Background/Objectives: The incidence of obesity is rapidly increasing resulting in performance of a greater number of gastric bypass procedures. Despite the high surgical risk the overall complication rate remains low. However, complications do occur and so far no study has prospectively examined a large cohort of patients to determine what preoperative clinical features predict postoperative complications.
METHODS: 548 patients (428 female, 120 Male) were prospectively evaluated for 10 potential risk factors: Age, sex, weight, body mass index, history of smoking, hypertension, osteoarthritis, diabetes, and sleep apnea and revisional operation. The hospital quality assurance coordinator monitored outcomes for all patients. Pulmonary embolus, evisceration, major anastomotic leak (requiring reoperation or hospital stay> 10 days), intraabdominal abscesses or sepsis, pneumonia and death were categorized as the major complications. Data with continuous variables (age, weight and body mass index) were compared by t-tests. Discrete variables (sex, smoking history, hypertension, osteoarthritis, diabetes, sleep apnea, and revisional operation) were evaluated by contingency table analysis.
RESULTS: 548 patients underwent gastric bypass procedure in the time period between December 1993 and December 1999. There were 19 major complications (3.5%) with nine deaths (1.6%). Males were more likely to have complications than females (p=.002), and there was a non significant trend for a higher complication rate in diabetics (p=.069). Weight was also an independent risk factor. The mean weight for patients without complications was 333.9±3.4 and for those with complications 397.3±23.6 (p=0.015). There were 6 major anastomotic leaks, 5 pulmonary emboli, 2 eviscerations, 2 patients developed sepsis with no source identified, 1 severe marginal ulcer, 1 anastomotic obstruction requiring reoperation, 1 bowel obstruction requiring reoperation and 1 portal vein injury.
CONCLUSIONS: Our gastric bypass patients were larger (mean BMI=53.8 ± 0.5) than those included in most other series yet have comparable morbidity and mortality. The major risk factors predicting significant complications were being male and superobesity. In contrast to prior retrospective analysis, revisional operations did not increase the risk of major postoperative complications. Major complications may be minimized by preoperative medically induced weight loss prior to gastric bypass surgery for superobese males.
