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Published on: June 11, 2012
Does concomitant cholecystectomy at time of Roux-en-Y gastric bypass impact adverse operative outcomes?
Robert B Dorman1, Wei Zhong, Anasooya A Abraham
1University of Minnesota, Minneapolis, MN, USA.
Insights
Performing Roux-en-Y gastric bypass with cholecystectomy increases risks for major adverse events in laparoscopic surgery and prolonged length of stay. These findings aid decisions on combining procedures.
Area of Science:
- Bariatric surgery outcomes
- Surgical safety and quality improvement
Background:
- Roux-en-Y gastric bypass (RYGB) is a common bariatric procedure.
- Concomitant cholecystectomy (gallbladder removal) during RYGB is sometimes performed.
- The safety of combining RYGB with cholecystectomy (RYGB + C) requires further investigation.
Purpose of the Study:
- To evaluate the risk of adverse events in patients undergoing RYGB + C compared to RYGB alone.
- To identify specific risk factors associated with combined procedures.
Main Methods:
- Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database (2005-2009).
- Inclusion of 32,946 patients who underwent RYGB, with 1,731 also undergoing cholecystectomy.
- Multivariate logistic regression to assess 30-day mortality, major adverse events, and prolonged length of stay (PLOS).
Main Results:
- RYGB + C was associated with increased major adverse events in laparoscopic RYGB but not open procedures.
- Patients undergoing RYGB + C experienced a higher incidence of PLOS regardless of surgical approach.
- No significant difference in 30-day mortality was observed between RYGB and RYGB + C groups after adjustment.
Conclusions:
- Concomitant cholecystectomy during laparoscopic RYGB increases the risk of major adverse events.
- RYGB + C is linked to a higher risk of prolonged length of stay for both open and laparoscopic approaches.
- These findings support informed decision-making regarding the safety of combining RYGB and cholecystectomy.
Background:
We hypothesized that patients undergoing Roux-en-Y gastric bypass (RYGB) with concomitant cholecystectomy (RYGB + C) would be at greater risk for adverse events compared to patients undergoing RYGB alone.
Methods:
Patients who underwent a RYGB were identified in the 2005-2009 American College of Surgeons National Surgical Quality Improvement Program Database. Multivariate logistic regression with adjustment for confounding variables was utilized to identify risk factors for mortality at 30 days, major adverse events, and prolonged length of stay (PLOS).
Results:
We identified 32,946 patients who underwent RYGB; of these, 1,731 (5.2%) underwent RYGB + C. Overall, RYGB + C was a risk factor for predicting major adverse events following laparoscopic but not open procedures. Regardless of approach, PLOS was more common among RYGB + C patients following adjustment. Overall mortality at 30 days was low and did not vary with concomitant cholecystectomy following adjustment.
Conclusions:
The risk for major adverse events is significantly greater for RYGB + C patients following laparoscopic procedures, and the risk for PLOS is greater for RYGB + C patients following both open and laparoscopic procedures. The short-term risks identified in this study can assist in decision-making when considering concomitant cholecystectomy at the time of RYGB.
