title: A nationwide safety analysis of bariatric surgery in nonseverely obese patients with type 2 diabetes.
abstract: BACKGROUND
  Bariatric surgery is more effective than medical therapy in treatment of type 2 diabetes (T2D) in patients with severe obesity. However, surgery is often not advocated for patients with T2D who are overweight or have mild obesity.
  
  
  OBJECTIVE
  To assess the safety profile of bariatric surgery in patients with T2D and mild obesity.
  
  
  METHODS
  Database of the American College of Surgeons-National Surgical Quality Improvement Program.
  
  
  METHODS
  Data of 1300 patients with T2D and a body mass index≥25 but<35 kg/m(2) who underwent bariatric surgery were retrieved from the American College of Surgeons-National Surgical Quality Improvement Program data set (2005-2014) to assess safety profile. Further stratified analyses were carried out between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).
  
  
  RESULTS
  The mean operative time and length of hospital stay were 109.4±58.3 minutes and 1.9±1.5 days, respectively. Incidence of all individual major complications was≤.5% in this cohort except for postoperative bleeding (1.7%). Thirty-day postoperative composite morbidity, serious morbidity, and mortality rates for total cohort were 4.2%, .7%, and .15%, respectively. Smoking (odds ratio = 2.75, 95% confidence interval: 1.34-5.64) and chronic obstructive pulmonary disease (odds ratio = 4.05, 95% confidence interval: 1.51-10.88) were predictors of composite morbidity. Thirty-day morbidity rates were not significantly different between those who underwent RYGB compared with SG.
  
  
  CONCLUSIONS
  Bariatric surgery, which is a 2-hour procedure requiring a 2-day hospital stay, is a relatively well-tolerated option in patients with T2D and mild obesity. RYGB and SG had comparable early postoperative morbidity. Smoking can be considered as a modifiable risk factor for early complications after bariatric surgery in patients with T2D and lower body mass index.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: aminiaa@ccf.org.
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.affiliation: Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Amin
authors.initials: A
authors.lastname: Andalib
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Zhamak
authors.initials: Z
authors.lastname: Khorgami
authors.affiliation: Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Sangeeta R
authors.initials: SR
authors.lastname: Kashyap
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio; Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bartolome
authors.initials: B
authors.lastname: Burguera
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000401:mortality / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000401:mortality; D015390:Gastric Bypass / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality / Q000601:surgery*; D061646:Operative Time; D050177:Overweight / Q000401:mortality / Q000601:surgery; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000401:mortality; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome
keywords: Bariatric surgery; Body mass index; Complication; Diabetes; Gastric bypass; Metabolic surgery; Morbidity; Mortality; NSQIP; Obesity; Overweight; Safety; Smoking