title: Perioperative outcome of laparoscopic sleeve gastrectomy for high-risk patients.
abstract: BACKGROUND
  Morbidly obese patients with excessive concomitant disease carry a significantly increased perioperative risk. Although they may benefit most from a bariatric intervention, they are often denied surgery. Laparoscopic sleeve gastrectomy (LSG), as it is less complication-prone than other bariatric procedures, suits the needs of those patients.
  
  
  OBJECTIVE
  To review the short-term outcome of LSG for high-risk patients SETTING: University hospital, Switzerland.
  
  
  METHODS
  A total of 110 patients with high perioperative risk undergoing LSG between January 2008 and December 2014 were prospectively recorded. Patients were defined as "high-risk" if they met 2 of the following criteria: American Society of Anesthesiologists physical status score (ASA)>III, Obesity Surgery Mortality Risk Score (OS-MRS)≥4, Revised Cardiac Risk Index (RCRI) class IV, Obstructive Sleep Apnea-Severity Index (OSA-SI)≥5, renal insufficiency chronic kidney disease ≥3, liver cirrhosis, or history of life-threatening perioperative events.
  
  
  RESULTS
  Of the patients, 59 (54%) were male. Median age was 49 years (range: 18-69), and median BMI was 51.7 kg/m2(38.7-89.2). Median operating time was 65 minutes (27-260). Eighty-six patients (78%) were classified as ASA IV, 65 (59%) as RCRI class IV, 51 (46%) as OS-MRS≥4 and 63 (57%) as OSA-SI≥5. Eighty-nine (81%) had type 2 diabetes, 70 (64%) were under antiplatelet and or anticoagulant therapy. Four patients (4%) were converted to open. Length of stay was 5 days (1-70). Major complications occurred in 12 patients (11%), including 1 mortality (1%).
  
  
  CONCLUSIONS
  "High-risk"-patients identified using a combination of established obesity- and co-morbidity-related risk scores profit from LSG as part of a uniform treatment pathway. Given the severity of co-morbidities, LSG can be performed safely. (Surg Obes Relat Dis 2016;X:XXX-XXX.) © 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.
authors.affiliation: Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Berne, Switzerland. Electronic address: yves.borbely@insel.ch.
authors.forename: Yves
authors.initials: Y
authors.lastname: Borbély
authors.affiliation: Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Berne, Switzerland.
authors.forename: Olivier
authors.initials: O
authors.lastname: Juilland
authors.affiliation: Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Berne, Switzerland.
authors.forename: Julia
authors.initials: J
authors.lastname: Altmeier
authors.affiliation: Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Berne, Switzerland.
authors.forename: Dino
authors.initials: D
authors.lastname: Kröll
authors.affiliation: Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, and University of Bern, Berne, Switzerland.
authors.forename: Philipp C
authors.initials: PC
authors.lastname: Nett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D050110:Bariatric Surgery / Q000379:methods; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D061646:Operative Time; D019990:Perioperative Care; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
keywords: Adult; Bariatric surgery; Cardiac; Co-morbidity; High risk; Liver cirrhosis; Mortality; Obstructive sleep apnea syndrome; Outcome; Perioperative; Renal insufficiency; Sleeve gastrectomy