Abstracts
1999 Digestive Disease Week

# 2183 RISK ASSESSMENT FOR ROUX-EN-Y GASTRIC BYPASS (RYGB) COMPLICATIONS.
Scott Lee, Holden Chang, UCLA, Los Angles, CA; Edward H Livingston, UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA

Risks associated with surgery in the obese are substantial. The purpose of this study was to quantify risk factors predictive of surgical complications following RYGB. Methods: 245 Consecutive patients undergoing RYGB at UCLA were examined for 10 potential risk factors by step-wise logistic regression. Results: The mean (±SEM) weight was 333±6 lbs with a body mass index of 53±0.8. There were 5 deaths (2.0%) and 38 complications (16%). 38(13%) cases were revisional operations with a complication rate of 30%. There were 27 complications in 207 primary operations for a complication rate of 13%. There were 12 (4.9%)anastomotic leaks, 4 (10.5%) in redo procedures and 8 (3.9%) in primary operation. Bowel obstruction or ileus occurred in 6 patients, splenectomy in 3, Pulmonary embolus in 3, sepsis of unknown cause in 3, marginal ulcer in 2 and 10 miscellaneous complications occurred resulting in prolonged hospitalization (> 1 wk). The probability of having a major complication from RYGB is: P=1/((1+EXP(-(-4.7634+(1.6584*redo)-(1.2385*OA)+(0.0492*Age)+(0.003475*Weight)+(0.7078*HTN)-(0.7001*SA)+(0.6429*DM))))) Where redo=revisional operation, OA=osteoarthritis, Age in years, Weight in pounds, HTN=Hypertension, SA=Sleep apnea and DM=Diabetes. Thus, the major predictors of adverse outcomes were (in order of importance) redo case>age>weight>HTN>Diabetes. In contrast, factors predicting favorable outcomes were Dx of osteoarthritis>Dx of sleep apnea. Sex, BMI or Hx of Smoking did not contribute to the model. Conclusion: A precise model for predicting complication rates following RYGB has been developed. Contribution of various factors to morbidity was stratified with revisional surgery being the single greatest predictor of complications. Risk can be calculated so that patients can be appropriately counseled for surgery.

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