Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study

William B. Inabnet; Steven H. Belle; Marc Bessler; Anita Courcoulas; Patchen Dellinger; Luis Garcia; James Mitchell; Brant Oelschlager; Robert O'Rourke; John Pender; Alfons Pomp; Walter Pories; Ramesh Ramanathan; Abdus Wahed; Bruce Wolfe

doi:10.1016/j.soard.2009.10.007

Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study

William B. Inabnet, Steven H. Belle, Marc Bessler, Anita Courcoulas, Patchen Dellinger, Luis Garcia, James Mitchell, Brant Oelschlager, Robert O'Rourke, John Pender, Alfons Pomp, Walter Pories, Ramesh Ramanathan, Abdus Wahed, Bruce Wolfe

Surgery

Research output: Contribution to journal › Article › peer-review

61 Scopus citations

Abstract

Background: The goals were to compare the morbidity and mortality between primary and revisional bariatric surgery and to identify the clinical predictors of adverse outcomes among patients undergoing revisional surgery in the Longitudinal Assessment of Bariatric Surgery consortium. The study was multi-institutional at university hospitals in the United States. Methods: Data from the LABS-1 (safety) cohort were analyzed, excluding primary gastric banding patients. A total of 3802 LABS-1 patients were included: 3577 who underwent primary surgery and 225 who underwent revisional surgery. The demographic, clinical, operative, and 30-day outcome data were compared between the 2 groups. A nonlinear mixed effects logit model was used to identify independent risk factors for adverse outcomes (death, deep vein thrombosis, pulmonary embolism, reintubation, reoperation, or discharge after 30 days). Results: Compared with those undergoing revisional surgery, the primary surgery patients were younger (median age 44 versus 49 years, P <.0001) and more likely to be male (20.5% versus 12.7%, P = .006) and heavier (median body mass index 47.3 versus 41.2 kg/m², P <.0001) and to have more co-morbidities (P <.0001), including hypertension (56.0% versus 46.0%, P = .0044), diabetes (35.7% versus 20.0%, P <.0001), and sleep apnea (50.3% versus 27.2%, P <.0001). The operative time for the revisional procedures was longer (median 181 versus 135 min, P <.0001) and associated with greater blood loss (median 100 versus <50 mL, P <.0001). Adverse outcomes were more likely after revisional surgery (15.1% versus 5.3%, P <.0001, odds ratio 2.4, 95% confidence interval 1.6-3.6). After adjusting for patient characteristics previously shown to be associated with adverse outcomes, this difference remained statistically significant (odds ratio 2.3, 95% confidence interval 1.5-3.8). The 30-day mortality rate was similar in the 2 groups (.4%). Conclusion: Revisional surgery was performed without substantial mortality but with a greater incidence of adverse outcomes than was primary bariatric surgery.

Original language	English
Pages (from-to)	22-30
Number of pages	9
Journal	Surgery for Obesity and Related Diseases
Volume	6
Issue number	1
DOIs	https://doi.org/10.1016/j.soard.2009.10.007
State	Published - Jan 2010

Bibliographical note

Funding Information:
S. Belle, none; M. Bessler, none; A. Courcoulas, none; P. Dellinger practices in an American College of Surgeons Bariatric Center, is a site visitor for the American College of Surgeons program to visit and gather information for certification of new centers, and is a consultant to GlaxoSmithKline, Merck & Company, Pfizer, and Wyeth; L. Garcia, none; W. B. Inabnet is an educational or research grant recipient from Covidien; J. Mitchell, none; R. O'Rourke, none; B. Oelschlager is on the Speakers Bureau for Covidien and Cook Surgical; J. Pender is a consultant to, and has received educational grants from, Tyco Health Care; A. Pomp, none; W. Pories has received a research grant from Johnson & Johnson and GlaxoSmith Kline; R. Ramanathan, none; A. Wahed, none; B. Wolfe is on the Speakers Bureau for the American College of Surgeons Bariatric Centers and Surgical Review Corporation and is a Consultant to Enteromedics.

