2020 General Surgery Presentations

Sasha Hornock, DO1, Oriana Ellis, MD1, Joshua Dilday, DO1, Benjamin Clapp, MD2, Eric Ahnfeldt, DO1; 1William Beaumont Army Medical Center, 2Texas Tech University Health Science Center

OBJECTIVES: Due to the increased rate of obesity, bariatric surgery continues to increase in popularity. However, many patients require revisional bariatric surgery for either complications or conversion to a different bariatric procedure. Patients undergoing revisonal bariatric surgery may present with other diagnoses warranting non-bariatric surgical intervention. This study evaluates 30-day outcomes of patients undergoing revisional bariatric surgery combined with other non-bariatric surgical procedures.

METHODS: A retrospective review of the 2005-2017 ACS NQIP identified 14,968 patients who underwent revisional bariatric surgery. Patients were identified by CPT codes for open and laparoscopic revisional procedures. Cohorts were separated by presence or absence of other simultaneous surgical procedures. Patient demographics and 30-day postoperative outcomes were compared between cohorts.

RESULTS: Of the 14,968 patient identified, 6,014 (40%) had additional non-bariatric procedures. The majority of patients were female (84.9%) and the most common age was 30-50 years old (49.4%). Those undergoing additional procedures had slightly lower BMI (36.2 vs. 37.5; p<0.001) but had higher rates of smoking (14.5% vs. 11.6%; p<0.001), COPD (2.2% vs. 1.5%; p<0.001), and ascites (0.6% vs. 0.1%; p<0.001). Laparoscopic removal of a gastric band was the most common primary procedure (n=6,811; 45.5%) followed by revision of gastrojejunostomy (n=1,299; 8.7%). Enterolysis was the most common simultaneous procedure (n=1,401; 23.3%). The overall complication rate was 9.3% with more overall complications occurring with simultaneous procedures (14.9% vs. 5.6%; p<0.001). The complication profile of the simultaneous procedure cohort showed higher major systemic complications (7.2% vs. 1.8%; p<0.001), major local complications (4.7% vs. 1.5%; p<0.001), and mortality (0.9% vs. 0.3%; p<0.001). Additionally, patient undergoing simultaneous procedures accrued both longer operative times (141.6 min vs. 74.6 min; p<0.001) and length of stay (5.0 vs. 1.9; p<0.001).

CONCLUSION: Patients may undergo revisional bariatric surgery for a multitude of reasons. However, patients may also require additional surgery intervention due to anatomical factors related to the prior bariatric surgery, complications of bariatric surgery, or unrelated physiology. The complication profile in these patients is much higher compared to patients undergoing revisional bariatric procedures alone. Future studies are needed before the safety of concurrent procedures in revisonal bariatric surgery can be fully evaluated.