Factors affecting morbidity and mortality of Roux-en-Y gastric bypass for clinically severe obesity: an analysis of 1,000 consecutive open cases by a single surgeon.

INTRODUCTION

Determinants of perioperative risk for RYGB are not well defined.

METHODS

Retrospective analysis of comorbidities was used to evaluate predictors of perioperative risk in 1,000 consecutive patients having open RYGB by univariate analyses and logistic regression.

RESULTS

One hundred forty-six men, 854 women; average age 38.3+/-11.2 years; mean BMI 51.8+/-10.5 (range 24-116) were evaluated. Average hospital stay (LOS) was 3.8 days; 87%<3 days. 91.3% of procedures were without major complication. The most common complications were incisional hernia 3.5%, intestinal obstruction 1.9%, and leak 1.6%. 31 patients required reoperation within 30 days (3.1%). A 30-day mortality was 1.2%. Logistic regression evaluating predictors of operative mortality correlated strongly with coronary artery disease (CAD) (p<0.01), sleep apnea (p=0.03), and age (p=0.042). BMI>50 (0.6 vs 2.3%, p=0.03) and male sex were associated with increased mortality (1.3 vs. 4.0%, p=0.02). Sex-specific logistic regression demonstrated males with angiographically proven CAD were more likely to die (p=0.028) than matched cohorts. Age (p=0.033) and sleep apnea (p=0.040) were significant predictors of death for women.

CONCLUSION

Perioperative mortality after RYGB appears to be affected by sex, BMI, age, CAD, and sleep apnea. Strategies employing risk stratification should be developed for bariatric surgery.