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Risk Factors Associated With Mortality After Roux-en-Y Gastric Bypass Surgery

Benotti, Peter MD*; Wood, G. Craig MS*; Winegar, Deborah A. PhD§; Petrick, Anthony T. MD; Still, Christopher D. DO*; Argyropoulos, George PhD; Gerhard, Glenn S. MD

doi: 10.1097/SLA.0b013e31828a0ee4
Original Articles

Objective: We sought to identify the major risk factors associated with mortality in Roux-en-Y gastric bypass (RYGB) surgery.

Background: Bariatric surgery has become an established treatment for extreme obesity. Bariatric surgery mortality has steadily declined with current rates of less than 0.5%. However, significant variation in the mortality rates has been reported for specific patient cohorts and among bariatric centers.

Methods: Clinical outcome data from 185,315 bariatric surgery patients from the Bariatric Outcome Longitudinal Database were reviewed. Of these, 157,559 patients had either documented 30 or more day follow-up data, including mortality. Multiple demographic, socioeconomic, and clinical factors were analyzed by univariate analysis for their association with 30-day mortality after gastric bypass. Variables found to be significant were entered into a multiple logistic regression model to identify factors independently associated with 30-day mortality. On the basis of these results, a RYGB mortality risk score was developed.

Results: The overall 30-day mortality rate for the entire bariatric surgery cohort was 0.1%. Of the 81,751 RYGB patients, the mortality rate was 0.15%. Factors significantly associated with 30-day gastric bypass mortality included increasing body mass index (BMI) (P < 0.0001), increasing age (P < 0.005), male gender (P < 0.001), pulmonary hypertension (P < 0.0001), congestive heart failure (P = 0.0008), and liver disease (P = 0.038). When the RYGB risk score was applied, a significant trend (P < 0.0001) between increasing risk score and mortality rate is found.

Conclusions: Increasing BMI, increasing age, male gender, pulmonary hypertension, congestive heart failure, and liver disease are risk factors for 30-day mortality after RYGB. The RYGB risk score can be used to determine patients at greater risk for mortality after RYGB surgery.

A study of risk factors for mortality after bariatric surgery utilizing recent data from the Bariatric Outcome Longitudinal Database. Demographic and clinical factors associated with mortality risk are identified and a new risk score is proposed.

*Geisinger Obesity Research Institute

Weis Center for Research

Department of Surgery, Geisinger Clinic, Danville, PA; and

§Surgical Review Corporation, Raleigh, NC.

Reprints: Peter N. Benotti, MD, PO Box 1515, Southold, NY, 11971. E Mail:

Disclosure: Dr Still receives grant and consulting support from Ethicon-Endosurgery. Dr Petrick has educational grants from Covidien and Ethicon-Endosurgery. This work was supported by funds from Geisinger Clinic, the Weis Center for Research, the Geisinger Obesity Research Institute, and grants DK072488 (GSG and CDS) and DK088231 (GSG) from the National Institute of Health. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.