A preoperative weight-reducing regimen is usually adhered to in most centers performing bariatric surgery for obesity. The potential to reduce postoperative complications by such a routine is yet to be defined.
Data on 22,327 patients undergoing primary gastric bypass from January 1, 2008, to June 30, 2012, were analyzed.
In all patients, median preoperative total weight change was −4.8%. Corresponding values in the 25th, 50th, and 75th percentile were 0.5, −4.7, and −9.5%, respectively. Complications were noted in 9.1% of the patients. When comparing patients in the 75th with those in the 25th percentile of preoperative weight loss, the risk of complications was reduced by 13%. For specific complications, the corresponding risks were reduced for anastomotic leakage by 24%, for deep infection/abscess by 37%, and for minor wound complications by 54%. Similarly, however, less pronounced risk reductions were found when comparing patients in the 50th with those in the 25th percentile of preoperative weight loss. For patients in the highest range of body mass index (BMI), the risk reduction associated with preoperative weight loss was statistically significant for all analyzed complications, whereas corresponding risk reductions were only occasionally encountered and less pronounced in patients with lower BMI.
Weight loss before bariatric surgery is associated with marked reduction of risk of postoperative complications. Moreover, the degree of risk reduction seems to be related to amount of weight lost and patients in the higher range of BMI are likely to benefit most from preoperative weight reduction.
In a large cohort of patients (n = 22,327), weight loss before bariatric surgery was found to be associated with a marked reduction of risk of postoperative complications. Patients with more profound weight loss (approximately 10% of total weight) and higher body mass index seem to benefit more.
*Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital and Department of Surgery, Ersta Hospital, Stockholm, Sweden
†Department of Surgery, Capio, St Görans Hospital, Stockholm, Sweden.
Reprints: Claes Anderin, MD, PhD, Department of Surgery, Ersta Hospital, 116 91 Stockholm, Sweden. E-mail: firstname.lastname@example.org.
Disclosure: There is no conflict of interest. Financial support was provided through the Erling-Persson Family Foundation and through the regional agreement on medical training and clinical research (A.L.F.) between Stockholm County Council and Karolinska Institutet.