title: Validation of Obesity Surgery Mortality Risk Score in patients undergoing gastric bypass in a Canadian center.
abstract: BACKGROUND
  The Obesity Surgery Mortality Risk Score (OS-MRS) has been proposed as a user-friendly tool for the assessment and risk stratification of patients undergoing Roux-en-Y gastric bypass (RYGB). We assessed the validity of the OS-MRS in 2121 primary RYGB procedures performed at our center during a 25-year period.
  
  
  METHODS
  A retrospective study of the patients who had undergone primary RYGB since 1983 was performed. The 90-day mortality and all mortalities related to complications of the RYGB were determined. For every patient, we assigned the relevant risk score according to their co-morbidities and relevant demographics. Each patient was assigned to a class (A, B, or C) according to the OS-MRS. We used the Z test to estimate whether the difference between the actual and predicted risk using the OS-MRS was statistically significant.
  
  
  RESULTS
  We identified 2121 patients who had undergone primary RYGB, of which 1254 (59%) were open (ORYGB) and 867 (41%) were laparoscopic (LRYGB). The mean body mass index was 50.7 +/- 8.6 kg/m(2), and the mean age was 39.7 +/- 9.9 years. The mortality rate for ORYGB was 1% (13 patients) and for LRYGB was .4% (4 patients). The overall mortality rate was .8% (17 patients). Of the 2121 patients, 1385 (65%) were in class A, 671 (32%) were in class B, and 65 (3%) were in class C. The expected versus observed mortality rate was .3% versus .3% for class A, 1.9% versus 1.5% for class B, and 7.5% versus 3% for class C, respectively. The difference between the mortality expected from applying the OS-MRS in our cohort and the observed mortality was assessed for statistical significance using Flora's Z statistic. No significant difference was found between the observed and expected mortality, suggesting that the OS-MRS was a valid tool for predicting mortality in our cohort.
  
  
  CONCLUSIONS
  In our bariatric center with >25 years' experience, the OS-MRS accurately predicted the postoperative mortality for RYGB surgery. It appears to be a user-friendly scoring system that could facilitate the informed consent process. Before the system is unequivocally adopted, additional validation trials of a prospective nature are required.
authors.affiliation: Section of Bariatric Surgery, Division of General Surgery, McGill University, Montreal, Quebec, Canada. e.efthimiou@doctors.org.uk
authors.forename: Evangelos
authors.initials: E
authors.lastname: Efthimiou
authors.forename: Olivier
authors.initials: O
authors.lastname: Court
authors.forename: John
authors.initials: J
authors.lastname: Sampalis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Christou
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods / Q000401:mortality*; D006801:Humans; D010535:Laparoscopy / Q000401:mortality; D007813:Laparotomy / Q000401:mortality; D008297:Male; D009765:Obesity / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate