Analysis of Bariatric Surgery in High-risk Patients

Abstract

Objective: In this study, we evaluated high-risk patients who underwent bariatric surgery. Patients who underwent bariatric surgery by the same surgical team were investigated. All patients’ medical records were obtained by examining follow up form of anesthesia, patients files and nurse observation files. Material and Methods: In this study, high risk criteria were divided in two groups as; major and minor criteria. Major criteria were accepted as; Cardiovascular, respiratory, renal, hepatic diseas and diabetes. Minor criteria were accepted as; Age > 40 years , tobacco usage, alcohol usage, body mass index > 43 kg/ m² , sleep apnea syndrome, gastroesophageal reflux disease. Patients withone major and one minor criterion or with two major criteria or two major criteria were classified as high risk patient group. In aspect of 120 patients within this study we evaluated morbidity, mortality and postoperative intensive care unit requirement. Results: We enrolled 3.3 % mortality rates, 42.5% morbidity rates and 25% intensive care unit requirement. Most frequent complications were respiratory failure, band related complications and cardiovascular complications. Conclusion: In our study; Age over 40 years , body mass index > 43 kg/ m² , sleep apnea syndrome, cardiovascular system disease, diabetes, prolonged pneumoperitoneum time at laparoscopic surgery, open surgery, hypoalbuminemia and blood glucose level over 126 mg/ dL were accepted as factors increasing morbidity and postoperative intensive care unit requirement.

Keywords

• Obesity
• anaesthesia
• surgery
• high risk

Yüksek Riskli Hastalarda Bariyatrik Cerrahi Analizi

Abstract

Amaç: Bu retrospektif çalışmada, bariyatrik cerrahi geçiren yüksek riskli hastalar değerlendirildi. Aynı cerrahi ekip tarafından bariatrik cerrahi geçiren 120 hasta incelendi. Tüm hastaların tıbbi kayıtları, anestezi takip formu, hasta dosyaları ve hemşire gözlem dosyaları incelenerek elde edildi. Gereç ve Yöntem: Bu çalışmada, yüksek risk kriterleri iki gruba ayrıldı: majör ve minör kriterler. Majör kriterler; kardiyovasküler sistem, solunum sistemi, böbrek, karaciğer hastalıkları ve diyabet olarak kabul edildi. Minör kriterler; 40 yaş üstü, tütün kullanımı, alkol kullanımı, vücut kitle indeksi > 43 kg/m2, uyku apnesi sendromu, gastroözofageal reflü hastalığı olarak kabul edildi. Bir minör artı bir majör kriter veya iki majör kritere sahip hastalar yüksek riskli hasta grubu olarak sınıflandırıldı. Yüksek risk kriterlerine sahip olmayan hastalar çalışma dışında bırakıldı. Bu çalışmada 120 hastada morbidite, mortalite ve ameliyat sonrası yoğun bakım ünitesi ihtiyacını değerlendirdik ve ayrıca mortalite, morbidite ve yoğun bakım ünitesi ihtiyacını etkileyen faktörleri belirlemeyi amaçladık. Bulgular: %3,3 mortalite oranı, %42,5 morbidite oranı ve %25 yoğun bakım ünitesi ihtiyacı tespit ettik. En sık görülen komplikasyonlar solunum yetmezliği, bantla ilgili komplikasyonlar ve kardiyovasküler komplikasyonlardı. Sonuç: Çalışmamızda; 40 yaş üstü, vücut kitle indeksi > 43 kg/m2, uyku apnesi sendromu, kardiyovasküler sistem hastalıkları, diyabet, laparoskopik cerrahide uzun süreli pnömoperiton süresi, açık cerrahi işlemler, hipoalbüminemi ve 126 mg/dL’nin üzerinde kan şekeri seviyesi, morbiditeyi ve ameliyat sonrası yoğun bakım ünitesi ihtiyacını artıran faktörler olarak kabul edildi.

