SSAT - CONCOMITANT LAPAROSCOPIC VERTICAL SLEEVE GASTRECTOMY AND CHOLECYSTECTOMY INCREASES ODDS OF READMISSION AND REOPERATION

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CONCOMITANT LAPAROSCOPIC VERTICAL SLEEVE GASTRECTOMY AND CHOLECYSTECTOMY INCREASES ODDS OF READMISSION AND REOPERATION
David J. Leishman^*¹, Zachary Leslie², Sayeed Ikramuddin¹, Eric Wise¹
¹Surgery, University of Minnesota, Minneapolis, MN; ²Carleton College, Northfield, MN

Introduction:
Rapid weight loss leads to cholelithiasis and its sequelae, a rationale that has been used to perform cholecystectomy (CCY) at the time of vertical sleeve gastrectomy (VSG). Multiple studies have investigated simultaneous CCY with Roux-en-Y gastric bypass, but there is a dearth of studies addressing concomitant CCY and VSG. The goal of this study is to explore trends and outcomes of concomitant VSG and CCY using a large bariatric database.
Methods
The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was queried from 2015 to 2023 to identify patients who had undergone VSG with appropriate Current Procedure Terminology (CPT) codes and they were then stratified by performance of simultaneous CCY (VSG + CCY v. VSG). Demographics, patient characteristics, and outcomes were tabulated, and performance of simultaneous CCY was utilized as an independent variable. Logistic regression analysis was performed with dependent variables of 30-day morbidity, 30-day readmission, and 30-day reoperation with p<0.05 as threshold for statistical significance.
Results
1,140,484 patients underwent VSG with 40,780 (3.6%) having concurrent CCY. The average age for concurrent VSG + CCY was 44.54 (SD 11.64) vs 43.25 (SD 11.91) years (p<0.001) in VSG alone. VSG + CCY was more common in female patients vs VSG alone (83.1% vs 80.5%, p<0.001). In VSG patients, concomitant CCY was not a risk factor for increased odds of 30-day morbidity (1.2 [0.99, 1.46], p=0.07); however, it was a risk factor for 30-day readmission (1.39 [1.31, 1.47], p<0.05) and 30-day reoperation (1.63 [1.48, 1.79], p<0.05). Patients undergoing concomitant VSG + CCY also had an increased rate of mortality, length of stay, infectious and cardiac complications, DVT/PE, and transfusion need within 72 hours of surgery compared to patients undergoing VSG alone (each, p<0.05) (Table 1).
Conclusions
This study highlights the risks associated with VSG + CCY compared to VSG alone. These patients had increased odds of reoperation and readmission as well as significantly higher mortality, length of stay, and post-operative complications. While detrimental to patients, it also increases cost and resource utilization. These results would argue against the routine performance of these surgeries simultaneously.

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