Benefit of feeding tube placement for refractory malnutrition after bariatric surgery

Surg Obes Relat Dis. 2018 Feb;14(2):162-167. doi: 10.1016/j.soard.2016.12.017. Epub 2016 Dec 26.

Abstract

Background: Bariatric surgery provides durable weight loss and decreases the incidence of co-morbid conditions for people with obesity. Most patients benefit from resultant weight loss, but some are at risk for postoperative refractory malnutrition, a serious but poorly understood complication.

Objective: To evaluate differences in bariatric surgery patients who received a feeding tube postoperatively for malnutrition compared with other indications.

Setting: Retrospective cohort study at an academic bariatric surgery center (1985-2015).

Methods: All bariatric surgery patients that received a feeding tube postoperatively over a 30-year period were identified. Data abstraction from the medical record was performed to assess demographic characteristics, operative details, tube indication, and resultant body mass index (BMI) changes.

Results: From a total of 3487 patients who underwent bariatric surgery during the study period, 139 (3.9%) required placement of a feeding tube postoperatively. Refractory malnutrition was the indication in 24 patients, all after Roux-en-Y gastric bypass. There were no significant differences between these patients and other bariatric surgery patients in terms of mean age (40.6±9.9 versus 43.1±13.4 years, P = .4) and preoperative BMI (47.5±10.5 versus 51.0±9.6 kg/m2, P = .1). The median time from surgery to tube placement for malnutrition patients was 4 years. Compared with other feeding tube indications, malnutrition patients had higher percent excess BMI lost after surgery (126.2±31.9 versus 52.5±44.3%, P<.0001). After tube placement, malnutrition patients had a significant increase in mean BMI compared with other indications (14.5±20.9 versus-13.0±14.0%, P< .001).

Conclusion: Patients with refractory malnutrition benefit from feeding tube placement, which results in a significant increase in BMI.

Keywords: Bariatric surgery; Feeding tube; Gastrostomy; Jejunostomy; Refractory malnutrition.

MeSH terms

  • Academic Medical Centers
  • Adult
  • Analysis of Variance
  • Bariatric Surgery / adverse effects*
  • Bariatric Surgery / methods
  • Body Mass Index*
  • Cohort Studies
  • Female
  • Humans
  • Intubation, Gastrointestinal / methods*
  • Male
  • Malnutrition / etiology*
  • Malnutrition / physiopathology
  • Malnutrition / therapy*
  • Middle Aged
  • Obesity, Morbid / diagnosis
  • Obesity, Morbid / surgery*
  • Postoperative Complications / physiopathology
  • Postoperative Complications / therapy
  • Prognosis
  • Retrospective Studies
  • Risk Assessment
  • Statistics, Nonparametric
  • Treatment Outcome
  • Weight Loss / physiology