Gautam Sharma1, Suriya Punchai, MD2, Ivy N Haskins, MD1, Zubaidah Nor-Hanipah, MD2, Jingliang Yan, MD1, Amelia Dorsey, MD1, Andrew T Strong, MD1, John H Rodriguez, MD1, Stacy A Brethauer, MD2, Philip R Schauer, MD2, Matthew Kroh, MD1. 1Section of Surgical Endoscopy, Dept. of General Surgery, Cleveland Clinic, 2Bariatric and Metabolic Institute, Cleveland Clinic
Introduction: Patients with impaired mobility undergoing bariatric surgery may have higher risk for post-operative complications. They may also experience significant improvement in mobility and weight-related comorbidities. This study aims to evaluate the short-term surgical outcomes, both with respect to ambulatory status and weight-related metrics, following bariatric surgery in patients with impaired mobility.
Methods: Using a prospectively maintained institutional database, individuals who underwent primary sleeve gastrectomy (SG) or roux-en-y gastric bypass (RYGB) from February 1, 2008 through December 31, 2015 were identified. Patients with impaired mobility, defined as using a wheelchair or motorized scooter for at least part of a typical day were included. Patients using only a walker or cane were excluded. Data collected included patient demographics, co-morbidities, perioperative parameters, and postoperative outcomes. Mobility improvement was defined as discontinuation of wheelchair or scooter use.
Results: Ninety-three patients underwent primary laparoscopic RYGB (n=65, 70%) and SG (n=28, 30%) during the study period. Sixty-six (71%) patients were female; median age 56 years (IQR 46-61) and median preoperative BMI of 55 kg/m2 (IQR 49-64). Comorbidities included: hypertension (n=84, 90%), diabetes mellitus (n=57, 61%), dyslipidemia (n=68, 73%), obstructive sleep apnea (n=79, 85%), reflux disease (n=56, 60%), and osteoarthritis (n=43, 46%). Early (≤ 30 days) post-operative complications occurred in 17 patients (18%). Early major complications included anastomotic leak (n=3, 3%), bowel obstruction requiring reoperation (n=2, 2%), venous thromboembolism (n=1, 1%) and respiratory failure requiring re-intubation (n=2, 2%). Early minor complications included marginal ulcer (n=1), anastomotic stricture requiring endoscopic intervention (n=1), nausea and vomiting (n=2), and dehydration (n=3).
At 12 months follow-up (n=61), median BMI and % excess weight loss (%EWL) were 40 kg/m2 (IQR 34-49), and 53% (IQR 32-66), respectively. Improvement in weight-related co-morbidities was noted for diabetes mellitus (n=25/35, 71%), hypertension (n=33/56, 59%), dyslipidemia (n=20/43, 47%), obstructive sleep apnea (n=26/46, 57%) and reflux disease (n=19/34, 56%). In terms of ambulation, 38/61 patients (62%) experienced improvement in their mobility status; 13 patients (21%) were able to walk unaided while 25 (41%) required only partial support with the use of a cane or walker, all eliminating the use of a wheelchair or scooter.
Conclusion: Patients with impaired mobility are an older cohort with a higher BMI and more associated comorbidities. While this patient population is at risk for additional postoperative morbidity, bariatric surgery results in short-term improvement in mobility status and weight-related comorbidities in a majority of patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79584
Program Number: P510
Presentation Session: Poster (Non CME)
Presentation Type: Poster
