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Resident PGY 2
Henry Ford Hospital
Introduction: The safety and efficacy of laparoscopic sleeve gastrectomy (LSG) and roux-en-Y gastric bypass (RYGB) for the treatment of obesity and associated comorbidities, including type 2 diabetes mellitus (T2DM), is well established. However, these comorbidities may add risk to the perioperative period. We sought to characterize perioperative outcomes of these surgical procedures in type 2 diabetics using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, and further analyze diabetic patients based on their insulin dependence.Methods: All patients undergoing LSG and LRYGB between the years 2015 and 2017 in the MBSAQIP database were identified. Patients were divided into three groups: non-diabetics (NDM), non-insulin dependent type 2 diabetics (NIDDM), and insulin dependent type 2 diabetics (IDDM). Primary outcomes included serious adverse events, 30-day readmission, 30-day reoperation, and 30-day mortality. Secondary outcomes included length of stay, renal events, cardiac events, respiratory complications, surgical site infections, septic events, urinary tract infections, venous thromboembolism, perioperative transfusions, and reinterventions. These were compared between the groups using Pearson chi square test or Fisher’s exact test as appropriate. Multivariate logistic regression was then used to adjust for demographics, co-morbidities, and operative variables, with adjusted odds ratio (AOR) reported for each outcome. This was done with the NDM group as reference for the diabetic groups, and then with the NIDDM group as reference for the IDDM group. Significance was established at p<0.05. All analysis was performed using IBM SPSS version 25.Results: Multivariable analysis of patients who underwent LSG with, NDM patients as reference, showed higher 30-day mortality (NIDDM AOR=1.52, p=0.043; IDDM AOR=1.91, p=0.007) and risk of serious adverse events (NIDDM AOR=1.15, p<0.001; IDDM AOR=1.58, p<0.001) in the diabetic versus NDM groups. The IDDM group was associated with higher 30-day readmission (AOR=1.69, p<0.001) and reoperation (AOR=1.40, p<0.001) risk as well. IDDM patients had higher risk of all secondary outcomes with the exception of venous thromboembolism events. When the IDDM group was compared to the NIDDM group directly, the IDDM group was at higher risk of serious adverse events (AOR=1.38, p<0.001), 30-day readmission (AOR=1.68, p<0.001), and 30-day reoperation (AOR=1.25, p=0.013), while also at higher risk of all secondary outcomes except septic events and venous thromboembolism events.Multivariable analysis of patients who underwent RYGB, with NDM patients, as reference showed higher risk of serious adverse events (NIDDM AOR=1.09, p=0.014; IDDM AOR=1.43, p<0.001) in the diabetic versus NDM groups. The IDDM group was associated with higher risk of 30-day readmission (AOR=1.26, p<0.001) and lower risk of reoperation (AOR=0.88, p=0.070). Both diabetic groups had higher risk of surgical site infection, while IDDM patients had higher risk of all other secondary outcomes with the exception of septic and venous thromboembolism events and reintervention. When the IDDM group was compared to the NIDDM group directly, the IDDM group was at higher risk of serious adverse events (AOR=1.32, p<0.001) and 30-day readmission (AOR=1.30, p<0.001), while also at higher risk of secondary outcomes except respiratory complications, septic events, venous thromboembolism events, and perioperative transfusions. Conclusions: Type 2 diabetes had significant associations with several perioperative complications in patients who underwent LSG and RYGB. IDDM had even stronger associations with perioperative complications than NIDDM. A preoperative emphasis on optimizing diabetes mellitus control may be of benefit in preventing perioperative complications.
Leonard-Murali, Shravan; Nasser, Hassan; Ivanics, Tommy; Shakaroun, Dania; and Genaw, Jeffrey A., "Perioperative Outcomes of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in Type 2 Diabetics: A MBSAQIP Analysis" (2019). Clinical Research. 31.