Causes of 30-day bariatric surgery mortality: with emphasis on bypass obstruction.
BACKGROUND
This is a study of the causes of 30-day postoperative death following surgical treatment for obesity and a search for ways to decrease an already low mortality rate.


METHODS
Data were contributed from 1986-2004 to the International Bariatric Surgery Registry by 85 sites, representing 137 surgeons. A spread-sheet was prepared with rows for causes and columns for patients. The 251 causes contributing to 93 deaths were then marked in cells wherever a patient was noted to have one of the causes. Rows and columns were then moved into positions that provided patterns of best fit.


RESULTS
11 patterns were found. 10 had well known initiating causes of death. Overall operative 30-day mortality was 0.24% (93 / 38,501). The most common cause of death was pulmonary embolism (32%, 30/93). 14 deaths were caused by leaks (15%, 14/93), and were equally prevalent after simple (15%, 2/14) or complex (15%, 12/79) operations. Small bowel obstruction caused 8 deaths, exclusively after complex operations. 5 of these involved the bypassed biliopancreatic limb and were defined as "bypass obstruction".


CONCLUSIONS
A spread-sheet study of cause of 30-day postoperative death revealed a rapidly lethal initiating complication of Roux-en-Y gastric bypass obstruction that requires the earliest possible recognition and treatment. Bypass obstruction needs a name and code to facilitate recognition, study, prevention and early treatment. Spread-sheet pattern analysis of all available data helped identify the initiating cause of death for individual patients when multiple data elements were present.
Mason
Edward E
EE
The Roy J and Lucille A Carver College of Medicine, Department of Surgery, The University of Iowa, Iowa City, IA 52242-1086, USA.
Renquist
Kathleen E
KE
Huang
Yu-Hui
YH
Jamal
Mohammad
M
Samuel
Isaac
I
D000328:Adult; D015992:Body Mass Index; D002423:Cause of Death; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000401:mortality*; D015391:Gastroplasty / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors