K. G. Ali1, N. Cho1, S. Sakowitz1, N. Chervu1, S. Kim1, J. Curry1, J. Hadaya1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles, Surgery, Los Angeles, CA, USA
Introduction:
Small bowel obstruction (SBO) is a known complication of bariatric surgical procedures and has a widely varied time course. However, outcomes of surgical intervention for SBO among patients with prior bariatric surgery remain ill-defined. We used a nationally representative cohort to characterize the outcomes of operative management in patients with prior bariatric surgery presenting with acute SBO.
Methods:
All adult hospitalizations involving bowel resection or lysis of adhesions for SBO were tabulated from the 2018-2020 National Inpatient Sample. Using ICD10 codes, only those with intestinal adhesions but without a concomitant diagnosis of cancer were included. Patients with prior history of bariatric surgery comprised the Bariatric cohort (others: Non-Bariatric). The primary outcome of interest was development of major adverse postoperative events (MAE), defined as a composite of in-hospital mortality and gastrointestinal complications. Perioperative complications, length of stay (LOS), hospitalization costs and non-home discharge were also considered. Elastic net regularization was used for variable selection and entropy balancing was employed to produce covariate balanced groups. Multivariable models were subsequently developed to evaluate the association of prior bariatric surgery with outcomes of interest.
Results:
Of an estimated 85,950 hospitalizations for surgical management for SBO, 5,010 (6.8%) had a history of prior bariatric surgery. Compared to Non-Bariatric, Bariatric patients were younger (55 [47-64] vs 68 [56-78] years, P<0.001), more commonly female (83.8 vs 59.9%, P<0.001) and had a lower Elixhauser comorbidity index (2 [1-3] vs 3 [1-4], P<0.001). On average, the Bariatric cohort underwent operative management earlier in their hospitalization, relative to Non-Bariatric (0 [0-2] vs 1 [0-3] days, P<0.001).
Following risk adjustment, Bariatric demonstrated lower odds of MAE (Adjusted Odds Ratio [AOR] 0.41, 95% Confidence Interval [CI] 0.29-0.57) compared to Non-Bariatric. Bariatric also had decreased likelihood of respiratory (AOR 0.51, CI 0.37-0.71), infectious (AOR 0.55, CI 0.42-0.71) and gastrointestinal (AOR 0.38, CI 0.26-0.55) complications. Furthermore, the Bariatric cohort faced a 4.4 day (CI 3.5-4.4 days) decrement in LOS and a $9,200 (CI $7,500-10,900) reduction in costs.
Conclusion:
Among patients receiving operative management for SBO, those with a history of bariatric surgery demonstrated lower likelihood of major adverse events and reduced resource utilization, relative to others. As the incidence of bariatric surgery continues to rise, future work is needed to minimize incidence of SBO among these patients, especially in the current era of value-based healthcare.
