Yen-Yi Juo, MD, MPH, Yas Sanaiha, MD, Erik Dutson, MD, Yijun Chen, MD. UCLA
Introduction: Anastomotic leak is one of the most morbid complications of Roux-en-Y gastric bypass (RYGB), yet its risk factors are ill-defined due to the rarity of the complication. We aim to identify both patient- and operative-level risk factors for anastomotic leak after RYGB using a national clinical database.
Methods: A retrospective cohort study was performed using the 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. All adult patients who underwent laparoscopic or open RYGB were included. Multivariate logistic regression models were used to identify patient- and operative-level variables associated with development of anastomotic leakage. Clinically relevant anastomotic leakage is defined as those that required readmission, intervention, or reoperation.
Results: Of the 45,109 patients who underwent RYGB, 194 (0.43%) patients experienced anastomotic leak. Of these, 145 (74.7%) required reoperation and 3 (1.6%) patients died. Risk factors included limited preoperative ambulation (OR 2.28, 95% CI 1.11-4.66, p=.02), previous foregut surgery (OR 2.4, 95% CI 1.60-3.61, p<.01), chronic steroids use (OR 2.59, 95% CI 1.17-5.73, p=.02), conversion procedure (OR 4.84, 95% CI 2.21-10.62, p<.01), re-do procedure (OR 1.91, 95% CI 1.31-2.78, p<.01), and prolonged operative time (OR 1.79, 95% CI 1.32-2.41, p<.01).
Conclusions: Anastomotic leak is a rare but morbid complication, frequently requiring reoperation. Most identified risk factors appeared to be unmodifiable. Accurate risk stratification is paramount in helping the patient make an informed decision when choosing to undergo bariatric surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86664
Program Number: P630
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster