In the Journals

Lower BMI, greater weight loss before bariatric surgery decrease risk for 30-day mortality

Wei Bao
Wei Bao
Yangbo Sun
Yangbo Sun

Among nearly half a million adults from the United States and Canada who underwent weight-loss surgery, those with lower presurgical BMI and those who lost even a small amount of weight before the procedure were less likely to die within 30 days, according to findings published in JAMA Network Open.

“Our findings have important clinical implications,” Wei Bao, MD, PhD, assistant professor in the department of epidemiology at the University of Iowa College of Public Health in Iowa City, and Yangbo Sun, MD, PhD, assistant professor at the department of preventive medicine at the University of Tennessee Health Science Center, told Healio. “Each year, hundreds of patients in the United States die after bariatric surgery. Our findings using a large dataset show that even a small reduction in preoperative weight (< 5%) was associated with a 24% reduction in odds of 30-day mortality following bariatric surgery. Although current clinical guidelines do not require preoperative weight loss — and a decision of bariatric surgery should not be based on whether and how much a preoperative weight loss is achieved — it may be beneficial for morbidly obese patients to be referred to an established weight loss program before the surgery in order to reduce the risk of mortality.”

Bao, Sun and colleagues analyzed data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program collected between 2015 and 2017 on 480,075 adults with obesity (mean age, 45.1 years; 20.2% men) who underwent bariatric surgery. The researchers assessed highest BMI within the year before surgery and the most recent BMI within 30 days before surgery to determine weight-loss categories.

There were 511 deaths within 30 days after bariatric surgery. The researchers found increasing odds of 30-day mortality with increasing BMI categories — both highest BMI within the year and most recent BMI before surgery. Compared with patients with BMI 35 kg/m2 to 39.9 kg/m2 (n = 82,634) in the year leading up to surgery, the adjusted OR for those with BMI 40 kg/m2 to 44.9 kg/m2 (n = 147,142) was 1.78 (95% CI, 1.24-2.54), BMI 45 kg/m2 to 49.9 kg/m2 (n = 109,179) was 2.26 (95% CI, 1.58-3.24), BMI 50 kg/m2 to 54.9 kg/m2 (n = 68,076) was 3.22 (95% CI, 2.24-4.65) and BMI at least 55 kg/m2 (n = 73,044) was 5.21 (95% CI, 3.69-7.36; P for trend < .001). With the same reference group for most recent BMI, the adjusted OR for those with BMI 40 kg/m2 to 44.9 kg/m2 (n = 146,559) was 1.37 (95% CI, 1.02-1.83), BMI 45 kg/m2 to 49.9 kg/m2 (n = 97,126) was 2.19 (95% CI, 1.64-2.92), BMI 50 kg/m2 to 54.9 kg/m2 (n = 55,155) was 2.61 (95% CI, 1.9-3.58) and BMI at least 55 kg/m2 (n = 51,347) was 5.03 (95% CI, 3.78-6.68; P for trend < .001).

Adjusted ORs for 30-day mortality by BMI reduction in the year prior to bariatric surgery vs. no BMI change
Among nearly half a million adults from the United States and Canada who underwent weight-loss surgery, those with lower presurgical BMI and those who lost even a small amount of weight before the procedure were less likely to die within 30 days.

Furthermore, the researchers found decreasing odds of 30-day mortality with increasing BMI reductions before surgery. Compared with those who had no change in BMI, the adjusted OR for those with a BMI reduction of less than 5% (n = 240,362) was 0.75 (95% CI, 0.59-0.95), a BMI reduction between 5% and 9.9% (n = 118,094) was 0.69 (95% CI, 0.53-0.9) and greater than 10% BMI reduction (n = 35,390) was 0.57 (95% CI, 0.4-0.81; P for trend = .003).

In commentary accompanying the study results, Micaela M. Esquivel, MD, a general surgery resident, and Dan Azagury, MD, assistant professor of surgery, both in the department of surgery at Stanford University School of Medicine, wrote that this study supports eliminating time-restricted weight-loss efforts often required for insurance coverage and offering weight-loss surgery at lower BMI.

“Perhaps the answer is not really about maximizing preoperative weight loss; perhaps the answer is treating patients in the earliest possible stage of their disease to negate the increased morbidity and mortality that is associated with more advanced disease and higher BMI,” Esquivel and Azagury wrote. “Patients should be provided early and rapid access to the care they need; in this case, that means access to a life-saving procedure without artificial insurance barriers, such as duration-based mandatory weight loss.” – by Jill Rollet

Disclosures: The authors report no relevant financial disclosures.

