LAS VEGAS — Being male and having a higher than normal preoperative hemoglobin A1c level were significantly associated with having a major complication following Roux-en-Y gastric bypass surgery, results from an ongoing single-center study showed.
However, the rate of overall complications at 1 year was 15%, which is lower than the 20%–25% that has been reported in the medical literature, Dr. D. Brandon Williams said during a poster session at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.
“In centers where we have a high volume—we do over 400 of these operations a year—the complication rate is very low, especially the rate of major complications,” said Dr. Williams, of the department of surgery at Stanford (Calif.) University.
Between June 5, 2000, and December 5, 2006, 613 patients with a mean age of 43 years and a mean body mass index of 47 kg/m
Major complications were defined as anastomotic leak, bleeding, deep vein thrombosis (DVT)/pulmonary embolism (PE), bowel obstruction, myocardial infarction (MI), cerebrovascular accident (CVA), intra-abdominal abscess, and pneumonia. Minor complications were defined as micronutrient deficiency, arrhythmia, wound infection/dehiscence/hernia, and ulcers/strictures.
Dr. Williams reported that 92 patients (15%) experienced 133 complications. Of those, 60 patients had minor complications, and 32 had major complications.
The most common complications included bleeding (28), ulcer/strictures (23), vitamin/nutrient deficiency (15), anastomotic leak (12), bowel obstruction (12), wound infection (11), pneumonia (10), DVT/PE (9), abscess (5), MI (3), arrhythmia (3), and CVA (2). There were no mortalities.
Univariate analysis revealed that patients with minor complications were generally older than those with major complications (a mean of 47 vs. 41 years, respectively).
Multivariate analysis revealed that significant predictors of having a major versus a minor complication were being male (OR of 2.1) and having a preoperative hemoglobin A1c level that was higher than normal (OR of 0.8).
“We actually expected more [factors] would be predictors of complications,” Dr. Williams said. “But there are a couple of things that you can use to counsel your patients preoperatively: They might be more likely to have problems if they have uncontrolled diabetes and if they're male.”
The researchers also observed a strong association between the rate of major complications and surgeon experience. For example, 16 major complications were attributed to surgeons who had performed up to 200 gastric bypass operations. That rate dropped to 6 for those who had performed more than 401 procedures.
However, the rate of minor complications remained about the same, regardless of surgeon experience. “This would suggest that there are patient-dependent [risk factors for complications] that you're not going to be able to predict no matter how good [a surgeon] you are,” he said.
'[Patients] might be more likely to have problems if they have uncontrolled diabetes and if they're male.' DR. WILLIAMS