title: Bariatric surgery outcomes in patients with systemic lupus erythematosus.
abstract: BACKGROUND
  Obesity is common among systemic lupus erythematosus (SLE) patients. An increased perioperative risk after major surgery in SLE has been reported. The aim of this study was to describe postoperative outcomes among SLE patients undergoing bariatric surgery.
  
  
  METHODS
  Charts were reviewed to identify patients with an active diagnosis of SLE before bariatric surgery. Demographic variables, perioperative data, and SLE-related parameters were extracted.
  
  
  RESULTS
  Thirty-one morbidly obese patients who underwent bariatric surgery between 2005 and 2013 had a SLE diagnosis. Twenty-three patients had laparoscopic Roux-en-Y gastric bypass (RYGBP), 3 underwent laparoscopic revisional surgery for failed bariatric procedure, 3 had laparoscopic sleeve gastrectomy and 1 underwent laparoscopic adjustable gastric banding. Mean age, body mass index, and excess weight (kg) at baseline were 52.8±9.4 years, 44.3±9 kg/m(2), and 52.5±25.7 kg, respectively. Of these 31 patients, 24 (77.4%) were taking immunosuppressive medications at the time of surgery. Early major postoperative complications occurred in 4 patients (12.9%), with 3 requiring reoperation (9.6%). Multivariate analysis identified immunosuppressive therapy to be significantly associated with postoperative complications (P = .05). At a mean follow-up of 3 years, 13 patients (42%) showed reduction in the number of immunosuppressive medications and 6 (19.3%) were off steroids completely. After bariatric surgery, mean body mass index decreased to 34.2±8.2 kg/m(2) (P<.005) and excess weight loss was 51.2%± 33.4%.
  
  
  CONCLUSIONS
  Results suggest that weight loss after bariatric surgery is associated with decreased SLE immunosuppression medication requirements; however, the risks are higher. Bariatric surgery in this patient population should be approached with caution.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Gastrointestinal Surgery, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Corcelles
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Daigle
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Hector Romero
authors.initials: HR
authors.lastname: Talamas
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Esam
authors.initials: E
authors.lastname: Batayyah
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: BRETHAS@ccf.org.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D009820:Ohio / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D015431:Weight Loss
keywords: Bariatric surgery; Perioperative complications; Systemic lupus erythematosus