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Society for Surgery of the Alimentary Tract

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Jessica Jou*2, Allison R. Schulman1, Jonathan F. Finks3, Amir A. Ghaferi3, Oliver A. Varban3, Ryan W. Stidham1
1Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI; 2Department of Internal Medicine, University of Michigan, Ann Arbor, MI; 3Department of Surgery, University of Michigan, Ann Arbor, MI

Background: Perceived increased risk of post-operative complications is a concern in patients with chronic immunologic conditions (IMMs) considering bariatric procedures. We assessed the risk of acute surgical and medical complications in patients with common IMMs undergoing Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) procedures.

Methods: 1688 patients undergoing bariatric surgery (RYGB n=534, SG n=1154) at a single tertiary care center between 2006-2017 were enrolled in an observational study. Acute surgical complications included anastomotic leak, bowel perforation, intestinal obstruction, abdominal abscess, or surgical site infection. Acute medical complications included VTE, sepsis, pneumonia, UTI, or hospital acquired infections; all complications occurred within 30 days of surgery. IMMs examined included rheumatoid arthritis (RA), Crohn's disease (CD), ulcerative colitis (UC), psoriatic arthritis (PSA), psoriasis, and systemic lupus erythematosus (SLE). Immunologic medications included in the analysis were corticosteroids, anti-TNF and other biologics, and immunosuppressants (thiopurines, methotrexate). The Student's t-test and Fisher's exact test were used for univariate analyses with logistic regression used for multivariable modeling (SAS 9.4, Cary, NC).

Results: Of 1688 subjects, 1154 patients underwent SG and 534 underwent RYGB procedures. A total of 200 subjects carried a diagnosis of an immunologic condition composed of 81 with psoriasis, 68 with RA, and 53 with IBD; there was no difference bariatric procedure type compared to non-IMM population (p=0.6246). Overall, bariatric surgery type was not associated with acute medical complications (n=121, RYGB 6.8% vs. SG 7.7%, p=0.4928), but was associated with surgical complications (RYGB 9.9% vs. SG 3.8%, p<.0001). On univariate analysis, subjects with an IMM, dominated by RA, more frequently experienced acute medical complications (RA 16.2% vs. non-RA 6.7%, p=0.004). The majority of complications were VTEs despite similar adherence to peri-operative VTE prevention guidelines compared to non-RA patients (83.8% vs. 88.1%, p=0.1145). Diagnoses of IBD (8.3%, p=0.733), PSA (10.5%, p=0.298), psoriasis (9.9%, p=0.3156), and SLE (11.1%, p=0.411) were not associated with post-operative complications. Adjusting for age, gender, surgery type, and medication use within the prior 3 months, increasing age (OR 1.24, 95%CI 1.01,1.40) and a diagnosis of RA (OR 2.13, 95%CI 1.03,4.40) were associated with post-operative medical complications.

Conclusion: Patients with RA may be more susceptible to acute medical complications following bariatric surgery, the majority appearing to be VTEs despite good compliance with peri-operative prophylactic guidelines. Causes of decreased mobility following surgery and expanded VTE prophylaxis in this population warrants further evaluation.

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