GRAPEVINE, TEX. — Preoperative application of the Obesity Surgery Mortality Risk Score to identify the highest-risk bariatric surgery candidates and refer them to medical specialists for aggressive risk reduction may improve surgical outcomes, according to results from a new series of 105 consecutive patients.
Historically, bariatric surgery patients in Obesity Surgery Mortality Risk Score (OS-MRS) Class C have had 90-day mortality rates of 2.4%-7.6% in published studies. However, in this series of patients, whose OS-MRS Class C status guided preoperative interventions aimed at getting them into optimal shape for surgery, there was zero 90-day mortality, Dr. Rebecca P. Petersen reported at the annual meeting of the American Society for Metabolic and Bariatric Surgery.
The OS-MRS, developed several years ago to stratify mortality risk in bariatric surgery patients, is a simple scoring method that identifies three risk classes based on five risk factors: a body mass index of 50 kg/m
Several previous independent studies have validated the OS-MRS as a predictive tool. Dr. Petersen presented the first study in which the score was used to guide preoperative risk-reduction interventions and thereby favorably influence surgical outcome.
The 105 OS-MRS Class C patients were identified among a consecutive series of 1,706 patients undergoing bariatric surgery in 2005-2008. The Class C patients were liberally referred to cardiologists, endocrinologists, primary care physicians, pulmonologists, and hematologists for preoperative risk reduction. For example, the goal requested of endocrinologists in referred patients with poorly controlled diabetes was to get their preoperative glycosylated hemoglobin below 8.0%.
All patients were urged by their surgeon to lose more than 10 pounds prior to surgery, a goal achieved by 25% of them, added Dr. Petersen of Duke University, Durham, N.C.
Ninety percent of the Class C patients underwent laparoscopic Roux-en-Y gastric bypass, the bariatric procedure of choice at Duke. Nine patients for whom this operation wasn't safe or technically feasible underwent laparoscopic adjustable gastric banding, and one had a gastric sleeve procedure.
The most common surgical complication, anastomotic leak, occurred in 6 of 95 gastric bypass patients. Venous thromboembolism occurred in four patients. In addition to the zero 90-day mortality, there were no myocardial infarctions.
At 1-year follow-up, patients had lost an average of 50% of their excess weight.
Dr. Petersen said that advances in laparoscopic bariatric surgery could have contributed to the favorable study findings, adding that a larger prospective multicenter study is needed to confirm the value of the OS-MRS as a tool for improving surgical outcomes.
She reported having no conflicts of interest in connection with her study.
In a series of patients who underwent risk-reduction intervention, there was zero 90-day mortality.
Source DR. PETERSEN