The effect of immunosuppressive medications on early outcomes in bariatric surgery

Chetan V Aher, MD, Matthew D Spann, MD, Ronald H Clements, MD, Wayne J English, MD, D Brandon Williams, MD. Vanderbilt University Medical Center

Introduction: Immunosuppressed patients undergoing surgical intervention are at increased risk of postoperative complications.  Little is known if there are salutary effects of withholding immunosuppressive medications in the preoperative period.  We report the outcomes of primary bariatric surgery on immunosuppressed patients at a high-volume, tertiary care center.

Methods: We conducted a retrospective review of all patients undergoing laparoscopic vertical sleeve gastrectomy or gastric bypass at a single institution from January 2008 – August 2015.  We analyzed all patients taking long-term, systemic, immunosuppressive medications.  We collected data on 30-day mortality and morbidities including gastrointestinal anastomotic leak, infection, and bleeding requiring transfusion.

Results: Within the study period, we identified 1,840 patients undergoing bariatric surgery.  Sixty-one (3.3%) had taken immunosuppressive medications in the preoperative period.  There were no mortalities or gastrointestinal anastomotic leaks.  We identified seven morbidities that occurred in five patients (8%) including two superficial wound infections, two bleeding episodes requiring transfusion, one urinary tract infection, one aspiration pneumonia, and one return to the operating room for small bowel obstruction due to intra-luminal thrombus.

Conclusion: Our results indicate that performing a primary bariatric operation on patients taking immunosuppressive medications has a low risk of perioperative complications.

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