Obesity, Morbid Clinical Trial
Official title:
Is Body Mass Index and Obesity Surgery Mortality Risk Score Important in Perioperative Complications of Laparoscopic Sleeve Gastrectomy Before Discharge? A Retrospective Cohort Study
The term obesity is defined as body mass index (BMI) 30 and over, and morbid obesity is
considered as BMI greater than 40 (1).Its incidence in the general population is
approximately 20% according to Organisation for data of Economic Co-operation and Development
(OECD) countries and unfortunately, it is increasing worldwide (2). Obesity should not be
thought ofas a single disorderasit is related tomany disorders like hypertension, diabetes,
obstructive sleep apnea, cardiovascular diseases, and increased risk of malignancies (1).For
years people have struggled with obesitywithboth metabolic and physical problems. Surgical
treatment is the most effective long-term therapeutic treatment in current and modern
medicine of obesity and obesity-related diseases as the last resort.(3-5). Roux-en-y
gastrojejunostomy is the method that has been applied for many years and there isconsensus on
its effect.However, in recent years, laparoscopic sleeve gastrectomy (LSG) has an increasing
number of procedures with a short learning curve and it is the most performed surgical
technique all over the world and also in Turkey (2,6).
Unfortunately, like any surgical procedure, this surgery has its own complications.Although
being performed frequently increases the experience of surgeons, this situation cannot reduce
the risk of complications of surgery to zero. In morbid obesity patients, the risk of any
complications in all surgical procedures is higher than withother patients who were not
morbidly obese. Due to these complications, prolonged hospital stays, increased
reapplications to the hospital, reoperations and deaths can result(5,7). Despite both an
increased risk of complications according to obesity and the risk of specific complications
due to sleeve gastrectomy, laparoscopic sleeve gastrectomy is associated with acceptable
postoperative morbidity and mortality rates (8).
Various classifications have been described in the literature for complications after
surgery.In one of these classifications, according to Clavien-Dindo (CD) Classification,
complications are divided into two groups as major and minor. (1, 9)(Table 1). This
classification can be applied to bariatric and metabolic surgeries as withall surgery types.
Especially major complications in this classification are life-threatening situations and
their early detection is important (8).
In fact, surgeons do not want to encounter mortality in any of their patients. In this
respect, DeMaria et al. developed an easily applicable mortality risk scoring system, which
is consisted of five items (age ≥45 years, male sex, body mass index (BMI) ≥ 50 kg / m2,
arterial hypertension, and risk factors for pulmonary thromboembolism) and can be used for
the pre-operative determination of risky patients in obesity surgery(Obesity Surgery
Mortality Risk Score; OR-MRS) (8,10,11).
In this study, it is aimed to determine the perioperative complications seen in the
laparoscopic sleeve gastrectomy patients that we performed in our clinic without being
discharged from the hospital and to evaluate the treatment processes of the complications
under literature. In addition, whether the OS-MRS risk assessment scale and BMI had a role
indetermining perioperative complications before discharge was investigated.
Material - Method Our study was carried out with the approval numbered 13281952-929 from
Elazig Training and Research Hospital. All procedures performed in studies involving human
participants were in accordance with the ethical standards of the institutional and/or
national research committee and with the 1964 Helsinki declaration and its later amendments
or comparable ethical standards. 1752 patients who met the criteria of patient selection in
terms of obesity and metabolic disease surgery, operated in the Elazığ Training and Research
Hospital General Surgery Clinic between January 2016 and October 2018 were evaluated
retrospectively. Patients' data were obtained from epicrisis forms in the hospital computer
system, patient follow-up charts and patient files. Data for OS-MRS and Clavien Dindo
complication classification were obtained from patient follow-up charts, patient files and
hospital computer records. Patients' demographic data (age, sex), presence of comorbidities,
complications (wound complications, thromboembolic events, leakage from anastomosis, splenic
infarction proven by imaging methods, bleeding detected due to low hemoglobin and hematocite
values during follow-up, acute renal failure due to deterioration in biochemical parameters)
seen in follow up period before discharge (postoperative first 72 hours), complication type
(major and minor), whether emergency surgery was performed, BMI values, postoperative
hospitalization and OS-MRS. Additionally, while grouping according to BMI values, patients
with BMI values below 40 were excluded and three groups with BMI values of 40 - 45 kg / m^2,
45 - 50 kg / m^2 and 50 kg / m^2 and above were created. It was investigated whether there
were any complications among these groups and the presence of major or minor complications by
CD classification. 1617 patients who met the inclusion criteria were evaluated.
IBM Statistical Package for Social Sciences (SPSS) 20.0 was used for statistical evaluation.
Kolmogorow-Smirnov test results were examined in terms of the suitability of the groups for
normal distribution. In comparisons between groups, independent sample t-test or Mann Whitney
U test was used to evaluate numerical data according to normality test. In the evaluation of
categorical data, chi-square analysis and Fischer's exact test were performed. In terms of
the relation between complication formation and BMI, univariate analysis and multivariate
analysis were performed. Numerical data were given as mean ± standard deviation (ss) (minimum
- maximum values) or median (minimum - maximum values) according to normality test.
Categorical data are given as count (n) and percentage (%).
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