BMI and preoperative weight may predict outcomes after weight-loss surgery, according to data spanning 15 years.

BMI and preoperative weight may predict outcomes after weight-loss surgery, according to data spanning 15 years.

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New research presented at this year’s Euroanaesthesia conference in Milan, Italy (4-6 June), suggests that preoperative body mass index (BMI) and weight play an important role in outcomes following bariatric (obesity) surgery.

The study by Dr. Michael Margarson and colleagues from St Richards Hospital, Chichester, UK, confirms the long-suspected view that preoperative deaths and ICU admissions are significantly more likely in patients with higher weight and BMI. .

“Surgical procedures are one of the most successful ways to help obese people lose weight, but unfortunately some patients may experience complications,” says Dr. Margarson. “Although the absolute risk of death after bariatric surgery is very low, less than one in 500 overall, our findings from a UK hospital highlight a strong association between patients in the top 10% of the index. Body mass before surgery (more than 62 kg/m.2) and weight (>182 kg/28 stone) and confirm a significantly increased risk of ICU admission and death within 30 days of surgery. “

As the rate of obesity continues to rise worldwide, more and more people are seeking weight loss surgery. Bariatric surgery — which involves procedures that limit the amount of food you can eat or reduce food absorption — can lead to permanent weight loss and reduce the risk of chronic diseases associated with severe obesity including cardiovascular disease, high blood pressure, type 2 diabetes and cancer. . However, it has not previously been clear how BMI and weight before surgery affect the risks of complications and death after surgery.

To find out more, researchers analyzed data from 4,170 adults (median age 44, 78% female) who had weight-loss surgery (such as sleeve gastrectomy, gastric bypass, pancreatic biliary diversion, or gastric banding) at St. Richards in Chichester between 2006. and 2020.

BMI measurements were available for all patients, but accurate weight measurements were available for only 85% (3545 patients). Participants were divided into ten equal-sized groups (decimals) based on BMI and preoperative weight, and the researchers analyzed differences in postoperative admission to the intensive care unit and death within 30 days.

Eight bariatric surgery patients died within a month of surgery, four after leaving hospital. However, patients are in the highest decimal point of BMI (62 kg/m2) were more than five times more likely to die within 30 days of the procedure than the other 90% – although deaths were rare in absolute terms.

Statistical analysis shows those participants in the highest decimal place for BMI (above 62 kg/m2) were 12 times more likely to be admitted to the intensive care unit than those in the lowest decile (<39 kg/m).2), while ICU admission rates were about 16 times higher among those in the highest weight category (>182 kg) compared to the lowest (<105 kg) weight category (0.8% vs. 13.3%).

“We suspect there may be selection bias toward elective admission for larger patients, so excluding primary admission from quasi-elective admission would be the next step in this analysis,” explains Dr. Margarson.

The authors acknowledge that their findings were observational and only assessed patients from one institution, and advise caution in generalizing to the general population. They point out several limitations including potential selection bias and confusion, and note that they cannot exclude the possibility that other unmeasured factors (including socioeconomic status, ethnicity, smoking) or missing data (for example, dietary habits, physical activity behaviors) may The results may be affected.

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more information:

Submitted by the European Society of Anesthesia and Intensive Care (ESAIC)

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2022-06-03 17:06:49

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