Samuel L Skulsky, BSc, Jerry T Dang, BSc, MD, Adrian Battiston, BSc, Noah Switzer, BSc, MD, Daniel Birch, BSc, MSc, MD, Arya Sharma, MD, PhD, Shahzeer Karmali, BSc, MPH, MD. University of Alberta
Introduction: The objective of this study was to determine the utility of the Edmonton Obesity Staging System (EOSS) in predicting postoperative complications. The EOSS is a functional staging system enabling physicians to describe the morbidity and functional limitations associated with obesity. The EOSS classifies patients according to their degree of obesity as well as any concomitant obesity-related diseases in order to determine their risk of further deterioration and mortality. The EOSS thus facilitates the identification and prioritization of patients who would benefit from metabolic surgery.
Methods: A retrospective chart review was performed for bariatric patients who received primary sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) from 2009 through to 2015 at a single centre. Collected data included patient comorbidities, preoperative EOSS stage, body mass index (BMI), age, 30-day and 1-year major complications and mortality. A major complication was defined as having a Clavien-Dindo of 2 or greater.
Results: A total of 639 patients (82.6% female) were reviewed. Patients had the following EOSS stages: 0 (n = 25), 1 (n = 78), 2 (n = 497), 3 (n = 39), 4 (n = 0). The mean preoperative BMI was 45.9 kg/m2 (SD +/- 6.35) and 43.0 kg/m2 (SD +/- 6.61) for RYGB (n = 385) and SG (n = 254) patients, respectively. The overall major complication rates at 30 days and one year were 3.29% and 7.36%, respectively. The 30-day major postoperative complications rates for EOSS stages 0, 1, 2, and 3 were 0%, 1.28%, 2.56%, and 5.12%, respectively. The one-year major complication rates for EOSS stages 0, 1, 2, and 3 were 4.00%, 3.85%, 6.64%, and 15.38% respectively. Patients undergoing RYGB with an EOSS stage ≥ 3 were more likely to experience major complications within one year after surgery when compared to EOSS < 3 (OR 2.66; [CI 1.02, 7.09], p = 0.046).
Conclusion: The results of our study suggest that patients undergoing RYGB with an EOSS stage ≥3 are at an increased risk of one-year major complications. As such, the EOSS demonstrates potential utility in stratifying metabolic surgery candidates and anticipating who may be at risk for major postoperative morbidity. Future high-powered studies are required to further assess the predictive capabilities of the EOSS for SG patients. Additional studies are also required to determine whether the use of the EOSS for pre-surgical risk stratification and earlier intervention reduces major complication rates, hospital readmission, or reoperation after metabolic surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94421
Program Number: S051
Presentation Session: Bariatric I – Complications
Presentation Type: Podium