Obesity surgery in patients with end-stage organ failure: Is it worth it?

Adrian T Billeter; Michael Zumkeller; Judith Brock; Felix Herth; Ulrike Zech; Martin Zeier; Christian Rupp; Petra Wagenlechner; Arianeb Mehrabi; Beat P Müller-Stich

doi:10.1016/j.soard.2021.11.012

Obesity surgery in patients with end-stage organ failure: Is it worth it?

Surg Obes Relat Dis. 2022 Apr;18(4):495-503. doi: 10.1016/j.soard.2021.11.012. Epub 2021 Nov 14.

Authors

Affiliations

¹ Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany. Electronic address: adrianbilleter@gmail.com.
² Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany.
³ Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), Heidelberg University Hospital, Heidelberg, Germany.
⁴ Department of Endocrinology and Metabolism, Heidelberg University Hospital, Heidelberg, Germany.
⁵ Department of Nephrology, Heidelberg University Hospital, Heidelberg, Germany.
⁶ Department of Gastroenterology, Infectious Diseases and Intoxication, Heidelberg University Hospital, Heidelberg, Germany.
⁷ Department of General Internal and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany.

PMID: 34920966
DOI: 10.1016/j.soard.2021.11.012

Abstract

Background: Little is known about the long-term outcomes of patients with end-stage organ failure (ESOF) undergoing obesity surgery.

Objective: To investigate the perioperative and mid-term outcomes of patients with ESOF undergoing obesity surgery.

Setting: University hospital, Germany.

Methods: A total of 1 094 patients undergoing obesity surgery from 2006 to 2019 were screened. Inclusion criteria were ejection fraction <30%, continuous oxygen/noninvasive ventilation therapy, liver cirrhosis, or kidney failure stage 4/5. ESOF patients were compared with matched standard (MS) patients without advanced organ failure and matched for age, gender, body mass index (BMI), operation type, diabetes, arterial hypertension, and sleep apnea.

Results: Twenty-seven ESOF patients (56% female, age 50.3 ± 8.6, BMI 53.8 ± 8.7 kg/m²) were identified. Eighty-five percent had a sleeve gastrectomy. Mid-term total weight loss was 26.6% ± 9.0% in the ESOF patients versus 17.8% ± 11.1% in MS patients (P = .181). Long-term improvement of type 2 diabetes was comparable (ESOF: HbA1C 8.79 ± 2.06% to 6.25±1.17%, P = .047; MS: HbA1C 7.94 ± 2.02% to 7.2 ± 1.28%; P = .343). Depression scores (Patient Health Questionnaire 9) among ESOF patients improved from 13.0 ± 6.3 to 6.1 ± 5.8 (P = .004) but without significant change in MS patients (9.4 ± 7.3 to 4.3 ± 5.7; P = .082). Lung function improved in all patients although only 15% were off oxygen therapy. Treatment goals were achieved in >50% of the other groups. Major complications occurred in 11% (ESOF) versus 4% (MS) of patients (P = .299) with one death in the ESOF group (4%).

Conclusion: Both groups had similar outcomes regarding weight loss and co-morbidity improvement. Depression only improved significantly in the ESOF group. Patients with ESOF should not be precluded from obesity surgery. Further investigation is needed to define optimized selection criteria.

Keywords: High-risk; Metabolic surgery; Obesity surgery; Organ failure.

MeSH terms

Adult
Bariatric Surgery* / adverse effects
Body Mass Index
Diabetes Mellitus, Type 2 / complications
Female
Gastrectomy / adverse effects
Glycated Hemoglobin
Humans
Male
Middle Aged
Multiple Organ Failure* / complications
Obesity* / complications
Obesity* / surgery
Oxygen
Treatment Outcome
Weight Loss

Substances

Glycated Hemoglobin A
Oxygen