Primary Inadequate Weight Loss After Roux-en-Y Gastric Bypass Is not Associated with Poor Cardiovascular or Metabolic Outcomes: Experience from a Single Institution.

Abstract

It is well accepted that bariatric surgery has cardiovascular and metabolic effects independent of weight loss. Weight loss outcomes of patients undergoing Roux-en-Y gastric bypass (RYGB) at a high volume referral center were collected at 1year postoperatively. Patients with failed primary weight loss were identified. Primary inadequate weight loss was defined as total body weight loss less than 15%. Changes in hypertension (HTN), dyslipidemia, type 2 diabetes mellitus (T2DM), and metabolic syndrome profiles were investigated using Student's t test. A total of 2500 patients underwent RYGB from the years 2001-2013 at our institution. One hundred five (4.2%) patients had primary inadequate weight loss. Within this cohort, 81 (77.1%) patients had hypertension, 67 (63.8%) had dyslipidemia, 53 (50.5%) had type 2 diabetes mellitus, and 66 (62.9%) patients had metabolic syndrome. At 1year postoperatively, all metabolic parameters were significantly improved. Measures of metabolic disease included high-density lipoprotein (HDL) (46.3±11.6 versus 54.1±12.7mg/dL, p<0.01), low-density lipoprotein (LDL) (103.6±35.8 versus 89.2±30.0mg/dL, p<0.01), triglycerides (177.3±139.1 versus 117.6±59.3mg/dL, p<0.01), mean plasma glucose (128.9±55.3 versus 102.7±27.3mg/dL, p<0.01), and hemoglobin A1C (7.3±1.9 versus 6.1±1.0%, p<0.01). HTN was noted to improve in 27 (33.3%) patients based on a decrease in the number of anti-hypertensives used (1.7±1.0 versus 1.3±1.3, p<0.01), and 21 (31.8%) patients had resolution of their metabolic syndrome. Improvement in cardiometabolic comorbidities still occurs despite suboptimal weight loss following RYGB.