Background

Metabolic and Bariatric Surgery (MBS) is a safe, effective and sustainable method for weight loss in patients with obesity. Nonetheless, there exists reluctance from the different specialties to refer patients for MBS due to safety concerns. We compared the safety profiles and complication rates of patients who underwent MBS to other common surgeries.

Methods

Data on ~1.69 million patients who underwent sleeve gastrectomy (SG), Roux-en-Y bypass (RYGB) and 11 other common abdominal, gastrointestinal, gynecologic and orthopedic procedures between 2012 and 2020 was obtained using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). Patient demographics and post-operative complications were compared to assess MBS safety profile. Continuous variables were analyzed using Kruskal-Wallis and reported as mean ± SD. Categorical variables were analyzed using Chi-squared test.

Results

The 30-day mortality rates of MBS (SG=0.1% and RYGB=0.1%) was equal to that of laparoscopic appendectomy (0.1%) and lower than laparoscopic cholecystectomy (0.2%), laparoscopic incisional hernia (0.2%), hip arthroplasty (0.2%), Nissen fundoplication (0.3%) and laparoscopic partial colectomy (0.8%) (p<0.0001). MBS showed significantly lower incidence of sepsis or septic shock (SG=0.3% and RYGB=0.6%) than Nissen fundoplication (0.7%), laparoscopic cholecystectomy (1.0%), open total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAHBSO) (1.1%), laparoscopic partial colectomy (2.9%) and laparoscopic appendectomy (3.7%) (p<0.0001). The bleeding, reoperation, readmission and unplanned intubation rates and comparisons are displayed in Figure 1.

Conclusions

Minimally invasive MBS has an excellent safety profile and compares favorably to other common procedures. All patients with indications for MBS should be encouraged to pursue these procedures.