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Risk analysis in bariatric surgery: Impact of disease burden
Abstracts: Plenary Session/Surgery for Obesity and Related Diseases / 1 (2005) 222–283
mellitus, the prevalence of these findings has not been correlated with liver histopathology. Methods: Routine core liver biopsy was simultaneously performed on 143 (13 (9%) males and 130 (91%) females) patients at the time of Roux-en-Y gastric bypass at UC Davis. Mean BMI was 46.9 ⫾ 5.8 kg/m2, and mean age was 43.5 ⫾ 8.9 years. Twenty-two patients (15.4%) of the 143 were diabetic. Routine LFTs were obtained on all patients preoperatively. Liver specimens were histologically evaluated for the presence of NASH. Results: Of the 143 patients, 56 (39.1%) were positive for NASH as confirmed by liver biopsy. Only 4 patients (2.7%) overall had elevated LFTs. All patients with elevated LFTs exhibited NASH on liver biopsy. In contrast, only 4 (7.1%) of the 56 patients, with biopsy-proven NASH, had elevated LFTs preoperatively. Seven (31.8%) of the 22 diabetic patients had NASH on liver biopsy, and only 7 (12.5%) of the 56 patients with NASH were diabetic. Conclusions: While abnormalities in LFTs may be associated with NASH, our findings indicate that NASH is more prevalent, in the morbidly obese, than can be deduced by changes in LFTs alone. Additionally, the presence of diabetes mellitus seems to be only loosely associated with NASH. PII: S1550-7289(05)00222-4
P35.
RISK ANALYSIS IN BARIATRIC SURGERY: IMPACT OF DISEASE BURDEN Peter N. Benotti, M.D.1, Hector Rodriguez, M.D.#, Nino Carnevale, M.D.1, Eduardo Liriano, M.D.2, Department of Surgery1 and Anesthesia#, Valley Hospital, Ridgewood NJ; Department of Surgery2, Englewood Hospital, Englewood, NJ. Purpose: Outcome data has identified age, body mass index (BMI) and male gender as risk factors in bariatric Surgery. In the general population, increasing BMI, and obesity disease burden have been shown to adversely affect life expectancy. At the present time, there is little information which relates obesity disease burden to surgical risk. Methods: Our 9 year experience with 1009 patients undergoing primary (n ⫽ 858) and revision (n ⫽ 151) gastric operations for morbid obesity demonstrated a mortality rate of 0.5%, a morbidity rate of 20% and a major complication rate of 6.8%. Surgical risk factors included BMI ⬎55 and age ⬎55. A preoperative patient database (n ⫽ 1210) was queried in order to investigate the relationship between BMI and comorbidity prevalence. In addition, patients in the database are separated according to age, BMI, and gender in order to determine which patient groups had the highest prevalence of comorbid conditions. Results:
COMORBIDITY PENETRATION 3.0
COMORBIDCONDITIONS
258
****
2.5 2.0
**
***
****
MEN
BMI>55
**
1.5 1.0 0.5 0.0
N:
AGE<55
1032
BMI<55
922
**P<.05
WOMEN
909 VS TOTAL
TOTAL
1210
***P<.001
301 VS TOTAL
288
AGE>55
146
****P<.0001
VS TOTAL
Conclusions: Disease burden appears to be associated with surgical risk as severe comorbid illnesses are more prevalent in patients with BMI ⬎55, and comorbidity penetration is higher in higher risk patient groups (men, BMI ⬎55, and age ⬎55). PII: S1550-7289(05)00223-6 P36.
