Elan R Witkowski, MD, MS, Julietta H Chang, MD, Matthew M Hutter, MD, MPH. Massachusetts General Hospital / Harvard Medical School
Introduction: Patients with “super-super obesity”, defined as a BMI≥60, are at higher risk of weight-related health problems and might benefit more than others from metabolic and bariatric surgery. However, these benefits need to be weighed against the potential for increased operative and perioperative risks. Accurate data regarding these patients is critical to guide procedure choice and informed, shared decision-making.
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) is a national accreditation and quality improvement program, which captures clinically-rich specialty-specific data for the majority of all bariatric operations in the United States. This is the first analysis of the MBSAQIP Participant Use File (PUF) focusing on this at-risk subpopulation.
Methods: All patients who underwent primary elective bariatric operations in 2015 were identified. Patients with a BMI of ≥60 were compared to patients with a BMI <60 with regards to patient characteristics, treatment patterns, and 30-day outcomes. Univariate analyses and multivariable logistic regression were performed.
Results: 140,649 patients underwent primary operations in 2015. Of these, 8,082(5.75%) had a BMI ≥60. Patients with BMI ≥60 were more likely to be male (28.11% vs 20.79%), black (24.68% vs 16.41%), have limited ambulation (6.12% vs 1.79%), and have several comorbid conditions (p<0.0001). They were less likely to undergo sleeve gastrectomy (60.64% vs 66.01%) or band (2.15% vs 3.13%), and more likely to undergo gastric bypass (32.12% vs 28.56%) or other procedures (p<0.0001). The initial approach was similar (88.35% vs 88.53% laparoscopic, 6.57% vs 5.96% robotic, ~0% open). However, rates of conversion to a different approach were higher in patients with BMI ≥60 (0.58% vs 0.23%, p<0.0001). Mean operative time was longer for patients with BMI ≥60 by 10 minutes (87 minutes vs 77 minutes).
Median LOS was 2 days for both groups. BMI≥60 was associated with slightly increased rates of readmission (5.95% vs 4.20%), complications (5.85% vs 4.06%), and death (0.10% vs. 0.45%) (p<0.0001). BMI≥60 was an independent predictor of complications (OR 1.32, 95%CI 1.2-1.46).
Conclusions: Metabolic and Bariatric Surgery at MBSAQIP accredited centers is safe for patients with a BMI≥60. However, univariate and multivariate analyses show that short term outcomes are slightly worse than in those with a lower BMI. This somewhat higher rate of complications need to be weighed against the significant benefits from surgery in order to help patients and providers decide if it is best to proceed with metabolic and bariatric surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88461
Program Number: P613
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster