Samantha Warwar1, Noah J Switzer1, Jerry Dang2, Megan Delisle3, Carla Holcomb1, Shahzeer Karmali2, Susan Maurer1, Bradley Needleman1, Sabrena Noria1. 1The Ohio State University, 2University of Alberta, 3University of Manitoba
INTRODUCTION: The purpose of this study was to identify predictors of 30-day mortality after bariatric surgery using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. . With improvements in perioperative care, 30-day mortality rates after bariatric surgery are < 0.1%; a rate similar to elective laparoscopic cholecystectomy. With such low mortality rates, identifying patients at increased risk becomes difficult. Given the emphasis on shared decision-making and informed consent, predictive tools have become increasingly useful to guide physician-patient discussions. Therefore,
METHODS AND PROCEDURES: This is a retrospective review of prospectively collected data from the MBSAQIP database for the years 2015 and 2016. Patients > 18 yo, who underwent a primary laparoscopic gastric bypass (RYGB) or sleeve gastrectomy (LSG) were included in the analysis. The outcome of interest was 30-day mortality. Multivariable logistic regression analysis selected by univariable screen was performed. A derivation was created using the 2015 dataset and validated using the 2016 data. Variables with p value < 0.05 in univariate analysis were included in the predictive model. A forward selection algorithm with an entry p value of < 0.01 was used to build a logistic regression model predicting probability of death within 30 days using the derivation data set. The area under the receiver operating characteristic curve was calculated for the derivation and validation dataset. The accuracy of the predictions was assessed with the Brier score
RESULTS: A total of 248, 286 patients were included in the analysis. Mean age was 44.64 + 11.93 years, with the majority of subjects being female (80%). Overall 30-day mortality rate was 0.1%, with 249 reported events. In the multivariable model, age (OR-1.04, 95% CI 1.02-1.05), gender(OR-0.56, 95% CI 0.42-0.73), BMI(OR-1.05, 95% CI 1.04-1.06), COPD (OR-1.82, 95% CI 1.09-3.04), operation length (OR-1.29, 95% CI 1.13-1.49), and therapeutic anticoagulation (OR-2.51, 95% CI 1.67-3.77) were all risk factors for 30 day mortality. The following prediction model was created.
Risk of Death= (13* therapeutic_anticoagulation) + (0.5*BMI) + (0.5*Age) + (3* Operationlength) + (-10* Female) + (8*Blackrace) + (3* Diabetes)
Subjects were stratified into high (>5%), medium (1- 5%), and low risk groups (<1%) for mortality at 30-days, based on points received from the model. The discrimination of the model was 0.80.
CONCLUSION: While death following bariatric surgery is rare, approximately 0.1%, a cohort of patients exist who are at increased risk. Identifying these patients before surgery may allow for proper informed consent and preoperative optimization.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95559
Program Number: P182
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
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