Multivariate Analysis of Risk Factors for Death Following Gastric Bypass for Treatment of Morbid Obesity

Adolfo Z. Fernandez, Eric J. Demaria, David S. Tichansky, John M. Kellum, Luke G. Wolfe, Jill Meador, Harvey J. Sugerman, Ken G. MacDonald, Michael L Hawkins, J. Patrick O'Leary, J. Bradley Aust, Achilles A. Demetriou, Gregory A. Timberlake

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Abstract

Objective: To identify the factors that increase mortality for either open or laparoscopic Roux-en-Y gastric bypass. Summary Background Data: Perioperative mortality is the most feared outcome of bariatric surgery, reported to occur in between 0.5% and 1.5% of patients. Methods: The bariatric database at Virginia Commonwealth University was queried for patients who had undergone either an open gastric bypass (O-GBP) or a laparoscopic gastric bypass (L-GBP). A multivariate logistic regression analysis to identify factors related to perioperative mortality was performed. Factors examined included age, gender, body mass index, preoperative weight, hypertension, diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, venous stasis ulcers, intestinal leak, small bowel obstruction, and pulmonary embolus. Results: Since 1992, more than 2000 patients had either an O-GBP (n = 1431) or a L-GBP (n = 580). Of the O-GBP, 547 patients had a proximal GBP (P-GBP) and 884 superobese (body mass index > 50 kg/m2) patients had a long-limb GBP (LL-GBP). The differences in patient demographics, complications, and perioperative mortality rates between L-GBP and O-GBP and P-GBP and LL-GBP patients were examined. Overall, the independent risk factors associated with perioperative death included leak, pulmonary embolus, preoperative weight, and hypertension. Conclusions: The risk factors for perioperative death can be separated into patient characteristics and complications. The access method, open versus laparoscopic, was not independently predictive of death, but the operation type, proximal versus long limb, was predictive. The data do not suggest that superobese patients should not undergo surgery, as they are high risk for early death due to their body weight and comorbidities without surgery. Surgery should not be reserved as a desperate last measure for weight loss.

Original languageEnglish (US)
Pages (from-to)698-703
Number of pages6
JournalAnnals of Surgery
Volume239
Issue number5
DOIs
StatePublished - May 1 2004

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Gastric Bypass
Morbid Obesity
Multivariate Analysis
Therapeutics
Extremities
Mortality
Embolism
Body Mass Index
Obesity Hypoventilation Syndrome
Hypertension
Bariatrics
Weights and Measures
Varicose Ulcer
Lung
Bariatric Surgery
Sleep Apnea Syndromes
Comorbidity
Weight Loss
Diabetes Mellitus
Logistic Models

ASJC Scopus subject areas

  • Surgery

Cite this

Fernandez, A. Z., Demaria, E. J., Tichansky, D. S., Kellum, J. M., Wolfe, L. G., Meador, J., ... Timberlake, G. A. (2004). Multivariate Analysis of Risk Factors for Death Following Gastric Bypass for Treatment of Morbid Obesity. Annals of Surgery, 239(5), 698-703. https://doi.org/10.1097/01.sla.0000124295.41578.ab

Multivariate Analysis of Risk Factors for Death Following Gastric Bypass for Treatment of Morbid Obesity. / Fernandez, Adolfo Z.; Demaria, Eric J.; Tichansky, David S.; Kellum, John M.; Wolfe, Luke G.; Meador, Jill; Sugerman, Harvey J.; MacDonald, Ken G.; Hawkins, Michael L; O'Leary, J. Patrick; Aust, J. Bradley; Demetriou, Achilles A.; Timberlake, Gregory A.

In: Annals of Surgery, Vol. 239, No. 5, 01.05.2004, p. 698-703.

