Samuel L Skulsky, BSc1, Jerry T Dang, MD2, Noah J Switzer, MD, MPH2, Arya M Sharma, MD, PhD2, Daniel W Birch, MD, MSc2, Shahzeer Karmali, MD, MPH2. 1University of Alberta, 2Department of Surgery, University of Alberta
INTRODUCTION: To assess the utility of the Edmonton Obesity Staging System (EOSS) in predicting major 30-day postoperative complications and mortality following laparopscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). The EOSS is a tool that assigns individuals with obesity a score of 0 to 4 according to their obesity-related comorbidities and functional status. Previous research demonstrates that the EOSS predicts overall mortality risk.
METHODS AND PROCEDURES: Primary LSG or LRYGB patients were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Patients were assigned EOSS scores according to their comorbidities and functional limitations extracted from the data registry. Multivariable logistic regression analysis was conducted to evaluate if EOSS score, age, sex, BMI, type of procedure, or operative time predicted 30-day major complications.
RESULTS: From 2015 to 2017, 430,238 patients (79.4% female) who underwent primary LSG or LRYGB were identified. The relative frequencies of patients by EOSS score were: 0 & 1 (23.9%), 2 (62.8%), 3 (10.5%), 4 (2.9%). Mean preoperative BMI was 45.4 (SD 7.9) kg/m2 and mean age was 44.6 (SD 12.0) years. The overall incidence of 30-day major complications was 3.5%. EOSS 2, 3, and 4 were significantly associated with major complications. The strongest predictors of major complications were EOSS 4 (OR 2.30; 95% CI 2.11 to 2.51, p < 0.001) and LRYGB versus LSG (OR 2.03; 95% CI 1.97 to 2.11, p < 0.001). The strongest predictors of death were the EOSS 3 (OR 2.37; 95% CI 1.53 to 3.67, p < 0.001) and 4 (OR 3.64; 95% 2.26 to 5.88, p < 0.001).
CONCLUSION: The EOSS independently predicts risk of 30-day major postoperative complications and mortality. The EOSS provides utility for bariatric surgeons in staging patients for earlier selection and planning to mitigate perioperative complications.
This abstract was accepted for Podium presentation at the 2020 SAGES Virtual Meeting in the Bariatric topic. Its program number was: S141 and its Abstract ID was: 101377