Key result
Bariatric surgery was associated with an increased risk of gastrointestinal admissions in the first 6 months, including obstruction after Roux-en-Y gastric bypass (aOR 33.17; 95% CI 18.01-61.10).
Why the study?
Bariatric surgery substantially modifies the gastrointestinal system depending on surgery type, but data on its subsequent impact on obesity-related gastrointestinal admissions are limited.
Does bariatric surgery increase the risk of gastrointestinal inpatient admissions in adults with obesity?
Cohort (n=284,792)
Yes
Does bariatric surgery increase the risk of gastrointestinal inpatient admissions in adults with obesity?
Bariatric surgery is associated with an increased risk of hepato-pancreatobiliary and colitis admissions in the first six postoperative months.
Answers are grounded in this paper and cite their sources.
Elevated obstruction risk after RYGB warrants caution in bariatric procedure selection; leaves open need for prospective confirmation.
BACKGROUND: Obesity worsens various gastrointestinal pathologies. While bariatric surgery ameliorates obesity, it substantially modifies the gastrointestinal system depending on surgery type, with limited data on subsequent impact on obesity-related gastrointestinal admissions. METHODS: Using the 2012-2014 Nationwide Readmission Database, we included individuals with obesity who received vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), or hernia repair (HR-control surgery). Our main focus was the adjusted odds ratio (aOR) for gastrointestinal inpatient admissions within 6 months following surgery compared to the 6 months preceding it, while controlling for several confounding factors. Gastrointestinal admissions were grouped into postoperative complications or obesity-associated gastrointestinal conditions. RESULTS: Our cohort included 140,103 adults with RYGB, 132,253 with VSG, and 12,436 HR controls. Postoperative gastrointestinal complications were most common after RYGB, prominently obstruction (aOR = 33.17, 95%CI: 18.01, 61.10), and Clostridium difficile infection (aOR: 12.52, 95%CI: 6.22, 25.19). VSG also saw significantly increased but less frequent similar conditions. Notably, for gastrointestinal conditions associated with obesity, acute pancreatitis risk was higher post-VSG (aOR = 6.26, 95%CI: 4.02, 9.73). Post-RYGB patients were most likely to be admitted for cholelithiasis with cholecystitis (aOR: 4.15, 95% CI: 3.24, 5.31), followed by chronic liver disease (aOR: 3.00, 95% CI: 2.33, 3.87). The risk of noninfectious colitis admissions was threefold higher after RYGB and VSG. No gastrointestinal conditions showed an increase after HR. CONCLUSION: Despite weight loss, bariatric surgery was associated with an increased risk of hepato-pancreatobiliary and colitis admissions related to obesity in the first six postoperative months, with considerable variations in rates of gastrointestinal conditions by surgery type.
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Patel et al. (2023) conducted a cohort in Obesity (n=284,792). Bariatric surgery (Roux-en-Y gastric bypass or vertical sleeve gastrectomy) vs. 6 months preceding surgery and hernia repair controls was evaluated on Gastrointestinal inpatient admissions within 6 months following surgery compared to the 6 months preceding it (aOR 33.17, 95% CI 18.01-61.10). Bariatric surgery was associated with an increased risk of gastrointestinal admissions in the first 6 months, including obstruction after Roux-en-Y gastric bypass (aOR 33.17; 95% CI 18.01-61.10).
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