New Tool Estimates Risks in Sleeve Gastrectomy Patients

A new calculator helps estimate early postoperative morbidity and mortality in patients undergoing laparoscopic sleeve gastrectomy (LSG).

Researchers at the Cleveland Clinic (OH, USA) extracted data on morbidly obese patients undergoing LSG in 2012 from the American College of Surgeons (ACS) National Surgical Quality Improvement Program database. The researchers included patients who underwent concurrent endoscopy, liver biopsy, cholecystectomy, abdominal wall hernia repair, and hiatal hernia repair. Patients who underwent revisional bariatric procedures and cases with unrelated concurrent procedures—such as appendectomy and hysterectomy—were excluded.

The researchers then reviewed 52 baseline variables to explore risk factors associated with mortality and a 30-day postoperative composite adverse event (AE), including mortality. They identified seven major risk factors for post-LSG serious AEs: history of congestive heart failure (CHF), steroid use for chronic conditions, male sex, diabetes, preoperative serum total bilirubin level, body mass index (BMI), and low preoperative hematocrit level. The risk factors were then used to develop a model of estimated risk, which is available online as a calculator.

When the required patient values are entered, percent estimate of serious AEs is calculated. The composite AE is defined as the presence of any of 14 serious AEs, such as deep vein thrombosis (DVT), pulmonary embolism (PE), and myocardial infarction (MI). For example, the estimated risk in a healthy woman with a BMI of 38 kg/m2 and hematocrit of 42% would be 1%. The estimated risk in a woman with a BMI of 60 kg/m2, with diabetes, history of chronic steroid use, and hematocrit of 44% would be 12.6%. The study and calculator were presented at Obesity Week, held during November 2014 in Boston (MA, USA).

“The data point to the overall safety of LSG as a treatment for severe obesity. Incidence of all of the individual complications, except postoperative bleeding, was no greater than 0.5% in this series,” concluded lead author and study presenter bariatric surgeon Ali Aminian, MD. “Estimating the risk for postoperative adverse events can improve surgical decision making and informed patient consent. Considerable benefit can be gained by identifying potentially modifiable preoperative factors that are associated with increased risk for postsurgical adverse events.”

LSG is a restrictive form of weight loss surgery intended for the morbidly obese which permanently reduces the size of the stomach by removing the lateral 2/3 of the stomach with a stapling device. While the stomach is drastically reduced in size, function is preserved, and there is no malabsorption of nutrients and supplements. LSG avoids the problems associated with bypass forms of weight loss surgery, including anemia, intestinal obstruction or blockage, osteoporosis, and protein and vitamin deficiency. Since about 100–200 mL of stomach capacity is maintained, there are very few restrictions on food consumption.

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