Zachary C Dietch, MD, MBA, Peter Hallowell, MD. University of Virginia
INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) has gained rapid popularity as a single-stage operation for the treatment of morbid obesity at the same time that gastric banding (BAND) has largely fallen out of favor due to poor outcomes in achieving durable weight loss and resolution of comorbidities. As a result, simultaneous conversion (CONV) of BAND to LSG is now commonly performed, however, little is known about the safety of such an approach. We hypothesized that CONV is associated with higher 30-day risk-adjusted serious morbidity.
METHODS AND PROCEDURES: Preoperative characteristics and 30-day outcomes from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Files 2010-2014 were selected for all patients who underwent LSG. Patients undergoing concurrent BAND removal were identified. Descriptive comparisons were performed using Chi-square and Wilcoxon rank-sum tests as appropriate. Multivariate logistic regression using a priori selected variables was performed to assess the independent association between BAND removal and a composite measure of 30-day serious morbidity and mortality.
RESULTS: Overall, 35,307 patients met criteria for inclusion, of which 34,364 (97.3%) underwent LSG alone and 943 (2.7%) underwent CONV. The median age of patients undergoing CONV was higher (46 vs 44 years, p<0.001) and a greater percentage of CONV patients was female (84.8% vs 77.9%, p<0.001) than LSG patients. In comparison to LSG patients, CONV patients had lower rates of common comorbidities, including diabetes (14.9% vs 23.1%, p<0.001), dyspnea (8.3% vs 12.3%, p<0.001), hypertension (41.9% vs. 48.6%, p<0.001) and tobacco use (7.2% vs 9.8%, p<0.001), as well as lower median BMI (41 vs 44, p<0.001). Individual unadjusted outcomes of serious 30-day complications were similar between both groups, as was a composite measure of serious morbidity (CONV 4.3% vs LSG 3.6%, p=0.1). However, after controlling for demographics, comorbidities, and concurrent band removal, CONV was associated with increased odds of serious 30-day morbidity (1.44, 95% CI 1.03-1.97) (c-statistic: 0.60)
CONCLUSION: Serious morbidity following LSG is uncommon, however, CONV is associated with a modest increase in risk-adjusted adverse 30-day outcomes. Patients being evaluated for CONV should be counseled about the added risks versus LSG alone. Additional variables not accounted for by ACSNSQIP likely account for the difficulty in predicting adverse outcomes after bariatric surgery and further research is warranted to identify whether the incremental risks of CONV may be modifiable.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80908
Program Number: S124
Presentation Session: Bariatric surgery – Sleeves, Conversions and More
Presentation Type: Podium