Are Concomitant Operations During Bariatric Surgery Safe? An Analysis of the MBSAQIP Database

The American College of Surgeons tracks 30-day outcomes using the Metabolic and Bariatric Surgery Accreditation Quality Initiative Program (MBSAQIP) database. We examined the short-term outcomes of patients that undergo bariatric surgery concomitantly with other operations such as hernia repairs and cholecystectomy to determine the safety of this practice.

The MBSAQIP Participant Use Data File for 2015-2017 was examined for differences in primary bariatric operations vs concomitant procedures (CP). We looked for concurrent CPT codes for laparoscopic cholecystectomy (LC) and hernia repairs (ventral, epigastric, incisional, and inguinal). p was significant at < 0.05.

There were 464,674 cases, of which 15,614 had CP. For both LRYGB+LC and SG+LC, there were increased operative times and length of stay. There were statistically significant higher rates of readmission, reintervention, and reoperation for SG+LC vs SG alone, as well as for LRYGB+hernia and SG+hernia. There was a higher risk of death (p < 0.001) in LRYGB+hernia patients. Also, LRYGB+hernia patients had statistically significant increases in unplanned admission to the intensive care unit and pulmonary embolus. SG+hernia patients had a higher rate of ventilation > 48 h, unplanned admission to the ICU, pulmonary embolism, deep vein thrombosis, and readmission, reintervention, and reoperation.

There is a statistically higher rate of complications with concomitant procedures in the MBSAQIP database. Length of stay and operative times are increased in concomitant operations as are readmissions, reinterventions, and reoperations. These findings would indicate that additional procedures at the time of bariatric surgery should be deferred if possible.