Diabetic nephropathy and postoperative complications in metabolic and bariatric surgery: a propensity score-matched nationwide cohort study

Diabetic nephropathy (DN) is increasingly prevalent among people with obesity undergoing metabolic bariatric surgery (MBS) in the United States, yet its impact on perioperative complications remains poorly understood.

This study utilizes a large nationwide database to investigate the association between DN and in-hospital postoperative complications after MBS.

This retrospective cohort study analyzed data from the National Inpatient Sample (2016-2019). Adults with obesity undergoing MBS were identified using International Classification Of Diseases, tenth revision (ICD-10) codes. DN patients were matched 1:1 to non-DN controls using propensity score matching, balancing demographics, hospital characteristics, and 24 Elixhauser co-morbidities. Multivariate logistic regression assessed the association between DN and perioperative complications.

DN patients had significantly higher odds of blood transfusion (odds ratio (OR): 1.178, 95% confidence interval (CI): 1.026-1.353), anastomotic complications (OR: 1.669, 95% CI: 1.158-2.492), acute myocardial infarction (OR: 1.553, 95% CI: 1.276-1.891), acute kidney injury (AKI) (OR: 3.024, 95% CI: 2.786-3.281), urinary tract infection (UTI) (OR: 1.175, 95% CI: 1.054-1.309), and extended length of stay (LOS) (OR: 1.205, 95% CI: 1.118-1.300).

This study demonstrates that DN is a significant independent risk factor for blood transfusion, anastomotic complications, acute myocardial infarction, AKI, UTI, and prolonged hospitalization after MBS. These findings highlight the need for enhanced preoperative counseling and targeted perioperative management in this high-risk population.