Impact of Bariatric Surgery on Outcomes of Patients with Sickle Cell Disease: a Nationwide Inpatient Sample Analysis, 2004–2014

  • Prabin Sharma
  • Thomas R. McCarty
  • Siddhartha Yadav
  • Julius N. Ngu
  • Basile NjeiEmail author
Original Contributions



With advances in disease-specific treatments and improved overall survival, obesity rates are rising among patients with sickle cell disease (SCD). The primary aim of this study was to evaluate the role of bariatric surgery on clinical outcomes among hospitalized obese patients with SCD.


The United States Nationwide Inpatient Sample database was queried between 2004 and 2014 for discharges with co-diagnoses of morbid obesity and SCD. The primary outcome was in-hospital mortality. Secondary outcomes included vaso-occlusive crisis, acute chest syndrome, biliary-pancreatic complications, renal failure, urinary tract infection, malnutrition, sepsis, pneumonia, respiratory failure, thromboembolic events, strictures, wound infection, length of stay, and hospitalization costs. Using Poisson regression, adjusted incidence risk ratios (IRR) were derived for clinical outcomes in patients with prior-bariatric surgery compared to those without bariatric surgery.


Among 2549 patients with a discharge diagnosis of SCD and morbid obesity, only 42 patients (1.7%) had bariatric surgery. On multivariable analysis, bariatric surgery did not influence mortality (P = 0.98). Bariatric surgery was not associated with increased risk for acute chest syndrome, sepsis, multi-organ failure, biliary-pancreatic, or surgery-related complications (all P > 0.05). Interestingly, bariatric surgery decreased risk of vaso-occlusive crises (IRR 0.21; 95% CI, 0.07–0.69; P = 0.01) in these patients and was associated with a shorter length of stay (P < 0.001) but higher hospitalization costs (P < 0.001).


Bariatric surgery may lower rates of vaso-occlusive crises in morbidly obese sickle cell patients without significantly affecting mortality and other adverse outcomes. In spite of this, these weight loss surgeries are underutilized in this select population.


Sickle cell disease (SCD) Obesity Bariatric surgery Weight loss Weight gain Vaso-occlusive crisis 


Financial Support

This study was supported by NIH 5 T32 DK 7356-37 (BN).

This article has not been published and is not under consideration elsewhere.

Author Contributions

Study concept and design—Sharma P, McCarty TR, and Njei B. Paper preparation—Sharma P and McCarty TR. Statistical analysis—Njei B. Critical revisions—McCarty TR, Yadav S, Ngu JN, and Njei B. All authors approved the final version of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval Statement

For this type of study, formal consent is not required.

Informed Consent Statement

Informed consent statement does not apply.

Supplementary material

11695_2019_3780_MOESM1_ESM.docx (15 kb)
ESM 1 (DOCX 14 kb)


