Analysis of Aborted Bariatric Surgeries and Potential Opportunities

Document Type

Conference Proceeding

Publication Date

6-28-2024

Publication Title

Surg Endosc

Keywords

abdominal wall, abortion, adult, bariatric surgery, biliopancreatic bypass, body weight loss, comorbidity, conference abstract, controlled study, diabetes mellitus, diagnosis, distress syndrome, emotional stress, female, gastric banding, gastric bypass surgery, hepatomegaly, human, major clinical study, male, Michigan, middle aged, retrospective study, sleeve gastrectomy, surgery

Abstract

Introduction: Aborted bariatric surgeries are an undesirable experience for patients as they are subjected to potential physical harm and emotional distress. However, unexpected and challenging intraoperative findings may ultimately lead a bariatric surgeon to decide the safest option is to abort the procedure. A thorough investigation of aborted bariatric surgeries has not been previously reported. This information may allow the discovery of opportunities to mitigate the risk of aborting some bariatric operations. Methods and Procedures: Data from the Michigan Bariatric Surgery Collaborative, a statewide bariatric surgery registry, was used to identify all aborted primary bariatric operations from June 2006 through January 2023. Demographics, comorbidities, procedure type, and socioeconomic variables were evaluated. Stepwise logistic regression with clustering around hospital/facility was performed to identify independent predictors of abortion. The reasons for aborting the surgery were divided into seven categories and potentially modifiable factors examined. Results: A total of 115,004 patients underwent bariatric surgery with 555 (0.48%) procedures aborted. Of those having an aborted operation the mean age was 52 years and mean BMI was 49.8 with females accounting for 71%. Sleeve gastrectomy had the lowest rate of abortion (0.38%) as compared to gastric bypass, adjustable gastric banding, and biliopancreatic diversion (p<0.0001). The most common aborted surgery reason categories included adhesions and hernias, tumors and anatomic anomalies, and inadequate visualization due to either hepatomegaly or abdominal wall thickness (Figure 1). The most significant (p<0.0001) independent predictors of aborted surgeries due to inadequate visualization secondary to hepatomegaly or abdominal wall thickness were BMI>60 (OR 10.7), BMI 50 to 59 (OR 3.1) and diabetes mellitus (OR 2.7). Preoperative weight loss was a protective factor for aborting surgery due to hepatomegaly or abdominal wall thickness (OR 0.9; p<0.0001.) Conclusions: Aborted surgeries are uncommon and occur in approximately 1 in 200 primary bariatric operations with the lowest rate identified in sleeve gastrectomy. Nearly 20% of operations are aborted due to hepatomegaly or abdominal wall thickness with inadequate visualization. Targeting patients with elevated BMIs and diabetes mellitus for preoperative weight loss might reduce the risk of these types of aborted procedures with inadequate visualization.

Volume

38

Issue

1

First Page

S3

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