The Edmonton Obesity Staging System Predicts Perioperative Complications and Procedure Choice in Obesity and Metabolic Surgery—a German Nationwide Register-Based Cohort Study (StuDoQ|MBE)

• Published in: Obesity surgery 2019-12, Vol.29 (12), p.3791-3799
• Main Authors: Chiappetta, Sonja, Stier, Christine, Weiner, Rudolf A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bariatric Surgery - adverse effects; Bariatric Surgery - classification; Bariatric Surgery - methods; Bariatric Surgery - statistics & numerical data; Body Mass Index; Choice Behavior; Cohort analysis; Cohort Studies; Female; Gastrointestinal surgery; Germany - epidemiology; Humans; Male; Medicine; Medicine & Public Health; Metabolism; Middle Aged; Mortality; Obesity; Obesity - diagnosis; Obesity - epidemiology; Obesity - surgery; Obesity, Morbid - diagnosis; Obesity, Morbid - epidemiology; Obesity, Morbid - surgery; Original Contributions; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Predictive Value of Tests; Prognosis; Retrospective Studies; Severity of Illness Index; Surgery; Treatment Outcome; Young Adult
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-019-04015-y

Objective To examine the relationship between Edmonton Obesity Staging System (EOSS) and perioperative complications as well as surgical procedure. Background The application of EOSS for the selection of patients with obesity is a more comprehensive measure of obesity-related diseases and a predictor of mortality than body mass index (BMI). Methods This was a nationwide cohort study using prospectively inserted data from the German register for obesity and metabolic surgery StuDoQ|MBE. All patients undergoing sleeve gastrectomy (SG), Roux-en Y gastric bypass (RYGB), and one-anastomosis gastric bypass (OAGB) between February 2015 and July 2017 as a primary treatment for severe obesity were included. Data included gender, age, BMI, ASA score, EOSS, early postoperative complications next to the Clavien-Dindo grading system, readmission, and 30-day mortality. Results A total of 9437 patients were included. The mean BMI was 49.5 kg/m 2  ± 7.8 (range 35–103.5). The total postoperative complication rate was 5.3%, with the highest rate in EOSS 3 (7.8%) and 4 (6.8%). Thirty-day mortality was 0.2% with the highest mortality after SG in EOSS 3 (1.16%) and EOSS 4 (0.92%) ( p  = 0.0068). Crosstabs showed a prevalence of Clavien-Dindo III and IV complications of 3.4% (SG), 3.6% (RYGB), and 1.6% (OAGB) in EOSS 2 ( p  = 0.0032) and 3.5% (SG), 5.1% (RYGB), and 5.6% (OAGB) in EOSS 3. Conclusion The highest postoperative complications and mortality occurred in patients with EOSS ≥ 3. SG and OAGB could be the procedure of choice to reduce perioperative morbidity; nevertheless, it has to be in mind that in EOSS ≥ 3, SG has the highest mortality. Trial Registration ClinicalTrials.gov Identifier NCT03556059.