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The impact of severe postoperative complications on outcomes of bariatric surgery-multicenter case-matched study
Magdalena Mizera1, Michał Wysocki2, Maciej Walędziak3
1Second Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland.
Insights
Severe postoperative complications after bariatric surgery did not impact long-term weight loss or remission of obesity-related diseases like diabetes and hypertension. Outcomes were similar compared to patients with an uneventful recovery.
Area of Science:
- Bariatric Surgery
- Obesity Management
- Surgical Complications
Background:
- Severe postoperative complications (Clavien-Dindo types 3-4) in bariatric surgery are infrequent but warrant investigation.
- The long-term impact of these complications on bariatric surgery outcomes is not extensively studied.
Purpose of the Study:
- To compare the outcomes of bariatric treatment in patients who experienced severe postoperative complications versus those with an uneventful perioperative course.
- To assess the influence of severe complications on weight loss and remission of obesity-related comorbidities.
Main Methods:
- Multicenter propensity score matched analysis of 206 patients from 6 Polish public hospitals.
- Comparison of 103 patients with severe complications (laparoscopic sleeve gastrectomy [SG] or laparoscopic Roux en Y gastric bypass [RYGB]) against 103 patients without severe complications.
- Assessment of peri- and postoperative outcomes, including total weight loss and remission rates of type 2 diabetes mellitus and arterial hypertension.
Main Results:
- No significant difference in median total weight loss at 12 months between the complication group (28.8%) and the no-complication group (27.9%).
- Similar remission rates for type 2 diabetes mellitus (36% vs. 42%) and arterial hypertension (41% vs. 46%) between the groups.
- No significant difference in outcomes between laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux en Y gastric bypass (RYGB) regarding disease remission.
Conclusions:
- Severe postoperative complications do not significantly affect the long-term weight loss efficacy of bariatric surgery.
- The occurrence of severe complications does not hinder the remission of obesity-related diseases such as type 2 diabetes and hypertension.
- Bariatric surgery remains effective in managing obesity and related comorbidities, even in the presence of severe postoperative complications.
Background:
Bariatric surgery has relatively low complication rates, especially severe postoperative complications (defined by Clavien-Dindo classification as types 3 and 4), but these rates cannot be ignored. In other than bariatric surgical disciplines, complications affect not only short-term but also long-term results. In the field of bariatric surgery, this topic has not been extensively studied.
Objectives:
The aim of the study was to assess the outcomes of bariatric treatment in patients with obesity and severe postoperative complications in comparison to patients with a noneventful perioperative course.
Setting:
Six surgical units at Polish public hospitals.
Methods:
We performed a multicenter propensity score matched analysis of 206 patients from 6 Polish surgical units and assessed the outcomes of bariatric procedures. A total of 103 patients with severe postoperative complications (70 laparoscopic sleeve gastrectomy [SG] and 33 with laparoscopic Roux en Y gastric bypass [RYGB]) were compared to 103 patients with no severe complications in terms of peri- and postoperative outcomes.
Results:
The outcomes of bariatric treatment did not differ between compared groups. Median percentage of total weight loss 12 months after the surgery was 28.8% in the group with complications and 27.9% in patients with no severe complications (P = 0.993). Remission rates of both type 2 diabetes mellitus and arterial hypertension showed no significant difference between SG and RYGB (36% versus 42%, P = 0.927, and 41% versus 46%, P = 0.575. respectively).
Conclusions:
The study suggests that severe postoperative complications had no significant influence either on weight loss effects or obesity-related diseases remission.
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