THE IMPACT OF PRIOR BARIATRIC SURGERY ON LABOR AND DELIVERY COMPLICATIONS
Violeta Popov*2, Heather Peluso3, Marc Georgi4,5, Christopher C. Thompson1
1Brigham & Women's Hospital, Boston, MA; 2NYU Langone Medical Center, New York, NY; 3Prisma Health Upstates, Greenville, SC; 4Catalyst Medical Consulting, Simpsonville, SC; 5University of South Carolina School of Medicine Greenville, Columbia, SC
Background: Bariatric surgery has been shown to improve obesity-related comorbidities. Rapid weight loss after bariatric surgery can also improve menstrual irregularities and increase the chance for conception. However, data is scarce on the optimal time of conception after surgery, the effects of nutritional deficiencies on fetal development as well as potential labor and delivery complications in this setting.
Aims: To determine the impact of bariatric surgery on complications of delivery. Secondary aims are length of stay (LOS) and costs of labor and delivery among pregnant women with and without bariatric surgery.
Methods: This is a retrospective cohort analysis of the 2012 Nationwide Inpatient Sample (NIS) database. Inclusion criteria were an ICD-9 CM diagnosis and procedure codes for labor/delivery. Exposure of interest was an ICD-9 code for a history of bariatric surgery. The primary outcome was common labor and delivery complications including cesarean delivery. Secondary outcomes were length of stay (LOS) and total hospitalization costs. Differences between cases and controls were compared with student t-test and chi-square tests, and multivariable logistic regression models were used to control for potential confounders.
Results: A total of 3,608,876 patient deliveries were captured in the United States in 2012.Of these patients, 9,159 had a history of bariatric surgery. Patients with history of bariatric surgery were older (33 vs. 28 years, p<0.01), had longer mean LOS (3.3 vs. 2.6 days, p<0.01), and higher hospitalization costs (18,945 vs. 15,071 USD, p<0.01). There was no mortality in the post-bariatric cohort, and the mortality in the general cohort was 9.5/100,000 deliveries. The rate of cesarean delivery was higher for women who had a history of bariatric surgery compared with those who did not, as well as the rates of breech deliveries, fetal distress, anesthesia complications, ectopic pregnancies, spontaneous or missed abortions, and infections in the puerperium (Table 1). Compared to pregnant women with obesity, the post-bariatric group had similar mean total hospitalization costs ($18,945 vs. $19,080, p=0.9). Prior bariatric surgery remained a significant predictor for cesarean delivery and longer length of stay after controlling for age.
Conclusion: Pregnant women who have a history of bariatric surgery should be considered to have high-risk deliveries as the rate of potential complications is higher than for those who have no history of bariatric surgery, including when compared to pregnant women with obesity. Additionally, we show that a history of bariatric surgery is not associated with lower labor and delivery costs than for pregnant women with obesity.
Table 1. Common labor and delivery complications in cases (pregnant women with prior bariatric surgery) and controls (pregnant women, no bariatric surgery, no obesity). 95%CI, 95% confidence interval. Significant comparisons in bold.
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