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Objectives <p>To compare perioperative and postoperative outcomes of bariatric surgery between individuals with Class 2–3 and Class 4 obesity and to evaluate procedure-specific differences within the Class 4 group.</p> Patients and Methods <p>This retrospective study included 570 patients who underwent sleeve gastrectomy, roux-en-y gastric bypass, or one-anastomosis gastric bypass between 2013 and 2022. Primary outcome was total weight loss percentage (%TWL). Secondary outcomes included remission of diabetes, hypertension, and dyslipidemia, postoperative complications, mortality, suboptimal clinical response and weight-regain rates.</p> Results <p>Individuals with Class 4 obesity had significantly higher %TWL (38.0% vs. 36.4%, <i>p</i> &lt; 0.05) than patients with Class 2 and 3 obesity. Suboptimal clinical response (3.% vs. 2.5%) and weight regain (11.9% vs. 17.4%) were comparable between groups. Remission of diabetes, hypertension, and dyslipidemia did not significantly differ. Overall complication rates were similar; however, mortality was significantly higher among individuals with Class 4 obesity (2.5% vs. 0.2%, <i>p</i> &lt; 0.05). Among the Class 4 obesity group, OAGB and RYGB resulted in the highest %TWL and lowest postoperative BMI, outperforming SG.</p> Conclusions <p>Both individuals with Class 2–3 and Class 4 obesity achieved significant and durable weight loss, though relative weight reduction remained lower in the Class 4 group. In patients with Class 4 obesity, OAGB and RYGB were associated with greater weight loss than SG during follow-up. However, these findings should be interpreted cautiously given the retrospective design, non-randomized procedure selection, and limited subgroup sample sizes. Bariatric surgery remains effective and generally safe, but individuals with Class 4 obesity require meticulous perioperative management given increased mortality risk.</p>

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Comparative Outcomes of Bariatric Surgery in Individuals with Class 2–3 and Class 4 Obesity : A Retrospective Cohort Study

  • 期刊论文

  • 发表日期：

    2026年7月21日

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  • Sönmez Ocak,
  • Ömer Faruk Bük,
  • Can Akgün,
  • Mehmet Alperen Avcı,
  • Ahmet Can Sarı,
  • Mustafa Safa Uyanık

摘要

Objectives

To compare perioperative and postoperative outcomes of bariatric surgery between individuals with Class 2–3 and Class 4 obesity and to evaluate procedure-specific differences within the Class 4 group.

Patients and Methods

This retrospective study included 570 patients who underwent sleeve gastrectomy, roux-en-y gastric bypass, or one-anastomosis gastric bypass between 2013 and 2022. Primary outcome was total weight loss percentage (%TWL). Secondary outcomes included remission of diabetes, hypertension, and dyslipidemia, postoperative complications, mortality, suboptimal clinical response and weight-regain rates.

Results

Individuals with Class 4 obesity had significantly higher %TWL (38.0% vs. 36.4%, p < 0.05) than patients with Class 2 and 3 obesity. Suboptimal clinical response (3.% vs. 2.5%) and weight regain (11.9% vs. 17.4%) were comparable between groups. Remission of diabetes, hypertension, and dyslipidemia did not significantly differ. Overall complication rates were similar; however, mortality was significantly higher among individuals with Class 4 obesity (2.5% vs. 0.2%, p < 0.05). Among the Class 4 obesity group, OAGB and RYGB resulted in the highest %TWL and lowest postoperative BMI, outperforming SG.

Conclusions

Both individuals with Class 2–3 and Class 4 obesity achieved significant and durable weight loss, though relative weight reduction remained lower in the Class 4 group. In patients with Class 4 obesity, OAGB and RYGB were associated with greater weight loss than SG during follow-up. However, these findings should be interpreted cautiously given the retrospective design, non-randomized procedure selection, and limited subgroup sample sizes. Bariatric surgery remains effective and generally safe, but individuals with Class 4 obesity require meticulous perioperative management given increased mortality risk.