Experience with over 3,000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality.
BACKGROUND
Intestinal leak is a potentially lethal complication of Roux en-Y gastric bypass (GBP). Identification of patients at high risk for leak may reduce complication rates of surgeons early in the procedure learning curve.


METHODS
A total of 3073 patients who underwent GBP were analyzed using univariate and multivariate logistic regression analyses of the following preoperative factors: hypertension (HTN), diabetes mellitus (DM), sleep apnea (SA), age, gender, weight, body mass index (BMI), and surgery type. Multivariate logistic regression analysis was performed for each procedure type.


RESULTS
There were 48 (1.5%) deaths. Independent risk factors for death included leak, weight, procedure type, and HTN. A total of 102 (3.2%) leaks were found. Independent factors for leak included age, male gender, SA, and procedure type.


CONCLUSIONS
The data suggests that older, heavier male patients with multiple comorbid conditions are at increased risk for leak and mortality. Surgeons early in their learning curve should avoid these high-risk patients to reduce complications.
Fernandez
A Z
AZ
Department of Surgery, Virginia Commonwealth University, Post Office Box 980428, Richmond, VA 23298, USA.
DeMaria
E J
EJ
Tichansky
D S
DS
Kellum
J M
JM
Wolfe
L G
LG
Meador
J
J
Sugerman
H J
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000706:statistics & numerical data; D015992:Body Mass Index; D002648:Child; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects* / Q000706:statistics & numerical data; D015391:Gastroplasty / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000401:mortality; D016019:Survival Analysis; D014768:Virginia