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« on: February 06, 2010, 03:38:04 pm » |
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Surgery for obesity (bariatric surgery) may result in remission of diabetes and improve cardiovascular risk. In extremely obese patients, it may reduce mortality by a third or more. There have been concerns, however, about the safety of such surgery. The 30-day outcomes have been reported from a US multicentre observational study.
The study included 4,610 patients who had a first bariatric procedure between 2005 and 2007 at 10 centres. Their mean age was 44.5 years, mean body mass index 46.5, and 79% were women. A Roux-en-Y gastric bypass was performed in 3,412 patients (87% done laparoscopically), and 1,198 had laparoscopic adjustable gastric banding. The 30-day mortality rate was 0.3%, and 4.3% of the study patients had at least one major adverse outcome. There were no deaths after laparoscopic adjustable gastric banding, and mortality was 0.2% after laparoscopic Roux-en-Y gastric bypass and 2.1% after open Roux-en-Y gastric bypass. The 30-day composite outcome (death, deep-vein thrombosis [DVT] or venous thromboembolism, re-intervention or hospital stay >30 days) occurred in 1% (laparoscopic adjustable gastric banding), 4.8% (laparoscopic Roux-en-Y) and 7.8% (open Roux-en-Y). Increased risk of this composite end point was associated with a history of DVT or pulmonary embolism, obstructive sleep apnoea, impaired functional status or extremely high BMI. Age, sex, race, ethnic group and other coexisting conditions were not associated with increased risk.
The risk after bariatric surgery was low.
The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the longitudinal assessment of bariatric surgery. NEJM 2009;361:445–454; Robinson MK. Surgical treatment of obesity—weighing the facts. Ibid:520–521.
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