L. A. Bayouth3, W. J. Pories3, M. B. Burruss3, K. Spaniolas3 3East Carolina University Brody School Of Medicine,Department Of Surgery, Minimally Invasive And Bariatric Surgery,Greenville, NC, USA
Introduction: Bariatric surgery has been established as a treatment modality for the control and remission of metabolic syndrome. Multiple studies demonstrated that preoperative severity of type 2 diabetes (T2D) affects likelihood of remission postoperatively. Limited data is available for how the severity of other components of metabolic syndrome impact outcomes. The aim of this study is to identify how severity of metabolic syndrome preoperatively affects disease remission following bariatric surgery.
Methods: We queried the BOLD database from 2005-2011 to identify patients undergoing gastric bypass or sleeve gastrectomy with available 12 month follow up information. Comorbidities at baseline and following surgery were recorded in a five-point Likert scale. A composite score was calculated for patients with all components of metabolic syndrome. Improvement and remission of components of metabolic syndrome (T2D, hypertension, and dyslipidemia) were assessed. Multivariable logistic regression models were built to determine effect of baseline disease, controlling for other baseline characteristics. Odds ratios (OR) with 95% confidence intervals are reported.
Results: Within a cohort of 51,081 patients who underwent bariatric surgery with 12 month follow up, we identified 20,089 (39.3%), 31,695 (62%), and 23,350 (45.7%) patients with T2D, hypertension and dyslipidemia, respectively; 11,075 (21.7%) patients had all three components of metabolic syndrome. Gastric bypass was performed in 46,381 (90.8%) patients. Mean age and BMI for the entire cohort were 47+11.6 and 47.7+8.5, respectively. Comorbidity remission significantly varied by baseline severity score (Fig 1 Comorbidity Remission for T2D, hypertension and dyslipidemia based on composite metabolic score. P<0.001 for all comparisons). After controlling for age, gender, BMI and procedure, the degree of baseline comorbidity independently associated with 12 month remission. In patients with metabolic syndrome, a composite score over 9 (median) was independently associated with lower rate of remission at 12 months (OR 0.46, 95% CI 0.41-0.51). Similarly, score over 9 was independently associated with 12 month remission of T2D (OR 0.37, 95% CI 0.34-0.4), hypertension (OR 0.59, 95% CI 0.54-0.65), and dyslipidemia (OR 0.68, 95% CI 0.63-0.74).
Conclusion: Bariatric surgery leads to remission of metabolic syndrome and individual components in a large percentage of patients. The remission rate at 12 months is significantly affected by preoperative severity of disease. This data proposes that early intervention would lead to significant benefit, improving remission rate. Bariatric surgery should not be reserved as last resort treatment of metabolic syndrome in the severely obese.
