Bariatric Surgery Mortality of 1.6% Higher Than Expected at 90 Days

ORLANDO — The risk of death from gastric bypass surgery continues beyond the immediate postoperative period, according to the results of a study reported by P. Jason Granet, M.D., at the annual meeting of the American Society for Bariatric Surgery.

“We are not out of the woods in the first 30 days. The main risk is pulmonary embolism, even after 90 days,” Dr. Granet said in a poster presentation.

Dr. Granet and his associates retrospectively analyzed the records of 1,250 patients who had divided gastric bypass between 1979 and 2003. All the operations were performed by John R. Kirkpatrick, M.D., chair of the surgery department at Washington Hospital Center and lead author of the study.

Patients were managed with a standard protocol for 24 months that included prophylactic antibiotics, anticoagulants, and monthly follow-up visits. High-risk patients routinely received an inferior vena cava (IVC) filter, he added. The researchers identified 44 anastomotic leaks during the 2-year study, said Dr. Granet, a general surgeon at Washington Hospital Center.

Seven deaths occurred in the immediate postoperative period, including two attributed to leak sepsis, three from pulmonary embolism (PE), one from wound sepsis, and one from respiratory failure.

Another six deaths occurred up to 30 days after surgery, including three from PE and three from sudden death syndrome.

“We had an extra eight deaths from 30 days to 90 days—more PE or suspected PE—and we were doing everything you can do [in terms of prophylaxis],” Dr. Granet said.

An additional five “late deaths” occurred between 90 days and 2 years.

If only the immediate postoperative period is considered, postoperative mortality is low, 0.5%. By 90 days, however, mortality is 1.6%, a “higher than expected” rate, Dr. Granet said.