Complications Associated with Bariatric Surgery

Chicago—A database analysis of bariatric operations found that most people do not need to undergo another surgery. If they do have an additional procedure, they have low rates of complications, according to the researchers.

Of the patients who had a re-operation, 1.86% had a serious adverse event at 30 days and 2.42% had a serious adverse event at 1 year. The mortality rate was 0.14% at 30 days and 0.26% at 1 year. Patients also had an average 36% weight loss in the year after surgery.

Ranjan Sudan, MD, the study’s lead author, presented the results on Sunday during a plenary session at Digestive Disease Week. Covidien provided funding for the trial through an unrestricted grant to the American Society for Metabolic and Bariatric Surgery (ASMBS). However, Dr. Sudan said Covidien did not have any input on data collection, analysis, results, or preparation of the manuscript.

Health insurers typically pay for complications associated with bariatric surgeries, according to Dr. Sudan, but they often deny coverage of re-operations due to inadequate weight loss or resolution of comorbidities. He said insurers do not cover the re-operations because they perceive that re-operations are associated with higher complication rates and uncertain benefits. They also blame patients for failing to comply with the prescribed diet and exercise regimens.

To address issues related to bariatric surgeries, the ASMBS convened a task force that performed a systematic review and found there was not much high quality data. In this analysis, the group gathered data from June 2007 through March 2012 from the Bariatric Outcomes Longitudinal Database, a large, multi-institutional database that included information from 1029 surgeons at 709 hospitals.

Patients were included in the study if they were at least 18 years of age and had a primary bariatric operation or a re-operation for any reason, including complications or inadequate results.

The task force defined a primary operation as when no further re-operation occurred. If an operation re-occurred, the first operation was referred to as the index operation and the second operation was called the re-operation. The group further categorized the re-operations as corrective (index and re-operations were the same type of surgery) or conversion (index and re-operations were different types of surgery).

Of the 451,485 bariatric operations, 420,753 were considered primary surgeries and 28,683 were considered re-operations. Of the re-operations, 19,970 were corrective operations and 8750 were conversions. Patients in the re-operations group were slightly older than those in the primary operations group (46.6 years of age versus 45.5 years of age), which Dr. Sudan said was expected. Approximately 80% of patients were between 30 and 60 years of age. As patients aged, the number of re-operations increased.

Dr. Sudan added that 21.3% of patients undergoing primary operations were male compared with 15.0% having another operation. He said the researchers did not know why females were more likely to have another operation, but he mentioned females might have less resolution of comorbidities and weight loss than males. He also said males might be more reluctant than females to have another operation.

Of the primary operations, 51.2% were Roux-en-Y gastric bypass, 36.4% were laparoscopic adjustable gastric banding, 10.1% were sleeve gastrectomy, and 1.0% were biliopancreatic diversion with duodenal switch. The remainder were other procedures that are not commonly used.

Of the conversion operations, 57.5% were people who initially had laparoscopic adjustable gastric banding and then switched to another procedure. Most of the re-operations were Roux-en-Y gastric bypass or sleeve gastrectomy. The next most common group to have re-operations were patients who initially underwent vertical banded gastroplasty surgery, which is no longer used. Patients who initially underwent Roux-en-Y gastric bypass and then had another operation were most likely to have laparoscopic adjustable gastric banding.

The mean length of stay was 1.78 days for primary operations and 2.29 days for re-operations, including 2.04 days for corrections and 2.86 days for conversions.

Dr. Sudan said the database had a few limitations. The outcomes were self-reported and could have been under-reported, although there was an audit system to ensure data entry. Also, if patients switched practice locations, data may have been missed. The database also did not include baseline data for patients who had bariatric surgeries before 2007.

—Tim Casey