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Bariatric, Metabolic, and Diabetes Surgery: What's in a Name?

Rubino, Francesco MD*,‡; Shukla, Alpana MD*; Pomp, Alfons MD; Moreira, Marlus MD*; Ahn, Soo Min MD*; Dakin, Gregory MD

doi: 10.1097/SLA.0b013e3182759656
Original Articles

Objective: This study investigated the practical clinical consequences of offering surgery for metabolic disease and diabetes as opposed to weight loss.

Background: The terms “metabolic” and “diabetes surgery” indicate a surgical approach whose primary intent is the control of metabolic alterations/hyperglycemia in contrast to “bariatric surgery,” conceived as a mere weight-reduction therapy.

Methods: A “metabolic surgery” program distinct from the “bariatric surgery” program was recently established at a tertiary US academic medical center. The 2 programs differ in their stated goals but offer the same procedures and use identical eligibility criteria for patients with morbid obesity. Demographics, clinical characteristics, and 30-day postoperative morbidity and mortality were assessed from a prospective database of 200 consecutive patients who underwent surgery at these units.

Results: Metabolic surgery patients were older (45.8 ± 13.4 v 41.8 ± 11.7, P < 0.05), had a lower body mass index (42.4 ± 7.1 vs 48.6 ± 9.5 kg/m2; P < 0.01), and a higher prevalence of being of the male sex (42% vs 26%, P < 0.05), having diabetes (62% vs 35%; P < 0.01), hypertension (68% vs 52%; P < 0.05), dyslipidemia (48% vs 31%; P < 0.05), and cardiovascular disease (14% vs 5%; P < 0.05). Diabetes was more severe among metabolic surgery patients (higher glycated hemoglobin levels; greater percentage of insulin use). There was no mortality, and there were no differences in perioperative complications.

Conclusions: Offering surgery to treat metabolic disease or diabetes rather than as a mere weight-reduction therapy changes demographical and clinical characteristics of surgical candidates. This has important and practical ramifications for clinical care and support consideration of metabolic/diabetes surgery as a novel practice distinct from traditional bariatric surgery.

The characteristics of patient populations and perioperative outcomes of the metabolic surgery program versus the bariatric surgery program in a tertiary US academic medical center were compared as a concrete method to define the emerging discipline of metabolic and diabetes surgery.

*Section of GI Metabolic Surgery, Department of Surgery

Section of Laparoscopic and Bariatric Surgery, Weill Cornell Medical College New York-Presbyterian Hospital, New York, NY; and

Catholic University of Rome, Italy

Reprints: Francesco Rubino, MD, Section of GI Metabolic Surgery, Department of Surgery, Weill Cornell Medical College New York-Presbyterian Hospital, 525 E 68th St, P-714, New York, NY 10065. E-mail: frubinomd@gmail.com.

Disclosure: F.R. has received research grants from Covidien and Roche and is Scientific Advisory Board Member of NGM Biopharmaceuticals. He has also received consulting fees from Ethicon. A.P. received consulting fees from Covidien, Gore. Other authors have no conflicts to disclose.

© 2014 by Lippincott Williams & Wilkins.