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BALTIMORE – A staging scale developed by the bariatric team at the University of Alberta has shown potential as a tool to accurately predict major complications 1 year after Roux-en-Y gastric bypass (RYGB) surgery, surpassing the predictability of body mass index alone, a researcher reported at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons.
Researchers at the university validated the predictive utility of the scale, known as the Edmonton Obesity Staging System (EOSS), in a retrospective chart review of 378 patients who had RYGB between December 2009 and November 2015 at Royal Alexandra Hospital in Edmonton, Alt. The EOSS uses a scale from 0 to 4 to score a patient’s risk for complications: the higher the score, the greater the risk of complications.
“The EOSS may help determine risk of major complications after RYGB, and, given its overall simplicity, you can also think of it as analogous to the American Society of Anesthesiologists physical status classification system or the New York Heart Association classification system for congestive heart failure,” said Samuel Skulsky, a 3rd-year medical student at the University of Alberta. “It may have utility as well in communicating to patients their overall risk.”
A previous study applied the EOSS score to the National Health and Human Nutrition Examination Survey to compare it to use of body mass index (BMI) as a predictive marker of mortality (CMAJ. 2011;183:E1059-66). Where the four BMI classifications were clustered on the Kaplan-Meier between 0.7 and 0.9 at 200 months post examination, the four EOSS stages analyzed, 0-3, showed more of a spread, from around 0.55 for stage 3 to near 1.0 for stage 0. This gave the researchers the idea that EOSS could also be used to predict morbidity and mortality specifically in obese patients scheduled for surgery, Mr. Skulsky said. “With the Kaplan-Meier survival curves, the EOSS actually nicely stratifies the patients with their overall survival,” he said. “In comparison, BMI did not do as well in stratifying overall mortality.”
The study reported the following 1-year complication rates in the EOSS stages:
- Stage 0 (n = 14), 7.1%.
- Stage 1 (n = 41), 4.9%.
- Stage 2 (n = 297), 8.8%.
- Stage 3 (n = 26), 23.1%.
There were no stage 4 patients in the study population.
The multivariable logistic regression analysis determined that patients with EOSS stage 3 have a 2.94 adjusted odds ratio of 1-year complications vs. patients of lower stages (P less than .043).
“Although the patients with higher EOSS scores above 3 and … end-organ damage … may benefit from bariatric surgery, they inherently have higher postoperative risk,” Mr. Skulsky said. “We must take that into consideration.”
Among the limitations of the study, Mr. Skulsky acknowledged, were that it included only patients who had RYGB, that it had a bias toward patients with EOSS stage 2 score, and that it included no stage 4 patients. “They’re not commonly operated on,” he noted, “so we didn’t actually get to study the entire scoring system.”
The next step involves moving the analysis forward to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, Mr. Skulsky said. “The results that we found so far are pretty encouraging,” he said.
Mr. Skulsky had no financial relationships to disclose.
SOURCE: Skulsky SL et al. SAGES 2019, Session SS12.
BALTIMORE – A staging scale developed by the bariatric team at the University of Alberta has shown potential as a tool to accurately predict major complications 1 year after Roux-en-Y gastric bypass (RYGB) surgery, surpassing the predictability of body mass index alone, a researcher reported at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons.
Researchers at the university validated the predictive utility of the scale, known as the Edmonton Obesity Staging System (EOSS), in a retrospective chart review of 378 patients who had RYGB between December 2009 and November 2015 at Royal Alexandra Hospital in Edmonton, Alt. The EOSS uses a scale from 0 to 4 to score a patient’s risk for complications: the higher the score, the greater the risk of complications.
“The EOSS may help determine risk of major complications after RYGB, and, given its overall simplicity, you can also think of it as analogous to the American Society of Anesthesiologists physical status classification system or the New York Heart Association classification system for congestive heart failure,” said Samuel Skulsky, a 3rd-year medical student at the University of Alberta. “It may have utility as well in communicating to patients their overall risk.”
A previous study applied the EOSS score to the National Health and Human Nutrition Examination Survey to compare it to use of body mass index (BMI) as a predictive marker of mortality (CMAJ. 2011;183:E1059-66). Where the four BMI classifications were clustered on the Kaplan-Meier between 0.7 and 0.9 at 200 months post examination, the four EOSS stages analyzed, 0-3, showed more of a spread, from around 0.55 for stage 3 to near 1.0 for stage 0. This gave the researchers the idea that EOSS could also be used to predict morbidity and mortality specifically in obese patients scheduled for surgery, Mr. Skulsky said. “With the Kaplan-Meier survival curves, the EOSS actually nicely stratifies the patients with their overall survival,” he said. “In comparison, BMI did not do as well in stratifying overall mortality.”
