Rami R Mustafa1, Heba A Elghalban, MD2, Abbas Mujjahid, MD1, Leena Khaitan, MD, MPH1. 1Department of surgery, Cleveland Medical Center, University Hosptals, 2Family Medicine Department, Faculty of Medicine, Menoufia University
INTRODUCTION: The MBSAQIP allows a bird’s eye view of the milieu of bariatric surgery in the United States. The aim of this study is to assess volume trends and outcomes in revisional versus primary laparoscopic sleeve gastrectomy and gastric bypass utilizing the MBSAQIP PUF 2015 and 2016.
METHODS: All primary and revisional laparoscopic sleeve (PSG and RSG) and gastric bypass (PGB and RGB) cases enrolled in the MBSAQIP data registry of 2015 and 2016 were included. Demographic data safety parameters including readmissions, reoperations, interventions, and drain placement in the first 30 days. Comparisons were made between PSG and RSG, PGB and RGB within and between years. SPSS was used for analysis. Chi square analysis used when appropriate. P<0.05 considered significant.
RESULTS: The total number of cases increased from 2015 (141,577) to 2016 (158,043), demonstrating 11.5% increase in case volume. Sleeve gastrectomy represented the majority of cases both years (98,292 (69%) in 2015 versus 114,251 (72.2%) in 2016). In 2015, 92,666 patients have PSG and increased by 16.2% in 2016 (107,726). RSG also increased 15.9% over the 2 years. (6525 VS 5626 patients) In contrast, PGB remained stable across the 2 years. RGB increase significantly by 17.4% (3718 to 4367 cases).
Outcomes across the years were reviewed. In 2016, 30-day readmission was higher with RSG versus PSG (4.0 vs 3.1%, p < 0.05). Reoperation higher for RSG versus PSG (1.5% vs 0.8%, p<0.05) as was reintervention within 30 days (1.8% versus 0.9%, p<0.05). 30-day readmission rate for RGB vs PGB was 8 % vs 5.9 % (p < 0.05). Reoperation and reintervention within 30 days with RGB vs PGB 4.4% vs 2.5% (p<0.05) and 3.9 vs 2.5%(p<0.05), respectively. RGB had higher readmission rates (8% vs 4%) than RSG. ICU admissions were doubled for RGB vs RSG (1.8% versus 0.6%, p<0.05). Incidence of at least one reoperation or one intervention following RGB were compared to RSG (4.4 vs 1.5% and 3.9 vs 1.8% respectively, p < 0.05). Overall, the incidence of reoperation, reintervention within 30 days, ICU admission, readmission all decreased from 2015 to 2016.
CONCLUSION: The number of revisions of gastric sleeve and gastric bypass is increasing, as is the number of primary sleeves. Primary bypass numbers are stable. RGB is twice as likely to have a complication as RSG. Despite the increase in revisional surgery, the overall incidence of complications is decreasing in bariatric surgery.
KEYWORDS: Safety, Revisional surgery, Gastric bypass, Sleeve gastrectomy, MBSAQIP
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95296
Program Number: S077
Presentation Session: Bariatric II – Revisions
Presentation Type: Podium