Bariatric and metabolic surgery (BMS) is largely safe and effective for patients who are living with severe obesity, according to a team of researchers led by Pennington Biomedical Research Center's Dr Florina Corpodean. Despite increased resource utilisation, the study suggests that BMI≥70kg/m2 alone should not be a deterrent for surgery, emphasising the need for nuanced care in this expanding demographic.
"This research aimed to survey the data from a population that is understudied, but we are proud to have contributed to this necessary data analysis," explained Corpodean, who is a postdoctoral researcher and surgical research fellow at Pennington Biomedical and who works in the Metamor Metabolic Institute. "Patients with this level of obesity represent a growing demographic, and one that requires nuanced care. The good news is, though these patients may be considered at high risk due to their BMIs, bariatric and metabolic surgery remain largely safe for these patients."
In the recent study titled, ‘BMI ≥ 70: A Multi-Center Institutional Experience of the Safety and Efficacy of Metabolic and Bariatric Surgery Intervention’, published in Obesity Surgery, the researchers analysed the data of 84 patients with excess obesity who received BMS, discerning that while these patients generally had an increased likelihood of visits to the emergency department, they exhibited low rates of complications at 30 days post-operation.
The researchers conducted an analysis of the data, reviewing it for demographics, postoperative outcomes, and changes in BMI and weight. Weight loss was evaluated at different intervals: 30 days, six months and one year. They also evaluated rates of emergency department visits, readmissions and reoperation in the first year following the surgery.
Outcomes
The majority of the patients were black (66.7%) and female (86.9%) with a mean age of 41.7 years. The majority underwent laparoscopic sleeve gastrectomy (SG, 88.1%). Patients exhibited a marked decrease in BMI (7.84% at 30 days, 20.13% at six months, and 26.83% at one year). Average length of stay was comparable across procedure (F(3,80) = 0.016, p=0.997). While 30-day complications were minimal (0.7%), 14.4% of patients experienced ED visits within 30 days, escalating to 19.6% by six months and 25% at one year. Readmission and reoperation rates at one year were 6.45% and 4.83%, respectively.
"As the prevalence of obesity continues on its current trajectory, doctors, surgeons and researchers are more and more likely to work with patients with BMIs above 70kg/m2," said Dr Philip Schauer, Director of the Metamor Institute. "Our analysis of the data demonstrates that the BMI levels of these patients do not warrant hesitation for performing BMS as a method of treatment to treat them. At Metamor, we see it as our mission to provide this kind of clarity, and we welcome other institutions to pursue future studies with this expanding demographic."
As of now, there is no accepted maximum BMI value considered to be prohibitive for those in need of BMS, but it is commonly accepted that an increased BMI translates to increased surgical risk. The researchers' findings indicated that patients in the demographic show robust weight loss following BMS, with results durable up to one year following the operation. Findings further showed that, though these patients exhibited high rates of emergency department visits, they demonstrated low rates of complications and reoperations within the first year following surgery.
"Addressing the leading health epidemic of our time is the mission of Pennington Biomedical, and our researchers at the Metamor Institute are delivering on that mission through studies and analysis like this," added Dr John Kirwan, Executive Director of Pennington Biomedical. "Though we encourage further research, this study and others like it offer hope to those who are suffering from the deleterious health effects of obesity. Researchers, patients and surgeons can have an increased sense of confidence that metabolic surgery is safe and effective in treating obesity."
To access the paper, ‘BMI ≥ 70: A Multi-Center Institutional Experience of the Safety and Efficacy of Metabolic and Bariatric Surgery Intervention’, please click here (log-in maybe required)
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