Related Experiment Video
Updated: Dec 26, 2025
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Conversions to open surgery greatly increase complications: an analysis of the MBSAQIP database
Benjamin Clapp1, Evan Liggett1, Cong Phan1
1Texas Tech Health Sciences Center Paul Foster School of Medicine, El Paso, Texas.
Background:
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database tracks patients, techniques, and outcomes for 30 days. The overwhelming majority of cases reported are performed using a laparoscopic technique. Bariatric surgeons rarely have to convert from laparoscopy to open surgery.
Objectives:
We examined the MBSAQIP to determine the characteristics of patients who underwent conversion and evaluated their short-term outcomes.
Settings:
University program in the United States and nationwide clinical database.
Methods:
The MBSAQIP Public Use File for 2017 was examined for primary bariatric operations. We identified patients who underwent a sleeve gastrectomy or gastric bypass using a minimally invasive technique. We identified patients who underwent conversion to another operative technique or were converted to open surgery and analyzed preoperative characteristics and postoperative complication rates. Relative risks (RR) were calculated for complications. P value was significant at < .05.
Results:
There were 186,962 patients in the entire cohort. Six hundred nine patients underwent conversion from the original surgical approach to either open surgery (n = 457) or to another technique (n = 152). Patients with preoperative oxygen dependency, poor functional status, previous foregut/obesity surgery, preoperative renal insufficiency, and anticoagulation were more likely to undergo conversion. Patients who underwent conversion to the open approach had longer operative times (191 versus 86.6 min [P < .001]) and longer time to discharge (6.2 versus 1.6 d [P < .001]). The RR of death was 18.2 (95% confidence interval 8.7-37.6, P < .001) for procedures converted to open. The RR of sepsis was 10.1 (95% confidence interval 4.2-24.2, P < .001) and the RR for all complications was increased throughout for patients undergoing conversion.
Conclusions:
Patients in the MBSAQIP database that undergo conversion to the open surgical approach are at a greatly increased risk for death and complications.
Insights
Conversion to open surgery during bariatric procedures significantly increases patient risk. Patients converted to open approach face higher rates of death, sepsis, and overall complications compared to minimally invasive techniques.
Area of Science:
- Bariatric Surgery Outcomes
- Minimally Invasive Surgery
- Surgical Complications
Background:
- The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database tracks bariatric surgery outcomes.
- Laparoscopic techniques dominate bariatric procedures, with rare conversions to open surgery.
Purpose of the Study:
- To analyze patient characteristics associated with conversion during bariatric surgery.
- To evaluate short-term outcomes for patients undergoing conversion from laparoscopic to open surgery.
Main Methods:
- Analysis of the 2017 MBSAQIP Public Use File for primary bariatric operations (sleeve gastrectomy, gastric bypass).
- Identification of patients converted to open surgery or another technique.
- Comparison of preoperative factors and postoperative complication rates, calculating relative risks (RR).
Main Results:
- Six hundred nine of 186,962 patients underwent conversion.
- Preoperative factors like oxygen dependency and prior surgery increased conversion likelihood.
- Conversion to open surgery led to longer operative times, delayed discharge, and significantly higher RR for death (18.2), sepsis (10.1), and overall complications.
Conclusions:
- Conversion to open surgical approach in bariatric procedures is associated with substantially increased risks.
- Patients undergoing conversion face a greatly elevated risk of mortality and severe complications.
More Related Videos
03:07Single-Port Robotic-assisted Transaxillary Breast-conserving Surgery: A Prospective, Single-arm, Non-randomized Phase IIa Clinical Trial
Published on: August 19, 2025
05:30Surgical Approach and Complications of Stand-alone Lateral Trans-Psoas Interbody Fusion
Published on: February 14, 2025
Related Concept Videos
01:25Urinary Tract Calculi VI: Surgical Management
01:14SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...