Connal Robertson-More, MD1, Aryan Modasi, MD, MSc2, Jerry T Dang, MD2, Noah Switzer, MD, MPH3, Daniel W Birch, MD, MSc2, Shahzeer Karmali, MD, MPH2. 1University Hospitals Coventry and Warwickshire NHS Trust, 2University of Alberta, 3Ohio State University
Introduction: Secondary to insufficient weight loss, weight regain or complications related to primary bariatric surgery, a growing proportion of individuals are seeking revisional bariatric surgery. Despite this, limited knowledge regarding the complication profile of revisional compared to primary bariatric procedures exists.
Methods and Procedures: The MBSAQIP datasets from 2015 and 2016 were combined in a single database and individuals undergoing primary and revisional laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) were identified based on CPT codes. Standard demographic information and complications within 30 days of surgery were analyzed for differences between those undergoing primary versus revisional procedures.
Results: Within the combined 2015/2016 MBSAQIP database, 278,869 and 20,159 individuals underwent primary and revisional procedures, respectively. Proportionally, LSG represented 71.7% and 60.1% of the primary and revisional procedures, respectively. Individuals undergoing revisional procedures had a greater mean age (44.7 vs. 47.8 yrs), a lower pre-operative BMI (45.5 vs. 42.3 kg/m2), represented a greater proportion of females, and displayed similar pre-operative comorbidity profiles outside of a lower proportion of individuals with diabetes, and sleep apnea. Additionally, a greater proportion of individuals with gastroesophageal reflux disease was observed in the revisional groups.
With respect to early peri-operative complications, revisional LRYGB was associated with a significantly higher mortality rate (0.015 vs. 0.26%, p = 0.025). Both revisional groups had a greater serious complication rate (2.7 vs. 4.4%, p < 0.001 and 6.4 vs. 10.4%, p < 0.001, pLSG vs rLSG and pLRYGB and rLRYGB), in particular, a greater post-operative bleed, leak and 30-day readmission, reoperation and reintervention rates. Multivariable logistic regression analysis determined that revisional LRYGB procedures were independently predictive of serious complications (OR 1.52, 95% CI 1.40 to 1.65, p < 0.001), leaks (OR 2.40, 95% CI 1.97 to 2.92, p < 0.001) and bleeds (OR 1.44, 95% CI 1.23 to 1.69, p < 0.001). Whereas revisional LSG procedures were independently predictive of serious complications (OR 1.46, 95% CI 1.33 to 1.61, p < 0.001) and leaks (OR 2.14, 95% CI 1.77 to 2.59, p < 0.001).
Conclusions: Utilizing the MBSAQIP database differences in demographic and comorbidity profiles were found between individuals undergoing primary vs revisional bariatric surgery. Further, revisional LRYGB procedures were observed to have a higher perioperative mortality and to be independently associated with the risk of serious complications, bleeds and leaks. On the other hand, revisional LSG was independently associated with the risk of serious complications and leaks.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94824
Program Number: P087
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster