Perioperative safety in the longitudinal assessment of bariatric surgery

N Engl J Med. 2009 Jul 30;361(5):445-54. doi: 10.1056/NEJMoa0901836.


Background: To improve decision making in the treatment of extreme obesity, the risks of bariatric surgical procedures require further characterization.

Methods: We performed a prospective, multicenter, observational study of 30-day outcomes in consecutive patients undergoing bariatric surgical procedures at 10 clinical sites in the United States from 2005 through 2007. A composite end point of 30-day major adverse outcomes (including death; venous thromboembolism; percutaneous, endoscopic, or operative reintervention; and failure to be discharged from the hospital) was evaluated among patients undergoing first-time bariatric surgery.

Results: There were 4776 patients who had a first-time bariatric procedure (mean age, 44.5 years; 21.1% men; 10.9% nonwhite; median body-mass index [the weight in kilograms divided by the square of the height in meters], 46.5). More than half had at least two coexisting conditions. A Roux-en-Y gastric bypass was performed in 3412 patients (with 87.2% of the procedures performed laparoscopically), and laparoscopic adjustable gastric banding was performed in 1198 patients; 166 patients underwent other procedures and were not included in the analysis. The 30-day rate of death among patients who underwent a Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding was 0.3%; a total of 4.3% of patients had at least one major adverse outcome. A history of deep-vein thrombosis or pulmonary embolus, a diagnosis of obstructive sleep apnea, and impaired functional status were each independently associated with an increased risk of the composite end point. Extreme values of body-mass index were significantly associated with an increased risk of the composite end point, whereas age, sex, race, ethnic group, and other coexisting conditions were not.

Conclusions: The overall risk of death and other adverse outcomes after bariatric surgery was low and varied considerably according to patient characteristics. In helping patients make appropriate choices, short-term safety should be considered in conjunction with both the long-term effects of bariatric surgery and the risks associated with being extremely obese. ( number, NCT00433810.)

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Bariatric Surgery / methods
  • Bariatric Surgery / mortality*
  • Body Mass Index
  • Comorbidity
  • Female
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Obesity / complications
  • Obesity / surgery*
  • Observation
  • Outcome Assessment, Health Care
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / mortality
  • Prospective Studies
  • Reoperation / statistics & numerical data
  • Risk Factors
  • Sleep Apnea, Obstructive / complications
  • Thromboembolism / epidemiology
  • Venous Thrombosis / epidemiology

Associated data