Farah Ladak, MD, MPH, Jerry Dang, MD, PhDc, Noah Switzer, MD, MPH, FRCSC, Valentin Mocanu, MD, Daniel W Birch, MSc, MD, FRCSC, FACS, Shazeer Karmali, MD, MPH, FRCSC, FACS. University of Alberta
INTRODUCTION: The objective of this study was to identify early complications that result in intervention or reoperation following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYBG), the timeframe within which to expect them, and factors that influence the likelihood of intervention and reoperation. Complications arising from RYGB and SG are not insignificant and can necessitate additional invasive interventions or reoperation. This study provides a granular assessment of the morbidity associated with these procedures.
METHODS AND PROCEDURES: Data for this study were obtained from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program’s participant use files for 2015 and 2016. Statistical analysis was performed using STATA 15 (StataCorp, College Station, TX). Between group differences were assessed via univariate analysis where chi2 was used for categoric data and independent t-test was used for continuous data. Predictors for reoperation and intervention were identified using multivariable logistic regression analysis. A combination of forward and purposeful selection was used in the creation of the final model. A goodness of fit test was conducted to estimate the predictive utility of the model.
RESULTS: In 2015 and 2016, 243,747 underwent RYGB or SG, of which 3,014 had a reoperation and 1,536 had an intervention. Complications occurred in 5.48% of RYGB patients and 2.28% of SG patients, the most common of which was bleeding. Anastomotic/staple line leaks were rare, affecting only 0.08% and 0.16% of SG and RYGB patients, respectively. SG was associated with far fewer interventions (0.85% vs. 2.2%). and re-operations than RYGB (0.67% vs. 2.5%) and was associated with a lower risk of re-intervention and re-operation (OR: 0.45, p<0.001). Renal insufficiency, including dialysis dependency, was an important predictor of reoperations among bariatric surgery patients. This was also true of interventions however, history of pulmonary embolism and use of therapeutic anticoagulation were marginally stronger predictors.
CONCLUSIONS: This study provides a representative assessment of perioperative morbidity in two of the most commonly performed bariatric procedures: SG and RYGB. Complications were predominantly bleeding and soft tissue infections with a very low incidence of anastomotic or staple line leaks. Reoperation and intervention were relatively infrequent but more common among RYGB patients, corroborating what has been observed in smaller studies. These findings, in conjunction with new efficacy data demonstrating comparable long-term weight loss between RYGB and SG, provide further support for the safety, effectiveness and cost efficiency of SG.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93185
Program Number: P047
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster