Haley Leesley, MD, Mia Shapiro, MD, Todd Stafford, MD, Beth Ryder, MD, Dean Roye, Sivamainthan Vithiananthan, MD. Warren Alpert Medical School of Brown University/Miriam Hospital, Providence, Rhode Island, USA
Introduction: Morbidly obese patients being evaluated for gastric bypass will often present with concurrent surgical pathology. The aim of this study is to determine if surgical risk is greater in patients undergoing an additional procedure at the time of laparoscopic roux-en-y gastric bypass (LRYGB) as compared to patients undergoing LRYGB alone.
Methods: A retrospective review was performed on all patients who underwent LRYGB or LRYGB plus a concurrent procedure between 2013-2017 at our institution using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. The most commonly performed concurrent procedures we included were paraesophageal hernia repair, ventral/umbilical hernia repair and cholecystectomy for symptomatic cholelithiasis. Our primary outcome was 30-day morbidity as defined by MSBAQIP. Our secondary outcomes included length of surgery, hospital length of stay, thirty-day readmission and major morbidity.
Results: We identified 620 total patients who underwent either a LRYGB or a LRYGB with one of the concurrent procedures listed above. 564 patients (91%) underwent LRYGB alone and 56 (9%) underwent LRYGB with a concurrent procedure. Patients who underwent LRYGB with concurrent procedures were significantly older (median age: 47.0 vs 43.0, p=0.02), however had a lower preoperative BMI (45 +/- 6.7 vs 47.8 +/-7.5 kg/m2, p=0.004). There were no significant differences in other medical comorbidities, including smoking, COPD, sleep apnea or hypertension. The average length of surgery was higher for patients undergoing a concurrent procedure (163 min +/- 47.7 vs. 146.7 min +/- 47.5, p=0.005). In regards to our primary outcome, we found that patients who underwent concurrent procedures were more likely to suffer a post-op morbidity (OR 4.11, 95% CI 1.74-9.72, p=0.005) when compared to those who had a LRYGB alone. They were also significantly more likely to suffer a major morbidity (OR 2.97, 95% CI 1.06-8.34) and the odds of a 30-day post-operative readmission was over 6 times higher (OR 6.05, 95% CI 1.96-18.8, p=0.005).
Conclusions: We found that adding a concurrent procedure on to a LRYGB was associated with increased length of surgery, increased rates of 30-day readmissions, and increased overall 30-day morbidity along with major morbidity.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94747
Program Number: P109
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster