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Five Years of MBSAQIP Data: Characteristics, Outcomes, and Trends for Patients with Super-obesity

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Abstract

Purpose

Incidence of super obesity (SO; BMI ≥ 50 kg/m2) is growing rapidly and confers worse metabolic complications than non-SO (BMI 30–50 kg/m2). We aim to characterize bariatric surgery patients with SO, their postoperative complications, and treatment trends over the last 5 years in hopes of informing SO-specific treatment protocols.

Materials and Methods

The MBSAQIP database was analyzed, and two cohorts were compared, those with SO and non-SO. Univariate analysis was performed to determine between-group differences. Multivariable logistic regression analysis was performed to determine if SO was independently associated with serious complications or mortality.

Results

We evaluated 751,952 patients with 173,110 (23.0%) having SO. Patients with SO were younger (42.2 ± 11.8 SO vs 45.1 ± 12.0 years non-SO, p < 0.001) and less likely to be female (74.8% vs 81.1%, p < 0.001). While comorbidities seem to be decreasing overall in bariatric surgery patients, those with SO have worse functional capacity and more endocrine, pulmonary, and vascular comorbidities. Patients with SO also have worse 30-day postoperative complications, and SO was independently associated with severe complications (OR 1.08; CI 1.05–1.11, p < 0.001) and mortality (OR 2.49; CI 2.12–2.92, p < 0.001)

Conclusions

Patients with SO have significantly increased preoperative comorbidities resulting in worse postoperative outcomes. SO remains an independent risk factor for serious complications and the greatest independent risk factor for 30-day postoperative mortality. Considering the expected increase in patients with SO, substantial work is required to optimize bariatric surgery strategies specific to these patients.

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Authors and Affiliations

  1. Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW EDMONTON AB, Edmonton, Alberta, T6G 2B7, Canada

    Kevin Verhoeff, Valentin Mocanu, Jerry Dang, Kieran Purich & Noah J. Switzer

  2. Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, Alberta, Canada

    Daniel W. Birch & Shahzeer Karmali

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  1. Kevin Verhoeff
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  2. Valentin Mocanu
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  3. Jerry Dang
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Correspondence to Kevin Verhoeff.

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Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was exempt from ethics review.

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Key Points:

• Patients with super-obesity represent a unique bariatric surgery patient population.

• Patients with super-obesity have worse 30-day postoperative complications.

• Super-obesity is independently associated with severe complications and mortality.

• Substantial work is required to optimize bariatric surgery strategies specific to these patients.

Appendix

Appendix

Data collection definitions

Leak- Defined by any of: reoperation for anastomotic/staple line leak, readmission for anastomotic/staple line leak, reintervention for anastomotic/staple line leak, drain present 30 days postoperatively, or death caused by anastomotic/staple line leak.

Postoperative VTE- Defined by any of: reoperation for pulmonary embolism or venous thrombosis, readmission for pulmonary embolism or venous thrombosis, reintervention for pulmonary embolism or venous thrombosis, venous thrombosis requiring anticoagulation therapy, pulmonary embolism requiring anticoagulation therapy, and does NOT include anticoagulation for presumed/suspected VTE.

Postoperative bleed- Defined by any of: reoperation for bleed, readmission for bleed, reintervention for bleed, transfusion required in first 72 hours of surgery start time, and death caused by bleeding.

Serious complication- Defined by any of: cardiac complications, pneumonia, acute renal failure, reoperation, reintervention, venous thromboembolism, deep surgical site infection, wound disruption, sepsis, unplanned intubation, leak, bleed, coma > 24 hours, and cerebral vascular accident.

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Verhoeff, K., Mocanu, V., Dang, J. et al. Five Years of MBSAQIP Data: Characteristics, Outcomes, and Trends for Patients with Super-obesity. OBES SURG 32, 406–415 (2022). https://doi.org/10.1007/s11695-021-05786-z

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