Background

Patients suffering from limited mobility may benefit from weight loss with increased weight loss and relief of comorbidities more significantly impacting long-term mobility. Although gastric bypass (RYGB) is thought to lead to more sustainable weight loss, sleeve gastrectomy (VSG) is often associated with fewer complications. We aim to determine rates of complications in patients undergoing RYGB versus VSG in patients requiring preoperative mobility device.

Methods

The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) was analyzed for years 2015 through 2019. Patients who required a mobility device prior to surgery underwent propensity score matching (PSM) using 19 covariates to achieve two well-balanced groups, RYGB and VSG. E-analysis was utilized to assess unmeasured confounding. Data is presented as odds ratio with 95% confidence interval and E values. Significance considered at p<0.05.

Results

3571 matched pairs of patients undergoing VSG and RYGB were identified who required a preoperative mobility device. The following complications were found to most significantly associated with RYGB compared to a VSG: acute renal failure (10.556 (2.474,45.035); p=0.0015, E=4.384), deep surgical site infection (6.52 (1.472,28.871); p=0.0135, E=2.307), pneumonia (5.185 (2.304,11.667); p=0.0001, E=4.038), postoperative ventilator requirement (3.852 (1.567,9.466); p=0.0033, E=2.51), postoperative sepsis (3.683 (1.493,9.089); p=0.0047, E=2.35), c. diff infection (3.51 (1.155,10.664); p=0.0268, E=1.579), and death within 30 days (2.79 (1.301,5.982); p=0.0084, E=1.928). See figure.

Conclusions

Patients undergoing RYGB had markedly higher rates of certain complications compared to VSG. These higher risk patients may benefit from prehabilitation, especially if the patient has associated comorbidities better treated by RYGB.