M. C. Cusack2, M. Venkatesh3, A. Pontes3, G. Shea3,4, D. Svoboda3, N. Liu3, J. Greenberg3, A. Lidor3, L. Funk3,4 4William S. Middleton VA,Madison, WI, USA 2Indiana University School Of Medicine,Indianapolis, IN, USA 3University Of Wisconsin-Madison,Madison, WI, USA
Introduction: Bariatric surgery has become much safer over the past two decades; however, postoperative complications remain a concern. Intraoperative leak testing is commonly performed to minimize the risk of postoperative complications, but its impact on outcomes is unclear. The aim of this study was to determine if intraoperative leak testing during sleeve gastrectomy or Roux-en-Y gastric bypass decreases the risk of 30-day postoperative leaks, bleeding, readmissions, and reoperations.
Methods: This was a retrospective cohort study utilizing 2015 and 2016 data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database, which includes preoperative, operative, and postoperative data from more than 700 accredited bariatric surgery centers nationally. Postoperative leak was defined as a drain present for >30 days, organ space surgical site infection, or leak-related 30-day readmission, reoperation, or intervention. Postoperative bleed was defined as transfusion within 72 hours or bleed related 30-day readmission, reoperation, or intervention. Patient characteristics and postoperative outcomes were analyzed via Chi-squared tests for categorical variables.
Results: 237,081 patients were included in the study cohort. 29.2% underwent gastric bypass, while 70.8% underwent sleeve gastrectomy. 79.2% were female, and the mean age was 44.7 (SD 11.9). For sleeve gastrectomy patients, intraoperative leak testing was associated with slightly higher rates of 30-day postoperative leak but lower rates of bleeding, reoperation and readmission within 30 days. For gastric bypass patients, intraoperative leak testing was associated with higher rates of 30-day postoperative leaks and bleeds, but lower reoperation and readmission (Table 1). Complications, readmissions and reoperations were 2-3 times more common in bypasses vs. sleeves regardless of whether a leak test was performed. All results were statistically significant (p<0.05).
Conclusion: In this retrospective study of a national sample of bariatric surgery patients, intraoperative leak testing was associated with paradoxically higher rates of 30-day postoperative leaks for both sleeve gastrectomy and bypass patients but lower rates of reoperations and readmissions. However, given the small differences associated with leak testing, its utility is unclear. Gastric bypass was associated with higher complication rates compared to sleeve gastrectomy during the 30-day postoperative period.
