Obese patients with end-stage renal disease (ESRD) should not be barred from bariatric surgery prior to kidney transplantation, according to investigators.
Dana A. Telem, MD, MPH, of the University of Michigan at Ann Arbor, and colleagues examined perioperative risks among patients undergoing laparoscopic sleeve gastrectomy or roux-en-Y gastric bypass from 2015 to 2017 using national registry data representing 95% of weight loss surgeries in the United States. Of the 418,647 bariatric operations, 1244 surgery patients (0.3%) had ESRD and the remainder had normal kidney function. ESRD patients tended to be older, black, and male, with multiple medical comorbidities and lower preoperative hematocrit levels.
ESRD was associated with significantly higher rates of 30-day surgical complications, medical complications, and death, according to results published in JAMA Surgery. Surgical complications drove significantly higher rates of unplanned reoperation (3.1% vs 1.1%), endoscopic intervention (1.6% vs 0.9%), transfusion (1.5% vs 0.7%), and sepsis (0.4% vs 0.2%). The study revealed no differences in anastomotic leak. Medical complications were mainly due to significantly higher rates of unplanned intensive care unit stay (1.5% vs 0.7%) and pneumonia (0.6% vs 0.2%). Absolute rate differences, however, never exceeded 4% for any outcome.
According to Dr Telem’s team, the increased reoperation and endoscopic intervention rates may reflect surgeons’ fears of failing to rescue clinically vulnerable ESRD patients.
“However, given the potential for improved access to transplant and better posttransplant outcomes, the common misperception that patients with ESRD have prohibitively high perioperative risks to undergo bariatric surgery is not justified and should not preclude obese patients with ESRD from operative consideration.”
Montgomery JR, Waits SA, Dimick JB, Telem DA. Risks of bariatric surgery among patients with end-stage renal disease [published online September 25, 2019]. JAMA Surg. doi:10.1001/jamasurg.2019.2824