PRE-ADMISSION BARIATRIC SURGERY IS ASSOCIATED WITH REDUCED MORTALITY IN SURGICAL PATIENTS WITH SEPSIS

Background: Obesity is associated with higher 90-day mortality compared to nonobese surgical patients. Bariatric surgery (BS) can reduce obesity-related comorbidities, even in those with persistent obesity. Objective: Evaluate the impact of prior BS on sepsis outcomes in surgical patients with obesity. Setting: University Hospital, United States. Methods: A single-institution retrospective review of all surgical patients with sepsis (SOFA≥2) was conducted. Patients were grouped into people with obesity and prior BS (OB/BS; n = 48), people with obesity without BS (OB; n = 717), nonobese (NOB; n = 574), and nonobese with prior BS (NOB/BS; n = 27). Demographic data, comorbidities, and sepsis presentation were compared. The primary outcome was cumulative 90-day mortality and survival. Results: Most OB/BS patients underwent gastric bypass <5 years from admission (61%). The OB/BS group was younger, more likely to be female, and transferred from an outside hospital. The mean BMI was highest in the OB/BS group (46.3± 14.7 kg/m 2 , P < 0.0005). Charlson Comorbidity Index was lower in the OB/BS and NOB/BS groups (2 (1-4) and 2 (2-4), respectively, P = 0.0033). Cumulative 90-day mortality was significantly lower in the OB/BS cohort (20.8%, P = 0.002). The OB/BS cohort was more likely to die from intra-abdominal sepsis not amenable to source control (60% vs. 22.5% vs. 22.8% vs. 37.5%, P = 0.04). Compared to the other groups, 90-day survival was highest in the OB/BS cohort (log-rank P < 0.009). Conclusions: This study demonstrated improvement in 90-day survival in OB/BS patients despite higher BMIs. However, this group was more likely to die from intra-abdominal sources, likely reflecting surgical complexity in the setting of prior bypasses.