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Cited by 18Bariatric Surgery and OutcomesCardiac, Anesthesia and Surgical OutcomesAutopsy Techniques and Outcomes

Postmortem findings in morbidly obese individuals dying after gastric bypass procedures

Cummings, Peter M., Le, Brian H., Lopes, M. Beatriz S.·2007·Human Pathology
DOI 10.1016/j.humpath.2006.09.021
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Abstract

Mortality has been reported to complicate gastric bypass, with common causes of death attributable to anastomotic leaks, sepsis, hemorrhage, and bowel obstruction. We evaluated autopsy reports from 10 patients having undergone gastric bypass. Medical records were reviewed to identify comorbidities. Data of interest included preoperative electrocardiogram (EKG) abnormalities, cause of death, body weight, anastamosis appearance, heart weight, extent of coronary artery disease, ventricular size, liver weight, and gall bladder status. A total of 7 men and 3 women were autopsied. Average age was 40 years (range, 30-49 years), and mean body mass index at autopsy was 60.3 kg/m(2) (range, 33.2-80.9 kg/m(2)). Evidence of anastomotic leaks was present in 7 cases, resulting in 4 deaths. Death was attributed to pulmonary embolism in one case. There were 5 cardiac-related deaths, all attributed to arrhythmias. Microscopic evidence of coronary artery disease was observed in 6. Cardiomegaly was seen in all patients, left ventricular hypertrophy in 8, right ventricular hypertrophy in 3, and hepatomegaly in all 10. Nine patients were status post cholecystectomy. Of the 8 preoperative EKG available, abnormalities were identified in 5. After gastric bypass, death was attributed to cardiac-related causes, pulmonary embolism, and operative complications. A significant proportion of cardiac-related deaths occured in the absence of atherosclerosis. Most patients had preoperative EKG abnormalities. As a high incidence of cardiomegaly was observed, operative stress associated with the procedure may increase the risk of arrhythmia in morbid obesity. Consequently, in morbidly obese patients, a detailed preoperative cardiovascular evaluation is warranted to reduce postoperative mortality.

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Crossref · 10.1016/j.humpath.2006.09.021

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  • Autopsy series have shown cardiac hypertrophy plus a variable extent of coronary artery disease in obese and nonobese subjects.

    “However, autopsy series present the opportunity to study heart tissue from obese and nonobese subjects, and in general, these studies have shown cardiac hypertrophy plus a variable extent of coronary artery disease (9, 64, 91, 147, 185–188, 300).”

    From Cardiac remodeling in obesity (2008) · cites this paper as [64]

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Authors
Cummings, P. M., Le, B. H., & Lopes, M. B. S.
Affiliations
University of Virginia Health System (US)
Corresponding author
Lopes, M. Beatriz S.
ORCID
Venue
Human Pathology
Publisher
Elsevier BV
Published
2007-04
Volume
38
Issue
4
Pages
593-597
ISSN
0046-8177 (ISSN-L)
DOI
10.1016/j.humpath.2006.09.021
OpenAlex
W1966043619
Cited by
18
References
24
Citations by year
2024: 1 · 2020: 2 · 2016: 2 · 2014: 1 · 2013: 3 · 2012: 1
FWCI
1.99
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Human Pathology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Autopsy Techniques and Outcomes
Keywords
morbid obesity, gastric bypass, postoperative mortality, anastomotic leakage, cardiac arrhythmias, cardiomegaly, left ventricular hypertrophy, coronary artery disease, pulmonary embolism, gallbladder disease, hepatomegaly
MeSH terms
Adult, Arrhythmias, Cardiac, Autopsy, Cause of Death, Female, Humans, Male, Middle Aged, Obesity, Morbid, Postoperative Complications, Pulmonary Embolism, Gastric Bypass

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