F. Corpodean1,2, R. Ross1, D. Danos2, P. Schauer1,2, V. L. Albaugh1,2 1Pennington Biomedical Research Center, Baton Rouge, LOUISIANA, USA 2Louisiana State University Health Sciences Center, New Orleans, LA, USA
Introduction: Metabolic and Bariatric Surgery Quality Improvement Project (MBSAQIP) is the largest bariatric surgery-specific clinical dataset, accruing data since 2015. Variables are added or removed as practice patterns and outcomes of interest change. Beginning in 2020, the definition of ‘emergency case’ was altered, and the aim of this study was to examine how this change affects the utility of the MBSAQIP for emergency case tracking.
Methods: Emergency cases were extracted from all available MBSAQIP data (2015-2021), as well as corresponding case characteristics. Outcomes and comorbidity profiles were compared, specifically before and after the change to the definition of ‘emergency’ in the dataset.
Results: 11,029 out of 1,048,575 total cases were coded as emergency cases, with most patients being female sex (83.4%; n=9199) with a mean age of 48.4 years and BMI of 34.93 kg/m2. Most patients had previously undergone foregut surgery (83.4%, n=9217) and had a mean operative length of 89.6 min. Patients were typically non-smokers (85.8%, n=9472), without COPD (97.8%, n=10780), sleep apnea (86.1%, n=9493), or diabetes (88.6%, n=9774). From 2015-2019 there were 10,574 total emergency cases performed (~2115 cases/year), which markedly decreased in 2020/2021 to only 455 cases (~228 cases/year). Prior to the definition changes, the most common procedures were (Table 1) unlisted procedure of the stomach (45.14%, n=3101), gastric band removal (25.3%, n=2676), and reduction of volvulus/internal hernia (11.8%, n=1244). Between 2020-2021, however, this distribution changed markedly with Roux-en-Y gastric bypass (RYGB) being the most common emergency procedure (29.23%, n=133) followed by unlisted procedure on the stomach (25.6%, n=116) and revision of gastrojejunal anastomosis (15.8%, n=72). As might be expected from the change capturing only revisional cases, average operative length was greater between 2020-2021 compared to previous years (127.6 vs. 86.5 min).
Conclusion: Capturable emergency cases declined between 2019 and 2020, a trend that is related to the artifact of changing the working definition of ‘emergency’ as part of MBSAQIP standards. This change excludes many cases, including data on internal hernia reduction, and does not likely reflect real change in the actual prevalence of emergency bariatric cases. Since accuracy and capture for emergency cases has dramatically diminished, so has any prior utility of using MBSAQIP data for studying emergency cases and outcomes.