SEROPREVALENCE OF HELICOBACTER PYLORI IN MORBIDLY OBESE PATIENTS Wei-Jei Lee, M.D., Ph.D., Weu Wang, M.D., Ching-Mei Lin, N.S., Tai-Chi Chen, M.D., Po-Li Wei, M.D., Department of Surgery and Nursing, En-Chu-Kong Hospital, and National Taiwan University, Taipei, Taiwan. Purpose: Helicobacter pylori is a major pathogen of stomach. Recent exciting findings linked H. pylori infection to ghrelin, then to obesity. The aim of the present study is to determine the prevalence of H. pylori infection in morbidly obese patients and analyze its clinical significance. Methods: The preoperative seropositivity of H. pylori was determined in 293 patients who had undergone bariatric surgery for morbid obesity during the past 5 years. A normal control group comprising normal volunteers matched in sex and age was included. All the clinical data were prospectively collected and stored in a personal computer system. Results: The overall seroprevalence of H. pylori in morbidly obese patients was lower than that of normal control (41.6% vs. 58.8%; p⬍0.01). Differences in the estimated risk of the presence of H. pylori were more pronounced in younger age group. Morbidly obese patients positive for H. pylori were associated with younger age, central obesity and abnormal liver function but not with sex, body mass index, blood pressure, blood lipid and glucose level. The perioperative parameters and weight reduction after bariatric surgery were similar between morbidly obese patients who were positive or negative for H. pylori. Conclusions: H. pylori is not a outcome predictor for bariatric surgery. A lack of H. pylori infection, especially during childhood, might enhance the risk of the development of morbid obesity. PII: S1550-7289(05)00224-8
Comorbidity prevalence:
N
%
BMI>55
BMI<55
P
P37.
Musculoskeletal/joint: Hypertension Sleep Apnea Diabetes Respiratory Venous Stasis Fluid Retention
564 519 426 246 191 39 16
48 44 36 21 16 3 1
50% 51% 52% 22% 17% 7% 4%
47% 42% 31% 20% 18% 2% .6%
ns ⬍.01 ⬍.0001 ns ns ⬍.001 ⬍.001
PREVIOUSLY UNDIAGNOSED MEDICAL CONDITIONS IN PATIENTS UNDERGOING BARIATRIC RISK ASSESSMENT Richard Gorman, M.D., James Ku, M.D., Penn State Surgical Weight Loss Penn State College of Medicine, S. Hershey Medical Center, Hershey, PA.
mellitus, the prevalence of these findings has not been correlated with liver histopathology. Methods: Routine core liver biopsy was simultaneously performed on 143 (13 (9%) males and 130 (91%) females) patients at the time of Roux-en-Y gastric bypass at UC Davis. Mean BMI was 46.9 ⫾ 5.8 kg/m2, and mean age was 43.5 ⫾ 8.9 years. Twenty-two patients (15.4%) of the 143 were diabetic. Routine LFTs were obtained on all patients preoperatively. Liver specimens were histologically evaluated for the presence of NASH. Results: Of the 143 patients, 56 (39.1%) were positive for NASH as confirmed by liver biopsy. Only 4 patients (2.7%) overall had elevated LFTs. All patients with elevated LFTs exhibited NASH on liver biopsy. In contrast, only 4 (7.1%) of the 56 patients, with biopsy-proven NASH, had elevated LFTs preoperatively. Seven (31.8%) of the 22 diabetic patients had NASH on liver biopsy, and only 7 (12.5%) of the 56 patients with NASH were diabetic. Conclusions: While abnormalities in LFTs may be associated with NASH, our findings indicate that NASH is more prevalent, in the morbidly obese, than can be deduced by changes in LFTs alone. Additionally, the presence of diabetes mellitus seems to be only loosely associated with NASH. PII: S1550-7289(05)00222-4
P35.
