Christopher R Daigle1, Stacy A Brethauer2, Chao Tu3, Anthony T Petrick4, John M Morton5, Philip R Schauer2, Ali Aminian6. 1. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio; The Bariatric Center, Department of General Surgery, Cleveland Clinic Akron General, Akron, Ohio. 2. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio. 3. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. 4. Department of Surgery, Geisinger Health Systems, Danville, Pennsylvania. 5. Department of Surgery, Stanford University, Stanford, California. 6. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: aminiaa@ccf.org.
Abstract
BACKGROUND: National quality programs have been implemented to decrease the burden of adverse events on key outcomes in bariatric surgery. However, it is not well understood which complications have the most impact on patient health. OBJECTIVE: To quantify the impact of specific bariatric surgery complications on key clinical outcomes. SETTING: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. METHODS: Data from patients who underwent primary bariatric procedures were retrieved from the MBSAQIP 2015 participant use file. The impact of 8 specific complications (bleeding, venous thromboembolism [VTE], leak, wound infection, pneumonia, urinary tract infection, myocardial infarction, and stroke) on 5 main 30-day outcomes (end-organ dysfunction, reoperation, intensive care unit admission, readmission, and mortality) was estimated using risk-adjusted population attributable fractions. The population attributable fraction is a calculated measure taking into account the prevalence and severity of each complication. The population attributable fractions represents the percentage reduction in a given outcome that would occur if that complication were eliminated. RESULTS: In total, 135,413 patients undergoing sleeve gastrectomy (67%), Roux-en-Y gastric bypass (29%), adjustable gastric banding (3%), and duodenal switch (1%) were included. The most common complications were bleeding (.7%), wound infection (.5%), urinary tract infection (.3%), VTE (.3%), and leak (.2%). Bleeding and leak were the largest contributors to 3 of 5 examined outcomes. VTE had the greatest effect on readmission and mortality. CONCLUSION: This study quantifies the impact of specific complications on key surgical outcomes after bariatric surgery. Bleeding and leak were the complications with the largest overall effect on end-organ dysfunction, reoperation, and intensive care unit admission after bariatric surgery. Furthermore, our findings suggest that an initiative targeting reduction of post-bariatric surgery VTE has the greatest potential to reduce mortality and readmission rates.
BACKGROUND: National quality programs have been implemented to decrease the burden of adverse events on key outcomes in bariatric surgery. However, it is not well understood which complications have the most impact on patient health. OBJECTIVE: To quantify the impact of specific bariatric surgery complications on key clinical outcomes. SETTING: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database. METHODS: Data from patients who underwent primary bariatric procedures were retrieved from the MBSAQIP 2015 participant use file. The impact of 8 specific complications (bleeding, venous thromboembolism [VTE], leak, wound infection, pneumonia, urinary tract infection, myocardial infarction, and stroke) on 5 main 30-day outcomes (end-organ dysfunction, reoperation, intensive care unit admission, readmission, and mortality) was estimated using risk-adjusted population attributable fractions. The population attributable fraction is a calculated measure taking into account the prevalence and severity of each complication. The population attributable fractions represents the percentage reduction in a given outcome that would occur if that complication were eliminated. RESULTS: In total, 135,413 patients undergoing sleeve gastrectomy (67%), Roux-en-Y gastric bypass (29%), adjustable gastric banding (3%), and duodenal switch (1%) were included. The most common complications were bleeding (.7%), wound infection (.5%), urinary tract infection (.3%), VTE (.3%), and leak (.2%). Bleeding and leak were the largest contributors to 3 of 5 examined outcomes. VTE had the greatest effect on readmission and mortality. CONCLUSION: This study quantifies the impact of specific complications on key surgical outcomes after bariatric surgery. Bleeding and leak were the complications with the largest overall effect on end-organ dysfunction, reoperation, and intensive care unit admission after bariatric surgery. Furthermore, our findings suggest that an initiative targeting reduction of post-bariatric surgery VTE has the greatest potential to reduce mortality and readmission rates.
Authors: Mohamed A Aboueisha; Meredith Freeman; Jonathan K Allotey; Leah Evans; Michael Z Caposole; Danielle Tatum; Shauna Levy; John W Baker; Carlos Galvani Journal: Surg Endosc Date: 2022-08-04 Impact factor: 3.453
Authors: Nestor de la Cruz-Muñoz; Luyu Xie; Hallie J Quiroz; Onur C Kutlu; Folefac Atem; Steven E Lipshultz; M Sunil Mathew; Sarah E Messiah Journal: J Am Coll Surg Date: 2022-09-15 Impact factor: 6.532
Authors: Mari Hult; Wouter Te Riele; Lars Fischer; Signe Röstad; Kai Orava; Timo Heikkinen; Rune Sandbu; Anne Juuti; Stephanie E Bonn Journal: Obes Surg Date: 2022-09-23 Impact factor: 3.479
Authors: Anita Courcoulas; R Yates Coley; Jeanne M Clark; Corrigan L McBride; Elizabeth Cirelli; Kathleen McTigue; David Arterburn; Karen J Coleman; Robert Wellman; Jane Anau; Sengwee Toh; Cheri D Janning; Andrea J Cook; Neely Williams; Jessica L Sturtevant; Casie Horgan; Ali Tavakkoli Journal: JAMA Surg Date: 2020-03-01 Impact factor: 14.766
Authors: Barbara Choromańska; Piotr Myśliwiec; Magdalena Łuba; Piotr Wojskowicz; Hanna Myśliwiec; Katarzyna Choromańska; Małgorzata Żendzian-Piotrowska; Jacek Dadan; Anna Zalewska; Mateusz Maciejczyk Journal: Antioxidants (Basel) Date: 2020-05-01