Preoperative weight gain might increase risk of gastric bypass surgery.
BACKGROUND
Weight loss improves the cardiovascular and metabolic risk associated with obesity. However, insufficient data are available about the health effects of weight gain, separate from the obesity itself. We sought to determine whether the changes in body weight before open gastric bypass surgery (OGB) would have a significant effect on the immediate perioperative hospital course.


METHODS
A retrospective chart review of 100 consecutive patients was performed to examine the effects of co-morbidities and body weight changes in the immediate preoperative period on the hospital length of stay and the rate of admission to the surgical intensive care unit (SICU).


RESULTS
Of our class III obese patients undergoing OGB, 95% had ≥1 co-morbid condition and an overall SICU admission rate of 18%. Compared with the patients with no perioperative SICU admission, the patients admitted to the SICU had a greater degree of insulin resistance (homeostatic model analysis-insulin resistance 10.8 ± 1.3 versus 5.9 ± 0.5, P = .001), greater serum triglyceride levels (225 ± 47 versus 143 ± 8 mg/dL, P = .003), and had gained more weight preoperatively (.52 ± .13 versus .06 ± .06 lb/wk, P = .003). The multivariate analyses showed that preoperative weight gain was a risk factor for a longer length of stay and more SICU admissions lasting ≥3 days, as were a diagnosis of sleep apnea and an elevated serum triglyceride concentration.


CONCLUSIONS
The results of the present retrospective study suggest that weight gain increases the risk of perioperative SICU admission associated with OGB, independent of the body mass index. Sleep apnea and elevated serum triglyceride levels were also important determinants of perioperative morbidity. In view of the increasing epidemic of obesity and the popularity of bariatric surgical procedures, we propose that additional clinical and metabolic research focusing on the understanding of the complex relationship among obesity, positive energy balance, weight gain, and perioperative morbidity is needed.
Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA. naistfan@bmc.org
Nawfal W
NW
Istfan
Wendy A
WA
Anderson
Caroline M
CM
Apovian
Donald T
DT
Hess
R Armour
RA
Forse
D000328:Adult; D015992:Body Mass Index; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000639:trends*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007333:Insulin Resistance; D007592:Joint Diseases / Q000453:epidemiology; D010535:Laparoscopy; D007902:Length of Stay / Q000639:trends; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D057234:Preoperative Period; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D015430:Weight Gain