title: [Factors associated with morbidity and mortality after gastric bypass. Alternatives for risk reduction: sleeve gastrectomy].
abstract: BACKGROUND
  The aim of this study was to analyze factors related to morbidity and mortality after gastric bypass and to evaluate lower-risk alternatives in selected patients.
  
  
  METHODS
  A prospective cohort of 761 patients who underwent gastric bypass was included. Prognostic factors were studied using a logistic regression model with SPSS 11.0. Independent variables were age, sex, body mass index (BMI), comorbidities, and the laparoscopic approach. Dependent variables consisted of medical complications, surgical complications, and mortality. We performed a preliminary descriptive study of morbidity and weight loss at 3 months after sleeve gastrectomy.
  
  
  RESULTS
  In the postoperative period, 2.8% of patients presented medical complications and 5.4% presented surgical complications. Mortality was 0.52%. Surgical complications were significantly associated with age > 45 years (P = .04; OR = 2.00 [1.03-3.8]) and male sex (P = .041; OR = 2.40 [1.12-5.14]). Medical complications were significantly associated with a BMI of > 50 kg/m2 (P = .012; OR = 3.32 [1.23-8.98]), and mortality was significantly associated with a BMI of > 50 kg/m2 (P = .006) and male sex (P = .006). Sleeve gastrectomy was performed in eight patients with a BMI of > 60 kg/m2, in three patients with a BMI of > 50 kg/m2, cardiopulmonary disease and android fat distribution, and in four patients with a BMI of between 35 and 40 kg/m2 and major comorbidity. Morbidity consisted of self-limited febrile syndrome in one patient. There was no mortality. Weight loss at 3 months was 39.8 +/- 5.36% of excess BMI in superobese patients (n = 4) and was 50.2 +/- 11.05% of excess BMI in morbidly obese patients (n = 4).
  
  
  CONCLUSIONS
  Postoperative morbidity and mortality was significantly higher in male patients, in patients aged more than 45 years, and in those with a BMI of > 50 kg/m2. Sleeve gastrectomy in selected patients could be a lower-risk alternative.
authors.affiliation: Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. raquelsanchezsantos@gmail.com
authors.forename: Raquel
authors.initials: R
authors.lastname: Sánchez-Santos
authors.forename: Amador G
authors.initials: AG
authors.lastname: Ruiz de Gordejuela
authors.forename: Nuria
authors.initials: N
authors.lastname: Gómez
authors.forename: Jordi
authors.initials: J
authors.lastname: Pujol
authors.forename: Pablo
authors.initials: P
authors.lastname: Moreno
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Francos
authors.forename: Antonio
authors.initials: A
authors.lastname: Rafecas
authors.forename: Carlos
authors.initials: C
authors.lastname: Masdevall
mesh_terms: D000328:Adult; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012308:Risk Management