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Obesity Surgery

, Volume 26, Issue 12, pp 2829–2836 | Cite as

Prognostic Factors for Morbimortality in Sleeve Gastrectomy. The Importance of the Learning Curve. A Spanish-Portuguese Multicenter Study

  • Raquel Sánchez-SantosEmail author
  • Ricard Corcelles Codina
  • Ramon Vilallonga Puy
  • Salvadora Delgado Rivilla
  • Jose Vicente Ferrer Valls
  • Javier Foncillas Corvinos
  • Carlos Masdevall Noguera
  • Maria Socas Macias
  • Pedro Gomes
  • Carmen Balague Ponz
  • Jorge De Tomas Palacios
  • Sergio Ortiz Sebastian
  • Andres Sanchez-Pernaute
  • Jose Julian puche Pla
  • Daniel Del Castillo Dejardin
  • Julen Abasolo Vega
  • Ester Mans Muntwyler
  • Ana Garcia Navarro
  • Carlos Duran Escribano
  • Norberto Cassinello Fernández
  • Nieves Perez Climent
  • Jose Antonio Gracia Solanas
  • Francisca Garcia-Moreno Nisa
  • Alberto Hernández Matias
  • Victor Valentí Azcarate
  • Jose Eduardo Perez Folques
  • Inmaculada Navarro Garcia
  • Eduardo Dominguez-Adame Lanuza
  • Sagrario Martinez Cortijo
  • Jesus González Fernández
Original Contributions

Abstract

Background

Complications in sleeve gastrectomy (SG) can cast a shadow over the technique’s good results and compromise its safety. The aim of this study is to identify risk factors for complications, and especially those that can potentially be modified to improve safety.

Methods

A retrospective multicenter cohort study was carried out, involving the participation of 29 hospitals. Data was collected on demographic variables, associated comorbidities, technical modifications, the surgeon's experience, and postoperative morbimortality. A multivariate logistic regression analysis was carried out on risk factors (RFs) for the complications of leak/fistula, hemoperitoneum, pneumonia, pulmonary embolism, and death.

Results

The following data were collected for 2882 patients: age, 43.85 ± 11.6. 32.9 % male; BMI 47.22 ± 8.79; 46.2 % hypertensive; 29.2 % diabetes2; 18.2 % smokers; bougie calibre ≥40 F 11.1 %; complications 11.7 % (2.8 % leaks, 2.7 % hemoperitoneum, 1.1 % pneumonia, 0.2 % pulmonary embolism); and death 0.6 %. RFs for complications were as follows: surgeon’s experience < 20 patients, OR 1.72 (1.32–2.25); experience > 100 patients, OR 0.78 (0.69–0.87); DM2, OR1.48(1.12–1.95); probe > 40 F, OR 0.613 (0.429–0.876). Leak RFs were the following: smoking, OR1.93 (1.1–3.41); surgeon’s experience < 20 patients, OR 2.4 (1.46–4.16); experience of 20–50 patients, OR 2.5 (1.3–4.86); experience >100 patients, OR 0.265 (0.11–0.63); distance to pylorus > 4 cm, OR 0.510 (0.29–0.91). RFs for death were as follows: smoking, OR 8.64 (2.63–28.34); DM2, OR 3.25 (1.1–9.99); distance to pylorus < 5 cm, OR 6.62 (1.63–27.02).

Conclusions

The safety of SG may be compromised by nonmodifiable factors such as age >65, patient comorbidities (DM2, hypertension), and prior treatment with anticoagulants, as well as by modifiable factors such as smoking, bougie size <40 F, distance to the pylorus <4 cm, and the surgeon’s experience (<50–100 cases).

