IBCOx-15 Bariatric surgery in patients with BMI greater than 70: analysis of the ACSNSQIP database

Abstract

Abstract Background Bariatric surgery offers patients short- and long-term benefits to their health and quality of life. Currently, we see more patients with superior body mass index (BMI) looking for these benefits. Evidence-based medicine is integral in the evaluation of risks versus benefit; however, data are lacking in this high-risk population. Objectives To assess the morbidity and mortality of patients with BMI 70 undergoing bariatric surgery. Setting University Hospital, Bronx, New York, USA using national database. Methods Using the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) database for years 2005 to 2016, we identified patients who underwent primary laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass. Patients with BMI ≥70 were assigned to the BMI ≥ 70 (BMI70+) cohort and less obese patients were assigned to the BMI < 70 (U70) cohort. Length of stay and 30-day morbidity and mortality were compared. Results A total of 163,413 patients underwent non-revisional bariatric surgery. Of those, 2322 had a BMI ≥ 70. BMI70+ was associated with increased mortality (0.4% versus 0.1%, P 5.0001), deep vein thrombosis (0.6% versus 0.3%, P 5.007), pulmonary (1.9% versus 0.5%, P 5.0001), renal (0.9% versus 0.2%, P 5.0001), and infectious complications (1.1% versus .4%, P 5 .0001). BMI 70+ patients had longer mean length of stay (2.6 versus 2.1 d, P 5.0001) and operative time (126.1 versus 114.5 min, P 5.0001). There was no statistically significant difference in the number of myocardial infarctions (0.1% versus 0.1%, P 5.319), pulmonary embolisms (0.3% versus 0.2%, P 5.596), and transfusion requirements (0.1% versus 0.1%, P 5.105) between groups. Conclusions Evaluation of risk and benefit is performed on a case-by-case basis, but evidence-based medicine is critical in empowering surgeons and patients to make informed decisions. The overall rate of morbidity and mortality for BMI 701+ patients undergoing bariatric surgery was increased over U70 patients but was still relatively low. Our study will allow surgeons to incorporate objective data into their assessment of risk for super-obese patients pursuing bariatric surgery.