Short-term Safety of Gastric Bypass: Misconceptions Dispelled

Marlene Busko

November 11, 2014

BOSTON, MA — In patients with type 2 diabetes, laparoscopic Roux-en-Y gastric-bypass surgery was as safe as or safer than seven other common surgeries, a new study illustrates.

The study was published online October 29 in Diabetes, Obesity, and Metabolism.

"The perception has been that gastric bypass is a very risky operation, but the reality is, it is as safe as, if not safer, than many of the most commonly performed surgeries in America," lead author Dr Ali Aminian (Cleveland Clinic, Ohio), said in a statement from the Cleveland Clinic, issued at Obesity Week 2014.

"The 30-day mortality risk of laparoscopic Roux-en-Y gastric-bypass surgery was three in 1000 patients — one-tenth that of cardiovascular surgery" and the same as the risk associated with knee-replacement surgery, he told attendees at the meeting, where he also presented the research.

In the month after surgery, only 3.4% of patients had one of nine serious adverse events, similar to the rate of complications following a gallbladder operation or a hysterectomy.

Benefits from the operation include significant weight loss and diabetes improvement or remission, and "earlier intervention with metabolic surgery may eliminate the need for some later higher-risk procedures [such as coronary artery bypass graft (CABG) surgery] to treat cardiovascular complications of diabetes," Dr Aminian pointed out.

"Part of the message is 'at least consider [surgery] if your main concern is risk and mortality' " from diabetes and obesity, coauthor and session comoderator Dr Stacy A Brethauer (Cleveland Clinic) commented to Medscape Medical News.

"One of the biases against bariatric surgery is [that there is] a higher complication and mortality [rate], and this study proves that is not true," at least in the month after surgery, said session comoderator Dr Ricardo V Cohen (Oswaldo Cruz Hospital and Marcia Maria Braido Hospital, São Paulo, Brazil), who was not involved with the study.

All three physicians agree, however, that longer-term safety studies are needed. Dr Aminian said that the database they used stopped at 30-day outcomes, but future findings from the Bariatric Outcomes Longitudinal Database (BOLD) and the Longitudinal Assessment of Bariatric Surgery (LABS) study should help clarify long-term safety.

How Safe Is Bariatric Surgery for Obesity and Diabetes?

Although recent studies reveal that in obese patients with type 2 diabetes, bariatric surgery can improve glycemic control, lower cardiovascular risk, and possibly lead to complete remission of diabetes, many patients and physicians still have concerns about the safety of this surgery, Dr Aminian explained.

He and his colleagues analyzed 66,678 diabetic patients who underwent gastric bypass or seven other common types of surgery during 2007, using the American College of Surgeons-National Surgical Quality Improvement Program database.

The patients had a mean age of 50, a mean body mass index (BMI) of 46, and 71% were female. They had a mean American Society of Anesthesiologists (ASA) score of 2.9 (on a scale of 6, where 3 is severe systemic disease); 37% were on insulin, and 78% were hypertensive.

They compared 30-day complication and mortality rates in the 16,509 patients who had laparoscopic Roux-en-Y gastric-bypass surgery with those of the remaining diabetic patients who underwent CABG, infrainguinal bypass, total-knee arthoplasty, or various laparoscopic abdominal procedures (such as appendectomy, gallbladder surgery, hysterectomy, or colectomy).

On average, patients who had laparoscopic gastric bypass stayed in the hospital for 2.57 days, and 2.5% required a reoperation, which was much lower than hospital stays and reoperation rates for cardiac surgeries.

The rates of nine serious adverse events within a month of having laparoscopic gastric-bypass surgery were low: bleeding requiring a transfusion (1.22%), sepsis (0.81%), pneumonia (0.66%), deep vein thrombosis (0.36%), septic shock (0.30%), pulmonary embolism (0.22%), acute renal failure (0.22%), myocardial infarction (0.16%), and stroke (0.05%).

"This study, along with many others, can help patients with diabetes and their doctors make better informed and realistic decisions about the potential risks and clear benefits of metabolic surgery," said Dr John M Morton (Stanford University, California), who was not involved in the study, in the Cleveland Clinic statement.

Dr Aminian reports that he has no relevant financial relationships. Dr Brethauer is a speaker and researcher for Covidien and a researcher for Ethicon. Dr Cohen is a researcher for Ethicon and GI Dynamics. Dr Morten is a consultant for Covidien and has received honoraria from Ethicon.

Diabetes Obes Metab. Published online October 29, 2014. Abstract

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