RISK ANALYSIS IN BARIATRIC SURGERY: IMPACT OF DISEASE BURDEN Peter N. Benotti, M.D.1, Hector Rodriguez, M.D.#, Nino Carnevale, M.D.1, Eduardo Liriano, M.D.2, Department of Surgery1 and Anesthesia#, Valley Hospital, Ridgewood NJ; Department of Surgery2, Englewood Hospital, Englewood, NJ. Purpose: Outcome data has identified age, body mass index (BMI) and male gender as risk factors in bariatric Surgery. In the general population, increasing BMI, and obesity disease burden have been shown to adversely affect life expectancy. At the present time, there is little information which relates obesity disease burden to surgical risk. Methods: Our 9 year experience with 1009 patients undergoing primary (n ⫽ 858) and revision (n ⫽ 151) gastric operations for morbid obesity demonstrated a mortality rate of 0.5%, a morbidity rate of 20% and a major complication rate of 6.8%. Surgical risk factors included BMI ⬎55 and age ⬎55. A preoperative patient database (n ⫽ 1210) was queried in order to investigate the relationship between BMI and comorbidity prevalence. In addition, patients in the database are separated according to age, BMI, and gender in order to determine which patient groups had the highest prevalence of comorbid conditions. Results:
COMORBIDITY PENETRATION 3.0
COMORBIDCONDITIONS
258
****
2.5 2.0
**
***
****
MEN
BMI>55
**
1.5 1.0 0.5 0.0
N:
AGE<55
1032
BMI<55
922
**P<.05
WOMEN
909 VS TOTAL
TOTAL
1210
***P<.001
301 VS TOTAL
288
AGE>55
146
****P<.0001
VS TOTAL
Conclusions: Disease burden appears to be associated with surgical risk as severe comorbid illnesses are more prevalent in patients with BMI ⬎55, and comorbidity penetration is higher in higher risk patient groups (men, BMI ⬎55, and age ⬎55). PII: S1550-7289(05)00223-6 P36.
SEROPREVALENCE OF HELICOBACTER PYLORI IN MORBIDLY OBESE PATIENTS Wei-Jei Lee, M.D., Ph.D., Weu Wang, M.D., Ching-Mei Lin, N.S., Tai-Chi Chen, M.D., Po-Li Wei, M.D., Department of Surgery and Nursing, En-Chu-Kong Hospital, and National Taiwan University, Taipei, Taiwan. Purpose: Helicobacter pylori is a major pathogen of stomach. Recent exciting findings linked H. pylori infection to ghrelin, then to obesity. The aim of the present study is to determine the prevalence of H. pylori infection in morbidly obese patients and analyze its clinical significance. Methods: The preoperative seropositivity of H. pylori was determined in 293 patients who had undergone bariatric surgery for morbid obesity during the past 5 years. A normal control group comprising normal volunteers matched in sex and age was included. All the clinical data were prospectively collected and stored in a personal computer system. Results: The overall seroprevalence of H. pylori in morbidly obese patients was lower than that of normal control (41.6% vs. 58.8%; p⬍0.01). Differences in the estimated risk of the presence of H. pylori were more pronounced in younger age group. Morbidly obese patients positive for H. pylori were associated with younger age, central obesity and abnormal liver function but not with sex, body mass index, blood pressure, blood lipid and glucose level. The perioperative parameters and weight reduction after bariatric surgery were similar between morbidly obese patients who were positive or negative for H. pylori. Conclusions: H. pylori is not a outcome predictor for bariatric surgery. A lack of H. pylori infection, especially during childhood, might enhance the risk of the development of morbid obesity. PII: S1550-7289(05)00224-8
Comorbidity prevalence:
N
%
BMI>55
BMI<55
P
P37.
Musculoskeletal/joint: Hypertension Sleep Apnea Diabetes Respiratory Venous Stasis Fluid Retention
564 519 426 246 191 39 16
48 44 36 21 16 3 1
50% 51% 52% 22% 17% 7% 4%
47% 42% 31% 20% 18% 2% .6%
ns ⬍.01 ⬍.0001 ns ns ⬍.001 ⬍.001
PREVIOUSLY UNDIAGNOSED MEDICAL CONDITIONS IN PATIENTS UNDERGOING BARIATRIC RISK ASSESSMENT Richard Gorman, M.D., James Ku, M.D., Penn State Surgical Weight Loss Penn State College of Medicine, S. Hershey Medical Center, Hershey, PA.