Postoperative complications in bariatric surgery using age and BMI stratification: a study using ACS-NSQIP data

Background Bariatric surgery results in long-term weight loss and significant morbidity reduction. Morbidity and mortality following bariatric surgery remain low and acceptable. This study looks to define the trend of morbidity and mortality as it relates to increasing age and body mass index (BMI)...

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Bibliographic Details
Published in:	Surgical endoscopy Vol. 28; no. 12; pp. 3302 - 3309
Main Authors:	Sanni, Aliu, Perez, Sebastian, Medbery, Rachel, Urrego, Hernan D., McCready, Craig, Toro, Juan P., Patel, Ankit D., Lin, Edward, Sweeney, John F., Davis, S. Scott
Format:	Journal Article
Language:	English
Published:	Boston Springer US 01-12-2014 Springer Nature B.V
Subjects:	Abdominal Surgery Age Age Factors Aged Bariatric Surgery - methods Body Mass Index Databases, Factual Diabetes Female Gastroenterology Gastrointestinal surgery Gynecology Hepatology Humans Hypertension Intestinal obstruction Laparoscopy Logistic Models Male Medicine Medicine & Public Health Middle Aged Morbidity Mortality Multivariate Analysis Obesity Obesity - surgery Obesity, Morbid - surgery Patient satisfaction Postoperative Complications - etiology Proctology Pulmonary embolisms Regression analysis Risk Factors Sleep apnea Surgery Surgical anastomosis Weight control United States > US NSQIP data Age and BMI stratification Postoperative complications Bariatric surgery
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Summary:	Background Bariatric surgery results in long-term weight loss and significant morbidity reduction. Morbidity and mortality following bariatric surgery remain low and acceptable. This study looks to define the trend of morbidity and mortality as it relates to increasing age and body mass index (BMI) in patients undergoing bariatric surgery. Methods We queried the ACS/NSQIP 2010–2011 Public Use File for patients who underwent elective laparoscopic adjustable banding (LAGB), sleeve gastrectomy (LSG) and gastric bypass (LGBP). Total morbidity and 30-day mortality were evaluated. Logistic regression models were created to estimate the effect of increasing age and BMI on morbidity for these bariatric procedures. Results A total of 20,308 laparoscopic bariatric procedures were reviewed (11617 LGBP, 3069 LSG and 5622 LAGB). Overall mortality and morbidity rates were 0.11 and 3.84 %, respectively. The odds of postoperative complications increased by 2 % with each additional year of age (OR 1.02, 95 % CI 1.02–1.03) and every point increase in BMI (OR 1.02, 95 % CI 1.01–1.03). Multiple logistic regression identified COPD, Diabetes, Hypertension, and Dyspnea as major risk factors for postoperative morbidity. Postoperative complications were three times more likely after LGBP (OR 2.87, 95 % CI 2.31–3.57) and two times more likely after LSG (OR 2.06, 95 % CI 1.57–2.72) when compared to patients undergoing LAGB. Conclusion Morbidity and mortality increase on a predictable trend with increasing age and BMI. There is increased risk of morbidity for stapling procedures when compared to gastric banding, but this must be considered in context of surgical efficacy when choosing a bariatric procedure. These data can be used in preoperative counseling and evaluation of surgical candidacy of bariatric surgical patients.
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ISSN:	0930-2794 1432-2218
DOI:	10.1007/s00464-014-3606-7