Bariatric surgery works safely in patients with extreme obesity, study finds
A nationwide study of 83,000 patients shows that weight-loss surgery can be performed safely even in people with the highest obesity levels, with complication rates no higher than in less obese groups. The finding could reshape surgical guidelines and expand treatment access for a population often considered too risky to operate on.
Originaltitel: Laparoscopic metabolic and bariatric surgery in patients with high body mass index—a nationwide registry-based cohort study
BACKGROUND: Metabolic and bariatric surgery (MBS) can be challenging in patients with a very high body mass index (BMI). OBJECTIVES: The objective of the study is to evaluate the outcomes of different weight categories in a publicly funded healthcare system with high adherence to current guidelines for perioperative optimization. SETTING: Nationwide, registry-based. METHODS: . RESULTS: The study included data for 83,057 patients. A postoperative complication occurred for 5855 (7.2%) with no difference between BMI groups. Operation time was longer for higher BMI groups for all procedures. At 2 years, patients lost the highest percentage of their total weight (%TWL) in all BMI categories after BPD/DS (37.9% ± 10.1% to 45.4% ± 15.3%), followed by RYGB (32.4% ± 8.6% to 36.8% ± 10.9%) and SG (26.6% ± 9.5% to 31.3% ± 8.9%). Mortality rates over a median of 9.8 years remained higher in the higher BMI groups (BMI: 50-59, odds ratio [OR] = 1.29 [1.15-1.46]; BMI: 60-69, OR = 1.66 [1.18-2.33]; BMI ≥70, OR = 2.33 [.96-5.68]). CONCLUSION: MBS can be performed safely in patients with obesity class 4 or higher. Higher BMI was associated with longer operating times and superior weight loss, especially after BPD/DS. Despite greater weight loss and similar remission of metabolic co-morbid diseases, patients with higher preoperative BMI still have an increased long-term risk of all-cause mortality.