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Diabetes boosts bariatric surgery complications

Key clinical point: Patients with diabetes who underwent bariatric surgery had significantly more complications compared with patients without diabetes.

Major finding: Patients with diabetes had a 49% increased rate of deep surgical-site infections, compared with patients without diabetes.

Study details: Review of 555,239 patients who underwent bariatric surgery during 2015-2017.

Disclosures: Dr. Wheeler had no disclosures.

Citation:

Wheeler AA et al. Obesity Week 2019, Abstract A133.

Commentary:

Most bariatric surgeons believe that patients with diabetes who undergo this surgery will have more complications than will patients without diabetes, based on their anecdotal experience and findings from previous, smaller studies. But in Dr. Wheeler’s report, we see this demonstrated in an incredibly large number of patients. This is one of the first studies to use 3 years of data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, which included more than half a million patients.

The results show that we need to carefully think about our bariatric surgery protocols, and about patient selection. It also means we need to focus on modifiable risk factors such as perioperative glycemic control. Having major surgery, and recovering from it, is like a marathon, and so patients should not have surgery without first preparing months in advance: quitting smoking, becoming more physically active, and doing a better job controlling blood sugar. Some reports suggest bariatric surgery patients benefit from a couple of weeks on a “liver-shrinking” diet before surgery, using replacement meals or liquids to reduce glycogen stores and decrease insulin resistance.

A randomized study involving more than 18,000 cases showed that putting bariatric surgery patients on an “enhanced recovery program” before surgery and including measures that minimized insulin resistance and catabolism perioperatively led to a substantial reduction in extended length of stay (Surg Obes Relat Dis. 2019 Nov;15[11]:1977-89). In routine care, bariatric surgeons are now often routinely using “prehabilitation” to prepare patients for surgery.

Corrigan McBride, MD , is professor of surgery and director of bariatric surgery at the University of Nebraska Medical Center in Omaha. She had no disclosures. She made these comments in an interview.