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The Edmonton obesity staging system (EOSS) is a multidimensional obesity classification tool that examines obesity-related clinical disease, functional limitations, and mental health burden beyond body mass index (BMI) alone.
Increasing obesity severity assessed by EOSS independently predicts a higher risk of postoperative complications after bariatric surgery.
The Edmonton obesity staging system (EOSS) is a multidimensional obesity classification tool that examines obesity-related clinical disease, functional limitations, and mental health burden beyond body mass index (BMI) alone. Previous studies have linked advanced EOSS stages with poorer surgical outcomes; however, evidence remains limited in patients with severe obesity and advanced disease burden undergoing Metabolic and bariatric surgery (MBS). This analysis explored the impact of EOSS severity on short-term postoperative outcomes, including complications within 90 days after primary MBS.
Adults undergoing primary MBS from January 2020 through December 2023 were identified from a prospectively collected registry at a Brazilian academic institution. The study population included patients who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). The study excluded patients treated with revision, conversion, staged, or other alternative bariatric interventions.
Data regarding patient demographics, obesity-associated comorbidities, EOSS stage, surgical characteristics, and postoperative outcomes were extracted from electronic medical records. Post-surgical complications identified within 90 days were graded using the Clavien–Dindo framework. To determine whether EOSS severity was associated with postoperative outcomes, univariate and multivariable logistic regression analyses were conducted.
Among the 335 patients evaluated, the median age was 47 years, with an interquartile range of 39–56 years. The cohort was predominantly female (81.8%) and had a median BMI of 44.9 kg/m² (IQR 40.8–49.4). One-third of participants (33.4%) were categorized as EOSS stage 3 or 4. Surgical practice varied significantly across EOSS categories (p=0.002), with SG increasingly favored as obesity-related health impairment became more severe.
Within 90 days after surgery, major complications occurred in 5.4% of patients (n=18). The incidence rose significantly with increasing obesity-related disease severity, ranging from 1.8% among patients classified as EOSS stages 0–2 to 12.5% among those in EOSS stages 3–4 (p<0.001). Only 1.5% of patients required a subsequent operation, and there were no reported deaths during the study period. In exploratory multivariable analyses, higher EOSS stages remained independently associated with an increased likelihood of:
These findings shows increasing obesity severity, as assessed by EOSS, is associated with a greater likelihood of adverse postoperative outcomes following MBS.
Higher EOSS stages were significantly linked to an increased risk of overall and major complications during the first 90 days after MBS. Patients classified as EOSS stages 3–4 represented a high-risk subgroup with substantially greater perioperative morbidity than those with less severe obesity.
Obesity Surgery
Association Between Edmonton Obesity Staging System Severity and 90-Day Postoperative Complications After Primary Metabolic and Bariatric Surgery: A Retrospective Cohort Study
Anna Carolina Batista Dantas et al.
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