Sleeve Gastrectomy: Preliminary Results From Bariatric Outcome Longitudinal Database (bold)

Jyoti Sharma, MD, Debbie Winegar, PhD, Donald Risucci, PhD, Anthony Maffei, MD FACS, Thomas Cerabona, MD FACS, Ashutosh Kaul, MD FRCS FACS. New York Medical College


INTRODUCTION: Sleeve gastrectomy (SG) has in the last decade emerged as an increasingly utilized procedure for weight loss. Laparoscopic SG (LSG) is gaining popularity as a definite, isolated bariatric procedure for morbid obesity due to satisfactory weight loss and resolution of co-morbidities. This study examines preoperative, operative and postoperative outcomes after LSG in the largest longitudinal bariatric database in the world, the Bariatric Outcomes Longitudinal Database (BOLD).

METHODS: BOLD was queried for data on adult patients (age > 18 years) who had SG between June 2007 and March 2, 2010. Variables of interest included demographic characteristics, co-morbidities, medications, functional status, additional procedures performed, operative/anesthesia length, estimated blood loss, blood transfusions, American Society of Anesthesiologists (ASA) class, intra-operative complications, postoperative complications, intervention for postoperative complication and length of stay. Data were analyzed using the Statistical Package for the Social Sciences (SPSS®) Version 19.

RESULTS: Of the 112,337 research-consented bariatric surgery patients with data entered into BOLD, 3448 (3.1%) had undergone SG. With an average age (Mean + Standard Deviation) of 46.0 ± 11.8 and a body mass index (BMI) of 48.2 ± 10.2, most patients were female (72.7%), white (80.7%), worked full time (54.6%), and had no functional status impairments (94.8%). Preoperative co-morbidities included the following: 47.4% had diagnosed hypertension; 26.3% had obstructive sleep apnea; 25.9% had diabetes mellitus; 23.0% were on medication for gastroesophageal reflux disease (GERD) and 22.2% had dyslipidemia. Almost all patients underwent LSG (96.6%) with a majority in ASA Class IV (63.6%). Mean operative time was 100.4 minutes and average length of stay was 2.4 days. Postoperatively, 4.1% had at least 1 readmission and 2.6% needed re-operation within the first 30 days. The 30- and 60-day mortality was 0.1% with most of the deaths in patients with ASA Class III. The most common adverse events reported were nausea/vomiting 3.5%, dehydration 1.1%, electrolyte imbalance 1%, stricture 0.8%, intraabdominal bleeding/hemorrhage 0.8% and leak 0.8%. Patients had lost an average of 73.2 lbs, 96.0 lbs, and 78.3 lbs at 6, 12, and 18 months respectively. Complete resolution of co-morbidities at 12 months occurred in 60.9% with diabetes mellitus, 44.9% withhypertension, 33.6% with dyslipidemia, and 38.7% with GERD patients.

CONCLUSION: SG is an increasingly performed bariatric procedure with significant weight loss at 1 year follow up and low mortality and morbidity. Co-morbidity reduction, weight loss and postoperative complications compare favorably to other commonly performed bariatric surgery procedures. Larger studies are needed especially with longer follow-up times to better assess its utility. Moreover, risk stratification of SG patients is recommended to optimize patient selection for prevention of complications.

Session Number: Poster – Poster Presentations
Program Number: P467
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