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Is There a Benefit to Preoperative Weight Loss Before Undergoing Bariatric Surgery?
John M. Morton, Ulysses S. Rosas*, Trit Garg, Manuel Cardenas, Homero Rivas
Surgery, Stanford University, Stanford, CA
BACKGROUND:
Some bariatric surgeons recommend pre-op weight loss to allow patients to become accustomed to dietary changes and to shrink the liver, improving intraoperative visibility. Few studies have evaluated the effects of preoperative weight loss (PWL) on postsurgical outcomes including long-term percent excess weight loss (EWL), complications, and readmission rate. In this study we aim to quantify the benefits of PWL on post-operative outcomes.
METHODS:
A total of 1,655 patients undergoing bariatric surgery at a single academic institution were included in this retrospective analysis. Preoperative data collected included patients' demographic information, and anthropometric features. Positive PWL was defined as preoperative percent weight loss, and negative PWL as preoperative weight gain. Postoperative anthropometric data were collected at 12-months postoperative. Comparison of PWL across surgery types was done using a one-way ANOVA.
RESULTS:
There were 1264 patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB), 235 for laparoscopic sleeve gastrectomy (SG), and 157 for laparoscopic adjustable gastric banding (AGB). Using a one-way ANOVA, we found PWL to be significantly different across surgery types, with 1.55% for RYGB, 1.03% for SG, and 0.60% for AGB. There was no difference in preoperative age, sex, BMI, and excess body weight between patients with positive and negative PWL for each surgery type. When all surgeries were analyzed, 12-month percent excess weight loss was significantly higher for patients with positive PWL vs. those with negative PWL (72.1% vs 68.6%, p=0.024). 12-month percent excess weight loss was significantly higher for patients undergoing AGB with positive PWL (50.0% vs. 36.6%, p=0.008). There was no such difference for RYGB and SG. Using a linear regression model showed that patients undergoing AGB, PWL strongly predicted 12-month EWL (b=1.55, p=0.02, r2=0.053). Incidence of any complication or readmission was not significantly different between patients with positive and negative PWL for each surgery type. However, using a multivariate logistic regression model controlling for preoperative age>50, BMI>50, white race, private insurance, and male sex, we found that low PWL increased chance of any complication after surgery, among all surgery types (OR=1.35, p=0.05).
CONCLUSION:
Preoperative weight loss can significantly reduce the chance of developing complications after bariatric surgery, as well as improve percent excess weight loss 12-months postoperatively for gastric band patients.
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