Assessment of Sleeve Gastrectomy Surgical Technique: First Look at 30-Day Outcomes Based on the MBSAQIP Database

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Journal of the American College of Surgeons


BACKGROUND: Obesity rates in the US have reached epidemic proportions, and sleeve gastrectomy (SG) is the procedure performed most commonly. Controversies exist about the most appropriate surgical technique. STUDY DESIGN: Using the 2016 MBSAQIP database, we selected all primary SG procedures and compared 4 surgical techniques (staple line reinforcement [SLR] alone; SLR and oversewing [OS]; no SLR or OS; and OS alone). Primary outcomes were bleeding and organ space infection (OSI), including leakage. Secondary outcomes were 30-day severe adverse events (SAEs) and readmissions. We conducted separate chi-square tests of association, followed by 4 separate exploratory multivariable logistic regression models. RESULTS: There were significant differences in bleeding (p = 0.002) and SAE rates (p = 0.003) among the 4 SG techniques; both SLR and OS yielded lower bleeding and SAE rates compared with the other techniques (0.3% and 1.9%, respectively). The associations between SG technique and OSI (p = 0.93) and readmission (p = 0.24) were not significant. The following SG techniques independently predicted less likelihood of bleeding: SLR alone (adjusted odds ratio [AOR] 0.70; 95% CI 0.54 to 0.90; p = 0.006) and both SLR and OS (AOR 0.50; 95% CI 0.33 to 0.77; p = 0.002). In addition, SLR and OS independently predicted less likelihood of SAEs (AOR 0.76; 95% CI 0.64 to 0.91; p = 0.003). CONCLUSIONS: Our study demonstrated that SLR resulted in lower postoperative bleeding rates, but not lower leak rates. When combined with OS, SLR yielded lower 30-day SAE rates. Future studies must clarify and confirm these results.

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