  1. 1.
    Sickle Cell Disease (SCD): Data and statistics. United States Centers for Disease Control and Prevention. Accessed March 31, 2018.
  2. 2.
    Yawn BP, Buchanan GR, Afenyi-Annan AN, et al. Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members. JAMA. 2014;312:1033–48.CrossRefPubMedGoogle Scholar
  3. 3.
    Bain BJ. Sickle cell haemoglobin and its interactions with other variant haemoglobins and with thalassaemias. In: Haemoglobinopathy Diagnosis. 2nd ed. Oxford: Wiley-Blackwell; 2005.Google Scholar
  4. 4.
    Hassell KL. Population estimates of sickle cell disease in the U.S. Am J Prev Med. 2010;38:S512–21.CrossRefPubMedGoogle Scholar
  5. 5.
    Herrick JB. Peculiar elongated and sickle-shaped red blood corpuscles in a case of severe anemia. 1910. Yale J Biol Med. 2001;74:179–84.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Herrick JB. Peculiar elongated and sickle-shaped red blood corpuscles in a case of severe anemia. JAMA. 2014;312:1063.CrossRefPubMedGoogle Scholar
  7. 7.
    Platt OS, Brambilla DJ, Rosse WF, et al. Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med. 1994;330:1639–44.CrossRefPubMedGoogle Scholar
  8. 8.
    Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet. 2010;376:2018–31.CrossRefPubMedGoogle Scholar
  9. 9.
    Hargrave DR, Wade A, Evans JP, et al. Nocturnal oxygen saturation and painful sickle cell crises in children. Blood. 2003;101:846–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Mitchell MJ, Carpenter GJ, Crosby LE, et al. Growth status in children and adolescents with sickle cell disease. Pediatr Hematol Oncol. 2009;26:202–15.CrossRefPubMedGoogle Scholar
  11. 11.
    Modebe O, Ifenu SA. Growth retardation in homozygous sickle cell disease: role of calorie intake and possible gender-related differences. Am J Hematol. 1993;44:149–54.CrossRefPubMedGoogle Scholar
  12. 12.
    Platt OS, Rosenstock W, Espeland MA. Influence of sickle hemoglobinopathies on growth and development. N Engl J Med. 1984;311:7–12.CrossRefPubMedGoogle Scholar
  13. 13.
    Odonkor PO, Addae SK, et al. Basal metabolic rate and serum thyroid hormone levels in adolescent sickle cell patients. IRSC Med Sci. 1982;10:891.Google Scholar
  14. 14.
    Hyacinth HI, Adekeye OA, Yilgwan CS. Malnutrition in sickle cell Anemia: implications for infection, growth, and Maturation J Soc Behav Health Sci 2013;7.Google Scholar
  15. 15.
    Zivot A, Apollonsky N, Gracely E, et al. Body mass index and the association with vaso-occlusive crises in pediatric sickle cell disease. J Pediatr Hematol Oncol. 2017;39:314–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Hibbert JM, Hsu LL, Bhathena SJ, et al. Proinflammatory cytokines and the hypermetabolism of children with sickle cell disease. Exp Biol Med (Maywood). 2005;230:68–74.CrossRefGoogle Scholar
  17. 17.
    Yanni E, Grosse SD, Yang Q, et al. Trends in pediatric sickle cell disease-related mortality in the United States, 1983-2002. J Pediatr. 2009;154:541–5.CrossRefPubMedGoogle Scholar
  18. 18.
    Le PQ, Gulbis B, Dedeken L, et al. Survival among children and adults with sickle cell disease in Belgium: benefit from hydroxyurea treatment. Pediatr Blood Cancer. 2015;62:1956–61.CrossRefPubMedGoogle Scholar
  19. 19.
    Piel FB, Steinberg MH, Rees DC. Sickle cell disease. N Engl J Med. 2017;376:1561–73.CrossRefPubMedGoogle Scholar
  20. 20.
    Gardner K, Douiri A, Drasar E, et al. Survival in adults with sickle cell disease in a high-income setting. Blood. 2016;128:1436–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Ashley-Koch A, Yang Q, Olney RS. Sickle hemoglobin (HbS) allele and sickle cell disease: a HuGE review. Am J Epidemiol. 2000;151:839–45.CrossRefPubMedGoogle Scholar
  22. 22.
    Farooqui MW, Hussain N, et al. Prevalence of obesity in sickle cell patients. Blood, 2014:124(21), 4932. Retrieved from Accessed March 31, 2018. .
  23. 23.
    Ballas SK. The sixth vital sign: body mass index in patients with sickle cell disease. J Clin Med Res. 2017;9:889–90.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Chawla A, Sprinz PG, Welch J, et al. Weight status of children with sickle cell disease. Pediatrics. 2013;131:e1168–73.CrossRefPubMedGoogle Scholar
