The dilemma of outcome assessment after operations for morbid obesity.
Outcome of 56 patients who underwent horizontal gastroplasty (HGP) and 126 who underwent Roux-en-Y gastric bypass (RYGB) was assessed at 18 months postoperatively according to three definitions of successful weight loss; also, outcome was evaluated in the context of amelioration of obesity-related medical problems. Outcome definitions included the following: I, loss of 25% or more of preoperative weight; II, loss of 50% or more of excess weight; III, loss to within 50% of ideal body weight. To evaluate the impact of preoperative weight on success rate, patients were divided into two weight groups: "morbidily" obese patients, who were 100 to 199 pounds overweight (n = 146), and "super"-obese patients who were 200 pounds or more overweight (n = 36). Weight loss was significantly greater with RYGB versus HGP by each of the three definitions of success. Medical problems either improved or resolved with weight loss in 95% of cases. There were statistically significant differences in success rate depending on outcome definition in both HGP and RYGB patients. Success rate ranged from zero in super-obese HGP patients by Definition III to 97% in super-obese RYGB patients by Definition I. Although super-obese patients lost more pounds than the lighter morbidly obese patients, a significantly lower number of super-obese patients lost within 50% of ideal weight. Super-obese patients must lose more weight to reduce their actuarial risk. These results show that the definition of successful outcome may significantly influence the overall success rate in a large series of bariatric surgical patients.
Brolin
R E
RE
Department of Surgery, Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019.
Kenler
H A
HA
Gorman
R C
RC
Cody
R P
RP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D001835:Body Weight; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors; D015431:Weight Loss