Preoperative Weight Loss Before Bariatric Surgery | Bariatric Surgery | JAMA Surgery | JAMA Network
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Original Article
December 21, 2009

Preoperative Weight Loss Before Bariatric Surgery

Author Affiliations

Author Affiliations: Department of Surgery, Saint Francis Medical Center, Trenton, New Jersey (Dr Benotti); Department of General Surgery, Geisinger Medical Center, Danville, Pennsylvania (Drs Still, King, Dancea, Gerhard, Petrick, and Strodel and Mr Wood); Department of Surgical Oncology, City of Hope National Medical Center, Duarte, California (Dr Akmal); Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio (El Arousy).

Arch Surg. 2009;144(12):1150-1155. doi:10.1001/archsurg.2009.209

Hypothesis  Preoperative weight loss reduces the frequency of surgical complications in patients undergoing bariatric surgery.

Design  Review of records of patients undergoing open or laparoscopic gastric bypass.

Setting  A comprehensive, multidisciplinary obesity treatment center at a tertiary referral center that serves central Pennsylvania.

Patients  A total of 881 patients undergoing open or laparoscopic gastric bypass from May 31, 2002, through February 24, 2006.

Intervention  All preoperative patients completed a 6-month multidisciplinary program that encouraged a 10% preoperative weight loss.

Main Outcome Measures  Loss of excess body weight (EBW) and total and major complication rates.

Results  Of the 881 patients, 592 (67.2%) lost 5% or more EBW and 423 (48.0%) lost more than 10% EBW. Patients referred for open gastric bypass (n = 466) were generally older (P < .001), had a higher body mass index (P < .001), and were more often men (P < .001) than those undergoing laparoscopic gastric bypass (n = 415). Total and major complication rates were higher in patients undergoing open gastric bypass (P < .001 and P = .03, respectively). Univariate analysis revealed that increasing preoperative weight loss is associated with reduced complication frequencies for the entire group for total complications (P =.004) and most likely for major complications (P = .06). Controlling for age, sex, baseline body mass index, and type of surgery in a multiple logistic regression model, increased preoperative weight loss was a predictor of reduced complications for any (P =.004) and major (P = .03) complications.

Conclusion  Preoperative weight loss is associated with fewer complications after gastric bypass surgery.