Journal of Gastrointestinal Surgery

, Volume 11, Issue 4, pp 500–507 | Cite as

Factors Affecting Morbidity and Mortality of Roux-en-Y Gastric Bypass for Clinically Severe Obesity: An Analysis of 1,000 Consecutive Open Cases by a Single Surgeon

Article
First Online:

Abstract

Introduction

Determinants of perioperative risk for RYGB are not well defined.

Methods

Retrospective analysis of comorbidities was used to evaluate predictors of perioperative risk in 1,000 consecutive patients having open RYGB by univariate analyses and logistic regression.

Results

One hundred forty-six men, 854 women; average age 38.3 ± 11.2 years; mean BMI 51.8 ± 10.5 (range 24–116) were evaluated. Average hospital stay (LOS) was 3.8 days; 87% <3 days. 91.3% of procedures were without major complication. The most common complications were incisional hernia 3.5%, intestinal obstruction 1.9%, and leak 1.6%. 31 patients required reoperation within 30 days (3.1%). A 30-day mortality was 1.2%. Logistic regression evaluating predictors of operative mortality correlated strongly with coronary artery disease (CAD) (p < 0.01), sleep apnea (p = 0.03), and age (p = 0.042). BMI > 50 (0.6 vs 2.3%, p = 0.03) and male sex were associated with increased mortality (1.3 vs. 4.0%, p = 0.02). Sex-specific logistic regression demonstrated males with angiographically proven CAD were more likely to die (p = 0.028) than matched cohorts. Age (p = 0.033) and sleep apnea (p = 0.040) were significant predictors of death for women.

Conclusion

Perioperative mortality after RYGB appears to be affected by sex, BMI, age, CAD, and sleep apnea. Strategies employing risk stratification should be developed for bariatric surgery.

Keywords

Obesity Morbid obesity Roux-en-Y gastric bypass Morbidity Mortality 
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References

  1. 1.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005;294:1909–1917.PubMedCrossRefGoogle Scholar
  2. 2.
    Livingston EH, Huerta S, Arthur D, Lee S, De Shields S, Heber D. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg 2002;236:576–582.PubMedCrossRefGoogle Scholar
  3. 3.
    Fernandez AZ Jr, Demaria EJ, Tichansky DS, Kellum JM, Wolfe LG, Meader J, Sugerman HJ. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg 2004;239:698–703.PubMedCrossRefGoogle Scholar
  4. 4.
    Gastrointestinal surgery for severe obesity. National institutes of health consensus development conference statement. Am J Clin Nutr 1992;55(2 Suppl):615S–619S.Google Scholar
  5. 5.
    Buchwald H, Avidor Y, Braunwals E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–1737.PubMedCrossRefGoogle Scholar
  6. 6.
    Liu JH, Zingmond D, Etzioni DA, O’Connell JB, Meggard MA, Livingston EH, Liu CD, Ko CY. Characterizing the performance and outcomes of obesity surgery in California. Am Surg 2003;69:823–828.PubMedGoogle Scholar
  7. 7.
    Courcoulas A, Schuchert M, Gatti G, Luketich J. The relationship of surgeon and hospital volume to outcome after gastric bypass surgery in Pennsylvania: a 3-year summary. Surgery 2003;134:613–623.PubMedCrossRefGoogle Scholar
  8. 8.
    Flum DR, Dellinger EP. Assessing the impact of bariatric surgery on survival. J Am Coll Surg 2004;199:543–551.PubMedCrossRefGoogle Scholar
  9. 9.
    Flum DR, Salem L, Brockel Elrod J, Dellinger EP, Cheadle A, Chan L. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA 2005;294:1903–1908.PubMedCrossRefGoogle Scholar
  10. 10.
    Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean APH, MacLean LD. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004;240:416–424.PubMedCrossRefGoogle Scholar
  11. 11.
    Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, deRamon RA, Israel J, Dolezai JM, Dohm L. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995;222:339–352.PubMedCrossRefGoogle Scholar
  12. 12.
    Dimick JB, Stanley JC, Axelrod DA, Kazmers A, Henke PK, Jacobs LA, Wakefield TW, Greenfield LJ, Upchurch GR Jr. Variation in death rate after abdominal aortic aneurysmectomy in the United States: Impact of hospital volume, gender, and age. Ann Surg 2002;235:579–585.PubMedCrossRefGoogle Scholar
  13. 13.
    Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137.PubMedCrossRefGoogle Scholar
  14. 14.
    Wolfe BM, Morton JM. Weighing in on bariatric surgery: procedure use, readmission rates and mortality. JAMA 2005;294:1960–1963.PubMedCrossRefGoogle Scholar
  15. 15.
    Steinbrook R. Surgery for severe obesity. N Engl J Med 2004;350:1075–1079.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  1. 1.Center for Weight Loss Surgery, St Luke’s–Roosevelt Hospital CenterColumbia University College of Physicians and SurgeonsNew YorkUSA
  2. 2.Department of SurgeryNorth Shore University Hospital at Glen CoveGlen CoveUSA

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