Bariatric surgery outcomes in oxygen-dependent patients: analysis of the MBSAQIP database

Background: The number of bariatric procedures performed on complex, oxygen-dependent patients has increased. These patients often have other medical co-morbidities that can be improved after bariatric surgery; however, questions remain regarding their perioperative risk. Objective: To assess the safety of bariatric surgery among oxygen-dependent patients, and to compare outcomes in this patient group after laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy. Setting: University and private hospitals enrolled in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry. Methods: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data from 2015 to 2017 was analyzed. A multivariable regression analysis was performed looking at 30-day serious complications for oxygen-dependent patients, with a secondary propensity matched analysis performed comparing patients undergoing laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass. Results: In total, 430,396 patients were analyzed, 3034 (0.7%) of whom were oxygen dependent. The absolute 30-day complication rate among oxygen-dependent patients was more than twice as high (8.24% versus 3.46%, P < .001). The postoperative leak (.69% versus.41%, P =.017), bleed (2.08% versus.91%, P < .001), cardiac event (.16% versus.07%, P = .034), and pneumonia rate (.89% versus.19%, P < .001) were all significantly higher. Mortality was significantly higher among oxygen-dependent patients (.49% versus.09%, P < .001). On multivariable analysis, oxygen dependency was an independent predictor of adverse outcomes (odds ratio 1.30 [1.22-1.50], P < .001). Laparoscopic Roux-en-Y gastric bypass was associated with a statistically significant higher complication rate compared with laparoscopic sleeve gastrectomy (13.23% versus 5.16%, P < .001). Conclusion: Oxygen-dependent patients undergoing bariatric surgery are at a higher risk of both morbidity and mortality postoperatively. (C) 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.