Perioperative Morbidity and Long-term Outcomes of Bariatric Surgery in Patients with Severe Obesity

Background: Long-term outcome data for bariatric surgery in patients with severe obesity (SO) (body mass index [BMI] >= 50 kg/m(2)) are scarce. Objectives: To compare perioperative morbidity and long-term outcomes between patients with SO and non-SO (NSO). Methods: Patients with SO who underwent primary bariatric surgery with a fallow-up a >= 5 years were age- and gender-matched with NSO patients in a retrospective, case-control study. Data included demographics, BMI, co-morbidities, early outcomes, current and nadir weight, co-morbidity status, and general satisfaction. Results: Of 178 patients, 49.4% were male, mean age 44.5 +/- 14 years. Mean preoperative BMI was 54.7 +/- 3.6 and 41.8 +/- 3.8 kg/m(2) in SO and NSO, respectively (P = 0.02). Groups were similar in preoperative characteristics. Depression/anxiety was more prevalent in NSO (12.4% vs. 34%, P = 0.03). Obstructive sleep apnea was higher in SO (21.3% vs. 10.1%, P = 0.04). Sleeve gastrectomy was performed most often (80.9%), with a tendency toward bypass in SO (P = 0.05). Early complication rates were: 13.5% in SO and 12.4% in NSO (P = 0.82). Mean follow-up was 80.4 +/- 13.3 months. BMI reduction was higher in SO (31.8 +/- 5.9 vs. 26.8 +/- 4.2 kg/m(2), P < 0.001) and time to nadir weight was longer (22.1 +/- 21.3 vs. 13.0 +/- 12.0 months, P = 0.001). Co-morbidity improvement and satisfaction were similar. Conclusions: Patients with SO benefited from bariatric surgery with reduced BMI and fewer co-morbidities. No added risk of operative complications was found compared to patients with NSO.