National Analysis of Emergent Reoperations After Metabolic Bariatric Surgery Over 6 Years

Discuss rates of emergency reoperations within 30 days after metabolic bariatric surgery (MBS) from 2017 to 2022 in Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) Centers of Excellence. Also, identify the preoperative factors contributing to increased risk of emergency reoperation after MBS and evaluate the impact of emergent reoperations on postoperative outcomes within 30 days.

While prior studies have evaluated the outcomes associated with revisional surgeries many years after index MBS and reoperations within 30 days, little is known about the trends in emergent reoperations after MBS.

MBSAQIP database from 2017 to 2022 was utilized for evaluating the trends and outcomes related to emergent reoperations after MBS.

Overall, the rate of emergency reoperations has declined significantly (from 0.84% to 0.60%). Up to half the emergency reoperations occurred within postoperative day 0-3 and two-thirds occurred within 7 days from surgery. Some of the preoperative comorbidities and demographics of patients requiring emergency reoperations were older age, males, history of deep venous thrombosis, history of myocardial ischemia, gastroesophageal reflux disease, therapeutic anticoagulation, and chronic obstructive pulmonary disease. Analysis of postoperative outcomes after matching patients who underwent emergency reoperation with those who did not undergo reoperation showed higher rates of death (3.48% vs 0.19%, P < 0.001), acute renal failure (3.4% vs 0.1%, P < 0.001), unplanned ICU admissions (30.83% vs 0.83%, P < 0.001) and organ space infections (21.32% vs 0.52%, P < 0.001).

Emergent reoperations after MBS have significantly worse morbidity and mortality. Recognition of high-risk preoperative factors can help optimize the modifiable factors preoperatively and facilitate closer monitoring of vulnerable patients.