Thirty days post-operative complications after Sleeve Gastrectomy, Gastric Bypass and Mini Gastric Bypass/one Anastomosis Gastric Bypass. Analysis of the Italian Society for Bariatric Surgery and Metabolic Disorders (S.I.C.OB.) database of 7 years time frame

Abstract

Background: To date, the scientifi c community has mainly focused on outcomes of obesity surgery such as weight loss and resolution of associated complications. Adverse post-operative events and reoperation rates have been poorly reported even if they are a marker of surgical safety and therefore of great importance in guiding patients and surgeons in the choice of the more suitable operation. Methods:This retrospective multicenter observational study is based on the data extracted from the Italian Society of Bariatric Surgery and Metabolic Disorders (S.I.C.OB.) database, which covers almost all the bariatric operations performed in Italy. We analysed the 30 days post-operative complications occurring, in the period from 2009 to 2015, after Roux-en-Y Gastric Bypass (RYGB), Sleeve Gastrectomy (SG) and Mini Gastric Bypass/One Anastomosis Gastric Bypass (MGB/OAGB) qualitatively, quantitatively and on the basis of the Clavien-Dindo classifi cation of surgical complications. Complications following surgeries were tested using the 95% confi dence interval. Statistical analysis was performed with Statistical Analysis System (SAS). Results:In the 2009-2015 time frame, a total of 31,624 operations were performed of which 6,864 RYGB, 10,833 SG and 992 MGB/OAGB. The complication rate was 4.39 %, 4.04 % and 3.83% respectively. The most frequent complications were hemoperitoneum (0.9%) and perforation, fi stula and dehiscence (1%) which were higher in SG when compared with RYGB (with a statistical signifi cance) and when compared with MGB/OAGB (without a statistical signifi cance). When dividing the complications by the different grades of the ClavienDindo classifi cation, the only signifi cant difference encountered, from a statistical standpoint, was between MGB/OAGB and SG. MGB/OAGB was associated with a lower grade I Clavien-Dindo complication rate (1.31% versus 2.34%). Conclusions:This study supports a safe profi le of obesity surgey in Italy, along with positive bariatric outcomes. The rate of 30 days post-operative complications is progressively lower after MGB/OAGB (3.83%), SG (4.04%) and RYGB (4.39%) respectively. In particular, MGB/OAGB records statistically less low-grade Clavien-Dindo complications compared to SG and RYGB.

Low overall mortality during 10 years of bariatric surgery: nationwide study on 63,469 procedures from the Scandinavian Obesity Registry

“…The present overall mortality is one of the lowest reported so far. Denmark reports a 30-and 90day mortality of .04% and .05%, respectively, in 11,374 operated patients [16], while other European countries report somewhat higher 30-day mortality, including Holland (.06%, n 5 18,783) [17], Britain (.14%, n 5 22,199) [18], and Italy (.15%, n 5 18,689) [19]. The present 90-day mortality is similar to a large French cohort (.12%, n 5 133,804) [20].…”

Results from the Scandinavian Obesity Surgery Registry: A narrative review

“…In a recent cohort study, a very low overall 90‐day and 1‐year mortality rate was shown, 0.06% and 0.19%, respectively, both decreasing over the 10‐year study period 33 . The result is in line or below the data published from other countries 34–37 . In a multivariate analysis, depression (OR 2.38), leakage (OR 9.32), and thromboembolic events (OR 7.60) increased mortality risks at both time points, whereas age and abdominal circumference were also associated with increased mortality at 1 year.…”

“…33 The result is in line or below the data published from other countries. [34][35][36][37] In a multivariate analysis, depression (OR 2.38), leakage (OR 9.32), and thromboembolic events (OR 7.60) increased mortality risks at both time points, whereas age and abdominal circumference were also associated with increased mortality at 1 year. The predictive value of the Obesity Surgery Mortality Risk Score (OS-MRS), constructed by DeMaria et al in 2007, 38,39 was also confirmed.…”