Reintervention or mortality within 90 days of bariatric surgery: population-based cohort study

Abstract

Background Bariatric surgery carries a risk of severe postoperative complications, sometimes leading to reinterventions or even death. The incidence and risk factors for reintervention and death within 90 days after bariatric surgery are unclear, and were examined in this study. Methods This population-based cohort study included all patients who underwent bariatric surgery in one of the five Nordic countries between 1980 and 2012. Data on surgical and endoscopic procedures, diagnoses and mortality were retrieved from national high-quality and complete registries. Multivariable Cox regression analysis was used to calculate hazard ratios (HRs), adjusted for country, age, sex, co-morbidity, type of surgery and approach, year and hospital volume of bariatric surgery. Results Of 49 977 patients, 1111 (2·2 per cent) had a reintervention and 95 (0·2 per cent) died within 90 days of bariatric surgery. Risk factors for the composite outcome reintervention/mortality were older age (HR 1·65, 95 per cent c.i. 1·36 to 2·01, for age at least 50 years versus less than 30 years) and co-morbidity (HR 2·66, 1·53 to 4·62, for Charlson co-morbidity index score 2 or more versus 0). The risk of reintervention/mortality was decreased for vertical banded gastroplasty compared with gastric bypass (HR 0·37, 0·28 to 0·48) and more recent surgery (HR 0·51, 0·39 to 0·67, for procedures undertaken in 2010 or later versus before 2000). Sex, surgical approach (laparoscopic versus open) and hospital volume did not influence risk of reintervention/mortality, but laparoscopic surgery was associated with a lower risk of 90-day mortality (HR 0·29, 0·16 to 0·53). Conclusion Reintervention and death were uncommon events within 90 days of bariatric surgery even in this unselected nationwide cohort from five countries. Older patients with co-morbidities have an increased relative risk of these outcomes.

Mid‐term Results of an ERAS Program of Bariatric Surgery in a Tertiary Referral Center

“…With an average length of stay of 2.0 ± 1.8 days (min–max; 1–24 days), 330 patients (47.3%) were discharged at POD‐1, 219 (31.4%) at POD 2, 90 (12.9%) at POD 3, 25 (3.6%) at POD 4 and 33 (3.7%) at POD 5, respectively. Over time of the study, the average length of stay during the last 2 years was significantly reduced compared to the 1st year (1.68 ± 1.79 [1–24] versus 2.53 ± 1.69 [1–17], p = 0.01. The reasons for delayed discharges beyond POD‐2 in the 148 patients (21.2%) of the ERAS‐F group are reported in Table 1.…”

“…To date, bariatric surgery is considered to be the most effective treatment for morbid obesity, given its results on long‐term weight loss maintenance and control of obesity‐related comorbidities [1]. However, although laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux‐en‐Y gastric bypass (LRYGB) are the two most performed bariatric interventions, they remain at risk of severe postoperative complications, including those leading to reintervention and even death [2]. For nearly two decades, enhanced recovery after surgery (ERAS) has changed perioperative care and management toward mainly surgical interventions [3].…”

Revisional Adjustable Gastric Band in Roux-en-Y Gastric Bypass—Is It Worth It?

“…[16][17][18][19] Laparoscopic RYGB is one of the most effective bariatric procedures with durable weight loss outcomes, acceptable morbidity, and low mortality. [22][23][24] However, the issue of insufficient weight loss or weight regain after RYGB is well recognized. 25 Anatomical, behavioral, and hormonal factors contribute to the unfavorable outcomes after RYGB.…”

Bariatric surgery volume by hospital and long-term survival: population-based NordOSCo data

“…Bariatric surgery in severely obese adults aims to induce weight loss, reduce co-morbidities, and improve quality of life, but many patients experience weight regain 1–5 . A worrying trend in bariatric operations underlines the expanding problem: even if they do reduce mortality 6–9 and medication use (for example treatment of diabetes) 10 , the cost is considerable. Does a mere 25 per cent loss of excess weight and 38 per cent reduction in medication use balance the initial high cost of preoperative care, operation, and considerable rehabilitation?…”

“…Does a mere 25 per cent loss of excess weight and 38 per cent reduction in medication use balance the initial high cost of preoperative care, operation, and considerable rehabilitation? 11 Published outcomes, with a reintervention rate of 2.2 per cent and 90-day mortality rate of 0.2 per cent, are from centres of excellence 10 , but do these reflect real-world data outside such centres?…”