SSAT - Preoperative GERD Is Associated With Higher Reoperation RATES After Bariatric Surgery

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Preoperative GERD Is Associated With Higher Reoperation RATES After Bariatric Surgery
Tammam Obeid^*, Aravind Krishnan, Gamal Abdalla, Michael Schweitzer, Thomas Magnuson, Kimberley E. Steele

Surgery, Johns Hopkins School of Medicine, Baltimore, MD

Background:
The past decade brought remarkable improvements in complication, readmission and reoperation rates for bariatric surgery. In addition to a major economic burden on the healthcare system, reoperations after bariatric surgery carry substantial morbidity and mortality for the patient. Despite extensive research on bariatric surgery outcomes, risk factors for reoperations after laparoscopic bariatric procedures are yet to be established. We believe that a study evaluating the role of patient characteristics, comorbidities and other surgical characteristics is warranted.
Objective: to evaluate the effect patient characteristics, comorbidities, preoperative excess weight loss, readmission status and length of hospital stay have on reoperation rates.
Methods:
We performed a retrospective analysis of all the patients that had laparoscopic gastric bypass (LGBP) or laparoscopic sleeve gastrectomy (LSG) surgeries at our institute between 2009 and 2013. A logistic regression model was constructed for any reoperation related to the original surgery up to current date. Out of the 22 variables considered in the initial analysis only age, gender, BMI at time of operation, race (Caucasian vs African American), surgery time (in hours), length of stay (more than 3 days), a history of diabetes, a history of gastroesophageal reflux disease (GERD), type of surgery (LGBP vs LSG) and whether the patient had a readmission within 30 days of the procedure were included in the final model. All relevant variable interactions were considered and those that were significant were included in results.
Results:
A total of 514 patients underwent either LGBP or LSG surgery between 2009 and 2013. The mean patient age was 43 ± 11 years and males represented 19% of the population. The overall reoperation rate was 10.3 %, the mean post-surgical follow up period was 43.9 months (median 45) and Caucasians constituted 73% of the dataset.
When stratified by race, preoperative GERD in Caucasians was associated with a significant 2.3-fold increased risk of reoperation (OR 2.3, 95%CI 1.1-4.9, P<.033), whereas the same disease in African Americans had only a 1.5 increased risk that did not yield significance (OR 1.5, 95%CI 0.4-5.8, P<.543).
Moreover, a history of readmission within 30 days of surgery increased the patient's reoperation risk by a factor of 5 (OR 5.0, 95%CI 2.5-10.1, P<.000) and a length of stay of 3 days or more was associated with a significant 2-fold increase in reoperation risk (OR 2.1, 95%CI 1.1-4.0, P<.031).
Conclusion:
Preoperative GERD in Caucasian bariatric patients is associated with a higher risk of reoperation. Additionally, a lengthy hospital stay and readmission within 30 days of laparoscopic bariatric surgery are independent predictors of higher reoperation rates in the bariatric population.

Logistic Regression Model of Reoperation Rate

Variable Unadjusted OR (95% CI) P value Adjusted OR (95% CI) P value
Age 0.99 (0.98-1.02) 0.522 0.98 (0.94-1.01) 0.173
Gender (male) 0.51 (0.21-1.22) 0.128 0.38 (0.12-1.15) 0.087
BMI on operation day 0.98 (0.95-1.02) 0.358 0.99 (0.95-1.03) 0.634
Length of Stay (> 3 days) 2.02 (1.13-3.62) 0.018 2.06 (1.07-3.97) 0.031
Readmission within 30 days 5.26 (2.70-10.23) 0.000 5.03 (2.49-10.17) 0.000
Lap Sleeve Gastrectomy 0.60 (0.29-1.24) 0.170 0.66 (0.28-1.55) 0.343
Surgery Time (h) 1.02 (0.76-1.36) 0.911 0.88 (0.61-1.28) 0.506
Diabetes 0.91 (0.48-1.74) 0.784 0.99 (0.47-2.09) 0.970
GERD:
- Caucasian 2.09 (1.04-4.21) 0.039 2.29 (1.07-4.91) 0.033
- African American 1.36 (0.47-3.93) 0.570 1.51 (0.40-5.75) 0.543

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