Bariatric Surgery Outcomes Improved By Pre-Op Weight Loss

DANVILLE, Pa., Oct. 15 -- Losing between 5% and 10% of body weight before bariatric surgery improves outcomes for morbidly obese patients, researchers here said. Pre-operative weight loss resulted in more rapid loss after surgery and a shorter hospital stay, according to Christopher Still, D.O., and colleagues at the Geisinger Health Care System here. That finding comes from a prospective, longitudinal study of 884 patients who underwent either open or laparoscopic Roux-en-Y gastric bypass between May 31, 2002 and Feb. 24, 2006, the researchers reported in the Oct. issue of Archives of Surgery. In a related study in that issue, Seattle researchers found that the Roux-en-Y surgery allowed many morbidly obese people to return to work after being medically disabled. Since 2001, Dr. Still and colleagues said, all patients seeking bariatric surgery at their center have been required to follow a pre-operative program that includes smoking cessation, counseling, and an attempt to lose at least 10% of body weight. For this analysis, patients were stratified according to weight changes before surgery -- gaining more than 5%, gaining 0% to 5%, losing 0% to 5%, losing 5% to 10%, and losing more than 10%. The researchers found that: 48% of the patients (or 425) lost more than 10% of their excess body weight before surgery. After a mean follow-up of 12 months, this group was significantly more likely (at P<0.001) to have lost 70% of their excess body weight, compared with those who lost between 0% and 5%. Losing between 5% and 10% of body weight was not significantly different from losing between 0% and 5% in terms of the chance of dropping 70% of body weight. On the other hand, those who lost more than 5% of excess weight before surgery were significantly less likely (at P=0.03) to stay in hospital more than four days. The study is the largest yet to look at the relationship between pre-operative weight loss and outcomes, Dr. Still and colleagues said, although -- because the patients were relatively older and more obese -- the results may not generalize to all bariatric surgery candidates. Importantly, it remains unclear why those who lost weight before surgery did better afterward, according to Edward Livingston, M.D., of the University of Texas Southwestern Medical Center in Dallas. "Could it be that successful preoperative weight loss is a measure of a patient's compliance and potential for success following weight loss surgery?" Dr. Livingston asked in an accompanying editorial. Exploring the effect that weight-loss surgery has on economic productivity, Richard Thirlby, M.D., and colleagues at the Virginia Mason Medical Center in Seattle, looked retrospectively at results for 38 medically disabled patients between Jan. 1, 1997 and Dec. 31, 2002. All had a Roux-en-Y procedure performed by a single surgeon. Sixteen medically disabled patients seen by the same surgeon -- but who did not have surgery -- served as a control group. After a mean follow-up of 44 months, 37% of the patients who had had surgery had returned to work, compared with 6% of those who did not have the procedure. The difference was significant atP=0.02. The key element in returning to work, the researchers said, was a reduction in the number of co-morbid conditions, rather than the amount of weight lost. Specifically: On average, the patients had four co-morbidities before surgery and 2.7 afterward, for a mean decrease of 1.3. Patients who had more than the mean reduction in co-morbidities were significantly more likely (at P=0.001) to return to work than those who had fewer. On average, patients who returned to work had a mean decrease of 2.4 co-morbidities, and 12 of the 14 patients working had greater than the mean decrease in co-morbidities. Of the 18 patients who saw more than two co-morbid conditions reversed, 12 returned to work. The results are "striking (and) clearly show that it is in the public's best interest to fund these operations to return otherwise indigent patients to work," Dr. Livingston said.

Primary source: Archives of Surgery Source reference: Still CD et al. "Outcomes of Preoperative Weight Loss in High-Risk Patients Undergoing Gastric Bypass Surgery." Arch Surg. 2007; 142(10): 994-98.  Additional source: Archives of Surgery Source reference:  Wagner AJ et al. "Return to Work After Gastric Bypass in Medicaid-Funded Morbidly Obese Patients." Arch Surg. 2007; 142(10): 935-40.  Additional source: Archives of Surgery Source reference:  Livingston EH. "Bariatric Surgery in the New Millennium." Arch Surg. 2007; 142(10): 919-22.