Funding

S. Belle, none; M. Bessler, none; A. Courcoulas, none; P. Dellinger practices in an American College of Surgeons Bariatric Center, is a site visitor for the American College of Surgeons program to visit and gather information for certification of new centers, and is a consultant to GlaxoSmithKline, Merck & Company, Pfizer, and Wyeth; L. Garcia, none; W. B. Inabnet is an educational or research grant recipient from Covidien; J. Mitchell, none; R. O'Rourke, none; B. Oelschlager is on the Speakers Bureau for Covidien and Cook Surgical; J. Pender is a consultant to, and has received educational grants from, Tyco Health Care; A. Pomp, none; W. Pories has received a research grant from Johnson & Johnson and GlaxoSmith Kline; R. Ramanathan, none; A. Wahed, none; B. Wolfe is on the Speakers Bureau for the American College of Surgeons Bariatric Centers and Surgical Review Corporation and is a Consultant to Enteromedics.

Funders	Funder number
American College of Surgeons Bariatric Center
American College of Surgeons Bariatric Centers
DuPont Merck Pharmaceutical Company
Speakers Bureau for Covidien and Cook Surgical
Tyco Health Care
National Institute of Diabetes and Digestive and Kidney Diseases	U01DK066555
Pfizer
GlaxoSmithKline
Johnson and Johnson
American College of Surgeons
Covidien

Keywords

Bariatric surgery
Complications
Failed restrictive procedure
Gastric bypass
Revision

ASJC Scopus subject areas

Surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.soard.2009.10.007

Cite this

Inabnet, W. B., Belle, S. H., Bessler, M., Courcoulas, A., Dellinger, P., Garcia, L., Mitchell, J., Oelschlager, B., O'Rourke, R., Pender, J., Pomp, A., Pories, W., Ramanathan, R., Wahed, A., & Wolfe, B. (2010). Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study. Surgery for Obesity and Related Diseases, 6(1), 22-30. https://doi.org/10.1016/j.soard.2009.10.007

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title = "Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study",

abstract = "Background: The goals were to compare the morbidity and mortality between primary and revisional bariatric surgery and to identify the clinical predictors of adverse outcomes among patients undergoing revisional surgery in the Longitudinal Assessment of Bariatric Surgery consortium. The study was multi-institutional at university hospitals in the United States. Methods: Data from the LABS-1 (safety) cohort were analyzed, excluding primary gastric banding patients. A total of 3802 LABS-1 patients were included: 3577 who underwent primary surgery and 225 who underwent revisional surgery. The demographic, clinical, operative, and 30-day outcome data were compared between the 2 groups. A nonlinear mixed effects logit model was used to identify independent risk factors for adverse outcomes (death, deep vein thrombosis, pulmonary embolism, reintubation, reoperation, or discharge after 30 days). Results: Compared with those undergoing revisional surgery, the primary surgery patients were younger (median age 44 versus 49 years, P <.0001) and more likely to be male (20.5% versus 12.7%, P = .006) and heavier (median body mass index 47.3 versus 41.2 kg/m2, P <.0001) and to have more co-morbidities (P <.0001), including hypertension (56.0% versus 46.0%, P = .0044), diabetes (35.7% versus 20.0%, P <.0001), and sleep apnea (50.3% versus 27.2%, P <.0001). The operative time for the revisional procedures was longer (median 181 versus 135 min, P <.0001) and associated with greater blood loss (median 100 versus <50 mL, P <.0001). Adverse outcomes were more likely after revisional surgery (15.1% versus 5.3%, P <.0001, odds ratio 2.4, 95% confidence interval 1.6-3.6). After adjusting for patient characteristics previously shown to be associated with adverse outcomes, this difference remained statistically significant (odds ratio 2.3, 95% confidence interval 1.5-3.8). The 30-day mortality rate was similar in the 2 groups (.4%). Conclusion: Revisional surgery was performed without substantial mortality but with a greater incidence of adverse outcomes than was primary bariatric surgery.",

