Cross-sectional analysis of 1,795,127 MBSAQIP registry patients (2015–2023) comparing preoperative comorbidity burden and 30-day outcomes across six BMI categories (< 40 to ≥ 80 kg/m²), with emphasis on extreme obesity (BMI ≥ 60 kg/m²).
Extreme obesity (BMI ≥ 60) affected 5.3% of the sample; BMI ≥ 70 was present in 1.1% annually (~1,520 cases/year). Compared to BMI < 40, patients with BMI ≥ 70 had higher rates of hypertension (56.7% vs. 46.9%), sleep apnea (59.6% vs. 34.6%), and functional dependence (4.5% vs. 0.5%). Serious complications rose from 0.7% to 2.6% and mortality from 0.05% to 0.35% at the highest BMI category (both p < 0.001).
- Cross-sectional design limits causal inference and long-term outcome assessment beyond 30 days. - Registry data may have incomplete or inconsistently recorded comorbidity fields. - No comparator group of non-surgical management, so relative risk of surgery vs. no surgery cannot be assessed.
Even at extreme BMIs, absolute 30-day complication and mortality rates remain low and should not preclude bariatric surgery referral. Pre-operative strategies to reduce BMI in patients with BMI ≥ 70 kg/m² deserve prospective evaluation.
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