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The Edmonton Obesity Staging System Predicts Perioperative Complications and Procedure Choice in Obesity and Metabolic Surgery—a German Nationwide Register-Based Cohort Study (StuDoQ|MBE)

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Abstract

Objective

To examine the relationship between Edmonton Obesity Staging System (EOSS) and perioperative complications as well as surgical procedure.

Background

The application of EOSS for the selection of patients with obesity is a more comprehensive measure of obesity-related diseases and a predictor of mortality than body mass index (BMI).

Methods

This was a nationwide cohort study using prospectively inserted data from the German register for obesity and metabolic surgery StuDoQ|MBE. All patients undergoing sleeve gastrectomy (SG), Roux-en Y gastric bypass (RYGB), and one-anastomosis gastric bypass (OAGB) between February 2015 and July 2017 as a primary treatment for severe obesity were included. Data included gender, age, BMI, ASA score, EOSS, early postoperative complications next to the Clavien-Dindo grading system, readmission, and 30-day mortality.

Results

A total of 9437 patients were included. The mean BMI was 49.5 kg/m2 ± 7.8 (range 35–103.5). The total postoperative complication rate was 5.3%, with the highest rate in EOSS 3 (7.8%) and 4 (6.8%). Thirty-day mortality was 0.2% with the highest mortality after SG in EOSS 3 (1.16%) and EOSS 4 (0.92%) (p = 0.0068). Crosstabs showed a prevalence of Clavien-Dindo III and IV complications of 3.4% (SG), 3.6% (RYGB), and 1.6% (OAGB) in EOSS 2 (p = 0.0032) and 3.5% (SG), 5.1% (RYGB), and 5.6% (OAGB) in EOSS 3.

Conclusion

The highest postoperative complications and mortality occurred in patients with EOSS ≥ 3. SG and OAGB could be the procedure of choice to reduce perioperative morbidity; nevertheless, it has to be in mind that in EOSS ≥ 3, SG has the highest mortality.

Trial Registration

ClinicalTrials.gov Identifier NCT03556059.

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Abbreviations

BMI:

Body mass index

EOSS:

Edmonton Obesity Staging System

T2DM:

Type 2 diabetes mellitus

SG:

Sleeve gastrectomy

RYGB:

Roux-en-Y gastric bypass

OAGB:

One-anastomosis gastric bypass

SD:

Standard deviation

GERD:

Gastroesophageal reflux disease

ASA:

American Society of Anesthesiologists

MAS:

Metabolic acuity score

OSAS:

Obstructive sleep apnea syndrome

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Acknowledgments

This work has been conducted using the StuDoQ|MBE registry provided by the Study, Documentation and Quality Center (Studien-, Dokumentations- und Qualitätszentrum, StuDoQ) of the German Society for General Surgery (Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, DGAV) with the ID StuDoQ-2017-0019.

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Authors and Affiliations

  1. Department of Obesity and Metabolic Surgery, Ospedale Evangelico Betania, Via Argine 604, 80147, Naples, Italy

    Sonja Chiappetta

  2. Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany

    Sonja Chiappetta & Rudolf A. Weiner

  3. Adipositaszentrum, University Hospital of Würzburg, Würzburg, Germany

    Christine Stier

Authors
  1. Sonja Chiappetta
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  2. Christine Stier
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members of StuDoQ|MBE of Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie/StuDoQ

Corresponding author

Correspondence to Sonja Chiappetta.

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The authors declare that they have no conflicts of interest.

Statement of Human and Animal Rights

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Chiappetta, S., Stier, C., Weiner, R.A. et al. The Edmonton Obesity Staging System Predicts Perioperative Complications and Procedure Choice in Obesity and Metabolic Surgery—a German Nationwide Register-Based Cohort Study (StuDoQ|MBE). OBES SURG 29, 3791–3799 (2019). https://doi.org/10.1007/s11695-019-04015-y

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