Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study.
BACKGROUND
The goals were to compare the morbidity and mortality between primary and revisional bariatric surgery and to identify the clinical predictors of adverse outcomes among patients undergoing revisional surgery in the Longitudinal Assessment of Bariatric Surgery consortium. The study was multi-institutional at university hospitals in the United States.


METHODS
Data from the LABS-1 (safety) cohort were analyzed, excluding primary gastric banding patients. A total of 3802 LABS-1 patients were included: 3577 who underwent primary surgery and 225 who underwent revisional surgery. The demographic, clinical, operative, and 30-day outcome data were compared between the 2 groups. A nonlinear mixed effects logit model was used to identify independent risk factors for adverse outcomes (death, deep vein thrombosis, pulmonary embolism, reintubation, reoperation, or discharge after 30 days).


RESULTS
Compared with those undergoing revisional surgery, the primary surgery patients were younger (median age 44 versus 49 years, P <.0001) and more likely to be male (20.5% versus 12.7%, P = .006) and heavier (median body mass index 47.3 versus 41.2 kg/m(2), P <.0001) and to have more co-morbidities (P <.0001), including hypertension (56.0% versus 46.0%, P = .0044), diabetes (35.7% versus 20.0%, P <.0001), and sleep apnea (50.3% versus 27.2%, P <.0001). The operative time for the revisional procedures was longer (median 181 versus 135 min, P <.0001) and associated with greater blood loss (median 100 versus <50 mL, P <.0001). Adverse outcomes were more likely after revisional surgery (15.1% versus 5.3%, P <.0001, odds ratio 2.4, 95% confidence interval 1.6-3.6). After adjusting for patient characteristics previously shown to be associated with adverse outcomes, this difference remained statistically significant (odds ratio 2.3, 95% confidence interval 1.5-3.8). The 30-day mortality rate was similar in the 2 groups (.4%).


CONCLUSIONS
Revisional surgery was performed without substantial mortality but with a greater incidence of adverse outcomes than was primary bariatric surgery.
Columbia University Medical Center, New York, New York, USA. william.inabnet@mountsinai.org
William B
WB
Inabnet
Steven H
SH
Belle
Marc
M
Bessler
Anita
A
Courcoulas
Patchen
P
Dellinger
Luis
L
Garcia
James
J
Mitchell
Brant
B
Oelschlager
Robert
R
O'Rourke
John
J
Pender
Alfons
A
Pomp
Walter
W
Pories
Ramesh
R
Ramanathan
Abdus
A
Wahed
Bruce
B
Wolfe
D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000401:mortality; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States