Spectrum and Risk Factors of Complications After Gastric Bypass
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Spectrum and Risk Factors of Complications After Gastric Bypass
Guilherme M. Campos, MD, PhD; Ruxandra Ciovica, MD; Stanley J. Rogers, MD; Andrew M. Posselt, MD, PhD; Eric Vittinghoff, PhD; Mark Takata, MD; John P. Cello, MD
Arch Surg. 2007;142(10):969-975.
ABSTRACT
Objective To study the spectrum of and risk factors for complications after gastric bypass (GBP).
Design Prospective cohort study.
Setting Academic tertiary referral center.
Patients All morbidly obese patients who underwent open or laparoscopic GBP between January 2003 and December 2006.
Main Outcome Measures Complications were stratified by grade: grade I, only bedside procedure; grade II, therapeutic intervention but without lasting disability; grade III, irreversible deficits; and grade IV, death. Data were analyzed using logistic regression to identify independent risk factors of complications after GBP. Predictors investigated were age, race, sex, marital and insurance status, body mass index, obesity-associated comorbidities, American Society of Anesthesiologists Physical Status Class, operating room time, open or laparoscopic approach, and surgeon experience.
Results Of the 404 morbidly obese patients who underwent consecutive open (n = 72) or laparoscopic (n = 332) GBP, 74 (18.3%) experienced 107 complications. Grade I and II complications were more frequent after open GBP (grade I, 19.4% after open vs 3.9% after laparoscopic operations, P < .001; grade II, 20.8% after open vs 8.4% after laparoscopic operations, P < .001), and 55% were wound related. Grades III and IV complications occurred in only 4 patients (1%), and frequency was similar for open and laparoscopic cases. Three factors were independently predictive of complications: diabetes mellitus (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.3; P = .02), early surgeon experience (OR, 2.5; 95% CI, 1.4-4.2; P = .001), and open approach (OR, 3.9; 95% CI, 2.1-7.3; P < .001).
Conclusions Complications occurred in 18.3% of patients, but 95% were treated without leading to lasting disability.
Presence of diabetes, early surgeon experience, and an open approach are risk factors of complications.
There is also 58% increased chance of suicide among GB recipients.
NIH complication rate from 20-40%
New Jersey study 10% surgery for bowel obstruction
Acute Kidney function problems 8.5%
I’m not suprised..DM complicates and is a risk factor for many things
This is for a summary I have to do for school. I need as much detail as possible. All input will be greatly appreciated!
Well, now you have a pretty good list of the POSSIBLE complications. Now let’s explore the other part of your question….
Preventing complications of type two diabetes is mainly an issue of keeping your blood sugar as close to "normal" as possible. You do that by simply giving your body what it needs and less of what your mind and taste buds want. Simply put, that means nothing but healthy, low carb, natural foods. Combine that with moderate daily exercise, and you have a recipe for good health.
Since adopting this simple premise, I’ve managed to go without medication for nearly a year after six years of the disease. And, no complications whatsoever.
This is for a summary I have to do for school. I need as much detail as possible. All input will be greatly appreciated!
Well, now you have a pretty good list of the POSSIBLE complications. Now let’s explore the other part of your question….
Preventing complications of type two diabetes is mainly an issue of keeping your blood sugar as close to "normal" as possible. You do that by simply giving your body what it needs and less of what your mind and taste buds want. Simply put, that means nothing but healthy, low carb, natural foods. Combine that with moderate daily exercise, and you have a recipe for good health.
Since adopting this simple premise, I’ve managed to go without medication for nearly a year after six years of the disease. And, no complications whatsoever.
i know the baby tends to be bigger but if they determine that the baby is healthy because of the diet, what other complications could occur during labor??
The two largest risks of GD are a hypoglycemic baby and the risk of placental calcification which occurs as the placenta ages. This can limit the nutrients to the baby but can be monitored via a Biophysical profile to ensure that the baby is well.
Contrary to all you’ll hear/read, the research does not support that women with well-controlled GD have babies that are statistically larger than non-GD babies.
The difference is really about 4 ozs when the GD is well-controlled (either with diet or meds).
Babies born to moms with uncontrolled GD can have disproportionate bodies, meaning the chest/shoulders can be larger than average and lead to a potential shoulder dystocia. However, true SD occurs in about 1/1000 pregnancies so it quite rare.
