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High-risk bariatric candidates: does red-flagging predict the post-operative course?
Rebecca C Dirks1, Dimitrios I Athanasiadis2, William A Hilgendorf3
1Department of Surgery, University School of Medicine, Indiana, USA. rcdirks@iu.edu.
Surgical Endoscopy
|May 14, 2021
Summary
High-risk bariatric surgery patients show similar long-term outcomes and major complications as controls. However, those undergoing Roux-en-Y gastric bypass (RYGB) experienced more minor complications, necessitating enhanced patient counseling.
Area of Science:
- Bariatric Surgery
- Surgical Outcomes
- Patient Selection
Background:
- Preoperative psychological evaluations are standard for bariatric surgery patient selection.
- Identifying trends in long-term follow-up and complications in "red-flagged" patients can optimize selection criteria.
Purpose of the Study:
- To analyze long-term follow-up and complication rates in bariatric surgery patients identified with high-risk psychosocial factors.
- To compare outcomes of "red-flagged" patients with a control group to refine patient selection protocols.
Main Methods:
- A case review conference (CRC) discussed "red-flagged" patients.
- Retrospective chart review compared 55 "red-flagged" patients to 273 control patients undergoing bariatric surgery.
- Exclusions included patients under 18, revisions, and gastric band placements; outcomes were tracked up to 5 years postoperatively.
Main Results:
- "Red-flagged" patients had similar age, sex, BMI, ASA, and comorbidities but underwent Roux-en-Y gastric bypass (RYGB) more frequently.
- Percent excess BMI loss and follow-up rates were comparable between groups.
- Flagged patients had more minor complications, including marginal ulcers and stenosis requiring dilation, particularly after RYGB. Major complications were similar.
Conclusions:
- High-risk bariatric patients exhibit comparable long-term follow-up, BMI loss, and major complication rates to controls.
- Roux-en-Y gastric bypass (RYGB) patients identified as high-risk experienced increased minor complications, suggesting a need for enhanced preoperative counseling.