keywords = "Bariatric surgery, Complications, Failed restrictive procedure, Gastric bypass, Revision",

author = "Inabnet, {William B.} and Belle, {Steven H.} and Marc Bessler and Anita Courcoulas and Patchen Dellinger and Luis Garcia and James Mitchell and Brant Oelschlager and Robert O'Rourke and John Pender and Alfons Pomp and Walter Pories and Ramesh Ramanathan and Abdus Wahed and Bruce Wolfe",

note = "Funding Information: S. Belle, none; M. Bessler, none; A. Courcoulas, none; P. Dellinger practices in an American College of Surgeons Bariatric Center, is a site visitor for the American College of Surgeons program to visit and gather information for certification of new centers, and is a consultant to GlaxoSmithKline, Merck & Company, Pfizer, and Wyeth; L. Garcia, none; W. B. Inabnet is an educational or research grant recipient from Covidien; J. Mitchell, none; R. O'Rourke, none; B. Oelschlager is on the Speakers Bureau for Covidien and Cook Surgical; J. Pender is a consultant to, and has received educational grants from, Tyco Health Care; A. Pomp, none; W. Pories has received a research grant from Johnson & Johnson and GlaxoSmith Kline; R. Ramanathan, none; A. Wahed, none; B. Wolfe is on the Speakers Bureau for the American College of Surgeons Bariatric Centers and Surgical Review Corporation and is a Consultant to Enteromedics. ",

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doi = "10.1016/j.soard.2009.10.007",

language = "English",

volume = "6",

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Inabnet, WB, Belle, SH, Bessler, M, Courcoulas, A, Dellinger, P, Garcia, L, Mitchell, J, Oelschlager, B, O'Rourke, R, Pender, J, Pomp, A, Pories, W, Ramanathan, R, Wahed, A & Wolfe, B 2010, 'Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study', Surgery for Obesity and Related Diseases, vol. 6, no. 1, pp. 22-30. https://doi.org/10.1016/j.soard.2009.10.007

Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study. / Inabnet, William B.; Belle, Steven H.; Bessler, Marc et al.
In: Surgery for Obesity and Related Diseases, Vol. 6, No. 1, 01.2010, p. 22-30.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study

AU - Inabnet, William B.

AU - Belle, Steven H.

AU - Bessler, Marc

AU - Courcoulas, Anita

AU - Dellinger, Patchen

AU - Garcia, Luis

AU - Mitchell, James

AU - Oelschlager, Brant

AU - O'Rourke, Robert

AU - Pender, John

AU - Pomp, Alfons

AU - Pories, Walter

AU - Ramanathan, Ramesh

AU - Wahed, Abdus

AU - Wolfe, Bruce

N1 - Funding Information: S. Belle, none; M. Bessler, none; A. Courcoulas, none; P. Dellinger practices in an American College of Surgeons Bariatric Center, is a site visitor for the American College of Surgeons program to visit and gather information for certification of new centers, and is a consultant to GlaxoSmithKline, Merck & Company, Pfizer, and Wyeth; L. Garcia, none; W. B. Inabnet is an educational or research grant recipient from Covidien; J. Mitchell, none; R. O'Rourke, none; B. Oelschlager is on the Speakers Bureau for Covidien and Cook Surgical; J. Pender is a consultant to, and has received educational grants from, Tyco Health Care; A. Pomp, none; W. Pories has received a research grant from Johnson & Johnson and GlaxoSmith Kline; R. Ramanathan, none; A. Wahed, none; B. Wolfe is on the Speakers Bureau for the American College of Surgeons Bariatric Centers and Surgical Review Corporation and is a Consultant to Enteromedics.

