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Comparison of Early Morbidity and Mortality Between Sleeve Gastrectomy and Gastric Bypass in High-Risk Patients for Liver Disease: Analysis of American College of Surgeons National Surgical Quality Improvement Program

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Abstract

Introduction

Chronic liver disease is prevalent in obese patients presenting for bariatric surgery and is associated with increased postoperative morbidity and mortality (M&M). There are no comparative studies on the safety of different types of bariatric operations in this subset of patients.

Objective

The aim of this study is to compare the 30-day postoperative M&M between laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-Y-gastric bypass (LRYGB) in the subset of patients with a model of end-stage liver disease (MELD) score ≥ 8.

Methods

Data for LSG and LRYGB were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from years 2012 and 2013. MELD score was calculated using serum creatinine, bilirubin, INR, and sodium. Postoperative M&M were assessed in patients with a score ≥ 8 and compared for the type of operation. This was followed by analysis for MELD subcategories. Multiple logistic regression was performed to adjust for confounders.

Results

Out of 34,169, 9.8% of cases had MELD ≥ 8 and were included. Primary endpoint, 30-day M&M, was significantly lower post-LSG (9.5%) compared to LRYGB (14.7%); [AOR = 0.66(0.53, 0.83)]. Superficial wound infection, prolonged hospital stay, and unplanned readmission were more common in LRYGB. M&M post-LRYGB (30.6%) was significantly higher than LSG (15.7%) among MELD15-19 subgroup analysis.

Conclusion

LRYGB is associated with a higher postoperative risk than LSG in patients with MELD ≥ 8. The difference in postoperative complications between procedures was magnified with higher MELD. This suggests that LSG might be a safer option in morbidly obese patients with higher MELD scores, especially above 15.

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Author information

Authors and Affiliations

  1. Department of Surgery, American University of Beirut, Beirut, Lebanon

    Mohamad A. Minhem, Bassem Y. Safadi & Ramzi S. Alami

  2. Faculty of Medicine, American University of Beirut, Beirut, Lebanon

    Sali F. Sarkis

  3. Hariri School of Nursing, American University of Beirut, Beirut, Lebanon

    Souha A. Fares

  4. American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon

    Ramzi S. Alami

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  1. Mohamad A. Minhem
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Corresponding author

Correspondence to Ramzi S. Alami.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

De-identified patient information is freely available to all institutional members who comply with the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Data Use Agreement. The Data Use Agreement implements the protections afforded by the Health Insurance Portability and Accountability Act of 1996 and the ACS NSQIP Hospital Participation Agreement, and conforms to the Declaration of Helsinki.

Informed Consent

For this type of study on de-identified datasets, formal consent is not required.

ACS NSQIP Disclaimer

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Minhem, M.A., Sarkis, S.F., Safadi, B.Y. et al. Comparison of Early Morbidity and Mortality Between Sleeve Gastrectomy and Gastric Bypass in High-Risk Patients for Liver Disease: Analysis of American College of Surgeons National Surgical Quality Improvement Program. OBES SURG 28, 2844–2851 (2018). https://doi.org/10.1007/s11695-018-3259-z

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