In a poster, Dr. Popov and her colleagues presented data from the NIS database looking at 10-year mortality and outcome trends for revisional surgery versus primary Roux-en-Y gastric bypass (RYGB) surgery. Inpatient mortality for RYGB decreased from 2.54% in 2003 to 1.80% in 2014, but was still substantially higher than the BOLD findings. But mortality for revisional surgery increased: 1.90% versus 2.03%. LOS for RYGB decreased from 5.9 days to 5.4 but increased for revisional surgery from 4.6 to 5.4 days. Cost for both procedures, adjusted for inflation, more than doubled between 2003 and 2014. And patients requiring ICU admission for both procedures went from 1% in 2003 to 3% in 2014.
The limitations of both analyses are their retrospective design, the NIS bias inferred by the inclusion of only inpatient procedures, and the lack of laboratory data or data on body mass index. In addition, during the study period, primary bariatric surgery began to be performed as an outpatient procedure. “Low-risk procedures performed in outpatient facilities will not be captured in the database and thus the higher mortality for these higher risk patients is expected,” Dr. Popov said. These patients are likely to be sicker and have more comorbidities. Revisional procedures are typically done in the hospital, but there are some low-risk revisional procedures such as lap band removal that could be done as outpatient procedures. Dr. Popov had confidence that the NIS database reflects real-world outcomes for revisional bariatric procedures.
She concluded that the explanation for the increase in mortality risk for revisional bariatric surgery may be because of more of these procedures being done outside centers of excellence and more, older patients with comorbidities having the surgery, and that nonsurgical alternatives should be explored for the older sicker patients.
Dr. Popova disclosed ownership of shares in Embarcadero Technologies but no conflicts of interest.
SOURCE: Popov VB et al. DDW 2018, Abstract 324.