Original article
Outcomes of Roux-en-Y gastric bypass in the super obese: comparison of body mass index 50–60 kg/m2 and≥60 kg/m2 with the morbidly obese

https://doi.org/10.1016/j.soard.2015.10.072Get rights and content

Abstract

Background

Reports on the outcomes of Roux-en-Y gastric bypass (RYGB) in super-obese patients are limited, especially on patients with body mass index (BMI)≥60 kg/m2.

Objectives

The aim of the present study was to evaluate and compare the tolerability and efficacy of RYGB in the super-obese by comparing patients with a BMI of 50–60 kg/m2 and a BMI of≥60 kg/m2 with patients with a BMI of 40–50 kg/m2.

Setting

Academic practice.

Methods

Between January 2004 and November 2013, a total of 2717 patients underwent RYGB at our institution. Of these, 661 (24.3%) had a preoperative BMI of 50–60 kg/m2 and 230 (8.5%) had a BMI≥60 kg/m2. A retrospective review of outcomes and complications was performed, comparing these patients with 1555 patients with a BMI between 40–50 kg/m2.

Results

Fifty-two (3.3%) patients in the BMI 40–50 kg/m2 group, 15 (2.3%) patients in the BMI 50–60 kg/m2 group, and 3 (1.3%) patients in the BMI≥60 kg/m2 had<30 days of follow-up. Readmission rates were 10.7%, 9.2%, and 11.7%, and reoperation rates were 7.3%, 5.0%, and 6.1%, in the BMI 40–50, 50–60, and≥60 kg/m2 groups, respectively. No significant difference was found in readmission rate among the 3 groups, and reoperation rate was significantly lower in the BMI 50–60 kg/m2 group. Mean percentage of excess BMI loss was 58.3%, 80.6%, 85.8%, 83.3%, and 80.9% in the BMI 40–50 kg/m2 group; 44.9%, 65.0%, 70.1%, 72.1%, and 65.9% in the BMI 50–60 kg/m2 group; and 38.5%, 57.4%, 62.2%, 62.8%, and 59.1% in the≥60 kg/m2 group at 6, 12, 18, 24, and 36 months, respectively. The differences in excess BMI loss were statistically significant among all 3 groups at all follow-up time points. All groups experienced a significant decrease in their mean number of co-morbidities after the procedure.

Conclusion

Readmission and reoperation rates were similar in the BMI 40–50, 50–60, and≥60 kg/m2 groups. Super-obese and super-super-obese patients are not at greater risk for surgical complications compared with those with lower BMIs.

Section snippets

Methods

After institutional review board approval and according to the Health Insurance Portability and Accountability Act guidelines, we performed a retrospective chart review of a prospectively maintained database of 2717 patients who underwent RYGB between January 1, 2004 and November 30, 2013. Most cases were done laparoscopically, except in 87 cases in 2004 done as open and 48 cases in 2013 done as robot-assisted laparoscopic. A total of 1555 patients were identified as having a BMI 40–50 kg/m2,

Results

Of 1555 morbidly obese patients with a BMI 40–50 kg/m2, 1294 were female and 261 were male. Patients had a mean age of 42.3±11.0 years (range, 18–70), and a mean preoperative BMI of 44.6±7.7 kg/m2 (range, 40.0–49.9).

Of 891 super-obese patients, 661 (74.2%) had a preoperative BMI between 50–60 kg/m2 and 230 (25.8%) had a BMI≥60 kg/m2. The BMI 50–60 kg/m2 group consisted 522 female and 139 male patients with a mean age of 42.1±10.8 years (range, 17–66) and a mean preoperative BMI of 54.1±2.7 kg/m2

Discussion

Prevalence of obesity in the United States has increased dramatically during the period of 1976 through 2000 [1]. Smaller changes were noted between 1999 and 2010, and overall, the percentage of obese population was 35% in U.S. adults during the 2009–2010 period. However, there is change in the distribution of the BMI. Flegal et al. [18] reported increased skewness with a greater shift in the upper part of the distribution, and so the heaviest subgroup was heavier than prior studies in 2000.

Conclusion

The readmission and reoperation rates were similar in the BMI 40–50, 50–60, and≥60 kg/m2 groups. Super-obese and super-super-obese patients are not at greater risk for surgical complications compared with those with lower BMIs.

Disclosures

Muhammad Jawad, Andre F. Teixeira, and Rena C. Moon received an honorarium as a consultant for Ethicon Endosurgery. The other authors have no commercial associations that might be a conflict of interest in relation to this article. Andre F. Teixeira received an honorarium as a consultant for Intuitive Surgical. None of these might be a conflict of interest in relation to this article.

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    The abstract of this manuscript was accepted for poster presentation at the 2015 ASMBS annual meeting in Los Angeles, CA.

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