Laparoscopic gastric sleeve banding is well-documented as capable of significant and sustained weight loss. We present a query of national bariatric surgery data investigating potential differences in surgical outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) by obesity class.
Patients were identified from the 2016 American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (ACS-MBSAQIP). Laparoscopic Roux-en-Y gastric bypass was identified based on Current Procedure Terminology (CPT) codes 43644 and 43645. Patients were subdivided according to the Centers for Disease Control and Prevention obesity classifications including underweight (BMI<18.5), normal weight (BMI 18.5-25), overweight (BMI 25-30), and obese classes 1-3 (BMI >30). Post-operative outcomes were compared between BMI groups with T test and chi squared analyses.
135,361 patients (underweight n=13, normal n=215, overweight n=614, obese n=134,519) were identified. Gastroesophageal reflux disease was more pronounced among overweight patients however prevalence of diabetes directly correlated with increasing obesity. Surgical procedures were statistically longer among normal weight and overweight patients and transfusion was more often reported among underweight and normal weight individuals. ICU admission, readmission, and reoperation were reported inversely to increasing BMI.
Out findings represent the first study investigating 2016 ACS MBSAQIP database for laparoscopic Roux-en-Y gastric bypass outcomes by patient weight class. While greater technical demands were evidenced among the increasingly obese, the most challenging postoperative crouses were seen among the underweight and normal weight cohorts. Bariatric surgeons should include this information in their preoperative candidate selection and counseling for weight-sparing surgery.