Is bariatric surgery effective for co-morbidity resolution in the super-obese patients?

• Published in: Surgery for obesity and related diseases Vol. 14; no. 9; pp. 1261 - 1268
• Main Authors: Hariri, Kamyar, Guevara, Daniela, Dong, Matthew, Kini, Subhash U., Herron, Daniel M., Fernandez-Ranvier, Gustavo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2018
• Subjects: Adult; Bariatric Surgery; Co-morbidities; Comorbidity; Diabetes; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Humans; Hyperlipidemia; Hyperlipidemias - complications; Hyperlipidemias - epidemiology; Hypertension; Hypertension - complications; Hypertension - epidemiology; Male; Middle Aged; Obesity, Morbid - complications; Obesity, Morbid - epidemiology; Obesity, Morbid - surgery; Obstructive sleep apnea; Percent total weight loss; Retrospective Studies; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - epidemiology; Super-obese; Weight Loss; Hypertension; Co-morbidities; Hyperlipidemia; Percent total weight loss; Bariatric surgery; Super-obese; Diabetes; Obstructive sleep apnea
• ISSN: 1550-7289; 1878-7533
• DOI: 10.1016/j.soard.2018.05.015

•A comparison of the most common obesity-related comorbidities—diabetes, obstructive sleep apnea, hypertension, hyperlipidemia—between patients with a body mass index (BMI) of 30-49.9 kg/m2 and BMI ≥ 50 kg/m2 (super obese) did not reveal a difference in resolution rates between the two groups.•Super obese patients achieved similar levels of postoperative percent total body weight loss (%TBWL) to patients with a BMI of 30-49.9 kg/m2. Type 2 diabetes (T2D), obstructive sleep apnea (OSA), hypertension (HTN), and hyperlipidemia (HLD) are common co-morbidities that are strongly associated with obesity. The purpose of this study was to compare the rate of obesity-related co-morbidity remission and percent total body weight loss of super-obese patients with a body mass index (BMI) ≥50 kg/m2 with bariatric patients who have a BMI of 30 to 49.9 kg/m2. Academic hospital, United States. A retrospective analysis of outcomes of a prospectively maintained database was done on obese patients with a diagnosis of ≥1 co-morbidity (T2D, OSA, HTN, or HLD) who at the time of initial visit had undergone either a sleeve gastrectomy or a Roux-en-Y gastric bypass at our hospital between 2011 and 2015. The patients were stratified based on their preoperative BMI class, BMI of 30 to 49.9 kg/m2 versus BMI ≥50 kg/m2. Of the 930 patients, 732 underwent sleeve gastrectomy and 198 underwent Roux-en-Y gastric bypass. The 6-month follow-up co-morbidity remission rates for patients with a BMI of 30 to 49.9 kg/m2 (n = 759) versus super-obese patients (n = 171) were 46.0% and 36.7% (P = .348) for T2D; 75.0% and 73.2% (P = .772) for OSA; 35.0% and 22.0% (P = .142) for HTN; and 37.0% and 21.0% (P = .081) for HLD, respectively. The 1-year follow-up co-morbidity remission rates for patients with a BMI of 30 to 49.9 kg/m2 versus super-obese patients were 54.2% and 45.5% (P = .460) for T2D; 87.0% and 89.7% (P = .649) for OSA; 37.4% and 23.9% (P = .081) for HTN; and 43.2% and 34.6% (P = .422) for HLD, respectively. Furthermore, there was no difference in the mean percent total weight loss for patients with a preoperative BMI of 30 to 49.9 kg/m2 versus the super-obese at the 6-month (21.4%, 20.9%, P = .612) and 1-year (28.0%, 30.7%, P = .107) follow-ups. In our study, preoperative BMI did not have an impact on postoperative co-morbidity remission rates or percent total body weight loss. Future studies should investigate the effect of other factors, such as disease severity and duration.