Body mass index and risk of mortality in patients undergoing bariatric surgery,Surgical Endoscopy

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Body mass index and risk of mortality in patients undergoing bariatric surgery
Surgical Endoscopy ( IF 2.4 ) Pub Date : 2022-09-26 , DOI: 10.1007/s00464-022-09651-7
Anastasios T Mitsakos _{1,

2} , William Irish ₃ , Eric J DeMaria ₁ , Walter J Pories ₃ , Maria S Altieri ₄

Affiliation

Background

Prior literature has demonstrated that bariatric surgery is a safe approach for patients with morbid obesity. However, the relationship between body mass index (BMI) and risk of mortality in these patients has not been fully elucidated. Primary objective of this study was to evaluate the relationship between BMI and risk of mortality using data obtained from a national database, with a special focus on patients with BMI ≥ 70.0 kg/m².

Methods

A retrospective cohort study of patients with morbid obesity (BMI ≥ 40 kg/m²) undergoing first-time bariatric surgery between 2015 and 2018 was performed using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Primary outcome was intra-operative death or death within 30 days post-operatively. Patients were categorized into quartiles according to BMI. Multivariable analysis was performed to evaluate the association of BMI with risk of mortality. Relative risk (RR) and 95% confidence interval (CI) are provided as measures of strength of association and precision, respectively.

Results

A total of 463, 436 patients were included with a 30-day mortality rate of 0.11%. Mean BMI (SD) was 48.2 (7.3) kg/m²; 1.5% of patients had BMI ≥ 70.0 kg/m². On multivariable analysis, highest quartile patients had a significantly higher risk of mortality than lowest quartile patients. For patients with BMI ≥ 70.0 kg/m², the risk of mortality was more pronounced with an eightfold increase compared to the lowest quartile. In patients with BMI ≥ 70.0 kg/m², although sleeve gastrectomy (SG) was the most common procedure, the risk of mortality was significantly higher in patients undergoing Roux-en-Y gastric bypass (RYGB).

Conclusions

BMI is associated with increased risk of 30-day mortality. The effect of BMI is more pronounced in patients with BMI ≥ 70.0 kg/m². In these patients, RYGB is associated with increased risk of mortality compared to SG.

Graphical abstract

中文翻译：

接受减肥手术的患者的体重指数和死亡风险

背景

先前的文献表明，减肥手术对于病态肥胖患者是一种安全的方法。然而，这些患者的体重指数 (BMI) 与死亡风险之间的关系尚未完全阐明。本研究的主要目的是使用从国家数据库获得的数据评估 BMI 与死亡风险之间的关系，特别关注 BMI ≥ 70.0 kg/m ²的患者。

方法

使用代谢和减肥手术认证和质量改进计划的数据，对 2015 年至 2018 年间接受首次减肥手术的病态肥胖症患者（BMI ≥ 40 kg/m ^{2 ）进行了一项回顾性队列研究。}主要结果是术中死亡或术后 30 天内死亡。根据 BMI 将患者分为四分位数。进行多变量分析以评估 BMI 与死亡风险的关联。相对风险 (RR) 和 95% 置信区间 (CI) 分别作为关联强度和精确度的度量。

结果

共纳入 463、436 例患者，30 天死亡率为 0.11%。平均 BMI (SD) 为 48.2 (7.3) kg/m ²；1.5% 的患者 BMI ≥ 70.0 kg/m ²。在多变量分析中，最高四分位数患者的死亡风险显着高于最低四分位数患者。对于 BMI ≥ 70.0 kg/m ²的患者，与最低四分位数相比，死亡风险增加了八倍，这一风险更为明显。在 BMI ≥ 70.0 kg/m ²的患者中，虽然袖状胃切除术 (SG) 是最常见的手术，但接受 Roux-en-Y 胃旁路术 (RYGB) 的患者死亡风险明显更高。