Analysis of emergent reoperations after bariatric surgery: an important metric for safe same-day surgery.

Background: Early reoperation after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) is a severe adverse event that may increase the risk of perioperative mortality if there is a delay in care. However, it is unclear what proportion of reoperations occur within 24 hours of surgery and who is at greater risk, which may impact the safety of performing safe same-day surgery.

Objectives: To evaluate the incidence of reoperation in the first 24 hours after primary SG and RYGB.

Setting: Michigan Bariatric Surgery Collaborative, Ann Arbor, Michigan.

Methods: Using a statewide bariatric surgery data registry, patients undergoing primary SG (n = 49,848) and RYGB (n = 11,267) cases were analyzed. Patients who had a subsequent reoperation were identified and reasons for reoperation were compared between those occurring <24 hours versus >24 hours. In addition, patients who underwent a reoperation <24 hours were compared with patients who underwent primary SG or RYGB and did not experience any complications.

Results: The overall rate of reoperation was .72% for SG and 2.1% for RYGB. Reoperation <24 hours of index procedure was 32.0% after SG and 24.2%, after gastric bypass, with the most common reason being hemorrhage (86.15%% and 55.4% respectively). Older age, hypertension, liver disease, and longer operative times were associated with reoperation <24 hours after SG, whereas longer operative times were associated with reoperation <24 hours after RYGB. Concurrent hiatal hernia repair was not associated with increased risk.

Conclusions: Reoperation after primary bariatric surgery is rare but occurs within 24 hours in approximately one third of the cases after SG and one quarter of cases after RYGB. Older patients with significant comorbidities are at increased risk and should be considered poor candidates for same-day surgery given the possibility of an early life-threatening event.