Benjamin Clapp, MD, Angela Guerra, Joshua Hahn, Matt Wynn, Alan Tyroch, MD, Colin Martyn, MD, Jesus Gamez, MD. Texas Tech PLF School of Medicine
Background: Anastomotic ulcer formation is a common problem after gastric bypass. The rate of ulcer formation after surgery is different for each surgeon and surgical technique also seems to make a difference. The MBSAQIP database contains data from all US Centers of Excellence including complication rates.
Methods: We queried the MBSAQIP database for the year 2015. This database includes patients that underwent metabolic or bariatric surgery and reports 30 day outcomes.
Results: There are a total of 168,093 patients in the 2015 MBSAQIP database. Among this cohort, 53,255 patients had undergone gastric bypass. After implementing eligibility criteria, a total of 44,379 patients were included in the analysis (excluded patients due to repeat procedures 8,821 and age <18). The average age and BMI of the included subjects in this study were 45 years and 45.9 Kg/m2 respectively with majority being females (80%).
The incidence of ulcer in entire cohort was 155 of 44,379 (0.35 %, 95%CI: 0.297%, 0.409%). Among 155 patients with ulcer, 88 (57%) patients had only one procedure, 69 had an intervention (therapeutic or diagnostic endoscopy), 16 had readmission and 3 had reoperation. Sixty five (42%) patients had two procedures with the majority having both readmissions and endoscopy (n=59); and 2 patients had 3 (1%) procedures. The incidence of readmission, intervention and reoperation within 30 days were 6.5%, 2.8% and 2.6% respectively. Ulcer formation was most common in intervention group (11.4%) followed by readmission group (4%) and reoperation group (1.5%). The most common post-operative complications were unplanned ICU admissions 597 (1.4%) followed by transfusions (n=538, 1.2%), post operative UTI (n=211, 0.48%), and pneumonia (n=193, 0.43%). The occurrence of ulcer was associated with unplanned ICU admissions (6.45%), transfusions (5.16 %), post operative UTI (3.87%), sepsis (1.94%) and myocardial infarction (0.65%). Death occurred in 76 patients with no related cases to marginal ulcers. The risk of ulcer was associated with increased BMI (OR=1.02, p=0.01), presence of percutaneous transluminal cardiac catheterization (PTC) (2.17, p=0.038), histories of DVT (1.72, p=0.085) and PE (2.84, p=0.002).
Conclusions: In a nationally reported database, anastomotic ulcer seems to occur rarely in the first month. The large majority are diagnosed and treated endoscopically with minimal need for surgical intervention. The risk of anastomotic ulcer was increased with increased BMI, DVT, PTC, and DVT/PE.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88641
Program Number: P637
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster