Comparison of Early Morbidity and Mortality Between Sleeve Gastrectomy and Gastric Bypass in High-Risk Patients for Liver Disease: Analysis of American College of Surgeons National Surgical Quality Improvement Program
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Springer New York LLC
Abstract
Introduction: Chronic liver disease is prevalent in obese patients presenting for bariatric surgery and is associated with increased postoperative morbidity and mortality (M&M). There are no comparative studies on the safety of different types of bariatric operations in this subset of patients. Objective: The aim of this study is to compare the 30-day postoperative M&M between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-Y-gastric bypass (LRYGB) in the subset of patients with a model of end-stage liver disease (MELD) score ≥ 8. Methods: Data for LSG and LRYGB were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from years 2012 and 2013. MELD score was calculated using serum creatinine, bilirubin, INR, and sodium. Postoperative M&M were assessed in patients with a score ≥ 8 and compared for the type of operation. This was followed by analysis for MELD subcategories. Multiple logistic regression was performed to adjust for confounders. Results: Out of 34,169, 9.8% of cases had MELD ≥ 8 and were included. Primary endpoint, 30-day M&M, was significantly lower post-LSG (9.5%) compared to LRYGB (14.7%); [AOR = 0.66(0.53, 0.83)]. Superficial wound infection, prolonged hospital stay, and unplanned readmission were more common in LRYGB. M&M post-LRYGB (30.6%) was significantly higher than LSG (15.7%) among MELD15-19 subgroup analysis. Conclusion: LRYGB is associated with a higher postoperative risk than LSG in patients with MELD ≥ 8. The difference in postoperative complications between procedures was magnified with higher MELD. This suggests that LSG might be a safer option in morbidly obese patients with higher MELD scores, especially above 15. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
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Bariatric surgery, Gastric bypass, Liver disease, Meld score, Sleeve gastrectomy, Adult, Databases, factual, Female, Gastrectomy, Humans, Laparoscopy, Length of stay, Liver diseases, Male, Middle aged, Morbidity, Mortality, National health programs, Obesity, morbid, Patient readmission, Postoperative complications, Prevalence, Quality improvement, Risk factors, Surgeons, Time factors, United states, Albumin, Alkaline phosphatase, Bilirubin, Creatinine, Sodium, Acute kidney failure, Article, Aspartate aminotransferase blood level, Bleeding disorder, Comparative study, Controlled study, Creatinine blood level, Gastric bypass surgery, High risk patient, Hospital readmission, Hospitalization, Human, International normalized ratio, Kidney failure, Laparoscopic sleeve gastrectomy, Laparoscopic surgery, Lung embolism, Major clinical study, Model for end stage liver disease score, Partial thromboplastin time, Platelet count, Postoperative period, Priority journal, Surgical infection, Total quality management, Venous thromboembolism, Wound dehiscence, Wound infection, Adverse event, Complication, Factual database, Morbid obesity, Organization and management, Postoperative complication, Procedures, Public health, Risk factor, Surgeon, Time factor