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Bariatric surgery outcomes in oxygen-dependent patients: analysis of the MBSAQIP database

Sadaf Afraz¹, Jerry T Dang², Aryan Modasi²

¹Department of Medicine, Nova Southeastern University, Fort Lauderdale, Florida.

Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery

|August 11, 2019

Abstract

Background:

The number of bariatric procedures performed on complex, oxygen-dependent patients has increased. These patients often have other medical co-morbidities that can be improved after bariatric surgery; however, questions remain regarding their perioperative risk.

Objective:

To assess the safety of bariatric surgery among oxygen-dependent patients, and to compare outcomes in this patient group after laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy.

Setting:

University and private hospitals enrolled in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry.

Methods:

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data from 2015 to 2017 was analyzed. A multivariable regression analysis was performed looking at 30-day serious complications for oxygen-dependent patients, with a secondary propensity-matched analysis performed comparing patients undergoing laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass.

Results:

In total, 430,396 patients were analyzed, 3034 (0.7%) of whom were oxygen dependent. The absolute 30-day complication rate among oxygen-dependent patients was more than twice as high (8.24% versus 3.46%, P < .001). The postoperative leak (.69% versus .41%, P = .017), bleed (2.08% versus .91%, P < .001), cardiac event (.16% versus .07%, P = .034), and pneumonia rate (.89% versus .19%, P < .001) were all significantly higher. Mortality was significantly higher among oxygen-dependent patients (.49% versus .09%, P < .001). On multivariable analysis, oxygen dependency was an independent predictor of adverse outcomes (odds ratio 1.30 [1.22-1.50], P < .001). Laparoscopic Roux-en-Y gastric bypass was associated with a statistically significant higher complication rate compared with laparoscopic sleeve gastrectomy (13.23% versus 5.16%, P < .001).

Conclusion:

Oxygen-dependent patients undergoing bariatric surgery are at a higher risk of both morbidity and mortality postoperatively.

Keywords:

Bariatric surgery Bariatric surgery outcomes Laparoscopic Roux-en-Y gastric bypass Laparoscopic sleeve gastrectomy MBSAQIP database Oxygen dependency

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