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Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry
Örebro University Hospital. Department of Surgery, Lindesberg Hospital, Lindesberg, Sweden; Department of Surgery, Örebro University Hospital, Örebro, Sweden .ORCID iD: 0000-0003-4958-1611
Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Surgery, Örebro University Hospital, Örebro, Sweden .
Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden .
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2014 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 260, no 6, p. 1040-1047Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To identify risk factors for serious and specific early complications of laparoscopic gastric bypass surgery using a large national cohort of patients.

BACKGROUND: Bariatric procedures are among the most common surgical procedures today. There is, however, still a need to identify preoperative and intraoperative risk factors for serious complications.

METHODS: From the Scandinavian Obesity Surgery Registry database, we identified 26,173 patients undergoing primary laparoscopic gastric bypass operation for morbid obesity between May 1, 2007, and September 30, 2012. Follow-up on day 30 was 95.7%. Preoperative data and data from the operation were analyzed against serious postoperative complications and specific complications.

RESULTS: The overall risk of serious postoperative complications was 3.4%. Age (adjusted P = 0.028), other additional operation [odds ratio (OR) = 1.50; confidence interval (CI): 1.04-2.18], intraoperative adverse event (OR = 2.63; 1.89-3.66), and conversion to open surgery (OR = 4.12; CI: 2.47-6.89) were all risk factors for serious postoperative complications. Annual hospital volume affected the rate of serious postoperative complications. If the hospital was in a learning curve at the time of the operation, the risk for serious postoperative complications was higher (OR = 1.45; CI: 1.22-1.71). The 90-day mortality rate was 0.04%.

CONCLUSIONS: Intraoperative adverse events and conversion to open surgery are the strongest risk factors for serious complications after laparoscopic gastric bypass surgery. Annual operative volume and total institutional experience are important for the outcome. Patient related factors, in particular age, also increased the risk but to a lesser extent.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014. Vol. 260, no 6, p. 1040-1047
Keywords [en]
bariatric surgery; laparoscopic gastric bypass; postoperative complications; risk factors
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-40584DOI: 10.1097/SLA.0000000000000431ISI: 000345217200018PubMedID: 24374541Scopus ID: 2-s2.0-84922330659OAI: oai:DiVA.org:oru-40584DiVA, id: diva2:780743
Conference
6th Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders, European Chapter, Brussels, Belgium, April 30 - May 3, 2014
Projects
Preventing complications in bariatric surgeryAvailable from: 2015-01-15 Created: 2015-01-08 Last updated: 2018-06-15Bibliographically approved
In thesis
1. Preventing complications in bariatric surgery
Open this publication in new window or tab >>Preventing complications in bariatric surgery
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Obesity is a major public health problem. Bariatric surgery is currently the only available treatment that offers sufficient weight-loss and metabolic benefits over time. Although bariatric surgery is considered safe now, serious complications still occur. The aim of this thesis was to identify factors associated with an increased risk for postoperative complication after laparoscopic gastric bypass surgery.

Study I included patients operated with laparoscopic gastric bypass surgery in Sweden from May 2007 until September 2012. The risk for serious complication was low (3.4%). Suffering an intraoperative adverse event or conversion of the operation to open surgery were the strongest risk factors for postoperative complication. The annual operative volume and experience of the procedure at the institution were also important risk factors. Patient-specific risk factors appeared to be less important although age was associated with an increased risk. In Study II, a raised glycated haemoglobin A1c (HbA1c) was evaluated as a risk factor for serious postoperative complications in non-diabetics. A higher incidence of serious postoperative complications was seen with elevated HbA1c values, even at levels classified as ‘‘pre-diabetic’’.

Study III was a multicentre, randomised clinical trial (RCT). 2507 patients planned for laparoscopic gastric bypass surgery were randomised to either mesenteric defects closure or non-closure. Closure of the mesenteric defects reduced the rate of reoperation for small bowel obstruction from 10.2% to 5.5% at 3 years after surgery. A small increase in the rate of serious postoperative complication within the first 30 days was seen with mesenteric defects closure. This relatively small increase in risk was however outweighed by the marked reduction of later reoperations for small bowel obstruction.

Study IV was a comparison between study III and an observational study on the same population under the same period of time. Although the observational study reached the same conlusion as the RCT, the efficacy of mesenteric defects closure was less pronounced. Observational studies may thus be an alternative to RCTs under situations when RCTs are not feasible. The efficacy may however be underestimated.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2016. p. 103
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 147
Keywords
postoperative complications, bariatric surgery, morbid obesity, risk factor, randomised clinical trial, haemoglobin A1c, prevention
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-50649 (URN)978-91-7529-149-9 (ISBN)
Public defence
2016-10-07, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2016-06-09 Created: 2016-06-09 Last updated: 2017-10-18Bibliographically approved

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Stenberg, Erik

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