MSS851: HEALTHCARE UTILIZATION FOLLOWING PRIMARY VERSUS REVISIONAL ROUX-EN-Y GASTRIC BYPASS IN A MILITARY TREATMENT FACILITY
Michael T Olson, MD; Yun Beom Lee, MD; Brian Layton, DO; Pamela Masella, DO; Department of Minimally Invasive and Bariatric Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
Objective: Revisional bariatric surgery is often performed for patients with weight recidivism or post-surgical complications, especially de novo or worsening gastroesophageal reflux disease (GERD). We aimed to compare the healthcare utilization, including postoperative complications, readmissions, and emergency department (ED) visits, between primary and revisional Roux-en-Y gastric bypass (RNYGB) within the first year postoperatively.
Methods: We conducted a retrospective cohort study of consecutive patients undergoing laparoscopic RNYGB between 01/01/2023 and 01/01/2024 by two surgeons at our tertiary military treatment facility. Patients were categorized based on undergoing primary versus revisional RNYGB. Demographics, comorbidities, operative characteristics, perioperative measures, and postoperative complications, readmissions, and ED visits were collected. Continuous variables were compared using t-tests or Wilcoxon tests; categorical variables were compared using Chi-square or Fisher’s exact tests as appropriate. Firth’s penalized logistic regression were used to assess revisional surgery as a predictor of 12-month complications, readmissions, and ED visits.
Results: A total of 68 consecutive patients underwent laparoscopic RNYGB during the study period: 52 (76.4%) primary and 16 (23.5%) revisional. Thirteen (81.3%) patients underwent sleeve-to-RNYGB conversion; the remaining three patients underwent gastric band-to-RNYGB conversion. The most common indication for revisional surgery was combined weight recidivism and GERD (N=7), followed by GERD alone (N=6), and weight recidivism alone (N=3). Primary and revisional were similar in age (mean 46.0±10.9 vs 48.5±9.7 years, p=0.38), female sex (82.7% vs 87.5%, p=0.95), frequencies of all preoperative comorbidities, and mean hospital length of stay (1.63 vs 1.69 days, p=0.79). Rates of 12-month complications were similar overall (43.8% vs 28.8%, p=0.360). Marginal ulcers were significantly more common after primary compared to revisional surgery. Readmissions and ED visits were higher in the revisional group at all time points, reaching statistical significance for 6-month and 12-month ED visits. Firth logistic regression showed revisional surgery was independently associated with increased 6-month (OR 7.38, 95% CI 1.45-73.7, p=0.005) and 12-month ED visits (OR 9.25, CI 1.23-419, p=0.011). All healthcare utilization outcomes between groups are summarized in Table 1.
Conclusions: These findings highlight that while revisional RNYGB in the military health system is generally safe, it is associated with increased postoperative healthcare utilization. These patients should be followed closely in the postoperative setting and counseled appropriately regarding these risks.
