title: Does concomitant cholecystectomy at time of Roux-en-Y gastric bypass impact adverse operative outcomes?
abstract: BACKGROUND
  We hypothesized that patients undergoing Roux-en-Y gastric bypass (RYGB) with concomitant cholecystectomy (RYGB + C) would be at greater risk for adverse events compared to patients undergoing RYGB alone.
  
  
  METHODS
  Patients who underwent a RYGB were identified in the 2005-2009 American College of Surgeons National Surgical Quality Improvement Program Database. Multivariate logistic regression with adjustment for confounding variables was utilized to identify risk factors for mortality at 30 days, major adverse events, and prolonged length of stay (PLOS).
  
  
  RESULTS
  We identified 32,946 patients who underwent RYGB; of these, 1,731 (5.2%) underwent RYGB + C. Overall, RYGB + C was a risk factor for predicting major adverse events following laparoscopic but not open procedures. Regardless of approach, PLOS was more common among RYGB + C patients following adjustment. Overall mortality at 30 days was low and did not vary with concomitant cholecystectomy following adjustment.
  
  
  CONCLUSIONS
  The risk for major adverse events is significantly greater for RYGB + C patients following laparoscopic procedures, and the risk for PLOS is greater for RYGB + C patients following both open and laparoscopic procedures. The short-term risks identified in this study can assist in decision-making when considering concomitant cholecystectomy at the time of RYGB.
authors.affiliation: University of Minnesota, Minneapolis, MN, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Dorman
authors.forename: Wei
authors.initials: W
authors.lastname: Zhong
authors.forename: Anasooya A
authors.initials: AA
authors.lastname: Abraham
authors.forename: Sayeed
authors.initials: S
authors.lastname: Ikramuddin
authors.forename: Waddah B
authors.initials: WB
authors.lastname: Al-Refaie
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Leslie
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002763:Cholecystectomy / Q000009:adverse effects* / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D020000:Decision Support Systems, Clinical; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D015390:Gastric Bypass / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000401:mortality / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015431:Weight Loss