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