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Pulmonary Complications Are a Strong Independent Predictor of 30-Day Mortality Following Elective Bariatric Surgery

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Abstract

Objective

Pulmonary complications in patients with obesity carry a high morbidity and mortality. An analysis of the MBSAQIP database was performed to determine the effect of post-operative pulmonary complications on patients undergoing elective bariatric surgery, with the primary outcome of 30-day mortality.

Methods

We extracted data from the MBSAQIP database from 2015 to 2019 on patients who underwent elective Roux-en-Y gastric bypass or sleeve gastrectomy. Pulmonary complications were defined as prolonged ventilation, pneumonia, unplanned intubation, pulmonary embolism, and coma past 24 h (with the assumption of this being due to hypercapnia). Data on post-operative complications and 30-day mortality was extracted. To determine the effect of pulmonary complications on 30-day mortality, a multivariable logistic regression model was developed.

Results

Pulmonary complications were associated with a near 50-fold increased odds of 30-day mortality (OR 47.1; 95%, 38.6–57.5; p < 0.0001). Pulmonary complications were also associated with higher rates of anastomotic leaks (9.5% vs. 0.3%; p < 0.0001), post-operative bleeding (13.7% vs. 0.9%; p < 0.0001), cardiac complications (6.6% vs. 0.0%; p < 0.0001), post-operative AKIs (9.6% vs. 0.1%; p < 0.0001), incidence of deep SSI (9.4% vs. 0.2%; p < 0.0001), incidence of post-operative sepsis (6.2% vs. 0.1%; p < 0.0001), and incidence of Clostridioides difficile (2.0% vs. 0.1%; p < 0.0001).

Conclusion

Pulmonary complications after elective bariatric surgery are a strong predictor of 30-day mortality. Patients who experience pulmonary complications have a higher incidence of co-morbidities and unfavorable baseline patient characteristics, and thus, likely form a unique subset of the bariatric patient population.

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Authors and Affiliations

  1. Department of Surgery, University of Alberta, Edmonton, AB, Canada

    Uzair Jogiat, Valentin Mocanu, Daniel W. Birch, Noah J. Switzer, Simon R. Turner & Shahzeer Karmali

  2. Division of General Surgery, Department of Surgery, University of Alberta, Dvorkin Lounge Mailroom, 2G2 Walter C. Mackenzie Health Sciences Centre, 8440 - 112 ST NW, Edmonton, AB, T6G 2B7, Canada

    Uzair Jogiat

Authors
  1. Uzair Jogiat
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  2. Valentin Mocanu
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  3. Daniel W. Birch
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  4. Noah J. Switzer
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  5. Simon R. Turner
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  6. Shahzeer Karmali
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Contributions

All the authors have contributed equally to this work.

Corresponding author

Correspondence to Uzair Jogiat.

Ethics declarations

Ethics Approval and Informed Consent

Consent was not required for this retrospective study. The MBSAQIP database is maintained in compliance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of Interest

The authors declare no competing interests.

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Key Points

• Pulmonary complications after bariatric surgery are predictors of 30-day mortality.

• Patients with pulmonary complications have more baseline co-morbidities.

• Identifying high-risk patients pre-operatively may enable optimization prior to bariatric surgery.

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Jogiat, U., Mocanu, V., Birch, D.W. et al. Pulmonary Complications Are a Strong Independent Predictor of 30-Day Mortality Following Elective Bariatric Surgery. OBES SURG 32, 696–703 (2022). https://doi.org/10.1007/s11695-021-05882-0

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  • DOI: https://doi.org/10.1007/s11695-021-05882-0

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