Propensity Score-Matched Analysis of Revisional/Conversional Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy in Patients with Hypoalbuminemia

Abstract

INTRODUCTION: Hypalbuminemia (HA) may place patients at increased risk when undergoing revisional/conversional bariatric surgery. The primary aim of this study was to assess complication in patients with HA undergoing Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy as revisional/conversional bariatric surgery. METHODS: Revisional/conversional bariatric procedures were extracted from the MBSAQIP database from 2015 to 2019. Nearest neighbor 1:1 propensity score matching (PSM) was performed on 23 covariates with E analysis to assess point estimate confounding. Outcomes were assessed via bivariate analysis and univariate regression. RESULTS: There were 4,825 revisional/conversional patients with HA who underwent the RYGB (n = 2,636) or sleeve gastrectomy (n = 2,189) procedure. PSM yielded 1,928 patient pairs with no difference in perioperative demographics. Matched patients who underwent the RYGB procedure were more likely to be readmitted within 30 days (9.18% vs 5.45%; p < 0.001, E = 2.07), have longer procedure time (137 minutes, interquartile range [IQR] 101–185] vs 93 minutes IQR [68–130]; p < 0.001), a reoperation (3.58% vs 1.61%; p < 0.001, E = 2.32), unplanned ICU admission (2.39% vs 0.99%; p = 0.001, E = 2.22), nonadmitting emergency room visit (8.04% vs 5.08%; p < 0.001, E = 1.83), and anastomotic leak complication (2.70% vs 1.40%; p = 0.007, E = 1.74). Patients who underwent RYGB procedure also had a higher incidence of surgical drain placement (36.10% vs 24.43%; p < 0.001, E = 2.41) and postoperative organ space infection (1.30% vs 0.57%; p = 0.03, E = 1.50). (Figure) CONCLUSION: Patients with HA who undergo a revisional/conversional operation are at increased risk of serious postoperative complication, and RYGB revisional/conversional procedures represent a higher-risk group for certain complications.Figure