Bariatric surgery: a viable option even in end-stage renal disease

  • Montgomery JR & al.
  • JAMA Surg
  • 25/09/2019

  • Yael Waknine
  • Clinical Essentials
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Takeaway

  • End-stage renal disease (ESRD) should not preclude consideration of bariatric surgery.

Why this matters

  • Morbid obesity is a predictor of delayed access to renal transplant and poorer graft outcomes.
  • Surgery is underutilized due to a common misperception of unacceptably high risk.

Study design

  • National registry data for 418,647 patients undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass during 2015-2017.
  • 1244 patients (0.3%) had ESRD; the remainder had normal renal function.
  • Funding: None disclosed.  

Key results

  • In multivariate analysis, ESRD was tied to significantly higher rates of 30-day surgical complications, medical complications, and death.
  • The complication rate was driven by unplanned reoperations (3.1% vs 1.1%; P<.001 endoscopic intervention vs transfusion and sepsis>
  • The medical complication rate was driven by unplanned ICU stays (1.5% vs 0.7%; P<.001 and pneumonia vs>
  • Absolute risk differences were ≤4% for all individual and composite outcomes.
  • No difference observed in anastomotic leak rates.
  • According to the authors, the higher reoperation and endoscopic intervention rates may be due to a lower surgeon threshold for aggressive interventions, for fear of failure to rescue in this vulnerable population.

Limitations

  • Research letter; incomplete data.
  • Potential misclassification bias.
  • May not extrapolate to all obese patients with ESRD.