Benefit of feeding tube placement for refractory malnutrition after bariatric surgery.
Bariatric surgery provides durable weight loss and decreases the incidence of co-morbid conditions for people with obesity. Most patients benefit from resultant weight loss, but some are at risk for postoperative refractory malnutrition, a serious but poorly understood complication.



To evaluate differences in bariatric surgery patients who received a feeding tube postoperatively for malnutrition compared with other indications.



Retrospective cohort study at an academic bariatric surgery center (1985-2015).



All bariatric surgery patients that received a feeding tube postoperatively over a 30-year period were identified. Data abstraction from the medical record was performed to assess demographic characteristics, operative details, tube indication, and resultant body mass index (BMI) changes.



From a total of 3487 patients who underwent bariatric surgery during the study period, 139 (3.9%) required placement of a feeding tube postoperatively. Refractory malnutrition was the indication in 24 patients, all after Roux-en-Y gastric bypass. There were no significant differences between these patients and other bariatric surgery patients in terms of mean age (40.6±9.9 versus 43.1±13.4 years, P = .4) and preoperative BMI (47.5±10.5 versus 51.0±9.6 kg/m2, P = .1). The median time from surgery to tube placement for malnutrition patients was 4 years. Compared with other feeding tube indications, malnutrition patients had higher percent excess BMI lost after surgery (126.2±31.9 versus 52.5±44.3%, P<.0001). After tube placement, malnutrition patients had a significant increase in mean BMI compared with other indications (14.5±20.9 versus-13.0±14.0%, P< .001).



Patients with refractory malnutrition benefit from feeding tube placement, which results in a significant increase in BMI.
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
Eric J
EJ
Charles
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
J Hunter
JH
Mehaffey
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
Robert B
RB
Hawkins
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
Dana
D
Safavian
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
Bruce D
BD
Schirmer
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia. Electronic address: pth2f@virginia.edu.
Peter T
PT
Hallowell
D000046:Academic Medical Centers; D000328:Adult; D000704:Analysis of Variance; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D044342:Malnutrition / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
Bariatric surgery; Feeding tube; Gastrostomy; Jejunostomy; Refractory malnutrition