Perioperative safety in the longitudinal assessment of bariatric surgery

David Reed Flum, Steven H. Belle, Wendy C. King, Abdus S. Wahed, Paul Berk, William Chapman, Walter Pories, Anita Courcoulas, Carol McCloskey, James Mitchell, Emma Patterson, Alfons Pomp, Myrlene A. Staten, Susan Z. Yanovski, Richard Thirlby, Bruce Wolfe

Research output: Contribution to journalArticle

901 Citations (Scopus)

Abstract

BACKGROUND: To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization. METHODS: We performed a prospective, multicenter, observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007. A composite end point of 30-day major adverse outcomes (including death; venous thromboembolism; percutaneous, endoscopic, or operative reintervention; and failure to be discharged from the hospital) was evaluated among patients undergoing first-time bariatric surgery. RESULTS: There were 4776 patients who had a first-time bariatric procedure (mean age, 44.5 years; 21.1% men; 10.9% nonwhite; median body-mass index [the weight in kilograms divided by the square of the height in meters], 46.5). More than half had at least two coexisting conditions. A Roux-en-Y gastric bypass was performed in 3412 patients (with 87.2% of the procedures performed laparoscopically), and laparoscopic adjustable gastric banding was performed in 1198 patients; 166 patients underwent other procedures and were not included in the analysis. The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding was 0.3%; a total of 4.3% of patients had at least one major adverse outcome. A history of deep-vein thrombosis or pulmonary embolus, a diagnosis of obstructive sleep apnea, and impaired functional status were each independently associated with an increased risk of the composite end point. Extreme values of body-mass index were significantly associated with an increased risk of the composite end point, whereas age, sex, race, ethnic group, and other coexisting conditions were not. CONCLUSIONS: The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics. In helping patients make appropriate choices, short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese. (ClinicalTrials.gov number, NCT00433810.)

Original languageEnglish (US)
Pages (from-to)445-454
Number of pages10
JournalNew England Journal of Medicine
Volume361
Issue number5
DOIs
StatePublished - Jul 30 2009

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Bariatric Surgery
Safety
Gastric Bypass
Stomach
Body Mass Index
Bariatrics
Venous Thromboembolism
Obstructive Sleep Apnea
Embolism
Ethnic Groups
Venous Thrombosis
Multicenter Studies
Observational Studies
Decision Making
Obesity
Weights and Measures
Lung

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Flum, D. R., Belle, S. H., King, W. C., Wahed, A. S., Berk, P., Chapman, W., ... Wolfe, B. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine, 361(5), 445-454. https://doi.org/10.1056/NEJMoa0901836

Perioperative safety in the longitudinal assessment of bariatric surgery. / Flum, David Reed; Belle, Steven H.; King, Wendy C.; Wahed, Abdus S.; Berk, Paul; Chapman, William; Pories, Walter; Courcoulas, Anita; McCloskey, Carol; Mitchell, James; Patterson, Emma; Pomp, Alfons; Staten, Myrlene A.; Yanovski, Susan Z.; Thirlby, Richard; Wolfe, Bruce.

In: New England Journal of Medicine, Vol. 361, No. 5, 30.07.2009, p. 445-454.

Research output: Contribution to journalArticle

Flum, DR, Belle, SH, King, WC, Wahed, AS, Berk, P, Chapman, W, Pories, W, Courcoulas, A, McCloskey, C, Mitchell, J, Patterson, E, Pomp, A, Staten, MA, Yanovski, SZ, Thirlby, R & Wolfe, B 2009, 'Perioperative safety in the longitudinal assessment of bariatric surgery', New England Journal of Medicine, vol. 361, no. 5, pp. 445-454. https://doi.org/10.1056/NEJMoa0901836
Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W et al. Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 2009 Jul 30;361(5):445-454. https://doi.org/10.1056/NEJMoa0901836
Flum, David Reed ; Belle, Steven H. ; King, Wendy C. ; Wahed, Abdus S. ; Berk, Paul ; Chapman, William ; Pories, Walter ; Courcoulas, Anita ; McCloskey, Carol ; Mitchell, James ; Patterson, Emma ; Pomp, Alfons ; Staten, Myrlene A. ; Yanovski, Susan Z. ; Thirlby, Richard ; Wolfe, Bruce. / Perioperative safety in the longitudinal assessment of bariatric surgery. In: New England Journal of Medicine. 2009 ; Vol. 361, No. 5. pp. 445-454.
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AU - Chapman, William

AU - Pories, Walter

AU - Courcoulas, Anita

AU - McCloskey, Carol

AU - Mitchell, James

AU - Patterson, Emma

AU - Pomp, Alfons

AU - Staten, Myrlene A.

AU - Yanovski, Susan Z.

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N2 - BACKGROUND: To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization. METHODS: We performed a prospective, multicenter, observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007. A composite end point of 30-day major adverse outcomes (including death; venous thromboembolism; percutaneous, endoscopic, or operative reintervention; and failure to be discharged from the hospital) was evaluated among patients undergoing first-time bariatric surgery. RESULTS: There were 4776 patients who had a first-time bariatric procedure (mean age, 44.5 years; 21.1% men; 10.9% nonwhite; median body-mass index [the weight in kilograms divided by the square of the height in meters], 46.5). More than half had at least two coexisting conditions. A Roux-en-Y gastric bypass was performed in 3412 patients (with 87.2% of the procedures performed laparoscopically), and laparoscopic adjustable gastric banding was performed in 1198 patients; 166 patients underwent other procedures and were not included in the analysis. The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding was 0.3%; a total of 4.3% of patients had at least one major adverse outcome. A history of deep-vein thrombosis or pulmonary embolus, a diagnosis of obstructive sleep apnea, and impaired functional status were each independently associated with an increased risk of the composite end point. Extreme values of body-mass index were significantly associated with an increased risk of the composite end point, whereas age, sex, race, ethnic group, and other coexisting conditions were not. CONCLUSIONS: The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics. In helping patients make appropriate choices, short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese. (ClinicalTrials.gov number, NCT00433810.)

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