WASHINGTON, Nov. 1, 2017 /PRNewswire/ -- Gastric sleeve surgery is one of the safest and most popular methods of weightloss surgery in America, but a new study* raises some cautions about performing the operation on an outpatient basis. The findings were presented today at ObesityWeek™ 2017, the largest international event focused on the basic
Same-day gastric sleeve surgery was associated with a 30-day mortality rate that was low at 0.10 percent, but still five times higher than patients who were discharged a day later. These patients had a mortality rate of 0.02 percent, most likely due to respiratory failure. There were no statistically significant differences for overall complications (0.98% vs. 0.86%), reoperations (0.54% vs. 0.33%), or readmissions (2.41% vs 2.10%).
"What a difference a day makes," said study senior author Ninh T. Nguyen, MD, Chair of the Department of Surgery at the University of California, Irvine School of Medicine. "This study cautions that surgeons performing outpatient gastric sleeve surgery should carefully select only low-risk patients for same day discharge, such as patients with no respiratory issues such as obstructive sleep apnea. The higher mortality rate in the same day discharge group is likely related to respiratory failure events that occurred in an unsupervised and unmonitored setting."
Researchers from the University of California, Irvine School of Medicine analyzed 37,301 gastric sleeve operations for 30-day mortality and complications, and readmission and reoperation rates from the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) national database. Patients were discharged either the same day of surgery (2,031 patients) or the day after (35,270 patients). Before surgery, patients had an average body mass index (BMI) of 43.
Sleeve gastrectomy has become the most popular method of bariatric surgery. According to the ASMBS, the procedure accounted for more than half the 216,000 bariatric surgeries performed in the U.S. last year. Gastric sleeve surgery involves removing approximately 80 percent of the stomach and leaving a narrow gastric tube or "sleeve." Because the stomach is made smaller, patients feel satisfied with less food.
"Both patients and doctors should approach outpatient bariatric surgery with caution," said ASMBS past-president Raul J. Rosenthal, MD, Chairman of the Department of General Surgery at Cleveland Clinic Florida, who was not involved in the study. "Bariatric surgery is safer than ever, but discharging patients too soon may have serious consequences. Patients should be evaluated very carefully before they go home."
Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for severe obesity and many related conditions and results in significant weight loss. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques. The risk of death is about 0.1 percent and the overall likelihood of major complications is about 4 percent. According to a 2014 study from the Cleveland Clinic's Bariatric and Metabolic Institute, laparoscopic bariatric surgery has complication and mortality rates comparable to some of the safest and most commonly performed surgeries in the U.S., including gallbladder surgery, appendectomy and knee replacement.
According to the National Center for Health Statistics, 39.8 percent of adults and 18.5 percent of children in the U.S. had obesity in 2015-2016, the highest rate ever for adults. Hispanic adults had an obesity rate of 47 percent and Non-Hispanic black adults a rate of 46.8 percent. Obese is medically defined as having a body mass index (BMI), a ratio of height to weight, of more than 30. The ASMBS estimates about 24 million Americans have severe obesity, which would mean a BMI of 35 or more with an obesity-related condition like diabetes or a BMI of 40 or more.
About the ASMBS
The ASMBS is the largest organization for bariatric surgeons in the nation. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of severe obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for patients with severe obesity. For more information, visit www.asmbs.org.
*How Safe is Same-Day Discharge for Laparoscopic Sleeve Gastrectomy? (A128)
Colette Inaba, MD; Christina Y Koh, MD; Sarath Sujatha-Bhaskar, MD; Ninh Nguyen, MD, FASMBS
– all from University of California, Irvine, Orange, CA
 Weiner, R. A., et al. (2010). Indications and principles of metabolic surgery. U.S. National Library of Medicine. 81(4) pp.379-394. https://www.ncbi.nlm.nih.gov/pubmed/20361370
 Encinosa, W. E., et al. (2009). Recent improvements in bariatric surgery outcomes. Medical Care. 47(5) pp. 531-535. Accessed October 2013 from http://www.ncbi.nlm.nih.gov/pubmed/19318997
 Agency for Healthcare Research and Quality (AHRQ). (2007). Statistical Brief #23. Bariatric Surgery Utilization and Outcomes in 1998 and 2004. Accessed October 2013 from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb23.jsp
 Flum, D. R., et al. (2009). Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine. 361 pp.445-454. Accessed October 2013 from http://content.nejm.org/cgi/content/full/361/5/445
 Gastric Bypass is as Safe as Commonly Performed Surgeries. Health Essentials. Cleveland Clinic. Nov. 6, 2014. Accessed October 2017 https://health.clevelandclinic.org/2014/11/gastric-bypass-is-as-safe-as-commonly-performed-surgeries/
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