Pre-Admission Bariatric Surgery is Associated with Reduced Mortality in Surgical Patients with Sepsis.

Abstract

Background: Obesity is associated with higher 90-day mortality compared to non-obese surgical patients. Bariatric surgery (BS) can reduce obesity-related comorbidities, even in those with persistent obesity.

Objective: Evaluate the impact of prior BS on sepsis outcomes in surgical patients with obesity.SettingUniversity Hospital, United States.

Methods: A single institution retrospective review of all surgical patients with sepsis (SOFA≥2) was conducted. Patients were grouped into people with obesity and prior BS (OB/BS, n = 48), people with obesity without BS (OB, n = 717), non-obese (NOB, n = 574), and non-obese with prior BS (NOB/BS, n = 27). Demographic data, comorbidities, and sepsis presentation were compared. The primary outcome was cumulative 90-day mortality and survival.

Results: Most OB/BS patients underwent gastric bypass <5 years from admission (61%). The OB/BS group was younger, more likely to be female, and transferred from an outside hospital. The mean BMI was highest in the OB/BS group (46.3±14.7, p < 0.0005). Charlson Comorbidity Index was lower in the OB/BS and NOB/BS groups (2 (1-4) and 2(2-4) respectively, p = 0.0033). Cumulative 90-day mortality was significantly lower in the OB/BS cohort (20.8%, p = 0.002). The OB/BS cohort was more likely to die from intra-abdominal sepsis not amenable to source control (60% vs 22.5% vs 22.8% vs 37.5%, p = 0.04). Compared to the other groups, 90-day survival was highest in the OB/BS cohort (logrank p < 0.009).

Conclusions: This study demonstrated improvement in 90-day survival in OB/BS patients despite higher BMIs. However, this group was more likely to die from intra-abdominal sources, likely reflecting surgical complexity in the setting of prior bypasses.