Background

Severity stratification and longitudinal evaluation of metabolic comorbidities in response to Roux-en-y gastric bypass (RYGB) are not standardized. We updated our previously published comorbidity severity scoring system to combine treatment and biochemical data and develop a more objective Assessment of Obesity-related Metabolic Comorbidities (AOMC) system, which assigns comorbidity severity on a 6-point scale to more precisely and reproducibly measure metabolic disease response to RYGB. Methods AOMC scores (Table 1) for diabetes (DM), dyslipidemia (DYS), and hypertension (HTN) were calculated pre- and post-operatively (1-, 2-, and 5-years) in patients who underwent RYGB over 5 years at our academic institution. AOMC trends were tested with Chi-squared analysis and post-hoc Fisher's exact tests. Results Of 351 patients, 214, 188, and 303, presented with any DM, DYS, or HTN respectively. Overall, one-year remission rates were: DM 57.1%, DYS 59.7%, HTN 29.3%. Over 5 years post-RYGB, remission rates declined for DM (Figure A, p<0.05) and DYS (Figure B, p<0.05), but remained steady for HTN (Figure C, p>0.05). Furthermore, remission was associated with preoperative disease severity: those with pre-metabolic disease had the highest remission rates (i.e. one-year: pre-DM 81.4%, pre-DYS 91.4%, pre-HTN 53.5%, Figure D-F blue, all p<0.05), while those with most severe scores preoperatively (untreated/poorly-controlled) had the lowest remission rates (Figure D-F).

Conclusions

AOMC allows precise assessment of comorbidity severity and disease-specific postoperative quantification of comorbidity responses and remission rates. These findings can guide preoperative metabolic disease optimization and postoperative metabolic recovery expectations as well as standardize communication regarding comorbidity severity.