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(Chest. 2006;130:517-525.)
© 2006 American College of Chest Physicians

Cardiorespiratory Fitness and Short-term Complications After Bariatric Surgery*

Peter A. McCullough, MD, MPH; Michael J. Gallagher, MD; Adam T. deJong, MA; Keisha R. Sandberg, MPH; Justin E. Trivax, MD; Daniel Alexander, DO; Gopi Kasturi, MD; Syed M. A. Jafri; Kevin R. Krause, MD; David L. Chengelis, MD; Jason Moy, MD and Barry A. Franklin, PhD

* From the Department of Medicine, Divisions of Cardiology, Nutrition and Preventive Medicine (Drs. McCullough, Gallagher, Trivax, Alexander, Kasturi, and Franklin, Mr. deJong, Ms. Sandberg, and Mr. Jafri), and the Department of Surgery (Drs. Krause, Chengelis, and Moy), William Beaumont Hospital, Royal Oak, MI.

Correspondence to: Peter A. McCullough, MD, MPH, Divisions of Cardiology, Nutrition, and Preventive Medicine, William Beaumont Hospital, 4949 Coolidge Hwy, Royal Oak, MI 48073; e-mail: pmc975{at}yahoo.com

Abstract

Background: Morbid obesity is associated with reduced functional capacity, multiple comorbidities, and higher overall mortality. The relationship between complications after bariatric surgery and preoperative cardiorespiratory fitness has not been previously studied.

Methods: We evaluated cardiorespiratory fitness in 109 patients with morbid obesity prior to laparoscopic Roux-en-Y gastric bypass surgery. Charts were abstracted using a case report form by reviewers blinded to the cardiorespiratory evaluation results.

Results: The mean age (± SD) was 46.0 ± 10.4 years, and 82 patients (75.2%) were female. The mean body mass index (BMI) was 48.7 ± 7.2 (range, 36.0 to 90.0 kg/m2). The composite complication rate, defined as death, unstable angina, myocardial infarction, venous thromboembolism, renal failure, or stroke, occurred in 6 of 37 patients (16.6%) and 2 of 72 patients (2.8%) with peak oxygen consumption (VO2) levels < 15.8 mL/kg/min or > 15.8 mL/kg/min (lowest tertile), respectively (p = 0.02). Hospital lengths of stay and 30-day readmission rates were highest in the lowest tertile of peak VO2 (p = 0.005). There were no complications in those with BMI < 45 kg/m2 or peak VO2 ≥ 15.8 mL/kg/min. Multivariate analysis adjusting for age and gender found peak VO2 was a significant predictor of complications: odds ratio, 1.61 (per unit decrease); 95% confidence interval, 1.19 to 2.18 (p = 0.002).

Conclusions: Reduced cardiorespiratory fitness levels were associated with increased, short-term complications after bariatric surgery. Cardiorespiratory fitness should be optimized prior to bariatric surgery to potentially reduce postoperative complications.

Key Words: bariatric surgery • exercise testing • gastric bypass surgery • obesity • oxygen consumption • preoperative evaluation • surgical complications






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