S. Julie-Ann Lloyd, MD, PhD, Gautam Sharma, MBBS, Jessica Ardila-Gatas, MD, Chao Tu, MS, Stacy A Brethauer, MD, Philip R Schauer, MD, Ali Aminian, MD. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
Introduction: Bariatric surgery is a safe and effective treatment for severe obesity and its co-morbidities. However, concomitant splenectomy is sometimes required due to uncontrolled bleeding during the surgery. Limited literature exists regarding the effects of concurrent splenectomy on outcomes of bariatric surgery. This study aimed to determine these outcomes.
Methods: Adult patients with obesity who underwent primary, elective laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) with concomitant splenectomy were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP, 2015) and National Surgical Quality Improvement Program (NSQIP, 2005-2014) datasets. Using propensity scores (based on 14 baseline variables), patients who underwent primary bariatric surgery were matched 1:10 to a control group (primary LRYGB/LSG without concomitant splenectomy) and thirty-day postoperative outcomes were compared. Continuous variables and categorical variables were categorized as medians with interquartile range (IQR) and counts with percentages, respectively.
Results: A total of 451 patients met inclusion criteria, of which 41 patients each underwent a primary bariatric procedure (LRYGB: n=31; LSG: n=10) with concomitant splenectomy. After propensity matching, patients in the concomitant splenectomy group were similar to the controls with respect to preoperative characteristics. Patients in the concomitant splenectomy group had a higher median operative time (185 min vs. 77 min; p<0.01) and postoperative length of stay (2 [IQR 1-3] days vs. 2 [1-2] days; p<0.001). The all-cause 30-day morbidity was higher for patients who underwent concomitant splenectomy (14.6% vs. 2.4%; p=0.002) when compared to controls. With respect to individual 30-day complications, patients with concomitant splenectomy experienced higher frequency of venous thromboembolism (4.9% vs. 0.5%; p=0.04) and infectious complications (12.2% vs. 2.4%; p=0.007), including superficial, deep and organ space infection, urinary tract infection, pneumonia, sepsis, and septic shock. While these patients were also more likely to have unplanned 30-day readmission (27.5% vs. 4.2%; p<0.001), the rates of mortality (0 vs. 0.1%; p>0.99) and return to the operating room (4.9% vs. 1.3%; p=0.10) were comparable between the two groups.
Conclusion: Concomitant splenectomy for uncontrolled bleeding at the time of primary LRYGB and LSG is associated with increased risk of short-term complications including infectious and thrombotic complications.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87515
Program Number: P558
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster