Key result
Moderate preoperative weight loss (>0% to <5%) was associated with a lower risk of 30-day mortality after bariatric surgery compared with no weight loss (OR 0.76; 95% CI 0.60-0.96).
Why the study?
Clinical guidelines do not require preoperative weight loss before bariatric surgery due to a lack of scientific evidence regarding its benefits, despite varying perceptions among patients, physicians, and payers.
Does preoperative weight loss reduce 30-day mortality in patients undergoing bariatric surgery?
Cohort (n=480,075)
Yes
Does preoperative weight loss reduce 30-day mortality in patients undergoing bariatric surgery?
Odds Ratio: 0.76 (95% CI 0.6–0.96)
p-value: p=.003
Preoperative weight loss, even in moderate amounts (>0% to <5%), is associated with a significantly lower risk of 30-day mortality following bariatric surgery.
May support preoperative weight loss before bariatric surgery; leaves open whether randomized trials confirm mortality benefit.
Importance: Perception of weight loss requirements before bariatric surgery varies among patients, physicians, and health insurance payers. Current clinical guidelines do not require preoperative weight loss because of a lack of scientific support regarding its benefits. Objective: To examine the association of preoperative body mass index (BMI) and weight loss with 30-day mortality after bariatric surgery. Design, Setting, and Participants: This cohort study used data from 480 075 patients who underwent bariatric surgery from 2015 to 2017 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which covers more than 90% of all bariatric surgery programs in the United States and Canada. Clinical and demographic data were collected at all participating institutions using a standardized protocol. Data analysis was performed from December 2018 to November 2019. Exposures: Preoperative BMI and weight loss. Main Outcomes and Measures: 30-day mortality after bariatric surgery. Results: Of the 480 075 patients (mean [SD] age 45.1 [12.0] years; 383 265 [79.8%] women), 511 deaths (0.1%) occurred within 30 days of bariatric surgery. Compared with patients with a preoperative BMI of 35.0 to 39.9, the multivariable-adjusted odds ratios for 30-day mortality for patients with preoperative BMI of 40.0 to 44.9, 45.0 to 49.9, 50.0 to 54.9, and 55.0 and greater were 1.37 (95% CI, 1.02-1.83), 2.19 (95% CI, 1.64-2.92), 2.61 (95% CI, 1.90-3.58), and 5.03 (95% CI, 3.78-6.68), respectively (P for trend < .001). Moreover, compared with no preoperative weight loss, the multivariable-adjusted odds ratios for 30-day mortality for patients with weight loss of more than 0% to less than 5.0%, 5.0% to 9.9%, and 10.0% and greater were 0.76 (95% CI, 0.60-0.96), 0.69 (95% CI, 0.53-0.90), and 0.58 (95% CI, 0.41-0.82), respectively (P for trend = .003). Conclusions and Relevance: In this study, even moderate weight loss (ie, >0% to <5%) before bariatric surgery was associated with a lower risk of 30-day mortality. These findings may help inform future updates of clinical guidelines regarding bariatric surgery.
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Sun et al. (2020) conducted a cohort in Bariatric surgery (n=480,075). Preoperative weight loss vs. No preoperative weight loss was evaluated on 30-day mortality (OR 0.76, 95% CI 0.60-0.96, p=.003). Moderate preoperative weight loss (>0% to <5%) was associated with a lower risk of 30-day mortality after bariatric surgery compared with no weight loss (OR 0.76; 95% CI 0.60-0.96).
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