The impact of bariatric surgery on admissions for gastrointestinal complications and conditions associated with obesity: A nationwide study

Arsheya Patel; Barham K Abu Dayyeh; Gokulakrishnan Balasubramanian; Alice Hinton; Somashekar G Krishna; Stacy Brethauer; Hisham Hussan

doi:10.1002/wjs.12013

The impact of bariatric surgery on admissions for gastrointestinal complications and conditions associated with obesity: A nationwide study

World J Surg. 2024 Jan;48(1):175-185. doi: 10.1002/wjs.12013. Epub 2023 Dec 10.

Authors

Arsheya Patel¹, Barham K Abu Dayyeh², Gokulakrishnan Balasubramanian¹, Alice Hinton³, Somashekar G Krishna¹, Stacy Brethauer⁴, Hisham Hussan⁵

Affiliations

¹ Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
² Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
³ Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA.
⁴ Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
⁵ Division of Gastroenterology, Department of Internal Medicine, University of California, Davis, Sacramento, California, USA.

PMID: 38436211
DOI: 10.1002/wjs.12013

Abstract

Background: Obesity worsens various gastrointestinal pathologies. While bariatric surgery ameliorates obesity, it substantially modifies the gastrointestinal system depending on surgery type, with limited data on subsequent impact on obesity-related gastrointestinal admissions.

Methods: Using the 2012-2014 Nationwide Readmission Database, we included individuals with obesity who received vertical sleeve gastrectomy (VSG), Roux-en-Y gastric bypass (RYGB), or hernia repair (HR-control surgery). Our main focus was the adjusted odds ratio (aOR) for gastrointestinal inpatient admissions within 6 months following surgery compared to the 6 months preceding it, while controlling for several confounding factors. Gastrointestinal admissions were grouped into postoperative complications or obesity-associated gastrointestinal conditions.

Results: Our cohort included 140,103 adults with RYGB, 132,253 with VSG, and 12,436 HR controls. Postoperative gastrointestinal complications were most common after RYGB, prominently obstruction (aOR = 33.17, 95%CI: 18.01, 61.10), and Clostridium difficile infection (aOR: 12.52, 95%CI: 6.22, 25.19). VSG also saw significantly increased but less frequent similar conditions. Notably, for gastrointestinal conditions associated with obesity, acute pancreatitis risk was higher post-VSG (aOR = 6.26, 95%CI: 4.02, 9.73). Post-RYGB patients were most likely to be admitted for cholelithiasis with cholecystitis (aOR: 4.15, 95% CI: 3.24, 5.31), followed by chronic liver disease (aOR: 3.00, 95% CI: 2.33, 3.87). The risk of noninfectious colitis admissions was threefold higher after RYGB and VSG. No gastrointestinal conditions showed an increase after HR.

Conclusion: Despite weight loss, bariatric surgery was associated with an increased risk of hepato-pancreatobiliary and colitis admissions related to obesity in the first six postoperative months, with considerable variations in rates of gastrointestinal conditions by surgery type.

Keywords: bariatric surgery; gastrointestinal admissions; obesity; outcomes.

MeSH terms

Acute Disease
Adult
Bariatric Surgery* / adverse effects
Colitis*
Gastrointestinal Diseases* / epidemiology
Gastrointestinal Diseases* / etiology
Humans
Obesity / complications
Obesity / epidemiology
Obesity / surgery
Pancreatitis*
Postoperative Complications / epidemiology
Postoperative Complications / etiology