Preoperative weight loss in super-obese patients: study
                    of the rate of weight loss and its effects on surgical morbidity

Santo, Marco Aurelio; Riccioppo, Daniel; Pajecki, Denis; Cleva, Roberto de; Kawamoto, Flavio; Cecconello, Ivan

doi:10.6061/clinics/2014(12)07

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

CLINICAL SCIENCES • Clinics 69 (12) • 2014 • https://doi.org/10.6061/clinics/2014(12)07 copy

Preoperative weight loss in super-obese patients: study of the rate of weight loss and its effects on surgical morbidity

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

The incidence of obesity and particularly super obesity, has increased tremendously. At our institution, super obesity represents 30.1% of all severely obese individuals in the bariatric surgery program. In super obesity, surgical morbidity is higher and the results are worse compared with morbid obesity, independent of the surgical technique. The primary strategy for minimizing complications in these patients is to decrease the body mass index before surgery. Preoperative weight reduction can be achieved by a hypocaloric diet, drug therapy, an intragastric balloon, or hospitalization. The objective of this study was to analyze the results of a period of hospitalization for preoperative weight loss in a group of super-obese patients.

METHODS:

Twenty super-obese patients were submitted to a weight loss program between 2006 and 2010. The mean patient age was 46 years (range 21-59). The mean BMI was 66 kg/m² (range 51-98) and 12 were women. The average hospital stay was 19.9 weeks and the average weight loss was 19% of the initial weight (7-37%). The average caloric intake was 5 kcal/kg/day. After the weight loss program, the patients underwent gastric bypass surgery.

RESULTS:

The statistical analysis revealed that after 14 weeks of treatment (15% loss of initial weight), the weight loss was not significant. All patients had satisfactory surgical recovery and were discharged after an average of 4.6 days.

CONCLUSION:

In super obesity, preoperative weight loss is an important method for reducing surgical risks. Hospitalization and a hypocaloric diet are safe and effective. After 14 weeks, the weight loss rate stabilized, signaling the time of surgical intervention in our study.

Severe Obesity; Very-Low-Energy Diet; Weight Loss; Bariatric Surgery

	Gender	Age (years)	Initial body weight (kg)	Initial BMI (kg/m²)	Comorbidities	% Loss of initial body weight	Final weight (kg)	Final BMI (kg/m²)
1	FEM	46	136	59	OSAS HBP knee arthrosis	20	108.8	56
2	MALE	54	207	70	HBP	27.7	149.6	48
3	MALE	24	213.4	78	HBP DM2	20.6	169.4	60
4	MALE	43	269	98	HBP DM2 congestive heart failure	53.5	124.9	54
5	MALE	46	191	68	HBP DLP OSAS arthrosis	20.5	151.9	54
6	FEM	48	208.7	85	HBP DM2 OSAS	14.1	179.3	73
7	FEM	45	152.2	70	HBP OCPD arthrosis	30.2	106.1	48
8	FEM	46	130	55	HBP DM2 DLP	15.4	110	47
9	FEM	47	170	62	HBP DLP poliomyelitis sequelae	37	107	39
10	MALE	47	220	78	HBP OSAS CAF	28.6	157	57
11	FEM	53	168.8	51	HBP DM2 OSAS	19.4	136	41
12	MALE	48	182.4	57	HBP DLP	21.6	143	45
13	FEM	52	142.1	64	HBP DM2 OSAS	7	132.1	59
14	MALE	50	217	68	HBP DM2 OSAS	26.7	159	50
15	FEM	59	130	51	HBP OSAS	8.3	119.2	50
16	FEM	43	175	58	HBP OSAS	14	150.6	50
17	FEM	56	158.6	72	HBP knee arthrosis	24.5	119.7	55
18	MALE	21	234	68	-	22.5	181.4	53
19	FEM	51	149	64	HBP DM2 OSAS knee arthrosis	16.6	123.4	53
20	FEM	27	173.6	83	DM2 DLP	19.3	140	67

Patient	Initial body weight (IniBW) (kg)	Weight 90% IniBW	Weight near 90%IniBW (kg) achieved during the treatment	Weeks of treatment required to achieve a weight near 90% IniBW
1	136	122.4	122.8	6
2	207	186.3	186.1	6
3	186.3	167.7	168.8	7
4	269	242.1	242.7	6
5	191	171.9	171	10
6	208.7	187.8	187	10
7	152.2	137	136.4	5
8	130	117	117.8	8
9	170	153	152	4
10	220	198	200.2	10
11	168.8	151.9	152	7
12	182.4	164.2	165	6
13	142.1	127.9	132.1(93%Pi)	8 (*)
14	217	195.3	194.6	4
15	130	117	119.2 (91.7%Pi)	17 (*)
16	175	157.5	156.6	11
17	158.6	142.7	142	11
18	234	210.6	211	6
19	149	134.1	133.8	14
20	173.6	156.2	156.8	9
Average length of stay required to achieve a weight near 90% of the initial body weight (*)				7.7

	Fistula % group	% total	Cavitary % group	Abscess % total	Bleeding % group	% total	Wound % group	Infection % total	Deaths % group	% total
BMI<50 n = 345	1	30.76	0.75	42.85	1.25	41.66	1.5	35.29	0.25	20
BMI≥50 n = 193	4.66	69.24	2.07	57.15	3.62	58.34	5.69	64.71	2.07	80
All BMI n = 538	2.19	100	1.18	100	2.6	100	2.2	100	0.55	100
BMI≥50 with preop Weight Loss n = 20	0		0		0		0		0

Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Santo MA and Ricciopo D were responsible for the the project design, data collection and assistance (surgical procedures and follow-up), analysis of the results and data review. Pajecki D was responsible for data collection and assistance (surgical procedures and follow-up) and review of the results. de Cleva R was responsible for data collection and assistance (follow-up). Kawamoto F was responsible for data collection and assistance (surgical procedures and follow-up). Cecconello I was responsible for data review.