Background

Stratification methods are helpful in identifying patients that may need further pre-operative considerations. Given the drastic improvement in morbidity and mortality following bariatric surgery in the past two decades, an updated assessment of the data is needed.

Methods

The MBSAQIP dataset was queried years 2019-2021. Fourteen risk factors were examined, and the primary outcome examined was a composite morbidity outcome that included MI, reoperation, leak, death, and others within 30 days. For each patient, risk factors were tabulated and the complication rate for each was examined. The odds ratio with 95% CI of each category compared against the no risk factor category was calculated.

Results

There were n=586,392 patients. The overall composite morbidity outcome rate was 2.3%. With each additional risk factor, the composite morbidity rate increased in a progressive fashion from 1.3% with zero risk factors to 6.1% with five risk factors. LOS also rose with increased number of risk factors. ESRD had the highest odds ratio for complication (OR 3.93, 95% CI 3.32-4.66). When grouping patients into three categories (Low risk: 0-1 risk factor, moderate risk: 2-3 risk factors, high risk: 4 or more risk factors), the complication rates were 1.62%, 3.05%, and 5.46%, respectively (p< 0.05).

Conclusions

Each additional risk factor a bariatric candidate possesses increases their risk of morbidity and increases LOS. Grouping patients into low, moderate, and high risk categories will be beneficial for pre-operative stratification and risk assessment for outpatient surgery candidates.