Análisis de resultados de los primeros 500 pacientes con obesidad mórbida intervenidos con cirugía bariátrica en el hospital general universitario de alicante

Abstract

The increase in the prevalence of morbid obesity augments the demand for bariatric surgery. The two most commonly used surgical procedures are the gastric bypass (GB) and sleeve gastrectomy (SG). POSSUM is a tool to audit results in surgery, but its use in bariatric surgery is limited. Our hypotheses were: 1) the cohorts of patients operated on by GB and SG differ in terms of demographic variables, comorbidities and postoperative morbidity; 2) the POSSUM scale will need a calibration to be useful in the prediction of risk in bariatric surgery; 3) the learning curve may have influenced the results obtained; and 4) the long-term weight results will be different in each procedure.Patients and Methods: A prospective, descriptive study was performed on 567 consecutive patients, operated between May 2008 and December 2015 through a laparoscopic approach (GB= 331 patients,SG= 236 patients). A statistical analysis was performed to determine variables that differ between the two groups and those related to morbidity. The expected morbidity rates were calculated applying the POSSUM equations. The degree of calibration was analyzed by the Chi-square test of Hosmer-Lemeshow (H-L).Results: Mean age was 44.5 ± 10.4 years, 392 were women. Body mass index (BMI) was 50.99 ± 7.73 Kg / m2. Main comorbidities were: sleep apnea syndrome (SAS) 66.5%, hypertension 50.3%, diabetes mellitus type 2 (DM2) 37.2%, dyslipidemia 33.3%, and previous abdominal surgery 35%. In 33 patients, 35 associated procedures were performed. Age and BMI were higher in patients with SG. The presence of heart disease, taking anticoagulants, treatment of sleep apnea, and DM2 were more frequent in patients undergoing SG than in those with GB. The mean score of the physiological and operative variables of the POSSUM scale was similar in both types of procedures, although the blood losses during the intervention were higher in the GB. The observed morbidity was lower than the expected morbidity in the POSSUM scale. However, if the same score was assigned to the surgical complexity of both techniques, the POSSUM scale adequately predicted the risk of morbidity in laparoscopic bariatric surgery. In the multivariate analysis, only blood loss during the procedure had a predictive value of postoperative complication. Fifty SG procedures were required to complete the learning curve. Weight loss over time was higher in patients with GB Conclusions: 1) Provided the same surgical complexity score is assigned to the GB and SG laparoscopic procedures, the POSSUM scale adequately predicts the risk of morbidity in bariatric surgery, with no differences between expected and observed morbidity. 2) Both cohorts of patients differ in demographic aspects, surgical details, mild postoperative morbidity and weight evolution. There are no differences in terms of serious complications. 3) Morbidity is related to blood loss during the procedure, which is an adverse intraoperative effect linked to the learning curve. 4) There is a morbidity not contemplated by the POSSUM scale, but most of it is not serious. 5) It is necessary to perform fifty SGprocedures to complete the learning curve.