Association of prior bariatric surgery with outcomes following emergency general surgery

Background Despite the favorable outcomes and safety profile associated with metabolic and bariatric surgery (MBS), complications may occur post-operatively, necessitating emergency general surgery (EGS) intervention. Objective To evaluate the association of outcomes in patients with prior MBS following EGS interventions Setting Academic, University-affiliated; USA. Methods All adults undergoing non-elective EGS operations were identified using the 2016 to 2020 Nationwide Readmission Database. Patients with a history of MBS were subsequently categorized as Bariatric, with the remainder of patients as Non-Bariatric. The primary outcome of interest was in-hospital mortality, while perioperative complications, length of stay (LOS), hospitalization costs, non-home discharge, and 30-day readmission were secondarily assessed. Multivariable regression models were developed to evaluate the association of history of MBS with outcomes of interest. Results Of an estimated 632,375 hospitalizations for EGS operations, 29,112 (4.6%) had a history of MBS. Compared to Non-Bariatric, Bariatric were younger, more frequently female and more commonly had severe obesity. Following risk adjustment, Bariatric had significantly lower odds of in-hospital mortality (AOR 0.83, 95%CI 0.71-0.98). Compared to others, Bariatric had reduced LOS by 0.5 days (95%CI 0.4-0.7) and hospitalization costs by $1,600 (95%CI $900-2,100). Patients with prior MBS had reduced odds of non-home discharge (AOR 0.89, 95%CI 0.85-0.93) and increased likelihood of 30-day readmissions (AOR 2.32, 95%CI 1.93-2.79) following EGS. Conclusion Prior MBS is associated with decreased mortality and perioperative complications as well as reduced resource utilization in select EGS procedures. Our findings suggest that patients with a history of MBS can be managed effectively by acute surgical interventions.