title: Are laparoscopic bariatric procedures safe in superobese (BMI ≥50 kg/m2) patients? An NSQIP data analysis.
abstract: BACKGROUND
  The safety of laparoscopic bariatric procedures in superobese patients is still debatable.
  
  
  METHODS
  Using the American College of Surgeons National Surgical Quality Improvement Program's participant-use file, the patients who had undergone laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding for morbid obesity were identified. Several perioperative variables, including 30-day morbidity and mortality, were collected, and the data were compared within each procedure after dividing the patients according to the body mass index: <50 kg/m(2) (morbidly obese group and ≥50 kg/m(2) (superobese group).
  
  
  RESULTS
  A total of 29,323 patients who had undergone laparoscopic bariatric procedures from 2005 to 2008 were identified. Overall, compared with the morbidly obese group, the superobese group had more men (3:2), younger patients, a greater incidence of co-morbidities (e.g., hypertension and dyspnea), a significantly increased length of stay, and a greater rate of 30-day mortality (.26% versus .07%, odds ratio [OR] 4.38, P = .0001). In the gastric bypass group, the superobese group had a significantly greater incidence of postoperative complications, including superficial wound infections (2.45%, OR 1.68, P = .0001), reintubation (.61%, OR 1.97, P = .003), pulmonary embolism (.30%, OR 2.13, P = .032), myocardial infarction (.07%, P = .017), deep vein thrombosis (.49%, OR 2.06, P = .006), septic shock (.44%, OR 1.74, P = .04), and 30-day mortality (.28%, OR 2.26, P = .026). In the laparoscopic adjustable gastric banding group, the superobese group had a significantly greater incidence of postoperative complications, including superficial (1.65%, OR 2.18, P = .0013) and deep (.23%, OR 2.56, P = .035) wound infections, sepsis, septic shock and 30-day mortality (.17%, OR 13.4, P = .0219).
  
  
  CONCLUSIONS
  Laparoscopic bariatric procedures in superobese patients have been associated with significantly increased complications, including 30-day mortality, compared with morbidly obese patients. However, overall, the procedures appear to be safe, with low complication and 30-day mortality rates.
authors.affiliation: New York Hospital Queens, Weil Cornell Medical College, Queens, New York, USA.
authors.forename: Venkata R
authors.initials: VR
authors.lastname: Kakarla
authors.forename: Kalyana
authors.initials: K
authors.lastname: Nandipati
authors.forename: Michael
authors.initials: M
authors.lastname: Lalla
authors.forename: Armando
authors.initials: A
authors.lastname: Castro
authors.forename: Stephen
authors.initials: S
authors.lastname: Merola
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods* / Q000401:mortality; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D016896:Treatment Outcome