Little is known about long-term outcomes of patients with end-stage organ failure undergoing bariatric surgery.


1094 patients undergoing bariatric surgery from 2006-2019 were retrospectively screened. Inclusion criteria were left ventricular ejection fraction <30%, continuous oxygen/non-invasive ventilation (NIV) therapy, liver cirrhosis/history of liver transplantation or kidney failure stage 4/5. High-risk patients were matched for age, gender, BMI, operation type, diabetes, arterial hypertension, and sleep apnoea with patients without advanced organ failure.


28 high-risk patients (57% female) were identified with a mean age of 50,0+-8,5 and mean BMI of 53,3+-8,9kg/m2. Matched patients had a mean age of 47,2+-8,7 and a mean BMI of 51,3+-7,8kg/m2. 86% had a sleeve gastrectomy. High-risk patients had complications (Clavien-Dindo>=3) in 11% vs. 4% (p=0,380) with a 3,5% in hospital mortality. Total bodyweight loss was 22% vs. 28% after 24 months (p=0,182) with equal improvement of comorbidities. Depression scores of high-risk patients decreased from 11,4+-7,5 to 4,9+-5,6 (p=0,002). Overall survival over 5 years in the high-risk group was 86%. Therapy goal (cessation continuous oxygen/NIV therapy) was achieved in 15% in patients with end-stage lung disease while the success rate for other diseases was >50%. However, lung function remained stable or improved in all patients.


Despite end-stage organ failure and a significantly reduced life expectancy, long-term survival was 86%. While lung disease had the lowest complete resolution rate, lung function still improved or remained stable. Patients with end-stage organ failure should not be precluded from bariatric surgery but further investigations which patients' benefit are necessary.