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TOPLINE:

Weight loss before laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) does not improve surgical outcomes except in select cases, new research suggested.

METHODOLOGY:

• Researchers retrospectively calculated total preoperative weight loss for 171,010 patients (mean age 43; 83% women; 55% White) who underwent LSG (69% of patients) or RYGB (31% of patients).
• They then divided participants into four groups: Those with no weight loss, those who lost 0 < to < 5%, 5% ≤ to < 10%, or ≥ 10% total weight loss preoperatively. Participants were also stratified by body mass index (BMI); 28% of the cohort had a BMI of ≥ 50.
• Investigators compared 30-day surgical outcomes and operating room time.

TAKEAWAY:

• For patients with a BMI < 50, preoperative weight loss led to no consistent improvement in surgical outcomes, although for those with 0 < to < 5% total weight loss, it led to a decrease in intra- and postoperative occurrences after RYGB and a decrease in reoperation rates after LSG.
• For patients with a BMI ≥ 50, preoperative weight loss showed a consistent improvement in 30-day reintervention rates after LSG and in readmission rates after RYGB.
• No improvement was seen in other outcomes, regardless of the amount of preoperative weight loss.

IN PRACTICE:

"In patients undergoing primary bariatric procedures, preoperative weight loss does not lead to a consistent improvement in outcomes or OR times," the authors wrote. "This data does not support a uniform policy of preoperative weight loss, although selective use in some high-risk patients may be appropriate."

SOURCE:

The study was led by Onmnia S. Saleh, MD, of Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, and published online on February 12, 2024, in the Journal of the American College of Surgeons.

LIMITATIONS:

The data were limited to 30-day outcomes, with no long-term weight data available. Researchers did not have access to many preoperative laboratory values or medication for non-obesity–related comorbidities. They also did not know why or how the patients achieved their preoperative weight loss or whether it was insurance- or surgeon-mandated. BMI may not capture patients for whom surgery is particularly challenging, such as those with central adiposity or an enlarged liver.

DISCLOSURES:

No funding information was provided. One coauthor is an employee of Alexion AstraZeneca. Other coauthors had nothing to disclose.