Bariatric Surgery in the Super-Super Morbidly Obese: Outcome Analysis of Patients with BMI over 70 using the ACS-NSQIP Database

Abstract Background Bariatric surgery offers patients short-term and long-term benefits to their health and quality of life. Currently, we see more patients with superior body mass index (BMI) looking for these benefits. Evidence-based medicine is integral in the evaluation of risks versus benefit; however, data is lacking in this high-risk population. Objectives To assess the morbidity and mortality of patients with BMI 70 and above undergoing bariatric surgery. Methods Using the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) database for years 2005-2016 we identified patients who underwent primary laparoscopic sleeve gastrectomy (SG) or laparoscopic Roux-en-Y gastric bypass (RYGB). Patients with BMI 70 and above were assigned to the over BMI 70 (BMI70+) cohort and less obese patient were assigned to the under BMI 70 (U70) cohort. Length of stay (LOS) and 30-day morbidity and mortality were compared. Results A total of 163,413 patients underwent non-revisional bariatric surgery. Of those, 2,322 had a BMI 70 and above. BMI70+ was associated with increased mortality (0.4% vs 0.1%, p=0.0001), deep vein thrombosis (0.6% vs 0.3%, p=0.007), pulmonary (1.9% vs 0.5%, p=0.0001), renal (0.9% vs 0.2%, p=0.0001) and infectious complications (1.1% vs 0.4%, p=0.0001). BMI70+ patients had longer mean LOS (2.6 days vs 2.1 days, p=0.0001) and operative time (126.1 min vs 114.5 min, p=0.0001). There was no statistically significant difference in the number of myocardial infarctions (MI) (0.1% vs 0.1%, p=0.319), pulmonary embolisms (PE) (0.3% vs 0.2%, p=0.596) and transfusion requirements (0.1% vs 0.1%, p=0.105) between groups. Conclusions Evaluation of risk and benefit is performed on a case-by-case basis, but evidence-based medicine is critical in empowering surgeons and patients to make informed decisions. The overall rate of morbidity and mortality for BMI70+ patients undergoing bariatric surgery was increased over U70 patients but was still relatively low. Our study will allow surgeons to incorporate objective data into their assessment of risk for super obese patients pursuing bariatric surgery.