Valentin Mocanu1, Jerry Dang1, Farah Ladak1, Noah Switzer2, Daniel Birch1, Shahzeer Karmali1. 1University of Alberta, 2The Ohio State University
BACKGROUND: The purpose of this study is to examine gastrointestinal leak in patients undergoing Roux-en-Y gastric bypass (RYGB) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement (MBSAQIP) data registry.
Gastrointestinal leak is one of the most severe postoperative complications following RYGB, occurring in up to 2% of all patients. This has led to adoption of simpler procedures, such as sleeve gastrectomy (SG), which have improved safety profiles but potentially less effective long-term metabolic outcomes. Yet, in contrast to SG, a paucity of modern literature exists regarding predictors of leak for RYGB.
METHODS AND PROCEDURES: We identified all MBSAQIP patients who underwent RYGB in 2015 and 2016. Primary outcomes of interest include identifying the prevalence, impact, and predictors of leak in RYGB patients. Our secondary outcomes of interest include characterizing overall complication rates in RYGB patients. Univariate analysis of pre-, intra-, and post-operative variables was performed using Chi-squared tests for categorical data and independent sample t-test for continuous data. A non-parsimonious multivariable logistic regression model was then developed to determine predictive factors for development of leak.
RESULTS: A total of 77596 patients underwent RYGB from 2015 to 2016. The majority of patients were female (79.8%), white (75.9%), and underwent laparoscopic RYGB (89.7%). The mean age of patients was 45.2 years (SD 11.9) with a mean BMI of 46.3 kg/m2(SD 8.17). Complication rates for RYGB were low with a mortality of 0.2% and a total complication rate of 7.5%. A total of 476 leaks were identified with an overall leak rate of 0.6% and a mortality of 1.5%. Leak was associated with a statistically significant increase in all complication rates. Multivariable logistic regression analysis revealed the following statistically significant independent predictors of leak: BMI, age, ASA score > 3, prior PE, and partially dependent functional status. Albumin and increased operative time were the only independent protective variables after adjusting for confounders and interactions.
CONCLUSION: Using the robust MBSAQIP database, we found RYGB to be a safe procedure with low morbidity and mortality. The overall leak rate was 0.6% with leak significantly increasing all other complications, readmission and reoperation rates at 30 days. Logistic regression identified prior PE and partially dependent functional status as the two largest predictors of leak while increased albumin was the only protective factor. Optimizing pre-operative nutrition and strength in these patients through structured multidisciplinary programs may therefore have a role in the ongoing improvement of outcomes following RYGB.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95778
Program Number: P154
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster