A high risk obese patient who loses five to ten per cent of his/her surplus body weight before gastric bypass surgery usually stays in hospital less time and loses weight more quickly after the operation, says an article in Archives of Surgery, a theme issue on bariatric surgery.
The authors explain that bariatric surgery is effective for the long-term treatment of patients who are morbidly obese and also have other medical problems. “To that end, older and higher-risk patients with multiple uncontrolled medical problems, such as diabetes mellitus, obstructive sleep apnea, steatohepatitis (liver inflammation), degenerate joint disease, venous stasis disease (loss of vein function in the legs) and cardiopulmonary vascular disease) are opting for bariatric surgery. Moreover, patients are seeking referral for bariatric surgery when the disease burden from their comorbidities eliminates meaningful quality of life,” the authors say. The chances of experiencing post-operative complications are much higher for these patients.
Christopher D. Still, D.O., Geisinger Health System, Danville, Penn. USA, and team looked at patients who received open or laparoscopic gastric bypass surgery during the period 2002-2006. “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 percent loss of excess body weight prior to surgical intervention,” the researchers said.
There were 884 patients, whose average age was 45 years. 19% (169) of them lost 5%-10% of their excess body weight before their surgical procedure, while 48% (425) lost 10% or more of their surplus weight prior to the operation.
The researchers found that the people who lost over 5% tended not to stay in hospital for more than four days. Those who lost over 10% of their excess weight prior to surgery had double the chance of losing 70% of their excess weight 12 months later, compared to individuals who lost either nothing or up to 5% of their excess weight before surgery.
The researchers believe that physiologic improvements linked to weight loss helped reduce surgical complications, thus shortening their hospital stay.
The authors write “Numerous reports have confirmed the beneficial effects of even limited weight loss on co-morbid medical conditions, such as hypertension, diabetes mellitus, degree of visceral fat, liver size, thromboembolism predisposition and severity of sleep apnea,” the authors write. “Additional studies will be required to pinpoint which comorbidity (or comorbidities) is responsible for reduced lengths of stay.”
The researchers added that more research is required to find out how preoperative weight loss might help with long-term weight loss following surgery.
“Outcomes of Preoperative Weight Loss in High-Risk Patients Undergoing Gastric Bypass Surgery”
Christopher D. Still, DO; Peter Benotti, MD; G. Craig Wood, MS; Glenn S. Gerhard, MD; Anthony Petrick, MD; Mary Reed, MD; William Strodel, MD
Arch Surg. 2007;142:994-998.
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Written by: Christian Nordqvist