Factors Affecting Morbidity and Mortality of Roux-en-Y Gastric Bypass for Clinically Severe Obesity: An Analysis of 1,000 Consecutive Open Cases by a Single Surgeon

INTRODUCTION: Determinants of perioperative risk for RYGB are not well defined. METHODS: Retrospective analysis of comorbidities was used to evaluate predictors of perioperative risk in 1,000 consecutive patients having open RYGB by univariate analyses and logistic regression. RESULTS: One hundred forty-six men, 854 women; average age 38.3 ± 11.2 years; mean BMI 51.8 ± 10.5 (range 24–116) were evaluated. Average hospital stay (LOS) was 3.8 days; 87% <3 days. 91.3% of procedures were without major complication. The most common complications were incisional hernia 3.5%, intestinal obstruction 1.9%, and leak 1.6%. 31 patients required reoperation within 30 days (3.1%). A 30-day mortality was 1.2%. Logistic regression evaluating predictors of operative mortality correlated strongly with coronary artery disease (CAD) (p < 0.01), sleep apnea (p = 0.03), and age (p = 0.042). BMI > 50 (0.6 vs 2.3%, p = 0.03) and male sex were associated with increased mortality (1.3 vs. 4.0%, p = 0.02). Sex-specific logistic regression demonstrated males with angiographically proven CAD were more likely to die (p = 0.028) than matched cohorts. Age (p = 0.033) and sleep apnea (p = 0.040) were significant predictors of death for women. CONCLUSION: Perioperative mortality after RYGB appears to be affected by sex, BMI, age, CAD, and sleep apnea. Strategies employing risk stratification should be developed for bariatric surgery.