Are laparoscopic bariatric procedures safe in superobese (BMI <50 kg/m ²) patients? An NSQIP data analysis

Background The safety of laparoscopic bariatric procedures in superobese patients is still debatable. Methods Using the American College of Surgeons National Surgical Quality Improvement Program's participant-use file, the patients who had undergone laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding for morbid obesity were identified. Several perioperative variables, including 30-day morbidity and mortality, were collected, and the data were compared within each procedure after dividing the patients according to the body mass index: 2 (morbidly obese group and 2 (superobese group). Results A total of 29,323 patients who had undergone laparoscopic bariatric procedures from 2005 to 2008 were identified. Overall, compared with the morbidly obese group, the superobese group had more men (3:2), younger patients, a greater incidence of co-morbidities (e.g., hypertension and dyspnea), a significantly increased length of stay, and a greater rate of 30-day mortality (.26% versus.07%, odds ratio [OR] 4.38, P =.0001). In the gastric bypass group, the superobese group had a significantly greater incidence of postoperative complications, including superficial wound infections (2.45%, OR 1.68, P =.0001), reintubation (.61%, OR 1.97, P =.003), pulmonary embolism (.30%, OR 2.13, P =.032), myocardial infarction (.07%, P =.017), deep vein thrombosis (.49%, OR 2.06, P =.006), septic shock (.44%, OR 1.74, P =.04), and 30-day mortality (.28%, OR 2.26, P =.026). In the laparoscopic adjustable gastric banding group, the superobese group had a significantly greater incidence of postoperative complications, including superficial (1.65%, OR 2.18, P =.0013) and deep (.23%, OR 2.56, P =.035) wound infections, sepsis, septic shock and 30-day mortality (.17%, OR 13.4, P =.0219). Conclusion Laparoscopic bariatric procedures in superobese patients have been associated with significantly increased complications, including 30-day mortality, compared with morbidly obese patients. However, overall, the procedures appear to be safe, with low complication and 30-day mortality rates.