Are Concomitant Operations During Bariatric Surgery Safe? An Analysis of the MBSAQIP Database
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Are Concomitant Operations During Bariatric Surgery Safe? An Analysis of the MBSAQIP Database Benjamin Clapp 1 & Isaac Lee 1 & Evan Liggett 1 & Michael Cutshall 1 & Bryson Tudor 1 & Grishma Pradhan 1 & Katherine Aguirre 1 & Alan Tyroch 1 Received: 2 November 2019 / Revised: 4 July 2020 / Accepted: 7 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction The American College of Surgeons tracks 30-day outcomes using the Metabolic and Bariatric Surgery Accreditation Quality Initiative Program (MBSAQIP) database. We examined the short-term outcomes of patients that undergo bariatric surgery concomitantly with other operations such as hernia repairs and cholecystectomy to determine the safety of this practice. Methods The MBSAQIP Participant Use Data File for 2015–2017 was examined for differences in primary bariatric operations vs concomitant procedures (CP). We looked for concurrent CPT codes for laparoscopic cholecystectomy (LC) and hernia repairs (ventral, epigastric, incisional, and inguinal). p was significant at < 0.05. Results There were 464,674 cases, of which 15,614 had CP. For both LRYGB+LC and SG+LC, there were increased operative times and length of stay. There were statistically significant higher rates of readmission, reintervention, and reoperation for SG+ LC vs SG alone, as well as for LRYGB+hernia and SG+hernia. There was a higher risk of death (p < 0.001) in LRYGB+hernia patients. Also, LRYGB+hernia patients had statistically significant increases in unplanned admission to the intensive care unit and pulmonary embolus. SG+hernia patients had a higher rate of ventilation > 48 h, unplanned admission to the ICU, pulmonary embolism, deep vein thrombosis, and readmission, reintervention, and reoperation. Conclusions There is a statistically higher rate of complications with concomitant procedures in the MBSAQIP database. Length of stay and operative times are increased in concomitant operations as are readmissions, reinterventions, and reoperations. These findings would indicate that additional procedures at the time of bariatric surgery should be deferred if possible. Keywords Metabolic and bariatric surgery accreditation quality improvement program (MBSAQIP) . Concomitant procedures . Combined procedures . Bariatric surgery
Background Metabolic and bariatric surgery (MBS) is the most effective treatment of morbid obesity, diabetes mellitus, and many other diseases. Sleeve gastrectomies (SG) and laparoscopic Roux-
en-Y gastric bypass (LRYGB) are the 2 most commonly performed operations. These are done laparoscopically, and the laparoscopic port placement is very specific for working on the foregut. Although laparoscopy allows examination of the abdominal cavity, performing other operations through the
* Benjamin Clapp [email protected]
Grishma Pradhan [email protected]
Isaac Lee [email protected]
Katherine Aguirre [email protected]
Evan Liggett [email protected]
Alan Tyroch [email protected]
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