L. Owei1, S. Torres Landa1, C. Tewksbury1, V. Zoghbi1, J. H. Fieber1, O. E. Pickett-Blakely1, D. T. Dempsey1, N. N. Williams1, K. R. Dumon1 1Hospital Of The University Of Pennsylvania,Gastrointestinal Surgery,Philadelphia, PA, USA
Introduction:
Preoperative weight loss theoretically reduces the risk of surgical complications following bariatric surgery. Current guidelines have focused on preoperative weight loss as an important element of patient care and, for some payers, a requirement for prior authorization. However, the association between preoperative weight loss and surgical complications remains unclear. The purpose of this study is to test the hypothesis that preoperative weight loss lowers operative risk in bariatric surgery.
Methods:
We conducted a retrospective analysis using the inaugural American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data -2015. Only patients who had primary laparoscopic gastric bypass, open gastric bypass and laparoscopic sleeve gastrectomy were included. Patients were stratified into 4 groups by percent preoperative total body weight (TBW) loss. Univariate analyses was performed. Logistic regression was also used to determine the association between preoperative weight loss and surgical outcomes (mortality, reoperation, readmission, and intervention) with adjustment for potential confounders.
Results:
A total of 120,283 patients were included in the analysis, with a mean age of 44.6 (±12.0) and 78.7% were female. Procedures were laparoscopic sleeve gastrectomy (69.0%), laparoscopic gastric bypass (30.3%), and open gastric bypass (1.2%). Of the total number of patients, 25% had <1% preoperative TBW loss, 22% had 1 – 2.99%, 29% had 3 – 5.99%, and 24% had ≥6%. When stratified by percent TBW loss, significant differences were found in age, sex, race, co-morbidities, smoking, and ASA classification (p<0.05). Using the <1% preoperative total percent body loss group as a reference, logistic regression revealed that a TBW loss of ≥3% was associated with a significant decrease in operative (30 day) mortality (p = 0.012). Preoperative weight loss in excess of 6% TBW was not associated with a further decrease in operative mortality. There was no significant association between percent TBW loss and reoperation, readmission or intervention within 30 days of operation (Table 1).
Conclusion:
A preoperative reduction of more than 3% of TBW is associated with a significant reduction in operative mortality following bariatric surgery. These results suggest that a modest preoperative weight loss may substantially reduce operative mortality risk in this population. Further studies are needed to elucidate the association between preoperative weight loss and other outcome measures (reoperation, readmission, intervention).
**The ACS MBSAQIP and the centers participating are the source of the data, and are not responsible for the validity or the conclusions.
