30-Day Postoperative Outcomes in Patients With Limited Mobility - A Propensity Score-Matched Comparative Analysis

There is limited data correlating preoperative mobility limitations with clinical outcomes in bariatric patients. This study uses propensity score matching (PSM) to compare 30-day outcomes between patients with preoperative limited mobility (LM) versus patients without (non-LM).

Using the 2016-2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, patients undergoing primary laparoscopic sleeve gastrectomy or gastric bypass were identified. Two cohorts were defined using preoperative LM status. To adjust for confounders, 1:1 PSM was performed using 25 preoperative characteristics, and balance was assessed with standardized mean difference. Preoperative patient demographics and postoperative 30-day outcomes were compared in both matched and unmatched cohorts.

453,146 patients were identified, of which 6942 (1.47%) were LM and 464,555 were non-LM. 1:1 PSM matched 6624 LM to 6624 non-LM patients with good balance for all covariates. LM had higher rates of unplanned intubation (0.4% vs 0.7%, P < .01), unplanned admission to ICU (1.4% vs 2.5%, P < .01), readmissions (4.1% vs 4.9%, P = .036), unplanned reoperation (1.5% vs 2.0%, P = .02), and 30-day mortality (0.2% vs 0.5%, P = .02). Complications including acute renal failure, intra/postoperative myocardial infarction, venous thrombosis, and pulmonary embolism were not significantly different between the matched groups.

After adjusting for confounders, patients with preoperative limited mobility have higher rates of intubation, ICU admission, reoperation, readmission, and mortality. Prudent pre-operative candidate selection, counseling, and risk mitigation strategies are needed when a patient with limited mobility status is being considered for bariatric surgery.