CHICAGO—High-risk morbidly obese patients who lose 5 to 10 percent of their excess body weight before undergoing gastric bypass surgery appear to have shorter hospital stays and more rapid postoperative weight loss, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals.

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Bariatric surgery is an effective long-term treatment for morbidly obese patients with co-occurring medical problems, according to background information in the article. "To that end, older and higher-risk patients with multiple uncontrolled medical problems (such as diabetes mellitus, obstructive sleep apnea, steatohepatitis [liver inflammation], degenerate joint disease, venous stasis disease [loss of vein function in the legs] and pulmonary cardiovascular disease) are opting for bariatric surgery," the authors write. "Moreover, patients are seeking referral for bariatric surgery when the disease burden from their comorbidities eliminates meaningful quality of life." These patients may face more complications following surgery.

Christopher D. Still, D.O., and colleagues at Geisinger Health Care System, Danville, Penn., assessed patients who underwent open or laparoscopic gastric bypass surgery between 2002 and 2006. "Patients were required to participate in a standardized multidisciplinary preoperative program that encompasses medical, psychological, nutritional and surgical interventions and education," the authors write. "In addition, patients were encouraged to achieve a 10 percent loss of excess body weight prior to surgical intervention."

Of the 884 patients (average age 45), 169 (19 percent) lost 5 to 10 percent of their excess body weight prior to the operation and 425 (48 percent) lost 10 percent or more of excess weight prior to the operation. Those who lost more than 5 percent were less likely to stay in the hospital longer than four days, whereas those who lost more than 10 percent of their excess weight before surgery were more than twice as likely to have lost 70 percent of excess weight one year afterward, compared with those who lost between none and 5 percent of their excess pounds before surgery.

The authors speculate that physiologic improvements associated with weight loss decreased surgical complications, reducing the length of hospital stay. "Numerous reports have confirmed the beneficial effects of even limited weight loss on co-morbid medical conditions, such as hypertension [high blood pressure], diabetes mellitus, degree of visceral [among internal organs] fat, liver size, thromboembolism [blood clot] predisposition and severity of sleep apnea," the authors write. "Additional studies will be required to pinpoint which comorbidity (or comorbidities) is responsible for reduced lengths of stay."

In addition, further research is needed to determine how preoperative weight loss could help with long-term weight loss following surgery, they note.
(Arch Surg. 2007;142(10):994-998.

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