Bariatric Surgery Outcomes in Patients with Prior Solid Organ Transplantation: an MBSAQIP Analysis
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Bariatric Surgery Outcomes in Patients with Prior Solid Organ Transplantation: an MBSAQIP Analysis Alexander M. Fagenson 1 & Michael M. Mazzei 1 & Huaqing Zhao 2 & Xiaoning Lu 2 & Michael A. Edwards 3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Obesity is a risk factor for poor patient outcomes after organ transplantation (TXP). While metabolic and bariatric surgery (MBS) is safe and effective in treating severe obesity, the role of MBS in transplant patients continues to evolve. Methods A retrospective analysis was performed of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) patients in the 2017 Metabolic and Bariatric Surgery Accreditation Quality and Improvement Project (MBSAQIP) database. Propensity and case-control matching, and multivariable logistic regression were performed for 30-day post-operative outcomes. Results A total of 336 transplant patients were compared with 157,413 patients without transplant. Propensity and case-control matching reveal no significant differences in mortality (p > 0.2). However, case-control matching revealed longer operative time (104 min versus 76 min, p < 0.001), increased length of stay (2 days versus 1 day, p < 0.05), perioperative transfusions (2% versus 0.22%, p = 0.009), and leak rates (2.2% versus 0.55%, p = 0.02) in the transplant cohort. On multivariable regression analysis, prior transplantation was associated with higher rates of overall (OR 1.6, p = 0.007) and bariatric-related morbidity (OR 1.78, p = 0.004), leak (OR 3.47, p = 0.0027), and surgical site infection (OR 3.32, p = 0.004). Prior transplantation did not predict overall (p = 0.55) nor bariatric-related mortality (p = 0.99). Conclusion MBS in prior solid organ transplantation patients is overall safe, but is associated with increased operative time and length of stay, as well as higher rates of some post-operative morbidity. Keywords Bariatric surgery . Solid organ transplantation . MBSAQIP . Perioperative outcomes
Introduction Obesity is increasingly prevalent after solid organ transplantation, and may negatively impact the transplant population on multiple levels [1–6]. Obesity in transplantation patients may also negatively impact perioperative and long-term outcomes after metabolic and bariatric surgery (MBS) [7–11]. In the systematic review by Sood et al., obesity was associated with a higher odds ratio for biopsy-proven acute rejection, mortality, allograft loss, and the development of diabetes [8].
* Michael A. Edwards [email protected]; [email protected] 1
Department of Surgery, Temple University Hospital, Suite, 3401 North Broad Street, Philadelphia, PA 19140, USA
2
Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA
3
Department of Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, USA
Patients with a history of solid organ transplantation are routinely considered to be high-risk patients. This risk stratification is comp
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