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Characteristics and outcomes for patients undergoing revisional bariatric surgery due to persistent obesity: a retrospective cohort study of 10,589 patients

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Abstract

Background

Revisional bariatric surgery in an option for patients who experience weight regain or inadequate weight loss after primary elective bariatric procedures. However, there is conflicting data on safety outcomes of revisional procedures. We aim to characterize patient demographics, procedure type, and safety outcomes for those undergoing revisional compared to initial bariatric interventions to guide management of these patients.

Methods

The 2020 Metabolic and Bariatric Accreditation and Quality Improvement Program (MBSAQIP) registry was analyzed, comparing primary elective to revisional bariatric procedures for inadequate weight loss. Bivariate analysis was performed to determine between group differences. Multivariable logistic regression determined factors associated with serious complications or mortality.

Results

We evaluated 158,424 patients, including 10,589 (6.7%) revisional procedures. Patients undergoing revisional procedures were more like to be female (85.5% revisional vs. 81.0% initial; p < 0.001), had lower body mass index (43.6 ± 7.8 kg/m2 revisional vs. 45.2 ± 7.8 kg/m2 initial; p < 0.001), and less metabolic comorbidities than patients undergoing primary bariatric surgery. The most common revisional procedures were Roux-en-Y gastric bypass (48.4%) and sleeve gastrectomy (32.5%). Revisional procedures had longer operative duration compared to primary procedures.

Patients undergoing revisional procedures were more likely to experience readmission to hospital (4.8% revisional vs. 2.9% initial; p < 0.001) and require reoperation (2.4% revisional vs. 1.0% initial; p < 0.001) within 30 days of the procedure. Revisional procedures were independently associated with increased serious complications (OR 1.49, CI 1.36–1.64, p < 0.001) but were not a significant predictor of 30-day mortality (OR 0.74, CI 0.36–1.50, p = 0.409).

Conclusions

In comparison to primary bariatric surgery, patients undergoing revisional procedures have less metabolic comorbidities. Revisional procedures have worse perioperative outcomes and are independently associated with serious complications. These data help to contextualize outcomes for patients undergoing revisional bariatric procedures and to inform decision making in these patients.

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Authors and Affiliations

  1. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Steffane McLennan

  2. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Kevin Verhoeff, Valentin Mocanu, Uzair Jogiat & Noah J. Switzer

  3. Centre for Advancement of Surgical Education and Simulation (CASES), Royal Alexandra Hospital, Edmonton, AB, Canada

    Daniel W. Birch & Shahzeer Karmali

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  1. Steffane McLennan
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  2. Kevin Verhoeff
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Correspondence to Steffane McLennan.

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None of the authors of this manuscript, including Steffane McLennan, Kevin Verhoeff, Valentin Mocanu, Uzair Jogiat, Daniel W. Birch, Shahzeer Karmali, and Noah J. Switzer have any disclosures.

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Appendix

Appendix

Data collection definitions

Anastomotic leak- Defined by any of: reoperation for anastomotic/staple line leak, readmission for anastomotic/staple line leak, reintervention for anastomotic/staple line leak, drain present 30 days postoperatively, or death caused by anastomotic/staple line leak.

Postoperative bleed- Defined by any of: reoperation for bleed, readmission for bleed, reintervention for bleed, transfusion required in first 72 h of surgery start time, and death caused by bleeding.

Serious complication- Defined by any of: cardiac complications, pneumonia, acute renal failure, reoperation, reintervention, venous thromboembolism, deep surgical site infection, wound disruption, sepsis, unplanned intubation, leak, bleed, coma > 24 h, and cerebral vascular accident.

  • Functional Status – reported as the best functional status demonstrated by the patient within 30 days prior to primary procedure or at the time that the patient is being considered a candidate for surgery. This is reported as:

  • Independent: the patient does not require assistance from another person for any activities of daily living. This includes a person who is able to function independently with prosthetics, equipment, or devices.

  • Partially dependent: the patient requires some assistance from another person for activities of daily living. This includes a person who utilizes prosthetics, equipment, or devices but still requires some assistance from another person for ADLs.

  • Totally dependent: the patient requires total assistance for all activities of daily living.

  • Unknown: unable to ascertain the functional status of the patient prior to surgery.

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McLennan, S., Verhoeff, K., Mocanu, V. et al. Characteristics and outcomes for patients undergoing revisional bariatric surgery due to persistent obesity: a retrospective cohort study of 10,589 patients. Surg Endosc 37, 4613–4622 (2023). https://doi.org/10.1007/s00464-023-09951-6

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