Safety of concomitant cholecystectomy with laparoscopic sleeve gastrectomy and gastric bypass

a MBSAQIP analysis

Stephanie Wood, Sandhya B. Kumar, Elizabeth Dewey, Matthew Y. Lin, Jonathan T. Carter

Research output: Contribution to journalArticle

Abstract

Background: Gallstone disease occurs more commonly in the obese population and is often diagnosed during the preoperative evaluation for bariatric surgery. Objectives: This study analyzed outcomes of laparoscopic gastric bypass (LGB) and laparoscopic sleeve gastrectomy (SG), with and without cholecystectomy (LC), using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Setting: Patients reported to Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers in the United States and Canada in 2015. Methods: All cases of LGB and SG, with and without LC, were analyzed. A 1:1 propensity-matched cohort was created for both SG and LGB, with and without concomitant LC. Multivariate logistic regression stratified by procedure was used to identify predictors of major complications after SG and LGB, using concomitant LC as a predictor. We also constructed a model for surgical site infections (SSIs) for SG group. Results: Of 98,292 sleeve operations, 2046 (2%) had concomitant LC. Of 44,427 bypass operations, 1426 (3%) had concomitant LC. For the sleeve group, concomitant LC increased operative time by an average of 27 minutes but did not affect length of stay, mortality, or major complications. Concomitant LC was associated with increased SSI (1% versus .4%) and need for reoperation (1.6% versus .7%) in univariate models. After adjusting for other predictors, concomitant LC was associated with increased risk for SSI (odds ratio 2.5, confidence interval 1.0–5.9, P = .04). For the bypass group, concomitant LC increased operative time by an average of 28 minutes to the operation, and postoperative length of stay averaged ∼5 hours longer (2.4 versus 2.2 d, P = .03). Thirty-day complications were similar between the groups. On multivariate analysis, concomitant LC was not a significant risk factor for major complications. Only operative time was an independent factor for major complications. Conclusions: Concomitant LC with laparoscopic sleeve gastrectomy or gastric bypass did not affect mortality or risk of major complication. For sleeve patients, concomitant LC was associated with a .6% increased risk (.4% to 1.0%) of SSI. Concomitant LC with laparoscopic sleeve gastrectomy or gastric bypass is safe when indicated for gallstone disease.

Original languageEnglish (US)
JournalSurgery for Obesity and Related Diseases
DOIs
StatePublished - Jan 1 2019

Fingerprint

Gastric Bypass
Laparoscopic Cholecystectomy
Gastrectomy
Bariatric Surgery
Surgical Wound Infection
Safety
Operative Time
Accreditation
Gallstones
Quality Improvement
Length of Stay
Mortality
Cholecystectomy
Reoperation
Canada
Multivariate Analysis
Logistic Models
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals

Keywords

  • Cholecystectomy
  • Complications
  • Laparoscopic gastric bypass
  • Laparoscopic sleeve gastrectomy
  • MBSAQIP
  • Surgical site infection

ASJC Scopus subject areas

  • Surgery

Cite this

Safety of concomitant cholecystectomy with laparoscopic sleeve gastrectomy and gastric bypass : a MBSAQIP analysis. / Wood, Stephanie; Kumar, Sandhya B.; Dewey, Elizabeth; Lin, Matthew Y.; Carter, Jonathan T.

In: Surgery for Obesity and Related Diseases, 01.01.2019.

Research output: Contribution to journalArticle

@article{0306e207315848cd882bed3bacd41094,
title = "Safety of concomitant cholecystectomy with laparoscopic sleeve gastrectomy and gastric bypass: a MBSAQIP analysis",
abstract = "Background: Gallstone disease occurs more commonly in the obese population and is often diagnosed during the preoperative evaluation for bariatric surgery. Objectives: This study analyzed outcomes of laparoscopic gastric bypass (LGB) and laparoscopic sleeve gastrectomy (SG), with and without cholecystectomy (LC), using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Setting: Patients reported to Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers in the United States and Canada in 2015. Methods: All cases of LGB and SG, with and without LC, were analyzed. A 1:1 propensity-matched cohort was created for both SG and LGB, with and without concomitant LC. Multivariate logistic regression stratified by procedure was used to identify predictors of major complications after SG and LGB, using concomitant LC as a predictor. We also constructed a model for surgical site infections (SSIs) for SG group. Results: Of 98,292 sleeve operations, 2046 (2{\%}) had concomitant LC. Of 44,427 bypass operations, 1426 (3{\%}) had concomitant LC. For the sleeve group, concomitant LC increased operative time by an average of 27 minutes but did not affect length of stay, mortality, or major complications. Concomitant LC was associated with increased SSI (1{\%} versus .4{\%}) and need for reoperation (1.6{\%} versus .7{\%}) in univariate models. After adjusting for other predictors, concomitant LC was associated with increased risk for SSI (odds ratio 2.5, confidence interval 1.0–5.9, P = .04). For the bypass group, concomitant LC increased operative time by an average of 28 minutes to the operation, and postoperative length of stay averaged ∼5 hours longer (2.4 versus 2.2 d, P = .03). Thirty-day complications were similar between the groups. On multivariate analysis, concomitant LC was not a significant risk factor for major complications. Only operative time was an independent factor for major complications. Conclusions: Concomitant LC with laparoscopic sleeve gastrectomy or gastric bypass did not affect mortality or risk of major complication. For sleeve patients, concomitant LC was associated with a .6{\%} increased risk (.4{\%} to 1.0{\%}) of SSI. Concomitant LC with laparoscopic sleeve gastrectomy or gastric bypass is safe when indicated for gallstone disease.",
keywords = "Cholecystectomy, Complications, Laparoscopic gastric bypass, Laparoscopic sleeve gastrectomy, MBSAQIP, Surgical site infection",
author = "Stephanie Wood and Kumar, {Sandhya B.} and Elizabeth Dewey and Lin, {Matthew Y.} and Carter, {Jonathan T.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.soard.2019.03.004",
language = "English (US)",
journal = "Surgery for Obesity and Related Diseases",
issn = "1550-7289",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Safety of concomitant cholecystectomy with laparoscopic sleeve gastrectomy and gastric bypass

