Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery

Abstract

Background The risks of bariatric surgical procedures must be balanced against their benefits and require further characterization. Methods Longitudinal Assessment of Bariatric Surgery-1 (LABS-1) was a prospective, multi-center observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States (2005-2007). A composite endpoint of 30-day major adverse outcomes (death; venous thromboembolism; percutaneous, endoscopic, or operative reintervention; no discharge) was evaluated among patients undergoing first-time bariatric surgery. Results There were 4776 patients (mean age 44.5 years, 21.1% male, 10.9% non-white, median BMI of 46.5 kg/m2) who had a first-time procedure. Over half had at least two comorbid conditions. Roux-en-y gastric bypass was performed in 3412 (87.2% laparoscopic) and laparoscopic adjustable gastric banding in 1198. The 30-day mortality rate for Roux-en-y gastric bypass or laparoscopic adjustable gastric banding was 0.3%; 4.3% of participants had at least one major adverse outcome. A history of deep vein thrombosis or pulmonary embolus, obstructive sleep apnea, and functional status were each independently associated with increased risk of the composite endpoint. Extreme values of BMI were significantly associated with an increased risk of the composite endpoint, while age, sex, race, ethnicity and other co-morbid conditions were not. Conclusion The overall risk of death and adverse outcome after bariatric surgery was low, varying considerably with patient characteristics. In helping patients make appropriate choices, short-term safety should be considered in conjunction with both the longer term effects of bariatric surgery and the risk of living with extreme obesity.

Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence

“…104 The Longitudinal Assessment of Bariatric Surgery (LABS) study subsequently reported a similarly low 30-day mortality rate (0.3 %) among 4776 patients. 105 Immediate-and long-term perioperative morbidity rates for bariatric surgery are lower than might be expected for this medically comorbid population; the LABS Consortium reported a 4.3% incidence of major adverse events in the early postoperative period. Although these reports are encouraging, a number of complications associated with bariatric surgery are potentially fatal and merit careful consideration.…”

The clinical research office of the endourological society percutaneous nephrolithotomy global study: Outcomes in the morbidly obese patient – a case control analysis

“…A large multicentre, observational study of 4776 patients with a median BMI of 46.5 kg/m 2 undergoing a bariatric surgical procedure reinforced the feasibility of surgery in obese individuals and demonstrated low rates of morbidity and mortality within 30 days of surgery. 16 This study highlighted the importance of risk stratification and particularly recognized the increased risk conferred by a history of deep venous thrombosis, pulmonary embolus, obstructive sleep apnea and impaired overall functional status.…”

The role of bariatric surgery in the treatment of type 2 diabetes mellitus

“…The 30-day perioperative mortality rate for gastric bypass (up to 0.4%) is at least four times higher when compared to the gastric band (up to 0.1%). 7 At two years, the gastric band mortality rate (0.0%) continues to be lower compared to the bypass (0.4%). 35 Recipients of the gastric bypass and sleeve are also at risk of nutritional deficiencies.…”

“…Most procedures are generally performed laparoscopically as observed in the Longitudinal Assessment of Bariatric Surgery (LABS) study. 7 Bariatric surgery is not only effective in weight reduction, it also results in greater improvement and remission of T2D. The most common procedures carried out in the National Health Service (NHS) are laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG).…”