BARIATRIC SURGERY OUTCOMES IN PATIENTS WITH OXYGEN DEPENDENCY: AN ANALYSIS OF THE MBSAQIP
Aryan Modasi*, Jerry Dang, Noah Switzer, Daniel W. Birch, Shahzeer Karmali
General Surgery, University of Alberta, Edmonton, AB, Canada
Background
As awareness of the health benefits of bariatric surgery has increased, so has the number of bariatric procedures performed on complex, oxygen-dependent patients. This group of patients often have other medical comorbidities that can be significantly improved following bariatric surgery, however the issue remains regarding their perioperative risk. Our study aims to look at the safety of bariatric surgery amongst oxygen-dependent patients.
Methods
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database contains data from 832 centres in the United States and Canada specific to bariatric surgery. We analyzed data from 2015 to 2017 on patients who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). Patients with a history of a previous bariatric surgery were excluded. A multivariable regression analysis was performed looking at 30-day serious complications for oxygen-dependent patients, with a secondary propensity-matched analysis performed comparing patients undergoing LSG vs LRYGB.
Results
A total of 430,396 patients were analyzed, 3,034 (0.7%) of which were oxygen dependent. These patients were older (55.0 (SD 10.3) vs 44.5 (SD 12.0) years, p < 0.001), more likely to be male (28.94% vs 20.57%, p < 0.001), with a higher mean body mass index (50.7 vs 45.4 kg/m2, p < 0.001). They had a higher associated rate of diabetes (55.27% vs 26.21%, p < 0.001), chronic obstructive pulmonary disease (41.07% vs 1.41%, p < 0.001), chronic steroid use (8.34% vs 1.63%, p < 0.001), and renal insufficiency (3.69% vs 0.62%, p < 0.001).
The absolute 30-day complication rate amongst oxygen-dependent patients was more than twice as high (8.24% vs 3.46%, p < 0.001). The post-operative leak (0.69% vs 0.41%, p = 0.017), bleed (2.08% vs 0.91%, p < 0.001) and cardiac event rate (0.16% vs 0.07%, p = 0.034) was all significantly higher as was the rate of unplanned intubation (0.82% vs 0.14%, p < 0.001), pneumonia (0.89% vs 0.19%, p < 0.001) and sepsis (0.46% vs 0.10%, p < 0.001). Mortality was significantly higher amongst oxygen-dependent patients (0.49% vs 0.09%, p < 0.001). On multivariable analysis, oxygen dependency was found to be an independent predictor of adverse outcomes (OR 1.30 [1.22 to 1.50], p < 0.001). LRYGB was associated with a statistically significant higher complication rate compared to LSG (13.23% vs 5.16%, p < 0.001).
Conclusion
Oxygen-dependent patients undergoing bariatric surgery are at a higher risk of both morbidity and mortality postoperatively. Controlling for confounding variables, oxygen dependency remains an independent risk factor for adverse outcomes. In particular, LRYGB compared to the LSG is associated with a significantly higher rate of post-operative complications. Surgeons must be aware of these risks when considering management options for these patients.
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