Predictors and outcomes of leak after Roux-en-Y gastric bypass: an analysis of the MBSAQIP data registry

Mocanu, Valentin; Dang, Jerry; Ladak, Farah; Switzer, Noah; Birch, Daniel W.; Karmali, Shahzeer

doi:10.1016/j.soard.2019.01.012

Cited by 40 publications

(27 citation statements)

References 16 publications

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“…It corresponded to the analysis from 2015 and was higher than the reported rate for primary LRYGB in MBSAQIP analysis (0.6%). [26] Our study showed that conv-LRYGB increased the risk of short term complications in comparison to conv-LSG 0.015 The medical specialty of the physician performing the principal operative procedure (bariatric surgeon) 0.011 significantly. However, the effect size was mainly moderate, and it is difficult to determine if both procedures are comparable in terms of long-term complications because there is not enough data.…”

Section: Discussionmentioning

confidence: 61%

Safety of Single Stage Revision Laparoscopic Sleeve Gastrectomy Compared to Laparoscopic Roux-Y Gastric Bypass after Failed Gastric Banding

Janik

Ibikunle

Khan³

et al. 2020

OBES SURG

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Background Reoperation, after failed gastric banding, is a controversial topic. A common approach is band removal with conversion to laparoscopic Roux-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in a single-step procedure. Objective This study aimed to assess the safety of revisional surgery to LSG compared to LRYGB after failed laparoscopic adjustable gastric banding (LAGB) based on MBSAQIP Participant User File from 2015 to 2018. Methods Patients who underwent a one-stage conversion of LAGB to LSG (Conv-LSG) or LRYGB (Conv-LRYGB) were identified in the MBSAQIP PUF from 2015 to 2017. Conv-LRYGB cases were matched (1:1) with Conv-LSG patients using propensity scoring to control for potential confounding. The primary outcome was all-cause mortality. Results A total of 9974 patients (4987 matched pairs) were included in the study. Conv-LRYGB, as compared with conv-SG, was associated with a similar risk of mortality (0.02% vs. 0.06%; relative risk [RR], 0.33; 95% confidence interval [CI], 0.03 to 3.20, p = 0.32). Conversion to LRYGB increased the risk for readmission (6.16% vs. 3.77%; RR, 1.63; 95%CI, 1.37 to 1.94, p < 0.01); reoperation (2.15% vs. 1.36%; RR, 1.57; 95%CI, 1.17 to 2.12, p = <0.01); leak (1.76% vs. 1.02%; RR, 1.57; 95%CI, 1.72 to 2.42, p < 0.01); and bleeding (1.66% vs. 1.00%; RR, 1.66; 95%CI, 1.7 to 2.34, p < 0.01). Conclusions The study shows that single-stage LRYGB and LSG as revisional surgery after gastric banding, are safe in the 30-day observation with an acceptable complication rate and low mortality. However, conversion to LRYGB increased the risk of perioperative complications.

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Section: Discussionmentioning

confidence: 61%

Safety of Single Stage Revision Laparoscopic Sleeve Gastrectomy Compared to Laparoscopic Roux-Y Gastric Bypass after Failed Gastric Banding

Janik

Ibikunle

Khan³

et al. 2020

OBES SURG

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“…Patients who undergo bariatric surgery have the highest chance of achieving long-term weight loss, reduced cardiovascular comorbidities, and overall reduced mortality and morbidity. [3][4][5][6] The American Society for Metabolic and Bariatric Surgery reports that 252 000 cases of bariatric procedures took place in 2018, with laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-En-Y gastric bypass (RYGB) representing 61.4% and 17% of all cases, respectively. 7,8 Although initially the bariatric procedure of choice, laparoscopic gastric banding has fallen out of favor to SG and RYGB, with SG gradually becoming the primary procedure undergone worldwide.…”

Section: Introductionmentioning

confidence: 99%

“…9 GL is an extremely serious complication and is one of the primary causes of readmission and reoperation in bariatric surgical cases. 5,9,[11][12][13][14] As a result, GL is one of the most dreaded complications. In order to reduce this risk, multiple surgical techniques have been developed such as oversewing of staples lines and the use of seam guard.…”

Section: Introductionmentioning

confidence: 99%

Drain Placement During Bariatric Surgery, Helpful or Harmful?

