Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study
Received 20 May 2009; received in revised form 4 September 2009; accepted 16 October 2009. published online 23 November 2009.
Abstract
Background
The goals were to compare the morbidity and mortality between primary and revisional bariatric surgery and to identify the clinical predictors of adverse outcomes among patients undergoing revisional surgery in the Longitudinal Assessment of Bariatric Surgery consortium. The study was multi-institutional at university hospitals in the United States.
Methods
Data from the LABS-1 (safety) cohort were analyzed, excluding primary gastric banding patients. A total of 3802 LABS-1 patients were included: 3577 who underwent primary surgery and 225 who underwent revisional surgery. The demographic, clinical, operative, and 30-day outcome data were compared between the 2 groups. A nonlinear mixed effects logit model was used to identify independent risk factors for adverse outcomes (death, deep vein thrombosis, pulmonary embolism, reintubation, reoperation, or discharge after 30 days).
Results
Compared with those undergoing revisional surgery, the primary surgery patients were younger (median age 44 versus 49 years, P <.0001) and more likely to be male (20.5% versus 12.7%, P = .006) and heavier (median body mass index 47.3 versus 41.2 kg/m2, P <.0001) and to have more co-morbidities (P <.0001), including hypertension (56.0% versus 46.0%, P = .0044), diabetes (35.7% versus 20.0%, P <.0001), and sleep apnea (50.3% versus 27.2%, P <.0001). The operative time for the revisional procedures was longer (median 181 versus 135 min, P <.0001) and associated with greater blood loss (median 100 versus <50 mL, P <.0001). Adverse outcomes were more likely after revisional surgery (15.1% versus 5.3%, P <.0001, odds ratio 2.4, 95% confidence interval 1.6–3.6). After adjusting for patient characteristics previously shown to be associated with adverse outcomes, this difference remained statistically significant (odds ratio 2.3, 95% confidence interval 1.5–3.8). The 30-day mortality rate was similar in the 2 groups (.4%).
Conclusion
Revisional surgery was performed without substantial mortality but with a greater incidence of adverse outcomes than was primary bariatric surgery.
aColumbia University Medical Center, New York, New York
bUniversity of Pittsburgh, Pittsburgh, Pennsylvania
cUniversity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
dUniversity of Washington/Virginia Mason Medical Center, Seattle, Washington
eMeritCare Health Systems/Neuropsychiatric Research Institute, Fargo, North Dakota
fOregon Health and Science University, Portland, Oregon
gEast Carolina Medical Center, Benson, North Carolina
hCornell University Medical Center, New York, New York
Corresponding author: William B. Inabnet, III, M.D., Division of Metabolic, Endocrine, and Minimally Invasive Surgery, Mount Sinai Medical Center, 5 East 98th St., Box 1259, New York, NY 10029
ABSTRACT