ESTIMATING THE EFFICACY OF REVISIONAL SLEEVE GASTRECTOMY AND ROUX-EN-Y GASTRIC BYPASS: A NEW APPLICATION OF THE MBSAQIP RISK/BENEFIT CALCULATOR
Lee Ying*, Randal Zhou, Maija Cheung, John M. Morton, Geoffrey Nadzam
Surgery, Yale New Haven Hospital, New Haven, CT
Background: The efficacy of revisional bariatric surgery compared to primary procedures is unclear. The MBSAQIP Risk/Benefit Calculator can be used to estimate the weight-loss a revision patient might have achieved if their surgery were a primary procedure.
Methods: This retrospective case control study included revision and primary surgery patients of three bariatric surgeons from 2014 until 2018. We measured the difference between actual and predicted one-year weight-loss outcomes after revisional laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass, and evaluated the influence of revision type, initial procedure, indication for revision, and race. An "efficacy gap" was calculated as the difference between the patient’s actual and predicted one-year BMI.
Results: 139 revision procedures were performed during the study period. The actual and predicted one-year BMI were highly correlated for primary surgeries (R2=0.63, p<0.01) and revision surgeries (R2=0.62, p<0.01). The actual one-year BMI was significantly higher than predicted for Surgeons A and B, but not Surgeon C. The efficacy gap of revision surgeries was 5.0±0.4 kg/m2, compared to 1.5±0.2 kg/m2 for primary surgeries (p<0.0001). The efficacy gap was not significantly affected by the type of revision or initial procedure, surgical indication, or race.
Conclusions:
Revision surgeries results in significantly less weight-loss than expected from primary surgeries. Adding an ‘efficacy gap factor’ of 5 kg/m2 to the predicted BMI may better estimate a patient’s one-year BMI. Although a patient’s motivation for undergoing revision surgery does not significantly influence their weight-loss, surgeon-to-surgeon differences may affect the efficacy of revision procedures.
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