1134 Bariatric Surgery Type Impacts the Risk for Gastrointestinal, Liver, and Pancreatic Diseases Admissions Within 1 Year From Surgery

Abstract

INTRODUCTION: Bariatric surgery (BRS) is an effective weight loss method that should, in theory, improve many gastrointestinal, liver, and pancreatic (GILP) diseases seen with obesity. At the same time, there is an increased morbidity related to BRS’s gastrointestinal alterations. Thus, we examined the short-term impact of BRS type on admission rates of various GILP diseases. METHODS: We queried the 2012-2014 Nationwide Readmission Database to identify obese patients who underwent vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), or, as a control, hernia repair surgery (HR). Our primary aim was to compare rates of GILP diseases within 6 months post- and 6 months pre-surgery in the VSG, RYGB, and HR cohorts. In a time to event analysis we evaluated readmission rates up to 11 months post-BRS. RESULTS: We identified a total of 140,103 patients in the VSG cohort, 132,253 patients in the RYGB cohort, and 12,436 patients in the HR cohort. HR patients were slightly older with a higher percentage of Medicare insurance carriers in contrast to VSG and RYGB (Table 1). RYGB was associated with a 33-fold increased risk of intestinal obstructions compared to pre-RYGB (P < 0.001). Other notably increased GILP diseases after RYGB from highest to lowest risk (Table 2): C. difficile infection [adjusted odds ratio (aOR): 12.52, P < 0.001], GI hemorrhage (aOR: 10.95, P < 0.001), biliary disease (aOR: 4.15, P < 0.001) and functional/motility disorders (aOR: 3.57, P < 0.001). In contrast, post- versus pre-VSG patients were most frequently admitted for acute pancreatitis (aOR: 6.26, P < 0.001), followed by C. difficile infection (aOR: 4.86, P < 0.001), biliary disease (aOR: 3.14, P < 0.001), noninfectious gastroenteritis (aOR: 3.05, P < 0.001) and functional/motility disorders (aOR: 2.74, P < 0.001). No increase in admissions was observed in the control HR cohort for any of these diseases. In our time to event analysis, the probability of being admitted was most notable for intestinal obstructions within 30 days after RYGB while functional disorders predominate afterwards (Figure 1). Similarly, patients were more frequently admitted for functional disorders following VSG. CONCLUSION: The type of BRS has a differential impact on GILP admissions after surgery. There may be a limited impact of weight loss on functional disorders that seem to dominate irrespective of BRS type. This data can help better inform patients on the choice of surgery to pursue, however more data are warranted.