Background

Bariatric surgery outcomes for patients on chronic immunosuppression are understudied, especially with the recent uptick in duodenal switch (DS). This study compares perioperative safety of sleeve gastrectomy (SG), Roux-en-Y gastric-bypass (RY), and DS in patients on immunosuppressants.

Methods

Utilizing MBSAQIP 2015-2021 data, we analyzed patients on immunosuppressants who underwent SG, RY, or DS; excluding revisional and open surgeries. Outcomes were 30-day reoperation, readmission, additional procedural intervention, mortality, composite complication, and anastomotic/staple-line leak. Propensity-score matched (PSM) analysis (3:3:1 SG:RY:DS) was performed

Results

We identified 19,414 patients: 14,358 SG, 4,864 RY, and 192 DS. DS patients had higher ASA Class, BMI and more comorbidities. RY patients more often had pre-operative GERD, COPD, and OSA. Overall complication rates were low. After PSM, LOS was similar (1 [1-2] SG vs. 2 [1-2] RY vs. 2 [1-3] days DS) and SG had the lowest complication, readmission, and reoperation rates; no difference between RY and DS. RY had higher rates of bowel obstruction (2.26 vs. 0.17 SG vs. 0.52% DS). DS had higher rates of unplanned intubation and ICU admission compared to SG. There was no difference in 30-day mortality.

Conclusions

Overall, SG, RY, and DS all have favorable safety profiles for patients on immunosuppressants, as evidenced by low mortality rates, short LOS, and minimal serious complications. PSM indicates RY and DS have higher risk of complication and reoperation compared to SG, but overall outcomes were similar, particularly between RY and DS. Thus, immunosuppression alone should not alter the bariatric procedure chosen.