How Safe Is Bariatric Surgery?

Prateek K Gupta, MD, Himani Gupta, MD, Xiang Fang, PhD, R. Armour Forse, MD PhD. Creighton University

Objectives: The question regarding safety of bariatric surgery persists. While a few studies have compared bariatric surgery to other commonly performed surgeries, a comparison controlling for patient demographics, comorbidities, and lifestyle factors does not exist. The objective of this study was to compare bariatric surgery with other surgeries in terms of postoperative morbidity and mortalityMethods: American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP: 2007 and 2008), a multicenter, prospective database with more than 180 participant hospitals, was used. Multivariate logistic regression analyses were performed for postoperative complications and mortality controlling for more than 50 comorbidities and lifestyle factors. Results: Of 468,795 patients who underwent surgery, bariatric surgeries were performed in 25,828 patients. Overall postoperative morbidity and mortality were 10.64% and 1.68%, respectively. Postoperative morbidity and mortality after bariatric surgeries were 5.75% and 0.16%, respectively. On multivariate analysis, bariatric surgery was associated with a lower risk for postoperative morbidity (c statistic 0.799) than anorectal, intestinal, other abdominal, spine, brain, breast, head and neck (except thyroid and parathyroid), gynecologic, skin and soft tissue, peripheral vascular, aortic, thoracic, foregut, hepatopancreatobiliary, orthopedic, cardiac, hernia, and urologic surgery (p<0.05 for all). There was no significant difference in comparison to gall bladder, adrenal, spleen, thyroid and parathyroid surgery (p>0.05 for all). On multivariate analysis, bariatric surgery was associated with a lower risk for postoperative mortality (c statistic 0.940) than intestinal, other abdominal, brain, aortic, thoracic, foregut, and hepatopancreatobiliary surgery (p<0.05 for all). There was no significant difference in comparison to anorectal, spine, head and neck (except thyroid and parathyroid), gynecologic, skin and soft tissue, peripheral vascular, urologic, orthopedic, and cardiac surgery (p>0.05 for all). Bariatric surgery was associated with a higher risk for postoperative mortality than breast, gall bladder, adrenal, spleen, thyroid, parathyroid, and hernia surgery (p<0.05 for all). Multivariate analyses using each individual postoperative complication as the outcome of interest were also performed.Conclusion: Bariatric surgery is safe. This study confirms that postoperative morbidity and mortality after bariatric surgery are not higher than most other commonly performed surgeries.