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Are laparoscopic bariatric procedures safe in superobese (BMI ≥50 kg/m2) patients? An NSQIP data analysis.
Surg Obes Relat Dis. 2011 Jul-Aug; 7(4):452-8.SO

Abstract

BACKGROUND

The safety of laparoscopic bariatric procedures in superobese patients is still debatable.

METHODS

Using the American College of Surgeons National Surgical Quality Improvement Program's participant-use file, the patients who had undergone laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding for morbid obesity were identified. Several perioperative variables, including 30-day morbidity and mortality, were collected, and the data were compared within each procedure after dividing the patients according to the body mass index: <50 kg/m(2) (morbidly obese group and ≥50 kg/m(2) (superobese group).

RESULTS

A total of 29,323 patients who had undergone laparoscopic bariatric procedures from 2005 to 2008 were identified. Overall, compared with the morbidly obese group, the superobese group had more men (3:2), younger patients, a greater incidence of co-morbidities (e.g., hypertension and dyspnea), a significantly increased length of stay, and a greater rate of 30-day mortality (.26% versus .07%, odds ratio [OR] 4.38, P = .0001). In the gastric bypass group, the superobese group had a significantly greater incidence of postoperative complications, including superficial wound infections (2.45%, OR 1.68, P = .0001), reintubation (.61%, OR 1.97, P = .003), pulmonary embolism (.30%, OR 2.13, P = .032), myocardial infarction (.07%, P = .017), deep vein thrombosis (.49%, OR 2.06, P = .006), septic shock (.44%, OR 1.74, P = .04), and 30-day mortality (.28%, OR 2.26, P = .026). In the laparoscopic adjustable gastric banding group, the superobese group had a significantly greater incidence of postoperative complications, including superficial (1.65%, OR 2.18, P = .0013) and deep (.23%, OR 2.56, P = .035) wound infections, sepsis, septic shock and 30-day mortality (.17%, OR 13.4, P = .0219).

CONCLUSION

Laparoscopic bariatric procedures in superobese patients have been associated with significantly increased complications, including 30-day mortality, compared with morbidly obese patients. However, overall, the procedures appear to be safe, with low complication and 30-day mortality rates.

Authors+Show Affiliations

New York Hospital Queens, Weil Cornell Medical College, Queens, New York, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21159564

Citation

Kakarla, Venkata R., et al. "Are Laparoscopic Bariatric Procedures Safe in Superobese (BMI ≥50 Kg/m2) Patients? an NSQIP Data Analysis." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 7, no. 4, 2011, pp. 452-8.
Kakarla VR, Nandipati K, Lalla M, et al. Are laparoscopic bariatric procedures safe in superobese (BMI ≥50 kg/m2) patients? An NSQIP data analysis. Surg Obes Relat Dis. 2011;7(4):452-8.
Kakarla, V. R., Nandipati, K., Lalla, M., Castro, A., & Merola, S. (2011). Are laparoscopic bariatric procedures safe in superobese (BMI ≥50 kg/m2) patients? An NSQIP data analysis. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 7(4), 452-8. https://doi.org/10.1016/j.soard.2010.10.009
Kakarla VR, et al. Are Laparoscopic Bariatric Procedures Safe in Superobese (BMI ≥50 Kg/m2) Patients? an NSQIP Data Analysis. Surg Obes Relat Dis. 2011 Jul-Aug;7(4):452-8. PubMed PMID: 21159564.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are laparoscopic bariatric procedures safe in superobese (BMI ≥50 kg/m2) patients? An NSQIP data analysis. AU - Kakarla,Venkata R, AU - Nandipati,Kalyana, AU - Lalla,Michael, AU - Castro,Armando, AU - Merola,Stephen, Y1 - 2010/10/26/ PY - 2010/05/29/received PY - 2010/09/25/revised PY - 2010/10/05/accepted PY - 2010/12/17/entrez PY - 2010/12/17/pubmed PY - 2011/12/13/medline SP - 452 EP - 8 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 7 IS - 4 N2 - BACKGROUND: The safety of laparoscopic bariatric procedures in superobese patients is still debatable. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program's participant-use file, the patients who had undergone laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding for morbid obesity were identified. Several perioperative variables, including 30-day morbidity and mortality, were collected, and the data were compared within each procedure after dividing the patients according to the body mass index: <50 kg/m(2) (morbidly obese group and ≥50 kg/m(2) (superobese group). RESULTS: A total of 29,323 patients who had undergone laparoscopic bariatric procedures from 2005 to 2008 were identified. Overall, compared with the morbidly obese group, the superobese group had more men (3:2), younger patients, a greater incidence of co-morbidities (e.g., hypertension and dyspnea), a significantly increased length of stay, and a greater rate of 30-day mortality (.26% versus .07%, odds ratio [OR] 4.38, P = .0001). In the gastric bypass group, the superobese group had a significantly greater incidence of postoperative complications, including superficial wound infections (2.45%, OR 1.68, P = .0001), reintubation (.61%, OR 1.97, P = .003), pulmonary embolism (.30%, OR 2.13, P = .032), myocardial infarction (.07%, P = .017), deep vein thrombosis (.49%, OR 2.06, P = .006), septic shock (.44%, OR 1.74, P = .04), and 30-day mortality (.28%, OR 2.26, P = .026). In the laparoscopic adjustable gastric banding group, the superobese group had a significantly greater incidence of postoperative complications, including superficial (1.65%, OR 2.18, P = .0013) and deep (.23%, OR 2.56, P = .035) wound infections, sepsis, septic shock and 30-day mortality (.17%, OR 13.4, P = .0219). CONCLUSION: Laparoscopic bariatric procedures in superobese patients have been associated with significantly increased complications, including 30-day mortality, compared with morbidly obese patients. However, overall, the procedures appear to be safe, with low complication and 30-day mortality rates. SN - 1878-7533 UR - https://www.unboundmedicine.com/medline/citation/21159564/Are_laparoscopic_bariatric_procedures_safe_in_superobese__BMI_≥50_kg/m2__patients_An_NSQIP_data_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(10)00710-0 DB - PRIME DP - Unbound Medicine ER -