John R Montgomery, MD1, Seth A Waits, MD1, Justin B Dimick, MD, MPH2, Dana A Telem, MD, MPH2. 1University of Michigan, Dept Transplant Surgery, 2University of Michigan, Center for Healthcare Outcomes & Policy
Objective: The association between bariatric surgery and long-term weight loss and comorbidity improvement among obese patients with end-stage renal disease (ESRD) is well established. Moreover, for patients who subsequently undergo kidney transplantation, it is associated with improved patient and graft survival. However, the perioperative risks of bariatric surgery among obese ESRD patients are poorly characterized as data are limited to single-center studies that lack generalizability and may not detect rare events. In this context, we performed an analysis of perioperative safety of bariatric surgery in obese patients with ESRD using a national registry capturing >95% of bariatric operations.
Methods: Patients who underwent primary, laparoscopic sleeve gastrectomy or gastric bypass between 2015-2016 were identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participant use file. The primary outcome was a composite variable of death and severe, life-threatening complications within 30 days of operation. Logistic regression was used to compare adverse outcomes between ESRD patients (defined as dialysis-dependent) and those with normal renal function.
Results: During the study period, 299,373 bariatric operations were performed; of these, 836 (0.3%) patients had ESRD. ESRD patients were more likely to be older (48.6±10.4 vs 44.8±11.9 years, p<0.001), male (43.7 vs 20.2%, p<0.001), hypertensive (88.4 vs 72.2%, p<0.001), diabetic (55.0 vs 25.7%, p<0.001), and have poorer functional status (5.9 vs 1.0% partially-or-fully dependent, p<0.001). After adjusting for patient age, smoking status, hypertension, diabetes, and functional status, ESRD was associated with increased chance of death or severe, life-threatening complications (4.8 vs 1.9%, aOR 2.61[1.93-3.52], p<0.001). This difference was primarily driven by higher incidence of reoperation (3.6 vs 1.3%, p<0.001), transfusion ≥3 units (0.8 vs 0.2%, p<0.001), and death (1.0 vs 0.1%, p<0.001) among ESRD patients.
Conclusion: ESRD is associated with increased risk of death and severe, life-threatening complications after bariatric surgery when compared to patients with normal renal function. However, the absolute risk is low and largely driven by increased reoperation rates; it should not be prohibitive for operative consideration. Given the established long-term benefits of bariatric surgery in obese ESRD patients and improved post-transplantation patient and graft survival, this supports consideration of CMS-mandated referral for comprehensive weight-loss management with availability of surgical options in all obese ESRD patients, and especially among patients being considered for renal transplantation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94150
Program Number: P197
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster