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Introduction <p>Metabolic and bariatric surgery (MBS) is a safe and effective treatment option to reduce weight and manage obesity-related medical conditions in patients with obesity. However, due to limited data, there is uncertainty regarding the short-, mid-, and long-term safety and efficacy profile of MBS in patients with a preoperative ASA IV status.</p> Methods <p>A single-center retrospective cohort study was performed on patients with ASA IV status who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion with duodenal switch (BPD-DS) between 2008 and 2020. Data collected included operative details; postoperative complications at 30&#xa0;days, 90&#xa0;days, and beyond 90&#xa0;days; BMI changes; and resolution of obesity-related comorbidities at 0, 6, 12, 24, 48, and 60&#xa0;months postoperatively.</p> Results <p>Among 131 ASA class IV patients, 43 patients underwent SG (32.8%), 66 patients underwent RYGB (50.4%), and 22 patients underwent BPD-DS (16.8%). The greatest %TWL occurred in the BPD-DS cohort (39.5%) at 24&#xa0;months post-op followed by the RYGB (32.5%) and SG (20.7%) cohorts (<i>p</i> &lt; 0.001). The overall major 30-day complication rate was 8.4% (<i>n</i> = 11/131), while the overall major 90-day complication rate within the cohort was 6.9% (<i>n</i> = 9/131). The overall major late (&gt; 90&#xa0;days) complication rate was found to be 14.5% (<i>n</i> = 19/131).</p> Conclusions <p>Our study demonstrated that MBS is relatively safe and effective in ASA IV patients in the short-, mid-, and long-term. Accordingly, careful procedure selection is required in this patient population. Further long-term studies are needed to support our findings.</p>

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Long-Term Safety and Efficacy Profile of Bariatric Surgery in Patients Classified with ASA IV Status

  • 期刊论文

  • 发表日期：

    2025年2月19日

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  • Noura Jawhar,
  • Kamal Abi Mosleh,
  • Kalpana Muthusamy,
  • Aryan Gajjar,
  • Richard S. Betancourt,
  • Simon J. Laplante,
  • Michael L. Kendrick,
  • Omar M. Ghanem

摘要

Introduction

Metabolic and bariatric surgery (MBS) is a safe and effective treatment option to reduce weight and manage obesity-related medical conditions in patients with obesity. However, due to limited data, there is uncertainty regarding the short-, mid-, and long-term safety and efficacy profile of MBS in patients with a preoperative ASA IV status.

Methods

A single-center retrospective cohort study was performed on patients with ASA IV status who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion with duodenal switch (BPD-DS) between 2008 and 2020. Data collected included operative details; postoperative complications at 30 days, 90 days, and beyond 90 days; BMI changes; and resolution of obesity-related comorbidities at 0, 6, 12, 24, 48, and 60 months postoperatively.

Results

Among 131 ASA class IV patients, 43 patients underwent SG (32.8%), 66 patients underwent RYGB (50.4%), and 22 patients underwent BPD-DS (16.8%). The greatest %TWL occurred in the BPD-DS cohort (39.5%) at 24 months post-op followed by the RYGB (32.5%) and SG (20.7%) cohorts (p < 0.001). The overall major 30-day complication rate was 8.4% (n = 11/131), while the overall major 90-day complication rate within the cohort was 6.9% (n = 9/131). The overall major late (> 90 days) complication rate was found to be 14.5% (n = 19/131).

Conclusions

Our study demonstrated that MBS is relatively safe and effective in ASA IV patients in the short-, mid-, and long-term. Accordingly, careful procedure selection is required in this patient population. Further long-term studies are needed to support our findings.