PY - 2010/1

Y1 - 2010/1

N2 - Background: The goals were to compare the morbidity and mortality between primary and revisional bariatric surgery and to identify the clinical predictors of adverse outcomes among patients undergoing revisional surgery in the Longitudinal Assessment of Bariatric Surgery consortium. The study was multi-institutional at university hospitals in the United States. Methods: Data from the LABS-1 (safety) cohort were analyzed, excluding primary gastric banding patients. A total of 3802 LABS-1 patients were included: 3577 who underwent primary surgery and 225 who underwent revisional surgery. The demographic, clinical, operative, and 30-day outcome data were compared between the 2 groups. A nonlinear mixed effects logit model was used to identify independent risk factors for adverse outcomes (death, deep vein thrombosis, pulmonary embolism, reintubation, reoperation, or discharge after 30 days). Results: Compared with those undergoing revisional surgery, the primary surgery patients were younger (median age 44 versus 49 years, P <.0001) and more likely to be male (20.5% versus 12.7%, P = .006) and heavier (median body mass index 47.3 versus 41.2 kg/m2, P <.0001) and to have more co-morbidities (P <.0001), including hypertension (56.0% versus 46.0%, P = .0044), diabetes (35.7% versus 20.0%, P <.0001), and sleep apnea (50.3% versus 27.2%, P <.0001). The operative time for the revisional procedures was longer (median 181 versus 135 min, P <.0001) and associated with greater blood loss (median 100 versus <50 mL, P <.0001). Adverse outcomes were more likely after revisional surgery (15.1% versus 5.3%, P <.0001, odds ratio 2.4, 95% confidence interval 1.6-3.6). After adjusting for patient characteristics previously shown to be associated with adverse outcomes, this difference remained statistically significant (odds ratio 2.3, 95% confidence interval 1.5-3.8). The 30-day mortality rate was similar in the 2 groups (.4%). Conclusion: Revisional surgery was performed without substantial mortality but with a greater incidence of adverse outcomes than was primary bariatric surgery.

AB - Background: The goals were to compare the morbidity and mortality between primary and revisional bariatric surgery and to identify the clinical predictors of adverse outcomes among patients undergoing revisional surgery in the Longitudinal Assessment of Bariatric Surgery consortium. The study was multi-institutional at university hospitals in the United States. Methods: Data from the LABS-1 (safety) cohort were analyzed, excluding primary gastric banding patients. A total of 3802 LABS-1 patients were included: 3577 who underwent primary surgery and 225 who underwent revisional surgery. The demographic, clinical, operative, and 30-day outcome data were compared between the 2 groups. A nonlinear mixed effects logit model was used to identify independent risk factors for adverse outcomes (death, deep vein thrombosis, pulmonary embolism, reintubation, reoperation, or discharge after 30 days). Results: Compared with those undergoing revisional surgery, the primary surgery patients were younger (median age 44 versus 49 years, P <.0001) and more likely to be male (20.5% versus 12.7%, P = .006) and heavier (median body mass index 47.3 versus 41.2 kg/m2, P <.0001) and to have more co-morbidities (P <.0001), including hypertension (56.0% versus 46.0%, P = .0044), diabetes (35.7% versus 20.0%, P <.0001), and sleep apnea (50.3% versus 27.2%, P <.0001). The operative time for the revisional procedures was longer (median 181 versus 135 min, P <.0001) and associated with greater blood loss (median 100 versus <50 mL, P <.0001). Adverse outcomes were more likely after revisional surgery (15.1% versus 5.3%, P <.0001, odds ratio 2.4, 95% confidence interval 1.6-3.6). After adjusting for patient characteristics previously shown to be associated with adverse outcomes, this difference remained statistically significant (odds ratio 2.3, 95% confidence interval 1.5-3.8). The 30-day mortality rate was similar in the 2 groups (.4%). Conclusion: Revisional surgery was performed without substantial mortality but with a greater incidence of adverse outcomes than was primary bariatric surgery.

KW - Bariatric surgery

KW - Complications

KW - Failed restrictive procedure

KW - Gastric bypass

KW - Revision

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Comparison of 30-day outcomes after non-LapBand primary and revisional bariatric surgical procedures from the Longitudinal Assessment of Bariatric Surgery study

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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