  25. 25.
    Woods KF, Ramsey LT, Callahan LA, et al. Body composition in women with sickle cell disease. Ethn Dis. 2001;11:30–5.PubMedGoogle Scholar
  26. 26.
    Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality (AHRQ): advancing excellence in health care. Accessed January 6, 2018.
  27. 27.
    Okam MM, Shaykevich S, Ebert BL, et al. National trends in hospitalizations for sickle cell disease in the United States following the FDA approval of hydroxyurea, 1998-2008. Med Care. 2014;52:612–8.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    McCarty TR, Echouffo-Tcheugui JB, Lange A, et al. Impact of bariatric surgery on outcomes of patients with nonalcoholic fatty liver disease: a nationwide inpatient sample analysis, 2004-2012. Surg Obes Relat Dis. 2018;14:74–80.CrossRefPubMedGoogle Scholar
  29. 29.
    Sharma P, McCarty TR, Njei B. Impact of bariatric surgery on outcomes of patients with inflammatory bowel disease: a Nationwide inpatient sample analysis, 2004-2014. Obes Surg. 2017;Google Scholar
  30. 30.
    Population Estimates. United States Census Bureau. Accessed March 31, 2018.
  31. 31.
    Anderson RN, Rosenberg HM. Age standardization of death rates: implementation of the year 2000 standard. National vital statistics report: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 1998;47:1–16, 20.Google Scholar
  32. 32.
    Pells JJ, Presnell KE, Edwards CL, et al. Moderate chronic pain, weight and dietary intake in African-American adult patients with sickle cell disease. J Natl Med Assoc. 2005;97:1622–9.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Hackney AC, Hezier W, Gulledge TP, et al. Effects of hydroxyurea administration on the body weight, body composition and exercise performance of patients with sickle-cell anaemia. Clin Sci (Lond). 1997;92:481–6.CrossRefGoogle Scholar
  34. 34.
    Santanelli J, Zempsky W, et al. (228) Obesity worsens pain impact in individuals with sickle cell disease. J Pain. 2014;15(4):S33.CrossRefGoogle Scholar
  35. 35.
    Tauman R, Gozal D. Obesity and obstructive sleep apnea in children. Paediatr Respir Rev. 2006;7:247–59.CrossRefPubMedGoogle Scholar
  36. 36.
    Narang I, McCrindle BW, Manlhiot C, et al. Intermittent nocturnal hypoxia and metabolic risk in obese adolescents with obstructive sleep apnea. Sleep Breath. 2018;22:1037–44.CrossRefPubMedGoogle Scholar
  37. 37.
    Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009:CD003641.Google Scholar
  38. 38.
    Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.CrossRefPubMedGoogle Scholar
  39. 39.
    Buck J, Davies SC. Surgery in sickle cell disease. Hematol Oncol Clin North Am. 2005;19:897–902. viiCrossRefPubMedGoogle Scholar
  40. 40.
    Neumayr L, Koshy M, Haberkern C, et al. Surgery in patients with hemoglobin SC disease. Preoperative transfusion in sickle cell disease study group. Am J Hematol. 1998;57:101–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Klebanoff MJ, Chhatwal J, Nudel JD, et al. Cost-effectiveness of bariatric surgery in adolescents with obesity. JAMA Surg. 2017;152:136–41.CrossRefPubMedGoogle Scholar
  42. 42.
    Panca M, Viner RM, White B, et al. Cost-effectiveness of bariatric surgery in adolescents with severe obesity in the UK. Clin Obes. 2018;8:105–13.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Prabin Sharma
    • 1
    • 2
  • Thomas R. McCarty
    • 1
  • Siddhartha Yadav
    • 3
  • Julius N. Ngu
    • 4
  • Basile Njei
    • 5
    Email author
  1. 1.Department of Internal MedicineYale University School of MedicineNew HavenUSA
  2. 2.Department of Internal MedicineYale New Haven Health-Bridgeport HospitalBridgeportUSA
  3. 3.Hematology-Oncology Fellowship ProgramMayo ClinicRochesterUSA
  4. 4.Department of SurgeryUniversity of Texas Medical BranchGalvestonUSA
  5. 5.Section of Digestive DiseasesYale University School of MedicineNew HavenUSA

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