The most common bariatric surgeries carry low rates of adverse perioperative outcomes when performed by experienced surgeons in established centers, according to a prospective, multicenter, observational study.
Thirty-day mortality was 0.3% and the rate of major complications was 4.1%, which are comparable to rates for other major operations. Those rates are considered low for bariatric surgery, because most patients are extremely obese and have multiple comorbid conditions, said Dr. David R. Flum of the University of Washington, Seattle, and his associates in the Longitudinal Assessment of Bariatric Surgery (LABS) study (N. Engl. J. Med. 2009;361:445–54).
The investigators evaluated 4,776 consecutive patients who underwent first-time bariatric surgery in 2005–2007, performed by 33 surgeons certified by the LABS consortium. “Our study provides standardized, prospective data on a cohort from multiple centers that is large enough to evaluate potential factors associated with safety outcomes,” they noted.
The most common procedure was Roux-en-Y gastric bypass (71% of patients), which was performed laparoscopically in 87% of cases and as an open procedure in 13% of cases. Another 25% of the study subjects underwent laparoscopic adjustable gastric banding, and the remaining 4% underwent other bariatric procedures.
The primary outcome of the study was a composite end point of death, deep-vein thrombosis, venous thromboembolism, reintervention, or failure to be discharged within 30 days. That occurred in 1% of the patients undergoing laparoscopic adjustable gastric banding, 4.8% of those undergoing laparoscopic Roux-en-Y gastric bypass, and 7.8% of those undergoing open Roux-en-Y gastric bypass.
Patients who had a history of thrombotic disorders, had poor functional status, or had sleep apnea were at increased risk of poor outcomes.
“Regardless of the type of procedure, the predicted probability of the composite end point was lowest among patients who did not have a history of deep-vein thrombosis or venous thromboembolism or of obstructive sleep apnea, and who were in the middle range of the spectrum of body mass index for the cohort,” Dr. Flum and his colleagues said.
The researchers added that the study focused on perioperative adverse events. Another study that has just completed recruitment (LABS-2) will assess the long-term effects of bariatric surgery on health conditions, quality of life, health care costs, and psychosocial issues.
Dr. Flum reported receiving grant support from Sanofi-Aventis and Covidien AG and serving as an expert witness on cases involving adverse events after bariatric surgery.
A history of thrombotic disorders, poor functional status, or sleep apnea yielded a risk of poor outcomes.
Source Dr. Flum