Anna Z Fashandi, MD, J Hunter Mehaffey, MD, Robert B Hawkins, Bruce D Schirmer, Peter T Hallowell. University Of Virginia
Introduction: The purpose of this study was to determine the long-term incidence of bone fracture after bariatric surgery, identify specific risk factors for fracture, and compare these data to baseline risk in a comorbidity-matched morbidly obese population. We hypothesized that, despite prior studies with conflicting results, bariatric surgery independently increases a patient’s long-term risk of fracture.
Methods and Procedures: All patients who underwent bariatric surgery at a single institution 1985-2015 were reviewed. Univariate analysis of patient demographic data including comorbidities, insurance payer status, procedure type and BMI were performed. Multivariate logistic regression was used to identify independent predictors of fracture in this population. Finally, we identified a comorbidity-matched control group of morbidly obese patients from our institutional Clinical Data Repository who were seen during the same timeframe but who did not undergo bariatric surgery in order to determine the expected rate of fracture without bariatric surgery.
Results: A total of 3,439 patients underwent bariatric surgery, with 220 (6.4%) patients experiencing a bone fracture during a median follow-up period of 12.2 years. On multivariate logistic regression, independent predictors of increased fracture included tobacco use and Roux-en-Y Gastric Bypass (RYGB) while private insurance and race were protective (Table). Additionally, 1:1 matching on all comorbidity and demographic factors identified 3,880 patients (1,940 surgical patients) with equal propensity to undergo bariatric surgery. Between the matched cohorts, patients who had a history of bariatric surgery were more than twice as likely to experience a fracture as those who did not (6.4% vs 2.7%, p<0.0001).
Conclusions: The present study of all patients undergoing bariatric surgery at our institution identified several independent predictors of postoperative fracture. Additionally, these long-term data demonstrated that patients who had bariatric surgery are at a significantly increased risk of bone fracture compared to a matched control group. Future efforts need to focus on nutrient screening and risk modification to reduce the impact of this long-term complication.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79301
Program Number: S018
Presentation Session: Bariatric and Metabolic Surgery
Presentation Type: Podium
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