Background

The safety and efficacy of metabolic surgery in patients with extreme obesity (BMI >= 70) is not well described. The aim of this study was to determine the outcomes of metabolic surgery in this high-risk group at two academic medical centers.

Methods

An analysis encompassing 84 patients with BMI >=70 from two institutions was conducted. Data included patient demographics, 30-day postoperative outcomes, and weight loss at different intervals (30 days, 6 months, 1 year). Additionally, rates of emergency department (ED) utilization, readmission, and reoperation in the first postoperative year were examined.

Results

Most patients were black (66.7%) and female (86.9%) with a mean age of 41.7 years and mean BMI of 76 (Table 1). Major comorbidities were common. Most underwent laparoscopic sleeve gastrectomy (SG) (88.1%). Postoperatively patients exhibited a marked decrease in BMI (7.84% at 30 days, 20.13% at 6 months, and 26.83% at 1 year). The average length of stay was 1.79 days and comparable across procedure types (p=.997). While 30-day complications were minimal (0.76%), 14.4% of patients had ED visits at 30 days, escalating to 25% at 1 year. Readmission and reoperation rates for one year were 6.56% and 3.23%, respectively, thirty-day mortality was 0%.

Conclusions

Analysis of two academic centers demonstrated low rates of 30-day complications but increased readmission rates and ED utilization in this high-risk population. Despite increased resource utilization, the study suggests that BMI >70 alone should not be a deterrent for metabolic surgery, emphasizing the need for nuanced care in this expanding demographic.