The study reported the following 1-year complication rates in the EOSS stages:
- Stage 0 (n = 14), 7.1%.
- Stage 1 (n = 41), 4.9%.
- Stage 2 (n = 297), 8.8%.
- Stage 3 (n = 26), 23.1%.
There were no stage 4 patients in the study population.
The multivariable logistic regression analysis determined that patients with EOSS stage 3 have a 2.94 adjusted odds ratio of 1-year complications vs. patients of lower stages (P less than .043).
“Although the patients with higher EOSS scores above 3 and … end-organ damage … may benefit from bariatric surgery, they inherently have higher postoperative risk,” Mr. Skulsky said. “We must take that into consideration.”
Among the limitations of the study, Mr. Skulsky acknowledged, were that it included only patients who had RYGB, that it had a bias toward patients with EOSS stage 2 score, and that it included no stage 4 patients. “They’re not commonly operated on,” he noted, “so we didn’t actually get to study the entire scoring system.”
The next step involves moving the analysis forward to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, Mr. Skulsky said. “The results that we found so far are pretty encouraging,” he said.
Mr. Skulsky had no financial relationships to disclose.
SOURCE: Skulsky SL et al. SAGES 2019, Session SS12.
BALTIMORE – A staging scale developed by the bariatric team at the University of Alberta has shown potential as a tool to accurately predict major complications 1 year after Roux-en-Y gastric bypass (RYGB) surgery, surpassing the predictability of body mass index alone, a researcher reported at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons.
Researchers at the university validated the predictive utility of the scale, known as the Edmonton Obesity Staging System (EOSS), in a retrospective chart review of 378 patients who had RYGB between December 2009 and November 2015 at Royal Alexandra Hospital in Edmonton, Alt. The EOSS uses a scale from 0 to 4 to score a patient’s risk for complications: the higher the score, the greater the risk of complications.
“The EOSS may help determine risk of major complications after RYGB, and, given its overall simplicity, you can also think of it as analogous to the American Society of Anesthesiologists physical status classification system or the New York Heart Association classification system for congestive heart failure,” said Samuel Skulsky, a 3rd-year medical student at the University of Alberta. “It may have utility as well in communicating to patients their overall risk.”
A previous study applied the EOSS score to the National Health and Human Nutrition Examination Survey to compare it to use of body mass index (BMI) as a predictive marker of mortality (CMAJ. 2011;183:E1059-66). Where the four BMI classifications were clustered on the Kaplan-Meier between 0.7 and 0.9 at 200 months post examination, the four EOSS stages analyzed, 0-3, showed more of a spread, from around 0.55 for stage 3 to near 1.0 for stage 0. This gave the researchers the idea that EOSS could also be used to predict morbidity and mortality specifically in obese patients scheduled for surgery, Mr. Skulsky said. “With the Kaplan-Meier survival curves, the EOSS actually nicely stratifies the patients with their overall survival,” he said. “In comparison, BMI did not do as well in stratifying overall mortality.”
The study reported the following 1-year complication rates in the EOSS stages:
- Stage 0 (n = 14), 7.1%.
- Stage 1 (n = 41), 4.9%.
- Stage 2 (n = 297), 8.8%.
- Stage 3 (n = 26), 23.1%.
There were no stage 4 patients in the study population.
The multivariable logistic regression analysis determined that patients with EOSS stage 3 have a 2.94 adjusted odds ratio of 1-year complications vs. patients of lower stages (P less than .043).
“Although the patients with higher EOSS scores above 3 and … end-organ damage … may benefit from bariatric surgery, they inherently have higher postoperative risk,” Mr. Skulsky said. “We must take that into consideration.”
Among the limitations of the study, Mr. Skulsky acknowledged, were that it included only patients who had RYGB, that it had a bias toward patients with EOSS stage 2 score, and that it included no stage 4 patients. “They’re not commonly operated on,” he noted, “so we didn’t actually get to study the entire scoring system.”
The next step involves moving the analysis forward to the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, Mr. Skulsky said. “The results that we found so far are pretty encouraging,” he said.
Mr. Skulsky had no financial relationships to disclose.
SOURCE: Skulsky SL et al. SAGES 2019, Session SS12.
REPORTING FROM SAGES 2019
Key clinical point: The Edmonton Obesity Staging System is predictive of complications after Roux-en-Y gastric bypass surgery.
Major finding: Patients with a score greater than 3 had a threefold greater incidence of complications at 1 year.
Study details: Retrospective chart review of 378 patients who had RYGB at a single center from 2009 through 2015.
Disclosures: Mr. Skulsky has no financial relationships to disclose.
Source: Skulsky SL et al. SAGES 2018, Session SS12.
