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An Academic Center Experience

Robert W. O’Rourke, MD; Jason Andrus, BS; Brian S. Diggs, PhD; Mark Scholz, MPH; Donald B. McConnell, MD; Clifford W. Deveney, MD

Arch Surg. 2006;141:262-268.

Hypothesis  As the demand for bariatric surgery increases, it becomes increasingly important to define predictors of morbidity and mortality. We hypothesize that specific clinical variables predict postoperative morbidity after bariatric surgery.

Design, Setting, and Patients  This is a retrospective review of 452 patients undergoing inpatient bariatric surgery at an academic tertiary care institution.

Interventions  Patients underwent open or laparoscopic gastric bypass or biliopancreatic diversion with duodenal switch at Oregon Health & Science University, Portland, from 2000 to 2003. Patient data were prospectively entered into a database.

Main Outcome Measures  Postoperative morbidity and mortality were analyzed among all patients, and logistic regression was used to identify clinical predictors of morbidity.

Results  Major and minor morbidity rates were 10% and 13%, respectively; mortality was 0.9%. Age was associated with postoperative complications (odds ratio = 1.056 for each additional year). Duodenal switch was also associated with higher morbidity than gastric bypass (odds ratio = 2.149). Body mass index, sex, diabetes, surgical approach, and surgeon experience did not predict complications.

Conclusions  Increased age is a predictor of complications after bariatric surgery. Duodenal switch is also associated with a higher morbidity rate than gastric bypass. Surgeons should caution older patients (60 years) of a higher risk of postoperative complications, and a higher risk associated with duodenal switch. Large multicenter studies will be necessary to accurately define other clinical predictors of morbidity and mortality after bariatric surgery.

Author Affiliations: Department of Surgery, Oregon Health & Science University, Portland.

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