Keywords

Sleeve gastrectomy Prognostic factors Complications Mortality Learning curve 

Notes

Acknowledgments

We would like to thank the Spanish Society for Obesity and Metabolic Disease Surgery (SECO), the Spanish Association of Surgeons (AEC), and the Portuguese Bariatric Surgery Society, as well as all the bariatric surgeons in the participating hospitals and the participating multidisciplinary teams.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained for all patients included in the study; no identifying information is included in this article. Human rights have been respected according to the law.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Raquel Sánchez-Santos
    • 1
    Email author
  • Ricard Corcelles Codina
    • 2
  • Ramon Vilallonga Puy
    • 3
  • Salvadora Delgado Rivilla
    • 2
  • Jose Vicente Ferrer Valls
    • 4
  • Javier Foncillas Corvinos
    • 5
  • Carlos Masdevall Noguera
    • 6
  • Maria Socas Macias
    • 7
  • Pedro Gomes
    • 8
  • Carmen Balague Ponz
    • 9
  • Jorge De Tomas Palacios
    • 10
  • Sergio Ortiz Sebastian
    • 11
  • Andres Sanchez-Pernaute
    • 12
  • Jose Julian puche Pla
    • 13
  • Daniel Del Castillo Dejardin
    • 14
  • Julen Abasolo Vega
    • 15
  • Ester Mans Muntwyler
    • 16
  • Ana Garcia Navarro
    • 17
  • Carlos Duran Escribano
    • 18
  • Norberto Cassinello Fernández
    • 19
  • Nieves Perez Climent
    • 20
  • Jose Antonio Gracia Solanas
    • 21
  • Francisca Garcia-Moreno Nisa
    • 22
  • Alberto Hernández Matias
    • 23
  • Victor Valentí Azcarate
    • 24
  • Jose Eduardo Perez Folques
    • 25
  • Inmaculada Navarro Garcia
    • 26
  • Eduardo Dominguez-Adame Lanuza
    • 27
  • Sagrario Martinez Cortijo
    • 28
  • Jesus González Fernández
    • 29
  1. 1.Sociedad Española de Cirugía de la Obesidad y Enfermedades Metabólicas, Complejo Hospitalario Universitario de PontevedraPontevedraSpain
  2. 2.Hospital Clinic de BarcelonaBarcelonaSpain
  3. 3.Hospital Universitario Valld´HebronBarcelonaSpain
  4. 4.Clinica ObesitasValenciaSpain
  5. 5.Quiron Salud-Hospital Universitari Sagrat CorBarcelonaSpain
  6. 6.Hospital Universitari Sagrat CorBarcelonaSpain
  7. 7.Hospital Universitario Virgen del RocioSevillaSpain
  8. 8.Hospital Geral, Centro Hospitalar Univertario CoimbraCoimbraPortugal
  9. 9.Hospital Sant Pau UABBarcelonaSpain
  10. 10.Hospital Gregorio MarañonMadridSpain
  11. 11.Hospital General de AlicanteAlicanteSpain
  12. 12.Hospital Clinico San CarlosMadridSpain
  13. 13.Hospital General Universitario de ValenciaValenciaSpain
  14. 14.Hospital Universitario de ReusTarragonaSpain
  15. 15.Hospital de BasurtoBilbaoSpain
  16. 16.Hospital de MataróMataróSpain
  17. 17.Hospital Virgen de las NievesGranadaSpain
  18. 18.Hospital Virgen de la PalomaMadridSpain
  19. 19.Hospital Clinico Universitario de ValenciaValenciaSpain
  20. 20.Hospital Virgen de los LiriosAlcoySpain
  21. 21.Hospital Clínico de ZaragozaZaragozaSpain
  22. 22.Hospital Ramón y CajalMadridSpain
  23. 23.Hospital Universitario de Getafe. GetafeMadridSpain
  24. 24.Clinica Universitaria de NavarraPamplonaSpain
  25. 25.Hospital Virgen del Castillo. YeclaMurciaSpain
  26. 26.Hospital Santa Lucia CartagenaCartagenaSpain
  27. 27.Hospital Universitario Virgen MacarenaSevillaSpain
  28. 28.Hospital de Talavera de la ReinaTalavera de la ReinaSpain
  29. 29.Centro Médico AsturiasOviedoSpain

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