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Gastric bypass risks lower than perceived, comparable to many common surgeries
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Laparoscopic gastric bypass surgery can be considered a relatively safe procedure in patients with type 2 diabetes, with complication and mortality rates similar to many commonly performed surgeries in the United States, according to research presented at Obesity Week 2014.
Researchers at the Cleveland Clinic Bariatric and Metabolic Institute found short-term morbidity was comparable to well-accepted procedures, including cholecystectomy and appendectomy, and mortality comparable to knee arthroplasty in a 30-day postoperative investigation.
“Our aim was to see how gastric bypass compared to other commonly performed operations in terms of morbidity and mortality, but also compared to operations done for the long-term complications of patients with diabetes and metabolic disease.” Stacy A. Brethauer, MD, associate director of the Cleveland Clinic Bariatric and Metabolic Institute, told Endocrine Today.
Stacy A. Brethauer
Using data from the American College of Surgeons National Surgical Quality Improvement Program database, Brethauer, along with Ali Aminian, MD, and colleagues, identified 66,678 patients with type 2 diabetes who underwent coronary artery bypass graft, infra-inguinal peripheral revascularization, various laparoscopic abdominal procedures and total knee arthroplasty.
The investigators compared length of postoperative hospital stay, postoperative composite complication (presence of stroke, myocardial infarction, acute renal failure, deep vein thrombosis, pulmonary embolism, pneumonia, sepsis, septic shock and need for transfusion), readmission, reoperation and mortality rates between laparoscopic Roux-en-Y gastric bypass (LRYGB; n=16,509; mean age, 50 years; mean BMI, 46.5 kg/m2; 71.5% female) and the comparator groups.
The mean operative time of LRYGB was 137.7 minutes and length of hospital stay was 2.57 days. Serious adverse events seen within 30 days after LRYGB were need for transfusion (1.22%), sepsis (0.81%), pneumonia (0.66%), deep vein thrombosis (0.36%), septic shock (0.3%), acute renal failure (0.22%), pulmonary embolism (0.22%), MI (0.16%) and stroke (0.05%); the composite complication rate was 3.43% and the composite mortality rate was 0.3%.
LRYGB demonstrated the lowest composite complication rate, followed by hysterectomy (3.5%) and cholecystectomy (3.7%). The mean length of hospital stay within 30 days after LRYGB was 2.6%, similar to laparoscopic appendectomy (2.5%); the readmission rates showed similar results within that time: 6.7% for LRYGB and 7.2% for laparoscopic appendectomy. The reoperation rate with LRYGB was 2.5%, lower than some and higher than others. The mortality rate with LRYGB rivaled that of knee arthroplasty at 0.3%, with only hysterectomy lower at 0%.
“The mortality risk with LRYGB was actually one-tenth that seen with cardiovascular surgery,” Brethauer said. “This suggests that earlier intervention for the treatment of diabetes and cardiovascular risk factors, which improved with bariatric surgery, could potentially eliminate the need for some higher-risk procedures in the future.”
For all examined variables, patients with LRYGB showed better short-term outcomes vs. coronary artery bypass graft, infra-inguinal revascularization and laparoscopic colectomy.
Patients taking insulin before undergoing LRYGB had higher complications than patients taking oral antidiabetic medications (4.1% vs. 3%, P<.001) and higher mortality (0.4% vs. 0.2%, P=.048).
Clinical data retrieved from such a large database have limitations in drawing conclusions, Brethauer said. “Further studies such as the multicenter Longitudinal Assessment of Bariatric Surgery (LABS) study can hopefully help address some of these long-term risks of cardiovascular endpoints.”
Brethauer said there are data to support bariatric procedures are altering the course of diabetic complications and mortality, but “more data evaluating micro- and macrovascular complications after bariatric surgery in this patient population is needed to see if we’re making an impact.”
For more information:
Brethauer S. Abstract A701. Presented at: Obesity Week; Nov. 2-7, 2014; Boston.
Disclosure: Brethauer reports no relevant financial disclosures.
Perspective
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Ranjan Sudan, MD
This study places the low risks of bariatric surgery in the context of other commonly performed operations and is important data that will help other medical providers such as primary care physicians, endocrinologists and orthopedic surgeons, among others, understand relative risks of bariatric operations. The number of bariatric operations performed have remained relatively stable and such data will drive in more referrals for bariatric surgery.
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