How safe is bariatric surgery in patients with class I obesity (body mass index 30–35 kg/m2)?

Abstract

BackgroundThe safety profile of bariatric surgery in patients with class I obesity, or body mass index ≥30 and <35 kg/m2, is a matter of concern among patients and physicians. ObjectiveTo assess the safety profile of bariatric surgery in patients with class I obesity. SettingThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) data set. MethodsThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 to 2016 data sets were queried for class I obesity patients who underwent primary bariatric procedures. The 30-day postoperative safety profile, predictors of adverse events, and comparison between Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (SG) were studied. ResultsA total of 8628 cases with a mean preoperative body mass index of 33.7 ± 1.1 kg/m2 were analyzed: 1838 (21.3%) underwent RYGB, 6243 (72.4%) underwent SG, 530 (6.1%) underwent gastric banding, and 17 (.2%) underwent duodenal switch; 33.9% had diabetes and 75% had hypertension. The composite morbidity rate (defined as presence of any of 24 postoperative adverse events) for the entire cohort was 3.8%, and the serious morbidity rate (presence of any of 9 serious complications) was .7%. The 30-day mortality rate was .05% (4 cases). Presence of chronic kidney disease was found to be associated with higher composite and serious morbidity (composite morbidity: odds ratio 5.1, 95% confidence interval 2.22–11.71; serious morbidity: odds ratio 5.66, 95% confidence interval 1.52–21.14). SG patients had significantly better short-term safety outcomes than RYGB patients. ConclusionFindings from this study, the largest series to date, indicate that bariatric surgery is safe in patients with class I obesity, with very low risk of morbidity and mortality.