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Outcomes of preoperative weight loss in high-risk patients undergoing gastric bypass surgery.

Still CD, Benotti P, Wood GC, Gerhard GS, Petrick A, Reed M, Strodel W

Geisinger Health Care System, Department of Gastroenterology and Nutrition, 100 N Academy Rd, Mail Code 2111, Danville, PA 17882-2111, USA. cstill@geisinger.edu

HYPOTHESIS: Modest, preoperative weight loss will improve perioperative outcomes among high-risk, morbidly obese patients undergoing Roux-en-Y gastric bypass. DESIGN: A prospective, longitudinal assessment of characteristics and outcomes of gastric bypass patients. SETTING: All patients undergoing open or laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity or its comorbid medical problems at Geisinger Medical Center in Danville, Pennsylvania, during a 3-year period from May 31, 2002, to February 24, 2006, were included in this analysis. Patients were required to participate in a standardized multidisciplinary preoperative program that encompasses medical, psychological, nutritional, and surgical interventions and education. In addition, patients were encouraged to achieve a 10% loss of excess body weight prior to surgical intervention. RESULTS: Of the 884 subjects, 425 (48%) lost more than 10% of their excess body weight prior to the operation. After surgery (mean follow-up, 12 months), this group was more likely to achieve 70% loss of excess body weight (P < .001). Those who lost more than 5% of excess body weight prior to surgery were statistically less likely to have a length of stay of greater than 4 days (P = .03). CONCLUSIONS: This study shows that high-risk morbidly obese candidates for bariatric surgery who are able to achieve a loss of 5% to 10% excess body weight prior to surgery have a higher probability of a shorter length of hospital stay and more rapid postoperative weight loss.

Published 16 October 2007 in Arch Surg, 142(10): 994-8; discussion 999.
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