Preoperative weight loss before bariatric surgery.

HYPOTHESIS

Preoperative weight loss reduces the frequency of surgical complications in patients undergoing bariatric surgery.

DESIGN

Review of records of patients undergoing open or laparoscopic gastric bypass.

SETTING

A comprehensive, multidisciplinary obesity treatment center at a tertiary referral center that serves central Pennsylvania.

PATIENTS

A total of 881 patients undergoing open or laparoscopic gastric bypass from May 31, 2002, through February 24, 2006.

INTERVENTION

All preoperative patients completed a 6-month multidisciplinary program that encouraged a 10% preoperative weight loss.

MAIN OUTCOME MEASURES

Loss of excess body weight (EBW) and total and major complication rates.

RESULTS

Of the 881 patients, 592 (67.2%) lost 5% or more EBW and 423 (48.0%) lost more than 10% EBW. Patients referred for open gastric bypass (n = 466) were generally older (P < .001), had a higher body mass index (P < .001), and were more often men (P < .001) than those undergoing laparoscopic gastric bypass (n = 415). Total and major complication rates were higher in patients undergoing open gastric bypass (P < .001 and P = .03, respectively). Univariate analysis revealed that increasing preoperative weight loss is associated with reduced complication frequencies for the entire group for total complications (P =.004) and most likely for major complications (P = .06). Controlling for age, sex, baseline body mass index, and type of surgery in a multiple logistic regression model, increased preoperative weight loss was a predictor of reduced complications for any (P =.004) and major (P = .03) complications.

CONCLUSION

Preoperative weight loss is associated with fewer complications after gastric bypass surgery.