Does routine upper gastrointestinal swallow study after metabolic and bariatric surgery lead to earlier diagnosis of leak?

Jessica Trac; Michael Balas; Denise Gee; Matthew M Hutter; James J Jung

doi:10.1016/j.soard.2024.02.005

Does routine upper gastrointestinal swallow study after metabolic and bariatric surgery lead to earlier diagnosis of leak?

Surg Obes Relat Dis. 2024 Feb 28:S1550-7289(24)00077-7. doi: 10.1016/j.soard.2024.02.005. Online ahead of print.

Authors

Jessica Trac¹, Michael Balas², Denise Gee³, Matthew M Hutter⁴, James J Jung⁵

Affiliations

¹ Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
² Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
³ Division of General and Oncologic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
⁴ Division of General and Oncologic Surgery, Massachusetts General Hospital, Boston, Massachusetts; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, Massachusetts.
⁵ Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, Duke University, Durham, North Carolina. Electronic address: james.jung@duke.edu.

PMID: 38570283
DOI: 10.1016/j.soard.2024.02.005

Abstract

Background: It is unclear whether routine upper gastrointestinal swallow study (SS) in the immediate postoperative period is associated with earlier diagnosis of gastrointestinal leak after bariatric surgery.

Objective: To investigate the relationship between routine SS and time to diagnosis of postoperative gastrointestinal leak.

Setting: MBSAQIP-accredited hospitals in the United States and Canada.

Methods: We conducted an observational cohort study of adults who underwent laparoscopic primary Roux-en-Y gastric bypass (RYGB) (n = 82,510) and sleeve gastrectomy (SG) (n = 283,520) using the MBSAQIP 2015-2019 database. Propensity scores were used to match patient cohorts who underwent routine versus no routine SS. Primary outcome was time to diagnosis of leak. Median days to diagnosis of leak were compared. The Nelson-Aalen estimator was used to determine the cumulative hazards of leak.

Results: In our study, 36,280 (23%) RYGB and 135,335 (33%) SG patients received routine SS. Routine SS was not associated with earlier diagnosis of leak (RYGB routine SS median 7 [IQR 3-12] days v. no routine SS 6 [2-11] days, P = .9; SG routine SS 15 [9-22] days v. no routine SS 14 [8-21] days, P = .06) or lower risk of developing leak (RYGB HR 1.0, 95%-CI .8-1.2; SG HR 1.1, 95%-CI 1.0-1.4). More routine SS patients had a length of stay 2 days or greater (RYGB 78.3% v. 61.1%; SG 48.6% v. 40.3%).

Conclusions: Routine SS was not associated with earlier diagnosis of leaks compared to the absence of routine SS. Surgeons should consider abandoning the practice of routine SS for the purpose of obtaining earlier diagnosis of postoperative leaks.

Keywords: Bariatric surgery; Gastrointestinal leak; Propensity score matching; Roux-en-Y gastric bypass; Sleeve Gastrectomy; Swallow study; Upper gastrointestinal series.