Research output: Contribution to journalArticle

Fernandez, AZ, Demaria, EJ, Tichansky, DS, Kellum, JM, Wolfe, LG, Meador, J, Sugerman, HJ, MacDonald, KG, Hawkins, ML, O'Leary, JP, Aust, JB, Demetriou, AA & Timberlake, GA 2004, 'Multivariate Analysis of Risk Factors for Death Following Gastric Bypass for Treatment of Morbid Obesity', Annals of Surgery, vol. 239, no. 5, pp. 698-703. https://doi.org/10.1097/01.sla.0000124295.41578.ab
Fernandez, Adolfo Z. ; Demaria, Eric J. ; Tichansky, David S. ; Kellum, John M. ; Wolfe, Luke G. ; Meador, Jill ; Sugerman, Harvey J. ; MacDonald, Ken G. ; Hawkins, Michael L ; O'Leary, J. Patrick ; Aust, J. Bradley ; Demetriou, Achilles A. ; Timberlake, Gregory A. / Multivariate Analysis of Risk Factors for Death Following Gastric Bypass for Treatment of Morbid Obesity. In: Annals of Surgery. 2004 ; Vol. 239, No. 5. pp. 698-703.
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abstract = "Objective: To identify the factors that increase mortality for either open or laparoscopic Roux-en-Y gastric bypass. Summary Background Data: Perioperative mortality is the most feared outcome of bariatric surgery, reported to occur in between 0.5{\%} and 1.5{\%} of patients. Methods: The bariatric database at Virginia Commonwealth University was queried for patients who had undergone either an open gastric bypass (O-GBP) or a laparoscopic gastric bypass (L-GBP). A multivariate logistic regression analysis to identify factors related to perioperative mortality was performed. Factors examined included age, gender, body mass index, preoperative weight, hypertension, diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, venous stasis ulcers, intestinal leak, small bowel obstruction, and pulmonary embolus. Results: Since 1992, more than 2000 patients had either an O-GBP (n = 1431) or a L-GBP (n = 580). Of the O-GBP, 547 patients had a proximal GBP (P-GBP) and 884 superobese (body mass index > 50 kg/m2) patients had a long-limb GBP (LL-GBP). The differences in patient demographics, complications, and perioperative mortality rates between L-GBP and O-GBP and P-GBP and LL-GBP patients were examined. Overall, the independent risk factors associated with perioperative death included leak, pulmonary embolus, preoperative weight, and hypertension. Conclusions: The risk factors for perioperative death can be separated into patient characteristics and complications. The access method, open versus laparoscopic, was not independently predictive of death, but the operation type, proximal versus long limb, was predictive. The data do not suggest that superobese patients should not undergo surgery, as they are high risk for early death due to their body weight and comorbidities without surgery. Surgery should not be reserved as a desperate last measure for weight loss.",
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AU - Demaria, Eric J.

AU - Tichansky, David S.

AU - Kellum, John M.

AU - Wolfe, Luke G.

AU - Meador, Jill

AU - Sugerman, Harvey J.

AU - MacDonald, Ken G.

AU - Hawkins, Michael L

AU - O'Leary, J. Patrick

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N2 - Objective: To identify the factors that increase mortality for either open or laparoscopic Roux-en-Y gastric bypass. Summary Background Data: Perioperative mortality is the most feared outcome of bariatric surgery, reported to occur in between 0.5% and 1.5% of patients. Methods: The bariatric database at Virginia Commonwealth University was queried for patients who had undergone either an open gastric bypass (O-GBP) or a laparoscopic gastric bypass (L-GBP). A multivariate logistic regression analysis to identify factors related to perioperative mortality was performed. Factors examined included age, gender, body mass index, preoperative weight, hypertension, diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, venous stasis ulcers, intestinal leak, small bowel obstruction, and pulmonary embolus. Results: Since 1992, more than 2000 patients had either an O-GBP (n = 1431) or a L-GBP (n = 580). Of the O-GBP, 547 patients had a proximal GBP (P-GBP) and 884 superobese (body mass index > 50 kg/m2) patients had a long-limb GBP (LL-GBP). The differences in patient demographics, complications, and perioperative mortality rates between L-GBP and O-GBP and P-GBP and LL-GBP patients were examined. Overall, the independent risk factors associated with perioperative death included leak, pulmonary embolus, preoperative weight, and hypertension. Conclusions: The risk factors for perioperative death can be separated into patient characteristics and complications. The access method, open versus laparoscopic, was not independently predictive of death, but the operation type, proximal versus long limb, was predictive. The data do not suggest that superobese patients should not undergo surgery, as they are high risk for early death due to their body weight and comorbidities without surgery. Surgery should not be reserved as a desperate last measure for weight loss.

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