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Factors Associated With Achieving a Body Mass Index of Less Than 30 After Bariatric Surgery. JAMA Surg 2017 Nov 01;152(11):1058-1064

Date

07/27/2017

Pubmed ID

28746723

Pubmed Central ID

PMC5710420

DOI

10.1001/jamasurg.2017.2348

Scopus ID

2-s2.0-85034754463 (requires institutional sign-in at Scopus site)   35 Citations

Abstract

IMPORTANCE: Achieving a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of less than 30 is an important goal of bariatric surgery, given the increased risk for weight-related morbidity and mortality with a BMI above this threshold.

OBJECTIVE: To identify predictors for achieving a BMI of less than 30 after bariatric surgery.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective study used data from the Michigan Bariatric Surgery Collaborative, a statewide quality improvement collaborative that uses a prospectively gathered clinical data registry. A total of 27 320 adults undergoing primary bariatric surgery between June 2006 and May 2015 at teaching and nonteaching hospitals in Michigan were included.

EXPOSURE: Bariatric surgery.

MAIN OUTCOMES AND MEASURES: Logistic regression was used to identify predictors for achieving a BMI of less than 30 at 1 year after surgery. Secondary outcome measures included 30-day postoperative complications and 1-year self-reported comorbidity remission.

RESULTS: A total of 9713 patients (36%; mean [SD] age, 46.9 [11.3] years; 16.6% male) achieved a BMI of less than 30 at 1 year after bariatric surgery. A significant predictor for achieving this goal was a preoperative BMI of less than 40 (odds ratio [OR], 12.88; 95% CI, 11.71-14.16; P < .001). Patients who had a sleeve gastrectomy, gastric bypass, or duodenal switch were more likely to achieve a BMI of less than 30 compared with those who underwent adjustable gastric banding (OR, 8.37 [95% CI, 7.44-9.43]; OR, 21.43 [95% CI, 18.98-24.19]; and OR, 82.93 [95% CI, 59.78-115.03], respectively; P < .001). Only 8.5% of patients with a BMI greater than 50 achieved a BMI of less than 30 after bariatric surgery. Patients who achieved a BMI of less than 30 had significantly higher reported rates of medication discontinuation for hyperlipidemia (60.7% vs 43.2%, P < .001), diabetes (insulin: 67.7% vs 50.0%, P < .001; oral medications: 78.5% vs 64.3%, P < .001), and hypertension (54.7% vs 34.6%, P < .001), as well as a significantly higher rate of sleep apnea remission (72.5% vs 49.3%, P < .001) and higher satisfaction rate (92.8% vs 78.0%, P < .001) compared with patients who did not.

CONCLUSIONS AND RELEVANCE: Patients with a preoperative BMI of less than 40 are more likely to achieve a BMI of less than 30 after bariatric surgery and are more likely to experience comorbidity remission. Policies and practice patterns that delay bariatric surgery until the BMI is 50 or greater can result in significantly inferior outcomes.

Author List

Varban OA, Cassidy RB, Bonham A, Carlin AM, Ghaferi A, Finks JF, Michigan Bariatric Surgery Collaborative

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Bariatric Surgery
Body Mass Index
Comorbidity
Female
Humans
Logistic Models
Male
Middle Aged
Obesity, Morbid
Retrospective Studies
Risk Factors