title: Association of super-super-obesity and male gender with elevated mortality in patients undergoing the duodenal switch procedure.
abstract: BACKGROUND
  Previous studies have reported that risk factors for elevated mortality after Roux-en-Y gastric bypass include male gender, as well as a very elevated BMI. The present study was aimed at determining whether these same risk factors applied to patients undergoing the duodenal switch (DS) operation.
  
  
  METHODS
  A retrospective chart review was performed of a cohort of 385 patients who underwent DS. The 30-day mortality of super-superobese (SSO) patients [BMI > or =60 kg/m2 (n=102)] was compared with the mortality of the super- and morbidly obese (SMO) patients [35<BMI<60 kg/m2 (n=283)].
  
  
  RESULTS
  Overall mortality in SSO patients was 7.8% (8/102), compared with 0% (0/283) in SMO patients undergoing the same procedure (P<0.001). When a gender-based subgroup analysis was performed in the SSO patients, men had a 16.7% mortality (7/42) while women had only a 1.7% (1/60) mortality.
  
  
  CONCLUSIONS
  In this study of patients undergoing DS, being SSO -- specifically SSO men -- was associated with increased mortality. Further studies will be needed to better determine the precise mechanism of these risk factors leading to such an elevation in mortality. Until then, caution should be exercised before performing DS in male patients with BMI > or =60 kg/m2.
authors.affiliation: Department of Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA.
authors.forename: Rafael M
authors.initials: RM
authors.lastname: Fazylov
authors.forename: Richard H
authors.initials: RH
authors.lastname: Savel
authors.forename: Joel H
authors.initials: JH
authors.lastname: Horovitz
authors.forename: Murali K
authors.initials: MK
authors.lastname: Pagala
authors.forename: Gene F
authors.initials: GF
authors.lastname: Coppa
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Nicastro
authors.forename: Richard S
authors.initials: RS
authors.lastname: Lazzaro
authors.forename: Jerzy M
authors.initials: JM
authors.lastname: Macura
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D015897:Comorbidity; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009767:Obesity, Morbid / Q000401:mortality* / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome