Owen Pyke1, Jie Yang2, Tyler Cohn1, Donglei Yin3, Salvatore Docimo1, Mark A Talamini1, Andrew T Bates1, Aurora Pryor1, Konstantinos Spaniolas4. 1. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nicolls Road, HSC T19, Stony Brook, NY, 11794, USA. 2. Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, 11794, USA. 3. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, 11794, USA. 4. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nicolls Road, HSC T19, Stony Brook, NY, 11794, USA. konstantinos.spaniolas@stonybrookmedicine.edu.
Abstract
BACKGROUND: Marginal ulcerations (MU) are a common and concerning complication following Roux-en-Y gastric bypass (RYGB) surgery. The aim of the present study was to examine the progression of MU and identify risk factors for the need for surgical intervention in patients with MU following RYGB. METHODS: A New York state longitudinal administrative database was queried to identify patients who underwent RYGB between 2005 and 2010 and who were followed for at least 4 years for the development of MU using ICD-9 and CPT codes. Patients with perforation as their first presentation of MU were excluded. Multivariable Cox proportional hazard model was built to identify risk factors for surgical intervention. Hazard ratios (HR) with 95% confidence intervals (CI) were reported. RESULTS: We identified 35,075 patients who underwent RYGB. Mean age was 42.47 ± 10.90 years and most were female (81.08%). There were 2201 (6.28%) patients with MU, of which 204 (9.27% of MU; 0.58% of RYGB overall) required surgery. The estimated cumulative incidence of having surgical intervention 1, 2, 5, and 8 years after MU diagnosis was 6% (95% CI 5-7%), 8% (95% CI 7-9%), 13% (95% CI 11-14%), and 17% (95% CI 13-20%), respectively. At time of MU diagnosis, younger age (HR 0.93 every 5 years, 95% CI 0.87-0.99), white race (HR 1.60, 95% CI 1.15-2.23), and weight loss (HR 2.82, 95% CI 1.62-4.88) were independent risk factors for subsequent surgical intervention for MU. Estimated cumulative incidence of MU recurrence was 15% (95% CI 9-22%) and 24% (95 CI% 15-32%) at 6 and 12 months after surgical intervention. CONCLUSIONS: The need for surgical intervention for MU after RYGB is uncommon. Young age, white race, and marked weight loss are risk factors for surgical intervention. Such patients may benefit from early intensive medical therapy at the time of MU diagnosis.
BACKGROUND:Marginal ulcerations (MU) are a common and concerning complication following Roux-en-Y gastric bypass (RYGB) surgery. The aim of the present study was to examine the progression of MU and identify risk factors for the need for surgical intervention in patients with MU following RYGB. METHODS: A New York state longitudinal administrative database was queried to identify patients who underwent RYGB between 2005 and 2010 and who were followed for at least 4 years for the development of MU using ICD-9 and CPT codes. Patients with perforation as their first presentation of MU were excluded. Multivariable Cox proportional hazard model was built to identify risk factors for surgical intervention. Hazard ratios (HR) with 95% confidence intervals (CI) were reported. RESULTS: We identified 35,075 patients who underwent RYGB. Mean age was 42.47 ± 10.90 years and most were female (81.08%). There were 2201 (6.28%) patients with MU, of which 204 (9.27% of MU; 0.58% of RYGB overall) required surgery. The estimated cumulative incidence of having surgical intervention 1, 2, 5, and 8 years after MU diagnosis was 6% (95% CI 5-7%), 8% (95% CI 7-9%), 13% (95% CI 11-14%), and 17% (95% CI 13-20%), respectively. At time of MU diagnosis, younger age (HR 0.93 every 5 years, 95% CI 0.87-0.99), white race (HR 1.60, 95% CI 1.15-2.23), and weight loss (HR 2.82, 95% CI 1.62-4.88) were independent risk factors for subsequent surgical intervention for MU. Estimated cumulative incidence of MU recurrence was 15% (95% CI 9-22%) and 24% (95 CI% 15-32%) at 6 and 12 months after surgical intervention. CONCLUSIONS: The need for surgical intervention for MU after RYGB is uncommon. Young age, white race, and marked weight loss are risk factors for surgical intervention. Such patients may benefit from early intensive medical therapy at the time of MU diagnosis.
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