital stay were 109.4±58.3 minutes and 1.9±1.5 days, respectively. Incidence of all individual major complications was≤.5% in this cohort except for postoperative bleeding (1.7%). Thirty-day postoperative composite morbidity, serious morbidity, and mortality rates for total cohort were 4.2%, .7%, and .15%, respectively. Smoking (odds ratio = 2.75, 95% confidence interval: 1.34–5.64) and chronic obstructive pulmonary disease (odds ratio = 4.05, 95% confidence interval: 1.51–10.88) were predictors of composite morbidity. Thirty-day morbidity rates were not significantly different between those who underwent RYGB compared with SG. ConclusionBariatric surgery, which is a 2-hour procedure requiring a 2-day hospital stay, is a relatively well-tolerated option in patients with T2D and mild obesity. RYGB and SG had comparable early postoperative morbidity. Smoking can be considered as a modifiable risk factor for early complications after bariatric surgery in patients with T2D and lower body mass index.