Perioperative Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Patients with Diabetes Mellitus: an Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Database

Abstract

Background The safety and efficacy of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) to treat obesity and associated comorbidities, including diabetes mellitus, is well established. As diabetes may add risk to the perioperative period, we sought to characterize perioperative outcomes of these surgical procedures in diabetic patients. Methods Using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, we identified patients who underwent LSG and LRYGB between 2015 and 2017, grouping by non-diabetics (NDM), non-insulindependent diabetics (NIDDM), and insulin-dependent diabetics (IDDM). Primary outcomes included serious adverse events, 30day readmission, 30-day reoperation, and 30-day mortality. Univariate and multivariable analyses were used to evaluate the outcome in each diabetic cohort. Results Multivariable analysis of patients who underwent LSG (with NDM patients as reference) showed higher 30-day mortality (NIDDM AOR = 1.52, p = 0.043; IDDM AOR = 1.91, p = 0.007) and risk of serious adverse events (NIDDM AOR = 1.15, p < 0.001; IDDM AOR = 1.58, p < 0.001) in the diabetic versus NDM groups. Multivariable analysis of patients who underwent LRYGB (with NDM patients as reference) showed higher risk of serious adverse events (NIDDM AOR = 1.09, p = 0.014; IDDM AOR = 1.43, p < 0.001) in the diabetic versus NDM groups. Conclusions Diabetics who underwent LSG and LRYGB had higher rates of several perioperative complications compared with non-diabetics. IDDM had a stronger association with several perioperative complications compared with NIDDM. This increase in morbidity and mortality is modest and should be weighed against the real benefits of bariatric surgery in patient with obesity and diabetes mellitus.

Postoperative short-term mortality between insulin-treated and non-insulin-treated patients with diabetes after non-cardiac surgery: a systematic review and meta-analysis

“…A total of 17,265 studies were retrieved, and 22 studies were eventually included ( 15 , 16 , 19 , 22 , 23 , 33 – 49 ). Details of the screening process are shown in Figure 1 .…”

“…The Revised Cardiac Risk Index included insulin-treated diabetes as a predictor of cardiac risk after non-cardiac surgery ( 20 ). Notably, although studies have reported higher short-term postoperative mortality in insulin-treated diabetes than in non-insulin-treated diabetes, there was no correlation between insulin-treated diabetes and postoperative mortality in multivariate logistic regression analysis ( 21 – 23 ). Another study also showed that in elderly patients with coronary artery disease or heart failure, insulin exposure 3 months before surgery was not associated with 30-day mortality after non-cardiac surgery ( 24 ).…”

Financial Impact of Metabolic Surgery on Prescription Diabetes Medications in Michigan

“…Moreover, extrapolating results assumes that the larger population of patients undergoing bariatric surgery have a similar distribution of prescription use for diabetes. Nevertheless, given that fewer than 1% of the eligible population undergo surgical treatment for obesity and metabolic disease in the US and only one-fourth of patients undergoing surgery are diagnosed with diabetes, we believe that there is an opportunity to decrease the financial and medical burden of diabetes …”

Type 2 Diabetes and HbA1c Predict All‐Cause Post‐Metabolic and Bariatric Surgery Hospital Readmission

“…Non-Hispanic Black (NHB) (odds ratio [OR]: 1.56, 95% CI: 1.34-1.81) and Hispanic (OR: 1.29, 95% CI: 1.05-1.58) individuals have the highest risk of readmission post MBS compared with non-Hispanic White (NHW) (7). Type 2 diabetes has been shown to be a significant predictor of readmission, serious adverse events, and mortality post MBS (7)(8)(9)(10)(11)(12)(13).…”

“…Non‐Hispanic Black (NHB) (odds ratio [OR]: 1.56, 95% CI: 1.34‐1.81) and Hispanic (OR: 1.29, 95% CI: 1.05‐1.58) individuals have the highest risk of readmission post MBS compared with non‐Hispanic White (NHW) (7). Type 2 diabetes has been shown to be a significant predictor of readmission, serious adverse events, and mortality post MBS (7‐13). A recent study demonstrated that patients with type 2 diabetes who had undergone MBS had up to 15‐fold‐higher readmission rate compared with those without diabetes (14).…”