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. 2020 May 1;3(5):e204803.
doi: 10.1001/jamanetworkopen.2020.4803.

Association of Preoperative Body Weight and Weight Loss With Risk of Death After Bariatric Surgery

Yangbo Sun  1 , Buyun Liu  1 , Jessica K Smith  2 , Marcelo L G Correia  3   4 , Dana L Jones  2 , Zhanyong Zhu  5 , Adeyinka Taiwo  3 , Lisa L Morselli  3 , Katie Robinson  3   6 , Alexander A Hart  1 , Linda G Snetselaar  1 , Wei Bao  1   4   7
Affiliations

Association of Preoperative Body Weight and Weight Loss With Risk of Death After Bariatric Surgery

Yangbo Sun et al. JAMA Netw Open. .

Abstract

Importance: Perception of weight loss requirements before bariatric surgery varies among patients, physicians, and health insurance payers. Current clinical guidelines do not require preoperative weight loss because of a lack of scientific support regarding its benefits.

Objective: To examine the association of preoperative body mass index (BMI) and weight loss with 30-day mortality after bariatric surgery.

Design, setting, and participants: This cohort study used data from 480 075 patients who underwent bariatric surgery from 2015 to 2017 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which covers more than 90% of all bariatric surgery programs in the United States and Canada. Clinical and demographic data were collected at all participating institutions using a standardized protocol. Data analysis was performed from December 2018 to November 2019.

Exposures: Preoperative BMI and weight loss.

Main outcomes and measures: 30-day mortality after bariatric surgery.

Results: Of the 480 075 patients (mean [SD] age 45.1 [12.0] years; 383 265 [79.8%] women), 511 deaths (0.1%) occurred within 30 days of bariatric surgery. Compared with patients with a preoperative BMI of 35.0 to 39.9, the multivariable-adjusted odds ratios for 30-day mortality for patients with preoperative BMI of 40.0 to 44.9, 45.0 to 49.9, 50.0 to 54.9, and 55.0 and greater were 1.37 (95% CI, 1.02-1.83), 2.19 (95% CI, 1.64-2.92), 2.61 (95% CI, 1.90-3.58), and 5.03 (95% CI, 3.78-6.68), respectively (P for trend < .001). Moreover, compared with no preoperative weight loss, the multivariable-adjusted odds ratios for 30-day mortality for patients with weight loss of more than 0% to less than 5.0%, 5.0% to 9.9%, and 10.0% and greater were 0.76 (95% CI, 0.60-0.96), 0.69 (95% CI, 0.53-0.90), and 0.58 (95% CI, 0.41-0.82), respectively (P for trend = .003).

Conclusions and relevance: In this study, even moderate weight loss (ie, >0% to <5%) before bariatric surgery was associated with a lower risk of 30-day mortality. These findings may help inform future updates of clinical guidelines regarding bariatric surgery.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Comment in

References

    1. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013;309(1):71-82. doi:10.1001/jama.2012.113905 - DOI - PMC - PubMed
    1. Benjamin RM. The Surgeon General’s vision for a healthy and fit nation. Public Health Rep. 2010;125(4):514-515. doi:10.1177/003335491012500402 - DOI - PMC - PubMed
    1. Finkelstein EA. How big of a problem is obesity? Surg Obes Relat Dis. 2014;10(4):569-570. doi:10.1016/j.soard.2014.02.028 - DOI - PubMed
    1. Kim J, Eisenberg D, Azagury D, Rogers A, Campos GM. American Society for Metabolic and Bariatric Surgery position statement on long-term survival benefit after metabolic and bariatric surgery. Surg Obes Relat Dis. 2016;12(3):453-459. doi:10.1016/j.soard.2015.11.021 - DOI - PubMed
    1. Kim JJ, Rogers AM, Ballem N, Schirmer B; American Society for Metabolic and Bariatric Surgery Clinical Issues Committee . ASMBS updated position statement on insurance mandated preoperative weight loss requirements. Surg Obes Relat Dis. 2016;12(5):955-959. doi:10.1016/j.soard.2016.04.019 - DOI - PubMed