title: Predictive factors of biliary complications after bariatric surgery.
abstract: BACKGROUND
  Obesity and rapid weight loss are risk factors for gallstone development. Bariatric surgery and significant postoperative weight loss are associated with postoperative biliary complications.
  
  
  OBJECTIVE
  We aim to identify predictive factors of biliary complications after bariatric surgery.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  After Institutional Review Board approval, charts at a single institution were reviewed to identify patients with biliary complications after bariatric surgery from 2005 to 2012. Data collected included baseline patients demographic characteristics, perioperative parameters, and postoperative biliary complications. Parameters were analyzed using paired and unpaired Student t test for continuous variables and χ2test for categorical variables. Univariate and multivariate analyses were used to assess risk factors for complications after bariatric surgery. All tests were 2 tailed; results with P<.05 were considered statistically significant.
  
  
  RESULTS
  One hundred thirty-eight (3.6%) of 3765 patients who underwent bariatric surgery developed postoperative biliary complications. Mean time from surgery to biliary complication was 1.8±1.4 years. Complications included acute cholecystitis (18.1%), chronic cholecystitis (70.2%), acute pancreatitis (9.4%), choledocholithiasis (5.7%), and jaundice (2.8%). Interventions were laparoscopic (n = 134, 97.0%) and open (n = 1, .7%) cholecystectomy. Forty patients (28.9%) had known cholelithiasis before surgery. There were no mortalities. Univariate analysis identified female gender, age>50, cholelithiasis at time of bariatric procedure, and Roux-en-Y gastric bypass independent of excess weight loss as predictive factors of biliary complications. Multivariate analysis confirmed advanced age as an independent predictive factor.
  
  
  CONCLUSIONS
  The results of our study suggest that patients of advanced age are at higher risk of biliary complications. However, the indications for prophylactic cholecystectomy at time of bariatric surgery remain unclear.
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: juliettac@gmail.com.
authors.forename: Julietta
authors.initials: J
authors.lastname: Chang
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Ricard
authors.initials: R
authors.lastname: Corcelles
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Mena
authors.initials: M
authors.lastname: Boules
authors.affiliation: Kuwait Medical School and Mubarak Teaching Hospital, Kuwait City, Kuwait.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Jamal
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Kroh
mesh_terms: D000367:Age Factors; D050110:Bariatric Surgery / Q000009:adverse effects*; D001660:Biliary Tract Diseases / Q000209:etiology*; D002763:Cholecystectomy / Q000706:statistics & numerical data; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Bariatric surgery; Cholelithiasis; Postoperative complications