Gray

Dawoud

Janelle

et al. 2020

The American Surgeon

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Introduction Routine drain placement is still widely used in both sleeve gastrectomy (SG) and Roux en Y gastric bypass (REYGB). There is mounting evidence that drains may increase complication risk without preventing reoperation or other complications. Methods Data from 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Participant Use File was evaluated for drain use during laparoscopic REYGB and SG. Primary outcomes were superficial and deep surgical site infections (SSI), reintervention/reoperation, and readmission. Preoperative patient risk factors were also compared to evaluate for association with drain placement. Results A total of 148 260 patients fit the inclusion criteria. Drains were used in 23 190 (15.6%) cases and not used in 125 070 (84.4%). Drain placement during surgery was associated with increased odds of superficial SSI, deep incisional SSI, and organ space SSI. Patients with drains were found to have increased odds of requiring at least 1 reoperation or intervention within 30 days of surgery. Preoperative risk factors associated with drain placement included diabetes mellitus, a history of chronic obstructive pulmonary disease, and oxygen dependence. Smokers were slightly less likely to have a drain placed. There was no significant association with chronic steroid and immunosuppressant usage. Conclusion There is mounting data against drain placement during bariatric surgery. Prior studies using MBSAQIP data have shown an increased complication rate with drains, and our data set supports the idea that drains may increase complications after surgery. While no randomized prospective trials have been performed looking at drain usage in bariatric surgery, the growing retrospective data certainly inform against the regular use of drains.

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“…Specific reasons behind this are unclear and may reflect an increased incidence of postoperative leak. The MBSAQIP does not have a specific variable for leaks and many authors use drain in place after 30 days as a surrogate [47,48]. However, this is at odds with the finding that Hispanic patients have less organ space infections; one would also expect to see an increase in Hispanic patients with a leak.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Bariatric Surgery Complications and Mortality Using the MBSAQIP Data Registry

et al. 2020

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Background Racial disparities in postoperative complications have been demonstrated in bariatric surgery, yet the relationship of race to complication severity is unknown. Study Design Adult laparoscopic primary bariatric procedures were queried from the 2015 and 2016 MBSAQIP registry. Adjusted logistic and multinomial regressions were used to examine the relationships between race and 30-day complications categorized by the Clavien-Dindo grading system. Results A total of 212,970 patients were included in the regression analyses. For Black patients, readmissions were higher (OR = 1.39, p < 0.0001) and the odds of a Grade 1, 3, 4, or 5 complication were increased compared with White patients (OR = 1.21, p < 0.0001; OR = 1.21, p < 0.0001; OR = 1.22, p = 0.01; and OR = 1.43, p = 0.04) respectively. The odds of a Grade 3 complication for Hispanic patients were higher compared with White patients (OR = 1.59, p < 0.0001). Conclusion Black patients have higher odds of readmission and multiple grades of complications (including death) compared with White patients. Hispanic patients have higher odds of a Grade 3 complication compared with White patients. No significant differences were found with other races. Specific causes of these disparities are beyond the limitations of the dataset and stand as a topic for future inquiry.

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Predictors and outcomes of leak after Roux-en-Y gastric bypass: an analysis of the MBSAQIP data registry

Cited by 40 publications

References 16 publications

Safety of Single Stage Revision Laparoscopic Sleeve Gastrectomy Compared to Laparoscopic Roux-Y Gastric Bypass after Failed Gastric Banding

Safety of Single Stage Revision Laparoscopic Sleeve Gastrectomy Compared to Laparoscopic Roux-Y Gastric Bypass after Failed Gastric Banding

Drain Placement During Bariatric Surgery, Helpful or Harmful?

Racial Disparities in Bariatric Surgery Complications and Mortality Using the MBSAQIP Data Registry

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