 

Wei Bao
Wei Bao
Yangbo Sun
Yangbo Sun

Among nearly half a million adults from the United States and Canada who underwent weight-loss surgery, those with lower presurgical BMI and those who lost even a small amount of weight before the procedure were less likely to die within 30 days, according to findings published in JAMA Network Open.

“Our findings have important clinical implications,” Wei Bao, MD, PhD, assistant professor in the department of epidemiology at the University of Iowa College of Public Health in Iowa City, and Yangbo Sun, MD, PhD, assistant professor at the department of preventive medicine at the University of Tennessee Health Science Center, told Healio. “Each year, hundreds of patients in the United States die after bariatric surgery. Our findings using a large dataset show that even a small reduction in preoperative weight (< 5%) was associated with a 24% reduction in odds of 30-day mortality following bariatric surgery. Although current clinical guidelines do not require preoperative weight loss — and a decision of bariatric surgery should not be based on whether and how much a preoperative weight loss is achieved — it may be beneficial for morbidly obese patients to be referred to an established weight loss program before the surgery in order to reduce the risk of mortality.”

Bao, Sun and colleagues analyzed data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program collected between 2015 and 2017 on 480,075 adults with obesity (mean age, 45.1 years; 20.2% men) who underwent bariatric surgery. The researchers assessed highest BMI within the year before surgery and the most recent BMI within 30 days before surgery to determine weight-loss categories.

There were 511 deaths within 30 days after bariatric surgery. The researchers found increasing odds of 30-day mortality with increasing BMI categories — both highest BMI within the year and most recent BMI before surgery. Compared with patients with BMI 35 kg/m2 to 39.9 kg/m2 (n = 82,634) in the year leading up to surgery, the adjusted OR for those with BMI 40 kg/m2 to 44.9 kg/m2 (n = 147,142) was 1.78 (95% CI, 1.24-2.54), BMI 45 kg/m2 to 49.9 kg/m2 (n = 109,179) was 2.26 (95% CI, 1.58-3.24), BMI 50 kg/m2 to 54.9 kg/m2 (n = 68,076) was 3.22 (95% CI, 2.24-4.65) and BMI at least 55 kg/m2 (n = 73,044) was 5.21 (95% CI, 3.69-7.36; P for trend < .001). With the same reference group for most recent BMI, the adjusted OR for those with BMI 40 kg/m2 to 44.9 kg/m2 (n = 146,559) was 1.37 (95% CI, 1.02-1.83), BMI 45 kg/m2 to 49.9 kg/m2 (n = 97,126) was 2.19 (95% CI, 1.64-2.92), BMI 50 kg/m2 to 54.9 kg/m2 (n = 55,155) was 2.61 (95% CI, 1.9-3.58) and BMI at least 55 kg/m2 (n = 51,347) was 5.03 (95% CI, 3.78-6.68; P for trend < .001).

Adjusted ORs for 30-day mortality by BMI reduction in the year prior to bariatric surgery vs. no BMI change
Among nearly half a million adults from the United States and Canada who underwent weight-loss surgery, those with lower presurgical BMI and those who lost even a small amount of weight before the procedure were less likely to die within 30 days.

Furthermore, the researchers found decreasing odds of 30-day mortality with increasing BMI reductions before surgery. Compared with those who had no change in BMI, the adjusted OR for those with a BMI reduction of less than 5% (n = 240,362) was 0.75 (95% CI, 0.59-0.95), a BMI reduction between 5% and 9.9% (n = 118,094) was 0.69 (95% CI, 0.53-0.9) and greater than 10% BMI reduction (n = 35,390) was 0.57 (95% CI, 0.4-0.81; P for trend = .003).

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In commentary accompanying the study results, Micaela M. Esquivel, MD, a general surgery resident, and Dan Azagury, MD, assistant professor of surgery, both in the department of surgery at Stanford University School of Medicine, wrote that this study supports eliminating time-restricted weight-loss efforts often required for insurance coverage and offering weight-loss surgery at lower BMI.

“Perhaps the answer is not really about maximizing preoperative weight loss; perhaps the answer is treating patients in the earliest possible stage of their disease to negate the increased morbidity and mortality that is associated with more advanced disease and higher BMI,” Esquivel and Azagury wrote. “Patients should be provided early and rapid access to the care they need; in this case, that means access to a life-saving procedure without artificial insurance barriers, such as duration-based mandatory weight loss.” – by Jill Rollet

Disclosures: The authors report no relevant financial disclosures.