Background

Background: It is well established that obesity severity is associated with the number and severity of comorbid diseases and may contribute to increased adverse postoperative outcomes. Few studies have evaluated surgical outcomes for patients with BMI≥60kg/m2. Objective: Evaluate the association between BMI≥60kg/m2 and 30-day outcomes following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).

Methods

We queried the MBSAQIP database for patients undergoing primary SG (CPT:43775) or RYGB (CPT:43644) in 2020-2021 and compared 30-day outcomes between patients with BMI≥60kg/m2 vs. BMI<60kg/m2. Logistic regression models estimated the probability of adverse postoperative outcomes as a function of BMI classification for SG and RYGB separately while controlling for age, sex, and race.

Results

For SG, 14 deaths occurred among the 10,652 cases with BMI≥60kg/m2 (0.13%) and 101 deaths among 218,922 with BMI<60kg/m2 (0.05%; OR:3.01). For RYGB, 9 deaths among 3,822 with BMI≥60kg/m2 (0.24%) and 73 deaths among 78,668 with BMI<60kg/m2 (0.09%; OR:3.68). For SG, BMI≥60kg/m2 was associated with a significantly higher risk of ICU admission (OR:3.10), GI bleeding (OR:2.04), septic shock (OR:2.80), acute renal failure (OR:4.03), ventilator support > 48hours (OR:3.41), unplanned intubation (OR:5.22), readmission (OR:1.35), and ED visit (OR:1.21). For RYGB, BMI≥60kg/m2 was associated with a higher risk of conversion to open technique (OR:5.38), acute renal failure (OR:2.62), ventilator support > 48hours (OR:2.41). There were no significant differences in venous thromboembolism or anastomotic/staple line leak.

Conclusions

BMI≥60kg/m2 is associated with higher 30-day mortality for SG and RYGB. Interventions to facilitate weight loss before surgery should be encouraged in this patient population.