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Morbidity Mortality and Weight Loss Outcomes After Reoperative Bariatric Surgery in the USA
Ranjan Sudan*1, Ninh T. Nguyen2, Matthew M. Hutter3, Stacy a. Brethauer4, Jaime Ponce5, John M. Morton6
1Department of Surgery, Duke University Medical Center, Durham, NC; 2Department of Surgery, University of California, Irvine, Irvine, CA; 3Department of Surgery, Massachusetts General Hospital, Boston, MA; 4Department of Surgery, Cleveland Clinic, Cleveland, OH; 5Department of Surgery, Hamilton Medical Center, Dalton, GA; 6Department of Surgery, Stanford Medical Center, Palo Alto, CA
Background: Obesity is a chronic disease that is successfully treated by different primary bariatric operations but, some patients will need reoperations. Although complications are covered by insurance carriers, requests for reoperations for inadequate weight loss or resolution of comorbidities are frequently denied. The perception of high complication rates and uncertain benefits after reoperations, combined with paucity of good data are likely contributory. Therefore, our aim was to evaluate the safety and weight loss outcomes after reoperative bariatric surgery from a large bariatric surgery-specific database.
Methods: The multi-institutional prospective database for the American Society for Metabolic and Bariatric Surgery was queried for all patients undergoing bariatric operations between 6/2007 and 03/2012. Operations for correction of complications as well as inadequate outcomes from the primary operations were included. Morbidity was defined as serious adverse events (bleeding, leaks, pulmonary embolism etc.). Excess weight loss (EWL) was calculated from the time of reoperation.
Results: 404,222 patients had no reoperations while 20,406 (4.8%) underwent reoperations. In the reoperative group, women were over represented (86 versus 78.5%), as were Caucasians (73 versus 69%) and Black race (15 versus 12%). Reoperative patients had a mean age of 46 ± 11.33 vs. 45 ± 11.86 years. Reoperations were within one year of the index bariatric operation in 25% of patients, one to five years in 40%, six to ten years in 21% and more than 10 years in 14% after primary operation. The rate of reoperations per year increased steadily from 3.1% in 2007 to 6.3% in 2012. Among patients undergoing reoperations 10,139 (50%) had previously undergone a laparoscopic adjustable band (LAGB) placement, 6411 (31%) a Roux-en-Y gastric bypass (RYGB), 444 (2%) a sleeve gastrectomy (SG), 1685 (8%) a vertical banded gastroplasty (VBG), and 236 (1.2%) a duodenal switch (DS). The operations were most commonly revised to a RYGB in 6801 (33.3%), LAGB (24.8%), SG 1684 (8.1%), DS 393 (1.9%), distal gastric bypass 259 (1.3%) and a group of other operations 6229 (30.6%). EWL at 1-year to RYGB was 27%, LAGB (15.4%), SG (16.5%) and DS (30.9%). The 30-day and 1-year morbidity and mortality rates of the four most common primary and reoperative bariatric operations are low and are shown in Table 1.
Conclusions: Although, the rate of reoperations has steadily increased over the last five years to 6.3% per year, most bariatric surgery patients do not need reoperations. Among those who do, the complication rate is low and with satisfactory weight loss. These findings from a large database are critical to convince all stake-holders that outcomes after reoperative bariatric surgery are better than previously believed and are needed to help increase access of patients who need reoperations.
Morbidity and Mortality Rates of Primary Bariatric Operations versus Reoperations
| 30-day morbidity (%) | 1-year morbidity (%) | 30-day mortality (%) | 1-year Mortality (%) | | primary | reoperation | primary | reoperation | primary | reoperation | primary | reoperation | | RYGB | 2.56 | 4.48 | 2.97 | 4.97 | 0.15 | 0.25 | 0.4 | 0.47 | | LAGB | 0.29 | 0.12 | 0.37 | 0.18 | 0.03 | 0 | 0.09 | 0.02 | | SG | 1.32 | 2.12 | 1.47 | 2.48 | 0.06 | 0.12 | 0.2 | 0.24 | | DS | 3.15 | 4.52 | 4.05 | 4.52 | 0.34 | 1.13 | 1.19 | 1.36 |
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