title: Concomitant removal of gastric band and sleeve gastrectomy: analysis of outcomes and complications from the ACS-NSQIP database.
abstract: BACKGROUND
  Conversion of adjustable gastric band to laparoscopic sleeve gastrectomy (LSG) is feasible, but multiple reports have indicated higher morbidity and staple line leak rates when this is performed as a single-stage procedure. The objective of this study is to compare the safety profile and outcomes of LSG with concomitant gastric band removal (LSG/GBR) versus LSG using the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP).
  
  
  METHODS
  Using the ACS-NSQIP database (2010-2012), LSG cases were identified using Current Procedural Terminology (CPT) code 43775 and concomitant LSG/LGBR using CPT code 43775+(43772 or 43774). Baseline patient characteristics and perioperative variables including postoperative mortality and morbidity rates were retrieved. The primary endpoint was sepsis within 30 days. Bivariate and multivariate analyses were carried out.
  
  
  RESULTS
  During the study period, 11,189 (96.9%) patients had LSG and 357 (3.1%) had LSG/GBR for a total of 11,546 patients. On bivariate analyses, the rate of sepsis was higher after LSG/GBR (1.68% versus .58%; P = .022), and the mean operative time was longer (124.6±52.3 versus 98.6±49.0 min; P<.001). There was no statistically significant difference in the rate of postoperative mortality (.28% versus .08 %; P = .27) or that of other outcomes such as return to the operating room, wound infection, or venous thromboembolism. After multivariate analysis, the odds of developing postoperative sepsis remained significantly higher for patients undergoing LSG/GBR compared with LSG alone (odds ratio [OR] 3.32; confidence interval [CI] 1.41-7.84; P = .006).
  
  
  CONCLUSIONS
  LSG/GBR can be performed with low morbidity and mortality. However, this procedure carries a higher rate of postoperative sepsis.
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Lebanon, Beirut.
authors.forename: Elie P
authors.initials: EP
authors.lastname: Ramly
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Lebanon, Beirut.
authors.forename: Ramzi S
authors.initials: RS
authors.lastname: Alami
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Lebanon, Beirut.
authors.forename: Hani
authors.initials: H
authors.lastname: Tamim
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Lebanon, Beirut.
authors.forename: Rami
authors.initials: R
authors.lastname: Kantar
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Lebanon, Beirut.
authors.forename: Elias
authors.initials: E
authors.lastname: Elias
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Lebanon, Beirut. Electronic address: bs21@aub.edu.lb.
authors.forename: Bassem Y
authors.initials: BY
authors.lastname: Safadi
mesh_terms: D000328:Adult; D000368:Aged; D020878:Device Removal / Q000009:adverse effects / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality / Q000601:surgery; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012086:Reoperation; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome
keywords: Adjustable gastric banding; National Surgical Quality Improvement Program; Revisional surgery; Sepsis; Sleeve gastrectomy