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IMPACT OF EARLY VERSUS LATE SURGICAL INTERVENTION IN ELECTIVE ADMISSIONS FOR BARIATRIC SURGERY
Daniel Guifarro
*2, Clive J. Miranda
1, Bhanu Siva Mohan Pinnam
2, Ali Aijaz
3, Aun R. Shah
11Gastroenterology, Creighton University, Omaha, NE; 2John H Stroger Jr Hospital of Cook County, Chicago, IL; 3University at Buffalo, Buffalo, NY
Elective bariatric surgery (BS) has become a pivotal intervention in addressing the escalating obesity crisis in the United States. The prevalence of adult obesity surged from 13.4% in 1962 to 42.4% in 2018, now affecting over 108 million adults. This rise in obesity has significantly increased the demand for bariatric procedures, with approximately 280,000 surgeries performed in 2022. Despite this growing number, only about 1% of eligible individuals undergo bariatric surgery annually, highlighting a substantial gap in treatment utilization. This study analyzes the impact of early versus late surgical intervention on patients undergoing elective BS, including Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).
We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2018 to 2021, identifying adult patients admitted for elective bariatric surgery during the pre-COVID-19 period (2018–2019). Both RYGB and SG procedures were grouped into a single variable (bariatric surgery). The primary outcome was same-admission mortality, with analyses comparing outcomes of early (<24 hours post-admission) versus late (>24 hours) procedures. Statistical analyses included measures of central tendency, t-tests, and linear and logistic regression. Statistical significance was set at p<0.05, and risk was assessed using odds ratios (OR). Confounders such as age, gender, hospital characteristics, Charlson Comorbidity Index, and insurance status were accounted for using STATA 18.
A total of 371,330 early bariatric surgeries were analyzed, including 113,095 RYGB and 258,235 SG procedures. Sociodemographic data for these procedures are shown in Figure 1. 10,850 patients did not undergo early BS; in patients admitted for elective RYGB who underwent an early procedure, the odds of mortality decreased by 85% (OR=0.15, p <0.001). However, the odds of undergoing an early procedure were 77% lower if admitted over the weekend (OR=0.23, p <0.001). Among admissions for elective SG, females had 15% lower odds of undergoing an early procedure (OR=0.85, p <0.05). In elective SG patients, those in the highest income group were 1.7 times more likely to undergo an early procedure (OR=1.73, p <0.05). Patients treated at medium and large sized hospitals were twice as likely to undergo early elective BS compared to those treated at small hospitals (OR=2.20, p <0.05). For patients undergoing early BS, the odds of requiring a blood transfusion were 55% lower, mechanical, ventilation 92% lower, acute kidney injury 67% lower, and sepsis 86% lower. These results are shown in Figure 2.
Elective BS performed within 24 hours of admission is associated with a significant reduction in adverse outcomes; however, there is notable variability in the demographics of patients undergoing these procedures and the institutions offering them.
Sociodemographic data of patients admitted for elective bariatric surgery.
Outcomes of patients undergoing early procedures (<24 hours after admission) for elective bariatric surgery.
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