title: Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity.
abstract: OBJECTIVE
  To identify the factors that increase mortality for either open or laparoscopic Roux-en-Y gastric bypass.
  
  
  BACKGROUND
  Perioperative mortality is the most feared outcome of bariatric surgery, reported to occur in between 0.5% and 1.5% of patients.
  
  
  METHODS
  The bariatric database at Virginia Commonwealth University was queried for patients who had undergone either an open gastric bypass (O-GBP) or a laparoscopic gastric bypass (L-GBP). A multivariate logistic regression analysis to identify factors related to perioperative mortality was performed. Factors examined included age, gender, body mass index, preoperative weight, hypertension, diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, venous stasis ulcers, intestinal leak, small bowel obstruction, and pulmonary embolus.
  
  
  RESULTS
  Since 1992, more than 2000 patients had either an O-GBP (n = 1431) or a L-GBP (n = 580). Of the O-GBP, 547 patients had a proximal GBP (P-GBP) and 884 superobese (body mass index > 50 kg/m) patients had a long-limb GBP (LL-GBP). The differences in patient demographics, complications, and perioperative mortality rates between L-GBP and O-GBP and P-GBP and LL-GBP patients were examined. Overall, the independent risk factors associated with perioperative death included leak, pulmonary embolus, preoperative weight, and hypertension.
  
  
  CONCLUSIONS
  The risk factors for perioperative death can be separated into patient characteristics and complications. The access method, open versus laparoscopic, was not independently predictive of death, but the operation type, proximal versus long limb, was predictive. The data do not suggest that superobese patients should not undergo surgery, as they are high risk for early death due to their body weight and comorbidities without surgery. Surgery should not be reserved as a desperate last measure for weight loss.
authors.affiliation: Department of General Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
authors.forename: Adolfo Z
authors.initials: AZ
authors.lastname: Fernandez
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Demaria
authors.forename: David S
authors.initials: DS
authors.lastname: Tichansky
authors.forename: John M
authors.initials: JM
authors.lastname: Kellum
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.forename: Jill
authors.initials: J
authors.lastname: Meador
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Sugerman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000401:mortality* / Q000601:surgery*; D012307:Risk Factors