Fernandez et al identified risk factors associated with perioperative mortality in an obese patient undergoing gastric bypass surgery. The authors are from Wake Forest University Baptist Medical Center, New Jersey Bariatrics, and Virginia Commonwealth University.

Risk factors associated with perioperative mortality (see Table 5, page 701):

(1) postoperative leak from an anastomosis done at surgery

(2) postoperative pulmonary embolism

(3) preoperative weight. The risk was greater for height body weight but no cutoff was given. 180 kg was arbitrarily selected for the implementation. The BMI was not a significant variable.

(4) preoperative hypertension


Additional risk factors noted in discussion:

(1) number of cases done per year by the surgeon and at a hospital (low volume teams were associated with greater risk)

(2) greater age (age > 55 years) was a risk factor in patients undergoing an open procedure


There was evidence in channeling bias in assignment of patients to open vs laparoscopic procedures and to use of short vs long limb bypass.


Despite the risk of surgery, the risk associated with untreated severe obesity is often greater. A laparoscopic technique done by an experienced team should be considered by any patient who has failed alternative methods for weight loss.

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