Background

Outcomes of patients with extreme obesity (EO, BMI≥70kg/m2) have not been reported leaving open the question of an upper weight limit for safe bariatric surgery. The purpose of this study was to determine if bariatric surgery can be performed safely in patients with extreme obesity.

Methods

All available MBS Accreditation and Quality Improvement Program (MBSAQIP) data were used to characterize the study cohort (2015-2021). Thirty-day outcomes for BMI≥70kg/m2 (n=12,441) vs. BMI<70kg/m2 (n=1,316,112) were assessed.

Results

EO was present in ~1% of MBSAQIP patients with mean BMI of 77.2 (range 70-148.6, median 74.7). Patients with EO had a greater frequency of diabetes, hypertension, sleep apnea, COPD, and immobility compared to those with BMI <70. Sleeve gastrectomy was the most common operation for both groups. Postoperatively, patients with EO had 41% higher readmissions (5.45% vs 3.87%), 8% higher reoperation (1.56% vs 1.45%), 23% higher reintervention (1.63% vs 1.32%), and longer average length of stay and unplanned ICU admissions (2.0 vs 1.6 days and 2.3% vs 0.7%, respectively). Infection (1.46% vs 0.99%), venous thrombosis (0.26% vs 0.20%), cardiac arrest (0.13% vs 0.04%) and mortality (0.13% vs. 0.04%) were also increased in patients with EO.

Conclusions

Patients undergoing bariatric surgery with extreme obesity (BMI≥70kg/m2) have a significantly higher risk of postoperative morbidity and mortality compared to patients with BMI<70kg/m2. However, morbidity and mortality of bariatric surgery even in patients with extreme obesity is reasonably low indicating that such patients are not “too heavy for bariatric surgery”.