Sn Zafar, MD, MPH, E S Wise, MD, H Jackson, MD, M Kligman. University of Maryland Medical Center
Introduction: Postoperative bleeding represents an infrequent, yet serious complication after bariatric surgery. Differences in the rate of postoperative bleeding reported for the two most common weight loss procedures—laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG)—are ostensibly confounded by patient and surgeon specific preoperative, intraoperative and postoperative factors, in particular, by the utilization of staple line reinforcement or oversewing. With this understanding, we aim to use a large national database to definitively characterize differences in bleeding rates between LSG and LRYGB.
Methods and Procedures: The 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use Data File (PUF) was queried for patients undergoing primary non-robotic multi-port LRYGB or LSG. Patients at the extremes of age were excluded. Furthermore, only LSG operations without any staple line reinforcement were considered. Postoperative bleeding was taken as any hemorrhage requiring a blood transfusion within 72 hours of surgery or another intervention for bleeding. To account for differences in patient selection, propensity scores on preoperative factors were used to match patients undergoing LRYGB with those undergoing LSG. Subsequent multivariate logistic regression was used to determine the effect of the type of procedure on postoperative bleeding rates, adjusting for intraoperative factors.
Results: A total of 168,093 patients from 742 centers were identified in the dataset. After applying our selection criteria, 65,881 patients met inclusion criteria: 43,280 (65.7%) with LRYGB and 22,601 (34.3%) with LSG. A total of 833 (1.3%) patients suffered a postoperative bleeding event, of which 215 (25.8%) required a re-operation. The unadjusted bleeding rate in the LRYGB group was 1.5% and was 0.8% in the LSG group. After propensity score matching and multivariate regression analyses, the odds of post-operative bleeding were 41% lower for patients having LSG compared to those having LRYGB (odds ratio 0.59, 95% confidence interval = 0.49 – 0.72).
Conclusions: After appropriate risk-matching, LSG patients have a reduced likelihood of a postoperative bleeding event compared to those undergoing LRYGB. This difference is likely more pronounced with intraoperative securing of the staple line via oversew, buttress or an alternative method. These findings from a large national database represent an important consideration for surgeons and patients alike when evaluating the appropriate bariatric operation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88270
Program Number: P660
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster