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).

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.