A nationwide safety analysis of bariatric surgery in nonseverely obese patients with type 2 diabetes.

BACKGROUND: Bariatric surgery is more effective than medical therapy in treatment of type 2 diabetes (T2D) in patients with severe obesity. However, surgery is often not advocated for patients with T2D who are overweight or have mild obesity.

OBJECTIVE: To assess the safety profile of bariatric surgery in patients with T2D and mild obesity.

SETTING: Database of the American College of Surgeons-National Surgical Quality Improvement Program.

METHODS: Data of 1300 patients with T2D and a body mass index≥25 but<35 kg/m(2) who underwent bariatric surgery were retrieved from the American College of Surgeons-National Surgical Quality Improvement Program data set (2005-2014) to assess safety profile. Further stratified analyses were carried out between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

RESULTS: The mean operative time and length of hospital stay were 109.4±58.3 minutes and 1.9±1.5 days, respectively. Incidence of all individual major complications was≤.5% in this cohort except for postoperative bleeding (1.7%). Thirty-day postoperative composite morbidity, serious morbidity, and mortality rates for total cohort were 4.2%, .7%, and .15%, respectively. Smoking (odds ratio = 2.75, 95% confidence interval: 1.34-5.64) and chronic obstructive pulmonary disease (odds ratio = 4.05, 95% confidence interval: 1.51-10.88) were predictors of composite morbidity. Thirty-day morbidity rates were not significantly different between those who underwent RYGB compared with SG.

CONCLUSION: Bariatric surgery, which is a 2-hour procedure requiring a 2-day hospital stay, is a relatively well-tolerated option in patients with T2D and mild obesity. RYGB and SG had comparable early postoperative morbidity. Smoking can be considered as a modifiable risk factor for early complications after bariatric surgery in patients with T2D and lower body mass index.