Jawhar Noura, Abi Mosleh Kamal, Muthusamy Kalpana, Gajjar Aryan, Betancourt Richard S, Laplante Simon J, Kendrick Michael L, Ghanem Omar M
Department of Surgery, Division of Metabolic and Abdominal Wall Reconstructive Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
Department of Internal Medicine, Division of Endocrinology, Metabolism, Diabetes, and Nutrition, Mayo Clinic, Rochester, MN, 55905, USA.
Obes Surg. 2025 Mar;35(3):701-714. doi: 10.1007/s11695-025-07753-4. Epub 2025 Feb 19.
Metabolic and bariatric surgery (MBS) is a safe and effective treatment option to reduce weight and manage obesity-related medical conditions in patients with obesity. However, due to limited data, there is uncertainty regarding the short-, mid-, and long-term safety and efficacy profile of MBS in patients with a preoperative ASA IV status.
A single-center retrospective cohort study was performed on patients with ASA IV status who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion with duodenal switch (BPD-DS) between 2008 and 2020. Data collected included operative details; postoperative complications at 30 days, 90 days, and beyond 90 days; BMI changes; and resolution of obesity-related comorbidities at 0, 6, 12, 24, 48, and 60 months postoperatively.
Among 131 ASA class IV patients, 43 patients underwent SG (32.8%), 66 patients underwent RYGB (50.4%), and 22 patients underwent BPD-DS (16.8%). The greatest %TWL occurred in the BPD-DS cohort (39.5%) at 24 months post-op followed by the RYGB (32.5%) and SG (20.7%) cohorts (p < 0.001). The overall major 30-day complication rate was 8.4% (n = 11/131), while the overall major 90-day complication rate within the cohort was 6.9% (n = 9/131). The overall major late (> 90 days) complication rate was found to be 14.5% (n = 19/131).
Our study demonstrated that MBS is relatively safe and effective in ASA IV patients in the short-, mid-, and long-term. Accordingly, careful procedure selection is required in this patient population. Further long-term studies are needed to support our findings.
代谢和减重手术（MBS）是一种安全有效的治疗选择，可帮助肥胖患者减轻体重并控制肥胖相关的疾病。然而，由于数据有限，对于术前美国麻醉医师协会（ASA）分级为IV级的患者，MBS的短期、中期和长期安全性及疗效尚不明确。
对2008年至2020年间接受袖状胃切除术（SG）、Roux-en-Y胃旁路术（RYGB）或胆胰转流十二指肠转位术（BPD-DS）的ASA IV级患者进行了一项单中心回顾性队列研究。收集的数据包括手术细节；术后30天、90天及90天以后的并发症；体重指数（BMI）变化；以及术后0、6、12、24、48和60个月时肥胖相关合并症的缓解情况。
在131例ASA IV级患者中，43例接受了SG（32.8%），66例接受了RYGB（50.4%），22例接受了BPD-DS（16.8%）。术后24个月时，BPD-DS组的最大总体体重减轻百分比（%TWL）最高（39.5%），其次是RYGB组（32.5%）和SG组（20.7%）（p < 0.001）。30天总体主要并发症发生率为8.4%（n = 11/131），而该队列中90天总体主要并发症发生率为6.9%（n = 9/131）。总体主要晚期（> 90天）并发症发生率为14.5%（n = 19/131）。
我们的研究表明，MBS在ASA IV级患者的短期、中期和长期治疗中相对安全有效。因此，对于这一患者群体，需要谨慎选择手术方式。需要进一步的长期研究来支持我们的发现。
