The Edmonton Obesity Staging System Predicts Early Complications After Bariatric Surgery
Monday, July 18, 2016
Regular readers will be well aware of the Edmonton Obesity Staging System (EOSS), which classifies individuals living with obesity according to the presence and severity of medical, mental and functional complications on a 5-point ordinal scale.
We have previously shown that EOSS provides a better assessment of mortality risk than BMI, waist circumference, or the presence of metabolic syndrome.
Now, a paper by Sonja Chiappetta and colleagues from Offenbach, Germany, published in SOARD, shows that EOSS strongly predicts early surgical complications and mortality in patients undergoing bariatric surgery.
The authors analysed data from 534 patients, collected prospectively, for patients undergoing laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), or laparoscopic omega-loop gastric bypass (LOLGB).
As typical for a bariatric surgery population, the mean BMI was around 50 kg/m2.
While the total postoperative complication rate for the entire patient sample was 9%, the complications rates were 0% for patients with EOSS Stage 0 (5% of patients), 1.6% for Stage 1 ( (12%), 8% for Stage 2 (71%), 22% for Stage 3 (13%) and 100% for Stage 4 (0.2%).
There was no significant difference in BMI levels across EOSS stages and not consistent association of EOSS stage with age.
From these findings the authors conclude that,
“Patients with EOSS≥3 have a higher risk of postoperative complications. Our data confirm that the EOSS is useful as a scoring system for the selection of obese patients before surgery and suggest that it may also be useful for presurgical stratification and risk assessment in clinical practice. Patients should be recommended for obesity surgery when their EOSS stage is 2 to prevent impairments associated with metabolic disease and to reduce the risk of postoperative complications.”
@DrSharma
Edmonton, AB
Friday, August 5, 2016
Those are scary numbers, especially since WLS seems to be pushed the hardest at those with higher BMIs.
Without reading the study (bad me) I can make some guesses as to the complications for the fatter people, just based on previous things I’ve read: anesthetics are harder to properly administer, plus if intubation is required that can be more difficult. General surgical complications can be more difficult – I remember years ago a surgeon saying that trying to sew up the skin of a morbidly obese person can be like trying to stitch together wet tissue paper. If the person also has IR and/or T2DM they are at higher risk for infections such as cellulitis. I’m sure there are others.
At the very least, I hope this stops those who push WLS on the fattest people and spurs forward research to find a more reasonable cure (or prevention) of the condition.