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Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery
Open accessAbstract
BACKGROUND: To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization. METHODS: We performed a prospective, multicenter, observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007. A composite end point of 30-day major adverse outcomes (including death; venous thromboembolism; percutaneous, endoscopic, or operative reintervention; and failure to be discharged from the hospital) was evaluated among patients undergoing first-time bariatric surgery. RESULTS: There were 4776 patients who had a first-time bariatric procedure (mean age, 44.5 years; 21.1% men; 10.9% nonwhite; median body-mass index [the weight in kilograms divided by the square of the height in meters], 46.5). More than half had at least two coexisting conditions. A Roux-en-Y gastric bypass was performed in 3412 patients (with 87.2% of the procedures performed laparoscopically), and laparoscopic adjustable gastric banding was performed in 1198 patients; 166 patients underwent other procedures and were not included in the analysis. The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding was 0.3%; a total of 4.3% of patients had at least one major adverse outcome. A history of deep-vein thrombosis or pulmonary embolus, a diagnosis of obstructive sleep apnea, and impaired functional status were each independently associated with an increased risk of the composite end point. Extreme values of body-mass index were significantly associated with an increased risk of the composite end point, whereas age, sex, race, ethnic group, and other coexisting conditions were not. CONCLUSIONS: The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics. In helping patients make appropriate choices, short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese. (ClinicalTrials.gov number, NCT00433810.)
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“The complication evidence base included those studies from the efficacy and predictors searches that included complication data,141,156 as well as those studies that met the expanded search criteria.139,143,145,146,152,153,160,170,171”
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“Relative to other major surgical procedures, the operative mortality rate after bariatric surgery is low and it ranges from 0.28% to 0.4% [110-113].”
From Bariatric surgery: remission of inflammation, cardiometabolic benefits, and common adverse effects (2020) · cites this paper as [111]
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The Hundred Most Cited Articles in Bariatric Surgery
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II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia
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“In contrast, functional dependency and a history of stroke were not separate variables in the present study and therefore not taken into consideration, which might be of additional value in validating this cohort or should be taken into account in future studies [12].”
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Bariatric surgery and diabetes remission: Who would have thought it?
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“able to test whether (1) confirmed OSA status, (2) severity of”
InfluentialClinical Outcomes after Bariatric Surgery: A Five-Year Matched Cohort Analysis in Seven US States
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“[6–8, 23, 25] The few nationally representative studies [12–16, 23, 28–30] have included only inpatient information [23, 29, 30] or elderly patients [15], had short follow-up [12–14, 23], and limited data on serious complications [12, 14, 16] or focused only on mortality [28].”
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“3 % of the patients had at least one major adverse outcome [34].”
BackgroundThereaux, J., Lesuffleur, T., Czernichow, S., Basdevant, A., Msika, S., Nocca, D., Millat, B., & Fagot‐Campagna, A. (2017) · Annals of Surgery · doi:10.1097/sla.0000000000002285 · Cited by 48
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“However, rates of major adverse outcomes and overall perioperative complications after bariatric surgery have been reported to be as high as 4% and 20%, respectively [3, 4].”
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Pannain, S., & Mokhlesi, B. (2010) · Best Practice & Research Clinical Endocrinology & Metabolism · doi:10.1016/j.beem.2010.07.007 · Cited by 48
Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial
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Dixon, J. B., Zimmet, P., Alberti, K. G. M. M., Mbanya, J. C., Rubino, F., & on behalf of the INTERNATIONAL DIABETES FEDERATION TASKFORCE on EPIDEMIOLOGY and PREVENTION (2011) · Journal of Diabetes · doi:10.1111/j.1753-0407.2011.00144.x · Cited by 50
“Morbidity and mortality associated with current conventional bariatric procedures, such as RYGB and laparoscopic AGB, is generally low and similar to that of gallbladder surgery.(1,11) Evidence to date also indicates that bariatric surgery for obese patients with T2D is cost-effective and, in some analyses, cost-savin…”
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Treatment of Obstructive Sleep Apnea Syndrome
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“Such policies, associated to laparoscopic and robotic surgery, which provide more accuracy, better training and preparation of the staff and surgeons may become a powerful tool to improve surgical safety and quality (47,48).”
BackgroundNational prevalence, causes, and risk factors for bariatric surgery readmissions
Garg, T., Rosas, U. S., Rivas, H., Azagury, D. E., & Morton, J. M. (2016) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2016.01.023 · Cited by 47
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EndoBarrier®: a Safe and Effective Novel Treatment for Obesity and Type 2 Diabetes?
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“34%.(37) Long-term complications are dependent on the type of bariatric surgery and have been well outlined in a review by le Roux and Heneghan.”
BackgroundKraljević, M., Köstler, T., Süsstrunk, J., Lazaridis, I. I., Taheri, A., Zingg, U., & Delko, T. (2019) · Obesity Surgery · doi:10.1007/s11695-019-04348-8 · Cited by 48
Roux-en-Y Gastric Bypass vs Gastric Banding for Morbid Obesity: A Case-Matched Study of 442 Patients
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Endoscopic management of post-bariatric surgery complications
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Neuroendocrine adaptations to bariatric surgery
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Laparoscopic Gastric Banding Is Safe in Outpatient Surgical Centers
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Metadata
- Authors
- The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium
- Affiliations
- University of Washington (US)
- Corresponding author
- The Longitudinal Assessment of Bariatric Surgery (LABS) Consortium
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2009-07-30
- Volume
- 361
- Issue
- 5
- Pages
- 445-454
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC2854565
- OpenAlex
- W1558000543
- Cited by
- 1,392
- References
- 21
- Citations by year
- 2026: 17 · 2025: 30 · 2024: 34 · 2023: 44 · 2022: 64 · 2021: 52 · 2020: 73 · 2019: 82 · 2018: 79 · 2017: 88 · 2016: 115 · 2015: 122 · 2014: 136 · 2013: 107 · 2012: 121
- FWCI
- 116.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR000005)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK066471, U01DK066557, U01DK066526, U01DK066568, U01DK066555, U01DK066667, U01DK066585)
- National Center for Research Resources (M01RR000037)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Keywords
- bariatric surgery, perioperative safety, morbid obesity, Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, postoperative mortality, venous thromboembolism, obstructive sleep apnea, body mass index, risk factors, patient decision-making
- MeSH terms
- Adult, Aged, Female, Humans, Length of Stay, Male, Middle Aged, Obesity, Postoperative Complications, Prospective Studies, Reoperation, Risk Factors, Thromboembolism, Comorbidity, Body Mass Index, Outcome Assessment, Health Care, Observation, Sleep Apnea, Obstructive, Venous Thrombosis, Bariatric Surgery
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