Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity

To identify the factors that increase mortality for either open or laparoscopic Roux-en-Y gastric bypass. Perioperative mortality is the most feared outcome of bariatric surgery, reported to occur in between 0.5% and 1.5% of patients. The bariatric database at Virginia Commonwealth University was qu...

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Bibliographic Details
Published in:Annals of surgery 2004-05, Vol.239 (5), p.698-703
Main Authors: Fernandez, Jr, Adolfo Z, Demaria, Eric J, Tichansky, David S, Kellum, John M, Wolfe, Luke G, Meador, Jill, Sugerman, Harvey J
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Comorbidity
Female
Gastric Bypass - adverse effects
Gastric Bypass - methods
Humans
Laparoscopy
Logistic Models
Male
Middle Aged
Multivariate Analysis
Obesity, Morbid - mortality
Obesity, Morbid - surgery
Original and Discussions
Risk Factors
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Summary:To identify the factors that increase mortality for either open or laparoscopic Roux-en-Y gastric bypass. Perioperative mortality is the most feared outcome of bariatric surgery, reported to occur in between 0.5% and 1.5% of patients. The bariatric database at Virginia Commonwealth University was queried for patients who had undergone either an open gastric bypass (O-GBP) or a laparoscopic gastric bypass (L-GBP). A multivariate logistic regression analysis to identify factors related to perioperative mortality was performed. Factors examined included age, gender, body mass index, preoperative weight, hypertension, diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, venous stasis ulcers, intestinal leak, small bowel obstruction, and pulmonary embolus. Since 1992, more than 2000 patients had either an O-GBP (n = 1431) or a L-GBP (n = 580). Of the O-GBP, 547 patients had a proximal GBP (P-GBP) and 884 superobese (body mass index > 50 kg/m) patients had a long-limb GBP (LL-GBP). The differences in patient demographics, complications, and perioperative mortality rates between L-GBP and O-GBP and P-GBP and LL-GBP patients were examined. Overall, the independent risk factors associated with perioperative death included leak, pulmonary embolus, preoperative weight, and hypertension. The risk factors for perioperative death can be separated into patient characteristics and complications. The access method, open versus laparoscopic, was not independently predictive of death, but the operation type, proximal versus long limb, was predictive. The data do not suggest that superobese patients should not undergo surgery, as they are high risk for early death due to their body weight and comorbidities without surgery. Surgery should not be reserved as a desperate last measure for weight loss.
ISSN:0003-4932
1528-1140
DOI:10.1097/01.sla.0000124295.41578.ab