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    Original Investigation
    Surgery
    May 14, 2020

    Association of Preoperative Body Weight and Weight Loss With Risk of Death After Bariatric Surgery

    Author Affiliations
    • 1Department of Epidemiology, University of Iowa College of Public Health, Iowa City
    • 2Carver College of Medicine, Department of Surgery, University of Iowa, Iowa City
    • 3Carver College of Medicine, Department of Internal Medicine, University of Iowa, Iowa City
    • 4Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City
    • 5Department of Plastic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
    • 6now with Scientific and Medical Affairs, Abbott Nutrition, Columbus, Ohio
    • 7Obesity Research and Education Initiative, University of Iowa, Iowa City
    JAMA Netw Open. 2020;3(5):e204803. doi:10.1001/jamanetworkopen.2020.4803
    Key Points español 中文 (chinese)

    Question  Are preoperative body mass index and weight loss associated with 30-day mortality after bariatric surgery?

    Findings  In a cohort study of 480 075 patients who underwent bariatric surgery from 2015 to 2017, even modest weight loss before bariatric surgery was associated with lower risk of 30-day mortality after the procedure. Compared with patients with no preoperative weight loss, patients with weight loss greater than 0% to less than 5.0%, 5.0% to 9.9%, and 10.0% and greater had 24%, 31%, and 42%, respectively, lower risk of 30-day mortality.

    Meaning  In this study of patients who underwent bariatric surgery, even moderate weight loss (ie, >0% to <5%) before the procedure was associated with lower risk of 30-day mortality; these findings may help to inform future updates of clinical guidelines regarding bariatric surgery.

    Abstract

    Importance  Perception of weight loss requirements before bariatric surgery varies among patients, physicians, and health insurance payers. Current clinical guidelines do not require preoperative weight loss because of a lack of scientific support regarding its benefits.

    Objective  To examine the association of preoperative body mass index (BMI) and weight loss with 30-day mortality after bariatric surgery.

    Design, Setting, and Participants  This cohort study used data from 480 075 patients who underwent bariatric surgery from 2015 to 2017 in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which covers more than 90% of all bariatric surgery programs in the United States and Canada. Clinical and demographic data were collected at all participating institutions using a standardized protocol. Data analysis was performed from December 2018 to November 2019.

    Exposures  Preoperative BMI and weight loss.

    Main Outcomes and Measures  30-day mortality after bariatric surgery.

    Results  Of the 480 075 patients (mean [SD] age 45.1 [12.0] years; 383 265 [79.8%] women), 511 deaths (0.1%) occurred within 30 days of bariatric surgery. Compared with patients with a preoperative BMI of 35.0 to 39.9, the multivariable-adjusted odds ratios for 30-day mortality for patients with preoperative BMI of 40.0 to 44.9, 45.0 to 49.9, 50.0 to 54.9, and 55.0 and greater were 1.37 (95% CI, 1.02-1.83), 2.19 (95% CI, 1.64-2.92), 2.61 (95% CI, 1.90-3.58), and 5.03 (95% CI, 3.78-6.68), respectively (P for trend < .001). Moreover, compared with no preoperative weight loss, the multivariable-adjusted odds ratios for 30-day mortality for patients with weight loss of more than 0% to less than 5.0%, 5.0% to 9.9%, and 10.0% and greater were 0.76 (95% CI, 0.60-0.96), 0.69 (95% CI, 0.53-0.90), and 0.58 (95% CI, 0.41-0.82), respectively (P for trend = .003).

    Conclusions and Relevance  In this study, even moderate weight loss (ie, >0% to <5%) before bariatric surgery was associated with a lower risk of 30-day mortality. These findings may help inform future updates of clinical guidelines regarding bariatric surgery.

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