Peri-operative Safety in the Longitudinal Assessment of Bariatric Surgery

By D. Flum, S. Belle, W. King, A. Wahed, P. Berk, W. Chapman, W. Pories, A. Courcoulas, C. McCloskey, James E Mitchell and 6 more. New England Journal of Medicine, 2009

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Background The risks of bariatric surgical procedures must be balanced against their benefits and require further characterization. Methods Longitudinal Assessment of Bariatric Surgery-1 (LABS-1) was a prospective, multi-center observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States (2005-2007). A composite endpoint of 30-day major adverse outcomes (death; venous thromboembolism; percutaneous, endoscopic, or operative reintervention; no discharge) was evaluated among patients undergoing first-time bariatric surgery. Results There were 4776 patients (mean age 44.5 years, 21.1% male, 10.9% non-white, median BMI of 46.5 kg/m2) who had a first-time procedure. Over half had at least two comorbid conditions. Roux-en-y gastric bypass was performed in 3412 (87.2% laparoscopic) and laparoscopic adjustable gastric banding in 1198. The 30-day mortality rate for Roux-en-y gastric bypass or laparoscopic adjustable gastric banding was 0.3%; 4.3% of participants had at least one major adverse outcome. A history of deep vein thrombosis or pulmonary embolus, obstructive sleep apnea, and functional status were each independently associated with increased risk of the composite endpoint. Extreme values of BMI were significantly associated with an increased risk of the composite endpoint, while age, sex, race, ethnicity and other co-morbid conditions were not. Conclusion The overall risk of death and adverse outcome after bariatric surgery was low, varying considerably with patient characteristics. In helping patients make appropriate choices, short-term safety should be considered in conjunction with both the longer term effects of bariatric surgery and the risk of living with extreme obesity.

Subfields: Cardiology and Cardiovascular Medicine, Surgery

View Paper: https://www.semanticscholar.org/paper/6ac0963e11a3455abb97042cd71e8e218cc2d067

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  1. Reinhard W. Holl
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