title: Is Laparoscopic Bariatric Surgery a Safe Option in Extremely High-Risk Morbidly Obese Patients?
abstract: BACKGROUND
  Age, superobesity, and cardiopulmonary comorbidities define patients as high risk for bariatric surgery. We evaluated the outcomes following bariatric surgery in extremely high-risk patients.
  
  
  METHODS
  Among 3240 patients who underwent laparoscopic bariatric surgery at a single academic center from January 2006 through June 2012, extremely high-risk patients were identified using the following criteria: age ≥ 65 years, body mass index (BMI) ≥ 50 kg/m(2), and presence of at least two of six cardiopulmonary comorbidities, including hypertension, ischemic heart disease, congestive heart failure, chronic obstructive pulmonary disease, obstructive sleep apnea, and history of venous thromboembolism. Perioperative and intermediate-term outcomes were assessed.
  
  
  RESULTS
  Forty-four extremely high-risk patients underwent laparoscopic Roux-en-Y gastric bypass (n = 23), adjustable gastric banding (n = 11), or sleeve gastrectomy (n = 10). Patients had a mean age of 67.9 ± 2.7 years, a mean BMI of 54.8 ± 5.5 kg/m(2), and a median of two (range, two to five) cardiopulmonary comorbidities. There was no conversion to laparotomy. Thirteen (29.5%) 30-day postoperative complications occurred; only six were major complications. Thirty-day postoperative re-admission, re-operation, and mortality rates were 15.9%, 2.3%, and 0%, respectively. Within a mean follow-up time of 24.0 ± 18.4 months, late morbidity and mortality rates were 18.2% and 2.3%, respectively. The mean percentage total weight and excess weight losses after at least 1 year of follow-up were 26.7 ± 12.0% and 44.1 ± 20.6%, respectively.
  
  
  CONCLUSIONS
  Laparoscopic bariatric surgery is safe and can be performed with acceptable perioperative outcomes in extremely high-risk patients. Advanced age, BMI, and severe cardiopulmonary comorbidities should not exclude patients from consideration for bariatric surgery.
authors: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors: Ali
authors: A
authors: Aminian
authors: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors: Mohammad H
authors: MH
authors: Jamal
authors: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors: Amin
authors: A
authors: Andalib
authors: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors: Esam
authors: E
authors: Batayyah
authors: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors: Héctor
authors: H
authors: Romero-Talamás
authors: 2 Department of Surgery, Loyola University , Chicago, Illinois.
authors: Bipan
authors: B
authors: Chand
authors: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors: Phillip R
authors: PR
authors: Schauer
authors: 1 Bariatric and Metabolic Institute , Cleveland Clinic, Cleveland, Ohio.
authors: Stacy A
authors: SA
authors: Brethauer
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D016896:Treatment Outcome