Fitness level affects bariatric surgery outcomes

Poor cardio fitness can lead to complications after bariatric surgery

Morbidly obese patients with poor cardiopulmonary fitness may experience increased complications after bariatric surgery. New research published in the August issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), shows that bariatric surgery patients with low cardiopulmonary fitness levels experienced longer operative times and suffered more postsurgery complications than patients with higher fitness levels. Bariatric surgery, a procedure that involves surgically shrinking the stomach in order to limit food intake, is associated with sustained weight reduction in the morbidly obese.

"Random complications may occur during bariatric surgery," said Peter A. McCullough, MD, MPH, William Beaumont Hospital, Royal Oak, MI. "However, complications may become more apparent in patients with low levels of cardiopulmonary fitness, because they have very little pulmonary reserve and have reduced ability to withstand surgery."

Dr. McCullough and colleagues evaluated the relationship between cardiopulmonary fitness and other clinical variables and postoperative complications after bariatric surgery. Included in the study were 109 morbidly obese patients (75.2 percent women) with a mean body mass index (BMI) of 48.7 7.2. Patients were divided into tertiles, with the first tertile having the highest BMI and lowest cardiopulmonary fitness and the third tertile had the lowest BMI and highest cardiopulmonary fitness.

All patients underwent bariatric surgery (laparoscopic Roux-en-Y gastric bypass surgery), and outcomes were organized into intermediate (operative and reversible), primary (permanent or potential organ damage), and secondary (length of stay and readmission). Overall, patients in the first tertile were seven times more likely to experience primary complications than patients in the next two tertiles. In the first tertile, 16.6 percent of patients experienced primary complications, including death, unstable angina, deep vein thrombosis, pulmonary embolism, renal failure, and/or stroke, compared with 2.8 percent of patients in the second and third tertiles. Operative times were 24.8 minutes longer in the first tertile, compared with the third. In addition, hospital lengths of stay and 30-day readmission rates were highest in the first group, as were intubation duration and estimated blood loss. Patients in the first tertile were more likely to be women, smokers, older, non-Caucasian, and have diabetes and hypertension.

"Morbid obesity is associated with numerous health risks, including cardiovascular disease, respiratory conditions, diabetes, sleep apnea, and an increased rate of death. Bariatric surgery has been shown to reduce comorbidities and long-term mortality in morbidly obese patients," said Dr. McCullough. "The benefits of bariatric surgery clearly outweigh the risks."

To minimize postoperative complications associated with bariatric surgery, researchers recommend measuring cardiopulmonary fitness prior to surgery. For patients with low cardiopulmonary fitness levels, a combination of medical weight loss and physical conditioning is recommended prior to bariatric surgery in order to increase preoperative fitness levels to an acceptable level.

"Physicians and other health-care providers should educate obese patients on current options for healthy and permanent weight loss in order to minimize long-term health complications," said W. Michael Alberts, MD, FCCP, President of the American College of Chest Physicians.

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CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at http://www.chestjournal.org. The ACCP represents 16,500 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at http://www.chestnet.org.


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