The importance of the Edmonton Obesity Staging System in predicting postoperative outcome and 30-day mortality after metabolic surgery

Abstract

BackgroundThe Edmonton Obesity Staging System (EOSS) is a more comprehensive measure of obesity-related diseases and predictor of mortality than body mass index (BMI) or waist circumference. Its application for the selection of obese patients for obesity surgery has been suggested. ObjectivesThe aim of this study was to determine whether the EOSS can also be used in predicting postoperative outcome and 30-day mortality after metabolic surgery. SettingCenter of maximum care in Germany MethodsWe collected data prospectively for patients undergoing laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), or laparoscopic omega-loop gastric bypass (LOLGB). The data collected included preoperative EOSS score, gender, age, BMI, waist circumference, waist-to-hip ratio, co-morbidities, early postoperative complications, and 30-day mortality. ResultsA total of 534 patients were included. The mean BMI was 45.57 kg/m2 (range 35–64.5) for LRYGB patients (n = 168), 53.27 kg/m2 (range 35.1–82.1) for LSG patients (n = 282), and 49.42 kg/m2 (range 36–73.1) for LOLGB patients (n = 84). The total postoperative complication rate was 8.99%. The most common EOSS stage was 2 (70.6% of patients), followed by stages 3 (12.55%), 1 (11.61%), and 0 (5.06%). The postoperative complication rates after LRYGB, LSG, and LOLGB were 0% for EOSS 0 and 1.61% for EOSS 1. The postoperative complication rates were 8.22% for EOSS 2 and 22.39% for EOSS 3. ConclusionPatients with EOSS≥3 have a higher risk of postoperative complications. Our data confirm that the EOSS is useful as a scoring system for the selection of obese patients before surgery and suggest that it may also be useful for presurgical stratification and risk assessment in clinical practice. Patients should be recommended for obesity surgery when their EOSS stage is 2 to prevent impairments associated with metabolic disease and to reduce the risk of postoperative complications.