T2 - a MBSAQIP analysis

AU - Wood, Stephanie

AU - Kumar, Sandhya B.

AU - Dewey, Elizabeth

AU - Lin, Matthew Y.

AU - Carter, Jonathan T.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Gallstone disease occurs more commonly in the obese population and is often diagnosed during the preoperative evaluation for bariatric surgery. Objectives: This study analyzed outcomes of laparoscopic gastric bypass (LGB) and laparoscopic sleeve gastrectomy (SG), with and without cholecystectomy (LC), using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Setting: Patients reported to Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers in the United States and Canada in 2015. Methods: All cases of LGB and SG, with and without LC, were analyzed. A 1:1 propensity-matched cohort was created for both SG and LGB, with and without concomitant LC. Multivariate logistic regression stratified by procedure was used to identify predictors of major complications after SG and LGB, using concomitant LC as a predictor. We also constructed a model for surgical site infections (SSIs) for SG group. Results: Of 98,292 sleeve operations, 2046 (2%) had concomitant LC. Of 44,427 bypass operations, 1426 (3%) had concomitant LC. For the sleeve group, concomitant LC increased operative time by an average of 27 minutes but did not affect length of stay, mortality, or major complications. Concomitant LC was associated with increased SSI (1% versus .4%) and need for reoperation (1.6% versus .7%) in univariate models. After adjusting for other predictors, concomitant LC was associated with increased risk for SSI (odds ratio 2.5, confidence interval 1.0–5.9, P = .04). For the bypass group, concomitant LC increased operative time by an average of 28 minutes to the operation, and postoperative length of stay averaged ∼5 hours longer (2.4 versus 2.2 d, P = .03). Thirty-day complications were similar between the groups. On multivariate analysis, concomitant LC was not a significant risk factor for major complications. Only operative time was an independent factor for major complications. Conclusions: Concomitant LC with laparoscopic sleeve gastrectomy or gastric bypass did not affect mortality or risk of major complication. For sleeve patients, concomitant LC was associated with a .6% increased risk (.4% to 1.0%) of SSI. Concomitant LC with laparoscopic sleeve gastrectomy or gastric bypass is safe when indicated for gallstone disease.

AB - Background: Gallstone disease occurs more commonly in the obese population and is often diagnosed during the preoperative evaluation for bariatric surgery. Objectives: This study analyzed outcomes of laparoscopic gastric bypass (LGB) and laparoscopic sleeve gastrectomy (SG), with and without cholecystectomy (LC), using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Setting: Patients reported to Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers in the United States and Canada in 2015. Methods: All cases of LGB and SG, with and without LC, were analyzed. A 1:1 propensity-matched cohort was created for both SG and LGB, with and without concomitant LC. Multivariate logistic regression stratified by procedure was used to identify predictors of major complications after SG and LGB, using concomitant LC as a predictor. We also constructed a model for surgical site infections (SSIs) for SG group. Results: Of 98,292 sleeve operations, 2046 (2%) had concomitant LC. Of 44,427 bypass operations, 1426 (3%) had concomitant LC. For the sleeve group, concomitant LC increased operative time by an average of 27 minutes but did not affect length of stay, mortality, or major complications. Concomitant LC was associated with increased SSI (1% versus .4%) and need for reoperation (1.6% versus .7%) in univariate models. After adjusting for other predictors, concomitant LC was associated with increased risk for SSI (odds ratio 2.5, confidence interval 1.0–5.9, P = .04). For the bypass group, concomitant LC increased operative time by an average of 28 minutes to the operation, and postoperative length of stay averaged ∼5 hours longer (2.4 versus 2.2 d, P = .03). Thirty-day complications were similar between the groups. On multivariate analysis, concomitant LC was not a significant risk factor for major complications. Only operative time was an independent factor for major complications. Conclusions: Concomitant LC with laparoscopic sleeve gastrectomy or gastric bypass did not affect mortality or risk of major complication. For sleeve patients, concomitant LC was associated with a .6% increased risk (.4% to 1.0%) of SSI. Concomitant LC with laparoscopic sleeve gastrectomy or gastric bypass is safe when indicated for gallstone disease.

KW - Cholecystectomy

KW - Complications

KW - Laparoscopic gastric bypass

KW - Laparoscopic sleeve gastrectomy

KW - MBSAQIP

KW - Surgical site infection

UR - http://www.scopus.com/inward/record.url?scp=85064987017&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064987017&partnerID=8YFLogxK

U2 - 10.1016/j.soard.2019.03.004

DO - 10.1016/j.soard.2019.03.004

M3 - Article

JO - Surgery for Obesity and Related Diseases

JF - Surgery for Obesity and Related Diseases

SN - 1550-7289

ER -