Background

Revisional and conversional bariatric surgeries occur in both elective and emergency settings. This study aims to compare the indications for and outcomes of emergency surgeries.

Methods

The MBSAQIP database was retrospectively analyzed from 2020 to 2022. Patients who underwent emergency revisional and conversional bariatric surgeries were identified and compared with those undergoing similar procedures electively. The primary outcomes were 30-day serious complications and mortality.

Results

A total of 641 (0.9%) patients underwent emergency revisional (59.9%) or conversional (40.1%) surgery, while 71,548 (99.1%) underwent elective surgery. For emergency revisions, the most common indications were perforation (19.3%), stricture or obstruction (16.7%), and mechanical malfunction (10.9%) compared with elective revisions which were weight gain (45.4%), reflux (12.8%) and inadequate weight loss (12.3%). Sleeve-to-bypass (59.5%) was the most common emergency conversion followed by band-to-sleeve (12.8%) and band-to-bypass (11.7%). The most common emergency revisions were gastric bypass revisions (50.8%) and band revisions (21.1%) while the most common elective revisions were bypass revisions (48.3%), re-sleeve gastrectomy (15.0%), and gastric pouch plications or revisions (11.8%). Emergency conversions had a higher rate of serious complications (9.7 vs 6.2%, p=0.026) but similar mortality (0.2 vs 0.0%, p=1.000). However, emergency revisions had a higher rate of postoperative bleeding (6.8 vs 1.5%, p<0.001), serious complications (6.8 vs 1.5%, p<0.001), and mortality (1.3 vs 0.1%, p<0.001) (Table 1).

Conclusions

Emergency revisional and conversional bariatric procedures are associated with higher complications compared to elective procedures. These findings underscore the need for heightened vigilance and tailored perioperative strategies in managing these high-risk cases.