Background

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 sleeve gastrectomy (LSG) by obesity class.

Methods

Patients were identified from the 2016 American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (ACS-MBSAQIP). Laparoscopic sleeve gastrectomy was identified based on the Current Procedure Terminology (CPT) code 43775. 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 analysis

Results

338,061 patients (underweight n=8; normal n=58; overweight n=413; obese n=335,130) were identified. Normal weighted patients were statistically more likely to demonstrate gastroesophageal reflux disease and experienced concomitantly longer surgical procedures (p<.05). Staple line reinforcement appeared to be utilized more frequently by surgeons operating on obese patients. Little meaningful difference was appreciated among postoperative complication rates by patient BMI, however increased unplanned ICU admission, hospital readmission, reoperation, and death were observed among normal weight patients.

Conclusions

Our findings represent novel investigation of 2016 ACS MBSAQIP database for laparoscopic sleeve gastrectomy outcomes by patient weight class. Surprisingly, it would appear greater concern should be paid to normal weight patients undergoing laparoscopic sleeve gastrectomy as they demonstrate more complex postoperative courses. Bariatric surgeons should include this information in preoperative candidate selection and counseling for weight-sparing surgery.