Keywords

• Obezite
• anestezi
• cerrahi
• yüksek risk

References

1. World Health Organization 2009. Global health risks : mortality and burden of disease attributable to selected major risks. https://iris.who.int/bitstream/handle/10665/44203/9789241563871_eng.pdf (Accessed: 12.02.2026)
2. Kopelman P. Health risks associated with overweight and obesity. Obesity reviews 2007; 8 (Suppl.1), 13-7.
3. Salihoglu T, Salihoglu Z, Zengin AK, Taskin M, Colakoglu N, Babazade R. The impacts of super obesity versus morbid obesity on respiratory mechanics and simple hemodynamic parameters during bariatric surgery. Obes Surg. 2013;23(3):379-83. doi: 10.1007/s11695-012-0783-0.
4. Maruta A, Iwashita T, Yoshida K, Shimizu S, Shimizu M. Endoscopic management of acute cholecystitis in high -risk surgical patients : A comprehensive review article. DEN Open. 2025;6 (1):e70133. doi : 10.1002/deo2.70133.
5. Salihoglu E, Salihoglu Z. American Society of Anesthesiologists score cannot be suitable for high -risk criteria . ANZ J Surg. 2019;89 (9):1174. doi : 10.1111/ans.15356.
6. Sandal B, Hacioglu Y, Salihoglu Z, Yagiz N. Fuzzy Logic Preanesthetic Risk Evaluation of Laparoscopic Cholecystectomy Operations. Am Surg. 2023;89 (3):414-423.
7. Antonio Pesce et al. Management of high - surgical -risk patients with acute cholecystitis following percutaneous cholecystostomy : results of an international Delphi consensus study. International Journal of Surgery. 2025;111:3185–3192
8. Okamoto K, Suzuki K, Takada T, Strasberg SM, Asbun HJ, Endo I, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2018;25(1):55-72. doi: 10.1002/jhbp.516. Epub 2017 Dec 20. Erratum in: J Hepatobiliary Pancreat Sci. 2019 Nov;26(11):534. doi: 10.1002/jhbp.686.

9. Poulose BK, Griffin MR, Moore DE, Zhu Y, Smalley W, Richards WO, et al. Risk factors for post-operative mortality in bariatric surgery. J Surg Res. 2005;127(1):1-7. doi: 10.1016/j.jss.2004.12.017.
10. Sapala JA, Wood MH, Schuhknecht MP, Sapala MA. Fatal pulmonary embolism after bariatric operations for morbid obesity: a 24-year retrospective analysis. Obes Surg. 2003;13(6):819-25. doi: 10.1381/096089203322618588.
11. Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S, et al. Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP). Diabetes Care. 2002;25(9):1551-6. doi: 10.2337/diacare.25.9.1551.
12. Weller WE, Rosati C, Hannan EL. Predictors of in- hospital postoperative complications among adults undergoing bariatric procedures in New York state 2003. Obes Surg 2006; 16: 702-8.
13. Mason EE, Renquist KE, Jiang D. Perioperative risks and safety of surgery for severe obesity. Am J Clin Nutr 1992;55 (2 Suppl):573-6.
14. Flum DR, Salem L, Elrod JA, Dellinger EP, Cheadle A, Chan L. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294(15):1903-8. doi: 10.1001/jama.294.15.1903.
15. Ogunnaike BO, Jones SB, Jones DB, Provost D, Whitten CW. Anesthetic considerations for bariatric surgery. Anesth Analg. 2002;95(6):1793-805. doi: 10.1097/00000539-200212000-00061.
16. Zafar SN, Khan MR, Raza R, Khan MN, Kasi M, Rafiq A, Jamy OH. Early complications after biliary enteric anastomosis for benign diseases: a retrospective analysis. BMC Surg. 2011;11:19. doi: 10.1186/1471-2482-11-19.
17. Jackson RS, Amdur RL, White JC, Macsata RA. Hyperglycemia is associated with increased risk of morbidity and mortality after colectomy for cancer. J Am Coll Surg. 2012;214(1):68-80. doi: 10.1016/j.jamcollsurg.2011.09.016.
18. Sharma SK, McCauley J, Cottam D, Mattar SG, Holover S, Dallal R, et al. Acute changes in renal function after laparoscopic gastric surgery for morbid obesity. Surg Obes Relat Dis. 2006;2(3):389-92. doi: 10.1016/j.soard.2006.02.002.
19. Salihoglu Z, Demiroluk S, Dikmen Y, Taskin M. Intramucosal pH measurements for extremely obese patients during laparoscopic bariatric surgery. Anesth Analg. 2004;98(1):265-266. doi: 10.1213/01.ANE.0000077682.55641.B2.
20. Zengin U, Salihoğlu Z. Obezite ve Metabolik Hastalıklar cerrahisinde Anestezi. Türkiye Klinikleri Tıp Dergisi. 2012;5: 9-12
21. Demiroluk S, Salihoglu Z, Zengin K, Kose Y, Taskin M. The effects of pneumoperitoneum on respiratory mechanics during bariatric surgery. Obes Surg. 2002;12(3):376-9. doi: 10.1381/096089202321088192.
22. Salihoğlu Z, Demiroluk S, Dikmen Y. Respiratory mechanics in morbid obese patients with choronic obstructive pulmonary disease and hypertension during pneumoperitoneum. Eur. J Anesthesiol 2003; 20: 658-61.
23. Zengin K, Taskin M, Sakoglu N, Salihoglu Z, Demiroluk S, Uzun H. Systemic inflammatory response after laparoscopic and open application of adjustable banding for morbidly obese patients. Obes Surg. 2002;12(2):276-9. doi: 10.1381/096089202762552773.