BARIATRIC SURGERY OUTCOMES IN PATIENTS WITH PREVIOUS ORGAN TRANPLANTS: 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 of 2017, the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) has started tracking the outcomes for bariatric surgery patients having undergone a previous transplant procedure. Traditionally considered a high-risk group, these patients often present unique challenges secondary to their inherent comorbidities, immunosuppressant history, and technical/anatomic factors related to their previous surgical history. Our study aims to look at the safety of bariatric surgery in this patient population, and to compare outcomes based on procedure performed (laparoscopic sleeve gastrectomy (LSG) vs laparoscopic Roux-en-Y gastric bypass (LRYGB)).
Methods
Data was collected from the 2017 MBSAQIP database, which collects preoperative, intraoperative and postoperative data from 832 centres in the United States and Canada based on standardized definitions for variables specific to metabolic and bariatric surgery.
Patients having undergone an LSG or LRYGB were included for analysis. Patients with a history of a previous bariatric surgery were excluded. A multi-variable logistic regression was performed to determine if a transplant history was independently associated with worse outcomes compared to non-transplant patients. Outcomes were also compared amongst transplant patients undergoing LSG versus LRYGB.
Results
A total of 156,310 patients were included for analysis. Patients having undergone a previous transplant were found to be older (49.2 (SD 11.5) vs 44.4 (SD 12.0) years, p < 0.001), more likely to be male (37.0% vs 20.2%, p < 0.001), with a lower mean body mass index (42.8 vs 45.2 kg/m2,p < 0.001). Patients with previous transplants had a significantly higher rate of associated comorbidities (renal insufficiency, diabetes, steroid use, anticoagulation use). The major 30-day complication rate after surgery was found to be three-fold higher in patients with a transplant history (OR 9.24 vs 3.09, p < 0.001). Mortality was higher (0.42% vs 0.08%) but did not reach statistical significance (p = 0.056). On multivariable analysis, previous transplant was as independent predictor of major complications (OR 1.88 [1.17 to 3.02], p = 0.009). In previously transplanted patients, LRYGB was associated with a higher complication rate compared to LSG (13.3% vs 8.7%), but this did not reach significance (p = 0.408).
Conclusion
The 30-day complication rate is three times higher amongst patients with a transplant history undergoing bariatric surgery. As a group, transplant patients have a significantly higher rate of associated comorbidities, however when assessed independently using multivariable analysis previous transplant remains an independent predictor of worse outcomes. Both patients and surgeons must be aware of this risk when determining candidacy for bariatric surgery in this patient population.
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