title: Outcomes of Roux-en-Y gastric bypass in the super obese: comparison of body mass index 50-60 kg/m(2) and≥60 kg/m(2) with the morbidly obese.
abstract: BACKGROUND
  Reports on the outcomes of Roux-en-Y gastric bypass (RYGB) in super-obese patients are limited, especially on patients with body mass index (BMI)≥60 kg/m(2).
  
  
  OBJECTIVE
  The aim of the present study was to evaluate and compare the tolerability and efficacy of RYGB in the super-obese by comparing patients with a BMI of 50-60 kg/m(2) and a BMI of≥60 kg/m(2) with patients with a BMI of 40-50 kg/m(2).
  
  
  METHODS
  Academic practice.
  
  
  METHODS
  Between January 2004 and November 2013, a total of 2717 patients underwent RYGB at our institution. Of these, 661 (24.3%) had a preoperative BMI of 50-60 kg/m(2) and 230 (8.5%) had a BMI≥60 kg/m(2). A retrospective review of outcomes and complications was performed, comparing these patients with 1555 patients with a BMI between 40-50 kg/m(2).
  
  
  RESULTS
  Fifty-two (3.3%) patients in the BMI 40-50 kg/m(2) group, 15 (2.3%) patients in the BMI 50-60 kg/m(2) group, and 3 (1.3%) patients in the BMI≥60 kg/m(2) had<30 days of follow-up. Readmission rates were 10.7%, 9.2%, and 11.7%, and reoperation rates were 7.3%, 5.0%, and 6.1%, in the BMI 40-50, 50-60, and≥60 kg/m(2) groups, respectively. No significant difference was found in readmission rate among the 3 groups, and reoperation rate was significantly lower in the BMI 50-60 kg/m(2) group. Mean percentage of excess BMI loss was 58.3%, 80.6%, 85.8%, 83.3%, and 80.9% in the BMI 40-50 kg/m(2) group; 44.9%, 65.0%, 70.1%, 72.1%, and 65.9% in the BMI 50-60 kg/m(2) group; and 38.5%, 57.4%, 62.2%, 62.8%, and 59.1% in the≥60 kg/m(2) group at 6, 12, 18, 24, and 36 months, respectively. The differences in excess BMI loss were statistically significant among all 3 groups at all follow-up time points. All groups experienced a significant decrease in their mean number of co-morbidities after the procedure.
  
  
  CONCLUSIONS
  Readmission and reoperation rates were similar in the BMI 40-50, 50-60, and≥60 kg/m(2) groups. Super-obese and super-super-obese patients are not at greater risk for surgical complications compared with those with lower BMIs.
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
authors.forename: Rena C
authors.initials: RC
authors.lastname: Moon
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
authors.forename: Lars
authors.initials: L
authors.lastname: Nelson
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
authors.forename: Andre F
authors.initials: AF
authors.lastname: Teixeira
authors.affiliation: Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida. Electronic address: muhammad.jawad@orlandohealth.com.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Jawad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D005431:Florida / Q000453:epidemiology; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
keywords: BMI over 60; Complications; Efficacy; Gastric bypass; Safety; Super-obese; Super-super-obese