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Relevance of the Obesity Surgery Mortality Risk Score in Patients Undergoing Roux-en-Y Gastric Bypass. A Study in the

BARIATRIC SURGERY. Obesity is a leading cause of death worldwideMokdad AH et al, JAMA 2004Bariatric surgery is currently, the only treatment available for sustained weight loss in the morbidly obese. Reduction in relative risk of death by up to 89%Colquitt JL et al Cochrane Database Systematic Review 2009Christou NV et al Annals of Surgery 2004 Good safety profile Overall, 90-day MR* = 0.35% = lap chole 90-day MR* Pories WJ Journal of Clin Endo

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Relevance of the Obesity Surgery Mortality Risk Score in Patients Undergoing Roux-en-Y Gastric Bypass. A Study in the

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    1. Relevance of the Obesity Surgery Mortality Risk Score in Patients Undergoing Roux-en-Y Gastric Bypass. A Study in the United Kingdom S Mansour, V Kaur, G Vasilikostas, KM Reddy, A Wan St George’s Healthcare NHS Trust, London, UK

    3. Roux-en-Y gastric Bypass (RYGB) Overall, reported MR for patients undergoing primary RYGB 0 – 1.5% DeMaria EJ et al Ann Surg 2002, Schauer PR et al Ann Surg 2000 Wittgrove AC et al Am J Surg 2000, Buchwald H et al JAMA 2004 Published data on MR in ‘high-risk’ patients 0 – 1.0% Usually addressed a single risk factor Age >60 yrs BMI >50 kg/m2 Wittgrove et al Obes Surg 2009, Adeles D et al J Am

    4. Risk stratification Important component of surgical decision – making Risk stratification tools in surgery APACHE P – POSSUM O – POSSUM NSQIP Surgical APGAR Does not recognise factors specific to bariatric patients Surgical scores - not designed as a pre-operative predictive tool

    5. Identifying Risk Factors Recent publications have attempted to identify risk factors for morbidity and mortality in bariatric surgery Fernandez AZ et al Ann Surg 2004, Livingston EH et al Ann Surg 2002 Sapala JA et al Obes Surg 2003, Jamal MK et al SOARD 2005 Courcoulas A et al Surgery 2003, Nguyen NT et al Ann Surg 2004

    6. Obesity Surgery Mortality Risk Score (OS-MRS) Developed from a single centre's experience with 2075 primary open and laparoscopic RYGB during a 10 year period Analysed multiple pre-op factors of potential significance Determined 5 pre-operative factors correlating with mortality Derived a pre-op scoring system for risk stratification OS-MRS DeMaria EJ et al SOARD 2007 … Applied to a large (n=4431) multi-centre cohort accurately predicted mortality risk DeMaria EJ et al Annals Surg 2007 OS-MRS is the first validated stratified scoring system for predicting post-op mortality in bariatric surgery Easy to use Pre-operative

    7. AIM To assess the utility of OS-MRS in patients undergoing primary laparoscopic RYGB in a hospital in the United Kingdom

    8. Methods All patients undergoing elective primary roux-en-Y gastric bypass surgery from June 2008 – Dec 2009 Planned laparoscopic approach Exclusion criteria – revision surgery Prospectively maintained database demographic & pre-op clinical data 90 day procedure-related mortality Eligibility for surgery – NICE guidelines BMI* >40 kg/m2 or BMI* >35 kg/m2 with obesity-related co-morbidities Assessed by a multidisciplinary team Patients have to display appropriate understanding of procedure

    9. Methods 5 OS-MRS variables (1 point each) SBP= systolic blood pressure, DBP = diastolic blood pressure, VTE = venous thromboembolism, IVC = inferior vena cava, HF = heart failure

    10. methods OS-MRS points are grouped into 3 categories

    11. Results 18 month period Total =116 patients No mortalities All procedures were completed laparoscopically F= Female, M= Male, ASA = American Society of Anesthesiologists

    12. results OS-MRS variables

    13. Results OS-MRS points

    14. Results OS-MRS classes (96.6%)

    15. results OS-MRS mortalities No significant difference seen between the observed and expected mortality OS-MRS was a valid tool for predicting mortality risk in our cohort

    16. OS-MRS risk factors

    17. Utility of OS-MRS Provide objectivity Aid informed consent Risk prediction Understanding prognosis / severity Pre-op optimisation especially in high risk patients Risk reduction strategies – decreasing BMI, optimise BP Aid surgical decision making in high-risk patients use alternative lower risk or staged procedures Planned critical care admission post-operatively Allow standardisation of outcome comparisons between different units Instigate ‘new and improved’ risk-stratification scores in bariatric surgery

    18. Conclusion Mortality risk in RYGB can be stratified based on independent variables that can be identified pre-operatively OS-MRS is a clinically relevant and valid scoring system for predicting mortality risk in our medium volume cohort OS-MRS may help contribute in surgical decision making in bariatric surgery

    19. Thank you for Listening Questions & Answers

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