Michael Mazzei1, Huaqing Zhao2, Michael A Edwards3. 1. Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Temple University Hospital, Philadelphia, Pennsylvania. 2. Department of Clinical Science, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania. 3. Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Temple University Hospital, Philadelphia, Pennsylvania. Electronic address: maeedw@gmail.com.
Abstract
BACKGROUND: Chronic steroids are a treatment option for many chronic diseases but predispose patients to both weight gain and surgical complications. They therefore represent a unique interface between obesity, chronic disease, and surgical risk. As the benefits of bariatric surgery for controlling metabolic disease become more apparent, patients with chronic illnesses on corticosteroids are increasingly being referred for surgery despite an unclear safety profile. The Metabolic and Bariatric Surgery Accreditation Quality Improvement Program database represents the largest bariatric-specific clinical data set for comparing outcomes in this complex patient population. OBJECTIVE: To compare perioperative outcomes following bariatric surgery in the setting of chronic steroid/immunosuppression. SETTING: University Hospital, United States. METHODS: Using the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program MBSAQIP database, we identified patients on chronic corticosteroids who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass in 2015 or 2016. Unmatched as well as propensity-score and case-controlled matched cohort analyses were performed of patients on corticosteroid therapy compared with those without. RESULTS: Of the 302,140 patients who underwent sleeve gastrectomy or laparoscopic gastric bypass in 2015-2016, a total of 4947 (1.63%) were on chronic steroids/immunosuppressive drugs. Patients using steroids were older with significantly higher rates of co-morbid conditions. Hospital length of stay, intensive care unit admission, reoperation, readmission, bleeding, leak, and infectious complications were significantly higher in steroid users; however, in a propensity and case-control matched analysis of 8710 patients and 6598 patients, respectively, steroids were not found to be independent risk factors for poorer outcomes except for an increased rate of leak. CONCLUSIONS: Generally, steroid use does not independently predict poorer outcomes among bariatric surgery patients except for an increased leak rate. With appropriate patient selection based on associated co-morbid factors, primary bariatric surgery is safe in patients using corticosteroids, with an acceptable 30-day postoperative risk profile.
BACKGROUND: Chronic steroids are a treatment option for many chronic diseases but predispose patients to both weight gain and surgical complications. They therefore represent a unique interface between obesity, chronic disease, and surgical risk. As the benefits of bariatric surgery for controlling metabolic disease become more apparent, patients with chronic illnesses on corticosteroids are increasingly being referred for surgery despite an unclear safety profile. The Metabolic and Bariatric Surgery Accreditation Quality Improvement Program database represents the largest bariatric-specific clinical data set for comparing outcomes in this complex patient population. OBJECTIVE: To compare perioperative outcomes following bariatric surgery in the setting of chronic steroid/immunosuppression. SETTING: University Hospital, United States. METHODS: Using the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program MBSAQIP database, we identified patients on chronic corticosteroids who underwent laparoscopic sleeve gastrectomy or laparoscopic gastric bypass in 2015 or 2016. Unmatched as well as propensity-score and case-controlled matched cohort analyses were performed of patients on corticosteroid therapy compared with those without. RESULTS: Of the 302,140 patients who underwent sleeve gastrectomy or laparoscopic gastric bypass in 2015-2016, a total of 4947 (1.63%) were on chronic steroids/immunosuppressive drugs. Patients using steroids were older with significantly higher rates of co-morbid conditions. Hospital length of stay, intensive care unit admission, reoperation, readmission, bleeding, leak, and infectious complications were significantly higher in steroid users; however, in a propensity and case-control matched analysis of 8710 patients and 6598 patients, respectively, steroids were not found to be independent risk factors for poorer outcomes except for an increased rate of leak. CONCLUSIONS: Generally, steroid use does not independently predict poorer outcomes among bariatric surgery patients except for an increased leak rate. With appropriate patient selection based on associated co-morbid factors, primary bariatric surgery is safe in patients using corticosteroids, with an acceptable 30-day postoperative risk profile.
Authors: M Varga; F Köckerling; F Mayer; M Lechner; R Fortelny; R Bittner; K Borhanian; D Adolf; R Bittner; K Emmanuel Journal: Surg Endosc Date: 2020-06-18 Impact factor: 4.584