Triple Play: The Skinny on Bariatric Surgery

With the growing realization that bariatric surgery is the best and possibly only effective way to reverse morbid obesity, the procedure has become common. In the last month, three articles explored various aspects of the surgery:

• Researchers from several organizations that routinely work with morbidly obese patients conducted a study to determine how gender and age affect bariatric outcomes. Basing their hypothesis on data that indicates that the female reproductive-axis function affects body fat, they assembled a sample of 1,787 women and 289 men, age 18 to 65 years, who underwent bariatric surgery. They found that at one and two years after bariatric surgery, women age 20 to 45 years lost more weight than women age 55 to 65 years. They also found an inverse relationship between age and bariatric-surgery outcome in women; the age-outcome trend did not occur in men. The researchers speculated that menopausal status affects bariatric surgery outcome, but indicated more studies are needed.
• A second study examined sleep-disordered breathing (SDB or obstructive sleep apnea) and postoperative outcomes after bariatric surgery. SDB has been identified as a possible risk factor for adverse perioperative outcomes like hypoxemia, endotracheal intubation, respiratory failure, intensive care unit requirements, increased length of stay (LOS), and postoperative infection. Using the Nationwide Inpatient Sample database, they analyzed 91,028 adult patients undergoing bariatric surgeries from 2004 to 2008. Primary outcomes were in-hospital death, total charges, and length of stay. Secondary outcomes were respiratory and cardiac complications. They identified associated SDB with increased rates of postoperative cardiopulmonary complications, increased risk of emergent endotracheal intubation, noninvasive ventilation (eg, CPAP or continuous positive airway pressure) and atrial fibrillation. SDB was negatively associated with rates of in-hospital death, total charges, or LOS—findings that surprised the researchers.
• The FDA accepted a resubmission of a New Drug Application (NDA) for sugammadex sodium injection from Merck in January 2013. Sugammadex sodium injection is an investigational agent for the reversal of neuromuscular blockade (NMB) induced by rocuronium or vecuronium. The drug is available in Europe. As the FDA continues its review, new evidence indicates morbidly obese patients—a group at increased risk for post-operative complications—may recover faster and more safely if sugammadex is used. Researchers at the University of Padove in Italy compared reversal times in 40 women undergoing laparoscopic removal of gastric bands. Half received neostigmine to reverse neuromuscular blockade; half received sugammadex. Each group had identical procedure times and was given the same anesthetics. Patients who received sugammadex had much shorter total anesthesia times of 47.9 versus 95 minutes in the neostigmine group. They experienced better swallowing ability, train-of-four ratio, and oxygen levels in the recovery room as well.