Valentin Mocanu1, Jerry T Dang2, Noah Switzer3, Karen Madsen4, Daniel W Birch3, Shahzeer Karmali3. 1. Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. vmocanu@ualberta.ca. 2. Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. 3. Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Canada. 4. Department of Gastroenterology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Abstract
BACKGROUND: While bariatric surgery is safe, rates of postoperative complications continue to vary considerably across specific patient populations. METHODS: We identified all Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry (MBSAQIP) patients who underwent primary laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) from 2015 to 2017. Categorical variables were expressed as percentages and continuous variables as weighted mean ± standard deviation (SD). Univariate analysis was performed using chi-squared tests for categorical data and independent sample t test for continuous data. Non-parsimonious multivariable logistic regression models were developed to determine predictive factors for mortality and major complications. RESULTS: A total of 430,936 patients were identified using the MBSAQIP database from 2015 to 2017 (Table 1). The majority of patients were female (79.3%), white (73.1%), and underwent laparoscopic sleeve gastrectomy (72.8%). The second most common identified race was African-American (17.6%) followed by other (9.3%). The mean age of our population was 43.9 ± 11.0 years with a mean body mass index of 46.6 ± 8.5 kg/m2 and a mean operative length of 89.7 ± 48.5 min. Males were more likely to experience serious complications (3.7% vs. 3.45%; p = 0.002) and increased reoperation rates (1.33% vs. 1.18%; p < 0.001) and had a 2-fold greater mortality (0.18% vs. 0.07; p < 0.001) in comparison with female patients. Female patients had increased intervention rates (1.34% vs. 1.18%; p < 0.001) and readmission rates (3.89% vs. 3.53%; p < 0.001) at 30 days. Black patients had higher rates of serious complications (4.14% vs. 3.41%; p < 0.001), mortality (0.13% vs. 0.09%; p < 0.001), intervention (1.74% vs. 1.24%; p < 0.001), and readmission (5.03% vs. 3.56%; p < 0.001) at 30 days when compared with white patients. Female sex (OR 1.05; 95% CI 1.05-1.10; p < 0.001) and black race (OR 1.30; 95 % CI 1.24-1.35; p < 0.001) were independent predictors of major complications. Female sex was the single greatest protective factor for mortality following bariatric surgery (OR 0.53; 95% CI 0.42-0.65; p < 0.001) while black race was one of the greatest independent predictors of mortality (OR 1.78; 95% CI 1.39-2.26; p < 0.001). CONCLUSION: Race and sex are independent predictors of adverse outcomes following bariatric surgery in a multivariate logistic regression analysis of the MBSAQIP database. The influence of these factors requires further study in order to continue optimizing bariatric surgery outcomes.
BACKGROUND: While bariatric surgery is safe, rates of postoperative complications continue to vary considerably across specific patient populations. METHODS: We identified all Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry (MBSAQIP) patients who underwent primary laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) from 2015 to 2017. Categorical variables were expressed as percentages and continuous variables as weighted mean ± standard deviation (SD). Univariate analysis was performed using chi-squared tests for categorical data and independent sample t test for continuous data. Non-parsimonious multivariable logistic regression models were developed to determine predictive factors for mortality and major complications. RESULTS: A total of 430,936 patients were identified using the MBSAQIP database from 2015 to 2017 (Table 1). The majority of patients were female (79.3%), white (73.1%), and underwent laparoscopic sleeve gastrectomy (72.8%). The second most common identified race was African-American (17.6%) followed by other (9.3%). The mean age of our population was 43.9 ± 11.0 years with a mean body mass index of 46.6 ± 8.5 kg/m2 and a mean operative length of 89.7 ± 48.5 min. Males were more likely to experience serious complications (3.7% vs. 3.45%; p = 0.002) and increased reoperation rates (1.33% vs. 1.18%; p < 0.001) and had a 2-fold greater mortality (0.18% vs. 0.07; p < 0.001) in comparison with female patients. Female patients had increased intervention rates (1.34% vs. 1.18%; p < 0.001) and readmission rates (3.89% vs. 3.53%; p < 0.001) at 30 days. Black patients had higher rates of serious complications (4.14% vs. 3.41%; p < 0.001), mortality (0.13% vs. 0.09%; p < 0.001), intervention (1.74% vs. 1.24%; p < 0.001), and readmission (5.03% vs. 3.56%; p < 0.001) at 30 days when compared with white patients. Female sex (OR 1.05; 95% CI 1.05-1.10; p < 0.001) and black race (OR 1.30; 95 % CI 1.24-1.35; p < 0.001) were independent predictors of major complications. Female sex was the single greatest protective factor for mortality following bariatric surgery (OR 0.53; 95% CI 0.42-0.65; p < 0.001) while black race was one of the greatest independent predictors of mortality (OR 1.78; 95% CI 1.39-2.26; p < 0.001). CONCLUSION: Race and sex are independent predictors of adverse outcomes following bariatric surgery in a multivariate logistic regression analysis of the MBSAQIP database. The influence of these factors requires further study in order to continue optimizing bariatric surgery outcomes.
Authors: Ninh T Nguyen; Hossein Masoomi; Cheryl P Magno; Xuan-Mai T Nguyen; Kelly Laugenour; John Lane Journal: J Am Coll Surg Date: 2011-05-31 Impact factor: 6.113
Authors: Pedro A Velásquez-Mieyer; Patricia A Cowan; Sylvia Pérez-Faustinelli; Ramfis Nieto-Martínez; Cesar Villegas-Barreto; Elizabeth A Tolley; Robert H Lustig; Bruce S Alpert Journal: Diabetes Care Date: 2008-01-09 Impact factor: 19.112
Authors: Valentin Mocanu; Krista Lai; Jerry T Dang; Noah J Switzer; Daniel W Birch; Geoff D C Ball; Shahzeer Karmali Journal: Obes Surg Date: 2021-02-06 Impact factor: 4.129
Authors: Timothy J Hartman; James W Nie; Keith R MacGregor; Omolabake O Oyetayo; Eileen Zheng; Kern Singh Journal: J Clin Orthop Trauma Date: 2022-09-11
Authors: Rishi Singhal; Victor Roth Cardoso; Tom Wiggins; Jonathan Super; Christian Ludwig; Georgios V Gkoutos; Kamal Mahawar Journal: Int J Obes (Lond) Date: 2021-12-15 Impact factor: 5.551
Authors: Noyan Gokce; Shakun Karki; Alyssa Dobyns; Elaina Zizza; Emily Sroczynski; Joseph N Palmisano; Celestina Mazzotta; Naomi M Hamburg; Luise I Pernar; Brian Carmine; Cullen O Carter; Michael LaValley; Donald T Hess; Caroline M Apovian; Melissa G Farb Journal: JAMA Netw Open Date: 2021-07-01