The best prevention of a SD for a large baby is to labor as upright as possible and changes positions frequently – lying on your back isn’t recommended.
1.
"Even with successful treatment, diabetes survivors are at risk of serious complications, such as CV disease, kidney failure, and blindness"
2.
"Truly successful treatment minimizes complications by narrowing the gap between a healthy glucose homeostasis pattern and that derived from therapeutic treatment"
-Matching basal and post-prandial glucose and insulin levels to those of healthy individuals.
-Individuals have different levels of dysfunction.
What’s the second point trying to say?
And what’s it mean by basal and post-pranial glucose/insulin levels?
The 2nd to me is saying that Diabetics if they follow the patterns of a healthy Ind. glucose pattern, on what the Non-Diabetics blood glucose levels are before a meal, after a meal, while sleeping, etc. they will have less health problems.
Basal rate, as it relates to Diabetics is calculated by how much insulin a normal pancreas secretes to keep a persons blood sugars in normal range or in a Diabetics case with the help of an insulin pump; it allows a Diabetic (insulin dependent) to set the appropriate basal rate or amount of insulin to pump every hour to maintain their blood glucose levels to the similar levels of a non-diabetic (ex. 0.65 per hour basal rate)
Post-prandial not 100% sure but have a strong feeling it means After Eating glucose levels which should be checked two hours after eating to ensure that your basal rate or as I call it fasting (no food) glucose level versus what my blood sugar is after I eat. Which determines if a Diabetic is taking to little or too much insulin over a period of time and if monitored closely a Diabetic can come close to the blood sugar levels of a non-diabetics basal and post prandial glucose levels and in the end have fewer complications.
Hope this helps a little, even I got a bit confused by this wording and pretty knowledgable about diabeties treatment and slang.
if im 16 and i have diabetes type 1, will i suffer those? because someone who is 69 years old, battled diabetes only 4 yrs then he died..will i survive?
You don’t know how long the 69 year old person had diabetes before he realized it. You don’t know how well he took care of himself. You don’t know what other problems he had. And although many people live longer than that, he wasn’t young either.
If you follow your doctors advice and take insulin as you are instructed to do, eat properly, exercise, watch you weight and see your doctor regularly (and the eye doctor once a year too) there is no reason to think you won’t live many, many more years.
To answer your question — diabetes complications are loss of sight, loss of limbs, heart attack, and kidney failure. Be aware of that, but don’t worry about it. Accidents happen and healthy people die, so just enjoy your life, because none of us come with a guarantee.
I personally do not, but I have known people who had them. It is a bother to have these and they are slow to resolve. Keep working with the people at the county health office and they can help you with your concerns.
I have just found out that I have gestational diabetes and I am over 37 weeks pregnant. It has gone undiagnosed and we have found out that I why my baby is so large. She is already 8 pounds 12 ounces based on the ultra sound. They won’t let us induce until at least 39 weeks. I have been eating healthy but not healthy for someone with gestational diabetes. My concerns are now with my baby and I want her to be healthy. Any personal expieriences would be great!
I was diagnosed with gestational diabetes with my first pregnancy. The only real difficulty was a very long labor due to a large baby. A large baby is probably all you will have to deal with. If the baby is too large you may end up with a C-section so prepare for that. Don’t worry, you will probably both be fine.
My husband has a moderately severe case of it. He is on Lantus and insulin 2 times a day. He takes this by injection. He is a bit overweight and has high cholesterol levels. He suffers from kidney failure, diabetic neuropathy. His family history is strong for diabetes. His father had it, his paternal grandmother had it, his great grandfather had it. He does not eat right no matter how I try to make healthy food, he would rather have a greasy hamburger and fries any day. He often sneaks off to the local fast food place to indulge. He worries me to death. His father dropped dead from a heart attack 4 years ago. He was only 65. My husband has diabetes a lot worse than his dad did.He does not heal well if he gets a scratch or cut,and it takes him much longer to heal than it takes me. He also gets these awful boils that have to be treated. He is usually very tired most of the time and has no energy. His fasting blood sugars tend to run around 140. His blood sugars have been over 600 at one time.
diabetes 2 complication (long term complication of diabetes type 2)