Bariatric Surgery Outcomes Improved By Pre-Op Weight Loss

DANVILLE, Pa., Oct. 15 -- Losing between 5% and 10% of body weight before bariatric surgery improves outcomes for morbidly obese patients, researchers here said.

Pre-operative weight loss resulted in more rapid loss after surgery and a shorter hospital stay, according to Christopher Still, D.O., and colleagues at the Geisinger Health Care System here.

That finding comes from a prospective, longitudinal study of 884 patients who underwent either open or laparoscopic Roux-en-Y gastric bypass between May 31, 2002 and Feb. 24, 2006, the researchers reported in the Oct. issue of Archives of Surgery.

In a related study in that issue, Seattle researchers found that the Roux-en-Y surgery allowed many morbidly obese people to return to work after being medically disabled.

Since 2001, Dr. Still and colleagues said, all patients seeking bariatric surgery at their center have been required to follow a pre-operative program that includes smoking cessation, counseling, and an attempt to lose at least 10% of body weight.

For this analysis, patients were stratified according to weight changes before surgery - gaining more than 5%, gaining 0% to 5%, losing 0% to 5%, losing 5% to 10%, and losing more than 10%.

The researchers found that:

• 48% of the patients (or 425) lost more than 10% of their excess body weight before surgery.
• After a mean follow-up of 12 months, this group was significantly more likely (at P

The key element in returning to work, the researchers said, was a reduction in the number of co-morbid conditions, rather than the amount of weight lost. Specifically:

• On average, the patients had four co-morbidities before surgery and 2.7 afterward, for a mean decrease of 1.3.
• Patients who had more than the mean reduction in co-morbidities were significantly more likely (at P=0.001) to return to work than those who had fewer.
• On average, patients who returned to work had a mean decrease of 2.4 co-morbidities, and 12 of the 14 patients working had greater than the mean decrease in co-morbidities.
• Of the 18 patients who saw more than two co-morbid conditions reversed, 12 returned to work.

The results are "striking (and) clearly show that it is in the public's best interest to fund these operations to return otherwise indigent patients to work," Dr. Livingston said.