Baseline patient profiling and three-year outcome data after metabolic surgery at a South African centre of excellence

Abstract

The bariatric team at Waterfall City Hospital in Gauteng has performed 820 metabolic surgeries under the guidance of an extended team, and with comprehensive recordkeeping. Baseline profiling on more than 50 variables afforded insight into patients undergoing surgery. The available outcome data over three years were comparable with those in the documented literature. The attempted weight loss period prior to agreeing to surgery was 16–18 years. Weight loss in the overall cohort was 29% at three years, with a two-year outcome as follows: diabetes mellitus remission of 81.6% in males and 83.1% in females, full and part-hypertension resolution of 84.8% in males and 74.6% in females, hyperlipidaemia on no treatment of 76.8% in males and 72.1% in females, and sleep apnoea of 75.5% in males and 76.8% in females. Separating out the diabetic group indicated a diabetes mellitus remission of 73.9% in males and 75.1% in females at one year. Improvement in the components of metabolic syndrome was demonstrated in the total cohort. There was an worse profile and higher risk in the male patients. Similarly, higher risk was recorded in the biliopancreatic diversion-duodenal switch cohort, and there was a higher percentage of elected diabetic patients. A wide range of revision surgery was performed, with a higher complication rate (20%) experienced compared to that recorded with the primary surgeries. The morbidity data were separated into medical and surgical morbidity. Major medical morbidity was documented at 5.6% and surgical morbidity at 3.9%. Surgical morbidity in the first 250 cases was reported to be 6% vs. 2.7% in the last 570 cases. Mortality for the cohort was noted to be 0.1%.

Keywords: bariatric surgery, outcome data, profiling, South Africa