Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass

doi:10.1016/j.soard.2007.01.005

Surgery for Obesity and Related Diseases

Volume 3, Issue 2, March–April 2007, Pages 134-140

Presented at the 2006 Plenary Session of the American Society for Bariatric Surgery (ASBS), San Francisco, CA, June–July 2006.

https://doi.org/10.1016/j.soard.2007.01.005 Get rights and content

Abstract

Background

Currently, no clinically useful scoring system is available to stratify the mortality risk for patients undergoing gastric bypass (GBP). We propose the obesity surgery mortality risk score as a clinically useful score system to predict the mortality risk for patients undergoing GBP.

Methods

Prospectively collected data from 2075 consecutive patients undergoing GBP at a single university from 1995 to 2004 were analyzed to determine the preoperative factors correlating with 90-day mortality.

Results

Four independent variables correlated with mortality using multivariate analysis, including body mass index ≥50 kg/m² (odds ratio [OR] 3.60, 95% confidence interval [CI] 1.44–8.99), male gender (OR 2.80, 95% CI 1.32–5.92), hypertension (OR 2.78, 95% CI 1.11–7.00), and a novel variable pulmonary embolus risk, that included previous thrombosis, pulmonary embolus, inferior vena cava filter, right heart failure, and obesity hypoventilation (OR 2.62, 95% CI 1.12–6.12). A fifth variable, patient age ≥45 years (OR 1.64, 95% CI 0.78–3.48), significant on univariate analysis, was added to the ultimate scoring system because of its significance in other studies. A scoring system was developed by arbitrarily scoring the presence of each independent variable as equal to 1 point, resulting in an overall score of 0–5 points for each patient. The factors were grouped into 3 risk classes (A, B, or C) to increase the evaluable cases in each class (e.g., <1% of 2075 patients accrued all 5 points). The mortality rate among the 3 risk classes was significantly different: class A, 0.31%; class B, 1.90%; and class C, 7.56%.

Conclusion

The analysis reveals that mortality risk for gastric bypass can be stratified based upon independent variables that can be identified before surgery. The OS-MRS, a simple, clinically relevant scoring system, is proposed, which stratifies mortality risk into low (Class A), intermediate (Class B), and high (Class C) risk groups in the current study population. This risk assessment scoring system may contribute to surgical decision making in bariatric surgery if its ability to stratify risk is validated in subsequent studies.

Section snippets

Methods

The database of 2075 patients who had undergone open or laparoscopic GBP at Virginia Commonwealth University hospitals from 1995 through 2004 was analyzed. Since the database was started in 1987, it has been prospectively maintained and updated using the patients’ in-hospital and clinic records. The institutional review board approved the collection of the data in a secure database and reporting on the analyses. Patients were considered eligible for surgery for obesity according to the 1991

Results

Table 1 shows the univariate analysis results of the preoperative variables examined. Several factors that increased the likelihood of postoperative pulmonary complications were identified as significant on univariate analysis, including obstructive sleep apnea, venous stasis disease, and OHS. Conditions known to correlate with an increased risk of PE include OHS, right heart failure, pulmonary hypertension, venous stasis disease with or without skin ulcers, and previous venous thromboembolism

Discussion

In this study, we used univariate and multivariate techniques to analyze the data from a database of a tertiary care center that has specialized in bariatric surgery for >2 decades. Statistically significant preoperatively attainable risk factors were identified using univariate analyses, and then a model was selected based upon multivariate regression analysis. The goal was to create a scoring system for risk assessment that might gain acceptance as a clinically relevant framework for

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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Citation Excerpt :
Recently, Sun Y et al. [17] also reported that greater preoperative BMI was associated with a higher risk of 30-day mortality after adjusting for age, sex, and ethnicity. Although the widely used Obesity Surgery Mortality Risk Score (OS-MRS) [18] sets the cut-off point of BMI at ≥ 50 kg/m2, in our study, the mortality rates in groups I and II were no different at 0.1 %. This probably highlights that in the era of laparoscopic BS, the cut-off of 50 kg/m2 is no longer clinically relevant.
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We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI - Group I (BMI<50 kg/m²), Group II (BMI 50–60 kg/m²), and Group III (BMI>60 kg/m²). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed.
This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 ± 24.4 Kgs and 43.03 ± 6.9 Kg/m^2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively.
The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = <0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of > 70 kg/m² had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass.
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Original articleObesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass

Abstract

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Disclosures

Am J Surg

Surg Obes Relat Dis

Surg Clin North Am

Am J Surg

Am J Clin Nut

J Am Coll Surg

Surgery

J Gastrointest Surg

Overweight and obesity in the United States: prevalence and trends, 1960–1994

Int J Obes Relat Metab Disord

The continuing epidemics of obesity and diabetes in the United States

JAMA

Therapeutic fasting in morbid obesity

Arch Intern Med

Who would have thought it?An operation proves to be the most effective therapy for adult onset diabetes mellitus

Ann Surg

Weight loss with vertical banded gastroplasty and Roux-en-Y gastric bypass for morbid obesity with selective versus random assignment

Am J Surg

Laparoscopic vertical banded gastroplasty and Roux-en-Y gastric bypass in morbid obesity

Obes Surg

Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity

Ann Surg

Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity

Ann Surg

Laparoscopic gastric bypass, Roux en-Y—500 patients: technique and results, with 3–60 month follow-up

Obes Surg

Original article
Obesity surgery mortality risk score: proposal for a clinically useful score to predict mortality risk in patients undergoing gastric bypass