Differences in open versus laparoscopic gastric bypass mortality risk using the Obesity Surgery Mortality Risk Score (OS- XXXX ).

@entity1 @entity101 @entity7748 @entity1151 @entity1150 @entity204
BACKGROUND: The Obesity Surgery Mortality Risk Score (OS- @entity7748 ) was developed to ascertain preoperative mortality risk of @entity1 having bariatric surgery. To date there has not been a comparison between open and laparoscopic operations using the OS- @entity7748 . OBJECTIVE: To determine whether there are differences in mortality risk between open and laparoscopic Roux-en-Y Gastric Bypass (RYGB) using the OS- @entity7748 . SETTING: Three university-affiliated hospitals. METHODS: The 90-day mortality of 2467 consecutive @entity1 who had primary open (1574) or laparoscopic (893) RYGB performed by one surgeon was determined. Univariate and multivariate analysis using 5 OS- @entity7748 risk factors including body mass index (BMI) gender, age>45, presence of @entity101 and preoperative @entity1150 ( @entity1150 ) risk was performed in each group. Each @entity1 was placed in 1 of 3 OS- @entity7748 risk classes based on the number of risks: A (0-1), B (2-3), and C (4-5). RESULTS: Preoperative BMI and @entity1150 risk factors were significantly greater in the open group (OG). Preoperative age was significantly greater in the laparoscopic group (LG). There were significantly more class B and C @entity1 in LG. Ninety-day mortality rates for OG and LG @entity1 were 1.0% and .9%, respectively. @entity1151 was the most common cause of @entity204 . All deaths in LG occurred during first 4 years of that experience. Mortality rate by class was A = .1%; B = 1.5%; C = 2.3%. The difference in mortality between class B and C @entity1 was not significant. Univariate analysis in the OG indicated that BMI, age, gender, and @entity1150 risk were significant predictors of mortality. In the LG only BMI and @entity1150 were significant predictors of @entity204 . Presence of @entity101 was not a significant predictor in either group. Multivariate analysis excluding @entity101 found that age was predictive of mortality in the OG while BMI (P = .057) and gender (P = .065) approached statistical significance. Conversely, only BMI was predictive of mortality in the LG with age approaching significance (P = .058). In multivariate analysis @entity1150 risk was not predictive of mortality in either group. CONCLUSIONS: There are significant differences in the predictive value of the OS- @entity7748 between open and laparoscopic RYGB. Although laparoscopic @entity1 were significantly older versus the open @entity1 , age was not predictive of mortality after laparoscopic RYGB. BMI trended toward increased mortality risk in both groups. Changes in technique and protocol likely contributed toward no mortality during the last 6 years of our laparoscopic experience.
