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Surg Obes Relat Dis. 2019 Nov 7. pii: S1550-7289(19)31081-0. doi: 10.1016/j.soard.2019.10.027. [Epub ahead of print]

Is it worth it? Determining the health benefits of sleeve gastrectomy in patients with a body mass index <35 kg/m2.

Author information

1
Department of Surgery, Michigan Medicine, University of Michigan Hospital, Ann Arbor, Michigan. Electronic address: ovarban@med.umich.edu.
2
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.
3
Department of Surgery, Michigan Medicine, University of Michigan Hospital, Ann Arbor, Michigan.
4
Department of Surgery, Michigan Medicine, University of Michigan Hospital, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan.

Abstract

BACKGROUND:

Criteria for undergoing sleeve gastrectomy (SG) is restricted among patients with a body mass index (BMI) <35 kg/m2.

OBJECTIVES:

To determine if low-BMI patients experience similar health benefits after SG compared with patients with a BMI ≥35 kg/m2.

SETTING:

Teaching and nonteaching hospitals in Michigan.

METHODS:

Patients with a BMI <35 kg/m2 at the time of primary SG were identified between 2006 and 2018 (n = 1073, 2.4%). Patient characteristics, 30-day risk-adjusted complication rates, and patient reported outcomes were compared with all patients who underwent SG with a BMI ≥35 kg/m2 (n = 44,511, mean BMI 46.7 kg/m2).

RESULTS:

Low-BMI patients were more likely to be older (50.7 versus 45.4 yr, P < .0001), have diabetes (36.7 versus 30.9%, P < .0001), hypertension (54.2% versus 51.0%, P = .0372), and hyperlipidemia (57.1% versus 44.8%, P < .0001). Both groups had comparable rates of discontinuation of medications for hypertension (59.7% versus 54.1%, P = .0570), hyperlipidemia (54.3% versus 52.2%, P = .5537), and diabetes (oral, 79.2% versus 78.1%, P = .7294; insulin, 64.2% versus 62.2%, P = .7438). However, low-BMI patients were more likely to achieve a healthy BMI (i.e., BMI ≤25 kg/m2; 36.3% versus 6.01%, P < .0001), and had higher body image scores (50.6 versus 42.4, P < .0001).

CONCLUSIONS:

Despite being older and with higher rates of metabolic disease, low-BMI patients reported high-resolution rates for diabetes, hypertension, and hyperlipidemia (>50%) and were more likely to achieve a healthy weight after SG. Abolishing the BMI threshold for SG among patients with metabolic disease should be considered.

KEYWORDS:

Bariatric surgery; Complications; Metabolic disease; Outcomes; Policy; Sleeve gastrectomy

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