C Blackledge, MD, L Graham, MPH, A Gullick, MSMPH, J Richman, MD, PhD, R Stahl, MD, J Grams, MD, PhD. The University of Alabama at Birmingham
Introduction
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective treatment for achieving and maintaining weight loss and for improving obesity-related comorbidities. As part of the approval process for bariatric surgery, many insurance companies require patients to have documented recent participation in a 6 to 12 month supervised dietary program. Surgeons may also require patients to lose 5-10% of excess weight as part of the preoperative evaluation. The goal of this study was to evaluate the relationship of preoperative weight loss with outcomes following gastric bypass.
Methods
An Institutional Review Board-approved retrospective review was conducted of all adult patients undergoing LRYGB between 2008 and 2012 at a single institution. Data collected included preoperative demographics, preoperative weight change from the initial visit to time of operation, intraoperative variables, postoperative weight loss, and 90-day morbidity.
Results
A total of 323 patients met inclusion criteria and were stratified into quartiles: median percent excess weight gain for Quartiles 1 and 2 were 5.37% and 1.74%, respectively, while median percent excess weight loss (%EWL) for Quartiles 3 and 4 were 0.0% and 2.92%, respectively. Although quartiles differed by weight and BMI at the initial visit, there was no significant difference at the time of operation. Patients with the greatest preoperative percent excess weight gain and %EWL had the greatest time from initial visit to operation (below). There were no significant differences in estimated blood loss or operative time (p=0.78 and p=0.35, respectively). The 90-day morbidity rate and postoperative %EWL at 6, 12, and 24 months are displayed below. Overall median follow-up was 541 days and was comparable among quartiles (p=0.92). Unadjusted and adjusted generalized linear models showed no statistically significant association between weight loss outcomes at 24 months based on preoperative weight change.
| Q1 | Q2 | Q3 | Q4 | p-value | ||
|---|---|---|---|---|---|---|
| Time to operation, days* | 260 | 184 | 128 | 232 | <0.001 | |
| 90- day morbidity | 12.4% | 6.3% | 7.4% | 4.9% | 0.31 | |
| Postoperative %EWL | 6 months | 51.1% | 51.1% | 48.8% | 43.9% | 0.004 |
| 12 months | 69.7% | 68.7% | 67.9% | 59.2% | 0.05 | |
| 24 months | 75.6% | 64.4% | 65.4% | 65.7% | 0.18 | |
*Median
Conclusions
Patients with the greatest percent excess weight gain and %EWL had the longest interval from initial visit to operation. Despite an initial difference in postoperative %EWL, there was no significant association between pre-operative weight change and %EWL at 2 years in either unadjusted or adjusted analyses. This study suggests that preoperative weight loss requirements may delay the time to operation without improving postoperative outcomes.