When BMI exceeds 50: what ten years of follow-up reveal after bariatric surgery (BARI-10-POL study)

Patients with severe obesity and BMI ≥ 50 kg/m² represent a high-risk group for metabolic bariatric surgery (MBS), and long-term outcome data in this population remain limited. This study aimed to evaluate the safety and long-term efficacy of MBS in patients with BMI ≥ 50 kg/m². A retrospective multicenter observational study including patients who underwent MBS between 2007 and 2014 and completed at least 10 years of follow-up. Patients were stratified into two groups based on preoperative BMI (< 50 vs. ≥50 kg/m²). Outcomes included long-term weight loss (%TWL, %EWL), remission of type 2 diabetes mellitus (T2DM), hypertension (HT), obstructive sleep apnea (OSA), and gastroesophageal disease (GERD); perioperative complications, and revisional procedures. Eighty-nine patients had baseline BMI ≥ 50 kg/m². Mean follow-up was 11.10 years. Patients with BMI ≥ 50 kg/m² more frequently reached ≥ 20% TWL (77.53 vs. 53.15%, p < 0.001). The proportion of patients achieving ≥ 50% EWL in group with ≥ 50 BMI was 58.43% and results were comparable between groups. Median final BMI remained higher in the BMI ≥ 50 kg/m² group (36.33 vs. 32.27 kg/m², p < 0.001). Remission rates in the BMI ≥ 50 kg/m² group were 59.1% for T2DM, 61.5% for HT, 57.1% for OSA, and 75.0% for GERD, with no significant differences between groups. 30-day postoperative complications occurred in 7.86% of patients with BMI ≥ 50 kg/m²; this value was not significantly different from the lower-BMI group. Revisional surgery was required more frequently in patients with BMI ≥ 50 kg/m² (43.82 vs. 19.90%, p < 0.001), predominantly due to weight regain. MBS in patients with BMI ≥ 50 kg/m² results in durable weight loss and significant improvement of obesity-associated diseases. However, patients with obesity class IV and higher remain at a elevated risk of revisional surgery.